I * 1973-74 Annual Keport Lakes Area Regional Medical Program, Inc. Contents 1 Theme 2 Faith and Fortitude Meet the Challenge! 3 A Word from the Executive Director 4 Goals and Objectives 5 Origin of RMP s 6 Enabling Role, Talking Toget er The Grantee Institution, Regional Advisory Group 7 Health Services Development Unit Program Committee 8 Central Management Services 9 Library Serv ces 1 0 Evaluation 1 2 Financial Report 14 Developing a Grant Proposal 15 Programs in Continuing Education 17 Cancer Teaching Days and Task Force 18 Inner City Health Activities 19 Status of Projects 20 List of Members Projects 23 Emergency Medical Services System 25 Nine County Medical Laboratory Improvement 26 Telephone Lecture Network 27 Rural Externship 28 Allegany County Mobile Health Unit 29 Lake Area Health Education Center 31 Lakes Area Regional Tumor Service Registry 32 Ambulatory Care Services Model Niagara County Ambulatory Medical Care Study SHARECO 33 Information Dissemination Service 34 Community Health Information Profiles (CHIP) Chronic Respiratory Disease Program 35 Planning and Articulation for Allied Health Model Program for Comprehensive Family Health Two County Nutrition Program (Cattaraugus and Chautauqua Counties) 36 LARMP Staff Listing April, 1974 Theme An appropriate theme for the Lakes Area Regional Medical Program, Inc. in 1973 can best be described by the word dedication. The National scene in 1973 was eventful and traumatic. Regional Medical Programs across the country were threatened by peremptory exclusion from the President's budget followed by phase- out orders from the Administra- tion. Instructions were given to terminate staff and project support without Congressional authority to do so. The Regional Medical Program process had, however, become stable. The results of its efforts were measurable, and searching hearings by Congress culminated in the passage of extension legislation. The bill, introduced by Congressman James Hastings, was passed by a resound- ing 372-1 in the House of Representatives. A similar bill passed by a vote of 94-0 in the Senate. Our efforts had been favorably identified and received constituency support. The National Association of Regional Medical Programs, Inc. came into its own and sought legal assistance in the release of appropriated but impounded funds. Meanwhile, the Lakes Area Regional Medical Program continued with assigned tasks and funded 13 projects at a sum exceeding $1 million. Acknowledging the uncertainties but carrying out regular business required a great deaf of dedication on the part of RMP staff, Advisory Groups and RMP constituents. A civil suit filed by the Lakes Area Regional Medical Program, Inc. along with the Medical Care Development Inc., fiscal agent for the Maine Regional Medical Program on behalf'of all RMPS, sought to release funds both authorized and appropriated by Congress, but impounded by the Administration. As a result of this civil action, funds were released by the Administration for RMPS. We are proud of our achievements, our staff, the Regional Advisory Group and its Board of Directors and all those who stood by us in this period of crisis. Faith and Fortitude Meet The Challenge! The year 1973 was filled with tension, pressure and spirited challenges for all the Regional Medical Programs throughout the nation. Our own Lakes Area Regional Medical Program, Inc. faced the multi-phased challenge of dissolution with faith and fortitude. All of those involved in our organization especially the officers and members of the Regional Advisory Group, which represents every sector of our nine-county region, gave unstintingly of their time and talents in determined efforts to keep RMPs alive. Keeping faith in our essential purposes and basic objec- tives, our dedicated county committee members and our competent professional staff met the challenge with a collaborative and cooperative action on a united front. One of the weapons employed by the Administration was its morale destroying maneuvers which consisted of piece- meal, short-term allocation of minimum funds. It demanded faith and genuine fortitude to remain steadfast and confi- dent that our cause would prevail. At the end of the calendar year 1973 we won the victory in the courts. This assured us of receiving the full funding intended by the U.S. Congress for the development of an equitable national health delivery system on a regional basis. Throughout our nation today there is a new and dominating interest in the health care of the American People. In our own geographical area there is a common and consuming Father Girard interest in the kind of health care actually available to our citizens. What abilities and facilities can be brought to bear on our health problems? The challenge of the immediate future appears to be the role we are willing to play in cooperation with our lawmakers to supply the in-put which Will create the delivery system our communities are demanding. This means that the Lakes Area Regional Medical Program must accept a large share of the responsibility for the development of a community life which is alert and active in solving our health problems. It means we must utilize to the utmost the riches, the humanities, the sciences, and especially the health sciences which have been made available to modern man. Father Cosmas Girard, OFM, Ph.D. President, Regional Advisory Group Lakes Area Regional Medical Program, Inc. 2 a word from the . . . Executive Director The events of last year have presented many moments of anguish for regional medical programs across the country. The Administration's directives to phase-out our programs, followed by congressional action to the contrary, namely to continue our work, taxed our staff and credibility almost to the limit. A large group of dedicated persons who are in- terested in continuing the regional medical program process provided strong constituency support. Your National Association of Regional Medical Programs, Inc., won a civil action in the courts which released funds appropriated by Congress but impounded by the Ad- ministration. We look forward to a new and exciting future. We will con- tinue striving to make quality health care delivery systems in our region effective and available to everyone. Dr. Ingall R. F. Ingall, M.D. Executive Director Lakes Area Regional Medical Program, Inc. 3 Goals and Objectives Goal No. 2 To develop and improve primary care services. Objectives 1 .To continue defining the need for additional, altered or new primary care services in each sub-regional area, based on a data profile of resources and services, an assessment of community characteristics and health problems, and on the receptivity of the pattern of services to the community. 2. To maximize the role of existing health personnel in delivering primary health care by (a) improving distribu- tion of health personnel, (b) encouraging the expansion associated with community of ambulatory care within or hospitals, (c) using an inter-disciplinary approach to the delivery of primary care, (d) encouraging the devel- opment and evaluation of innovative methods of health care delivery, and (e) promoting improved referral Goal No. 1 patterns to assure continuity of care. To stimulate and promote preventive services in health 3. To encourage general and family practice an ot er maintenance. forms of primary health care. 4. To stimulate development of already defined new roles Ob ectives of health personnel. 1 . To continue defining the need for additional or new 5. To seek feasible solutions to the problems of distance preventive services in each sub-regional area, based on and lack of transportation as barriers to utilization of a data profile of resources and services, an assessment primary care, preventive and rehabilitation services. of the community's characteristics and health problems, 6. To promote consumer education regarding availability and on the acceptability of the service to the communi- and utilization of existing health services. ty. 2@ To encourage delivery of preventive services through sources of primary care with emphasis on the role of Goal No. 3 allied health personnel. To encourage the development, expansion and integration 3. To encourage coordination among government, volun- of rehabilitation services to the continuum of medical tary, and private agencies to (a) maximize the impact of services. preventive services and (b) assist public health agen- cies in responding to community needs. Objectives 4. To encourage expanded programs in health education. 1 .To continue de fining the need for additional, altered or new rehabilitation services in each sub-regional area, based on a data profile of resources and services, an assessment of the community's characteristics and health problems, and on the acceptability of the patterns of service to the community. 2. To promote the continued development of a variety of facilities and programs to assure placement of patients at the appropriate level of care. Origin of RMPs Legislation By these means, the program attempts to improve the Regional Medical Programs were established by quality and enhance the capacity of the health manpower Congressional action in 1965 under Public Law 89-239. and facilities available to the region and to improve health Under this legislation categorical emphasis was placed on services for persons residing in areas with limited health the three major killers-heart disease, cancer and stroke. services. In 1970 this legislation was amended to include kidney The program attempts to accomplish these ends without in- disease and other related diseases as Public Law 91-515. terfering with the patterns or the methods of financing of The legislation promotes through grants the development of patient care or professional practice, or with the ad- regional cooperative arrangements among the nation's ministration of hospitals, and in cooperation with practicing health professions and institutions in order to improve physicians, medical center officials, hospital ad- regional organization of health resources and services and ministrators, and representatives from appropriate volun- to enhance health care by supporting the providers at the tary health agencies. community level. There are currently 53 Regional Medical Programs covering the United States and its trust territories. The c programs vary considerably in their size and characteristics. However, each program has been A organized through local initiative and cooperative arrangements. Unlike many federal programs, the RMP s BUF operate primarily under local direction. Their strength lies in the "grass roots" participation by the many devoted volunteers who make up their regional advisory groups. I E COUNTY, LARMP Purpose UNKIRK CATTARAUGUS COUNTY ALLEGANY The Lakes Area Regional Medical Program, Inc. is IAUTAUOUA COUNTY designed through grants and contracts to encourage and COUNTY assist in the establishment of regional cooperative 0 SALAMANCA JAMESTOWN OLEAN WELLSVILL arrangements among medical schools, research in- stitutions, and hospitals for the promotion of research and IE CC rORD training, medical data exchange and demonstrations of patient care in the fields of heat disease, cancer, stroke AN COUNTY, PA. and kidney disease, and other related diseases. It strives to improve the personal health care system in the nine-county region It represents in Western New York and The Region Northwestern, Pennsylvania. The program affords to the The LARMP is one of 53 federaly funded, locally controlled medical profession and medical institutions, through such regional medical programs in the United States. Cooperative arrangements, the opportunity of making available to their patients the latest advances in the preven- Nine counties comprise the region, seven in Western New tion, diagnosis, treatment and rehabilitation of persons suf- York and two in Northwestern Pennsylvania. The counties fering from these diseases. It also promotes and fosters are: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, regional linkages among health institutions and seeks to Wyoming and Niagara in Western New York, and Erie and McKean in Pennsylvania. strengthen and Improve primary care and the relationship The region covers an area of 71 00 square miles with a between specialized and primary care. population well over two million people. 5 The Enabling Role The Grantee Institution Over the years the Lakes Area Regional Medical Program The Board of Directors of the Lakes Area Regional Medical has taken particular pride in its designation as an "enabler". Program, Inc., was established in February 1972 to assume The LARMP staff emphasizes its brokerage role whereby functions previously performed by the Research Founda- help is given where it is required. If LARMP cannot provide tion of the State University of New York. direct assistance, other appropriate organizations are This board receives, administers and accounts for Federal contacted. The LARMP staff continues to keep up to date Grant funds used in implementing programs to be sup- on other funding sources and agencies that can be of help ported by the Lakes Area Regional Medical Program in solving a particular health problem. according to federal regulation and policies. Another aspect of the enabling role has been insistence that The Board's membership Includes- projects have a viable marketing strategy. LARMP resources are invested as seed monies for activities that Chairman- Allan Korn, Associate Professor, Environmental - Consumer Studies Depart- can be integrated into the health care pattern of the region. ment, State University College at Buffalo. LARMP has been successful in attracting additional monies Herbert Bellamy, Buffalo, New York to RMP-supported activities: voluntary agencies and ot er Businessman and Community Lea er. groups have committed monetary investment to what Irwin Felsen, M.D., Past President Lakes otherwise would have been exclusively RMP operations; Area Regional Advisory Group, and a private county medical societies and hospitals contribute funds to physician from Wellsville, New York. the LARMP advisory group to meet expenses that cannot be paid by federal funds' RMP's investment in the Lake Maynard Parker, Retired executive previously Area Health Education Center led to investment in the cen- with the Hooker Chemical Corporation of ter by the Boards of Trustees of two Erie, Pennsylvania Niagara Falls, New York. hospitals and the Veteran's Administration; and the Rural Norman Slawinski, Branch Manager, Marine Externship project attracted private contributions from Midland Bank - Western, Buffalo, New York. hospitals, physicians and local governments. Talking Together Regional Advisory Group One of the strengths of the LAR MP has been its ability to The Regional Advisory Group assists in planning, encourage health professionals at all levels to talk together. development, and coordination of all projects in the area supported by the Lakes Area Regional Medical Program. Very often more than just money is necessary if patients are to receive the care they need and deserve. This 43-member group is broadly representative of the as and social groups served by LARMP. It geographic are In order for a system of care to work there must be a includes practicing physicians, medical center officials, cooperative effort on the part of all concerned to see that hospital administrators, representatives from medical health care needs of people are identif led and ways to solve societies, health and related professions, voluntary and related problems are carried out. By cooperating together in clarifying health needs and the resources available to public agencies, and representatives of other meet these needs the LARMP has helped to foster a bond organizations, institutions, and agencies as well as of cooperation among health care providers. members of the public concerned with the need for services provided under this program. Often the solution to a health problem lies within the The expanded membership-at-large was undertaken to community itself and LARMP acts as a catalyst to help the represent all elements of the provider and general popula- community realize its own powerful resources. tion with attention given to Involving minority group members, labor leaders, businessmen and women. The group usually meets on the second Thursday of every month at 7:30 p. m. at the LARMP offices, 2929 Main Street, Buffalo, N.Y. 6 The Health Services Development Unit Program Committee The Health Services Development Unit of the Lakes Area A program committee composed of Regional Advisory Regional Medical Program serves in a liaison capacity with Group (RAG) members was organized in 1972 for the all of the nine counties that comprise the LARM P region. In purpose of providing continuous assessment of all LARMP addition, members of the unit help with the development of operational projects and program staff activities. The proposals that may arise from the individual counties. committee examines these efforts in terms of their Keeping good communication lines open between county relationship to present goals, objectives, and priorities of committees, other constituents or interested organizations LARMP. The group usually meets each month, prior to the and the LARMP central office is one of the unit's main regular RAG meeting. The formal charge to the committee functions. Helping to develop ideas for proposals that are is: (a) assess goals, objectives, and priorities of LARMP aimed at improving the availability and quality of health and make recommendations regarding these matters to the care in these areas is another prime function. RAG, lb) in the context of objectives an priorities, review The HSDU is also working toward promoting a regional and evaluate on-going projects and activities to determine approach in the development and implementation of health effectiveness and make recommendations to the RAG. services with special regard to specific diseases such as This group has been the principal RAG sub-comm ttee r heart disease, cancer, stroke, kidney and related diseases. program planning. Members of the HSDU and their assigned counties are: Robert Beebee, Niagara and Genesee William Crage, Erie, New York Patrick Egan, Cattaraugus; southern part of Chautauqua County; and McKean, Pennsylvania (except EMS project). Suzanne Manson, Allegany and Wyoming Jean Hanna, Northern Chautauqua and Erie, Pennsylvania Michael Miller, Inner City Representative Health Services Development Unit 7 Central Management Services Organizationally, the LARMP, Inc, is divided into two inter- Communications related yet distinct functional areas. The principal function Keeping key target groups and the public informed on the consists of program staff activities. The second functional activities and accomplishments of the Lakes Area'Regional area is Central Management Services. This provides direct Medical Program is achieved with extensive use of the support to program staff activities. mass media. CMS is divided into five categories - Comptroller, Per- Television and radio have been utilized effectively for sonnef, Purchasing, Communications and Printing. This special interviews, press conferences and news coverage arrangement offers a mechanism to provide direct ad- of LARMP activities. News releases, and newsletters are ministrative support to program staff activities and funded projects. also used as vehicles for dissemination of LARMP related information. Feature stories as well as day to day program CMS serves both LARMP program staff and all funded activities have appeared in almost all of the daily project activities. It has contributed significantly to the newspapers in the region. The communications department reduction in administrative overhead costs from over 48 prepares a monthly newsletter, FORUM, for distribution to percent in early 1972 to the current administrative cost rate approximately 15,000 health professionals, other in- of approximately 8 percent. Taking note of this accomplish- dividuals and institutions. In addition, brochures, ment, other Regional Medical Programs have begun to pamphlets, booklets and the Annual Report are prepared by establish central management services within their own this unit. A well maintained mailing list assures the organizations patterned after LARMP. continual flow of pertinent program information, The media has provided good local coverage to our Comptroller continuing education programs for health professionals The Comptroller's office deals with grants management, throughout the region. Additionally, items of significant budgets, and contracts. This office also prepares and community interests such as the Telephone Lecture maintains all financial transaction records formerly under- Network's role in providing needed telephone com- taken by the Research Foundation. munications during Hurricane Agnes and the Allegany County Mobile Health Unit, which played a significant part Personnel in saving a life in Allegany County, are brought to public Personnel administration is concerned with recruitment notice. and placement, salary administration and payroll, employee relations and support staff training. Health Information Systems Unit The Health Information Systems Unit is a derivative of Purchasing the Community Health Information Profile (CHIP) a pro- Purchasing undertakes such functions as inventory control, ject which previously received financial support from supply acquisition, and pricing. The purchasing department the Lakes Area Regional Medical Program, Inc. has significantly contributed to the overall lowering of the The Unit provides assistance to projects and is the data administrative expenses required to operate LARMP analysis for the central Lakes Area Regional Medical program activities and funded projects. All equipment and Program administration; for program development, plan- supplies are properly inventoried and accounted for. ning, project evaluation; and special purpose research Likewise, termination of RMP funding of a project requires and analysis for other community agencies and institu- that ownership of project equipment either remains with tions. Computer based files of sociological, demographic, LARMP or is transferred upon suitable request and economic and health related information available to justification to the institution continuing the project after Health Information Systems users provide Important data RMP support is terminated. for sound planning and evaluation. The Information sys- tems within the unit have been designed to meet both Printing general and specific data collection, storage and analytic Contributing to the lowering of administrative costs Is the needs. LARMP Printing Department, which prints and assembles Since the inception of the CHIP project, computer pro- nearly 90 percent of all LARMP publications. Formerly grams have been developed to handle a variety of data contracted to private commercial organizations at con- ated processing functions for analysis of data provided by the siderable expense, this "in-house" service has gener user or with data available from the Health Information about $20,000 in annual publication cost savings. Systems Unit. 8 Library Services Since 1972 the Lakes Area Regional Medical Program's By action of the Regional Advisory Group of LARMP, Library Program has continued to operate in two phases: $5,000 in developmental funds were allocated to two in-house informational system and the hospital library Allegany county hospitals to share equally in the improve- consultation service. The staff professional librarian divides ment of their respective libraries. The hospitals will adhere her time equally between that of general staff Information closely to NLM grant guidelines and the library managers Specialist, Librarian for the in-house library, and Library will each receive "mini-courses" in basic library skills. Consultant to the 56 health care institutions, other health Development of the staff library has proceeded with agencies and colleges in the LARMP nine county area. acquisition of a Health Care basic collection and current Visits have been made to most of the institutions in the informational materials. The library receives 50 current region. In many cases there have been repeated visits to periodicals, 47 newsletters, and all other RMP newsletters. meet with library committees, assist in National Library of The library is now open to area students and health Medicine (NLM) grant applications and to assess library professionals. collections. Three institutions in the region are presently Information services utilize a variety of networks and considering Project Grant Applications. resources to answer staff questions concerning drug At initial visits with administrators or library managers the information, biographical, legislative, and manpower data consultant reviews a packet of reprint material compiled to as well as other information. The expanding Emergency encourage and assist library development. The concept of Medical Services and Hypertension Projects place in- shared library development has been promoted on a creasing demands on the in-house system. The staff of geographic basis both with individual administrators and LARMP and others rely heavily on the excellent services of the librarian. IDS in photocopy, book loan and computer searches of the The library program staff is assisting in the formation of a MEDLARS data base. The Information Dissemination Western New York Health Sciences Librarians Association. Service searches are edited and reprinted for distribution at LARMP teaching days. In 1973 the Telephone Lecture Network programs for Current awareness services consist of circulation of journal librarians were planned by the Information Dissemination title pages, compilation of selective bibliographies and Service - State University of New York at Buffalo and servicing informational needs. LARMP. A new series for 1974 will feature nationally known personalities in Medical .Librarianship made available through the TLN teleconference capabilities. For these monthly lectures, groups of students and librarians will meet at LARMP headquarters. The lecture will be followed by professional organization meetings. A two-day workshop was held in Buffalo, New York in August, 1973. It was well received and attended by 60 librarians from around New York State and Southern Canada. In 1974 the Regional Medical Library and the new steering committee will assist in planning for another workshop, LARMP through its consultant receives directional Input and program assistance from NLM; Medical Library Association, Office of Education: Regional Medical Library, New Yo'rk Academy of Medicine; and SUNYAB Health Sciences Library. 9 Evaluation A major function of the Evaluation Section is to assist Evaluation of proposal authors in the selection and design of an ap- Operational Projects propriate methodology for their projects. Such a methodology includes: identification of the target popula- Information Dissemination Service tion, documentation of the extent and degree of the In February 1973, the Information Dissemination Service, problem, statement of project objectives in operational in conjunction with LARMP, initiated a detailed evaluation terms, description of project activities corresponding to and analysis of IDS utilization. This study was undertaken each objective, establishment of success criteria before to assess the resource needs of the SUNYAB Health commencement of project activities, and quantitative or Sciences Library and participating health care facilities in objective measurement of project results. - the region. It will provide the basis for improving the State A well conceived evaluation design is related to each phase University of New York at Buffalo's Health Sciences Library of project activity. It consists of a measuring device or as it functions as a resource library. It will also provide the instrument which assesses the effect of project activities basis for improving the journal holdings of hospital libraries on the target population in such a way that results can be throughout the region. compared with some previously established standard or criterion of success. Emergency Medical Services Evaluative effort aims to study change, specifically the NFL Stadium Survey change effected by a project on either the health status of a A survey of all NFL stadia, conducted in the fall of 1973, group of people or the effectiveness and efficiency of the grew out of the EMS project's involvement in planning health care delivery system. The evaluation process emergency medical services at Erie County's Rich provides a greater understanding and documentation of Stadium. This survey was conducted to collect data on the LARMP's impact on the region, thus enabling the program facilities, services and medical personnel available to to continue responding to the changing health needs of the persons requiring medical treatment while attending a community. sporting event at stadia used by National Football League Part of this evaluation effort is the Quarterly Activities teams. Survey data are now being tabulated. Reporting system. Reporting forms summarizing activities Rural Externship Project and progress during the quarterly reporting period are completed by each project director. Summary reports on An evaluation of the 1973 Rural Externship Project was the progress and problems of each project are prepared by conducted to determine changes in attitudes of health the Evaluation Section and provided to the Program science students towards rural health care delivery Committee for review and program planning. systems and their Intentions towards practicing In a rural setting. Evaluation of Sickle Cell Information and Education Project Teaching Days and Workshops Under the sponsorship of the Niagara Frontier Association The many teaching days and workshops sponsore y for Sickle Cell Disease, Inc., numerous sickle cell educa- LARMP are systematically evaluated through the use of tion meetings took place in the inner-city of Buffalo during evaluation forms completed by program participants. These the latter part of 1973. The purpose of these meetings was forms are analyzed to determine the impact of each to provide members of the community with basic Informa- program in meeting the needs of participants. A report is tion about sickle cell disease and to answer questions submitted to the program planning committee to aid them which the public might have had regarding the disease. in the planning of future teaching days and workshops. Tests were administered to meeting participants prior to the educational presentation and following each program to determine the effectiveness of the program In Increasing knowledge of sickle cell disease. Staff support was requested for tabulation and analysis of the results of these pre and post tests. (continued) 10 Fvaluation Nurse Practitioner Program The State University of New York at Buffalo School of Nursing has been considering the possibility of developing a nurse practitioner program in several clinical areas and formed a committee to make recommendations in 1972. At the same time the Lakes Area Regional Medical Program was considering a study of all aspects of the nurse practitioner concept. As a result, two surveys were con- ducted within the seven New York State counties in the LARMP region during the summer of 1973. The first involved all hospitals, nursing homes and health departments and the second was sent to all physicians in the region. The purpose of the surveys was to determine acceptance of the nurse practitioner concept and willingness of respondents to employ nurse practitioners. The analyses of both the institution and physician surveys have been completed and were presented to the committee for use in its planning processes in the health manpower area. Migrant Dental Education Project Collaborative/Joint Agency Efforts During the summer of 1973 a program of dental education During 1973 several surveys were conducted to document was introduced in Niagara County whereby children of the current status and determine the changing health needs migrant workers were instructed in basic dental health care of various sectors of the professional and lay populations. by a dental hygienist. To determine the effectiveness of the project, tests on dental health were administered to the Lackawanna Community Health Center children prior to the education class and at the end of ten A household survey concerning the Lackawanna Communi- weeks. Pre and post test scores were recorded and the ty Health Center was carried out in conjunction with the results were sent to the New York State Education Erie County Health Department during the summer of 1973. Department which funded this project. Data from this survey will be used to facilitate access and appropriate referral to existing health services and to help Consultative/Community Group Activities plan for future activities better suited to the needs of the community served by the Center. West Side Health Center Early in 1973, the West Side Health Center in Buffalo, New York requested assistance in evaluating various clinics sponsored by the Center. Staff support was given to help determine user attitudes toward these clinics and to assist the Center staff in planning for future clinic activities. Comprehensive Home Care Survey In March, 1973 a survey was conducted to determine the extent to which social service agencies In Erie County, Pennsylvania are involved In the home care delivery system. The results of the survey were subsequently analyzed and presented to the Blue Ribbon Committee for its use In future planning'processes. Lakes Area Regional Medical Program, I nc. Balance Sheet February 28, 1 974 (unaudited) Assets Federal Fund Income Fund Special Fund Total Cash $ 90,647 $ 93,746 $ 10,306 $ 194,699 Federal grant receivable (Note 1) 844,420, - - 844,420 Accounts receivable 8,481 7,929 - 16,410 Due from Income Fund 11,403 - 6,395 17,798 Total assets $954,951 $101,675 $ 16,701 $1,073,327 Liabilities, Reserves and Fund Balances Federal Fund income Fund Special Fund Total Liabilities: Due to Federal Fund $ $ 11,403 $ - $ 11,403 Due to Special Fund 6,395 - 6,395 Employee withholding deductions 1,305 - - 1,305 Other accruals 20,522 - - 20,522 Total liabilities 21,827 17,798 - 39,625 Reserves: Reserve for encumbrances 345,569 345,569 Fund Balances 587,555 83,877 16,701 688,133 Total liabilities, reserves and fund balances $954,951 $101,675 $16,701 $1,073,327 12 Lakes Area Regional Medical Program, Inc. Statement of Revenues, Expenditures, Encumbrances and Fund Balances Year ended February 28, 1974 (unaudited) Federal Fund Income Fund Special Fund Total Fund Balances at February 28, 1973 $1,110,307 $76,765 $ 9,731 $1,196,803 Revenues: Grants awarded 1,535,036 - - 1,535,036 Service fees - 56,393 - 56,393 Contributions - 8,405 8,405 Miscellaneous - 953 59 1,012 Total Revenues 1,535,036 57,346 8,464 1,6001846 Expenditures 1,712,219 50,234 1,494 1,763,947 Encumbrances 345,569 - - 345,569 Total expenditures and encumbrances 2,057,788 50,234 1,494 2,109,516 Fund Balances at February 28, 1974 $ 587,555 $83,877 $16.701 $ 688,133 Note I Note 2 nd Effective March 6, 1974 an additional award of $133,403 Grants from the Department of Health, Education, a Welfare for the period March 1, 1973 through June 30, was received. Simultaneously, the grand period was ex- 1974 amounted to $1,535,036 allocated by components as tended from June 30, 1974 to June 30, 1975. follows: Program Staff $607,537 Note 3 Rural Extern Program 72,204 Comprehensive Health Information Profile 19,425 A substantial grant award is expected for the period July 1, Telephone Lecture Network 95,042 1974 through June 30, 1975. This is the result of a suit filed Chronic Respiratory Disease Program 10,787 in Federal Court by the National Association of Regional Tumor Service Registry 76,292 Medical Programs, Inc. The court directed the Executive Model Program for Comprehensive Branch of the United States Government to release Family Health 38,047 Impounded 1973 and 1974 funds appropriated by the Allegany County Mobile Health Unit 941 Congress. Emergency Medical Services System 216,111 Lake, Area Health Education Center 149,021 Ambulatory Care Facilities Study .99,726 Rural Laboratory Improvement 25,000 Two County Nutrition Program 10,000 SHARECO 25,000 Ambulatory Care Study (Niagara County) 25,000 @Regional Hy ertension Education 64,90 p $1,535,036 13 Developing a Grant Proposal Letter of Intent Regional Advisory Group Review A letter of intent is the first step in developing a proposal for Comments of the county committees, the Proposal submission to LARMP. It is a brief summary of the project Committee, and the Comprehensive Health Planning Coun- concept. A copy of this letter must go to the LARMP cils are forwarded to the Lakes Area Regional Medical Executive Director. RMP program staff and county com- Program Regional Advisory Group (RAG). The RAG is the mittees use the letter of intent to determine if the idea is final review and the decision-making body. It considers the pertinent to the goals and objectives of LARMP. The author recommendations provided by all other review groups, and may receive consultation and assistance in preparation of makes the final decision on approval of projects. The the letter from the RMP staff. The letter must include: author is specifically requested to attend the RAG meeting v a brief statement of what is proposed and by whom at which his proposal is being considered. 9 documentation of the need The actual funding is dependent upon RAG's priority o what is to be accomplished - the objectives ranking of approved projects within LARMP goals and o how it is to be accomplished - the methodology objectives, subject to the availability of funds. o anticipated cost over requested funding period The LARMP review mechanism promotes: 0 plans for measuring the effect of the project- 0 involvement of the sub-regional groups evaluation component. El education of author and reviewers 0 equity of review. Review Criteria The proposal author is in personal contact with the series of The letter of intent is reviewed by the county committees to groups who review his proposal. In particular, he must be determine if an idea is pertinent to the goals and objectives prepared to explain to the county committees his concept of the Lakes Area RMP. The two Comprehensive Health and its applicability to their particular situation. The Planning Councils in the region, are provided copies of the Regional Advisory Group has final authority for both letters of intent for their staff's review and comment. approval and funding decisions. Special forms are used by the county committees, LARMP The proposal, if approved here, then goes to Washington staff, and CHP staff, to review letters of intent. for their approval and confirmation and eventual funding. Proposal Review Process C.H.P. Staff Allied Health Review & Committee County Comment Comments Committees L.A.R.M.P. uthor Staff L Review & RAG Technical Review Assistance County 2. Proposals Committee Review Chairmen Committee Assessment (3 task forces) "3 Task Forces: '(Consultation available with 1. Health Manpower Resources Health services Development 2. Education and Training Staff) 3. Health Services Development 14 programs in Continuing Education 1973 Date Program Location Registrants Co-Sponsors January 31 EMS Conference Statler Hilton Hotel 206 New York State February 1,2,3 "First Annual Conference Buffalo, New York Department of Health on Emergency Medical Services" January 25 Cancer Teaching Day Kenwell Auditorium 120 Millard Fillmore Hospital "Changing Evaluation Millard Fillmore and Treatment of Lymphomas Hospital American Cancer Society Buffalo, New York Erie County Unit February 15,16 Communications Workshop Executive Motor Inn 90 Continuing Education Committee "Interpersonal Relations Buffalo, New York School of Health Related Pathway to Improved Professions Communications" State University of New York at Buffalo March 15 Cancer Teaching Day Buffalo General Hospital 55 Approx. Continuing Dental Education "Oral Cancer from the Buffalo, New York School of Dentistry Dental Practitioner's State University of New York Viewpoint" at Buffalo Buffalo General Hospital American Cancer Society Erie County Unit March 24 Cancer Teaching Day Memorial Medical Center 211 Niagara Falls Academy of "Carcinoma of the Breast" Niagara Falls, New York Medicine American Cancer.Society Niagara County Unit March 28 Health Guides Workshop Parkway Ramada Inn 79 Part 11 "Communications - Niagara Falls, New York Process and Problems" April 4 Cancer Teaching Day Gannon College 180 American Cancer Society "Viral Factors in Cancer" Erie, Pennsylvania Erie County-Pennsylvania Unit May 3 Cancer Teaching Day W.C.A. Hospital 114 American Cancer Society "Current Management of Jamestown, New York Chautauqua County Unit Gynecologic Malignacies" May 5 Nutrition Workshop Campus School 134 Center of Disease Control "Coffee, Herb Tea& Buffalo, New York U.S. Public Health Service Vitamin E" May 17 Aging Workshop Rusch's Restaurant 177 Comprehensive Health Planning "Meeting the Needs of the Dunkirk, New York Council of Western Elderly through County New York, Inc. Organization" June 8.9 Dialysis Workshop Treadway Inn 200 Kidney Foundation of "Human Aspects of Niagara Falls, New York Western New York Inc. Renal Disease" American Association of Nephrology Nurses & Technicians (continued) 15 Programs in Continuing Educationg 1973 Date Program Location Registrants Co-Sponsors June 13 Aging Workshop Jamestown Community 350 Study Commission on the "Death and Dying" College Problems of the Aging June 14 Aging Workshop St. Bonaventure U. 165 "Alternatives to Olean, New York Institutional Living" June 21 Cancer Teaching Day Castle Inn 131 American Cancer Society "Skin Cancer & Malignant Olean, New York Cattaraugus County Unit Melanoma" June 28 Cancer Teaching Day Moonwinks 102 American Cancer Society "Current Concepts in the Cuba Lake, New York Allegany County Unit Management & Treatment of Hodgkins Disease" August 15,16 Hospital Library Workshop Lord Amherst 60 Information Dissemination Service Amherst, New York Health Sciences Library State University of New York at Buffalo September 19 Stroke Workshop Sheraton Motor Inn 270 In cooperation with the "The Three R's of Stroke Lockport, New York staff of Mount View Hospital Care: Referral, Restoration Lockport, New York and Rehabilitation" October 3,4 Nursing Home Personnel Erie County Home 173-(Oct. 3) Supported by a contract Program , and Infirmary 170- (Oct. 4) with the Department of "Rehabilitative and Restorative Alden, New York Health, Education and Welfare, Nursing Skills" Region II, Health Services and Mental Health Administration, New York, New York October 12 First Annual Neonatal Sheraton-East 170 Department of Pediatrics Workshop Buffalo, New York State University of New York at Buffalo "The Critically III Newborn" and Regional Intensive Care Nursery of WNY October 25 Heart Teaching Day Holiday Inn 101 Heart Association of "Live Longer Electrically, Bradford, Pennsylvania Western New York, Inc. with a Pacemaker" Genesee and Wyoming County Units October 26 Aging Program Jamestown Community 392 Study Commission on the Problems of "Mental Status of the Elderly" College Jamestown, New York the Aging Jamestown, New York November 1 Cancer Teaching Day Cameo Restaurant 92 American Cancer Society "Diagnosis and Treatment Wellsville, New York Allegany County Unit of Genitourinary Malignancy 1973" November 8 Cancer Teaching Day Holiday Inn 164 American Cancer Society "New Concepts in Earlier Batavia, New York Genesee County Unit Diagnosis of Malignancy-1973" Batavia, New York November 29 Health Care Delivery System Rusch's Restaurant 164 Western New York Public Program Dunkirk, New York Health Association - An "Current Status of the Health Affiliate of the New York State 16 Care Delivery System ... Total Public Health A ssociation Expectations for the Future" Registrants 4070 Cancer Teaching Days Nine Cancer Teaching Days were conducted during 1973. These are usually held in co-sponsorship with the local American Cancer Society Unit in the county where the program is being held, and Roswell Park Memorial I nstitute. Program topics included "Changing Evaluation and Treat- ment of Lymphomas", "Oral Cancer from the Dental Practitioner's Viewpoint", "Carcinoma of the Breast", "Viral Factors In Cancer", "Current Management of Gynecologic Malignancies", "Skin Cancer and Malignant Melanoma", "Current Concepts In The Management and Treatment of Hodgkins Disease", and "Diagnosis and Treatment of Genitourinary Malignancy-1973". Over 1, 1 69 nurses, physicians, therapists and other health professionals attended these programs. Dr. Gerald P. Murphy, Director, Roswell Park Memorial Institute, serves as chairman of the LARMP Cancer Committee which schedules all Cancer Teaching Days. Cancer Task Force Chairman: Gerald P. Murphy, M.D. - Director E. Douglas Holyoke, M.D. John P. Shutt, M.D. Roswell Park Memorial Institute Chief, General Surgery Brooks Memorial Hospital Buffalo, New York Roswell Park Memorial Institute Dunkirk, New York Buffalo, New York Alfred Stein, M.D. Charles Barranco, M.D. Leo D. Moss, M.D. Buffalo, New York Salamanca, New York Olean General Hospital Paul Welsh, M.D. Theodore T. Bronk, M.D. Olean, New York LeRoy, New York Director of Laboratories Thomas Petrick, M.D. Richard T. Williams, M.D. Mount St. Mary's Hospital Genesee Memorial Hospital Lewiston, New York Wyoming Community Hospital Batavia, New York Warsaw, New York Gerald J. Diesfeld, M.D. Steven Piver, M.D. O'Dell Medical Center Roswell Park Memorial Institute LARMP Staff: Arcade, New York Buffalo, New York Mrs. Patricia Shine Hoff, R.N. Giles Hamlin, M.D. Olean, New York 17 Inner City Health Activities Hypertension Particular attention has recently been focused on ciooa pressure hypertension - high blood pressure, both nationally and 'the silent killer' locally. Studies show a high incidence of deaths, strokes and heart attacks within black communities due to the disease. To help combat the problem in this region, LARMP, through its Hypertension Task Force, has undertaken a massive Public Information/Education program to make persons more aware of the dangers of the disease. These efforts are designed to support already established or proposed screening efforts by other groups such as the Heart Association and the Health Departments. No actual screening is done by LARMP. The emphasis by LARMP is to alert the public to the dangers of uncontrolled high blood pressure and encourage them to have their blood pressure checked regularly. Coordinators of public information and education efforts have been appointed in Erie County, New York and Erie County, Pennsylvania. Eventually the hypertension project will develop into a totally regional endeavor. As part of the Public Education aspect of the project, Professional Education Teaching Days have been planned A great number of organizations and individuals at many for physicians, nurses, and allied health professionals. Lay levels are involved in the public information/education aspect of the hypertension project. They include: Education sessions for community organizations, schools, churches, and block clubs have also been planned. Medical Organizations: Publicity has been provided to support existing screening Upstate Medical Alliance, Inc., Medical Advisory Group activities and public education. to the United Organization of Neighborhood Facilities, Inc., The Health Association of Niagara County, Inc., Also under development is a Regional Hypertension Practical and Registered Nurses (Black Nurses) Club. Screening, Follow-up and Treatment proposal, which will include curriculum development for training hypertension Community Organizations: technicians, patient evaluation and treatment and program Niagara Frontier Association for Sickle Cell Disease, evaluation models. BUILD of Buffalo, Inc., 1490 Jefferson Enterprises, Inc. (Community Center), Buffalo, New York, Urban League Other areas of LARMP involvement have been the Family Life Consort ium; Perry Valley Health Center (a community of Buffalo, Community Action Organization of Erie County New York, Tract I I Community Center of Niagara planning group); BU I LD of Buffalo; Erie County Health Falls, New York, Nia-CAP, Community Center of Niagara Guide Program of the Erie County Health Department; Falls, Planned Parenthood of Niagara Falls, Martin United Organization of Neighborhood Facilities, Inc. which Luther King Community Center, Booker T. Washington includes the Booker T. Washington Erie I Center; Martin Community Center, John F. Kennedy Community Center, Luther King - Bayfront Center; and the John F. Kennedy Hamot Medical Center, St. Vincent Hospital, Doctor's Community Center, NATO 1; all of Erie, Pennsylvania; and ospital (all of Erie, Pennsylvania). the Model Cities Transportation Committee. Osteopathic H Public and Voluntary Agencies: LARMP also has worked closely with the Erie County Erie County New York Health Department, Heart Health Department, the Lackawanna Health Center, State Association of Western New York, The Kidney Founda- University of New York at Buffalo, Department of Medical tion of Western New York, Erie County, Pennsylvania Sociology, Niagara Frontier Association for Sickle Cell Health Department, Visiting Nurses Association, Erie Disease and the Consortium for Allied Health, which County, Pennsylvania, Veterans Administration Hospital, includes Buffalo area colleges, who are all working toward Erie, Pennsylvania, Heart Association of Northwestern the inclusion of Blacks, Spanish surname, American Pennsylvania, Mayor's Office of Community Affairs, Erie, Indians, and poor whites In the allied health professions in 18 Pennsylvania. Western New York. 0 Status of Projects (Those active and completed) The following projects received funding from the Lakes Area Regional Medical Program during 1973: Project Status Coordinator Telephone Lecture Network self-sustaining after 12/31/73 Joseph Reynolds (LARMP will fund on deficit basis) Chronic Respiratory Disease Program Completed 8/31/73 John Vance, M.D. Tumor Service Registry Funded to 6/30/74 John Patterson, M.D. Information Dissemination Service Funded to 6/30/73 Jean Miller, R.N. (grants from hospitals, etc. now) Model Program for Comprehensive Funded to 12/31/73 Ernest Haynes, M.D.' Family Health (continuing with other funds) Allegany County Mobile Health Unit Funded to 6/30/74 Virginia Barker, R.N., Ed.D. (Alfred University thereafter) Margaret Connelly, R.N., B.S. Planning and Articulation for Completed 5/31/73 Phyllis Higley, Ph.D. Allied Health Comprehensive Continuing Care for Completed 4/30/73 Evan Calkins, M.D. Chronic Illness Regional Hypertension Funded to 6/30/74 Michael Miller (and thereafter if funds available) Emergency Medical Services Funded to 6/30/74 James H. Cosgriff, Jr., M.D. (and thereafter if funds available) Lake Area Health Education Center Funded to 6/30/74 Michael Carey (and thereafter if funds available) Ambulatory Care Services Model Phase I - completed 12/31/73 Richard Chalmers Phase I I - funded to 6/30/ 74 Gunter Schmitz Ambulatory Care Study for Niagara County Funded to 6/30/74 Peter Forster Nine County Medical Laboratory Funded to 6/30/74 Sara Marie Cicarelli Improvement (to be completed) SHARECO - Genesee and Funded to 6/30/74 John Sifling Wyoming Counties (to be completed) Two County Nutrition Program - Funded to 6/30/74 Ruth Kocher, R.D. Cattaraugus and Chautauqua Counties (to be completed) Comprehensive Health Information Profile Funded to 6/30/73 Harry Sultz, D.D.S. Health Services Information Unit - Frank Rens successor to Community Health Information Profile and part of Core Program Rural Externship Program Will be continued if funds are William Crage available after 7/l/74 'Dr. Haynes resigned 8/31/73. Current acting director is John Robinson, M.D. 19 List of Members of the Regional Advisory Group and Steering (Executive) Committee c: E ML cr 0 > r LL Institution and/or Occupation Categories of Representation Name and Address Chairman: Father Cosmas Girard, OFM, Ph.D.** Sociologist-Anthropologist Cattaraugus County Olean, New York St. Bonaventure University Committee Vice-Chairman: Niagara County Theodore T. Bron k, M.D.* Physician mt. St. mary's Hospital Director of Laboratories Medical Society Lewiston New York Secretary: Podiatrist Chautauqua County Bert Klein, D.P.M." Jamestown, New York Committee Treasurer: John C. Patterson, M.D." Physician Roswell Park Memorial Buffalo, New York I nstitute Other Members: Hugh Allen, M.D. Physician Erie County Pa. Medical Society Erie, Pennsylvania Hamot Medical Center ter Bernadette Armiger, R.N., Ph. D. Dean, School of Nursing Member of the public Sis Niagara University Niagara University Niagara Falls, New York Member of the public Dean, School of Nursing Virginia Barker, R.N., Ed-D. Alfred University and Health Care Alfred, New York Alfred University Executive Director Member of the public Norman Berg* Jamestown, New York Lutheran Social Services Lester H. Block Attorney Legalcounsel Buffalo, New York Member of the public Mrs. Charlotte Bruner' Tonawanda Indian rvation Basom, New York Rese Official health agency New York State Health LaVerne Campbell, M.D. Buffalo, New York Department - Regional New York State Health Health Director Department max Cheplove, M.D. Physician Erie County, New York Buffalo, New York Medical Society Mrs. Ramona Charles Tonawanda Indian Reservation Member of the public Basom, New York Mrs. Carolyn Daughtry Erie County Department Erie County N.Y. Buffalo, New York of Mental Health Health Department William H. Ennis* Hamot Medical Center Erie County Pa. Executive Director Committee Erie, Pennsylvania Indicates new member since May 1, -1 973 20 Indicates member of Executive Committee List of Members Name and Address institution and/or Occupation Categories of Representation Irwin Felsen, M.D." Physician Past President, RAG Wellsville, New York Allegany County Medical Society Dominic Falsetti, M.D. Physician Niagara County Niagara Falls, New York Medical Society John Foster Martin Luther King Member of the public Erie, Pennsylvania (Bayfront NATO) Center William Gaiter Director Member of the public Buffalo BU I LD Organization Buffalo, New York Larry J. Green, D. D.S. State University of New Upstate Medical Alliance Buffalo, New York York at Buffalo, School of Dentistry Robert Haith, Jr. Director Veterans Administration Erie, Pennsylvania Veterans Administration Hospital, Erie, Pennsylvania United Auto Workers Member of the public William Hilger* Lockport, New York Herbert Joyce, M.D. Physician Member at large Past President, RAG Buffalo, New York Edward F. Marra, M.D., MPH Physician State University of New York at Buffal6 Buffalo, New York School of Medicine Murray S. Marsh W.C.A. Hospital Member of the public Jamestown, New York Administrator C. Conrad Monroe Banker C.H.P./N.W. Pa. Corry, Pennsylvania Marine National Bank Member of the public Elizabeth Moore Director, American Red Batavia, New York Cross Chapter, Genesee Unit Erie County Health William E. Mosher, M.D. Commissioner, Erie County Buffalo, New York Health Department Department Gerald P. Murphy, M.D., D.Sc. Director, Roswell Park Roswell Park Memorial Buffalo, New York Memorial Institute I nstitute Robert Harris Director, Western New York Western New York New York Hospital Association Hospital Association Kenmore, Veterans Administration Joseph Paris Director, Veterans Administration Hospital, Buffalo, New York Buffalo, New York Faculty of Health Dean, School of Health Related J, Warren Perry, Ph.D. Buffalo, New York Professions, State University Sciences, State University of of New York at Buffalo New York at Buffalo Edward Roche, Jr., M.D. Physician McKean County Medical Society Bradford, Pennsylvania Professor Earl Stopfel* Chairman, Medical Services Member of the public Alfred, New York Department State University New York, Agriculture and (continued) 21 Technical College List of Members Name and Address Institution and/or Occupation Categories of Representation Harry A. Sultz, D.D.S. Professor, School of Medicine Erie County, New Buffalo, New York State University of New York at Buffalo York Committee Patricia Stopen, R.N. Wyoming County Health Department Wyoming County Warsaw, New York Committee George E. Taylor, Jr., M.D. Phy'sician Allegany County Cuba, New York Committee Donald Watkins, M.D. Physician McKean County Medical Bradford, Pa. Society Paul Welsh, M.D. Physician Genesee County LeRoy, New York Medical Society Richard T. Williams, M.D. Physician Wyoming County Warsaw, New York Wyoming County Community Hospital Medical Society Eugene Wliczewski Director, Comprehensive Health C.H.P./W.N.Y. Buffalo, New York Planning Council of Western New York, Inc. Duncan C. Wormer, M.D. Physician Cattaraugus County Portville, New York Medical Society Regional Advisory Group Alternates Gerald Farmer, Director (Representing Conrad Monroe) Comprehensive Health Planning Erie, Pennsylvania Craig Fisher, M.D (Representing Dr. Dominic Falsetti) Niagara Falls, New York Mrs. Fleeta Hill (Representing William Gaiter) BU I LD Organization Buffalo, New York Robert A. Jackson (Representing Robert Haith, Jr.) Chief of Professional Services Veterans Administration Hospital Erie, Pennsylvania Dana Lundquist, Associate Director (Representing William Ennis) Hamot Medical Center Erie, Pennsylvania Roland Miller, M.D. (Representing Dr. Hugh Allen) Chief of Ambulatory Care Hamot Medical Center Erie, Pennsylvania Mrs. Ray Crumbley (Representing John Foster) 'Martin Luther King Center Erie, Pennsylvania Gerald Schofield (Representing Dr. Gerald Murphy) Deputy Director for Administration Roswell Park Memorial Institute 22 Buffalo, New York Pro ects Emergency Medical Services System A Blue Ribbon committee, comprised of providers of health services, private and volunteer agencies involved in health and safety, community leaders and general health con- sumers was appointed in April, 1971 by Erie County (N.Y.) Health Commissioner Dr. William Mosher. Dr. James A. Cosgriff, Jr., a Buffalo, N.Y. surgeon, was named chairman of this Erie County (N.Y.) committee. The committee works toward recommendations for improvement In four basic areas of emergency service: communications, trained emergency personnel, emergency vehicles and emergency facilities. Its broadly based membership assures community-wide participation in the decision making process. The Emergency Medical Services Project was inaugurated with Lakes Area Regional Medical Program, Inc. funding in the Spring of 1972. Its purpose is to improve emergency health care in the nine-county LARMP region by re- searching the existent system, establishing an Emergency Medical Radio Communication Network, and training am- bulance and rescue squad attendants. The project was originally developed in Erie County, New York, so as to better determine the feasibility of extending it throughout the entire region, and ultimately New York State. However, when the possibility of funding termination arose in May, 1973, the project immediately expanded its efforts regionally. In an attempt to solidify this expansion, an Emergency Medical Care Committee was established in each of the counties. They are responsible for planning and coordinating local Emergency Medical Services. A Regional Emergency Medical Services Coordinating Coun- cil was also developed. The Regional Council consists of two representatives from each of the nine counties in the LARMP region, and one each from the New York State Health Department, Com- prehensive Health Planning Councils of Western New York and Comprehensive Health Planning Council of North- western Pennsylvania. Subcommittees include: Training - all nine training coor- dinators from the LARMP region; Communication - one advisor from each of the nine LARMP counties-, Bylaws - five members. The Coordinating Council is responsible for planning, developing and coordinating the emergency medical services activities in all nine counties. (continued) 23 Emergency Medical Services System The Blue Ribbon Committee that developed the EMS proposal and submitted it to LARMP for funding lists four major objectives. They are: 1. Education EMT Training - a major element of EMS is properly trained emergency medical personnel. Article 31 of the New York State Public Health Law mandates EMT training for all commercial ambulance attendants; however, this does not apply to members of volunteer agencies. To date the pro- gram has conducted training courses for 800 Emergency .Medical Technicians of volunteer and commercial units throughout the region. This is equivalent to 20% of the total certified in New York State. About 800 more technicians are expected to be trained by June 30, 1974, bringing the total number trained to about 1600. Development of EMT Instructor program is also underway. Special EMT refresher courses have also been conducted over the Telephone Lecture Network. A standardized training kit including basic supplies needed to conduct a course have been made available to EMT Instructors. These supplies The project is also developing a demonstration project are provided to the counties by the Project. dealing with a digital ambulance-to-base data transfer. This is a method of transmitting patient information by means of 2. Research an electronic code to reduce radio transmission air time in dealing with accident victims. This application is being The research and evaluation component of this project is addressed directly to the Department of Transportation In being conducted by a qualified staff. This component is Washington. directing regional surveys intended to provide baseline data for the region and local areas to help bring about changes necessary to establish a fully integrated and more respon- 4. Public Information sive emergency care system. The Erie County (NY) survey There has been significant publicity of the LAEMS Project is now in the hands of appropriate subcommittees who throughout the LARMP region and beyond. Newspaper together with hospital administrators are developing coverage has taken place in all municipalities in the area. recommendations. The county committees throughout the "Emergency Lifelines", the project's official newsletter, Is region will similarly process their own surveys in the distributed to over 4,500 persons and the mailing list will interests of determining recommendations and activity be expanded in 1974. In addition, Public Service Tele- areas. vision sports are in final form to provide public information in various elementary aspects of EMS access and utilize- tion. Also under development are an EMS brochure and a 3. Communication regional EMS access directory. The Medical Emergency Radio System (MERS) will soon be installed in Erie County, New York. This system will tie 10 The EMS project is receiving support from many concerned hospitals, 50 ambulance units and 1 1 service coordinators political and professional health interests of the region, thereby greatly enhancing its chance for successful lm- into a functional communications system. Cost of the plementation. equipment Is $160,000. Communication coordinators out- side Erie County, New York are meeting with the New York State Communications Coordinator to confer on a regional EMS communications network. (continued) 24 Emergency Medical Services System First Annual Regional Conference Staff on Emergency Medical Services James H. Cosgriff, Jr., M.D. Project Director The First Annual Regional conference on Emergency Gerald J. Surette Deputy Director Medical Services was held February 1-3, 1973 at the Ronald Roche Staff Supervisor Statler Hilton Hotel in Buffalo, New York. Sponsored by the Lakes Area Regional Medical Program, Gary Canfield Staff Associate & the New York State Department of Health, and the Erie Regional EMT Coordinator County Department of Health's Emergency Medical Care Geoffrey Gibson Research Consultant Committee, its objectives were to motivate individuals to Roger Fenlon Public Information develop greater concern about Emergency Medical Ser- Consultant vices; to promote the establishment of well coordinated county committees; and to develop interest in and support Michael Walters EMT Consultant for Emergency Medical Services Robert Barnes Ass't. Research Director The conference brought together nurses, physicians, public Gregory Photiadis Research Associate health personnel, volunteer firemen, Civil Defense and Red Cross representatives, ambulance and emergency squad Cathy Rohrer Research Associate members, hospital administrators, police officers and other Steve Ramspacher Staff Aide interested persons, who exchanged their ideas and exper- tise in a combined effort to establish ways to improve the Connie Heineman Staff Secretary emergency health care system. Officials were pleased with the'good mix'of interested participants who opened up timely and important avenues Nine County Medical of dialogue in trying to find ways to improve Emergency Medical Services. Laboratory Improvement Dr. James H. Cosgriff, Jr., Director of the Emergency Improving health care in rural or small hospitals by Medical Services Project, called for a sweeping change in improving the performance of clinical laboratory personnel philosophy on the part of all concerned in emergency is the main focus of this LARMP supported project. It is health care delivery. "To be operational, appropriate also designed to provide accurate data for diagnosis, legislative changes and training programs are needed treatment and health maintenance of patients. along with reassessment of the roles for each member of One of the major objectives is to develop short term the emergency care team. The responsibility for solutions courses in compensory education such as workshops cannot rest alone with isolated groups - it must be multi- covering the topics of bacteriology, hematology, clinical disciplined", Dr. Cosgriff noted. chemistry and blood banking. A long list of national, state, county, State University of Remedial courses of four days duration have been offered New York at Buffalo officials as well as local ambulance. on autoanalyzer techniques used in clinical chemistry, medical and agency officials participated as speakers. blood banking techniques followed by a three-five ay A complete report on the conference is available in the course in instrumentation. publication "Emergency Medical Services Regional The educational programs will eventually Include all clinical Conference" - February, 1973. For copies contact the laboratory personnel In the LARMP's nine counties Director of Communications, Lakes Area Regional Medical Priorities have been established according to need. The Program, Inc. first programs are In compensatory education. The par- ticipants have been identified as personnel In rural or small hospital clinical laboratories whose performance has barely met standards and whose needs are most urgent. Project Director Sara M. Cicareill, Associate Professor, Associate Chairman Medical Technology - School of Health Related Professions State University of New York at Buffalo El 25 Telephone Lecture Network The Telephone Lecture Network is a closed circuit system that broadcasts, via a telephone line, continuing education programs to members of the professional community and allied health occupations scattered to its 39 regional network locations. The primary purpose of TLN is to make first rate, non- commercial, hospital wide continuing education programs available to all hospitals and other health related in- stitutions. During 1973 thirty-five institutions actively participated in the hospital-wide education service provided by the TLN. A new weekly series of lectures for Food Service Personnel was introduced in the Fall of 1973. The School of Nursing at Niagara University, the District 1, New York State Nurses Association, the W.N.Y. Diabetes Teaching Association, and the Nursing Inservice Department of the Millard Fillmore Hospital joined with the School of Nursing, State I n cooperation with the State University of New York, University New York at Buffalo, in developing the year's Agricultural and Technical College (Alfred, N.Y.), a three lecture series for nurses. Twenty-eight other sponsoring (3) quarter, credit bearing, college level course covering institutions, agencies, and organizations cooperated in an Introduction to Anatomy and Physiology 1, 11, and III program development during the year. was conducted. Total enrollment for all three courses exceeded 120 students. The regular lecture schedule included 187 programs offered in a wide variety of lecture series attended by Thirty Emergency Medical Technicians were recertified members of over 28 disciplines providing health care or following a refresher training course offered over the health care support. network by the Lakes Area Emergency Medical Services project. An estimated 35 persons audited this course at Reported attendance (approximately 75% of actua atten- dance) was 16,743. Requests for continuing education various locations. certification totaled 10,359. The Buffalo State Hospital Staff conducted a special series of 12 hour-long sessions for physicians at several network In the last 24 months, 74 guest lecturers from outside the locations in Preparation for Certification by the American Lakes Area region have been conferenced from 24 states Board of Psychiatry and Neurology. in the U.S.A. and Canada. On six occasions the Parents of Diabetic Children and the Twelve components of the Lakes Area Regional Medical Niagara Frontier Asthma Chapter of the American Allergy Program, the Lakes Area Regional Advisory Group, and Foundation, conducted community health information and other cooperating agencies conducted a total of 31 education programs for their membership and other in- conferences/meetings on the Telephone Lecture Network terested persons over the TLN. in 1973. During this period, the TLN provided audio/visual support at thirty-three (33) seminars (43 days) conducted Approximately $58,000 in non-federal funds was generated by the LARMP and cooperating organizations. in this period toward project support. Beginning In September 1973, the network broadcast ts on Staff schedule was expanded to provide regular rebroadcas Friday of any lecture given during the week. Joseph L. Reynolds, Coordinator Robert Mathiebe Doris Unger Marjorie Witkop Susanne Fimiani Leslie Solomon n 26 Rural Externship Program The eight-week Summer Rural Externship project (June 18 August 10, 1973) provided health sciences students with first hand living and working experiences which were designed to expose them to the delivery of health care in rural areas of the Lakes Area Regional Medical Program region. Close working relationships were developed between the principal preceptors and their students. For some, the experience pointed to a future career away from large cities. The program's structure permitted a great deal of flexibility which allowed the student to decide how to spend part of his time according to his own individually developed interests. Externs were paid a stipend of $100 per week. A modest beginning in the summer of 1970 saw nine health sciences students participate in the project. The number jumped to 55 in 1973. The project enabled students to participate in an inter- disciplinary "team" approach to health care, based in many cases on a rural or semi-rural hospital setting. It provided exposure to rural health care delivery and the life style of a rural community. Students also became aware of the Rural Externship Program-Summer, 1973 characteristics and problems of rural health practice. Externs by Discipline The diversity of experience afforded the externs was most Medical 1 6 29% extensive. In addition to having contacts with all hospital Dental 4 7% departments, most of them went out Into the community Pharmacy 1 3 24% under supervision of various preceptors an en oye Nursing 8 15% enriching experiences in many aspects of health care delivery and delivery of health related services. This Physical Therapy 6 1 1% occurred in rural, semi-rural, and small urban areas and Medical Technology 3 5% included patients from each of these areas. The ap- Dietetics 1 2% proximate cost of this project in 1973 was $53,190 which Hospital Administration 3 5% was funded by the LARMP. Podiatry 1 2% As a result of the 8-week summer experience, three of the @5 1-00% 55 externs accepted positions in rural or semi-rural areas after completion of their studies. Others, 32.7%, definitely William D. Crage, Project Director planned on rural health practice following graduation. This project received good publicity and visibility. A large number of feature stories regarding the pro- gram's activities appeared In the local newspapers of the region. The project also was carried on the wire services. Articles included several feature stories of per- sonal Interviews with externs and preceptors. Accounts of the project were also heard on radio broadcasts. Letters were written to area legislators concerning the project. One local congressman delivered a commendation statement on the floor of Congress and placed this and samples of the newspaper accounts In the Congressional Record. 0 2 7 Allegany County Mobile Health Unit A mobile health unit, designed to provide health assessments and health education to Allegany County residents was funded by the Lakes Area Regional Medical Program, Inc. in mid 1972. The unit is sponsored by the Alfred University School of Nursing and Health Care and the Allegany County Board of Legislators through the County Public Health Nursing Service. During 1973 the Allegany County Public Health Nursing Service, which is operating the unit, assessed 329 adults. Of this number 203 were referred to family physicians or a physician of the client's choice for one or multiple problems. This is a referral rate of 62% compared to the initial assumption that there would be a 40% referral rate. Each person referred was also provided with follow-up by agency nurses to insure that all recommendations were followed and to lend assistance whenever needed. The educational effort in connection with the Mobile Health Unit actually consisted of two phases. One is client education conducted by the Public Health Nurses and the student nurses on the Unit. The second phase is the education of the health professionals themselves, whether Well Child Conference Project it be the nurse practitioner or the student in the bac- The Allegany County Public Health Nursing Service also calaureate program. At present group education of the operates a Well Child Conference Project. This is funded by clientele in the county is met in the area of the expectant the Appalachian Child Development Commission. Three of parents classes. Additional education classes were these conferences per month are held in the Mobile Health planned to begin in the spring of 1974. Unit. Children clients are assessed by a team of nurses Officials note that one of the real strengths of the Mobile from the Allegany County Public Health Nursing Service, ' eaded by a Pediatric Nurse Practitioner, who is also Health Unit has been the one-to-one health counseling and n health education carried on within the Unit by the Public employed by the nursing agency. Since the well child project began on August 27, 1973, a total of 87 children Health Nurses and the student nurses with the individual were assessed in the unit. The referral rate is 18%. There Is members of the society as they come through the Mobile also follow-up by nurses for these referrals. Health Assessment Program. This has been attested to by letters of support received from county residents who have Beyond The Call Of Duty availed themselves of the services of the Unit. On January 31, 1974 the mobile unit during a regularly The introduction of the Mobile Health Unit in Allegany scheduled visit in Bolivar, New York, became involved in County has opened up learning experiences for students in providing first aid and oxygen to three victims of a major Alfred University's baccalaureate nursing program. As of fire that destroyed four buildings. Nurses aboard the unit, September 1973 all seniors in the nursing program were which was parked across the street, administered the required to serve on the unit. Beginning in February 1974 service to the victims during the height of the blaze, whose all sophomore students received rotation assignments on flames were fanned by 40 mile per hour winds. No injuries the unit. This is a reflection of the trend of the University's were reported. An account of the unit's participation In the nursing curriculum toward the development of the Family fire appeared in local area newspapers. Nurse Practitioner Program at the undergraduate eve . The project received honors from the New York State Co-Project Directors Nurses Association as an Innovative development in Virginia Barker, Ed.D., Dean, Alfred University School of nursing practice which Is changing the health care delivery Nursing and Health Care, Alfred, N.Y. pattern In a particular area. The Association saw it as a Mrs. Margaret Connelly, R.N., Director of Patient Services, means of demonstrating an effective role for the Allegany County Public Health Nursing Service, Angelica, N.Y. professional nurse in meeting today's health needs. Reynard Meachum, Driver Secretary. Alfred Station, N.Y. Lake Area Health Education Center The Lake Area Health Education Center is a non-profit because of LAHEC staff's promotion of its use, or how corporation based in Erie, Pennsylvania. As a community- many persons have benefited from the LARMP-funded based regional system of educational and training Information Dissemination Service, the Drug Information programs (basic and continuing) it coordinates and Service and the VA-funded Medline. It would be difficult to develops area resources in order to meet area needs in attain accurate statistics concerning the numbers of health-care manpower. Presently LAHEC relates to the five laypersons who have been reached through LAHEC's contiguous counties of Astabula (Ohio); Chautauqua (New educational programs in health for the non-health-pro- York); Crawford, Erie and Warren in Pennsylvania. The fessional community (reached via face@to-face contacts, consortium's activity has no strict geographical boundaries and pamphlets as well). Each person within the region's and accepts all responsibilities and affiliations, all working half-million-and-more population is receiving better care and formal relationships that further its aim of regional self- because of the up dated professionalism of its health-care- sufficiency in health care manpower. man-and-woman-power at a cost of about a penny per Funds to support LAHEC's regional activities come from person. three sources: (a) Lakes Area Regional Medical Program Minority Health Education lb) Veteran's Administration, through the VA hospital in Erie, Pennsylvania and (c) diverse local contributions, both The Minority Health Education Delivery System (NHEDS) in cash but chiefly in kind, from the healthcare and relates to the Spanish-speaking migrant and sedentary educational facilities and institutions from all five counties, populations along the tri-state shores of Lake Erie. Bilingual and the professional health manpower societies within the health advocates visit migrant camps and inner-city areas same region. in order to reach their Spanish communities with These funds vary from year to year. It is LAHEC's intent to educational and testing programs. The needs of people of become generally free from federal support by 1980. Since all ages are identified, The health advocates themselves, June 1971, when the first LAHEC staff person was through Villa Maria College of Erie, are given paramedical employed, the consortium has received over one million training. A 30-hour course touches upon a medley of dollars of support, with approximately 75% derived from subjects including nutritional practices, water supplies, federal sources and the remaining 25% from local sources. childhood diseases, care of infants at home, first aid LARMP awards are about 80% of the federal contribution. techniques, methods of assessing health needs, etc. Health Erie's St. Vincent Hospital and Hamot Medical Center are advocates teach migrants and residents how to obtain the chief cash contributors among the local donors. proper medical treatment by using available community families and teach them preventive health. Ladies from the First Two Years Erie Council of Churches make up first-aid kits, which are IIn its first two operational years, LAHEC has sponsored, distributed to Spanish homes with instructions in their use. promoted and/or administered twenty-five programs for St. Martin's Center in Erie is serving as a hub for multi- numerous health disciplines, thereby helping to maintain media programs which have been provided for Spanish the competence of thousands of health professionals, both teenagers on topics such as alcohol, drugs, and sex within and outside the LAHEC area. At least two dozen education. Adults attend sessions on first-aid - all con- counties in the tri-state area previously mentioned are ducted in Spanish. As MHEDS develops, classes will represented among the participants in programs offered by expand to provide instruction in nutrition, pre-natal care, LAHEC. and caring for babies at home. Pamphlets and films in Over 1200 professionals have registered at LAHEC Spanish have been distributed and shown. A glossary of seminars, workshops, etc. There is no way of determining common health terms is in preparation. Three college the number of professionals reached through LAHEC's seniors joined MHEDS during the winter semester for their local library program, or LAHEC's speaking and con- practicum: one is a community-development student in sultative efforts on state and national levels. There Is no health planning; the other two are nursing students. practical way of taking a census of those who now listen to the Instructional LARMP Telephone Lecture Network (continued) 29 Lake Area Health Education Center New programs are envisaged to help solve needs in the LAHEC area. New funding sources for programs barely underway are also needed. LAHEC is investigating the health-educational potential of supra-regional cable TV, a nurse-practitioner program and a yet to be developed nursing institute. LAHEC continues to develop its two-dozen-plus programs throughout the area. It is now looking to other problems to solve - again, on a voluntary basis. There is a need 0 to produce more managers and administrators * to develop health professionals at all levels o to nurture mutual understanding among institutional members of the LAH EC consortium (there are close to 150 of them) o to re-educate health professionals o to catalyze community participation * to describe career mobility opportunities a to produce innovative educational processes and curricula o to evaluate and gather current data necessary for sound planning o to promote interinstitutional and interdisciplinary education to be the ferment for total collaboration Planning Staff Michael C. J. Carey, MA, MPH Executive Director Linda L. Arnold, BS Administrative Assistant Kathleen A. Bennett, BA Research Assistant Clara M. Burleigh, BA Secretary Robert F. Corrigan, EdD Planning & Evaluation Diane M. Hrach, BS Secretary Robert J. Olszewski, BS Planning Assistant Sylvia A. Payne Receptionist Paul E. Pazerski, BA, MPH Planning Assistant Janine Powell, BA Administrative Assistant Gloria E. Rogosky Administrative Secretary Edward L. Taylor Office Manager 30 Lakes Area Regional Tumor Service Registry The Lakes Area Regional Tumor Service Registry has completed its fourth year of operation and has during that time experienced a steady and healthy growth. As time and experience have indicated, modifications to basic systems and procedures have been implemented so that the registry nearing maturity, will soon achieve its statistical goal of producing "end-results" and "survival" analyses. The Tumor Service Registry was designed to serve the hospitals, physicians and cancer patients of the nine county region of the Lakes Area Regional Medical Program. This service is presently shared by 21 hospitals now par- ticipating in the program, representing 40% of all hospitals within the region. The data bases include approximately 8500 cancer cases and are being expanded at an in- creasing rate with the continual enrollment of new member hospitals. The data, which is coded from source documents prepared by hospital tumor registrars, is maintained at a high level of accuracy through a rigorous system o qua ty control, including multiple case reviews, telephone con- sultation and periodic training programs. Recently made program revisions have enabled diverse analytical repor- ting of these data reflecting incidence by primary site of disease, sex, age, stage of disease and first course of treatment for an individual year or any number of con- secutive years. Many such reports have been prepared in response to specific requests from physicians or In- stitutions as well as for general distribution and educational programs. To keep pace with this increasing caseload, cancer patient follow-up, and expanded scope of activities it has been necessary to employ additional registry personnel. Dr. John C. Patterson@ Project Director, oversees the daily clerical, STAFF statistical, and data processing efforts of his staff. Dr. John Patterson, Project Director Modification and development of computer programs are Dolores Gamble also carried out. The ultimate goal of this tumor registry continues to be Joyce Greenwood service - service to the cancer patient by promoting Freda Honig continuity of care through yearly requests for follow-up Mary Penkacik data, service to the physician by enabling evaluation of all Kathleen Franz forms of cancer therapy on the basis of survival and end- Angelika Saxer results analyses, and service to the community by collec- John O'Day ting data which may assist in cancer epidemiology and (part time consultant, data processing) development of improved methods of cancer detection and prevention. 31 Ambulatory Care Services Model Niagara County Ambulatory Medical Care Study Phase I In December of 1972 the School of Architecture and This project is concerned with conducting a study of Environmental Design, State University of New York at ambulatory care needs in Niagara County. Buffalo, began an analysis of ambulatory care services with The Health Association of Niagara County, Inc. is gathering the intent of planning new hospital based facilities. The the pertinent existing data relating to the ambulatory care project was conducted in conjunction with Deaconess needs in Niagara County. Hospital of Buffalo, which hopes to use the results of the study in planning its new ambulatory care facility. The Under study are the ambulatory care needs in the county as project was divided into two phases. they relate to physical debility, including: pediatrics, general medicine, obstetrics, surgery (limited to out-patient Under a five month grant from the Lakes Area Regional surgery), family practice and geriatrics. Medical Program a model of ambulatory care service delivery was developed. The model in the first phase output The results of this study (a first for Niagara County) is of a two-phase project aimed at enhancing the decision- necessary in assessing the ambulatory care needs and the making capabilities of professionals in the health care field. delivery and scope of present and projected services, both The model provides hospital administrators, architects, or quantitatively and qualitatively, in Niagara County. health program supervisors with information about detailed The project was launched on July 11 1973 and scheduled workings of an ambulatory care facility so they can make for completion by June 30, 1974. sound decisions concerning such things as: (1) ways to improve health care delivery, (2) criteria for designing new Peter L. Forster is director of this project. ambulatory care facilities, (3) ways to evaluate existing health care services. The model, operated by means of a SHARECO computer program, stores and retrieves detailed informa- tion about the costs incurred, the time expended, the SHARECO is a plan designed to facilitate the continuing personnel utilized, and the space required for every task and in-service education efforts of its cooperating performed in an ambulatory care facility. The user of the members particularly through the sharing of all types of program can employ this information in order to attain a educational resources. Participants include Genesee Corn- better understanding of the way an AC facility works, and in munity College, Batavia, New York and the following order to make intelligent judgments concerning ways in hospitals: Genesee Memorial, St. Jerome, Veteran's Ad- which ambulatory care can be improved. ministration, all of Batavia; Wyoming County Community, Structure of the Model: the value of the Ambulatory care Warsaw, New York; Arnold Gregory, Albion, New York; and Medina Memorial, Medina, New York. Services Model is derived directly from the level of detail of the data it stores: the more detailed the information a A $25,000 grant from the LARMP launched the project on decision-maker has to work with, the better his ability to December 12, 1973. SHAREGO has completed an make sound decisions. The data stored by the model educational needs inventory in the area upon which it has based its program planning. A consolidated listing of describing the internal workings of an AC facility is much educational resources slated for distribution to participating less aggregate, much more detailed than is the data which hospital administrators and hospital architects presently institutions, has been compiled. have to work with. In an effort to expand educational programs, videotapes are being made to supplement certain programs and a Phase 2 distribution system is being set up. Also available Is assistance in arranging, upon request, instructors, lec- Intends to improve a simulation model of ambulatory health turers and guest speakers. care services developed by Phase 1. The project is aimed at increasing the quality of programs ACMS-Phase 1-John P. Eberhard, Dean, Principal already offered by making available more educational Investigator; Gunter Schmitz, resources to participating Institutions. This Includes sharing Associate Professor, Project Director of audio visual equipment, media and personnel expertise. ACMS-Phase 2-Gunter Schmitz, Associate Professor, The project also calls for developing programs of general or Principal Investigator; Scott Danford, special interests which can be presented In a central Project Director location, such as Genesee Community College, In the hospitals or video taped for distribution to the participating institutions. 32 John P. Sifling is coordinator of the project. Information Dissemination Service The Information Dissemination Service is designed to improve library services in the nine county area of LARMP by distributing health related information quickly and directly to all members of the health professions, including physicians, nurses, physiotherapists, occupational therapists, podiatrists, dieticians, medical record librarians, aids, and other allied health professionals. The Health Sciences Library at the State University of New York at Buffalo is the medical resources library. e resources of medical libraries across the state and nation are available to the users of IDS through established avenues for inter-library loans. Means of communication for receipt and transmission of requests include the LARMP Telephone Lecture Network, U.S. Mail, telephone, teletypewriter (TWX), and the SUNY Biomedical Com- munications Network. Xerox 2400 and 7000 high speed duplicating machines provide copies of journal articles. The computer facilities of the SUNY Biomedical Com- munications Network provides users with subject bibliographies and a current awareness service. Conven- tional medical reference service and consultation regarding library management is also provided. Services A Medical Librarian is assigned responsibility for operation Photocopy requests 9,331 of the Information Dissemination Service and is assisted by Pages provided 81,279 a library technician and clerk-typist. The Librarian of the Health Sciences Library supervises the project. Journals loaned 96 The IDS offers the following library services to all health Booksloaned 699 professionals in the region: photocopy and mailing of Bibliographic searches 525 journal articles and mailing of books, preparation of subject References requests 119 bibliographies in the areas of interest designated by users, In addition, the IDS has kept detailed records of hospital medical reference service and library consultation service utilization over its period of funding. to hospital libraries. During the period of January 1973 to June 1973, the IDS As of July 1, 1973 the IDS became self-supporting. The has provided health professionals in the LARMP area with budget for the program receives support from the SUNYAB the following services: Library Service (60%) and a fee-for-service contribution from participating hospitals in the region to approximate 90% of present costs. STAFF Miss Jean Miller, Project Director Ruth Opler Joanne Nichter 33 Community Health @ Information Profiles (CHIP) Community Health Information Profiles (CHIP), which has The support provided by LARMP has given the CHIP been supported by the Lakes Area Regional Medical program of this area recognized national leadership in this Program since 1970, has continued in its efforts to develop health planning technology. In addition to the LARMP, a health-related data base. This has involved obtaining and CHIP provides data and services on an ad hoc basis to t e integrating vast amounts of data from a wide variety of U.S. Department of Health, Education, and Welfare, sources and developing and testing computer technologies Comprehensive Health Planning Council of Western New and presentation formats. Such a data base is considered York, Inc., Erie County Department of Health, Niagara to be a prerequisite to reliable health-planning decisions. County Department of Health, New York Urban Develop- The range of activities required to produce this body of ment Corporation, as well as to hospitals, universities, and information for a county is characterized as a small area professional societies in the region. profile and for special groups within communities or Project Director regions as categorical profiles. CHIP of LARMP produced several of each type of profile in 1973. Harry A. Sultz, D.D.S., M.P.H. Department of Social and Preventive Medicine Small Area Profiles State University of New York at Buffalo Profiles for Allegany County and Chautauqua County were completed in 1973. Both of these reports detail the population, demographic, and economic characteristics as well as vital statistics for the county. Also part of each Chronic Respiratory Disease Program profile is a comprehensive description of the county's This many-faceted, comprehensive project featured health resources which include institutions, manpower, and screening for evidence of chronic respiratory disease, services and a measure of their utilization. The profiles continuing education for nurses and physicians, a model identify the gaps in service, the projected needs for pulmonary care facility, a respiratory Intensive Care Unit, service, and the overlapping of services. County com- an Associate Arts degree program in Inhalation Therapy mittees are now at work developing solutions to some of and a Home Care Program. The project became the problems. operational in March 1972. Categorical Profiles Each year approximately 16,000 people have been A Community Health Profile, Family Planning Needs and screened for chronic respiratory disease in the region in Services in Western New York, completed in February, cooperation with the American Lung Association of 1973, documented the population at risk to the need for Western New York's mobile unit operation. This program organized family planning services, the services currently became totally self-supporting In March 1972. available, and the knowledge and attitudes around family The School of Respiratory Therapy at Erie Community planning of a specified group of disadvantaged women by College, which trained inhalation therapists, also became means of a home interview. A second categorical profile, totally self-supporting In March 1972, receiving funding Factors Affecting the Utilization of Maternal and Infant from Erie County (NY). Care Services of the Department of Health, Erie County, All elements of the Model Pulmonary Care Facility, except New York, identified populations at risk to the need for the Home Care and Rehabilitation programs, are now maternal and infant care services, the populations served, self supporting. and the attitudes toward and knowledge of services from a home interview of a sample of users and controls. The Millard Fillmore Hospital of Buffalo, N.Y. has assumed A definitive statement on community health Information the major financial support of the Chronic Respiratory Disease Program. profiling was the subject of a technical paper entitled Pertinent Concepts, Content and Output Formats of Com- Project Director munity Health Profiles, published and distributed by the John Vance, M.D. Community Profile Data Center, HSMHA. Millard Fillmore Hospital A paper entitled "Community Health Information Profile: Prerequisite to Planning or Exercise In Futility?" was presented before the 101st'Annual Meeting of the American Public Health Association In San Francisco, California, November 7, 1973. 34 Model Program for Planning and Articulation for Allied Health Comprehensive Family Health This project was concerned with developing a voluntary This program, designed to identify community health needs coordinating council for allied health education. and meet these needs using the "health care team approach," became operational in 1972. This involves the The project sought to identify present and projected allied well-trained family physician, family practice nurse and the health manpower needs, and current and projected modern social worker, all working in concert to "expand enrollment .s in present vocational - technical allied health the arms of the physician", thereby providing more time for programs in the region. It also involved the comparison of his main role of diagnosis and treatment. It also allows the pros and cons of regional planning and articulation for more people to obtain better medical care more efficiently, allied health vocational technical education and the con- effectively and economically. struction of a master plan for this special education in the region. The Health Care Team has been developed to provide A major accomplishment of the project was the establish- service to the patients registered with the Family Practice ment of a viable communication network among persons Center. It has also developed a system of census tract responsible for planning and developing allied health filing, morbidity coding and general assessment. education programs. Persons responsible for institutional The Lakes Area RMP provided funding to underwrite the planning with respect to the need to develop in- costs of research, assessment and evaluation o t e terinstitutional cooperative efforts in meeting regional program as it relates to the practice of family medicine and manpower needs were made more aware of their respon- the development of the health care team approach. sibilities through this interaction. Deaconess Hospital of Buffalo, New York initiated the Institutional representatives have reported a number of program in 1969 and subsidizes it to @ major degree. instances where their planning has been influenced by the The motto of the family practice center is "To Create information which was shared at coordinating council Family Physicians By Intent and Not By Default." meetings. Two participating institutions reached a mutual conclusion of who should initiate long range planning for a Project Director program to prepare therapeutic radiologic technicians. Ernest R. Haynes, M.D. (resigned) Another institution began a feasibility study on a program to prepare clinical dietitians. This project has also resulted in making available accurate Two County Nutrition Program data on existing programs in allied health education, current and projected enrollments and a survey of those Cattaraugus and Chautauqua Counties programs which are now in the planning stage. This project involved joint funding from the LARMP and the This study has also highlighted the need for some agency to Appalachian Regional Commission to support a nutritionist assume responsibility for providing reliable data in man- position to be shared between Cattaraugus and Chautau- power trends. qua counties. This extends nutrition services to all age groups in both counties, and greatly enhances the oppor- Project Director tunity to study feasibility and cost/effectiveness of this new Phyllis Higley, Ph.D. service. It would also develop a program of nutrition Department of Health Sciences education for the public. Education and Evaluation Evaluation of the program will be based on utilization of State University of New York at Buffalo nutrition services, costs of services (both direct and indirect), and changes in nutritional status of selected patients receiving services. The ultimate success of the program would be establishment of a permanent nutr t on st position In the county budgets. Project Director Miss Ruth E. Kocher, R.D. Regional Public Health Nutritionist New York State Department of Health Miss Kathy Child (as of January 15, 1974) 11 35 Professional Staff John R. F. I ngall, M.D. - Executive Director James J. McCormack, Ph.D. - Deputy Director Robert J. Miller, M.B.A. - Executive Assistant to the Director Patricia Shine Hoff, R.N., M.A. - Assistant Director - Nursing & Allied Health Benjamin Morgan, B.S. - Comptroller Anthony Zerbo, Jr., B.A. - Assistant Director - Communications Robert J. Beebee, M.B.A. -Staff Associate Helen Brown, M.A. - Staff Associate John B. Clark, B.S. -Accountant William D. Crage, M.S.W. - Staff Associate Patrick M. Egan, B.S., M.B.A. - Staff Associate Janet Gelsinger, B.A. - Staff Associate Jean Hanna, M.P. H. -Staff Associate Suzanne K. Manson, M.S.W. - Staff Associate Michael Miller, B.A. - Staff Associate Diane Pinchoff, M.A. - Staff Associate Joan Philipps, B.S. -Staff Assistant Gary Smith, B.A. - Staff Assistant .Support Staff Urban Batt Alice Bragg Carol Butcher Curtis Oashmore Hazel Cunningham Elizabeth Eberl Karen Harper Charlene Kane Bonnie Kirisits Janet Knauf Brigette Kunzeck Mary Mietus Marcia Moule Rose Parker Richard Raelhie Diane Williams Mary Yadav 36