inillimpapilli PROFILE: OHIO VALLEY REGIONAL MEDICAL PROGRAM Grantee: University of Kentucky Research Foundation Current Chief Executive: William McBeath, M.D. Originally prepared by: Michael J. Posta Original date: September 1969 Up-dated: TABLE OF CONTENTS Face Sheet Map of Region 1. Geography and Rationale 11. Demography population land area health statistics facilities statistics Personnel statistics III. Politics IV. Historical Review V. Core Staff VI. Organization VII. Grand Design VIII. Funded Operational Projects Appendix Table I Policy Statement on Program Thrust )V, P TICIP.A TIAIG INSTITU7'IOAIS opEf,,@-. T.,ONAL GRANRAPPLICATIONS OHIO 'IALLEYREGIOT@AL @,r-DIC4L PROGRAIF P-7,rt;cipating Institution (First Grant Only) Participating Institu!ion (S6cond Grant Onlyj Per,icipating Institution (Both Grants) OHIO *:2 Cincinrati 13% W. VI INDIANA Lexington "O L KENTUCKY 2 GEOGRAPIIV- 1) The Ohio Valley Regional Medical Program is composed of 140 counties comprising portions of Indiana, Kentucky, Ohio, and West Virginia. 2) Six major metropolitan areas include Cincinnati, Dayton, Evansville, Haniilton-Middletown, Huntington-Ashland, Lexington, and.Louisville. 3) Medical schools are located at the University of Cincinnati, University of Kentucky, and University of Louisville. 4) Most of Kentucky's 101 counties (excluding the southwest bordering on Tep-nessee), 21 counties of Indiana, 16 Ohio counties including -6'inciiinati-Dayton areas and 2 counties of West Virginia altogether comprise the Cincinnati-Lexington-Louisville triad or the Ohio Valley Regional Medical Program. 5) There is some overlap with Ohio State University RNP and, in Kentucky, with the Tennessee Mid-South PIIP. Rationale 1) The boundaries are intended to be reflections of existing medical service areas, not determinants of future health care patterns. 2) Health interests within the defined region are free to participate in other Regional Medical Programs, and those outside the boundaries are welcome to participate in OVr@. DEYOGRAPIIY 1) population: Roughly 6 million persons: Per Cent of State in OVRMP a) Kentucky 2.8 million 87% b) Ohio 2.4 million 2 3rl. c) Indiana .65 million 127. d) west Virginia .15 million Urban areas:- population includes 2.7 million persons in the following metropolitan areas: a) Cincinnati 1.3 million b) Evansville .2 million c) Huntington- Ashland .25 million d) Louisville .8 million e) Total Region is 71%,urbari. 2) Land Area: 50,000 square miles: Kentucky - 35,000; Ohio - 7,600; Indiana 7,300; West Virginia 800 3) Health Statistics: 1964 Mortality Rate per 100,000 Rates by States U.S. Ohio Ind. Heart Diseases 366 368 381. 375 Cancer 151 140 159 153 CNS Vascular Lesions 104 122 113 122 4) Facilities Statistics: A. Medical Schools Enrollment Cincinnati 308 Kentucky (Lexington) 263 Louisville 344 B. Schools of Nursing: There are 20 diploma and 5 degree granting nursing schools in the .Region. C. Schools of Medical Technology: There are 28 accredited schools: 12 Ohio, 2 Indiana, I West Virginia and 13 Kentucky. D. Physical Therapy School - I (University of Kentuckyj E. Cytotechnology School I (Louisville) F. Hospitals: in 1969, there are 157 hospitals with 2755 beds. The great majority of hospitals are,short-term, non-federal facilities. 5) Personnel Statistics: As of 1969, there are: a) 5913 physicians b) 265 osteopaths c) 17,188 registered nurses d) 2,245 dentists POLITICS West Virginia 2 counties (Cabill and Wayne) District 4 Indiana - 21' counties - District 8 & 9 Ohio (Cincinnati Dayton) District 1, 2, 3, 4, 6, 7, 24 West Virginia, Senators: Jennings Randolph (D) Special Committee on Aging, Select Committee on Small Business, Public Works (Chairman), Labor & Public Welfare, P.O. & Civil Service Robert C. Byrd (D) Appropriations, Judiciary, Rules, and Administration Congressman: District 4 Ken Heckler (D) Science and Astronautics Indiana Senators: Vance Rartke (D) Commerce, Finance, Post Office and Civil Service, Special Committee on Aging Birch Bayh (D) Judiciary, Public Works, Special Committee on Aging, Select Committee on Small Business Congressmen: District 8 & 9 (8) Roger H. Zion (R) Public Works (9) Lee H. Hamilton (D) - Foreign Affairs, Post Office and Civil Service Ohio Senators: Stephen M. Young (D) - Special Committee on Aging, Public Works, Armed Services, Aeronautical and Space Sciences William Saxbes (R) - Labor and Public Welfare, Special Committee on - Aeronautical and Space Science District 1, 2, 3, 4, 6, 7, 24 Robert Taft, Jr. (R) Foreign Affairs Donald D. Clancy (R) Armed Services Charles W. Whalen, Jr. (R) Armed Services 11 mccullock (R) Judiciary, Joint committee on Atomic Energy, Wi iam M. Joint Committee on immigration and Nationality Policy William H. Harsha (R) Thomas L. Ashley (D) Banking'- and Currency, Merchant Marine and Fisheries Donald E. Lukens (R) Post Office and Civil Service, Science and Astronautics Kentucky Senators: John Sherman Cooper (R) Foreign Relations, Public Works, Rules and Administration, Joint Committee on Library, Select Committee on Standards and Conduct Marlow W. Cook (R) Agriculture and Forestry, Judiciary, Select Committee onnutrition & Human Needs, Select Committee on Small Business Conpressmen: Frank A. Stubblefield (D) - Agriculture, Merchant Marine and Fisheries William H. Natcher (D) Appropriations William 0. Cowger (R) Banking & Currency, Government Operations M.-C. (Gene) Snyder (R) - Public Works Tim Lee Carter (R) - Interstate and Foreign Commerce John C. Watts (D) - Ways and Means, Joint Committee on Internal Revenue Taxation Carl D. Perkins (D) - Chairman, Education and Labor Covernor: Louie B. Nunn (R) four year term IV. HISTORICAL REVIEW Spring 1966 Deans of eight medical schools (Cincinnati, Ohio State Case Western Reserve, Pitts- burgh, Indiana, Kentucky, West Virginia, and Louisville) met and determined that geographical area to be served by these 8 schools was too extensive and too hetero- genious to be organized into a single regional medical program. June 1966 - Three of the 8 medical schools join forces to plan for Ohio Valley Regional Medical Program. August 1966 - William McBeath, M. D., Program Director, submits application for planning grant. 1) Region includes 3 schools of medicine. (Kentucky, Cincinnati and Louisville) 2) University of Kentucky ResearchFbunda- tion was accepted by 3 universities as the grantee organization. January 1, 1967 - First Year Planning Award of $285,000 (DC) January 30, 1967 - Grants Management visited Lexington to obtain justification for proposed $50,000 sub-contract to Greater Cincinnati Plan- ning Council for "Patient Origin Studyll also checked out previous and present federal support to three medical institu- tions. February 21-22, 1967 Initial Regional Advisory Council meeting was conducted: Mr. Stephen Ackerman, DRMP was main speaker. 1) Primary objective stressed manpower to improve the quality and availability of care; less concerned about the need for addi- tional facilities and public information problems. May 9, 1967 Program Director visited Division head- quarters regarding Continuing Education interests of the Ohio Valley RNP.' May 20, 1967 OVRNP headquarters were established @ 1718 -y. Alexandria Drive, Lexington, Kentucl% June, 1967 Conference on Continuing Education was conducted with National participation. August, 1967 Regional Advisory Council develops 13 point criteria for future project development (See Section VII). @December, 1967 - Second year planning grant awarded for @320,000. July 12, 1968 - Initial operational grant application reviewed by National Review Committee; site visit recommended. September, 1968 Site visitors expressed hope that Operational status will crystalize plan- nin5- efforts: application contained 6 operational projects. Visitors find: 1) Strong conceptual strategy with focus of program at community hospital level; emphasis being placed on staff'develop- ment at selected'hospitals and strengthening of educational resources of medical centers. 2) Good formulation of functional relation- ships. 3) Active involvement of key people includin- Regional Advisory Council. 4) Strong commitments of support from 2 of the 3 medical schools. November, 1968 National Council recommended approval for operational status totaling @866-000 (DC) and carryover of $50,000 from unexpended funds from 2nd year planning grant to implement a "patient origin study." This program was not carried out by the Cincinnati planning Council during the planning grant. January 1, 1969 Initial operational award granted for $338,781 (DC) to fund Core Staff (Project #1). Anniversary year established Jan. 1, 1969 - December 31, 1969. January 23, 1969 National Council defers supplemental project applications #7, 8, 9, 10 and 11 for a site visit. February 28, 1969 Grant Award (Jan..l, 1969 above) amended to: 1) Fund projects #2, 3, 4 -and 5. These were funded at 75% of Council's recommendation; total amounted to $410,414 (DC). 2) Increase core staff to fund "Patient Origin Study"; total amounted to $50,000 3) Total amount of amended operational award = $799,195 (DC). March, 1969 Site Visit: Drs. Phillip White) Lawrence Meltzer and Frank A. Perry: The site visitors re'ported favorable progress of funded projects; found RAC active and reported OVFI'IP appears to be stimulating involvement throughout the Region; suggested internal review mechanism be strengthened; Recommended: 1) Reduced funding for Project #7, "Auto- mated Mtiltiphasic Screening. 2) More planning needed for Projects #8 and #10 involving Stroke and Coronary Care. 3) Conditional approval for Project #9, "Dosime@' pending Council's special -study. 4) Approval for Project [11, Home Care Dcaioxistration Pro@ani. April, 1969 Regional Advisory Council established new thrust for Program development. (See Grand Designs Section VII). May, 1969 National Council approved $305,000 (DC) for Projects #7' 10, and 11 pending release of FY 1970 funds; Project #8, "Coronary Care Demonstration" was returned for revision; Ptoje-ct #9, "Dosimetry" was deferred until special stipulations 'th Council's could be answered in accord WI policy regarding radiation projects October 1969 Representatives of Grants Management and Program Assistance Branchs were requested to visit Region. Discussed available options to be considered for the Continuation application for the 2nd year of the operational grant. V. CORE STAFF 1) The cent.ral office of tlie Coro Staff is located at 1718 Alexandria Drive, Lexington, Kentucky. Staff personnel include: a). Program Director - William McBeath, M.D. b) As sociate Director Program Development - Mr. Laurel True c) Associate Director Research and Evaluation - Donald Freeborn, Ph.D. @d) Program Development Specialist - Mr.'-Quintin Allen e) Program Development Specialist - Vacant, R.N. f) Administrative Officer - Mr. T. R. Newman g) Research Associate - Mrs. Greers 2) University Coordinators are stationed at each of the University Medical Schools: a) Cincinnati - James- Schieves M.D.. b) Kentucky Frank Lemon, M.D. c) Condiut Moore, M.D.- Louisville Each are employed on-a 1/2 time basis. Each has secretarial assistance. 3) The Core budget for the 01 year includes: a) Personnel - $238,613 b) Consultants - 8,000 c) Equipment - 102078 d) Supplies - 8,100 e) Travel - 31,640 f) Publication - 9,500 g)- other - 32,850 h) "Patient Origin Study" 50,000 Total $398,781 Additionally, Project #3,( onal Medical Television) and Project #6 .(Drug Inforriiation Service) can be described as planning functions of Core staff. A sum of approximately @16,000'has been earmarked for planning in these two areas. Project #10 (Regional Stroke Management Demonstration) will become part of the Core's planning effort effective January 1, 1970. A sum of approximately $20,000 will be appropriated for this purpose. All Core staff participate in surveillance of ongoing projects. BIOGRAPHICAL INFORMATION 1) William McBe'ath, M.D. Program Director a) Born February, 1931 b) B.S., Georgetoiin College, Kentucky, 1953 c) M.D., University of Louisville, 1957 d) Community Health Resident, USPHS assigned to Kentucky State Health Department, 1961-62 e) MPH - Michigan University, Ann Arbor, Michigan 1964 f) Director, Division of Medical Care, Kentucky State Health Department 1962-65 2) Mr. Laurel True, MPH a) Born 1933 b) A.B.,, Georgetox-m College, Kentucky 1955 c) MPH, Michigan University 1963 d) Medical Assistance Program, Kentucky State Health Department 1961-62 e) Assistant Director, Division of Medical Care, Kentucky State Health Department 1963-65 3) Donald Freeborn, Ph.D. a) Born April 26, 1934 b) B.A. Dearee, Lynchburg College, Lynchburg, Virginia 1955 c' c) MH Administration - Medical Colle-e of Virginia 1957 d) Ph.D. - Medical Care Organization, University of Michigan 1964 e) Assistant Director, University of Virginia Hospital 1957-60 Research Associate, United Auto Workers - 1965-66 g) Research Associate, University of Michigan 1967-68 4) Frank R. Lemon, M.D. a) Born October 16, 1917 b) Certificate from La Sierra College, Riverside, California 1945 c) M.D. Loma Linda University School of Medicine 1950 d) MPH -'Tulane 1955 e) Private practice 1951-52 f) Department of Preventive Medicine, Loma Linda University School of Medicine 1963-64 g) Residency, Internal Medicine, Long Beach VA Hospital h) Private practice 1966-68 i), September 1968 - present Associate Dean of Continuing Education, University of Kentucky 5) Conduit Moore, M.D. a) Born - April 29, 1916 b) A.B. - Princeton, 1938 C) M.D - Columbia 1942 d) Residency, St. Luke, New York 1942-43 e) Navy 1943-46 f) Residency Methodist Hospital 1947-49 g) Teaching (Full Professor) University of Louisville 1952-present 6) James Schieves, II.D. a) Born - March 12, 1918 b) DVN - Michigan State College, 1940 c) M.D. - Cincinnati, 1943 d) Professor of Medicine, Ohio State University, 1962-67 e) Assistant Dean, University of Cincinnati College of Medicine VI. ORGANIZATION (see chart - next page)- ML3-onal _Advisory Council: 1) Currently has 36 members: approximately 1/3 are physicians, 1/3 are representatives of various health care interests and 1/3 are lay consumers. 2) The Chairman is Mrs. Rex Blazer, a volunteer civic leader from Ashland, Kentucky. 3) Meeting's are conducted quarterly, last for two days, and are held at various locations within the Region. 4) Functions: Provides policy guidance in planning the content and direction of program development; also, is the final authority on approving project applications. 5) Elects its own Chairman'and Vice Chairman; PVRMP Director (Coordinator) serves as ex-officio member and Secretary. The formula of Council membership was devised by Deans of the three medical schools to provide geographical balance from the three principal areas of the Region and from the schools. Executive Board: 1) Is composed of the elected Chairman and Vice Chairman of the Council along with a designated representative from each of the three medical schools. 2) Functions: Serves as a surveillance body for the staff's administration of grant funds; not involved with review process or planning of the conceptual strategy of the Region. 3) Meets at least twice per year; sets salary scales. 4) Role is minor when compared to RAC Standing Liaison Committees: 1) Serve as -formal auxilliary advisory groups which have been actively involved in pro-ram development. C> 2) To date, Committees have been established on Medical practice (22 members) and Community Hospitals (12 members); others are planned for the future. OVRNP ORGANIZATION C CO'UNCIL Official Grantee-Fiscal Agent Standing Committees: Univ. of Ky. Research Foundationi Community Hospital s XECUTIVE BOARD Medical Practice University Coordinators James Schieves,!M.D. Director Task Force and i Panels Kentucky: Frank Lemon, M.D.@ Louisville: Conduit Moore, M.D. illiam H. McB6ath,, M.D.p M.P."ri. w Associate Director Pro-ram Development Administrative Officer Associate Director Laurel W. True,, B.A., M.P.X.. T. R. Newman, B.A. Research and Evaluation .7 Donald K. Freeborn, M.H.A., Ph.Df Pro-ram Development Specialist Secretary Research Associate Mrs. Mrs. Nancy Milam Ann Cook Operational Officer Secretary i Research Associate Program Development Specialist Wanda Estep ! 'I Janet Ockerman Vacant Editorial Assistant Secretary ',Iacant Mary Norfleet Task Forces: 1) Ad hoc task forces, specifically in the areas of Continuing Education, Library Services and Television provide a broad base of technical assistance to staff in the development of program elements. Panels 1) Composed of medical center representatives, Council members, standing Committee members and others with technical expertise. 2) Serve primarily to review proposed operational program elements on behalf of RAC; make recommendations concerning the technical content of project applications; also serve as special study groups. Review Process of Project Prol2osals, 1) Operational grant applications are reviewed in the following manner: (see graphical illustration on the next page). 2) All proposals are subjected to a "13 point criteria" which were prepared by the RAC. C ES S for REG IO NA L REVIEW of PRO G R AM PROP OS A L S 00000000000000000800000000000000000080000000000000000008000000000000000000aoc!00090000.OOOOOOOCC tanding PROPOSAL 8 0 VP,!V P 8 REFERE.,CE 8 IEGIOPIAL 8 LIA-Tq0t,@ i SPOP-ISORS 8 CORE STA@T 8 PANELS 8ADVISORY COUI"ICIL8 C09,@YITI',5ES i 8 8 8 1 000000000000000008000000000000000000800000000000000000080000000000000000008,000000000000000cio0i 8 8 8 8 80000000000000000000000000000008 8 8 8000000000000000000000000008 8 1. A -proposed idea for a 8 8 @011,4011--i element t 8 8 la. Covncit is sv-rveTied 8 8 to the attention pf staff 8 8 f elim-&nai-I-I conzirie77t. 8 @f. Rr pr 8 8 8 8 00000080000000000000000008000000 0000800000000000000000080000 8 8 8 8 00000000000000000000000000000000000000008 8 8 2. Staff wor?-,s with the r'esour--es 8- 8 8 ,,'nte2--sted in cooperatively sponso2",nq 8 8 8 the r)roar-con eter,,eizt to V ntly 8 8 -8 develop the idea into a fo2-,nal 8 8 pro,-)osat @,A-@-bs,;c-,tce- -j,',ned. 8 8 8 8 8 8 00000000000000000800000000000000000080000 8 8 8 8 8 8 0000; 800000000000000000000000000000000000008 800000000000000000000000- 8 3. Staff presents the proposal to 8 8 3a. Coi,-rfittees receive 8 -@p- ap i n@l @o @r e 8 8 pr4 8 and re Oil-3. 8 8 @ cor.?,,ients 8 8 8 800000000000000000080000000000000000008 00000000080000CO00000OOCOooo. 8 8 8 8 00000000000008 8 8 80000000000000000000 800000000000000000000000000008 8 4.' CoLincit receives proposals 8 8 4a. Staff assists Coz-racit 8 8 and reco?r,,-Penda4tl-@ons 81 4 8 in 8 8 for review crid establishes 8 1 p -ty 8 - deterrT 8- 8 roposat's prio@ 8 i 8 8 8 relative to ali' 8 000080000000000000000008000000 8 8 8 8 0000000800000000000000000080000000 8 8 8 8 0000000000000000000000000000000000008 5. Staff assists sponsors with 8 8 8 d--tail.,ed reparation o, requests 8 8 8 fo r fmL',.i i7q 8 8 8 x- 8 8 8 000000000000060008000oooooooooodooOO8 8 8 8 8 8 8 8 8 8000000000000000000000000000008 -s 8' 8 8 6. Counc-", fo--,i@allz.l act 8 I.- -- 8 8 8 on -.02@OOOSOI as a part 8 8 8 8 8 8 8 8 8 0 0 0 0 06 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 08 0 0 0 0 0 0 8 8 8 8 8 8 000000@coooooooooooooooooocoooooooocooocooooooooooo0000000000000000000000o0000ooooocooooocooc-- VII.Grand Desian Through the leadership and involvement of the Regional Advisory Council, several policy statements have been prepared to enable the OVRIT to estab is direction and emphasis in the development of project applications which will focus on primary priorities. The first of these concentrated on the 13 criteria to be considered for project proposals. They were formally adopted by the Council, published and widely distributed in August, 1967. They included: 1) The proposal is a cooperative effort. More than one type of health care interest (e.g., medical schools, hospitals, physicians, voluntary.health agencies, etc.) will jointly provide support to, influence control of, and derive benefit from the activities proposed. 2) The proposal activates a regional a22roach to health care lems. Resources and needs of multiple geographic communities will be involved and considered. Proposed activities will be functionally related to other elements and levels of the health services system. Potential benefits will eventually accrue to the entire OVIOIP area. 3) The 2rO2Osal is directed toward improved medical care,. Quality personal health services for individuals will be the ultimate .goal and the primary concern of proposed activities. Concern for quantitative and qualitative adequacy will be assured. 4) The proposal emphasizes a concern for the problems of health manpower. The net effect of the proposal will be to advantage the supply, distribution, accessibility, productivity, effectiveness, -,nd efficiency of health sciences personnel. 5) The proposal contains interrelated education, research' and service aspects. Activities emphasizing any one aspect of health endeavor will maximize reasonable opportunities to develop other aspects as strengthening adjuncts. 6) The proposal bears significant relation to the control of heart disease, cancer, stroke, and related conditions. Sponsored activities will offer a reasonable expectation for beneficially affecting the mortality associated with these conditions-. Principles emphasized in the proposal will preferrably have applicability in the management of other health problems also. Activities will not be.so categorically oriented as to compromise more comprehensive approaches to general health care. 7) The proposal presents justification of a need for action. Activities will serve to neutralize needs which are'objectively defined as to nature, extent, severity, urgency, and potential for correction. 8) The proposal defines specific objectives which are subject to subsequent evaluation'. Proposal design and planning will be influenced by evaluation 'consider- ations. Both short--t6n-a and long-range objectives w4.11 be established. Evaluation will include independent assessments of objective attainment. 9) The proposal seems practical. Evidence indicates that the proposed activities will be pursued by capable sponsors, in a manner which is technically sound and economically feasible, and with reasonable potential for success. @10) The proposal represents new or'expanded activity. OM,IP funds will not be utilized as substitutionary or replacement financing for established programs. Recipients of funds in support of expanded activities will satisfactorily demonstrate a maintenance or increase of non-OVRMP support. 11) The proposal 2rojects activities relatively dependent upon some OVRMP support. OVRMP funds will not normally be utilized to finance activities either eligible for funding under new appropriate existing federal programs, or acceptable for financing under established programs of voluntary agencies. 12) The proposal gives due consideration to continuation su2port. Alternative potential means for continuing financial maintenance of successful activities will be identified a.@.d evaluated. Demonstration activities will offer high potential for future adoption under non-OVBM auspices. 13) The proposal is contributory to and supportive of the total pr'@relLq of OVRNP. Sponsors will identify their activities as a cooperating participant in OVP,@IP and its broader purposes. Cooperating participants in OVRMP will accept the responsibility to be mutually supportive. The second policy document related to the development of a combination of interrelated education, patient care and research activities within and among a defined network of cooperating hospitals. It is known as the "Skeleton" program and consists of: 1) CONPRED - Continuing.Krofessional Education 2) PRETECT -Prevention - defection Program CORONET -Coronary Control Network 4) STREHAB -Stroke Rehabilitation Program 5) LIBREXS -Library Extension Service Current funded projects (#2 through #5) deal with the above five program activities. The third (and present policy statement) was endorsed by the Regional Advisory Council in April, 1969. it serves as the current focus (or thrust) of the OVRNP. The initial priority calls for "the developmen t and more effective utilization of health manROV7er for the d @f imeroved ambulatory care". The term "ambulatory care" is defined as "all patient care except institutional in-patient care.11 Within the focal area of priority, six aspects are highlighted for potential consideration. They include paramedical personnel, emergency services, prevention and follow-up, Coordination of Community Resources, Patient Medical Records and Institutional Ambulatory Care Programs such as hospital OPD's and health department clinics. For a complete statement of the present OVIW focus, please refer to appendix A. (page FUNDED OPERATIONAL PROJECTS Note: This narrative deals only with project objectives; progress is not described. Funding levels are denoted in Table 1. CORE-' Objectives: Support is requested for a core staff in Lexington, Kentucky with general administrative planning and coordinating functions. Coordinating staffs at the three medical schools at the University of Kentucky, Cincinnati, and Louisville would also be supported. oups include general university The functions of these gr coordination, as well as personnel contributing to the operational projects. #2 COMUNITY HOSPITAL STAFF DEVELOPilENT Objectives: support is-requested for seven Directors of Continuing Professional Education to serve eight hospitals'committed to OVRMP objectives. The seven DME's serving either full-tii or part-time, represent an effort equal to 5.7 full-time directors. The primary function of the director is to develop and coordinate an organized, hospital-based program of continuing education The outcome of these. educational efforts will be evaluated in terms of their effect upon needs. Serve 16 hospitals. Hospitals involved include Brown County General Hospital, Good Samaritan, Harlan Appalachian Regional Hospital, Hopkins County, Muhle-,iberg Community, Oxqensboro-Davies County, St. Claire Medical Center, and St. Elizabeth Hospital. #3 REGIOI\TAL MEDICAL TELEVISION Objectives: Support is requested for the first steps toward long- range goals established in preliminary planning to develop inter-connections between the three University medical tele- vision functions. Partial support is also projected for the cost of tapes, production materials and distribution. #4 LIBRARY EXTENSIOIN SERVICES Objectives: This project proposes to provide a strong library support function in the eight demonstration hospitals for which educational activities are to be developed in this operational application Project funds are to be utilized at each of the hospitals listed under Project #2 and at each of the participating medical centers at Kentucky, Louisville and Cincinnati Universities. #5 UNIVERSITY CONTINUING EDUCATION RESOURCES objectives: This project proposes to augment the continuing education resources of the three medical centers, described as not staffed, equipped or supported so.as to respond effectively to needs in the life-time learning of health professionals. Also, that the medical center resources must be made more accessible to the cooperating community hospitals by means of staff specifically devoted to mobilizing these resources in response to specific local needs. #6 (DRUG INFORMATION SERVICES) Funded as a feasibility study. #7 "AUTO@TED IIULTIPHASIC SCREENING" - Cincinnati, Ohio approved 'conditionally'(awaiting FY 1970 funds) #8 "60OPERATIVE CORONARY CARE- DELV.ONSTRATION" returned for revision #9 "RADIOTHEP@" - needs documentation per July 3, 1969 (News Information Data), can be sent to December 1969 Council if affirmative answers can be obtained #10 "REGIOil@ STROKE MANAGEMENT DFMOliSTRATION" - funds to be granted for only (from FY 1970 funds) - not yet funded. #11 "RURAL MLTI-COUli'fY HOME CARE DEIIONSTRATION" approved pending releabe of FY 1970 funds not yet funded.