i ;I.! - - "I i aid I 1 ; I @i!@ iiii i , I , ill It I!i ! * no I . . D E P A R T M E N T 0 F H E A L T 11, E D U C A T I O,, N A N D W E L F A R E National Institute6 of Health Division of Regional Medical Programs 711 National Advisory Council on Regional Medical Programs Minutes of Meeting May 27-28, 1968 -National Institutes of Health conference Room 4 Building 31 DEP@.RTM@@',iiT OF I.!E.,kLTH, EDUCATIO14 AND WELFARE PUBLIC IIFALTII SERVICE NATIONAL ADVISORY f-'OUiNCIT, ON REGIOLNIKL MEDICAL PROGRAMS Minutes of Twelfth Meeting May 27-28, 1968 The National Advisory Council on Regional Medical Programs convened for its twell'tci a,t.- 'or;@'),O, Oil, 'May 2,7,, 1968, in Conference Room 4 Building 31, National Institutes,,bfHealth, Bethesda, Maryland. Dr. Robert Q. Marston, of Regional and Mental Health Medical Programs, and Administrator, Health Service Administration, presided. The Council members present were: Dr. Edwin L. Crosby Dr. George E. Moore (5/27 Only) Dr. Michael E. DeBakey Dr. Edmund D. Pellegrino Dr. Bruce VI. Everist Dr. Alfred M. Popma Dr. John R. Ilogness Dr. @lack 1. Shatitioltz (5/27 Only) Dr. James T. Howell Yr. Curtis Treen Dr. Clark H. Millikan The Council member absent was: Dr. Helen G. Edmonds Public Health Seryice members attending some of the sessions included: Dr. K. Kasuga, Bureau of Health Services Mt. J.L. Pendleton, Bureau of Disease Prevention & Environmental Control National Center for Chronic Diseases Dr. E. G. Phoebus, Bureau of Health Manpower Dr. E. P. Offutt, Extramural Programs, OSG Liaison members attending: Dr. Edward W. Dempsey, NlGtIS Coundil Dr. A. Earl Walker, (5/27 Only), NINDB Council 1/ Proceedings of meetings are restricted unless cleared by the Office of the Director, NIH. The restriction relates to all material submitted for discussion at the meetings, the agenda for the meetings, the supplemental material, aild All other official documents. 2/ For the record, it is noted that members absent themselves from the meeting when the Council is discussing applications: (a) from their respective institutions, or Y'b) in which a conflict of interest might occur. This procedure does not, of course, apply to en bloc actions-- Iiscjsqior.. Others attending-: Dr. Lionel Bernstein, Ve-erans Administration Dr. N.G. Lawton, Yale Regional Medical Program Dr. Ian Mitchell., National Cancer Institute Dr. Stani.ey Olson, Vanderbilt University Dr. R.L.Ringler, National Heart Institute Dr. Mathilda Soloway, National Institutes of Neurological Diseases and Blitidrtess Prof. Dean Wilson, University of Michigan DRMP Staff: Mr. Stephan Ackerman, Associate Director for Pl,anning and Evaluation Mr. Edward Friedlander. Associate Director for Communication and Public Information Dr. Louis Gerber, Operations Office Mrs. Eva Handal, Committee Management Officer Mr. Charles Hilsenroth, Executive Officer Mr. Greg Lewis, Chief, Grants Management Branch Dr. Richard Manegold, Associate Director for Program Dejelopment and Research Mr. Maurice Odoroff, Assistant to the Director for Health Data Mrs. Martha Phillips, Chief, Grants Review Branch Dr. Alexander Schmidt, Chief, Continuing Education and Training Branch Dr. Margaret Sloan, Associate Director for Organizational Liaison Dr. Richard Stephenson, Associate Director for Operations Mr. Karl Yordy, Deputy Director, Dl*iP Miss Rhod a Abrams,Oitice'of.,,the-Ass6c@,%to Directbr for Planning & Evaluation Mr. Ira Alpert, Office of the Associate Director for Operations Mr. Robert Anderson, Office of the Associate Director for Operations Miss Sheila Beach, Committee Management Office Mr. James Beattie, Grants Management Branch Dr. Thomas Boderiheiiner, Office of the Associate Director for Operations Mrs.. Marilyn Buell, Grants Review Branch Mr. Cleveland Chambliss, Assistant Associate Director for Operations Mr. Peter Clepper, Grants Review Branch Dr. Veronica Conley, Continuing Education and Training Branch Miss Cecelia Conrath, Continuing Education and Training Branch Mr. Arthur Curry, Grants Management Branch Miss Judith Fleisher, Office of the Associate Director for Communications and Public Information Mrs. Elizabeth Fuller, Office of the Director Mr. S. Gilmer, 001;ice-,of-.tl---i,Asabciate Director for Operations Dr. David Colde, Continuine Education and Training Branch Dr. John Hamilton, Office of the Associate Director for Operations Mr. Arthur Hiatt, Office of the Associate Director for Planning& Evaluation Mr. George Hinkle, Grants Management Branch Dr. C.A. Imboden, Office of the Associate Director for Organizational Liaison Mr. Robert Jones, Grants Review Branch TN@ fn-r and Evaluation -3- l,irs, Lorraine ttlc.., Grants Review Branch ly 6r. J. Mark, Continuing Ed@zcation and Training Branch Dr. H.O. lia'L-lic@,@qsoiL, Continuing Education and Training Branch Miss Majorie Morrill, Continuing Eettication and Training Branch Miss Elsa Nelson, Continuing Education and Training Branch Mr..Harold O'Flah--rty, Office of the Associate Director for Planning ai:,d Evalitatio-n Miss Leah Resnick, Office of the Associate Director for Planning and Evaluation Mrs. Rebecca Sadin,, Continuing Education and Training Branch Mrs. Jesse Salazar, Gratit,3 Review Branch Dr. Jack Schneider, Continuing Education and Training Branch Mrs. Judy Silsbee, Continuing Ed.ucation and Training Branch Miss Jane Shouse, Office of the Associate Director for Planning and Evat@,@iation Mr. Alphonse Strachocki, Office of the Associate Director'for Operations Mr. Lee Teets, Grants Management Branch Mrs. Mary A. Teller, Office of the Associate Director for Planning and Evaluation Miss Charlotte Turner, Continuing Education and Training Branch Mrs. Virginia Waller, Office of the Associate Director for Operations Mr. Stephan Walsh, Office of the Associate Director for Planning and Evaluation Mrs. Anna Windsor, Financial Management Office 1.@, CALL TO ONDER AND OPENING REYi.4,RKS Doctor Marston called the meeting to order at 8:30 a.m. II. A,NL\TOUNCr.,@T-PNTS Doctor Marston made general announcements aboi.Tt the Service Desk, ari.d cal'Le.fl, attc:pllior. f.,o @he statements cn, "Conflict of Interest,," and "Confident.-Li,.-.ity of Meetings." Mr. Curtis Tree-,a, Director, Pension and Insurance Department, United Riibber., Cork, -,-,',Lnole,.im, and Plastic Workers of America was welcomed as a new Council member. Doctor Pellegrino was congratulated on his new title as Vice President for the Health c@ciences,, Director of the Center, State University of New York, effective April 15; and Doctor DeBakey for his new titles as Vice President fdr Med4-.cal Affairs, Chief Executive Officer of Baylor University, and Professor a-,id Chairman, Department of Surgery College of Medicine, Baylor University, effective May 20. III. CONSIDERATION OF FUTURE 'L'IfIrIETING DKTES The Council reaffirmed the.@g-.Icwing dates for future meetings: These meetings will be held in Conference Room 4., Building 31, beginning at 8:30 a.m. -4- IV. CO'@.iSID-@,RATIOII OF l,li-NTJTES O,,.? FEB'IIU,,,RY It)68 COUNCIL @IT,,F@TiliG The Couicil unanimously recommended approval of the Minutes of the February 26-27, 1968, i-r-,eeting as written. V. LEGISL.ATION . . . . . . . . . . . . . . . . . . . . . . Mr. Yordy Since our last (council meeting, the House on Interstate Foreign Cor=erqe Committee considered the Bill extending the authorization of the Regional Medical Programs. The Sub-Conmiittee held Hearinos LI in late March, and was chaired by Mr. Rogers of Florida. The Hearings went smoothly and well. l@lith no significant exception, the testimony was supportive of the Regional Medical Programs' progress to date and strontlyin favor of the extension of the legislative authority. There was some confusion because the Bill not only includes the extension of the Regional Medical Programs, but also the extension of services for Alcoholics and Narcotic Addicts, as well as a program for Migratory Viorkers. Regarding Regional Medical Programs, Mr. Rogers expressed concern about (@) the paucity of hospital involvement in Regional Medical Programs; (2) the relationship between Regional Medical Programs and Comprehensive Health Planning, P.L. 89-749. He indicated that he hoped these two programs P-tight be more effectively dovetailed in their administration at the Federal level. Mr. Springer, the senior Republican on the full CO=ittee@ made a brief appearance during which he recounted the budget history of Regional Medic@,tl Progr@ from the first administration authorization request in 1965 to the current request being made of the Congress on the extension. His point was that the funds requested by the Administration for Regional Medical Programs had been greatly in excess of the real need. His implication, that the funds currently being requested were excessive, was clear. The Sub-Committee will make recommendations to the full Committee which will then report out HR-15758. VI. CO@DENTS FRO14 LIAISON MMP)ERS None of the liaison members had comments to make. VII. COliSIDERATION OF GRANT APPLICATIONS NEW PIL,-NING GRANT APPLICATIOI@S Puerto Rico Re@ional Med s Council concurred with the recommendation of Committee for approva of this application in the time and amount requested. This will round out national planning coverage. There was agreement that the Program Coordinator has outstanding ability and that there exists a tradition be urged to recruit an Associate Director who will devote full-time to @-,P activities. Council members, we-re aware of the unique backdrop that Puerto Rice furnishes for both P.L. 89-239 and P.L. 89-249, and regional planners are aware of this. Indeed, they believe that the two programs must work together 41.n order to mobilize for health services. The iniounts requested are: $194,839, first year, and $194,097, second year, plus appropriate indirect costs. PLAt4NING SUPPI.,@,Y,,Ll@,ITS Mass@ichusetts, @7ew Hanorhire, and Rf-,Viionail Medical PrograE% (Tri-State) In discussing this application, the Council felt that it was lacking precise information as to what was desired and what could be accomplished from this support. Therefore, during the meeting a Council member called the Region for more information. It was learned that all previously awarded funds have been committed, and that utiobligated funds for additional planning activities are not available. Among other things, the request involves a new position of Regional Coordinator for Rhode Island and the acquisition of rental space suitable for the Regional Medical Program staff. The Council, therefore, agreed that these activities were appropriate and deserved support. This supplemental planning grant application was recommended for approval in the time and ariount requested of $87,,824 (si)c months), and $123,717 for an additional year. Indirect costs were not requested. Oregon RoRional Medical Pro ram The Council noted that this is a modest supplemental planning grant request which will enable the Region to analyze data obtained from on-going studies and provide for additional secretarial support. The Council recommends approval for the time and amount requested for $34,408, first year, $16,448, second year, and $17,447, third year. Indirect costs are to be negotiated. Mississippi Rr=2ional 14ed--,'Ical Pr@a@m The Council concurred wit.h the recommendation of the Subcommittee on Earmarked Funds that the application for a rural community hy ertension control pro,-,,ram be deferred for a site visit to p clarify a number of issues. This application is to be returned to the Review Committee and National Advisory Council for final action. 40 be returned to the Revie-d Committee and National Advisory Council for final action. The training program in diagnosis nnd treatment of chromic pulmonary diseases is a well-thouglit-out pi7ol)osal. in a region badly in need of higher quality medical care. The only questions raised about this proposal were whether support should be committed for tiree to five years, and if the budget requested should be reduced. Since the Mississippi Region has already received earmarked funds for one activity and has one other being reviewed concurrent with this request, Council thought that the three might constitute an operational program. Therefore, Council recommended that a site visit be made to ascertain the Region's readiness for an operational award and to resolve the issues mentioned above. ColoradoA@'yominr, Reg onal Medi @L ram The Earmarked Subcommittee agreed that this project for establishing a Pediatric Pulmonary Extension has merit and deserves approval. The Council endorsed this recommendation in the amount and time requested of $74,206. Maine Regional Medi Pro ram The Council agreed with the recommendation of the Review Committee that this is a reasonable supplemental planning grant request for funds to support additional staff and feasibility studies. It was suggested that Division staff investigate the possible overlap of personnel between this application and the operational application also under review at this time. The Council recommends approval for the time and in the amount requested of $163,010 for one year only. Indirect costs were not requested. illinoi,- Pe,!-c-ial Med4'-cal Pro ram The Council concurred with the Earmarked Subcommittee's recommendation of approval in the time and amount requested to establish a hyper- tension screening program. First year funding requested $149,000, plus appropriate indirect costs. Doctor Crosby absented himself. Alabama Regional Medi,ca Pro ram it was pointed out that participation of the Mobile area in a Federally sponsored pro.-ram was a breakthrough and th@ the emergency nature of this request, based on the need to respond quickly to strong local show of interest, was well justified. The Council recommends approval in the time and amount requested of $14,509, -7- Flo The Council concurred with the Earniarked Subcommittee's recommendation establish a hypertension screening project. The of approval to i amount requested is @68,000, plus appropriate indirect costs. Indiana ReRional Medical ra.-@ This application is for funds to supplement the Flanner House Multi- phasic screening program a pilot demonstration of which is being 0 31 conducted as part of the Indiana Regional Medical Programs' planning program. The proposed activities will provi.4e for a special summer health program for the disadvantaged urban population of Indianapolis. The Council discussed the importance of developing proposals that will aid the urban poor, and this application was viewed as an excellent example of such an endeavor. The Council recommends approval for the time and amount requested of $94,269 (one year only), plus appropriate indirect costs. New York Metropolitan Regional M@dical Provram The Council concurred with the @.',a7.-marked Stibcommitteets recommendation of approval in the amount of $90,419. This project will establish a mobile coronary care unit operating out of St. Vincent's Hospital. The Council aMcurred with the Earmarked Subcommitteets recommendation of approval of the Pediatric Pulmonary Disease grant application in the time and amount requested of $206,870, plus appropriate indirect costs. Nor erional Medical Prpf thlan@, The Council felt that this supplemental planning grant application does not show evidence of progress nor any a@.)arent relationship of these projects to one another or to a developing regional concept* Since three of the proposed activities--all except the St. Paul Heart, Cancer, and Stroke project--are of an operational nature, the Council agreed that the three should not be funded at this time. The Coitncil recommends approval in the amount of $55,698 for one year only with the condition thatfunds be granted only for the St. Paul Heart, cancer, and Stroke proposal and after staff determines that this activity interrelated with the planning activities of the Northland Regional Medical Program.. Doctor Millikan absented himself. Ohio State ReRional M-@dt al P@ograil about 50 percent of the funds requested for core planning for the first year, and commitment of the requested amount for the second year; (b) a site visit by a technical team of computer specialists to clarify questions concerning the Coinpul@er-Assisted Instruction Study, with authority to determine t-.he level of funding for the study; (c) funding of the two other feasibility studies for time and amount requested (approx@,ately $791,860 direct costs in the first year). Council i.riferred from this competing renewal planning grant application that the basis for planning the regio@,-tal medical program was established this past year in the Ohio State area. A permanent Coordinator was hired, and a planning process was organized. Plans were made for the identification of information and material to guide the development of operational projects. The amounts requested are: $1,122,528, first year, and $643,930 for the @":.'three additional years, plus appropriate indirect costs. Mr. Treen absented himself. Arizar.;5t Regional Medical Pr am Council recognized that this program is just beginning and that it needs to acquire a larger full-time staff. The amount approved, however, should be commensurate with realistic projections of what can be profitably obligated. It was suggested that the final approved amount car, be determined by staff negotiations and does not require further peer group review at this time. The primary intent is to carry on a broad informational program which, hopefully, will bring about a higher degree of public support. It is difficult to be specific in reviewing the objectives and resources of the Arizona Regional Medical Program in detail. There is no leading center of excellence at the present time; there are very few identifiable qualified persons available who could lend vitally .needed assistance and guidance. The Medical School is a new one and is still in the process of attracting a faculty. Planning activities for the Region are necessarily proceeding slowly and the Region is still in the preplanning phase. Council recommends approval of this supplemental planning grant application subject to downward budgetary revisions to be negotiated between the Region and DRMP staff. The amount requested is $106,813, plus appropriate-indirect costs. The Council concurs with the recommendation of the Subcommittee on Earmarked Funds that the application to establish an adult pulmonary disease center should 'ue deferred until a site visit can be arranged. Central New Yorl< -icuse) Regional The Council concurred with the recommendation of the Review Committee to approve this as Presented. The Council was cognizant that L@." ' '@ I @ '@@5 ".J, @@, -- tj ,L - - I- @ -@; --, @ @ ". ) , @ :..@ , -@L,-j@ L , @@- i-,; @ % -9- the additional professional staff requested in this application was well just'-fied and support,@,d by 1,1@e findings of a recent site visit to this Region. The Council fully discussed the possible substitution of time/effort of other departmental physicians in lieu of the time/effort of the three part-titrt--, Senior Teaching Associates budgeted. It was agreed that this would be appropriate 1,)ro-vified all applicable grantee, and Division policies were adequately met. The amount requested is $138,268, plus appropriate.indirect costs for seven months. NEW OPERkTIO@-i-L Central New York State (SXracuse) Rc--i.@onal Medical Pro@am In considering this revised application, the Council reviewed the findings of the site-visit made in March. The Council noted that this application had been processed through the complete review cycle with presentations to the Revie,.i Committee on two separate occasions. On the basis of the information presented by the Committee and the site visit report, the Council moved approval as presented in the time and amount requested with the first year costs of $39lp952 plus appropriate indirect costs, and restriction of expenditure of @29,255 for a mobile unit in project #2 until authorized by the Division. The amounts requested are: $285,569, first year, $391,3939 second year, and $389,622, third year, plus appropriate indirect costs. California Re5zional Medica The Council addressed itself. to the basic problem of the RESion-- its size and means by which it could be forged into a functioning and cohesvie Regional Medical Program. It appears to be separated into at least six "regions", which raises questions concerning the validity of the central coordinating office. This problem is common to other regions, but clearly needs study and a statement of policy by Council. There is overlap in the projects, with no apparent coordination or screening before submission. There was feeling that the program could be improved with the strengthening of the central administrative committee The amounts requested are: $11,052,294 (01) for five years; and $2,147,645 (01SI) for five years, plus appropriate indirect costs. The Council concurred with the recommendation of the Earmarked Subcommittee of approval for a Pediatric Pulmonary Disease Center in the Irvine area, in the amount and time requested of '$292,936. hypertension proposal in the San Francisco area. The Council &'tiared the site visitorc" di44;ppointment with the progress made in this bu'. thou-,ht that the site visit report represented a thoughtful analysis which trerits Councills acceptance. Following d@,@',.scussi@n of individual projects, the Council recommends conditional approval of $402,779 for the time and amount requested for core administration z,.nd planning staff, CPR training, CCU training and Out-of-ItoE;pital Services; reduction of award for the Stroke Center, Comprehersive Stroke W-Lnage-cc@r:!iit, and Mobile CCU; no funds to be calculated in the award for tumor registry or telemetered ECG. The amounts requested are: $947,718, first year, and $5,169,059, for vine projects with one to five years support. New Mexico R(@p.,iionalL Mme(,4,4,c@ I ProRram In weighing the findings of the site visit, the recommendations of staff and Rc-tviet-i Committee, Council thought the seven projects range from fairly good to @ir'Ly poor. Co-,@.ncil was in unanimous agreement that the approval of a modest operational arant would be in the est means of encouraging the region in the development of a meaningful program. Thus, for the first year of the combined (>perational-planni@g request, Council recow,@-rided $593,549 for support of the seven projects plus an amount for core support at approximately $400,000 (based on findings of technical site visit by management staff). Concern over the long-range operational program remains, particularly theW.,,jo4ordinary relatio.@hip and i-nterdigitation of the N@ with the Sch4ql of Medicine. It is further recomended that prTgress reports at more than the usual intervals be requested and that a second informal., informationeseelcing and hopefully stimul&tqry site visit be scheduled in the falls The @nt requested is: $768ol85 first year. Future support request wtll be furni*hod by the region and will include a separate component f*r core activities. The Coupcil concurs with the recv=ndation of the SubcowAittee p2i Earmarked Funds that the proposal tQ establish a demonstration olinic for pediatric pulmonary disease at the Lovelace Clinic has merit and shqu roved in the amount and time requested of $7188 ,Id also be app Texas ReRio7.ril Medical m Council shared the concerns brought outby Co=4ittee review; the similarity of proposals -.Rith no apparent coordination; the relative roles of the Regional Advisory Group and staff in program development; the relationships of the Coordinator in Austin and the Associate Coordinator in GaINiest@-n and of both to the various planning offices; it is determined thatc?eratioiaal proposals fit into a plan. Also, Council was concerned about whether the ti,7o-year planning effort .1 whether had indicated that Teyas should remain a single region o. alternative courses %,,ere still under consideration. While the application inadequately covered these matters, Council felt that many answers would be readily available to the site visit team. Council also felt that a number of the proposed operational activities would clearly improve cooperative arrangements and result in better patient care, and should be funded as soon as possible, providing, of course, the site visit team found the over-all regional medical program viable. Other operational proposals should undergo further review of the site visit findings by both committee and Council before funds were made available. The Council recommends conditional approval for the time and in an amount to be determined by a site visit team, after exploring the via' bility and feasibility of a single regional medical program for the state of Texas, and to gather further information about how the proposed operational activities relate to the over-all plan and priorities for action. The amounts requested are: $2,513,785 (includes funds requested for Project #5 which was considered by the Council Subcommittee on Earmarked Funds, but not for Project 'v'14 which has already received an earmarked award), first year and $2,328,876 second year, plus appropriate indirect costs. The Council concurs with the recommendation of the Subcommittee on Earmarked Funds that the program for area-wide total respiratory care is a reasonable project and recommends conditional approval for the time and amount requested. The amount-. recommended is $193,066, plus appropriate indirect costs. Doctor DeBakey.absented himself. Maine Regional Medical Program The Council agreed that the application provides an adequate resume of planning activities but is not indicative of strong regional development. It was fell,- that the readiness of the Region for an operational program could be assessed during the site visit. The Council r(-Tomends conditional approval for the time requested subject to favorable findings doming a site visit, but with the stipulation that no Regional Medical Programs' fund be granted or used fcr the Physician Seminar. ($334,989 direct costs for the first year). The amount requested for a five year period is $1,440,630, plus -12- South Carolina Re ional II'P-dical Pr2,5,1-f_@m The consensus of the Courci.1 was t:htt this operational grant application holds merit, ar,,d that a i@tit-iber of the proposed activities ,ire worthy of support. It vi@@ felt that the viability of the South Carolina Regional 14edl-cal Program as well as its capability and resources to i.ii.,,jtigurate an operatiotiel program of significant proportion could best be assessed thi@ough the site visit mechanism. Council recommends conditional approval at a reduced level of funding subject to a Cou-ncil site visit. The amount requested for a five year period is: $5,7,64,380 plus appropriate indirect costs* Georgia Reaional MediS. o ram It was pointed out that the application shows the efforts of enthusiastic leadership with well-coordi.nated proposals and good understanding of the purposes of Regional Medical Programs, Regional viability seems well assured. Several projects need further clarification by the site visit team. The Council recommends conditional approval upon completion of a site visit with limited project funding recommendations to be determined by the site visitors; and with the provision that Project No. 12, Stroke Instruction Clinic, not be supported at this time. The amount requested for a five year period is $8@638pO4O, plus appropriate indirect costs. The Subcommittee on Earmarked Funds agreed that the project for establishing a pulmonary pediatric diagnostic center has merit, but it shows a lack of information concerning the methodology involved. The Council concurs with the recommendation of the Subcommittee that approval should be based upon satisfactory findings 'of a site visit team. The Council Subcommittee on Earmarked Funds recommended approval of this project for a Stroke Instruction Clinic pending a forth- coming site visit. The Council, however, after a lengthy discussion recommended disapproval of this project because it reflects obsolescent treatment met-.hods and lacks any signs of significant progress or capacity for productive expansion. @M his Regional Medic . Pro ram Council members felt that the application reflects local discussions of local needs but that it does not show much imagination or substance. The projects are not related together into a total program. It was undertaken soon and tha;'-- the activation of some operational projects may be an appropriate means of stimulating more intensive regional planning and cooperation. The Region is a poor one outside the city o4 Meraphis end is l,ackiTig iii r,,c(ltcal resources. There is evidence of grm4irtg @l-nterest in regio'Lial programs on the part of in communities in the medical societies and other I,,roups Regi,on. The Council reco@.n-,nds conditi(iAnal approval, based on site visit team recommendations as to project funding levels, with report of final action tv be Liub,@iittee to the Review Committee, The amount requested for a five year period is $4,615,901, plus appropriate indirect costs. The Council Subcommittee on Earmarked 'FiLitide ree nded approval in the amount of $95,482 of a project for establishment of a Stroke Intensive Care Unit, Ilie Council concurred with the reco=endation that it should be reviewed by site visitors in connection with the review of the current Vemphis operational grant application. it appeared to Council that this large, disjointed application invo ves a heavy commitment to administrative and planning staffs. On the other hand, regional development has made progress since the submission of the application and regional readiness for moving into more advanced plannin- and operational statue may be greater than what the application indicates, Co=ents on specific projects need clarification by the site visit team. The Council recommends approval of planning activities in the time and amount requested, and Onditional approval of operatioti4l projects subject to satisfactory completion of a site visit with recommended funding or other action at the discretion of the site visitors,, The amount r6quosted far a three year period is $5,644$51lr plus .appropriate indirect costs. Doctor Howell absented himself. Cl ram CQ uncil felt that the application was 4 remarkably lucid document that rcay well become a model for a comprehensive program Plan* However, it cc@,2zukred with the Review CCui@miLteie, that a site visit for further information, was essential betore adequate consideration of the major policy questions could ta@ place, In general, Co=cil was favorably disposed toward CQnnecticut."s broad approach to planning, but co,.icerned that funds were requested from P,L. 89v239 authority for all the operational activities Which the lanninZ had yielded, C@ril wa,; impreseed At the apparent involvement of ttie ma.Ifit health cfr@) instttt;tions and agencies And The amounts requested aret $3,252,208, first year and $17,985,385 for four additt(mal years. plus appropriate indirect costs* OPF,RATIO"I.@l-, S'(JIPLF@ME,:IITS ioinal liedi s Tc,nnessi@,i--@ Itid Otith R@1-0-,P-l li--, it was pointed out that although there has been a great range of planning activities in the there has been a lack of Medical Society participation and that efforts to overcome this gap are implicit in the additional staffing requested in this application. The need for a large, well-qualified staff is also obvious from the size of the Region, the scope of activities now underway, and the task of further development to meet stated objectives. The Council recommends approval for the seven months requested in the amount of $382,279, plus appropriate indirect costs. Doctor Olson absented himself. Washington-Alaska Rep,,ional Medical Proprani app oval as requested to expand current The Council reco-,nmenus r planning activities through the establishment of (a) a subregional office in Spokane during the current grant period and to continue through the next -03 year without additional funds; and (b) a pilot continuing education program in guest residents during the current grant period without additional funds, and to continue through the next -03 year with additional funding in the amount of $8;500. The Council concurred with the Earmarked Subcommittee's recommendation of approval for one year requested in the amount of $64,470, plus appropriate indirect costs of the project for Pediatric Pulmonary Disease. Doctor Hogness absented himself. Oregon Regional Medical Pr@r,-@2,i The Council agreed with the Review Committeets favorable analysis of the content of this operational supplemental application, and, likewise, felt that some problems should be resolved before the application is funded. Speci.'Lically mentioned were the uncertainties in the resdotch designs for project #2, Early Diagnosis and Therapy of Cerebrovascular Discase, and project 1,@5, Project Evaluation and Education of Statewide Program. There was also concern about the administrative details in the coronary care unit training projects, #6 and #7. Since Council felt that these problems could easily be corrected,, it recommended that Division staff negotiate budget items with the Region and with assistance of the NINDB in advising the Region on the design of project #2. questions about research desi&,ns and administrative detai'Ls in specific projects. The.amounts requested are: $443,060, first year, $387,988, second year, and $397,287, third year. indirect costs are to be negotiated. N a Re@ioiia@L Medical PL ram Council agreei with thc,@ Revie,,q Co,@iii,,--tee"o@recormendation that Project l@10. 12, "Tlie Regional Corc)-;.iary Care Unit," in this supplemental operational application should be returned for revision with a better, more detailed justification of the educational and training programs this unit will serve. It was also agreed that Project No. 15, the, "Co-@npr(-,he,.tsive Stroke Program," is an ambitious project but is still essentially in the planning stages. Involvement of a wide variety of regio-,ial institutions and individuals seems to be more developed here than in most other regions. The Council recommends approval in the time and amount requested of @222,831, plus appropriate indirect costs for Project Nos. 13, 14, 15, and return for revision of Project No. 12 (Regional Coronary Care Unit for Physician and Nurse Education). The Council concurs with the Earmarked Subcommittee's recommendation of approval in the aTt-ount of $49,411 to establish a ConLmunity Hypertension Screening Program in North Carolina. Rochester The Council recommended that the program periods for all four of the components of this application be made for three years each rather than the five years requested. It was felt that the multiphasic screening activity (project #7) could provide a vehicle @'r -gith@r.irig.,_§5tt4,pn healt.h,.-man@o-,ier utilization,. The Council concurs with the Review Comitt;ee's recommendation of approval in the amount requested for a three year program period, with the first year direct costs in the amount of $411, 284p plis appropriate indirect costs Kansas I nal Medical Program It was the consensus of the Council that the funds requested for the renewal of the core planning activates and program administration were reasonable and well justified. The opinion was expressed that the amounts budgeted over the next five years would permit the continued orderly growth and development of the Kansas Region within the functional framework already established The Council recommends conditional approval of this supplemental operational grant application as submitted to reflect the following actions: which is $855,856 plus appropriate indirect costs); -16- (b) Deferral of the multiple hospital stroke program (project #1,3) ior a site visit and return for review, and; (c) Approval of ttie four new continuing education activities (#I.4-17) in the total amount of $27,446 with indirect costs i,ihere applicable. The amounts requested are: $1,311,638@ first year, and $5,959,451 for an additional five years, plus appropriate indirect costs. The Council concurs with the Earmarked Subcomitteels recommendation for approval for the two years requested with a first year budget in the amount of $203.956i plus appropriate indirect costs for a hypertension program in Kansas. The Council concurred with the recommendation of the Subcommittee on Earmarked Funds for deferral of the stroke Application pending a site visit. Missouri Re ional Medi Projzram Council rec4ni-mends approval in the time and amount requested on this supplemental- operational application in concert with three other supplemental requests from the Missouri RMP (-02SI, -02S2, and -02S3). Council concurrred in the site visit team and Review Cor,mitteels recommendations for approval of both projects #28@ Cooperative Tumor Registry and Computation Service and -i-29, Northeast Missouri Cooperative Stroke Pilot Project in the time and amounts requested. The amounts requested arO: $155,072, first year, $82,651, second year, and $82,651, third yeari plus appropriate indirect costs. PART A--Council concurred with both the site visit team and Review Cormitteels recommendations to provide full support for Project #25, the Stroke Intensive Care Unit.i. and Project #26, for Training Unit for Intensive Care of the Cardiac Patient@ both based at the University of Missouri Medical Center; and support for three years only at 50% the requested level for Project #27t Programmed Comprehensive Cardiovascular Care, based at the Kansas City General Hospital. The project budgets will have to be renegotiated, particularly that for Project #27, as part of the over-all supplemental award encompass-.tna Council action on the four separate applications from the Missouri Regional Medical Program. Council recommends conditional approval for three years, at the first year level of $632,546, (approximately $822,998 in total costs) '.?par level of $1,586,017, plti s appropriate -17- indirect costs. The level of finding for the second year would be $469,674, and for the third year at $483,797, plus appropriate indirect costs. PART B--Council concurred with the Review committee's recommendations relating to full two year support for Project #32, the "Detail Man" approach, and at 50% level for Project #33, Continuing Education for 'L-he Health Prof-,P-ssion (a feasibility study for one year). Council disagreed -,,,itli the Cormnittee's recomendations regarding Project IF34, Community Services for Heart Disease, Cancert and Stroke Patients and recommended that it be funded for the one year period requested. The project budgetparticularly the budget for Project 1133p will have to be renegotiated as part of the over-all supplemental award encompassing Council action on the four separate applications from the Missouri Regional Medical Program. Council recommends conditional approval for two years at a first year level of $161,087, and $21,603 for the second year for Project #32 only, plus appropriate indirect costs. PART C--Th's application has not been reviewed previously by the Review Cc=4-ttee but represents the amount over the committed level of the Regions continuation application for support of planning and the original 16 projects (operational program). coun.cil felt that the material prepared by the Directors of the ongoing projects indicated a clear need for the additional funds and recommended approval of this request. At the s@Tm time, Council asked staff to convey their concern about the quality of the written presentations received from the Missouri Regional Medical Program and their expectations that future Presentations will be much more improved. Furthermore, Council asked that in the future *the M4Lsqouri Pegional Medical Program include specific information aboTit future funding planned for these activities beyond the requested period. Council recommends approval in the time and amount requested of $806,183, plus appropriate indirect costs. IiiteriTiot.inta-',-n P-epio-Li 1 Me;.Iical Ilro7,ram Council expressed so-.qe of the same concerns previously identified by Committee about regional geographic expansion. The region has, however, exhibited &ood progress in all areas, and the program seems to be successful and movina ahead. The Council recommends conditional approval with a site visit to assess the current status of the regional development and of the its in T,, r o,i. e c t s i i -@q d c., ncluding project #17 (Cornnary Care Un Council regarding the expansion of core staff and enlarging of five of the ongoing projects were approved, with elevation of authority d - to the site visitors to determine the appropriateness of the increases a-ad the amounts. Theanotint@s requested are: $29,092 (02Al); and $515,371, first year, $2@0,822, second year, and $173,313, third year (02SI), plus appropriate indirect costs. Wisconsin Regional Y,.edical Program The Council expressed confidence in the onocological resources which would be available to this activity, and the competent professional staff that would be responsible for its direction. It was generally felt that the proposal has worthwhile objectives and is worthy of support, but at a decreased level of funding. Specific questions were raised in regard to funds budgeted for personnel including the need for two senior project coordinators., two fellows, and the nine full or part-time secretaries; further, the amounts requested for consultants and travel were considered somewhat high.. It was concluded t@iat a reduced negotiated annual budget containing $40,000 for personnel and fifty percent of the consultant and travel funds, plus other expenses as budgeted, should permit the implementation of this activity. Council recommends conditional approval. in the time requested but in the reduced annual amount of $60,050 plus appropriate indirect costs. The amounts requested are: $128,485 (for 14 months so as to align the requested budget periods with the parent grant); $100,500 second year, and $106,800 third year., plus appropr ate indirect costs. * Application for Earmarked Funds VIII. REPOPT O-.1 APPLICATIONS WHICH WERE CONSIDER D AT THE' FEBRUARY n-Ob@-CIL IEETING APPRO'V-ED APPLICATTO,NT Ntrf4P@ER REGION 3G02 RYi 00002-OISI Kansas 3G02 RY, 00015-OIS2 Intermountain 3G02 RM 00013-02S2 Western New York 3G02 RY, 00031-0251 & 02 Metropolitan Washington$ D.Co 3G02 P,,M 00044-02Sl Maryland 3G02 RM 00045-02Sl West.Virginia 3G02 PJ4 00046-@02SI Georgia ..DISAPPROVED 3G02 rM 00028-02Sl Alabama DEFERRAL 3G02 RM 00009-OIS3 Missouri ix. F@,,@@Ttj"L)E!7f I ',P@T.,TH ORGt,.NIZ,&TION COIN'TRACTS Dr. Manegold Since March, the, Division has been exploring the possibility of supporting the Student Health Organization projects as a means of involving Ri@iP more fully in the proble@ms of Urban Health care, There have been a number of difficulties in individual regions developing act4.ve programs in the inner city aiLd. recognizing the urgency oi-' the problem and the direction given by the Council and others, we have begun negotiation of contracts with the University of Colorado, the University of Southern California, the Presbyterian- St. Lukess in Chicago, the West Philadelphia, and @iontefiore Hospital in New York, Each contractor will sponsor the summer project with thu assistance of the Student Health Organization, The contract mechanism is most appropriate for this purpose. The objectives of the Division for supporting these projects are to investigate the most appropriate method for obtaining different types of health data in the urban areas and to investigate the use of these methods in collecting information to assist the various regions in planning health care programs to disadvantaged urban areas. The work scope for the projects is as follows: The contractor will: (a) develop the most appropriate methods for obtai,rz-'@-.ig certain types of data on health problems in urban areas; and (b') irves'-..Lgate the use of these metL@ods in collecting data egional that v,@,@ild assist the various regions and the Division of R Iliedical@ Programs in planning health care programs in disadvantaged urban areas. These data would assist the definition of; (1) new types of cooperative arrangements between professional and community organizations and individuals; (2) urban community organization problems pertinent to RMP programs; (3) present adequacy of health services in the community as perceived by the residents; (4) health attitudes, and the response to health education; including the influence on both of social and cultural factors; (5) new types of health careers and roles, and the effect of health manpower recruitment efforts in disadvantaged urban areas; (6) health status of tie urban community in terms of heart disease, Cancer, stroke, and.any other diseases of major significance. The contractor will col'.ect,, analyze, and interpret data concerning these six areas of inqu-Lry. The contractor will work closely with the Division and its consultants in order to enhance comparability of data collected in the various cities. The contrac or will evaluate -20- The Student Health Progr@-m in each co-iTr@iunity will be able hopefully to obtain information and @17ill have immediate and continuing influence on RI-IP activities. The Student Health Organization has already established the necessary relationships with the disadvantaged urban communities. They have recruited a substantial number of workers for these sutrmp-r projects and have sought the advice of social scientists in their areas to effectively use the tools of the behavioral scientists. We recently had a meeting with outside consultants to discuss this matter. As a vesult,, we proposed to have an orientation pro-ram for 0 the students prior to instituting the contracts. These contracts probably will be funded by the middle of June. (B),. REPORT ON,,_ "EAUIARYr-,D FLTHTDS" A progress report was presented on all of the requests for, earmarked funds. The action on each individual applications is "Consideration of Grant Applications." 3.ncluded under Item VII, X. POLLU@,,T-UP REPORT 011. "CO',,-.-T-RACT FO,7, IIEART STUDY--- PROGRP-SS REPOiTf ON OF SECTION 907 Dr. Sloan All of the work has been completed for a contract with the American Heart Association to carry out a three year study of the criteria necessary for medical facilities providing the highest quality of diagnosis and treatment in the field of heart disease. We were very pleased with the response of all interested professional organizations vfnich met here on April 17, and believe that their cooperation will be assured by the AIIA in a committee organization which they will develop. The AHA was very pleased to secure a commitment from Dr. Irving Wright to serve as Chairman of this Committee. Award will be made as soon as FY 169 funds are available. The American College of Surgeons' effort to develop criteria for medical facilities in the field of cancer is moving along steedf.,4y, but will require more tire than originally anticipated. They have applied for an extension of their contract through March, 1969. Xi. PROGRESS REPOI@T Olq "DET,"LOaYNT OF TIIF, HEALTH POLICY RESEARCH CONT'@RACTU@'.kL 1,RCGRA-i%ll'. Mr. Ackerman' At the last NAtional Advisory Council meeting some interest was expressed as to the nature of the Health Polidy Research Contract which is presnntly being developed by the Division. For the purposes of clarifying the Councills understanding as to the nature and purposes of the contract and to keep the members informed as to the present status of the contractual program, summary information concerning the background of the development of the contract was sent in advance to the C@,-..tncil. As noted in tie Material transmitted, (). 17 @ @u . 11 - .-@ U @. 'il ' @ 1-1 L j@ @ j@ @ -_, u y0 -21- eral study areas The specifications were dl.vic,t@.@d into five gen which the Division Committee felt were of primary importance s development. This delineation to the program all- this stage of it of topics, hoxqever, was made with the I,,@tiowledge that there would be overlapping aspects of these areas, and that each area of study was of relatively equal importance. For these reasons$' It-was decided that one contractor s,ioiild undertake the entire package. The'Divisioii's -'ontracts Committee believes that the specifications represent those areas of the program in which there exists a present need for an in-depth, out-side examination. Since its inception, Regional Medical Programs has been characterized by a marked divergence in the development of the fifty-four regional programs. In addition, the National picture has been further complicated by the recent transition from the planning to the operational stage. During the recent legislative hearings before the House Interstate and Foreign Commerce Committee the @Lk urged that there be an evaluation of the P.L. 89-239 program by an objective nongovernmental source. in addition, Congress has been making a standard one percent reservation of funds in all IIEW authorizations to support an evaluation program on the Hb@l level. Therefore, an effort to develop some approaches to evaluation of the l@IP program from an over-all natural standpoint seems indicated. The Committee also felt tlia4@- the securing of an outside resource ,will complement the staff in carrying out its present functions, while at the same time making available to the Division an experienced multi-disciplinary source which could provide the program with a continuity of consultation for many years to come. For the foregoing reasons, therefore, the Division proposes to enter into contractual negotiations with Arthur D. Little, Inc.-Osti to undertake this two-year health policy research contract, .RESOLUTION TO DOCTOR MARSTON FR THE COUNCIL The Council made the follixqng resolution to Doctor Marston: "In recognition of your outstanding achievement in establishing and developing the Division of Regional Medical Programs of the National. Institutes of Ilealth and of your many contributions to the improvement of the health standards of--the American people, we, the undersigned members of the national Advisory C6uncil on Regional Medical Programs) wish to express our deep appreciation and high esteem for the wise and devoted leadership and vision you have provided during the formative years of this Program and for the personal unselfishness, good humor, and friendship we have all enjoyed." Dr. Ed-viin L. Crosby 14illikan Dr. Michael E. DeBakey Dr. @eorge E. Moore Dr. Helen G. Ednonds Dr, EdTriund D. Pellegrino Dr. James T. Howell Mr. Curtis Treen -22- XII. AD,JOLR@,ENT The meeting was adjourned on May 28, 1968, at 1:15 p.m. I hereby certify that, to the best of my knowledge, the foregoing minutes and attachment are accurate and complete. Robert Q. I-.arston, D. Acting Director, Division of Regional Medical PrograTis Eva M. Handal Committee Management Officer, DRMP NATIOi@,@L ADVISOPY COUNCII. ON RE%-710.NkL IEDIChiL PROGRADIS Edwin L. Crosby, M.D. (71) Clark 11. Milligan, M.D. (68) Director Coristiltant in Neurology Amer l.can Hospital Asf-,oc.@iall-ion Mayo Clinic Chicago, Illinois 6063,1 Rochester, Minnesota 55902 Michael E. DeBakey, M.D. (68) George E. Moore, M.D.,, Ph.D. (68) Vice President for Medical Director, Public Health Research Affairs of Baylor University New York State Department of Health Professor and Chairman RosNqr@1.1 Park Memorial Institute Department of Surgery 666 Elm Street College of Medicine Buffalo, New York 14203 Houston, Texas 77025 Edmund D. Pellegrino, M.D. (70) Helen G. Edmonds, Ph.D. (71) Vice President for the Health Dean., 'Graduate School Sciences North Carolina College Director of the Center Durham, North Carolina 27707 State University of New York Stony Brook, New York 11790 MAILING ADDRESS Alfred M. Popma, M.D. (70) P.O. Box 432 Regional Director tDurhan, North Carolina 27707 Regional Medical Program 525 West Jefferson Street Bruce W. Everist, M.D. (71) Boise, Idaho 83702 Chief of Pediatrics Green Clinic Mack I. Shanholtz, M.D. (70) 709 South Vienna Street State Health Commissioner Ruston, Louisiana 71270 State Department of Health Richmond, Virginia 23219 John R. Hogness, M.D. (70) Dean, School of Medicine Mr. Curtis Treen (71) University of Washington Director Seattle, WAshin&ton 98105 Pension and Instirance Department Ur'Xted Rubber, Cork, Linoleums James T. Howell, M.D. (68) and Plastic Workers of America Executive Director 87 S. Hi Street Henry Ford Hospital Akron, Ohio 44308 Detroit, Michigan 48202 James A. Shannon, M.D. (Chairman) Direc-@or National Institutes of Health Bethesda, Maryland 20014 June 1968 DrXP/CYO