'HEALTH I 0 N EDUCAT D.EPARTMENT OF AND WELFARE h Administration Health Services and I-lental Healt ional @1--didal Progr'ams Division of Reg 6 Council on National Advis. ry 1 Programs Re gio@ Medica minutes'of Meeting ..Decerriber 16-17$ 1969 National Institutes of Health Conference Room 4. Building 31 DE, p AR -)JCATIOi'4, AND WEI.FP.RE PLTBLIC -ILT'Fii SERV-RCE -so@,,y Coun@ -lal Medical Programs 1 on qegiot National Adv-L 21 Minutes of the EiF;iteenth Meeting Decerrber lo -17, 1-969 line National Advisory Council on Regio,-Ial- Yiedical Programs L ned for its eighteenth meeting at 8:80 aim., Tuesday, conve u DeceTrber 16.1' 1969, in Conference Room 4, Building 31, National Institutes of Ilealth island. Dr. Stanley W. Olson, Director, Regional l@ledica-I -Flags Service presided for the Administrator, Health Services and P4bnta-I Health Administration, who was unable to attend the meting. 'Ihe Council members present, ,,ere: Dr. Michael J. Brennan Dr. Clark H. Millikan Dr. Bland W. Cannon Dr. Ednmd D. Pellegrino Dr. Edwin L. Crosby (12/16 or.1y) Dr. Alfred M. Popma Dr. Michael E. DeBakey Dr. Russell B. Roth Dr. Bruce W. Everist Dr. @lack I. Shanholtz R. Wyckoff Dr. John R. Ho@ess ,,,,'16 only) Yirs. Florence A listing of RMP staff' mmbers and others attending is appended. I. CALL TO OPD-@ AND OPENTING PEti:@M.S Doctor Olson called the rwe@L.@o, to order at 8:30 a.m. II. ANNOIR@ICEMENTS It was noted that Doctor HoTess vias meting with the Council for the last tim prior to his resignation to accept an appointment to a Committee advisory,,.@',,,@ the Director of the National Institutes of Health. 1/ Proceedings of metings are restricted unless cleared by the Office of the Administrator, HSrvM. The restriction relates to all material submitted for discussion at the meetings, the supplemnbal material, and all other official documnts, including the agenda. 21 For the record., it is noted that mmbers absent themselves from the wBeting when the Council is discussing applications: (a) from their, respective institutions, or (b) in which a conflict of interest mipht t -V, Page2 -,I9ATION OF FUTURE ',MIHG DATES CONSIDE. 8 31-f@.pril The dates of !4arch 1, 1970 and Decertber -9, 1970 were was changed to July 28-29, 1970. confined. Tne July 14-15 date nE@ Au-usT 1969 DEETING -TV. coNTSIDE,9ATION OF 3 OF he August 26-27, cil unanilriously reco@nded approval of t The Colin 1969, r.,.ee@uing as written. V. E,=TISION OF LEGISLATIO,@@' -- Proposed and In Planniniz Doctor Chadwick called the attention of the Council to the two legislative proposals for extension of Regional Medical Progr@ that have been introduced into the House of Representatives. These are House Bill 14284 introduced by Congressn-an Harley 0. Staggers (D. West Virginia) and 'Liouse Bill 14486 introduced by Congressman Paul G. Rogers (D. Florida). He reviewed briefly the contents of each,-particularly-as tney mdify the current legislation. He also repor ed his understanding that Senator Ralph Yarborough (D. Texas) is preparing still another proposal to be introduced into the Senate so@time later in the session. Counc@l 1 was reminded of the fo @l recommendation, which it rode at the t@ of the August meeting, that the scope of the authority of Title IX be expanded to include Kidney Disease explicitly and that the expanded authority be administered under the Regional Medical Pro@ Service. Doctor Chadviiek reported that this recommendation was forwarded promptly for consideration by the Acb@stration in its oivn plans for developmnt of legislative proposals. He said that he had had several indications that such a plan ATas included in the legislative proposal being prepared by Senator Yarborough. VI. REGIO@IAL i%EDIC.AL PROGR i@@ -TN FY 1970 AND BEYOND SO@E MMA,@AL ASSI A. Projections of Available Resources 197Q and 1971 Doctor Olson reviewed for the Council the current status of the Appropriation legislation for FY 1970.. The proposal currently under consideration in the Senate had been forwarded by the House of '@ Representatives with a substantial cut having been applied to the Administration's original budget proposal. The net effect of the legislative process to date would allow $73.5 million for Regional Medical Program grants. p@ io Pe 3 nst this figure it is necessary d Doctor Olson exol-a,"'e that a-Sai continuation of on- -renien'. for to P-C)ject a$69.1 rlil-lion @ui @@e Of sliOltly ns, I-eavino, a goinu actil.r@l.ties jyj the 55 Rei@io operational- PrOgr@'ns in the over @4 ii-Lil,ii-ol,i to b@- used to fund _ng 'ran ts. Tn-- Division Regions which still have only Plai@ im-ately $6.5 million will estimates that a tot,@ Of aPPrOx jonal l@dviso@y Council during Fy 1970 for be approved by en of the rerpaining the initiation of operational gran-s in t f costs eleven Regions - 'Ibis alloi,is no margin for inflation b onal 'undirip, of any ).en-.p-nta-I activities in operati or foi- re,;i -L p Regions. ly stated position by voting 'Ihe Council reconfi-culed its previous intention to on's stated unanimusly in SU',OPort of Doctor Ols of for FY 1970 and 1971-the funding adopt, as first priority operp r:,5 Regions as they are approved for such ,tional gr,@s to all Council. There was considerable ional Adiiisory fund!-rZ by the 1,4at r reallocation of grant discussion of a variety of proposals fO s funding possible. dollars in order to @e tlii ssential a@emnt that reallocation could have a There was e riorities can be agreed upon for favorable effect only if P Doctor Pellegrino suggested the administration of the proo Each d accomplishing these ends follo,;ring five steps to-t@lar est should be examined carefully to dete@e new initial requ not it iqill :Lqprove cooperative elnents'in the whether or tention should be given to the progress Region. (2) Careful at Is and their component projects when r,ledical Pr-09ran of Regional @ chase of major they.are reviewed for re@-iia-1. (3) Requests for pur hard,,,rare should be closely examined, elindhating all but those which are absolutely essential and for which no other source of le. (4) AtteTle,(.-.it should be made to increase, funding is availab whenever possible, the concentration of program effort On the zorical disease. (5) Care should be taken specifically related cate-. as models and to avoid to identify project activates which can serve n individual unnecessary duplication of these rhodels awng thi Regions. B. Anniversar- -view -- 'A to Look at Pro Asvects of W th Based upon the foregoing discussion of budget l@tations$ bo in the Current year and as projected, Doctor Olson posed several c questions regarding the continued development of Regional Vledi al programs.throughout the nation as organizational entities. (1) What al Programs be? kind of organizations should the 55 Regional Medic. institute? (2) Vqmt kind of program should they plan for and vi few years, it is apparent that project developmnt5 re el"j, and ent the total, nor even the dorrdr-ant i@ip-noni-,ntion cannot repr,es I --.- PaEe 4 Ins su,,,L-ested an alterai,@. concept of Re@,ional @lpadical Prot7a 'or this con,e-ot to the need -'L as change agents. relat@ operational and organ!-.2-.ati.on flexibility in each of the Regions her tl,)@a the stability which l@egions have sought a,,-id continue i,at to seek in operating a project grant program. @re is agree,-rei-it on the part of all members that the Council must continue to accept responsibility for setting broad Neteional priori-ties for the pro&rrani. 'they recognize the growing impox+,a-nce of the dovelopm@ent of an arrangement by iihich they can -assess the progress of individual Reg-Lons in jitple!yl-enting these priorities .1 - and in actually af r@ the patterns of delivery of care i @-I the areas they serve. Mrs. Phillips reviewed the Division's proposal for a system of Anniversary Review" which has been studied and refined by an ad hoc SubcomTittee of representatives of both the Review Committee @d@ounci-1 and has also been discussed by the Review Committee. 'Ihere was general agreement with Doctor l@lillikan's assessment of su-.miparized as being the Anr-iversary Review proposal which he generally meritorious but requiring extre,@ care in its implemen- tation T-ie pointed especially to its potential for regarding Regional achievement, but to 'the possibility, on the other hand., of its serving to.:'.-.:@,alize Regions whose slower start resulted from the timing o, Lliaeir initial operational application There was alleement th-@IQ the implementation of a system of Anniversary Review will emphasize the need for the Council to have a set of well defined priorities against which they may evaluate Regional Medical s both now and over time. Doctor Brennan warned against "cannonizing a system of distribution of resources which came about by chance." Mr. Paul Vlard, who represented the Coordinator's Steering Committee at the Council meeting, pointed out the advantages and-disadvantages of such a system to the chief administrative officers of Regional @,edical Programs, noting especially their vulnerability to local pressures for, allt.-..'@--,tion of "flexible rmnies.1' Doctor DeBakey recommended caution in the development of restrictive guidelines which could stifle the whole concept of regionalization, which he said was visualized in the original legislation as the mechanism of carrying out the purposes o.L tne program. It is his. opinion that the Council should concentrate on the development of standards by means of-which regions' progress towards the programs objectives could measured, rather than on attempting to change These., he ' ded the group, were the basic program -ctives. remm established by law. Final Council aeti.ni-i on the anniversary n--o-)osal 4ias pos'u-ooneci Pa,e 5 f Driorities (Item C below) the Council Fol-ludirig the discussion 0- LI -n !,-,,.ousiv endorsed Doctor Ca-nnon's ori@inal rmtion returned to a.'I Lin@-- p@@-@r , in crinc'Lple, tl,e anniversary review concept, with for ap at to vlo@ with selected regions a suggestion to staff th urle-N, begin along these tjon of' their prozrai-ns in the ad--,.il-iistr-,'U,-,Ve or z@iL. for -r.tla,-r sr pulation that.the :Lines, and with tl) .e ty @erriaa fo@r sections of rsary 'y "P e restuC e@vie@,,ild'ocill,@nt i. ctured in line with the findings of the special subcc-7,@ilittee of Council on priorities. C. ies - -iia vriii Affected Nati th- ing general agreement zed the necessity of reach The Council recogni v,,ould about ,he nature of trie pro@ a-rid its objectives before it be -Dossible to consider a rP-%,i pro,@ Mchanism such as @versary Review. There eras also, however, a considerable difference of opinion as to what kind of a program Regional Medical Programs is,, and is beco,@. ent legislation and Doctor DeBakey recalled the temis of the Pres slative history which urged the program's -olaceffent within the legi- in surfypary its @or purpose was carrying forward the NIH; since the work of NIH. it is his opinion that the -shift of the program into liSYM was for ease of organization and manaO.e@nt and not to change its goals or directions. ressed general agreemnt with this position., Doctor Ho@-less em t si . he has been increasingly statino, t@t with-in the las -x mnths of mainta@- IW Is unique impressed with the importance capability to carry on activities of this kind; especially as the efforts of other agencies are teing directed to the development of to @et reqt.Lirements for health care broad scale probes service of special pop,-,,,-ation groups. Doctor DeBakey and Doctor Hogness both e@asized the increasing importance of Regional -4edical PrograTns concentr@-ILlig its limited funding resources on i;h- @rOven@p-nt of the It OF care. They ei-u@ed the eyamPle ,Df the tremendous do l@ invesrnp-nt in .v of care to 14edicare @dnich has admittedly itripro,,red the deliver. one clearly defined group of individuals (those over 65) but has completely litipped the balance in the system" at the expense of medical research training and education. While agreeing with the S, they strongly need for the development of pro@am guideline recommend that Council attempt to keep them suf ficiently flexible clinical ar S -ng from research and. their @leiw,,n@aL; 4- 'onrrir)nql 14edical Programs has Pa,,,- l,ea,ltl) care. 1,Riether this has been as a result of' "the farsightedne s of th,@ framers of the-le,- station or by serendipity, (D i@ u " he believes that too priority most be P,-iveii to rrL-aiiitai-niricr and further encouraging these cooperq,'@live arra-nc- -!ents and co,@@7.-pi-niccLtions a,-id that only secondary er,.-nhasis placed on the delivery of care the developwnt or acquisition of hardAare, or, concentration on aiiy specific disease entities. Doctor Bretu,@i expressed another approach to the matter of pro@am priorities. He viewed the most successful Regions as being those which have developed -6-ff----tive core s@,,--Lff and operational mechanisms which are bringing about change whether or not the changes are those "autti r@ized" in the law. He' suggests that- two kinds of "technology" Trust be e loyed: (1) the translation of "new advances in health care" into "improved resai-rces for health care; 11 and (2) the use of those resources to bring about actual improvenr-nt in care. He used as an example the control of cervical cancer in a certain geographic area. He stated that by the application of new advances vie know their" to contro-IL the disease, but that we'still do not know exactly what a-re the costs and e-@rfects of various approaches to the use ol@ this knowledge. It is his opinion that the development of this second "teleology" is an important RMP fwiction. At the opening of the afternoon session of the meeting Doctor Olson briefly reviewed the foregoing discussion. In response to Doctor PelleUino's Motion, the Council recommended that there be created a subco,@ttee on priorities which would include one or two members of the Revievi Cor@ttee and at least one representative of the Regional Medical Programs Coordinators I Steering Co@ttee. it was further agreed that there should be close working liaison between this subcondttee and the one previously convened to consider the matter of Anniversary Review. As a possible point of departure for the deliberations of this group, Doctor Everist offered a series of four priorities wnich he follows in considering Regional Medical Programs: (1) Tne qualitv of the core pro;-Tam - the personal qualification @f the s -Laff rco-=nfoers; ity of developing and handling information between and among the core staff, the cooperating agencies in the Region, and the national level; (2) the effectiveness of the core program - which he believes can be judged ahnost SC effectiveness, and permanence of the cooperative arrargem--,nts which are developed and developing; (3) the accessibility of the co're program - its responsiveness to needs for ervices a onalization of services by means of HT proj ect mnies and otherwise; and (4) the capacity of the core proaw -to be judged by the. continuing enlargement of the syst m o@ both care ard informtion in the Region. In view of the iiTo@uance of the establishment of some priority Pi.ildel-i-ne--, ?.s th@- troves in F-7 '171. -)nJ. iir!71,-4near or e-xtenlei Page c-!,y ofa on the neces ecislative authority, the Co'dnc jew the.mcc-@,.endatio@ O,, LI-,@? entire COLLncil to rev sp,-c,,ial iiieeti -L g.was tentatively set for Monday, of the sdbco.,Tr@-,ittee. Such a nieet-Ln @4arch 2, 19'70. 'P -@Ns Vii. c C D 1 ST' -ie eV ents leadir Doctor Olson revievied for the Council tl _E to the anu,E;@-t-on of t- Division of Chronic Disease with the I -L .,e - Division of Pegional I.Ir-dical Pio@a.Tns to forni the Regio@,)@l Medical piogranBService, an-d the. subsequent discontinu.-@@nce of five of the categorical progl,-@is which had been part ol@ the nic Disease Division. Chro Doctor.DeBakey asked that the Council consider seriously'the effect of the phase-out of these prop.-ams flas a further diminution of the @d total of all Fede-@l funds available to fiF;,it the categorical diseases (.-Lncluding research, training, edacation, clinical studies., service demnstrations, etc.)." There was a reneral expression of concern and the Council requested that the staf f prepare an analysis of activities of these pi@@arm and the Ad-ministration's plans for their co.@uii-iuation. i@ey also requested that @-ther discussion of this issue, based on their better understanding of the progra-ms and thei@ potential, be p.laced on the agenda of the next meting of the National Advisory Council. Brief progress notes from each of the three remaining pro,7am Branches (Clearinghouse for Nutrition and Health, Clearinghouse for Smoking and Health, and the Kidney Disease Control Program) were presented. Doctor Olson reported briefly on the @,--qite House Conference on Food, Nutrition, and Health and some of the activities beino,, planned by the Nutrition and Health p--ogram for carrying out so@- of the recoiTmenda:tions of the Conference. mertioned specially the work on a series of contracts for co ty nutrition demonstration projects to ascertain whether the capacity for dealing with malnutrition can be substantially increased by using a pr@y health care meci-@sm as an out- reach to the conuunity. Close ties will be sought with local Regional Medical Prograrns to coordinate these efforts. R,,4P PARTICIPATION D4 I'L"qD4G C(Y4PRIaIFNSIVE HEALTH ST2'-.,@CE PROGIW,,!S The staff reported increasing numbers of inquiries concerning the appropriate role of individual Regional l@ledical Pro@am staffs, and utilization of RMP grant dollars, in comprehensive co.@,-Lnl-tv health. !7@-Y,.,-,-ce T)rograns. After somp- discussion of Severzi-,L p --@ c " '@' @ !' I- i@ii u -@- -,@ I , i tl@ -1 . -@; @. i i, I,-' 6 ,L,:@- .to delegate to the Dii@ctor, Regional Medical Programs Service, Pa,,e sts, which ra-ively aop-@'Ove reque the authority to aclm-lnls+- Region-al Advisorv Group approval, Por reallocation of bear s (rersonnel and/or dollars) ,a;,n resource onal Vedi@ pro@ 'Re@i -ining of co3-,,@- hensive health service for par'Llicipa4 ion in pi"@ Such approval. May pro@ for comLu"ities within the -,eoion. yold one elyc, for continuation be not include or, imply cc)T,"! year of plan-ang nor involvement in the provision or financing of the s--rv'Lces. V,Ijj. OF APPL,IC@LIONS A. Issues requiring clarification and interpretation of policy guidelines itation Training 1. diopul-monarj 1.1e,3usc,-@a7,,-o,, -L@@@ cussion L-or 01 son of his dis After hearing'a report from Doc+, of this matter with Dr. Campbell i@loses, Medical Director, American Heart Association, the Council was reassured rt of projects ition in regard to 7,T.,!P SUPPO that its pOs of this kind was entirely in keeoing with the position of therefore voted the American Heart Associat.ion. Council cy guideli usly to restate as a fo@ P01i -ne, unanim the position it had adopted at the time of the August meeting in regard to a group of pending projects: fundi@c, for Regional Medical Program grant projects in cardiovascular resuscitation training is to be limited to training activities which are directed principally to mdical and allied health personnel who are employed in hospitals and in other in-Patient facilities, or in out- patient or emergency facilities operated by or directly related to institutions in which follow-up care is inmdiateiv available. 2. Kidnby Disease -hree Regional Medical Programs Applications from t tropolitan (viisconsin, Crew York Metropolitan and Me Washi@on,.D. O@.) propose exoensive projects in-various aspects of end--staae care of chronic renal disease. In discussing these particular proposals, Council reconsidered the policy guideline that it adopted in May 1969 . It was agreed that the policy remains perfectly appropriate.but it is becoming increasingly difficult to apply in the case of the very complicated and complex project applications Page 9 ed by these three and about eight of the kii-d represe,' Inore of i-i@aich, CO',Illc-Ll l;as informed by staff, are currently in the r,-vlew process. Council discussed a,@ the futility of atterPting to rently projected provide, under the present and cur g,4P bud@et, programs like these in all 55 of the Regions. They were also reminded of the fact that it is possible that icidney disease may be targeted for special consideration in extension of Regional Medical Program legislation next year. After consideratio@n of a number of options the Council recomended that action on the three specific proposals be deferred at this t@. They also requested continued study of the ffatter by staf f and the preparation of proposed draft guidelines for Councills consider8Lti-on at a later meting. 3. Categorical Relevance In this round of review the.Review Conmittee was unable to co@ to a final reco, a@ndatibn on a. iT@er of projects the subjects of which they felt were of questionable relevance to the purposes of Regional Medical Pro@. These were grouped under four headings and included the trai '@o' for and Implementation of Home Health Aide programs (Wes-uerr,, Pemsylvania R4P and New York Metropolitan RT), training and demns@urations of perinatal mnitoring (California RMP and Indiana RMP), training for and implementation of a nutrition pro@ for rural poverty. groups (Ohio State R',!P), and production c-f a set of audio-visual aids principally for in-service training of mdical students and house staff (Florida Me). In considering the matter of the "relevance" of component activities of any Regional imedical Program, the Council generally agreed with Doctor Millikan's statement that rather than being a matter of its direct relationship to one of the disease entities mentioned in Title IX., a project should be reviewed according to five basic considerations: (1) is it a valid scientific experiment; (2) is it a mdel for educational experience; (3) is It something other than a direct patient service; (4) will it open co cations channels for improved local and Regional arrangemnts that will help to reach the long range goal of the Regional Medical Program; and (5) is it something that should be replicated in this or another Region? These questions were Page 10 Genetic kl"oi,insel@@ k Regional D@dical Program) 'See DiscussiGn of liesteni New Ybr B. Reco@mneiadatioris for Action The Council av@eed to record their reconarendations in the Slightly altered fonnat which was proposed by the staff and alre v adopted by the technical panels and the Review Conprittee Appendix I) ALABA,@IA REGIO!@@L.,j, P4MICAL PROG@M 12/69.1 Operational Suoolemnt Approval with the specific conditions as dete iew Committee. 01 $242 238 02 $136,035 @7- i AMNS.8,S IE, GIO'-'IAL l@ICAL PROGRAM 12/69.1 - Operational @u-oplement - Approval with specific @u by the Review Co@ttee. conditions as cier@@@--,@ ol - $6o,621 02 - $42,102 03 - $44,ol6 CALIR,ORNIA REGIONAL @-TEDICAL PROGRAM 12/69.1 - Operational SuDiDlement'- Approval with specific conditions s follows. Project #41 Non-approval II = The revised application to answer, as far as possible, the questions raised by the site visit team and the Review Committee and to be studied by a special technical panel. Project #44-_7 Approval with the conditions specified by the Review Condttee. (Continued) 1/ All amounts axe direct costs only and unless otheTwise specified refer to 12-mnth periods. The designation etc. relates to the first, second, etc., budget periods cf:-t;r ie-subject application, not necessarily.the budget periods that, will @ctually be supp-Leriiented. Page 11 pl-ioGF9@l (Continued) CALIP9@ REGION.AL @-,)IC ecified h the conditions sP al wit Project #46 Approv by the Review Co@ttee. Project #47 the conditions specified by Project #48 Approval with Co,@ttee. the Review 1,,Ion-approval I. Project #Llg Project #50 -.Approval I Project #51- Nlon-apprOval I(the inappropriateness of this project for Regional Medical Prograni funding was based on the-Councills is of this kind opinion that training f the hospitals the legitimate concern o of and clinical pathologists as a part g activities. their regular in service trainin -i the conditions specified by Project #52 -Approval witi the Review Co @ ttee, and to be studied by the special technical Panel- Project #53 -Non-approval II. 01 $569,776 02 $526,065 03-$520,310 c @ICAL PROGRAM operational Supplemnt Approval 12/69.1,,12/69.2. 12/69.3 with specific C( cified th the conditions spe Project #15 Approval wi ew Condttee. by the-Revi with Project #16 Approval II = Council concurs tee and further the Review Condt recoamnds that the "coordination" ed functions proposed here t@ carri out within the existing core staff @,iiork Project #17 @-Approval I with the conditions specified by the Review Coffdttee. Project #i8 -Approval with the conditions specified tee in the amounts by the Review Co@t staff. considered appropriate by the 01 $117.,505 02 $127,714 03 $24,944 " - - ing renewal.of core SUT)TK- - 12/69.1 @e.-atioral SupPleMent (Includ )noi@t) Page 12, FLORIDA i-EGIO--,,IAL 1, @E, D-TCAL PROGRAM (Continued) Approval with soecific conditions as follows: Core Approval I for one year as specified by the Ileview CornTiittee. Project #28 - Approval I. 1 Project #29 - llon--.approva porject #30 @ion-appr'oval II Project #31 I\Ton-approval I (the inappropriateness of this project for RNT funding is based nn the Council's opinion that this project is designed principally for the education of medical students and house staff and has,no plan for reach or for the encouragement regional out of cooperative arrangements). Project #32 Non-aPilDroval II ol - $43,370 02 $725,180 03 $45,100 NOIIE: The Council further concurred with the Review Committee te visit which is specially designed in recomrr,--rding a si to assist the Region in assessi@- its entire Program and -in balancing the activities in the three areas of the Region. HAWAII PSGIONAL MEDICAL PROGRAM 12/69.1 - operational Supplement - Approval (of the core-pupplement only) wife detailed by the Review Co@ttee. Projects 12 through 16 Non-approval II Council'further recommended that no additional funds beyond this presently approved core supple@nt be approved for this region until a site visit has been nade and there is some further delineation of a plairboth for Hawaii and for the extension of programs into Gaar,-i and the Trust Territories. The site visit is also charged ip..th specific investigation of projects #15 and #16 alona- the lines re@-6rrmended by the Review Co@ttee. ol - $87,387 02 - $90)295 INDIANA REGIOI%IAL @IEDICAL PROGRAM s (Continued) Parre 13 -itinued INDDliA RT,.-GIO',NIAL I,--HDICAL PROG13M (Coi Core Staff Supplement - Approval @-oj ect #1.5 - Approval, in principle, contingent upon the findings of a technical panel regarding this iDaru-icular 'tori@- in application of pei@ixiatal rro.@ clinical practice; and upon the sub,@sion of better evidence of the relationship to regionalization in of the project IRie. ol -$265,445 02 - $2935iO5l 03 - $113,o48 Il\=@IOUNTAIII RV-GIOI\TAL 14EDIC-kL PROGRAM 12/69.1 - Operational Rene,@l - Approval with specific conditions as detailed by the site visit team and with the advice and guidance on the individual projects as detailed by the Revie-vi Cormttee. Council further recommends that the Region be advised to undertake an orderly phase-out of the projects v7hich are predominantly "R&D" and be discouraged from further development of ''automated gadgetry" aspects of the other projects. 01 $2.,.o643229 02 $2,145,656 03 $2,199,208 04 - $123,756 0- - $82,5o4 12/69.2 - Project #25 - Approval vTith specific conditions, for t e years, to be determined by staff but not in excess of the amunts requested. ol $165,170 02 $161,868 03 $174,130 NOTE: This p@oject v,,as not am ng those held for further consideration of the kidney disease issue (see VIII, A, 2 of the--Minutes) because it had been revised to comply with the existing policy guidelines and built intothe cooperative arrangemnts fram-v7ork which is the basis of DM. Also, it represents an opportunity for IRMP to contribute to the operation of a complete and extre@ly high quality chronic renal disease service. Page 14 LOUISTW.IA RErjoil aDICAL PROG@ nt Disa-ol)roval 12/69.1 C)perational SuT)T)lellle ttee in their The Council concurred with the Review Conmi assessn--nt of this Proposal. The Region's requested withdrawal was received after the application had been distributed to the Council meTibers. The Council agreed with the panels and the c-eted Review Co-,iiiittee that the current proposal is elaborately b,@d. but weal,, and ill-defined and would require major revision before it could be considered for funding. The Council considered the Region's plan to withdraw the application as an opportunity for developing a revised proposal to be submitted for a cor@nlete ch a site visit would probably be an app,-oprip@ review cycle, of whi part. YZTHIS RBGIOiqAL YIEDICAL PROGRAYI 12 /69.1 Operational SuDDlement Approval with specific conditions as aeralieu by the Review Condttee. 01 - $20,600, 02 $23,972 03 - $27,657 (See also "Special Actions" at the end of this Section). YMIROPOLITP14 WASHINGTON, D. C. REGIONAL YMICAL PROGRPd4 12/69.1 - CqDerational Supplement - Approval with specific conditi,- as To'llows: -Project 27 - Nc)n-approval II. Project 28 - Approval with the contingencies specified by the Review Co @ ttee. Project 29 - Approval with the specified conditions described by the Review Committee. Project 30 - Non-approval II. Project 31 - Deferral for further consideration (see Section VIII, A, 2 of the Minutes). 01 $168,369 02 - $54,471 03 - $55,860 12169.2 Operational Sui)plement - Council concurred with the reco@nclarion iew Comnittee for non-approval. Project 32 Non-approval J. -15 Pacle -0 SulDy)le-i,,ent Appi val 12./69.1 C)Derationa with the innortance of the questions raised The Council agreed by the.Revieil CoDnittee all of which had also been identified of review of this project at the local level. in the process Ansviers to these questions, prepared in response to the DUIT k, ess ard subini' ed to the Division too late for review proc L't consideration by the Review Condttee, were found to be adequate by the Cour@i,l-... m-iey therefore recomend approval of @u-ids project. 01 $743400 02 $773139 MISSISSIPPI @OIOiqAL 14EDICAL PROGRAM 12/69.1 - Operati nal Project Renewal Approval vT!th the spei io Condttee. 01 - $149,75 4 02 $1313094 03 $141,623 (15 D4onths) -rfLISSOURI REGIONAL D@'u@ PROGRAM 12/69.1, 12/69.2) 12/69.3 - Approval with specific conditions. @-National Advisor-j Council concurred with the reco.@-nda tion of the site visitors and the Review Committee that the extension of the components of the Missouri Regional Medical Program be app-roved, as requested, for three months ending Ju-ne 30., 1970.'.. ($995,152). Project #46 Approval v.-ith the specific conditions recommended by the Review Cormttee. Project- !qon-approval II, according to the ceco@ndations of the site visitors. 01 $155,995 02 $160,237 03 $173,094 YOTJTWADI STATIES FEGIO@4P@F M)ICAL P@RAM Operat, ement - Approval with specific conditims.-@ai view Committee. 01. $84,235 02 $1,09,071 03 $110,209 Page 16 IM4 @SEY PR@OG-RA,'%l 12/69.1 - Cro-er tonal Sar)-o -, -..nt Approval ,,iith the conditions detailed Sy the -Review Cor'@i--ittee. ol $6o.,45r.) 02 $:')I-3 463 03 $63,156 ,10,1 YOFV, MFMOPO-TITAN FC-G!'D'IAL MEI)IC@T PRC)GW34 12 69.1 Operational pD'-e.,,,@nt Approval with specific conditions. Project #10 D---.:'e-rral for a site visit4 If the visitors are persuaded that the project is (1) feasible and (2) relevant to the I\Te-... York Metropolitan Reo-ional Medical Pro@ (see Section VIII, A, 3 of the 'Dlin,,ites) the proposal should be revised accordingly and resubmitted. val I with the advice provided by Project #11 Appro the Review Co @ ttee. Project #12 Approval I viith the advice provided by the Review Co @ ttee. Project #13 Deferral for a site visit and possible revision (see Section VIIII, A, 2 of the Minutes). ol $1443,446 02 - $147,823 03 $156,501 NORI'ff CAROLIN-A, RI-7GIONAL IIEDIC.AL PROGRA24 12169.1 - Operational SulD-olement - Approval with specific conditions. @ject #24 Approval II. Council believes that this can be done through the core staff without additional funds being assigned to a specific project. Project #25 Approval I. ol $43.,443 02 - $44 $45,309 374 03 NO S REGIOMAL MEDICAT, PROGRAM Project #2S Appro,.,al I. Pmiect #12 Ar)Droval I vilth the advice provided by Page 17 val I with the specific conditions Proj ect 13 Appro the Review Corm-dttee. detailed by upon the submission ect 14 Approval I contingent of evidence satisfactory by tile proposer th the to staff that they a@ working wi the American Academy of Opthamlogy, and P24A Council on Education towards the developmnt- of their curriculum and training standards. 01 $248,670 02 - $219,512 03 $142,953 NOMRFh-,STER,,,' 01110 REGIOI,.IAL @ICAL PROGRAM 12,/69.1 Coerational Supplement Return for Revision. The Council concurred with the Review Conm'ttee in each of its recomend@-ti-ons. OHIO STATQ, RFj"TIOIiAL I[IMICAL PROGRAM 12/69.1 - C.-cerational ement- - Approval with specific conditions. Project 15 Approval I with the contingencies detailed by the Review Cormiittee. Project 16 Non-approval II with the advice of the Review Committee. Pmj ect 17 Non-approval I. 01 $79,400 02 $67,500 03 $79,100 04 -.$591200 PUERTO RICO REGIONAL PIMICAL PROGRP24 12/69.1 - Initial Operational- - Approval with specific conditions. 'Ihe Council concurred vrith the Review Condtteo in its reco@,. nd@,,ions that this Region be awarded operational status, and in their recommendations regarding each of the individual application components. The Council also requested that staff mke very certain that the disapproval of Project #8 does not serve to discourage the development of stroke activities in the Puerto Rico Regional Medical Program. 01 $1,134,087 02 $1,190.,760 03 $ 1,200,064 Page 18 FOK@IFE, S@tR FE, CTIOIQAL I,=ICA: '-'TM 12/69.1 -Operational Renewa-1. (Core Cc),,monent) ALn,2o%,al with specific conditions. The Council concurred with the Review Con@i-nittee in approving this application for one year only in the amount requested. 01 $373,573 SUSQTJFHA'-ND,!A VALLEY T@' IO@D- --i--L'CAL PROGRA-IL 12/69.1 - -it Approval with specific @erational Suppleme conditions (project #6R only). The Council concurred with all of the reconTnendations of the 'ttee, both in re@ to the individual projects Review Conm and to the Region as a whole. They further specified that the staff arrange for a site visit to this Region for purposes ng the Region in better organization and delineation of assisti of its plans and organizational arrangements and in the revision of Project #16. Council Was unable to detemine precisely which of the tr.",.@. @.,--Ig components of this project were supportable and --,--re not. They were also interested whic, in further information on the capability of the hospital to provide training of all these kinds and in this depth. Project #6R - Approval I. Projects 10 through 16 - Non-approval II. 01 $26,978 02 $29,425 03 $31,551 TRI-@iAr-PE REGIONAL @ICAL PROGRAM 12169.1 - 92eratibnp-l (Core Staff and Planning Activities) - Approval. 'Ihe Council concurs with the recoirrnendations of the Review Condttee and suggests that staff convey to the Region the need for greater detail and wre specificity in future applications both ih presenting progres-@.to date and plans for the future. 01 - $1,348,732 12/69.2 - Operational Approval 4ith specific conditions as follows: (Continued) Page 19 (Cobtimied) IOTIAL M-M-TOAL PRO,@IU'-,"'4 TRI-,@TATE dv!ce specifically Approval with the a Project #8 set forth by the Review Co-ju-nittee. $14,3'15 03 $14,375 ol - $14,575 02 CAL PROGPATA v-IRGINT-A @IO'IAL 14M, - specific conditions. /69.1 - D itial Op ionil - Approval with te visitors in the recomnendatioll Of the Si urred The Council conc this Region be awarded operat@ ttee that and the Review Co@ rather Specific differences' tatus. There were however soM s individual components two bodies regardir@@ f inion between the e OTrnends as follows: 0 OP Tne Council r c and the total to be awarded. oval I with the specific conditions Appr Project #1 - Conmttee. recoi@ nded by the Review merded by the site Project #2 Approval,I as reco , . ion treat the visitors with the cOndlt f the apprised 0 project director be the Cardiovascular questions raised by consultation seek the necessary 1 and Pane the answers- to find specific conditions I with the Project #3 -Approval recormiended by the. Review Com-nittee. recomended by the site Project #4 -Approval I as visitors, contingent upon the necessary .certification of the extended care facilit involved. y al II as recomended by both Project #5 NOn-aPProv the Review co@ttee and site visitors- nded by both Non-approval II as recome project #6 Review Co@ttee and site visitors. the conditions specified Project #7 Approval I ith the by the Review Comdttee. 02 $330,776 03 $337,375 oi - $345,695 KA REGI WASI nditiorlS. ional Renewal Approval with specific Co 12/69.1 OPe the Review CoMittee in its con@i)r-rfr!d i-Ti tv U.L thz s l@e@il @t to ontinued) (c Page 20 conditions specified in each case. 01 $l,li94,586 02 $1,555,984 03'- $1,605,248 12169.2,- Operational supplement Approval with specific conditions.. The Council concurred with the Review ComELittee in regard to each of' its recommendations on each of the four supplemental projects. 01 - $100,611 02 $46,700 03 $48,570 I-IESTMN iNTEd YORK REGIOINAL MEDICAL PROGRA14 69.! - Operational Supplen,,ent - Approval with specific.conditions. 121 The Council concurred vTith the recommendations of the Reviea Co@t'u-ee on each of the three component requests. 01 $276,522 $84 02 - $81 644 03 788 04 $54,954 05 $57.i859 12/69.2 Operational Supplenient Disapproval. After a great deal of consideration and review of the special information obtained by.the staff at the request of the Council at its last meeting, the Council decided that this project proposes the demonstra'tion of a technique which has not yet been developed to the extent that it is of primry @ortance in patient care and one v;hich is not sufficiently relevant to the problem of the categorical diseases. In recognition of the continuing basic research and clinical investigation on this technique the Council @ agreed to reconsider, two years from now, its applicability to direct patient care. WESTMI PENNSYLVANIA REGIONAL 14MICAL PROGRAM 12/69.1 - Operational Supplerent - Non-approval I. The Council considered this ao lication very carefully in the @p light of the Review Comittee's request for policy guidance on projects of this general. nature. Although they agreed that e circumstances the trainin(r and demonstration under appropriat of home health aide activities could be very relevant to Regional Yiedical Programs (see Sedtion VIII, A, 3 of the radical Program nationally. 'fhey therefore recommnded that other funds be so@t for the pursuit of. this pro-.raTr, plan. p6,ge 21 AL ACTIONS SPECT Council were presented by special ac-ions by the requests for Four thp, staff. IC the activities R al of the continuation of The Council reco'@ymemds approv circumstances presented by the j ect i,' Li . under the ion to sL'bl@t a revised initiated under PrD to allow the Reg tee and t staff, for a sufficient time project support for Review CO,@ proposal for full operational Council consideration. DEDICAL PROG@ RBGIONAJ, /SOT@ DAYOTA . KA16UJ-ull of the oval, without additional funds., s appr ect #4 as presented ouncil reco@-Vend - it t,of proj The c asoe, nt of the mobile un reinstateme and explained by the staff. C) VATTEY REGIOIMT.. OHIO VRI@, oposal to -principle, a pr d, in cil approve this region. The 969 the COun n February 1 dnc, activity in tiphasic screer hat the project., mul of evidence t subm-ssl n establish a c ingent li@n -0 of the budget 1 was o@nt approVa id be accomplished within the as conceived, cou recommended. ii is fnat the revised proposal is acceptable., The consensus of COunO ly by staff for assu-,,@e although .the project is to be watched close that th provisions are being made for patient follow-up .e.necessary sued for support of the continuity of and that plans are being pur -- this grant. this ' ject beyond the two year limit Of pro firmed. of aPPrOv commendeion al is reaf .The re WISCONSIN on of -oroject #15 and of the entire issue of After further considerate - projects. related to control of, Regional Medical 'Prop?am support of es) the Council disease (see Section VIII, A, 2 of the Minut chronic renal on this application. again deferred final action I A Page 22 X ADJOURNIMFNT ourned at 12:30 P.rP. on December 17, 19'9- Tne meeting Has. adj the best I hereby certify that, to dge, the for going min@ues of uW knowle e e accurate and co@lete. ar Director Service onal @ledical Pro@ Regi s and Text of the staterwnt -vlhich additional materials ed at the. meting Here distribut are available in the Office of the Council Secretary. 23 Pacre l@ING CIE SoRy COUN CE f@Ti Tff, NATIO,'IAL ADV-I ATTENDAN 16-17, 1969 Dece STAFF pj@, iDIliG Dep@uy Director, D@'IP Chadwick,, iona3. Liaison Dr. Donald R - V_ Br . office of Organizat anch Mr. Cleveland @l'ss, i@aing on & Tr@- Conley, COnt Educati Dr. Veronica & Stroke control Program cations L)r Sarn Fox., Chief, Heart Disease Fdward Friedlander) Assistant Director for Cb@ Mr. ic Information and Pabl @grams Assistance Branch ant Sam Gilmr, - Manage Mr. ant Director for es Hilsenroth, Assist r4r. Charl- PS,3istance Branch S, Chief, PrO@ s Review Mr. Pobert Jone @fice of Grant ne Kyttle, 0 Branch Mrs. L<)rrai ManaVmnt ve wis, Chief. Grants ctor for FdT operations & De 'OP@nt Mr. Gregory s;ociate Dire Analysis Branch egold Systems Richard & Dr plannin.. & Evaluation Mark3l Chie Dr. Frank and Contract Policy Roland Peterson3 for Grant for Nutrition and Health PhilliPs to the Director c fliloslav Rechci -ive officer@ cut Mr. Donald Riedes,-l,E Grants Review Rissell, office of Mr. Richard istant Director for Grants Review isbee, Ass zational Liaison imrs. Judy Si ociate Director for Organi ) Ass anch Dr. Margaret Sloan Assistance Br sky., Pro@ Mr. Frank Zizlav @RS ATMODIG Veterans A@stratiOn Dr. L. G. Christianson Inc. op, A. D. Little, J. H. Dunl A Dr Dr. Frederick Featherstone, HSMWO 'Rosenberger, NCI Mr. Charles ton, IICHS&FD Mr. John Pendle -,ton, NEM Dr. R. A. Walkin veverka, CHS Dr. Euv-ene Dr. WilliaTn J -Zukel, NHI Page 2LI RECORDIIR, Ol-, RECO-I,;I@!EiZ)ATIONS F-ro,,n the Panels to the Review Co.@.Littee (On Projects Only) 'Pechnically so,@ and capably directed Feasible under specified conditions Unappr'ovable on technical grotLyns Fro,-n the Review Co@ttee to the I\Tatio@l Advisory Council (on Projects) -Approval I Additional funds reconnended roVal II No additional funds recomended App Non-approval I - Inappropriate for D@ fending Non-approval II - Revision required No action taken - Need additional information Need site visit Need Council decision (on Entire Applications) Approval Approval with specific conditions Deferral Return for Revision D.isapproval - Inappropriate for DTT funding FmTn the National AdvisorY Council to the Administrator (on Entire Applications) Approval Approval with specific conditions (as recommended by the Feview Comdttee or others) Deferral n for Revison Retur Disapproval Inappropriate for DRMP funding IonkL IO? Clark M.D. (72) T Il@N Michael J., 14.D. (72) consultant in Neurology BRF,@,TNA14, ancer Foundation llayo Clinic 'an C President, ',iLich o@ et sota 55902 Rochester, i'@"iylne 4811 jc,Lln R Stre 48201 Detroit, Michigan D.) M.D. (70) Edmand f igedicine dent for the Health Sciences Vice Presi professor 0 er Center Wayne state Uni@r sity and Director of the New York state University Of CAM-ION, Bland, W-, M.D. (73) Stony Brook, New York 11790 glo Madison Avenue 38103 M.D. (70), Merrphis, Tennessee pop,,viA, Alfred M Regional Director osurgery Medical PrO@ Division of Neur Regional of Temessne College on Street University 525 I'lest Jeffers dicine Boise.% Idaho 83702 of Me in 1.1D (71) 11 B., M.D. (73) ROTH, Russe CROSBY, Edw Director 240 West 41st Street ion ania 165o8 can Hosuital Associat Erie, PennsYlv -Amri icago, I 11 nois 60611 of the House of Vice Speake M.D. (72) lie Arnerican Medical 14ichael E Deleaates Of t DEBAKFY, President and Chief Executive officer Association of Medicine Baylor College Texas 77025 z TIIack I M. D. (7 0) Houston, SHPalHOLT ssioner state Health CO@ prof ssor and Chairman State Department of Health e Department of surgery Richmond) Virginia 23219 of Medicine College air. Curtis (71) TRFF--N, -and EVERIST, Bruce W., M.D. (71) united Rubber, Cork, LinoleuTn Chief of Pediatrics Plastic Vlorkers of Pinerica Street Green Clinic reet 87 South High 44308 709 South Vienna St Akron@ Ohio Ruston, Louisiana 71270 Director surance Department John R., M.D. (70) HOGNESS Pension and In F '@e Vice President Xecuti ity of Washington Mrs. Florence R. (72) Univers i,,iYCKOFF, v Seattle Viashington 98105 os Road 243 Corra-. ni 95076 lqatsonville, Califor a CHAIR4Pf) Dr. Josenh T. Fn,7 _,Iish and 20853 Rockv- Lile, @Yl