No B&B ImpoRmikriom & lm^se MAkmAkgl@E@ 300 "twom D=stuctn U=uLxvAno Ulmosicst MAIRLSOItOt Mftlt Pro ZC'772 0 US^ " C301) 249-01 1 0 O/'-'9./7 0 PM CANCER REGISTRY ACTIVITIES The American College of Surgeons, the American Cancer Society, and the former Cancer Control Division of the National Center for Chronic Disease Control have promoted and supported patient service- oriented tumor registry activities as part of comprehensive cancer programs for many years. Tumor registries are used to insure continued medical follow-up of patients, to evaluate the management of the disease by practicing physicians, as a resource in profes- sional and public education, as a stimulus to the improvement of patient records, and in the development of cancer programs to serve the needs of the community. In the furtherance of these ends, Regional Medical Programs have been supporting the development and improvement of cancer registries as integral parts of their cancer programs. At the present time, the National Advisory Council has approved and RMPS has funded 23 cancer registry activities in 21 Regional Medical Programs. RMP cancer programs are currently funded at approximately $10 M or 13 percent of total grant dollars. Of this amount@ it is estimated that about $1.3 M or 1.7 percent are obligated for the organization and operation of tumor registries. This amount includes training of registry personnel in two Regions. RNPS'is also support- ing a contract with the University of California San Francisco for the training of registry directors and secretaries. Four additional cancer programs with registry activities have been approved, but have not yet been funded. There are indications that several additional Regional Medical Programs are interested in developing registry activities as.part of their comprehensive cancer programs. During the past two years, RMPS staff has provided consultation and assistance to virtually all of the approved cancer programs with registry activities and, since January, staff has visited 19 Regional Medical.Programs for this purpose (several more than once). As with other Regional Medical Program grants, those supporting cancer registries have been made for limited periods of time. All of the grantees have indicated that-they intend to seek other funding for their cancer registry activities after RMPS support is termin- ated. Many hospitals are already supporting their own registry activities. In some states these activities are currently being financed-by third party payments from Group Hospitalization, Inc. (Blue Cross), or by Medicare as part of normal hospital operating costs. Several State Health Departments either are already supporting, or have made the commitment to assume support of, Page 2 these activities. The American Cancer Society also expects to continue to make some funds available to registries through their various divisions. The American College of Surgeons has been providing voluntary accreditation to hospitals for their cancer programs for many years, and an effective service-oriented cancer registry has been a principal requirement for their approval. Three years ago they also made mandatory the existence of a cancer activities program in addition to the registry. Recent actions of the Cancer Commis- sion of the American College of Surgeons have strengthened the Approvals Program and the stimulus to registry development has been enhanced. The College.does not support the expenses of registries, but does contribute to consultation and continuing education activities for registry staffs. They also inspect registries as a part of the hospital cancer programs in the surveys carried out for their approvals function. The Cancer Guidelines Report soon to be published by the College will add additional pressure for hospitals to support their own registries. The RMPS has funded a part of the Approval Programs and the Guidelines Report under two contracts. In the future, it seems likely that hospitals providing definitive diagnosis and treatment for cancer patients will increas- ingly accept financial responsibility for the maintenance of cancer registries as part of their cancer programs in the same way that they now support a medical records department. RNPs can accelerate the attainment of this goal through seed money--judiciously distrib- uted--to help in the improvement of hospital and regional cancer programs, including effective registries, and the training of the necessary personnel when these are in shortage categories. The need for careful follow-up of patients with 'cancer in order to assure the prompt recognition and treatment of recurrence or new disease,and to provide a basis for evaluation of the results of treatment, h@s been well established. The use of registry data in the continuing education of physicians and in obtaining their interest and cooperation in improving the care of cancer patients has been an added justification for the inclusion of registry support in RMPs and has led to the level of expenditure shown above. Now we are urged to consider proposals to establish some type of follow-up registry for: 1) Stroke 2) Myocardial infarction 3) Hypertension Page 3 4) Rheumatic fever 5) Diabetes 6) Pulmonary disease I Some day, when patient h@stories, physicals, and lab findings are all entered into a computerized combined in-patient and out- patient record system, the needed data for registration of any type of disease will become available automatically. Until our record systems reach such a serviceable stage, what should our policy be regarding registries? Abraham RKg Marga;let H. Sloan, M.D. Cancer Registry Consultant Associate Director for Operations Research and Organizational Liaison Systems Analysis Branch 10/2 9/70 CANCER REGISTRY ACTIVITIES SUPPORTED BY RMPS Year anal Medica@-Program Base or Area Project Funded 1. Arkansas Regionwide Central Computerized- Little Rock 6 '69 Northwest Kansas 7 '69 Ft. Smith - 10 counties 12 '69 2. California Mt. Zion Hospital - San Francisco 15 '70 3. Colorado/ljyoming Regionwide - part of Rocky Mountain 2 '69 4. Georgia Regionwide 13 '68 5. Illinois Presbyterian - St. Luke's Hospital extended to 3 other hospitals in Chicago 4 170 6. Indiana Feasibility.study Discontinued 7. Intermountain Regionwide - Center for 6-state Rocky Mountain registry 11 '68 8. Iowa Regionwide 12 '69 9. Louisiana Develop self-teaching training program for registry secretaries 1 t7O 1k @etro D.C. Computerized cancer registry D.C. Health Department 19 '69 11. Missouri Computerized cancer registry based at 28 '69 Ellis Fischel Cancer Hospital Discontinued 12. Mountain States Regionwide - part of'Rocky Mountain States Cooperative Cancer Registry - Boise 6 @168 13. New.Mexico Core '68 14. NY Metropolitan Memorial Hospital and 34 cooperating hospitals consultation and training 2 166 15. North Carolina Regionwide - State Health Department 4 '67 16. Oklahoma Tulsa 5 168 17. Puerto Rico Regionwide 5 170 18. South Carolina Statewide U. of S. Carolina Med. Center 25 170 19. Texas Statewide State Health Department 8 '68 20 lashington/Alaska Regionwide - U. of Washington Med. Center 32 '69 21. Western New York Regionwide - Roswell Park 10 '69 October 1970 BRIEF S i@IARY OF AUTOMATED F-EALTH TESTING - L@IULTIPHASIC SCREENING ACTIVITIES SUPPORTED BY @IPS At the present time, @fPS supports ten major AIIIIT--@kIPS projects. In general these projects use some automated testing equipment, allied health personnel and computers to acquire health data including medical histories, laboratory data and physiologic measurements. Most projects are either part of or closely related to programs for the deliverv of primary care to the medically underprivileged. OEO and Model City neighborhood health centers and 314e clinics are often major sources of patients. Training and employing the underprivileged as a paramedical personnel, the projects attempt to supply to those who deliver care a comprehensive data base from which diagnosis can be made by physicians and treatment initiated and continued. The projects focus heavily on the early detection and prevention of heart disease, cancer, stroke, pulmonary and kidney disease, diabetes and related diseases. Results indicate that approximately 50% of those patients screened have signifi- cant medical abnormalities. Many of these projects are becoming excellent examples of optimal utilization of funds and resources. Not only do they serve as centers of service and teaching but also as centers of research. Their investi- gations include studies of attitudes and behavior of health providers and patients, utilization of health facilities, clinical epidemiology and other problems of the organization and delivery of health care services. Most projects serve as demonstration and consultation centers which assist others in the Regions in the development of strategies to improve the acquisition of patient data and the organization of future health delivery systems. The Operations Research-Systems Analysis Branch of @IPS has served as a consultation resource to at least 20 Regions which are involved in or planning AMHT-@IPS activity. This assistance has taken the form of referral to I-IPS centers of excellence, planning of projects, correspondence, office'and telephonic consultations, visits, development of evaluation protocols and the establishment of L@IPS committees in Regions. In addition in a number of Regions our consultation has helped to stimulate regional conferences on the role of AYil!T-i@IPS in improving health care delivery. This consultation has paid dividends in the improvement of project proposals, and in the general education of core staffs and project applicants regarding improved methods of patient data acquisition,._ optimal use of health facilities, the organization of health care systems and the sy@terqs approach to the solution of health problems, and the short cutting of the planning process. PROJECT FUNDING FOR PRESENT OPERATIONAL YEAR Palo Alto, California $ 91,000 Regional Medical Program San Joaquin Valley, California 186,700 Regional Medical Program Gainsville, Florida 179,200 -Regional Medical Program Indianapolis, Indiana 265,000 Regional Medical Program Baltimore, Maryland (2 pediatric projects) 101,000 Regional Medical Program Nashville, Tennessee 604,500 Mid-South Regional Medical Program Memphis, Tennessee 269,500 Memphis Regional Medical Program Northeast, Mississippi 312,600 Memphis Regional Medical Program Rochester, New York 259,900 Rochester Regional Medical Program Salt Lake City, Utah 389,000 Intermountain Regional Medical Program Richmond, Virginia approved but unfunded Virginia Regional Medical Program 10/29/70 R-MP CANCER REGISTRY.ACTIVITIES The American College of Surgeons, the American Cancer Society, and the former Cancer Control Division of the National Center for Chronic Disease Control have promoted and supported patient service- oriented tumor registry activities as part of comprehensive cancer programs for many years. Tumor registries are used to insure continued medical follow-up of patients, to evaluate the management of the disease by practicing physicians, as a resource in profes- sional and public education, as a stimulus to the improvement of pat.ient records, and in the development of cancer programs to serve -,..--,-,the needs of the community. In the furtherance of these ends, Regional Medical Programs have been supporting the development and improvement of cancer registries as integral parts of their cancer programs. At the present time, the National Advisory Council has approved and RMPS has funded 23 cancer registry activities in 21 Regional Medical Programs. RMP cancer programs are currently funded at approximately $10 M or 13 percent of total grant dollars. of this amount, it is estimated that about-$1.3 M or 1.7 percent are obligated for the organization and operation of tumor registries. This amount includes training of registry personnel in two Regions. RNPS is also support- ing a contract with the University of California San Francisco for the training of registry directors and secretaries. Four additional cancer programs with registry activities have been approved, but have not yet been funded. There are indications that several additional Regional Medical Programs are interested in developing registry activities as.part of their comprehensive cancer programs. During the past two years, RMPS staff has provided consultation and assistance to virtually all of the approved cancer programs with registry activities and, since January, staff has visited 19 Regional Medical Programs for this purpose (several more than once). As with other Regional Medical Program grants, those supporting cancer registries have been made for limited periods of time. All of the grantees have indicated that they intend to seek other funding for their cancer registry activities after RMPS support is termin- ated. Many hospitals are already supporting their own registry activities. In some states these activities are currently being financed by third party payments from Group Hospitalization, Inc. (Blue Cross), or by Medicare as part of normal hospital operating costs. Several State Health Departments either are already supporting, or have made the commitment to assume support of, Page 2 these activities. The American Can cer Society also expects to continue to make some funds available to registries through their various divisions. The American College of Surgeons has been providing voluntary accreditation to hospitals for their cancer programs for many years, and an effective service-oriented cancer registry has been a principal requirement for their approval. Three years ago they also made mandatory the existence of a cancer activities program in addition to the registry. Recent actions of the Cancer Commis- sion of the American College of Surgeons have strengthened the Approvals Program and the stimulus to registry development has been enhanced. The College does not support the expenses of registries, but does contribute to consultation and continuing education activities for registry staffs. They also inspect' registries as a part of the hospital cancer programs in the surveys carried out for their approvals function. The Cancer Guidelines Report soon to be published by the College will add additional pressure for hospitals to support their own registries. The @IPS has funded a part of the Approval Programs and the Guidelines Report under two contracts. In the future, it seems likely that hospitals providing definitive diagnosis and treatment for cancer patients will increas- ingly accept financial responsibility for the maintenance of cancer registries as part of their cancer programs in the same way that they now support a medical records department.. RNPs can accelerate the attainment of this goal through seed money--judiciously distrib- uted--to help in the improvement of hospital and regional cancer programs, including effective registries, and the training of the necessary personnel when these are in shortage categories. -up of patients with cancer in order The need for careful follow to assure the prompt recognition and treatment of recurrence or new disease,and to provide 'a basis for evaluation of the results of treatment, h@s been well established. The use of registry data in the continuing education of physicians and in obtaining their interest and cooperation in improving the care of cancer patients has been an added justification for the inclusion of registry support in RMPs and has led to the level of expenditure shown above. Now we are urged to consider proposals to establish some type of follow-up registry for: 1) Stroke 2) Myocardial infarction 3) Hypertension Page 3 4) Rheumatic fever 5) Diabetes 6) Pulmonary disease Some day, when patient histories, physicals, and lab findings are all entered into a computerized combined in-patient and out- patient record system, the needed data for registration of any type of disease will become available automatically. Until our record systems reach such a serviceable stage, what should our policy be regarding registries? Abraham MargaVet H. Sloan, M.D. Cancer Registry Consultant Associate Director for Operations Research and Organizational Liaison Systems Analysis Branch 10/2 9/70 CANCER REGISTRY ACTIVITIES SUPPORTED BY @IPS Year )nal Medical Program -Base or Area Project Funded 1. Arkansas Regioniqide Central Computerized- Little Rock 6 169 Northwest Kansas 7 '69 Ft. Smith - 10 counties 12 '69 2. California Mt. Zion Hospital - San Francisco 15 170 3. Colorado/Wyoming Regionwide - part of Rocky Mountain 2 '69 4.. Georgia Regionwide 13 '68 5. Illinois. Presbyterian - St. Luke's Hospital extended to 3 other hospitals in Chicago 4 t7O 6. Indiana Feasibility study Discontinued 7. Intermountain Regionwide - Center for 6-state Rocky Mountain registry 11 '68 8. Iowa Regionwide 12 '69 9. Louisiana Develop self-teaching training program for registry secretaries 1 '70 l@ ietro D.C. Computerized cancer registry - D.C. Health Department 19 '69 11. Missouri Computerized cancer registry based at 28 '69 Ellis Fischel Cancer Hospital Discontinued 12. Mountain States Regionwide part of'Rocky Mountain States Cooperative Cancer Registry - Boise 6 '68 13. New Mexico Core '68 14. NY Metropolitan Memorial Hospital and 34 cooperating hospitals consultation and training 2 '66 15. North Carolina Regionwide State Health Department 4 '67 16. Oklahoma Tulsa 5 '68 17. Puerto Rico Regionwide 5 '70 18. South Carolina Statewide - U. of S. Carolina Med. Center 25 170 19. Texas Statewide - State Health Department 8 '68 2(' lashington/Alaska Regionwide - U. of Washington Med. Center 32 '69 21. Western New York Regionwide - Roswell Park 10 '69