I I III I I AN m 4 i I i 'A AN r oc)nens 1. MISSION AND HISTORY 4. PROGRAM ACTIVITIES Mission 3 Development 22 Legislative and Administrative History 3 Implementation and Progress- Appropriations and Budgetary History 4 Operational Activities 24 Functional Emphasis 25 Disease Focus 26 2. CHARACTERISTICS Priority Concerns 26 Geographic Area/Map 6 Reinvestment of Funds 28 Demographic Facts 8 Evaluation 29 Funding 8 Organizational/Operational Status 8 5. REGIONAL MEDICAL PROGRAMS SERVICE Organization and Functions 32 ORGANIZATION Highlights of Fiscal Year 1972 34 Chart 1 0 "Grantees 10 GLOSSARY 36 Regional Advisory Groups 10 Executive Committees 13 Committees and Local Advisory Groups 14 Program Staffs 16 Minority and Femate'Representation 18 "There is little reason to doubt that we are now beginning to move in the proper direction. The right of all citizens to have equal oppor- tunity for good medical care is no longer contested. Nor is there any remaining controversy about the need to control medical costs; to redistribute and maximize the use of existing manpower; and to do all this, and perhaps more, without delay." Address by Merlin K. DuVal, Jr., M.D. Assistant Secretary for Health and Scientific Affairs National Meeting of the Regional Medical Programs, January 18, 1972 Regional Medical Programs are a pluralistic approach to dealing with the nation's health problems. The Programs have developed a coalition of thousands of health pro- viders and interested consumers to plan and implement activities for health care at the local level, This Fact Book presents an updated report of how Regional Medical Programs have or- ganized this effort and the progress they have made in achieving their goals. It is hoped that this publication will serve as a ready reference source for those interested in Regional Medical Program activities. Harold Margulies, M.D. Director Regional Medical Programs Service MISSION AND HISTORY he Regional NLedical Programs practitioners, health professionals, hos- The initial concept of Regional Medi- (RMPS) seek to strengthen and im- pitals, and other institutions acting alone. cal Programs was to provide a vehicle T. prove the Nation's personal health The RMP provides a framework delib- by which scientific knowledge could be care system in order to bring about more erately designed to take into account local more readily transferred to the providers accessible, efficient, and high quality resources, patterns of practice and re- of health services, and by so doing, im- health care to the American public. To ferrals, and needs. As such it is an im- prove the quality of care provided with accomplish these ends the Regional Medi- portant force for bringing about changes emphasis on heart disease, cancer, cal Programs: in the provision of personal health serv- stroke, and related diseases. The imple- ices and care. mentation and experience of RMP over Promote and demonstrate among pro- viders at the local level new techniques Highlights of Legislative and Administrative History and innovative delivery patterns for im- proving health care, with particular atten- 1964 DECEMBER The Report of the President's Commission on Heart Disease, Can- tion to those diseases which are major cer and Stroke presented 35 recommendations including develop- causes of death and disability; ment of regional complexes of medical facilities and resources. o Stimulate and support those activities 1965 JANUARY Companion administration bills-S. 596 and H.R. 3140-were intro- which will both help existing health man- duced in the Senate by Senator Lister Hill (Ala.), and in the House power to provide more and better care by Representative Oren Harris (Ark.), giving concrete legislative and result in the more effective utiliza- form to presidential proposals. tion of new kinds and combinations of manpower,- OCTOBER P.L. 89-239, the Heart Disease, Cancer and Stroke Amendments of 1965, was signed. The Commission concepts of "regional medical Encourage providers to accept and complexes" and "coordinated arrangements" were replaced by enable them to initiate regionalization of "regional medical programs" and "cooperative arrangements," thus health facilities, manpower, and other re- emphasizing voluntary linkages. sources so that more appropriate and better care will be accessible and avail- DECEMBER National Advisory Council on Regional Medical Programs met for able at the local and regional levels; and the first time to advise on initial plans and policies. Identify or assist to develop and facili- 1966 FEBRUARY Dr. Robert Q. Marston appointed first Director of the Division of tate the implementation of new and spe- Regional Medical Programs and Associate Director of National cific mechanisms that provide quality Institutes of Health (NIH). ,control and improved standards of care. APRIL First planning grants approved by National Advisory Council. Each RMP develops its programs through a consortium of providers and 1967 FEBRUARY First operational grants approved by National Advisory Council. consumers which comes together to plan JUNE The Surgeon General submitted the Report on Regional Medical and implement activities to meet health Programs to the President and the Congress, summarizing progress needs which cannot be met by individual made and recommending its extension. MISSION AND HWRORY 1968 MARCH Companion bills to extend Regional Medical Programs were intro- the past seven years, coupled with the duced in the House by Harley 0. Staggers (W.Va.) (H.R. 15758) and broadening of the initial concept espe- in the Senate by Senator Lister Hill (Ala.) (S. 3094). cially as reflected in the most recent legislative extension, has clarified the na- JULY Health Services and Mental Health Administration (HSMHA) estab- ture and character of Regional Medical lished; Division of Regional Medical Programs changed from NIH Programs. Though RMP continues to have to HSMHA. a categorical emphasis, to be effective OCTOBER P.L. 90-574, extending the Regional Medical Programs for two years, that emphasis frequently must be sub- was signed. Changes were: include territories outside of t@e 50 @,u med within or made subservient to States; permit funding of interregional activities; permit dentists oroader and more comprehensive ap- to refer patients; and permit participation of federal hospitals. proaches. RMP must relate primary care Division of Regional Medical Programs became Regional Medical to specialized care, affect manpower dis- Programs Service. tribution and utilization, and generally im- prove the system for delivering compre- 1970 JAN,OCT. Bills extending RMP introduced; hearings held. hensive care. OCTOBER P.L. 91-515 was signed into law. New provisions. emphasis on pri- Even in its more specific mission and mary care and regionalization of health care resources; added pre_ objectives, RMP does not function in iso- lation. Only by working with and contrib- vention and rehabilitation; added kidney disease; added authority uting to related federal and other efforts for new construction; required review of RMP application bv Area- at the local, state and regional levels, wide Comprehensive Health Planning agencies; emphasized health particularly state and areawide Compre- services delivery and manpower utilization. hensive Health Planning activities, can 1972 SEPTEMBER Proposals for June 1973 legislative extension of RMP being drafted. the RMPs achieve their goals. Appropriations and Budgetary History (dollars in thousands) Fiscal Fiscal Fiscal Fiscal Fiscal Fiscal Fiscal Year Year Year Year Year Year Year 7966 1967 1968 1969 1970 1977 1972 Authorization ------------------------ $50,000 $90,000 $200,000 $65,000 $120,000 $125,000 $150,000 Amount appropriated for grants ----------- 24,000 43,000 53,900 56,200 73,500 99,500 90,500 Amount actually available for grants I ------- 24,000 43,934 48,900 72,365 78,500 70,298 135,000 Amount actually awarded for grants -------- 2,066 27,052 43,635 72,365 78,202 70,298 111,40V Authorization-a grant of authority from the Congress to the executive branch to spend federal funds for specified purposes. Appropriation-legal sanction by the Congress for a Government agency to obligate not more than a stated sum for specified purposes within a stated period. I Includes unspent funds carried forward from previous year minus amounts held in reserve by the Office of Management and Budget. Does not include earmarked amounts for Emergency Medical Services ($8.0 million), Cancer construction ($5.0 million), Health Maintenance Organizations ($9.4 million), Contracts ($1.0 million), and evaluation activities ($.6 million). 4 I I i CHARAMRISTICS Geographic Area of Regional Medical Programs 1. ALABAMA-Covers the state of Alabama. 17, INTERMOUNTAIN-Includes the state of Utah, 32. NEW JERSEY-Covers the state of New Jersey. portions of Wyoming, Montana, Idaho, Colorado (Overlaps in seven southern counties with 2. ALBANY-Includes 21 northeastern New York and Nevada. (Overlaps Colorado-Wyoming and Greater Delaware Valley RMP.) counties centered around Albany and contiguous Mountain States RMPS.) portions of southern Vermont and Berkshire 33. NEW MEXICO-Covers the state of New ty _ Coun in western Massachusetts. (Overlaps Tri- 18. IOWA-Covers the state of Iowa. Mexico. State and Northern New England RMPS.) 19. KANSAS-covers the state of Kansas. 34i NEW YORK METROPOLITAN-Includes New 3. ARIZONA-Covers the state of Arizona. York City and Westchester, Rockland, Orange and rs the state of Arkansas. 20. LAKES AREA-includes seven western New Putnam counties. 4. ARKANSAS-Cove York counties centered around Buffalo, and the (Overlaps in the northeast portion with Memphis Pennsylvania counties of Erie and McKean. 35. NORTH CAROLINA-Covers the state of North RMP.) Carolina. -STATE-Includes southern Illinois and east- 21. LOUISIANA-Covers the state of Louisiana. 5. 81 36. NORTH DAKOTA-Covers the state of North ern Missouri counties centered around the St. 22. MAINE-Covers the state of Maine. Dakota. Louis metropolitan area. (Overlaps Illinois RMP.) ALIFORNIA-Covers the qate of California. 23. MARYLAND-Covers the state of Maryland and 37. NORTHEAST OHIO-includes 12 counties in 6. C York County, Pennsylvania. (Overlaps in south- Northeast Ohio centered around Cleveland. (Overlaps Mountain States RMP in sections of central Maryland with the Metro@,olitan Washing- Nevada.) ton, D.C. RMP.) 38. NORTHERN NEW ENGLAND-includes the state of Vermont and three contiguous counties 7. CENTRAL NEW YORK-Includes 15 Central York. (Overla c around Syracus@, 24. MEMPHIS-includes the western Tennessee in northeastern New ps Albany New York counties entered area centered around Memphis; northern Missis- RMP.) and the Pennsylvania counties of Bradford ano sippi; northeastern Arkansas; portions of south- Susquehanna. western Kentucky; and three counties in south- 39. NORTHLANDS-Covers the state of Minne- 8. COLORADO-WYOMING-Covers the states of western Missouri. (Overlaps Mississippi, Arkansas, sota. Colorado and Wyoming. (Overlaps Mountain and Ohio Valley RMPS.) 40. OHIO-Covers the central corridor of the state States and Intermountain RMPS.) 25. METROPOLITAN WASHINGTON, D.C.,-In- from the northwest to the southeast. 9. CONNECTICUT@vers the state of Connecti- cludes the District of Columbia and contiguous cut. counties in Maryland and Virginia. (Overlaps 41. OHIO VALLEY-includes most of Kentucky Maryland and Virginia RMPS.) (101 of 120 counties), southwest Ohio (Cincinnati- 10. DELAWARE-Covers the state of Delaware. Dayton and adjacent areas), contiguous parts of 26. MICHIGAN-Covers the state of Michigan. Indiana (21 counties) and West Virginia (2 11. FLORIDA-Covers the state of Florida. counties). (Overlaps Indiana, Memphis, Tennes- 12. GEORGIA-Covers the state of Georgia. 27. MISSISSIPPI-Covers the state of Mississippi. see Mid-South and West Virginia RMPS.) (Overlaps in northern part of state with Memphis 13. GREATER DELAWARE VALLEY-includes RI.IP.) 42. OKLAHOMA-Covers the state of Oklahoma. southeastern Pennsylvania (Philadelphia-Cam- den), northeastern Pennsylvania (Wilkes Barre- 28. MISSOURI-Covers the state of Missouri, ex- 43. OREGON-Covers the state of Oregon. Scranton) and southern New Jersey counties. clusive of the Metropolitan St. Louis area. (Overlaps New Jersey RMP.) 44. PUERTO RICO-Covers the Commonwealth of 29. MOUNTAIN STATES-includes portions of Puerto Rico. 14. HAWAII-Includes the state of Hawaii, Amer- Idaho, Montana, Nevada and Wyoming. (Overlaps ican Samoa, Guam, and the Trust Territory of the California, Intermountain and Colorado-Wyoming 45. ROCHESTER-Includes ten counties centered Pacific Islands. RMPS.) around Rochester, New York. 15. ILLINOIS-Covers the state of Illinois. (Over- laps Bi-State RMP in the southern portion of the 30. NASSAU-SUFFOLK-includes the counties of 46. SOUTH CAROLINA-Covers the state of South I Carolina. state.) Nassau and Suffolk (Long Island) of the state of 16. INDIANA-Covers the state of Indiana. (Over- New York. 47. SOUTH DAKOTA--Covers the state of South laps Ohio Valley RMP.) 31. NEBRASKA-Covers the state of Nebraska. Dakota. 6 CHARACTERISTICS 48. SUSQUEHANNA VALLEY-includes 27 coun- 51. TRI-STATE-Covers the states of Massachu- 54. WEST VIRGINIA-Covers the state of West ties in central Pennsylvania centered around the setts, New Hampshire and Rhode Island. (Over- Virginia. (Overlaps in two counties with Ohio Harrisburg-Hershey area. laps in western Massachusetts with Albany Valley RMP.) RMP.) 49.,TENNESSEE MID-SOUTH-includes 84 coun- 52. VIRGINIA-Covers the state of Virginia. (Over- 55. WESTERN PENNSYL"NIA-Includes 28 coun- ties in the central and eastern sections of Ten- laps in northern section with Metropolitan Wash- ties in Western Pennsylvania centered around nessee and portions of southwestern Kentucky. ington, D.C. RMP.) Pittsburgh. (Overlaps Ohio Valley RMP.) 53. WASHINGTON/ALASKA-Covers the states of 50. TEXAS-Covers the state of Texas. Washington and Alaska. 56. WISCONSIN-Covers the state of Wisconsin. CHARACTERISTFCS Demographic Facts FUNDING LEVELS: Programs vary from FUNDING LEVEL RANGES: Programs with Highest: California ($10 million) Less than $500,000 4 Lowest: Delaware ($200 thousand) $500,000 - $999,999 ... 19 There are 56 Regional Medical Programs MEDIAN FUNDING LEVEL: $1.1 million $1 million - $1,499,999 --- ........ 8 which cover the United States, Puerto $1.5 million - $1.999.999 .... . ....... 17 Rico, and the Trust Territories of the Pa- $2.0 million - $2,499,999 . .... ..I. ... .....4 cific. The Programs include the total 1972 $2.5 million and above --. - ----- 4 population of the United States (esti- mated at 207 million) and vary consider- Organizational and operational Status ably in size, funding, and geographic characteristics. -60 COMPARISON OF PROGRAMS IN ORGANIZATIONAL AND OPERATIONAL STAT S, 1966-72 LARGEST PROGRAM Number Organizational In population: California (20 million of _,, RMPs Operational In size: Washington/Alaska (638 '000 square miles) SMALLEST PROGRAM -40 In population: Northern New England (445,000) In size: Metropolitan Washington, D.C. (1,500 square miles) -30 GEOGRAPHIC BOUNDARIES: Number of Programs which primarily -20 Encompass single states ----------------------- 34 Encompass two or more states -- ------ 4 Are parts of single states -------------------- 11 -10 Are parts of two or more states ........ 7 POPULATION: Number of Programs which -0 - have 1966 1967 1968 1969 1970 1971 1972 Less than I million persons ------------- -- 6 FISCAL YEAR 1 million to 2 million ----------------- --------- 11 Note: Although all of the original 55 RMPs had achieved operational status by the end 2 million to 3 million ---------------------------- l@ of the 1970 calendar year, there have been subsequent organizational and boundary 3 million to 4 million ----------- ----------------b modifications, as reflected in the organizational/@operational status comparison shown 4 million to 5 million --- ..... .... .. ..........5 ;bove. Most significant among these have been the following: (1) in 1971, what had pre- Over 5 million ......................... ... --- 13 viously been the Nebraska-South Dakota RMP divided into two separate Programs, with Nebraska remaining in operational status and South Dakota receiving its initial organi- zational grant on July 1; (2) the State of Delaware split off from Greater Delaware Val- ley RMP and was awarded its first organizational grant as a separate Program in the spring of 1972; and (3) two Ohio Programs (Ohio State and Northwest Ohio) merged to form the Ohio RMP as of September 1972. 8 ORGANIZATION ORGANIZATIONAL STRUCTURE OF A Grantee: The grantee organization man- REGIONAL MEDICAL PROGRAM ages the grant of the Regional Medical Categories of Grantees, Fiscal Year 1972 Program in a manner which will imple- ment the program established by the Grantee ...................... .................. ............ 56 Coordinator Regional Advisory Group and in accord- Universities ................. 33 and ance with Federal regulations and poli- Program cies. Public ----- ------ ------- ......... ... .......... (26) Staff o Chief Executive Officer (Coordinator): Private ..... -------------------------- -------------- ( 7) The grantee's full-time employee who has Other ..... .............. .......... 23 day-to-day responsibility for the manage- New agencies/corporations ------ ....... (16) ment of the RMP; he is also responsible Existing corporations --. ........ ... ---- ( 3) to the Regional Advisory Group which Medical societies ----------------- ............ @( 4) establishes program policy. The Chief Executive Officer and his program staff provide support to the Regional Advisory Group and its subcommittees, including Grantee Regional local advisory groups where they exist. Regional Advisory Groups Advisory (fiscal Group and agent) Committees PURPOSE: The Regional Advisory Group (RAG) is the organized voluntary body of Grantees of health providers and consumers in each Regional Medical Programs RMP which has responsibility for program RESPONSIBILITIESANDRELATIONSHIPS and project determinations and overall There are three major components of a program direction. Reajonal Medical Program at the regional PURPOSE: Each Regional Medical Pro- A Regional Advisory Group, through gram is fiscally administered by a grantee membership composed of representatives level: The Regional Advisory Group; the which may be a public or private non- from most health interests as well as grantee organization; and the Chief profit institution, agency, or corporation. many consumers in the Region, attempts Executive Officer (often referred to as the The grantee is responsible for manage- to identify critical health needs in the RMP Coordinator) with his or her program ment of the RMP grant in such a manner area; develops, reviews, and approves staff. as to implement the program established appropriate activity proposals designed 9 Regional Advisory Group- The Regional by the Regional Advisory Group and in to meet those needs; and monitors and Advisory Group has the responsibility for accordance with federal regulations and evaluates funded programs. The Regional setting the general direction of the RMP policies. This includes primarily fiscal Advisory Group has final decisionmaking and formulating program policies, objec- control, fund .ICCOLinting, and administra- authority concerning program content and tives and priorities. tive support. policy in each RM@ 10 ORGANIZATION SIZE: COMPOSITION OF REGIONAL ADVISORY GROUPS BY CATEGORY OF REPRESENTATION, FISCAL YEAR 1972 FY 1969 -------------- 2,500 total membership 18 (hundreds of members) 67% 45 average group size FY 1970 .... ......... 2,700 total membership 15 48 average group size FY 1971 .@,2,743 total membership 12 49 average group size FY 1972 -------------- 2,667 total membership 9 48 average group size ---- 25% 6 RANGES, FISCAL YEAR 1972 3 Size No. of RAGS 8% 0 10- 39@ ..... . ................. ......... ... ...... 2 1 Provider Consumer Indeterminable 40 - 69 ... ... 70 - 99 . ......... ...... ............. . .......6 100 - 129 ---- ------------------------------------------ -------I 130 - 159 -------------- ---- ------------- -------------------------1 10% TOTAL ......... .......................... 56 Other 21% Business & Prof 1% Manag So Other COMPOSITION: Regional Advisory Groups are composed of volunteers, both health care providers and consumers. Member- 5-/. ship is shown in the following charts, both or by profession and by type of institution, 119 organization, or group represented. Make- Education Local up of these groups has changed some- Govt. what over the years since Regional Medi- cal Programs have been in existence. Practicing physician representation, for ORGANIZATION Composition of Regional Advisory Groups EDUCATION: by 449 tota I Profession 237 medical (physicians) 53% Fiscal 50 nursing 11% Year 29 dental 6% 1972 45 other health fields 10% @8 general/other 20% MEDICAL SCIENCES: 1056 tota I 853 medicine (physicians) 81% 77 nursing 7% 67 dentistry 6% 59 allied health/other 6% allEALTH RELATED OCCUPATIONS: 434 total 94 health planning or public health 22% 220 hospital administration 50% 120 general/other 28% i-SOCIAL/BEHAVIORAL SCIENCES: 20 total 17 sociology 85% 3 general/other 15% -OTHER PROFESSIONS/OCCUPATIONS: 668 total 230 business/industry/agriculture 35% 63 law 9% 41 politics 6% 34 clergy 5% 14 students 2% 66 housewives 10% 79 civil service 12% 40 retired 6% 101 other 15% NOT SPECIFIED/INDETERNfiNABLE: 40 total ORGANIZATION example, was 22% of the total member- COMPOSITION: Like Regional Advisory ship in June of 1969; today it has in- Group composition, that of Executive creased to 32%. Additionally, consumer Committees appears also to have shifted groups have experienced increasing emphasis over the past several years. representation from 15% of the '69 mem- In fiscal vear 1969, for example, physician bership to 25% by the end of fiscal year membership accounted for 67% of the 1972. total; this year, their proportion has de- clined to 50%. Executive Committees Composition by Profession, Fiscal Year 1972: PURPOSE: An Executive or Steering Education .... 11.1 I".." ... ... I I.,. .....I... 91 (20%) Committee is a subgroup of the Regional Medical and Related Health Sciences 191 (42%) Advisory Group which has as its primary Health Related Occupations .. ......... ... .... 75 (17%) function the surveillance and coordina- Social/Behavioral Sciences .................... 3 ( 1%) tion of the Program between full RAG Other Profession or Occupation .............. 88 (19%) sessions, In addition, this group has the Non-specified/indeterminable ................ 4 ( 1%) responsibility for acting as the day-to-day 452 (100%) advisor to the Chief Executive Officer (Coordinator) and his staff on program Composition by Category of Representation, matters. Executive Committees are either Fiscal Year 1972: elected or appointed by the total RAG; as Flovider .. ........................................................ 290 ( 65%) a rule, they are not as broadly represent- Consumer . @ ..... ... .................................... 83 ( 18%) ative as the larger body. Although these Indeterminable ........................ . . ......... ..... 79 ( 17%) committees act in the RAG's stead be- 452 (100%) tween full meetings, they are not em- powered to make final determinations concerning program policy, content or funding. SIZE: Executive Committees range from three members (California and North Da- kota RMPS) to 42 members (Memphis RMP). Groups average eleven in total membership. Aggregate total membership of these bodies as of June 1972 was 452 '15 Programs either have no Executive Com- (41 RMPs'), compared to approximately mittee or have not reported membership compo- 460 in 1971. sition. ORGANIZATION COMPARISON OF NUMBER OF COMMITTEES BY TYPE, FISCAL YEARS 1969, 1971, 1972 TYPE: 100 Heart Cancer 80 Stroke Other Disease Committees and Local Advisory Groups Planning, Review & 60 Evaluation PURPOSE: Regional Advisory Group com- mittees have major responsibilities for- (1) program activity development and re- Education/Manpower view; and (2) monitoring and evaluation 40 of funded activities. Most are composed of experts in a given field and as such have significant influence in terms of the scientific and professional competence of program activities. The last two years has 20 Other seen a marked increase in the number of planning, review and evaluation com- mittees, giving these functions an added and much needed emphasis. Local Advisory Groups, although they 0 are tied to the Regional Advisory Group Per 1969 1971 1972 (in many instances membership of the cent Fiscal Year bodies overlaps), serve primarily in a liaison and program development capac- ity at the community level. Generally, HIGHLIGHTS: they attempt to foster cooperation among * Categorical disease committees have continually declined in emphasis, from 218 local health organizations and consumer (44%) in FY 1969 to 192 (33%) in FY 1972. groups, and in many instances provide linkages with CHP area-wide groups. Lo- The largest percentage increase has been in planning, review-and evaluation com- cal groups serve as reactors to commu- mittees, which have more than tripled (from 30 to 93) in the three year period. 14 ORGANIZATION NUMBER AND SIZE OF COMMITTEES AND LOCAL ADVISORY GROUPS, FISCAL YEAR 1972 Number Size (in hundreds) 250 200 150 100 0 0 10 15 20 25+ Heart Cancer Stroke Kidney Other Categorical/ Multicategorical Planning/Review/ Evaluation Education/Manpower/ Allied Health Health Care Delivery/ Patient Care nity needs and problems and relate these, Procedures (By-Laws, as well as possible solutions, to decision- Nominating) making bodies at the regional level. Management/Finance NUMBER AND SIZE: Comparison FY 1969-72 1 1969: = 864 ..... , 10,163 Total Membership Local Advisory 1971; = 875 . ..... 12,426 Total Membership 1972: = 850 12,315 Total Membership Community Health/ Liaison Note: Total membership of these groups overlaps considerably with Regional Ad- Other visory Groups; in addition, committee memberships overlap to some extent with 250 -150 -1 0 OIN51 101 151 20 25+ each other, so that totals shown are based on numbers of memberships rather than numbers of individual members. ORGANIZATION Program Staffs SIZE:, Comparison of staff size in full- time equivalents, fiscal years 1969-72: PURPOSE: Program staffs are the salaried FY 1969 - 1,546 total - 28 average staff employees of the Regional Medical Pro- FY 1971 - 1,640 total - 29 average staff gram. They are responsible primarily for the conduct and administration of the FY 1972 - 1,374 total - 25 average staff Program and the provision of staff support to the Regional Advisory Group and its committees. COMPOSITION.- Program staffs attract SAMPLE ORGANIZATION CHART: persons with a variety of professional and technical competencies. Along with the new directions of RMP, the composition Coordinator or Chief of these staffs has altered to some degree Executive Officer over the past three years. Most notable -inionl, o Although the actual number of staff em- ployed has decreased considerably, the percentage of physicians has steadily de- Program clined from 15% in June of 1969 to only Administration 10% in June 1972. 9 Accountants, business administrators, and other financial management person- nel have increased to the extent that they now make up 9% of program staffs, as opposed to the 5% they accounted for in Program FY 1969. operations o The percentage of persons in related health (non-medical) and social science professions has risen from the FY 1969 F- proportion of 10% to 14% of the present tota 1. Health Care Manpower and Quality Delivery Education Control Systems Mechanisms Does not include reported vacancies, which totaled 321 at the end of fiscal year 1972. 16 ORGANIZATION Program Staff Composition by Professional Category, Fiscal Year 1972 EDUCATION: 111 total 36 medical (physicians) (33%) 14 allied health (12%) 17 nursing (16%) 40 general/other (36%) 4 dental ( 3%) MEDICAL SCIENCES: 149 total 96 medicine (physicians) (64%) 10 allied health ( 7%) 35 nursing (24%) 4 general/other ( 3%) 4 dentistry 2%) HEALTH RELATED OCCUPATIONS: total 123 73 health planning/public health (60%) 30 hospital administration (25%) 20 general/other (15%) SOCIAL/BEHAVIORAL SCIENCES: total 66 21 psychology (32%) 13 economics (19%) 11 sociology (17%) 21 general/other (32%) ADMINISTRATION/MGMT.: total 119 15 grants (12%) 27 business administration (23%) 14 accounting (11%) 63 general/other (54%) OTHER SCIENCES: total 76 8 physical/biological (11%) 7 computer programming (10%) 16 statistics (20%) 19 communications media (25%) 20 operations research/ 6 other 7%) systems analysis (27%) PUBLIC INFORMATION/RELATIONS: total 52 OTHER PROFESSIONAL and TECHNICAL: total 110 SECRETARIAL/CLERICAL: total 569 625 125 100 75 50 25 0 Number (Full-time Equivalents) UKUAIIIILM I full Minority and Female Representation Appropriate participation of minority groups (Blacks, Ameri'can Indians, Spanish- Americans, Asians, and others, such as Polynesians) and women at all levels of RMP planning, decisionmaking, and implementation is requisite to responsive and relevant program development. The data presented in the following charts reflect minority and female representation on program and project staffs, Regional Advisory Groups, and committees of RAGS. Per MINORITY REPRESENTATION OF PROGRAM AND PROJECT STAFFS Cent (FULL-TIME EQUIVALENT), FISCAL YEARS 1971 and 1972 25 Professional 21% Secretariai@ :20% 20 per cent 19% 191% minorities i n U.S. popula- 16% tion (18%) 15 12% lo g% 6% 5 0 m 1971 1972 1971 1972 1971 1972 1971 1972 PROGRAM: STAFFS' PROJECT STAFFS HIGHLIGHTS: 9 Minority representation on program staffs has increased considerably in the last year: the current ratio is 12%. 9 Minorities exceed parity in both categories (professional and secretarial) of project personnel. 18 ORGANIZATION MINORITY REPRESENTATION ON REGIONAL ADVISORY GROUPS AND OTHER COMMITTEES OF REGIONAL MEDICAL PROGRAMS - FISCAL YEARS, 1969,1971,1972 20 Minority Population of U. S. 15 RAG Committees 10 5 0 FY 1969 FY 1971 FY 1972 HIGHLIGHTS: o Minority representation on Regional Advisory Groups has increased from 10% to 17% during the past year and closely approximates parity involvement. * Though supporting committees of the Reaional Advisory Groups (technical review groups, local advisory groups, etc.) have also experienced an increase in minority rep- resentation, involvement remains at a less than desirable level. Fiscal year 1973 should show more accomplishment in this area. 19 Percent FEMALE REPRESENTATION IN REGIONAL MEDICAL PROGRAMS, Female FISCAL YEAR 1972 100 80 60 40 20- 0 Prof. Sec. Prof. Sec. REGIONAL ALL ADVISORY OTHER PROGRAM STAFFS PROJECT STAFFS GROUPS COMMITTEES HIGHLIGHTS: 4, A majority (57%) of the professional project personnel are women. o Female representation on Regional Advisory Groups has risen slightly in the past year (from 14% to 15%) and is expected to show considerably more progress by 1973. - Although, as depicted above, females make 'up 26% of professionals on program staffs, it should be noted that the vast majority of these women are not in decisionmak- ing positions, and tend to be members of the traditionally female professions such as nursing, education, and allied health fields. 20 PROGRAM ACTIVITIES Development responsible for its actual development. The cycle is completed by staff provision of information and feedback to the Re- Program development for each Regional gional Advisory Group. Medical Program is carried out primarily Program staffs function in a number by its Program staff in cooperation with of ways, involving not only developmental the Regional Advisory Group and its sub- activities, but also such tasks as adminis- structure. While the voluntary bodies de- tration, coordination, and evaluation of termine the general program direction Program components. A breakdown of and framework within which the RMP these functions according to staff re- operates, Program employees are directly sources allocated follows: Estimated Percent Staff Amount Funds Program Direction and Administration: .-. ------- $@,9.5M. 27% Overall direction and coordination, policy development, financial management, project coordination, communication and information activities, program evaluation. Project Development, Review and Management: --------------------- ------- 7.7 M- ------- ---- --------- 22 Assistance to local applicants in project design and conduct, proces- sing of individual operational applications, staff support to project review groups, project monitoring and evaluation. Professional Consultation, Community Relations and Liaison: .. .... 9.lM-- --- ------- 26 Staff assistance to other health programs, facilitation of cooperative relationships, development of and assistance to sub-RMP groups, etc. 22 PROGRAM ACTIVITIES PROFESSIONAL CONSULTATION AND Estimated Percent Staff ASSISTANCE: Amount Funds a The Wayne State component of the Mi- chigan RMP has, over the past several Planning Studies and Inventories: .... -------- - -- - ----- ----------------------- 3.7M ------------------------ 11% years, provided extensive and continuing Staff time and/or sub-contract costs technical assistance to the Detroit Model for studies designed to provide Cities Program in developing comprehen- guidelines in development of program sive, prepaid health care for approximate- objectives, baseline data, etc. ly 10,000 inner city residents. Funding for initiation of this program has now been Feasibility Studies: ----------------------------------------- --------------------------------- --------- 2.7M .... ----------------7received from the Department of Housing and Urban Development and other Staff time and/or sub-contract ;ources. expenditures for activities . The departure earlier this year of the designed to assess the potential only two physicians in Mono County, Cali- of prototype programs or techniques fornia, left its 5,000 residents without for larger scale application. medical services. Through efforts of Area VI (Loma Linda) of the California RMP, Central Regional Services - ------------ --------- - --- -- -- -- - ------------------------ 1.8m ... ------ ------------ physicians from neighboring areas were Centralized services supported on a obtained to fill this gap temporarily. Area continuing basis, such as libraries, VI staff are now studying Mono County's data banks, etc. additional medical needs with a view to providing permanent physicians for the Other: --------------------------------------------- ------------------------- -- -- ---- --------- - --------------- 7M -------- ------ local hospital. Staff time devoted to any number of PLANNING STUDIES AND other activities, ranging from the INVENTORIES: conduct of seminars and workshops to the development of delivery In 1969 a community health survey in models. the San Fernando Valley was undertaken by Area IV (UCLA) of the California RMP. TOTAL $35.2M 100% An extreme shortage of health manpower was found to exist. As a result represen- tatives from San Fernando Valley State Among the functions listed above, several may be described as being of a primarily College began meeting with physicians developmental nature. These, along with examples of how they are carried out, appear and other providers and the RMP. These opposite: discussions in turn have led to the de- nn PROGRAM ACTIVITIES velopment of the San Fernando Health A pilot-project to screen Pittsburgh gram and operational activities. Program Consortium, again with funding help from school children for sickle cell anemia was activities, as noted in the previous sec- Area V (University of Southern California) initiated last year by the Western Penn- tion, are defined as those functions cen- as well as IV. sylvania RMP. Testing will provide an tral to the RMP's operation. They en- * A survey by the Texas RMP showed indication of the problem in school age compass all activities performed by the that 19 counties in the State had no prac- groups, with data analysis to be per- Program staff, including administration, ticing physicians and that the 1970 physi- formed by the Allegheny County Health consultation, project development and cian-to-population in Southwestern Texas Department and the University of Pitts- management, evaluation, and so forth. was 1:1,017. This past year the University burgh Health Center. Operational projects, on the other of Texas Medical School at San Antonio * A small but growing number of Pro- hand, are those activities conducted by announced establishment of the State's grams (e.g., Wisconsin, Tri-State, North- outside institutions and organizations but first bachelor degree program to train lands, Bi-State) are initiating contract supported totally or in part by RMP grant physicians assistants. programs in specified problem areas to funds. Each such activity must go through The Maryland RMP was a co-sponsor encourage feasibility studies and pilot the Program's review process and be ap- projects, The Wisconsin RMP, for ex- proved by the Regional Advisory Group. of a recent Evaluation of Emergency Med- ample, announced such a program solicit- with 54 Regional Medical Programs now ical Resources Seminar in Baltimore con- ing proposals in three areas-sharing of in operational status, fiscal year 1972 ducted with the cooperation of the Mary- . wed a total of over one thousand op- resources or services by two or more sno land Hospital Association. This recent hospitals, development of health services erational projects supported with $76 study identified 16 specific findings and f.or medically deprived areas, and pre- million dollars in RMP funds. corresponding challenges in non-linked ad.mission testing. The total available was here has been a marked expansion services now available, and has recom- $100,000. Like Wisconsin, most Programs in both the level and scope of RMP op- mended an initial plan of action. that have initiated similar activities are erational activities during fiscal year 1972, setting relatively modest amounts aside as well as a fairly emphatic change in FEASIBILITY STUDIES: for this purpose from funds budgeted for tneir nature. Expansion in the level of program activities. activities was a direct result of the sig- Eight seniors studying medicine, nurs- nificant increase in grant funds available ing and pharmacy at the University of as compared to prior years; expansion in New Mexico School of Medicine last year scope and change in nature reflect a con- formed a Rural Health Committee to tinuing trend which has become increas- address the dual problem of providing ingly evident during the last several years, comprehensive health care throughout Implementation and Progress- that of a comprehensive approach to med- the state while at the same time obtain- Operational Activities ical care and its delivery. This section ing clinical experience. Initial financing by deals with such activities and presents the New Mexico RMP has enabled the some indications as to their success in Committee to open and work in a small Once a Regional Medical Program has terms of national and local objectives. clinic in Hatch, a small town having no achieved operational status, awarded They are described in-a number of ways, physician. grant funds are allocated for both pro- including (1) functional emphasis (con- 24 PROGRAM ACTIVITIES tinuing education, organization and de- Research and Development: Activities gation of prototypes for new systems, livery of patient care, etc.), (2) disease which emphasize the testing or investi- processes, techniques, etc. focus, (3) priority concerns, and (4) re- investment of RMP funds. FUNCTIONAL EMPHASIS OF OPERATIONAL PROJECTS, FISCAL YEARS 1969-1972 FUNCTIONAL EMPHASIS: RMP opera- 100 General Continuing tional activities are described according Education to major functions as follows: Improving Manpower Productivity and Distribution: Pertains to those activities 80 which emphasize: (1) upgrading the per- Manpower Productivity formance of existing personnel through and Utilization addition of new skills and (2) expanding the manpower pool through the develop- 60 ment of new categories of health and allied health professionals, training of new health personnel, and recruitment or reactivation of health personnel. 40 General Continuing Education: Those Organization for activities aimed at either providing or Delivery of Patient Services studying some aspect of continuing edu- cation. General continuing education is 20 defined as education above and beyond what is normally considered appropriate for qualification or entrance into a health or health-related profession. Continuing Research and Development education programs are generally de- 0 FY 1970 FY 1971 FY 1972 signed to maintain or improve the level Percent ($55.2M) ($45.3M) ($76.5M) of practice of the health professional. o Organization for Delivery of Patient Highlights Services: Activities which relate directly to patient care delivery through demon- Emphasis on continuing education activities continues to decrease, from strations of new techniques, development approximately 21% of total funding in FY 1970 to only 16% in FY 1972. and demonstration of organizational mod- o At the same time that education and training activities have shown a decrease, sup- els for delivery, and improving coordina- port of patient care demonstration programs has increased by over four million dollars tion of patient services. in the three year period. PROGRAM ACTIVITIES DISEASE FOCUS: Perhaps one of the same was true of only 31% in FY 72. Data Manpower development, distribution, and major indicators of Regional Medical presented below describe the trend away utilization-RMP emphasis in terms of Programs' changing mission is the rather from RMP sponsored education programs education and manpower has undergone marked decrease in specific categorical in specific categorical disease areas: considerable change in the recent past. disease targeted activities. The over- Programs aimed at providing continuing whelming percentage of operational funds education (primarily for physicians and in fiscal year 1972 was allocated for ac- Percentage of Persons Trained by nurses) are now being considered in tivities which dealt with health care or Disease Category terms of health service needs. Those pro- delivery systems in general, rather than Fiscal Years 1969-72 grams designed to upgrade nursing and with specific disease entities. The only allied health personnel through the addi- exception to this was in activities directed Disease Category FY 69 FY 70 FY 71 FY 72 tion of skills and to create, train, and toward kidney disease, whose proportion- utilize new categories of personnel are ate share of total operational funds has Heart disease 46% 48% 49% 31% increasing. Over 20% ($17 million) of op- doubled since last year. The following Cancer 4 7 7 7 erational funds during the past year were - Stroke 8 13 10 12 table presents highlights of this trend Related diseases, allocated for utilization and development over the past five years: including Kidney 8 15 10 6 activities, as opposed to the $12 million Multicate@orical or not targeted for continuing education. In ad- related to specific dition, health professionals receiving Percentage of funds disease entities 34 17 24 45 these kinds of training services (addition Disease Category FY 68 FY 71 FY 72 TOTALS 100% 100% 100% 100% of new skills or training in new profes- sions) reached a high in FY 72 of almost Heart disease & hypertension 34% 26% 10% 62,000-a fivefold increase over the FY 69 Cancer .. ............ ... 9 13 .... @. 9 level. The following examples are illus- Stroke .. ............. ....... 12 12 ......... 5 Kidney disease 4 ., 8 PRIORITY CONCERNS: trative of typical RMP efforts in this area: Related diseases 8 6 ... 7 N Availability and Accessibility of Health In Syracuse, New York, the Central Multicategorical and/or 37 .... .36, 61 comprehensive Care: Regional Medical Programs are sup- New York RMP has provided a grant to TOTAL loo% loo% ioo% porting a wide variety of activities aimed a community hospital for the conduct of at increasing the availability and accessi- a seven-month course for registered bility of health care. They address such nurses; the course has as its objective the In noting the numbers of health profes- problems as the acute lack of health availability of health care services to sionals and others receiving educational manpower and services in rural and areas with inadequate physician coverage services through RMP operational funds, inner-city areas; the poor utilization of by teaching nurses how to render pri- one can again see a continuing deempha- physicians and allied health manpower in mary patient care. sis on categorical disease areas. For ex- most medical trade areas; and the un- ample, while 51% of those receiving serv- even availability and accessibility of Pediatric nurse practitioner and nurse ices in FY 68 were trained in coronary care health services, again most scarce in clinician programs are being started and other heart disease programs, the rural and inner-city areas. with RMP financial and other assistance 26 PROGRAM ACTIVITIES in a number of Programs, such as Cali- signed to build a prototype model where- doing, the project provides rural com- fornia and Kansas; in the latter instance, by the new low-cost testing and follow-up munities and community hospitals with it was determined by survey that most procedures can be made available to all access to health science students and a physicians preferred to hire nurses re- black people within a community. means of attracting them to careers in trained for expanded assistant roles 9 The people of some three communities rural medicine. rather than ex-medical corpsmen or in northern New Mexico have set up clin- At the same time, this program provides newly trained personnel. ics designed to bring medical care direct- health science students with firsthand * Part of the stroke program of the ly to the poor of the towns and remote exposure to primary care and to health Puerto Rico RMP trains high school mountain villages in the area. Special care settings not currently utilized in graduates to become "Assistentes de courses in emergency medical care pro- their formal clinical curricula. During the Salud Familiar." Their mission is to help video by the New Mexico RMP train com- summer of 1971, the Rural Externship the patient maintain good health and munity members to be self-reliant in Program placed 22 students in 11 com- bring together the patient and the com- treating illnesses and accidents. The New munities in outlying areas of the region. munity in cooperation with health pro- Mexico RMP's "Operation Home Run" in During the eight weeks they spent on fessionals. Santa Fe has provided surplus medical assignment, the students were exposed to equipment to La Clinica de la Gente, the over 50 professional preceptors. It is an- Minority populations, inner-city, and rural first full-time outpatient clinic of its kind ticipated that the program will be ex- areas: In fiscal year 1972, activities direc- in that city. panded to 50 students during the next ted at special target populations such as 9 The California RMP has awarded funds phase of operation. Blacks, Spanish-Americans, and Indians to the Central Valley Indian Health proj- more than doubled, from 46 projects and ect to improve health care services for N Quality of care: Improvement in the $5.4 million to 147 projects with $17 mil- 2,000 rural Indians. Part of the money quality of health services provided has lion in RMP funding. Some examples of will be used to equip health aids with been addressed by the Regional Medical RMP activities targeted for these under- shortwave radios to improve communica- Programs since its establishment in 1966. served groups follow: tions between the isolated Indians and The primary focus has been on the indi- o More than 5,000 black children in physicians located at Valley Medical Cen- vidual patient encounter and improving Grand Rapids, Michigan have been ter in Fresno. quality of services provided through such screened in a free program of testing for o Under the sponsorship of the Lakes individual encounters. the crippling fatal disease of sickle-cell Area RMP in Western New York, the Rural anemia, a hereditary condition which Externship Program has become an ef- Provider education: The primary means primarily attacks black people. Begun 16 fective means of directing health man- of accomplishing this task has been months ago, the tests are part of a dem- power toward delivery of primary care in through RMP continuing education ef- onstration program funded by a grant underserved rural areas, The program forts: during the past year alone, regis- from the Michigan RMP, The project also places teams of health science students trations in RMP-sponsored courses, work- provides screening for relatives of car- from a variety of disciplines in a number shops, and seminars of this type totaled riers, as well as genetic counseling for of rural health care settings for a period over 132,000. During the same period, affected families. The total program is de- of eight weeks during the summer. By so RMP teleconferences and other rapid 27 media educational programs reached a ing in small towns and isolated rural education unit was also designed to help total audience of 37,000 individuals. areas of Alabama have instant access to patients and their families learn to cope specialists at the University of Alabama with long-term effects of stroke disability. Continuing education efforts have been in Birmingham through the MIST. Calls Operating in 19 counties, this program, concentrated on upgrading skills and can be placed free of charge from any funded by the North Carolina RMP, has knowledge in areas of identified defi- point in Alabama, at any time of the day resulted in a decrease in mortality, fewer ciency. In New Mexico, which is the first or night, on the MIST circuit. MIST has in-hospital complications, shorter hos- state to make relicensure for physicians not only served as a prototype for similar pital stay, and reduction in hospital contingent on formal credits, the New programs in other RMPS, but has been charges. Mexico RMP is developing three types of duplicated in the form of "Medicall," the That improvement in the quality of continuing education programs designed first nationwide, low-cost telephone con- care can reduce mortality has also been to assist the physician in fulfilling the sultation service available to every U.S. shown in New York, where the New York mandates of the new law. The New Mex- physician. Metropolitan RMP, in cooperation with ico RMP is one of a few agencies in the I-Icirleiii Hospital, has undertaken a pro- state with an active, viable program of gram for stroke management in the inner- continuing education. Most of its pro- Quality of health services: Efforts to im- city area. Coupling a comprehensive pre- grams, which are given in communities prove the quality of health services de- vention and treatment program with a de- throughout the state, are designed to be livered have centered on patient care tection and information effort in the com- practical in nature, making liberal use Of demonstrations involving innovations in munity, the preliminary mortality rate of case material and often incorporating health care patterns. Between fiscal years those brought to the hospital suffering actual patient visits. Physicians have 1971 and 1972, patient care demonstra- from stroke has dropped from 48% to found the follow-up program with current tion projects (operational activities) rose 27% in the nine months since the proj- patients most helpful, and are able to from 150 and $15.4 million to 250 and ect's inception. relate what was presented directly to $31.4 million, an increase of over 100 patient care. percent. Some of these efforts have clearly REINVESTMENT OF FUNDS: Communications systems: In order to pro- demonstrated that early, continuing care vide medical information which is needed can pay dividends. In North Carolina, for The concept of time-limited support has quickly, a variety of communications sys- example, a Comprehensive Stroke Pro- always been central to Regional Medical tems' have been supported. These ac- gram was initiated which included among Programs. This concept embodies the tivities, such as dial access, usually in- its range of activities the publication of idea of "seed money," or RMP investment volve a system through which a health guidelines for community stroke pro- in a specific activity only for the period professional (normally a physician or grams, educational activities such as of time necessary to get it begun and ac- nurse), may request information or medi- training programs for nurses, annual cepted by the community. The extent of cal consultation via telephone. In Ala- stroke workshops, and stroke consultation incorporation of RMP funded activities bama, for example, a Medical Information service for physicians through the co- within the regular local health care fi- Service Via Telephone (MIST) has been operation of the neurological staffs of the nancing system, therefore, has become a initiated by the RMP. Physicians practic- three medical centers. A family-patient significant measure of RMP effectiveness. 28 PROGRAM ACTIVITIES -National policy mandates termination A comprehensive Regional Radiation significance of evaluation activities in the of RMP support after a three-year period, Therapy Program for the St. Louis area, past two years. A recently completed although allowances of up to 24 months which includes training of radiation the- study of the evaluation function in the after that time are made to ensure order- rapy technicians, radiation planning and RMPs provides the following information: ly termination or "phasing out" of proj- physics services, and multidisciplinary ects. An analysis of terminated activities cancer conferences, was initiated several Fifty-three of the 56 RMPs have an made in the spring of 1971 indicated that years ago with monies from the Bi-State Evaluation Director. About half of the only about 40% of RMP-initiated opera- RMP. It will be continued with support Directors hold a doctorate and most of tional programs had been ended within from multiple sources. These include con- the others a masters degree. Over 40% the @pecified time limit; it did suggest, tributions from each of the nine partici- have backgrounds in the social and be- however, that most of those phased out pating hospitals, tuition fees, and third havioral sciences, 15% in education and were being continued by other health or- party payments which will largely offset slightly over 10% in medicine or public ganizations or groups. the continuing consultation and therapy health. In addition to the Evaluation Di- There are indications that this earlier planning costs. rectors, there are an additional 110 pro- performance has improved considerably fessional evaluation staff in the 56 RMPS. during the last year and a half. Based In many cases, of course, RMP activities About 90% of these additional staff mem- upon data available from recent reports are deliberately discontinued with no bers are full time and 80% have been from about one-third of the Programs, it further funding sought from within the trained in the behavioral or social is estimated that RMP support, in dollar community. Because of the RMP nature, sciences. terms, is being phased out within three that is, to a large extent one of demon- o It is estimated that in 1971, $3.5-4 mil- years in some 75-80% of all operational stration and testing, evaluation of some lion was spent for evaluation activities projects. These same data indicate, again activities proves them to be either of little with an additional $1.5 million or so ex- in terms of dollars, that roughly 60% of value in meeting health care needs or pended for the collection and analyses of those projects from which RMP grant sup- unsuccessful in terms of achieving their health and demographic data. This con- port is being withdrawn will be continued stated objectives. In other instances, ac- stitutes about 10% of the total program from other sources, at approximately 80% tivities may have time-limited objectives, staff budget. of their RMP funding level. which, once met, do not call for con- 9 Nearly all the present RMP evaluation A multiplicity of these other sources tinuation. efforts and activities are directed at as- is involved; they include in-kind as well sessing operational activities and proj- as dollar support, as noted in the ex- Evaluation ects. There is, conversely, little evaluation amples below: of program staff activities. o The Progressive Coronary Care Pro- gram, supported for three years at an Evaluation is used by the Regional Medi- o Certain promising new aproaches and annual cost of approximately $100,000 by cal Programs to measure progress and techniques are being tried by a number the Northern New England RMP, is being impact and as a tool to aid management of RMPS. Project site visits and evalua- continued with joint funding from partici- in decisionmaking and future planning. tion committees, for example, are being pating hospitals and the Vermont Heart The increased pressure to demonstrate utilized increasingly. These and other de- Association. accomplishments has heightened the vices may prove helpful in tying evalua- ,)a tion more closely to regional decision- of a Management Evaluation and Report- making. ing System for RMPS. This system will be 9 Total program evaluation as opposed modified and installed in an additional to the evaluation of individual projects, nine Regions during fiscal year 1973. though actually being implemented in o The development and field testing in only a few RMPS, is in the developmental eight Regions of a problem-oriented ap- stages in many Regions. proach for program evaluation. This Regional Medical Programs Service Information Support System for Manage- and various RMPs are also working col- ment, Control, and Evaluation of RMPs laboratively in several areas related to was developed under contract by the Cen- evaluation; these include: ter for Community Health and Medical a The development of an Ad Hoc Evalua- Care at Harvard. It seeks to evaluate tion Group (composed of Evaluation RMPs in terms of the relevance of their Directors and Program Coordinators) activities to locally identified priority which meets with the staff of the RMPS problems, the geographic scope of those Office of Planning and Evaluation to dis- activities, and their impact. The approach cuss mutual problems and to share ex- and methodology developed will be dis- periences in evaluation activities. seminated through a series of seminars 9 The development, under contract with for key RMP staff. RMPS, by the Washington/Alaska RMP 30 I I I i i I I i I t(tUIUNAL Organization and Functions Staff The Regional Medical Programs Service (RMPS), including both its employed staff and Office of the Director: establishes objec- its voluntary structure, has several major responsibilities. Specifically, these include: tives and policies and directs the activi- (1) development and coordination of policies affecting conduct of the program; (2) over- ties of the Regional Medical Programs all guidance and direction of both the Service and its RMP components; (3) monitoring Service; develops and coordinates policy and evaluating the performance of RMPS; (4) accountability for RMP to Congressional and operational relationships with public and other interests for purposes of budgetary and legislative extension; (5) technical and private organizations which support and professional assistance to RMPS; and (6) the determination of RMP funding levels. and carry out health programs related to Interrelation of the various RMPS components can be seen from the organization the objectives of the Service; and estab- chart below: lishes and maintains liaison with leaders in the medical community, state and local officials, and members of Congress Deputy OFFICE OF THE DIRECTOR directly related to this mission. Equal Employment National Opportunity Office Advisory Council Office of Administrative Management: plans, directs and evaluates the adminis- trative management activities of the Service; develops and implements man- agement policies, procedures, and sys- I Review Committee tems; provides guidance to the staff of the Director of HSMHA's Office of Finan- cial Management, including program policy interpretation in budget formula- tion and execution, preparation of pro- gram planning and budgeting data, and Office of the financial management of grants; and Off ice of Communications Office of Office of Planning serves as the focal point for liaison with Administrative Systems officials of the Office of the Administrator and Public and Evaluation Management Information Management and the Office of the Secretary on finan- I cial, personnel, organization, supply, con- F- tracts, and other management matters. Office of Communications and Public Division of Operations Division of Professional Information: advises the Director on and Development and Technical Development policies and activities dealing with com- munications and public information de- Functions of the individual units within RM PS vary widely. Briefly, these may be de- signed to achieve Lmderstanding and scribed as follows: acceptance of the objectives and ac- 32 REGIONAL MEDICAL PROGRAMS SERVICE tivities of the Service; directs staff in and evaluation offices of the Administra- ordinates a program of continuing educa- developing programs and plans for effec- tion and the Department; formulates and tion and pilot demonstrations directed tive liaison with representatives of the articulates program goals and objectives toward improving the availability and national news media and other informa- for the Director; performs long and short- quality of the health care system; aids in tion outlets, including those at the Federal range planning, and conducts and directs the continuing development and opera- level and those of the national voluntary program evaluation studies; collaborates tion of Regional Medical Programs health and health-related organizations; with counterpart offices and budget and throughout the Nation through profession- maintains liaison with the information fiscal offices in development and imple- al and technical assistance and project staffs of the Regional Medical Programs mentation of the Department's Program review; develops, tests, and evaluates to ensure the development of an inte- Planning and Budgeting System; and methods of disseminating and applying grated effort for the achievement of monitors planning and evaluation activi- knowledge; promotes the application of maximum understanding, acceptance, ties of Regional Medical Programs and, the 'latest techniques in the health care and support for all Regional Medical Pro- upon request, provides technical advice field; develops and coordinates a program gram related efforts. and assistance to them on these program of demonstrations which will lead to im- Office of Systems Management: plans, aspects. provement in the availability and quality develops, and coordinates the Service's of primary health care; and supports con- management information system, includ- Division of Operations and Develop- tinuing education and the development ing data obtained from applications, ment: promotes and sustains, through and utilization of allied health manpower. awards, contracts,, progress reports, and professional advice and assistance to other documents; conducts statistical Regional Medical Programs: development analyses and assists components of the of cooperative arrangements for the re- Voluntary Structure Service by collectin and analyzing speci- gionalization of health resources; en- 9 fic data required for planning, evaluation, hancement of the capabilities of providers program development, and grants and of care at the community level; and im- National Review Committee: reviews contract review; provides computer pro- provement of the quality of health care RMP grant applications and makes recom- gramming and tabulating services for the and the strengthening of the health care mendations to the National Advisory Service; develops and coordinates Serv- system throughout the nation by placing Council with respect to approval and ice-wide programs for determining the special emphasis upon communication appropriate funding levels. Composed of requirements for and the utilization of and cooperation with the professional leaders in medicine, health, and other Automatic Data Processing equipment; sector. This Division is composed of five related fields, this body provides the ma- and upon request, provides the regional branches: Grants Management, Eastern jor analytic review of applications, utiliz- organizations with technical advice and Operations, South Central Operations, ing in its review the RMPS review criteria assistance in data systems design. Mid-Continent Operations, and Western for establishing the relative merit of indi- Operations. vidual RMPS. In addition, the Committee Office of Planning and Evaluation: pro- may make recommendations to the vides primary staff support to the Di- Council re,,,7arding the approval and spe- rector on program planning and evalua- Division of Professional and Technical cial funding of project applications for tion and maintains liaison with planning Development: plans, develops, and co- nationally earmarked funds. National Advisory Council: (1) provides gram Coo,-dinator) has made clear thal of a long-range "life plan" approach for assistance and advice in the preparation the Regional Advisory Group, rather than dealing with the major problems repre- of regulations for and policy matters aris- the grantee institution, has responsibility sented by the 8-10,000 new patients af- ing with respect to the administration of for the determination of Program direc- flicted with end-stage kidney disease Regional Medical Programs, and (2) tion, scope, and priorities. Secondly, every year, The principal aim of the "life makes recommendations to the Director, RMPS has undertaken an investigation of plan" approach is the efficient linkage RMPS, concerning approval and funding the adequacy of the individual review ard orderly growth of scarce resources of RMP grant applications. In reviewing processes in the various RMPS. Having throughout the United States. The pro- applications, the Council considers the developed a series of criteria for assess- gram guidelines developed by RMPS and appropriateness of proposed programs ing these processes, the Service is now approved by the National Advisory Coun- and their consistency with RMPS policies. in the process of visiting all RMPs for cil seek to exploit the opportunities for purposes of verification and certification regionalization of end-stage kidney dis- of systems in use. ease programs without sacrificing quality and accountability. These guidelines re- Highlights of Fiscal Year 1972 RMP REVIEW CRITERIA: In an attempt quire, that in order to be eligible for grant to strengthen its own review and approval support, RMP-proposed activities should process, RMPS has developed a set Of include certain specified components DECENTRALIZATION: During the past national review criteria aimed at assess- such as early identification, rapid refer- year major steps have been taken toward ing the individual Regional Medical Pro- ral, adequate organ procurement and the further decentralization of decision- grams. These measures attempt to evalu- preservation facilities, etc. making authority from the national ate an RMP in the three major areas of The advantages of such an approach (HSMHA/RMPS) to the local (RMP) level. performance, process and structure, and are multiple: it would allow patients to Each Program now has sole responsibility quality of the current proposal. Staff, site have access to conservative treatment for both determining technical adequacy visitors, and the National Review Corn- before kidney function stops; it would of activity proposals and priority funding miftee utilize these measures (as simplify and expedite organ procurement; of approved proposals. Further, this de- weighted) to arrive at an overall Program and it would ensure that almost all oa- cisionmaking power has been vested en- score which permits qualitative ranking tients will be involved in dialysis outside tirely in the Regional Advisory Group of of RMPS; these rankings, in turn, assist of the hospital. each Program-only this body has final in determination of Program funding decisionmaking authority on program levels. EMERGENCY MEDICAL SERVICES: concerns of the RMP. Emergency medical services (EMS) was The role of the Regional Medical KIDNEY DISEASE LIFE PLAN: In fiscal highlighted as a national health priority Programs Service in the decentralization year 1972, Regional Medical Programs in the President's Health Message in process has been on several levels. First, became increasingly concerned with the January 1972. Regional Medical Programs the issuance of an official policy state- development and implementation of Service had responsibility for developing ment regarding the respective responsi- regionalized, end-stage kidney disease guidelines for RMP proposals in this area, bilities of the Regional Advisory Group, programs. At the national level this was and did so early in the,,@alendar year. By grantee, and Chief Executive Officer (Pro- reflected in the development, by RMPS, the end of the fiscal year, in fact, 36 34 REGIONAL MEDICAL PROGRAMS SERVICE RMPs had responded with over 50 EMS proposals. The rapidity of response was due in large part toRMPS assistance in the development of the various proposals. The Service is now in the process of de- veloping and designing measurement tools for evaluating RMP Emergency Medical Systems programs across the nation. GLOSSARY Such a grant includes funds for only pro- Sources and Timing of Data gram staff activities and does not au- thorize awards for operational projects. An Consumer: a person involved in the health RMP achieves organizational status at the Information presented in this Fact Book care system as a recipient rather than time of the initial organizational award. was extracted primarily from Regional provider of heajth care services. Parity: as used in this report, it refers to Medical Program grant applications and Local advisory group: a consortium of the relationship between persons affiliated progress reports. Other sources of data health care providers and consumers re- with the RMP and the minority population include 1) RMP grant award statements; siding in a geographic subsection of a in the Region. Parity is reached when 2) vignettes of program activities sub- Region and brought together by the RMP minority involvement (employees and mitted by RMPS, and 3) the RMPS Annual for advice concerning program needs, volunteers) is equivalent in percentage Report to Congress (fiscal year 1972). priorities, and plans. terms to the proportion of minorities in a Unless otherwise noted, data presented Operational activity: a component (proj- given Region or the nation as a whole. are current as of June 30, 1972. ect) receiving RMP support and carried Project Staff: persons responsible for the out by another institution or organization conduct of RMP operational activities with RMP grant funds. who are employed by the sponsoring in- Operational grant/status: f u n d i n stitutions or organization rather than by the RMP itself. awarded by Regional Medical Programs Service to an RMP for the actual opera- Provider: a person whose career or occu- tion and implementation of the Program. pation concerns the organization, financ- An operational grant includes funds for ing, or delivery of health services; re- both program staff activities and opera- search in medical or health sciences tional projects. An RMP is considered to fields; and/or education in medical and have achieved operational status at the related sciences. time of the initial operational award from Regionalization: linkages established RMPS. among health care institutions and in- Organizational grant/status: f u n d i n g terests in a given geographical area for awarded by Regional Medical Programs the purpose of improving the personal Service to an RMP for the initial organi- health care system. zation and development of the Program. 36 The Fact Book was prepared by the Office of Planning and Evaluation with informa- tional assistance from the Office of Sys- tems Management and the Division of Operations and Development. Graphic services were provided by the Office of Communications and Public Information. tions concerning Comments and sugges this publication are welcomed and should be addressed to: Evaluation Branch Office of Planning and Evaluation Regional Medical Programs Service Health Services and Mental Health Administration 5600 Fishers Lane Rockville, Maryland 20852 Additional copies may be obtained by writing: Office of Communications and Public Information Regional Medical Programs Service 5600 Fishers Lane Rockville, Maryland 20852 I