. . I -i i@ i , ji iii I 11 illitli ;!i@illiii no . i. 6 OUESTIONS FOR DR. WILSON 1. Dr. Wilson, can you tell us about your own involvement with Regional Medical Programs (RMPs)? 2. What can you tell us about the intellectual and political origins of the RMP program? How and why did the program as it emerged differ from the recommendations in the DeBakey report? 3. What do you think were the major accomplishments of RMPS? What specific aspect were you personally most pleased with? 4. Why was the RMP program moved in 1968 from NIH to HSMHA, an agency that you headed from 1970 to 1973? 5. What can you tell us about why and how RMPs were terminated? 6. How did RMPs relate to other programs designed to integrate health care activities, such as Comprehensive Health Planning? 7. What can we learn from the RMP experience? 8. Is there any other point that you would like to make concerning RMPS? GENERAL STATEMENT TO OPEN WILSON INTERVIEW This is Dr. Donald Lindberg, Director of the National Library of Medicine in Bethesda, Maryland. The interview that I am about to conduct is one of a series of interviews designed to record and document the history of Regional Medical Programs. With me in the NLM studio today, July 24, 1991, is Dr. Vernon E. Wilson. Background for Wilson Interview Dr. Wilson was Administrator of the Health Services and Mental Health Administration (HSMHA) in HEW, 1970-73. He also served as the first Program Coordinator of the Missouri Regional Medical Program (established in 1966). He served under two Secretaries of HEW: June, 1970 - October, 1972 Elliot Richardson From November, 1972 Caspar Weinberger House RMP Oversight Hearings held May 8, 1973 Attachments: American Men and Women of Science biographical sketch of Wilson Copy of his presentation on "Program Evaluation" at the 1967 Conference on RMPs u'; -@'@@,-Xubur@Univ, 75-80; vpres agr, home econ & vet mect, bu_, @r Exi) DcgEM GENETICS, NAT HEART, LUNG & BLOOD INST, decomposition; rubber and inorganic chemistry. Mailing Ad& 7 Rockbrook STS HEALTH, BETHESDA, MD. Mem: AAAS; Genetics Soc Am; Dr Camden ME 04843 ;@i Asn; Am Soc Animal Sci; Am Genetic Asn. Res: Selection studies WILSON, THOMAS PUTNAM, b New York, NY, Sept 4,18; m 44,80; c 1. alium, mice, poultry and swine; effects of mating systems on selection HETEROGENOUS CATALYSIS. Educ: Amherst Co], BA, 39; Harvard tic parameters. Mailing Add: Nat Heart Lung & Blood Inst NIH Bldg Univ, PhD(chem physics), 43. Prof Exp: Res chemist, Manhattan Proj, M W Rockville Pike Bethesda MD 20205 Kellogg Co, NJ, 43-44; res chemist, Kellex Corp, 44-45; res chemist, Manhattan Proj & S A M Labs, Chems & Plastics Div, 45-46 & 46-62, asst STEPHEN ROSS,.B Oklahoma City, Okla, Mar 13,46; m 67; c 2. dir res, 62-72, res assoc, 72-73, CORP RES FEL, RES & DEVELOP DEPT, ETIC ORGANIC CHEMISTRY. Educ: Rice Univ, BA, 69, MA, 72, ETHYLENE OXIDE/GLYCOL DIV, UNION CARBIDE CORP, 73- chem), 72. Prof Exp: NIH fel org chem, Calif Inst Technol, 72-74; Mem: Am Chem Soc; Catalysis Soc. Res: Kinetics and catalysis; catalytic org chem, Ind Univ, Bloomington, 74-78, assoc prof, 78-80; ASSOC reaction mechanisms; ethylene polymerization; catalyst development and @RG CHEM, NY UNIV, 80- Concur-rent Pos: Sigma Xi res award, characterization. Mailing Add.- 701 Myrtle Rd South Charleston WV 25314 v, 72. Mem: Royal Soc Chem; Am Chem Soc. Res: Development of )roaches to the synthesis of naturally occurring compounds of WILSON, THORNTON ARNOLD, b Sikeston, Mo, Feb 8, 21; m 44; c 3. .1 significance, and the structure elucidation and total synthesis of AERONAUTICS. Educ: Iowa State Col, BS, 43; Calif Inst Technol, MS, 48. ;tances. Mailing Add: Dept Chem NY Univ Washington Square New Prof Exp: Mem staff, 43-57, asst chief tech staff & proj eng mgr, 57-58, vpres 10003 & mgr Minuteman br, Aerospace Div, 62-64, vpres opers & planning, 64-66, exec vpres & dir, 66-68, pres, 68-72, CHIEF EXEC OFFICER & CHMN BD, STEPHEN W, b Hackensack, NJ, Feb 6, 52; m 731- c 1. BOEING CO, 72- Concurrent Pos: Sloan fel, Mass Inst Technol, 52-53; mem OMY OF PLANTHOPPERS. Educ: Rutgers Univ, BS, 73; bd gov, Iowa State Univ Found. Mem: Nat Acad Eng; fel Am Inst Aeronaut st Mo State Univ, MA, 75; Southern III Univ, PhD(zool), 80. Prof & Astronaut. Mailing Ad& Boeing Co PO Box 3707 Seattle WA 98124 , ,t prof biol, Calif State Univ, Chico, 80-82; asst prof, 82-85, ASSOC WILSON, TIMOTHY M, b Columbus, Ohio, Aug 3,38; c 2. SOLID STATE !OL, CENT MO STATE UNIV, WARRENSBURG, 85- Mem: PHYSICS. Educ: Univ Fla, BS, 61, PhD(chem physics), 66. Prof Exp: Fel oc Am. Res. Systematics and ecology of planthoppers (Homoptera: solid state physics, Univ Fla, 66-68, asst prof chem, 68-69; from asst prof to lea) with emphasis on Delphacidae. Mailing Add: Dept Biol Cent assoc prof physics, 69-78, asst dir exten, Col Arts & Sci, 77-79, assoc dir ,- Univ Warrensburg MO 64093-5053 . exten, 79-82, PROF PHYSICS, OKLA STATE UNIV, 78- Concurrent Pos: Res staff mem, Solid State Div, Oak Ridge Nat Lab, 74-75. Mem: Am Phys STEVEN PAUL, b New Castle, Pa, Oct 12, 50; m 72; c 1. Soc; Sigma Xi; Am Asn Physics Teachers. Res: Theoretical studies of the CHEMISTRY. Educ.- Univ Pittsburgh, BS, 72; Duke Univ, optical and magnetic properties of impurities and defects in crystalline solids. -hem), 76. Prof Exp., Guest worker, Nat Heart, Lung & Blood Inst, Mailing Ad& Dept Physics Okla State Univ Stillwater OK 74078 -78, staff fel, 78-79; vis scientist, Dept Med Biochem, Wellcome Res rToughs Wellcome Co, Research Triangle Park, NC, 79-81; ASST WILSON, VERNON EAR@ b Plymouth Co, Iowa, Feb 16, 15; m 47; c 2. :-!S PROF, DEPT PHARM, DUKE UNIV MED C-TR, DURHAM, MEDICAL ADMINISTRATIO!4, FAMILY MEDICINE. Educ: Univ III, Concurrent Pos: Fel neurol, Sch Med & Dent, George Washington BS, 50, MS & MD, 52. Prof Exp: Asst pharmacol, Univ III, 50-52; intern, Univ 6-78. Mem: Soc Neurosci. Res. Biochemical aspects of Hosp, Chicago, 52-53; asst prof, Sch Med, Univ Kans, 53-59, asst dean sch ismitter secretion and synapse formation; regulation of med, 57-59, actg dean sch med & actg dir med ctr, 59; prof pharmacol, Univ imine and opioid peptide biosynthesis, neurobiology of adrenal Mo-Columbia, 59-70, dean sch med & dir med ctr, 59-67, exec dir health in cells. Mailing Add: Dept Pharmacol Box 3813 Duke Univ Med affairs, 67-68, vpres acad affairs, 68-70; adminr, Health Serv & Mcnt Health am NC 27710 Admin, Dept Health Educ & Welfare, Md, 70-73; prof community health, Univ Mo-Columbia, 73-74; vchancellor med affairs, Vanderbilt Univ, 74-81; THEODORE A(LEXANDER), b Elgin, 111, June 20, 35. RETIRED. Concurrent Pos: Exec officer, Mo State Crippled Childrcn's Serv, AUTICAL ENGINEERING, BIOMECHANICS. Educ: Cornell 60-68; mem exec coun, Am Asn Med Cols, 61-67; mem, Am Bd Family Pract, @IngPbysics, 58, PhD(aeronaut eng), 62. Prof Exp: Res scientist, 62-74; consult, USPHS, 65-69; coun mem med educ, AMA, 67-75; coordr, @rett Res Lab, 62-63 & Jet Propulsion Lab, 63-64; from asst prof to Mo Regional Med Prog, 66-68; mem coun fed relationship, Am Asn Univ, )f aeronaut & eng mech, 64-72, PROF AEROSPACE ENG & 68-70; ed, Continuing Educ for Family Physician, 73-75; mem liaison comt, UNIV MINN, MINNEAPOLIS, 72- Mem: Am Physiol Soc. Res: Grad Med Educ, 73-75. Mem: AMA; hon mem Acad Anesthesiol. Res: Renal )ry mechanics; acoustics; fluid mechanics. Mailing Ad& Dept of pharmacology; medical education; public health administration. Mailing Add: !e Eng & Mech Univ of Minn Minneapolis MN 55455 Box 196 Rte No I Ashland MD 65010 THOMAS EDWARD, b Chicago, 111, Feb 20, 42; m 66; c 2. WILSON, VERNON ELDRIDGE, genetics, phytopathology, see previous )NMENTAL & CHEMICAL ENGINEERING. Educ: edition ;tern Univ, BS, 64, MS, 67; III Inst Technol, PhD(environ eng), 69. WILSON, VICTOR JOSEPH, b Berlin, Get, Dec 24, 28; m 53; c 2. ): Asst prof environ eng, Rutgers Univ, New Brunswick, 67-70; NEUROPHYSIOLOGY. Educ:Tufts Col, BS, 48; Univ 111, PhD(physiol), 53. -T POLLUTION CONTROL & WATER TREATMENT, Prof Exp: Res assoc, 56-58, from asst prof to prof neurophysiol, 58-69, PROF 7-Y & HANSEN, 70- Mem: Am Inst Chem Engrs; Int Asn Water NEUROPHYSIOL, ROCKEFELLER UNIV, 69- Mem: Am Physiol Soc; Res; Water Pollution Control Fedn; Am Soc Civil Engrs; Am Water Soc Neurosci; Int Brain Res Org. Res: Organization and synaptic transmission sn; Sigma Xi. Res: Pollution control; advanced waste treatment; in the central nervous system, particularly the spinal cord and brain stem; @hemical treatment processes; solids and sludge disposal; industrial vestibular system. Mailing Add: Rockefeller Univ 1230 York Ave New York atment; treatment plant operations. Mailing Ad& 1527 E Fleming NY 10021-6399 ngton Heights IL 60004 WILSON, VINCENT L, CHEMICAL CARCINOGENESIS, GENE THOMAS G(EORGE), b Annapolis, Md, Jan 19, 26; m 49; c 3. REGULATION. Educ: Ore State Univ, PhD(pharmacol & toxicol), 80. Prof ,ICAL ENGINEERING. Educ.- Harvard Univ, AB, 47, SM, 49, Exp: SR STAFF FEL, NAT CANCER INST, NIH, 83- Mailing Add: Nat eng), 53. Prof Exp: Physicist, US Naval Ord Lab, 48, elec engr, US Cancer Inst NIH Bldg 37 Rm 2CO9 Bethesda MD 20892 s Lab, 49-53; mgr res & develop, Magnetics, Inc, 53-59; assoc prof, mn dept, 64-70, PROF ELEC ENG, DUKE UNIV, 63- Mem: Inst WILSON, WALTER DAVIS, b Merced, Calif, Oct 20, 35; m 59; c 3. Ilectronics Engrs; Sigma Xi. Res: Magnetic devices, materials and ATOMIC PHYSICS. Educ. Univ Calif, Berkeley, BS, 57, PhD(nuclear eng), i; nonlinear electromagnetics; energy conversion. Mailing Ad& 66. Prof Exp: Chem engr, Acrojet Gen Nucleonics, Calif, 58-59; mem tech ---Iec Eng Duke Univ Durham NC 27706 staff high-altitude nuclear effects, Aerospace Corp, 65-69; PROF PHYSICS, CALI@POLYTECH STATE UNIV, SAN LUIS OBISPO, 69- Concurrent POS: Tech consult, Sci Applns, Inc, Calif, 71-75. Mem: Am Inst Physics. Res: THOMAS HASTINGS, b Philadelphia, Pa, Jan 31, 25; m 52; c 2. LOGY. Educ. Univ Pa, MD, 48; Sheffield Univ, 51-53, High altitude physics, particularly electromagnetic field propagation, -hem), 53. Prof Exp: Instr physiol, Univ Pa, 49-50; instr biochem, chemistry and trapped radiation; plasma physics; nuclear reactor theory. iv, 56-57; assoc physiol, 57-59, from asst prof to assoc prof, 59-68, Mailing Ad& Dept of Physics Calif Polytec@U-niv San Luis Obispo CA 93407 IYSIOL, HARVARD MED SCH, 68- Mem: Am Soc Biol Chem; iol Soc; Brit Biochem Soc. Res: Active transport of materials across WILSON, WALTER ERVIN, b Salem, Ore, Apr 1, 34' RADIOLOGICAL :)ranes. Mailing Add: Dept of Physiol Harvard Med Sch Boston MA PHYSICS. Educ: Willamette Univ, BA, 56; Univ Wis, MS, 58, PhD(physics), 61. Prof Exp: RADIATION PHYSICIST, PAC NORTHWEST LABS - - @ .-. I 1. --- n__. C-1 D-@-I T I-;@, t I I Iniv Proceedings: Conference on January 15-17, 1967 U.S. DEPARTMENT Regional Medical Programs Washington, D.C. OF HEALTH, EDUCATION, AND WELFARE Public Health Service National Institutes of Health Division of Regional Medical Programs For Sale by the Superintendent of Documents, L). S- Government Printing Office, Washington. D. C. 20102 Price 75 cents (@)aper covers) Program Evaluation Vernon E. Wilson, M.D. Dean, School of Medicine, University of Missouri Program Coordinator, Missouri Regional Medical Program )Iva to The dilemma of a dean from the day We have already heard that the ap- ical of his appointment is to know when to pearance of the Regional Medical Pro- ility j hen to remain silent. grams through Federal legislation was speak out and w :'In Speaking requires at least an acknowl- a direct result of growing public and :hat edged topic and at best a brief, flavor- professional unrest centered around ful and meaty content. In pursuing the the slow rate at which new knowledge somewhat evanescent title assigned was being put to use. This concern is ility rids for this topic-which evolved from not unique to the health field but it ries "Program," to "Program and Evalua- Is new as a major emphasis among jec- tion," to "Program Evaluation," I must the concerns of the health care profes- )nal confess that the merit of silence sions. The agricultural and engineering loomed ever more attractive. experiment stations, long an integral red, ilch Since detailed discussion of technical part of the land-grant colleges, repre- of evaluation procedures would not be sent one attempt to deal with this appropriate under our limits of time, problem. The Engineers already have a let us compromise and discuss some t6rm for it. They label this activity the well known principles of program and, "transfer of technology." , for the health field, some relatively It would appear then that the special unused principles of evaluation. We will examine both in the light of bppor- mission of Regional Medical Programs tunities presented by the Regional Is primarily one of. research In the "distribution of health care" with the Medical Programs. focus placed firmly upon the patient's The challenge to Regional Medical Pro- needs, rather than upon those of the grqms, as I see It, is to demonstrate institution or the health professions. that this new endeavor, established primarily in behalf of heart, stroke, Until the early part of this century the cancer, and related diseases, Is more healing arts possessed a dismally than a static assemblage of existing small amount of scientific Information; resources. This In itself is a basis for consequently, the need was primarily very careful thought. Most of the prin- for basic medical knowledge. With the ciples and programs which can be con- momentum now established in basic sidered in the field of health and research we can give increased empha- health care have been studied by one sis to Indirect factors, such as popula- or another of the existing Govern. tion size, number of related organiza. mental, academic, professional or vol- tions and groups, Increased capabilities untary groups. Thus, at the outset It In communication facilities, -and an seems apparent that the aim of the ever accelerating rate of obsolescence Regional Medical Programs must be of knowledge. The magnitude of re,cent Congressional appropriations Indicates one of synthesis. an effort to combine the need for Immediate action. Addi- various factors into a whole these which will be greater than the sum of tional and similar legislation Is under the parts. serious consideration. The comprehen. -2 1 WWW academic step is the establishment of and those of the profession are not sive health planning act provides a professional and con- The first always the same. To accomplish our logical outlet for knowledge developed tributions; it will require a formal and need, either recognized or unrecog- extensive under Regional Medical Programs. scientific search for an appropriate re. nized. The next step, after the need is task we must now direct Thus, research being done in the more lationship between all academicians determined, is to define it and to study toward the patient and his needs limited field of Regional Medical Pro- and professionals whose skills can be create recognition of that specific need within the context of his normal pat- grams can be of value throughout the helpful. Concurrently, the integrity of in both the consumer and producer. tern of living. total health care field. the academic and research commu.ni- Here we have a direct parallel with the Professional action has classically Because of the large amount of time tY must be preserved, both as an in- opportunities open to Regional Medical been one of response, after the patient and money to be expended, realistic ternal system and as a part of society Programs. requests and is given access to the evaluation of the results is mandatory. at large. Thus, the analogy of market- ing is in all probability much more Having identified a specific need or formal health care system. We must Unfortunately, we are hampered by a needs, it is necessary to undertake now accept responsibility for health lack of effective measurement tools. than an analogy. It may prove to be basic and applied research in materi. care of the public as a dynamic, inti- We must start by using available and an actual pattern which will provide us als, resources and their synthesis. The mate part of daily performance. simple techniques, while admitting with illustrations and some basic prin- medical profession has expended pro- their inadequacies. It is essential that ciples for fruitful pursuit of the tasks portionately small amounts of its own Identification of needs for concentrat- collaborative research in system de. ahead. energies in the endeavor of synthesis ed research endeavors will require the sign for the distribution of health care and at the same time has frequently development of end points or goals ,be initiated in concert with those aca- The Distribution Process. As a layman against which the effect of change In demic disciplines which have a long in this special field, may I off@r the poorly utilized the contributions which qualitative performance can be meas- tradition in simulation, systems re oversimplified explanation that the could be made by other disciplines. ured. Unfortunately, at present, such search, and communications research, Production and distribution process Having completed the "basic" research end points are few and largely unpro- thus providing a base for continuin amounts to a coordination of many and formulated working models, the ven. analysis and measurement. g disciplines, assembled for the con, next step is the production and de. Most of the measurement systems cur, Existing resources for use in the tribution which each can make to a livery of materials and services which rently used in the health professions design of such systems are impres- single goal. While such grouping of re, may come from a variety of places. are quantitative rather than qualitative sive indeed. If one looks at the great sources, particularly in the research In the analogy the patient may move In nature. We can measure quite ade, array of governmental health agencies, process, suggests the antithesis of the to the resources, or the resources May quately deaths, morbidity, numbers ol traditional academic departmental or' be brought to the patient, but finally academic institutions, voluntary and ganization, the concept is not unfamil- the delivery process requires that the personnel, and similar items, but we professional groups. as well as sup- iar to academic institutions. It is end product of health care be synthe- have few means by which we can tesl portive organizations like welfare agen- exemplified frequently in institutes on sized in a coordinated and personalized the impact of health care upon thf cies, community action groups and university campuses, in land-grant ex- manner for the benefit of the consumer. daily performance of a given individual others, it readily becomes apparent periment stations, and . research Thus, our first requirement is for - that the major problem is not that of centers. These patterns allow m ny Market Identification. If we consider measurement system which can assesi creating resources which could appro- disciplines to proceed in a systematic health care in the light of the patient's the ability of the individual to perforn priately handle the problem but rather fashion in searching for new informa- need, recognized or unrecognized, the as a useful member of society and hil a coordination of those resources into tion and combining that information first painful but necessary step will be own attitude toward that performance an effective unit. Although to some the into an orderly whole. a shift in emphasis. Much basic re- Also required will be a measurement a comparison may be a bit unpalatable, search has been sponsored upon the the social or peer group's estimate o I submit that this is a market and dis- Taking the marketing analogy one step assumption that improvement of the the value of the individual's contribu tribution process and should be han- further, the rational distribution proc- professions and institutions will auto- tion to the group and their attitude dled as such. An approach of this kind ess would be simulated and developed matically benefit patients. However, it toward that contribution. No single on, does not deny the essential nature of as follows: may be that the goals of the patient of these factors can be used as th 22 d party in the in, A third problem concerns the obsoles- most iliol,ly motivate cellt mind. both as it relates to the about health is not ive assigned him nrot#-Ission itself and to the shed knowledge qi inte(i terchini;e. yet we h S. I stit)- 11,L,(Iical @ it is clear that assembled II those best ac I ost passive role. Patient large. sole parameter, but when utilized even by ,Helpless as SO(TIC public at cation for the n they should provide at Ia rich the "' continuing edu as a patter qualitative wit" it. Advertising research I Is tech- nlit- may lot be so planned, d the lublic is necessary. least the first steps In a of basic knowledge and ir practices would seem to imply profession an ial integral nt of health care. body s, or why Of O' .ology should be able A searching look at potent measureme n,ques dealing wittl facilitator product our friends in soci art of mar- one service or to help is here. tion of such education with the care Since diagnosis is also ap pei)ie choose another. These tools final phase of our called for. Feedback ,nosis Of' s opposed to sfully in in the fourth and process seems ket definition and since diap sed so succes e a variety Of )rob- d for a open" communications betNeen and analogy. we will fac mechanisms must be establishe ten sI individuals, early detec, and techniques u adapted in the delivery Of health care. progre sive analysis of cause and advertising could be public lems ntation of re-s professions ease would appear to be ashould be useful in broadening include impleme effect, or, at least, correlation between tion of dis for improve, personal responsibility These and development in dis, continuing education and change. logical first research effort f health care. education and search nts should have ac- t- ment in the distribution 0 in health care. tir analo- tribtition. All patie t source of care n system will 1 Such research avoids the necessity of Turning to the third item in o -A successful distribute ted information ing to do with jais and cess to the bes financial re r premature decisions hav gy, namely research in mater regardless of geography. self require an integ aould be derived f health care and would allow formation sh ommunications resources, we should comment lirst on sou rces, or special interests of particti- delivery 0 service. in a -,tooling- up" of the cmotional ten, basic research whicil has a long unt. tar professional grottos. New patterns from the home, from the avenue of system under reduced e foundation access to the health care system, the upport can be versitY tradition and is the h is con- are required. e large medical sion. Much diagnostic spractitioners upon which applied researc st all The relationship between centers of local hospital, and th provided to individual 11MO inimal change in their present ducted. Basic research in , celience and the population wilicil center. it will require the development with a m academic disciplines will make irnpor, ex will need to be of common identification systems and practice patterns. I 'ns to health care. HiPh they would serve f us hope that in tant contribut o search in izations which STIP- vocabularies. Many ity Status of the patient needs study. In on the list should be re defined. most organ deter- 0 e social secur iduais is heavily synthesis of systems, including model port health care use politically the very near future th f teraction between indiv the influenced by the status. stated and building. In our past, testing throtieh mined boundaries.i.e., City, number will be issued at the time o felt, of each person. We are proposing had little systematic and County, or State. The probability Of birth, or entry into tile country, and tatus of the pa. models hasa attention. It could gaining coordinated support from all will provide Stich identification. The maior changes in the s CoMprehensiv- r s as well interested organizations for the assist, ed information system should tient in the health ca e system. Thi savings in time. propos and method inter- 'lined to utilize. assist produce large as fundsi but will require the talents Of ance of a single and specific individual be dest- calls for a "shorthand woven into the system itself to assess a variety of existing discipiines-the will be enhanced by a maximum Over- refine present systems, not compete. .status, particu- ho until re- lap in geographical areas of designed with them. status, and change in engineers, for example, w tarry of the patient. cently were seldom formally invited into responsibil.ity. This is part ictllarly im- correl exists be, the health research conversation. portant in evaluation procedures. The decision for diagnosis and treat. An interesting. ation of re- which depend upon many prottl)s for iiient of tile patient will take into ac- tween the way we use the time m- An interesting facet of the dilemma their information. count his desires which. anionv. other others and our estimate of theirIlated to manpower shows in the f tliinUs. relate the distance from tly, accurate de- that act A second problem to be considered to the patient's knowl- portance. Cc)nsequen - the altlioilgil we are faced with a tre deals will, control- Should shelf dis. health care and fidence in the recom- termination of our expenditure of mendotis silortape of health personnel Ietige of and con e design of of national tonemPlOY- tribution systems be totally tinder iliL ended resource. Other considerations patient's time tlirotleh th and a low level ith professions? If n' ccessible, measure as a health care group have control of the tiea of the health care health services is a ment, we how milcil of the process should ire the adequacy eable and potentially valuable. r greatest po. not, to the patient and largely ignored one of ou ti,er resources, the cost patient himself. lie is be conducted in cooperation with ID maxt. field of knowledge tentials-tlie hoill(I con- tl'L' involved agencies, and the Another little used often tile Interested (,,rOLlf)S? Wileft S process :I(ivertisine re- usually the most involved, to them? intim benefit from the care snfi certainly the trot be turned 23 which includes such by-products as met by a specific answer to the ques- cause progress toward them can be integrated with detection and health education, research, and economic im- tion, along with additional synoptic measured. Their evaluation should give care systems. pact upon the community at large. background information or bibliogra- us some insiglit into whether or not 0 Lay health education will be a vital Finally, as we have already heard, n pliies which should be helpful in his we are Moving in the direction that part of the regional program. Existing 0continuing education. Such inquiries may be most effective in meeting the adult education and extension pro- matter how one may describe a Medi- will also serve as a guide to the physi- actual needs of patients. grams and activities of voluntary or- cal Region, it must interact with other cian's needs. In this manner diagnos- 0 The primary goal is to deliver the ganizations will be utilized so that the regions. Mechanisms must be devel- tic and delivery patterns of health care highest percentage of quality patient potential recipient of care may be in- oped which will minimize the mec@@ni, can quickly be modified in detail when care as close to the patient's home as formed as to the role which his physi- cal problems of interregional relation- research indicates the desirability of possible. This is not only economical cian, the hospital, and the various sup- ships and permit us to focus upon the doing so. in the total picture but in keeping with porting agencies will play and to the patient. the desires of most patients. CertAinly things which he, the patient, can ex- The Example. With no claims to as- The data handling facility developed at the latter assumption merits study. pect. We need more scientifically de- sured success, the Missouri Regional the University of Missouri for the pur- pose of extending the competency of 0 Every patient should have equal ac- signed studies of public attitudes to- @rogram has attempted to face these the physician will be integrated with cess to any needed national resource. ward health care. challenges in the planning process, cooperative data handling programs, For very special services which are not 0 Finally, in my view, a crucial goal Projects will arise from community established by hospitals, physician's available in the area, patients can be will be for each of the several regions ,groups and be funneled through aoffices, and state agencies. This inte- sent to centers of excellence else- to take a unique approach to the spe- refinement process. This should en- prated system is expected to furnish where, thus eliminating the necessity cial needs for their particular areas. courage maximum motivation and par- feedback and monitoring which will for needless duplication of expensive Through meetings such as this one, ticipation at the grassroots level. make it possible to provide the desired equipment, staff and facilities. we can share ideas so that a minimum A general objective of the program is information while studying and coordi. 0 Maximum coordination will be Of waste will ensue as we seek to meet the development of models of early nating the total process in an objective sought between the inputs of those our respective responsibilities. detection integrated with continuing and efficient manner. who provide health care directly, as New paths are seldom explored b) education. well as those involved in supporting faint hearts. We need to be mindful ir A University multidiscipline research that care, such as welfare, community the development of new systems thal Primary emphasis will be placed on unit is developing new tools with resources, environmental control one may at times work with less thar those endeavors which can be quariti. which to measure achievement. Its groups, and others. perfect parts in order to set the sys go tatively evaluated, and the initial as. staff members have joint appointments 0 The development of programs to tem itself in operation. It is possible 41 sumption is made that adequate infor. with other schools on campus, includ- assist in early and effective detection even desirable, to have "proof runs" mation and communication will ing Nursing, Education, Engineering, of disease will be an important goal. a practice long utilized by the printini provide qualitative improvement. The Journalism, Business and Public Ad-The information gained can be used to industry. From less than perfect initia qm long range plan provides for qualita- ministration, Liberal Arts. and Veteri-effect changes in delivery of health operations, changes and correction tive measurement of delivered health nary Medicine. Presently members of care, both through personnel and can be made to improve the fine care. this unit are studying two different systems. Early detection is perhaps product. communities in which they will meas- Only a few projects are proposed tor least threatening to the present health As participants In this national pr( ure efforts toward community health studies of delivery of care. It is Our goals, such as rehabilitation of the pa- care professions and is among the gram, I believe We dare not do les intent simply to be supportive to exist- tient. family reactions and the like. easiest procedures to measure quanti- than marshal the best available ta ing care patterns while setting up the tatively. It also possesses,the highest ents, from whatever quarters, to joi necessary information-gathering mech- In conclusion. let us review, quite potential for successful qualitative in this quest for improved health cari anisms. Under this plan, a request for briefly, some goals worthy of consider. measurements of health care. The opportunities are attractive an information by the physician will be ation. These goals were picked be- 0 Postgraduate education should be challenging, to say the least. 24