0 0 0 Regioiaal Medical Programs Report to Congress -- P.L. 91-515 1. IHTRODUCTION AND SL,-\L\IARY The initial concept of Regional Medical Programs was to provide a vehicle by which scientific knowledge could be more readily transferred to the providers of health services and, by so doing, improve the quality of care provided with a strong emphasis on heart disease, cancer, stroke, and related diseases. The mission of Regional Medical Programs-as originally conceived was, broadly stated, to assist the health professions and institutions of the-Nation in thei@ efforts to improve.the quality of care and to organize and develop preventive, diagnostic, and treatment services directed toward the control of heart disease, cancer, stroke, and other related diseases. This original mission strongly reflected the program's origin, namely the President's. Conm-Lission-on Heart Disease, Cancer and Stroke. In its report, that Commission recommended that A major national effort be mounted to reduce the toll from these diseases which account for 75 of all the deaths in America. During the legislative process an awareness of the need to-involve all health,providers and institutions in an attack upon this problem, and a recognition of the potential which regionalizatiot of service patterns and education would bring led to the concept of regional "cooperative arrangements" among pro- viders as the principal means (or mechanism) to be employed in the pursuit of that end. The implementation and experience of KT over the past six years, -2- of coupled with the broadening the initial concept especially as reflected in the most recent legislation extension (P.L. 91-515), has clarified the operational premise on which it is based -- namely that the providers of care in the private sector, given the opport'un- ities, have both the innate capacity and the will to provide quality care to all Americans. The concept and the.reality of the Regional Medical Program has -evolved and changed considerably since the enactment of the initial authorizing legislation (P.L. 89-239) in October 1965o Its goals have been broadened considerably; and there is every reason to believe that these goals.will be expanded and altered in future years as the major health problems and needs of the Nation change. It is RMP's approach rather than its goals (or mission) which is unique. For RMP, as a echanism, has and continues to be a functioning and action-oriented consortium of providers responsive to-health needs 0 and problems. It is aimed at doing things which must-be done to resolve those problems. RMP is a framework or organization within. which all providers can come together to meet health needs that cannot be met by individual practitioners, health professionals, hospitals and other institutions acting alone. It also is a structure deliberately designed to ta e into account local resources, patterns of practice and referrals, and -3- needs. As such it is a potentially important force for bringing about and assisting with changes in the provision of personal health services and care. RMP also is a way or process in which providers work together in a structu re which offers them considerable flexibility and autonomy in determining what it is they will do to improve health care for their communities and patients, and how it-is to be done. As.such, it gives the health providers of this country an opportunity to exert leadership in addressing health problems and needs and provides them with a means for doing so. RMP places a great corollary responsibility upon providers for the health problems and needs which they must help meet are of concern to and affect all the'ppople.' Insofar as mission is concerned, it has become clear that KIP shares with al 1 health groups, institutions, and programs private and public, the broad., overall goals of (1) increasing availability of care, (2) enhancing its quality, and (3) moderating its costs making the organ- ization-of services and delivery of care more efficient. Among government programs @IP is unique in certain of its salient characteristics and particular approaches. Specifically that (1) it is primarily linked to and N4orks through providers, especially practic- ing health professionals,which means the private sector largely; (2) RMP essentially is a voluntary approach drawing h@vil-y upon existing:health resources; and though RMP continues to have a categorical emphasis, to be effective that emphasis frequently uiust be subsumed within or made subservient.to broader and more comprehensive approaches. IUIP's more specific mission.and objectives, as outlined and discussed below, are.the pr6duct of the above broad, shared goals on the one hand and its unique characteristics and approaches on the other. s LEGISLATIVE AI\TD ADNIINISTIZATIVE BI@CKGIZOUND In addition to extending the l@\,IP legislative authority through June 30, 19731 P.L. 91-515 made a number of changes in that authority. Among them: (1) Explicit contract as well as grant authority was provided. (2) "Kidney disease" was specifically added as a categorical disease concern- of RMP. (3) The scope of the program in non-categorical terms was consid- erabl.y broadened. Specifi cally the attention of RMP was directed to (a) "Strengthen and improve primary care and the relationship between specialized and primary care." (b) "Improve generally the quality and enhance the capacity. of heal th manpower and facilities available to the nation." (c) "Improve health services for persons res iding in areas with limited health services." (4) Requirements with respect to Regional.Advisory Group compo- sition were expanded.. Nbst importantly, RAG membership had to include representatives of "health planning agencies.11 (5) Required a-reai%Tide CEIP agency review and cement on RNIP appli- cations prior to their final consideration by Regional, Advisory Groups (ivhich must approve all PNIP operational pro- posals) and submission to RNLPS. 6 (6) ExTanded National Advisory Cowicil on Regional Medical Programs membership to 20, with specific provision made, for (a) "One person outstanding in the study or health care of persons suffering from kidney disease." (b) Four public members. (c) The Cliief.@ledical Director of the Veterans Administration as an ex-officio member. The so-called lfultiprogram Services authority wider Section 910 was significantly broadened to allow grants to public or non- profit or private agencies (includin but not limited to R\lPs) 9 to (a) "Assist in meeting the costs of special projects for hTroving or developing new means for the delivery of health services concerned with the diseases with which this title is concerned." (b) "Support research studies, investigations, training, and demonstrations designed to maximize the utilization of manpower in the delivery of health services." The above changes have been or are in the process of being ii-aple- mented administratively and/br reflected programmatically- Kidn2Z Disease Since the categorical scope of R\ffl was broadened to specifically include kidney disease, a growing number of Regions have submitted pro- 7 posals in this disease area. Kicbicy disease. treatment capabilities now are being expanded in 20 Regioiis. 'fl-ie current annual level of RMP grant fundii-i to these R%iPs for kidne is about .9 y disease activities $2.1 million, which is roua,]-ily.double'the level of funding prior'to the enactment of P.L..91-515@ a-.little over one year ago. New awards made (or pending. final action), durina that period have equalled $.8 million. (In addition, P@IPS is continuing to support by contract home dialysis., transplantation, and other demonstration and training pro3ects -relating to kidney disease,'at a current annual level of approximately $4 million.) Recognizing beforehand that requests and approvals very probably would exceed RNIPS' ability to fund kidney disease activities, specifi- cally end-stage treatment programs, the National Advisory Council early on adopted-a policy according top funding priority to those proposals which in effect build upon and/or link up.with existing resources and programs for end-stage.treatment of kidney disease. The aim is to expand present capacity and services thus making treatment available to increased numbers-of people over larger areas of the country; in short, to maximize the number of additional people served and treated -unds and other resources, such as spec within the limited f ialized facilities and trained manpower, presently available. Thus, proposals funded generally have fallen into one or another of two broad categories. Specificall),, (1) those where a modest increment has allowed the extansion,in the capacity of existing integrated 8 dialysis-traiisplantatioii programs or (2) those that i@Totild help provide the element(s) presently missing but needed (e.g., tissue typing lab- oratory) in order to put together a comprehensive program f6r end-stage treatment of high quality. Particular encouragement is being given to programs of an inter-regional character, those serving or linking several (or parts of several) Regions, so that the duplication of expensive facilities and services may be avoided, scarce manpower might be better used, and the patient suffering from renal failure might reCeive optimal treatment and care.-.-'- Scope of Program The categorical disease emphasis of R\IP has in recent years been a major issue; and in the 1970 legislative 6xtension the explicit broad- ening of the-program's scope to include all "other major diseases" was proposed. Although this expanded language was not retained in the bill finally enacted P.L. 91-515 did broaden R@IP's scope significantly. For as already. noted the amended legislation incorporated specific changes with respect- to strengthening primary care, improving services for those presently underserved, developing new means for the delivery-of health services, and maximizing the utilization of health manpower as part of Is mandate. Quite apart from these legislative cliange's, e-\Perience in reLent years and the directions increasingly pursued by most Regions clearly indicates that the categorical emphasis on heart disease, cancer, stroke, and kidney disease is, operationally aIt"lcast, viewed as an important 9 focus rather than a narrow program restraint or limitation. Though the issue perhaps is not entirely a nioct one, the following si-,ggests that it largely overlooks what Regions have actually been doing. Connecticut's continuing central thrust towards regionalizatioii of services, comprehensively defined, around the community hospitals in that State. The early efforts of the California RMP in the l@atts-Willoivbrook area of Los ktojes and, more recently, their efforts which have been instrumental in leading to OEO funding of community health networks in San Francisco and Los Angeles. * New Jersey's continuing efforts to help with the health problems of poor urban blacks iv]-iich.have entailed working closely with and supporting llodel Cities programs in many cities in that State. * Goorgials concern with imp@oving and linking emergency care services generally in an eleven-county area in the southeastern part of that State. The technical assistance, feasibility studies, and other support provided by the @letro New York, Ohio Valley, and IVest Virginia @lPs this past year to--groups and communities interested in developing l@10s. The iriajor 'Contributions made by the Arkansas, @lountain States, and Northern New @gland @lPs to the development of Expe @ ental Systems proposals funded last year. nd assisting with the development Ma,ine's efforts in promting a. 10 of a medical school in.that State. The pilot'sickle cell anemia programs funded recently by the Michigan and IVestern Pennsylvania D-IL3s. This reality and the broadened legislative mandate are, it will be seen below rIeflected in the "neiv directions" and priorities of Regional Medical Programs at both the nation al and rdgional levels. Relationships with aip The changes made by P.L. 91-515 have served to reinforce the relation- ships and cooperation between Regional Medical Programs and Coinprel-iensive Health Planni-ng. The new legislative requirement tl,-at DIP Advisory Groups include health planning agency representatives was interpreted to mean representa- tives of S@atcoand areai,7ide CHP.agencies specifically and implemented accordingly. IN'hile most ]@Gs previously included CI-IP representatives, such cross-over.representation has increased significantly. There are, based upon the most recent information available 149 State CI-IP representatives on @IP Advisory Groups and 124 areawide CIIP representatives. In addition, the-re are over 250 CHP representatives on other @,IP working committees and task forces. (Conversely there are 850 @IP representatives serving on the Advisory Councils and other'conimittees of both State and areawide CI-IP aaencies., The review and comment requirement was implemented effective May 1, 1971. As'of that date all RMP applications submitted had to include the comments of the appropriate areaivide CliP agencies. Information available at that time indicated that cooperative..-revicii mechanisms had already been established with 107 funded arcaiiide agencies and with wi additional 69 such agencies not yet funded by Cf-Ul. Furthermore, 46 l@lps. also i-,@.re providing State.Cl@' agencies with the opportunity to re view their proposal-@. It is still too early to determine what the effect of this-review ar@d comment by CI-IP agencies will be It certainly should help over time to insure that activities and efforts proposed by @ff's are consonant with the local needs and problems as perceived by communities and expressed through their CIIP areai-jide planning efforts and priorities. Decentralization to Regions One salient characteristic of the RNT mechanism is the large degree of regional (or local) autonomy which Regions have had and exercised. Singular legislative-expression of this is that all operational proposals submitted to R\,PS for,Council review and recommendations must be approved by that R69ionts Advisory Group. Another major step in this direction was taken in mid-1971 with the decentralization of project review and funding authority and responsibil- ity to the 56 PNIPS. Now Regions are,. if their own review processes meet defined minimum standards, given primar y responsibility for deciding (1) the technical adequacy of proposed operational projects and (2) which proposed activities are to be funded within the total amount available to them. Although it is assumed that the review process of all Regions meet the prescribed standards or can with minimal changes- or adaptations, PINIPS is verifying this through a series of staff visits and examinations of 12 their review processes. It is-anticipated this verification procedure will have been largely completed by June 30, 1972. National Review Process and Selective Fundina The Council and national review process noi%r are assessing RviPs laraely in terms of their overall program and progress. I\To longer is the t6c]-inical adequacy of individual projects or discrete, singular activities the primary focus or concern.. This change from project to program review has led to, and indeed necessitated, the development of program review criteria, aimed'at assessing each Region's (1) performance to date, (2) the process and organization that has been established, and (3) its proposal for future activities. These criteria and a corollary scoring system have been used on a trial basis over the past six months, found operationally adequate and ivorkable, dnd are being iiicorp.orated as an integral part of the national review process. As a result, Regions are now being ranked or grouped in terms of quality (A) those which have demonstrated the greatestmaturity and potential, (B) those which are generally satisfactory in their performance and progress, and (C) those which are below average. This in turn has per- mitted @ff'S to implement astronger policy of selective funding. Under this selective funding policy, which was formally initiated this fiscal year, those Regions which have demonstrated outstanding maturity and potential and whose proposals are most nearly congruent with the expanded lt%IP mission-and national priorities, are being awarded proportion- ately greater increases. 13 PROGRA@L DIRE-CrIO,'@S A\TD ACCO,\IPLISI@- IEN7S The broadened concept of Regional @ledica-1 Programs, with its emphasis on improving the availability, efficiency and quality of care, sets the frameivork within i..Thich specific objectives and program priorities are developed. Within this framework, Regional @ledical Programs have identified four areas of program concentration, the principal objectives of which are to: Promote and demonstrate among providers at the local level (1) both new techniques and innovative delivery patterns for improving the accessibility, efficiency, and effectiveness of health care. This might include, for example, encouraging provider acceptance of and extending resources supportive of Health Maintenance Organizations. In relation to new compre- hensive health care systems, emphasis i@,ill be placed on assistance in developing and implementing.iiiecl-ianisms that provide quality control and improved standards of care, such as performance review mechanisms. (2) Stimulate and support those activities that will both help existing health manpower to proviao.-more and better care and will result in the more effective utilization of new kinds and combinations of health manpower. @ther, to.do this in a way that will insure that professional, scientific, and technical activities of all kinds (e.g., informational, trainin,a,) do indeed lead to professional growth and develop- ment and are appropriate] placed within the context of y .14 medical practice and the community. At this time emphasis will be on activities which most effectively and immediately lead to provision of care in urban and rural areas presently underserved. (3) Encourage providers to accept and enable them to initiate regionalizatioii of health facilities, manpcn@r, and other resources so that more appropriate'and better care will be accessible and available at the-local and regional levels. In fields where tllere are marked scarcities of resources, such as kidney disease, particular stress will be placed on regionalization so that the costs of such care may be moderated. (4) Foster close cooperation and coordination witli other health programs. Experience to date has.sboi@,n that the Regional @ledical Program can best help to improve the overall of ctive- ness of the health care delivery system by ivorkin with and 9 contributing to related Federal and other efforts at the State, local and regional levels. Cooperative linkages with the Comprehensive Health Planning agencies and the Experimental Health Services Deli-kTei-y Systems of ]\'ClISR&D are prime targets to provide effective organizational'.f-rameivorks for identifying and utilizing community health resources.- During 1970 and 1971 the Regional Medical Programs may be said to have become fully operational in atib mpting to meet these objectives. Indeed, of the 56 Regional Nledicdl Programs that were establislied,for planning purposes, 55 are now operational, with the 56th region moving toward operational stMis. As -.such for varying to only a periods of time ranaiiig from over four years feiv.mont-lis, these programs are now involved in activities especially designed to meet the health needs of their own Regions. The approach of these Regions,is reflected in certain broad areas of acc lislment which are being realized around the country. ODP All'operational Regions, the now as well as those ivliicji made earlier starts, have developed a base for 'effective regional planning and decisionmal,-ing throu broad representation and participation of health gh institutions, organizations and individuals on the plannina committees, .and the Regional Advisory Gro s of each Reaioii. UP The Regional Advisory Groups,-whicli serve as the policy-maldng body of each Region, and are -responsible for the selection and content of osals sent forward for funding, have grown to include 2,700 prop individuals. In addition, each Region also' has a variety of task forces and planning committees designed to en-sure broaa-based participation. Some 12,000 health professionals and public-representatives are on Regional @ledical Program planning committees and local action groups. Those represent a variety of health and healtli-related institutions-, including all medical schools, every state medical society, health departments, cancer and heart associations, many other voluntary and public agencies, and over 2,100 hospitals. This-widespread, voluntary participation in MT by, literally tjious.ands of health 'd'hwidreds of health inst :professionals an itutions is an important 16 strength and characteristic of the Pr.ogrmi. The 56 Reg ions are moving in a variety of ways to achieve their objectives. Perhaps one of the most -important roles is played by the professional (or core) staff in each Region. These have developed to include over 1,500 full-time persons. A primary role of the professional st affs is to serve as a facilitator for cooperative planning and joint programming. Because o ts net- work of relation-ships, the RNT staff can serve as a convenor of multiple-inte-rest groups to solve local problems. 'The staff may encourage health groups to develop joint efforts rather than institute autonomous programs. 'fl-iis involves development of regional li@,agies which demonstrate methods of institutional planning to avoid duplication of effort, and sharing of resources and facilities to improve efficiency, such as joint employment of -r c -ry services. certain professionals o onnon laborato The professional staff has played another ii.Torta nt role in serving as'a technical -resource and providing consultation services to health organizations such as hospitals, Comprehensive Health Planning agencies, educational insti-iiitions, @iodel Cities, OEO, and others. Professional staff also support many central regional resources) such as data systems., evaluation resources, information networks, and parts of the manpower training system. orRilig to improve the health care The Regional @-ledical Programs are iq system directly through opeydtional projects as well. 'flee movement toivard -redirection of grant funds is reflected in the areas of program enThasis of tlie'nearly 600 operational activities. Activities emphasizing organization and delivery of patient services and the training of new types of personnel are increasing, while funds for continuing education and planning are decreasing. Almost one-fif-th of R'%IP operational funds are now in wbulatory care acti-%rities.such as neighborhood healih.centers and out-patient departments of hospitals. Moreover, these professional staff and operational activities a-re leading to the cre ation of important institutional linkages among hospitals, practicing physicians, and medical centers which affect and improve the whole system of delivering medical care. lVithin these broad areas of program direction, program accomplishments and problem can be looRed at in relation to specific areas of focus. Imo-xrations-and Im-D-rovements in Health Care Delivery Systems New techniques and innovative delivery patterns that lead to improved accessibility, efficiency and effectiveness of health care are being developed and tested under R@ auspices. 'nie need for improvements in health care delivery patterns is evidenced by the poor utilization of physicians and allied health manpower in most medical trade-areas; th e acute lack of such mai-ip(x,;er in rural and ghetto areas; the -rising cost of medical care, particularly for hospitalization and related services; the uneven availability and accessibility of health services, again most scarce in'rural and ghetto areas; and the development of over-Sp ecialization in medicine due, in part, to the rapidity of 18 medical scientific advances. out-Patient Care In an effort to.promote greater out-patient care, for example, five community hospitals in Massaci-iusetts have begun home care program through the efforts of the Tri-State Reuional @ledical Program and the Mas.sachusetts Hospital Association. Such programs will provide continuity of care for hospitalized patients.after discharge, as well i the hospital. To date, one hospital as reduce.the length of stay._ n has achieved a fully coordinated home care program with excellent multidisciplinary input. Three hospitals are planning to hire full- time nurse coordinators and have opened a much improved information interchange with tho-local Visiting Nurse Association. One hospital moved the Visiting ',\Iu-rse Association -richt into the hospital building and also appointeda full-time qualified nurse as coordinator. Accessibi:Lity in-Inner-city Areas A variety of'activitids attempt to improve accessibility in inner-city areas where the problem are more concentrated. The New York @l,-tro- politan Regional @,I,-dical Program for example, has undertakena program, administered by Harlem Hospital, for stroke management of Blacks in the Harlem inner-city area of Neiv York. The activi@, has three facets: intensive and follow-tip care of the stroke victim; screening and surveillance of potential Victims; and training of inner city residents as-coitnunity health aides to assist in follo@v-up and surveillance activities. In addition,Ithe @ffl funds help to support the ho5pital's hypertension clinic, which reports that all but one of 19 the patients referred there in the last year. have had their ailments brought under-control solely throii(Th reoular out-patient visits. Preliminary mortality-statistics reveal that the mortality rate of stroke patients admitted to Harlem Hospital has dropped from 48 to 27.4 percent in the nine months Vince the project's inception. ]Rural Health Delivery Sys-tems In rural areas and in concert with related Federal, state and local programs, specific efforts are being directed to encourage the providers of healthcare to male care available and accessible to-those areas where there is a distinct scarcity of resources. In the State of Washington,,for example,.because of a physiciai-i-manpoiver shortage, the iso lated community of South Bend and surrounding areas were about to C, lose their hospital until the IVashii-igton/Alaska Regional @ledical Program stepped in to organize community, State, and Federal interest ancl resources to save it. Not only are new physicians locating in South Bend but additional services beyond those formerly offered are now available. Rural health care system cannot be developed immolation nor can there be a set pattern for their desion'. They must be based first on the M'x of services available in each area with other services added where the need exists. The emphasis needs to be on bringing the available services together in a systematic approach to meeting health care needs. The Tennessee @lid-So-uth @IP-)ia@ helped plan for a comprehensive health care program in an isolated community in eastern Tennessee and Kentucky in cooperation with the Ohio Valley @T and the 20 Appalachian Regional Co,='s-@ion, 'Fliroi-ic,,Ii @,IP -;upport it has been possible to linl-, three isolated rural clinics in a mountain valley of eastern T@-uiessee for the first time by telephone ,so that the clinic nurses can co@mpunicate with one another and with the physicians on whom they depend for consultation and support. Emergency Health Care Systems Another area which will.be receiving increasing emphasis by Regional @ledical Programs is emergency health 'care systems. Systems are needed which bring together better transportation services, communication which would tie hospitals, transportation facilities and other emergency organizations into rapid response systems and emergency medical centers with specially trained physicians and nurses. Once again, care must be taken to assure that such systems ate integrate d with the total health care delivery system of a com=ity or region. @T's and Technological Innovations Regional @ledical Programs are supporting activities which provide opportunities for increasing the rate of implementation of systems innovations, new technologies including automation, and changes in delivery patterns, particularly those developed through the efforts of the National Center for Health--Services Research and Development. As Health Maintenai-ice Organizations and Experimental Health Services Delivery Systems reach operating status, MT's will, where appropriate, link their demonstrations to those ongoing service.systems so as to effectively improve the quality of care provided by the latter. 21 Health \Iai-nt&nanco Organizations In relation to Health Maintenance Organizations in particular, Regional @ledical Programs are becominc, in-koli7-ed in developmental activities in a variety of ways. Because of their provider linl-,ages, the RI,@Ulls can act as catalytic agents to bring together the various elements of tJie health care system, provide an envirornent conducive to planning, and give staff support and technical assistance as necessary. In this way, Regional Medical Programs will support organizations which have the potential for becoming Health Maintenance Organizationsi In addition, subsequent to the establishment of 1-1\10's, Regional @ledical Programs will be actively engaged in the professional aspects of planning for manpower programs, mechanisms for monitoring the quality of care, ambulatory and emergency medical care services, centralization of. laboratory facilities, data system , etc. Development activity by the Ohio Valley @T, for example, includes receipt of a HSNIHA planning grant at a level of $51,250 to assist comunity interests in planning an IDIO for the Louisville, Kentucky area. After moving the proposal to the stage-of funding, it has turned over@major responsibility to the Falls R6'ion Health Council, the Areai-jide CHP. 9 agency for the area. The MT continues to contribute about 2 man days per week to this Louisville effort. Quality Standards As new and more effective comprehensive healt]-i.-systems are developed, such as Health Maintenance Organizations, rural health delivery systems, and emergency health syst e@ , there is-a' need to ensute'tliat the care 22 provided meets quality standards. 'flie need for. such assurance is, particularly pertinent in terms of the new 1-@10's which are designed to bring toaether a comprehensive range of medical services in.a single organization. To provide guidance in this area, MIPS as the lead agency in l@ilia has taken the responsibility to develop guidelines for review of the quality of medical care delivered by I-DD's, and to design procedures and criteria for both internal and external medical audits. RI\TS has also developed under contract with the Inter-socie@ Commission for Heart- Disease Resources the Heart Guidelines. As.the @D program and other comprehensive health systems are developed, it is expected that the 56 Regional @ledical Program will be involved in implementing the guidelines and evaluating their impact on the processes of care of individual and institutional provi ers. Manpower Development and Utilization Regional Ethical Programs :Ls and will be promoting a broad array of manpower activities, designed around the central concepts of enabling existing health manpower to provide more and better care, and training and more effective utilizdtion--of new kinds of health manpower. Among new areas of program priority are Area Health Education Centers. The basic concept of RNIPS efforts in this area wil I be that better use can be made of existing manpower assets. lqithi:n a.given situation, this requires an accounting of the types of manpoi%,er already there, a task or labor analysis of the kinds of services which each type of manpower performs, and an effort to determine hoij the total services rendered can be increased by reorganizing tlid ivorl%. structure of this same manpower The concept of haviiic, tile least expensive unit provide as much group of a given health service as is consistent with quality care is essential here. If-certaii -i medical f-unctions currently being clone by professionals are capable of being transferred to a less expensive type of personnel, either existing manpower can be retrained to acquire this skill, or new kinds of health-iiiajipower can be developed to take over these functions. New Cat@gorios of @lanpoi,:er Many Regional @ledical.Progranis have conducted studies to determine the need for, willingness to accept and feasibility of training categories of manpower to extend the services of physicians. @lost of these are related to the physician's assistant concept. Some @IP's are designing such projects and have funded operational activities in this area. In North Carolina, the Physician's'Assistant Pro ram at Duke an Boi@,man 9 Cray is an effort to provide-a well-traii-ied and educated assistant at the intermediate professional level AIio, by working with the physicians, can complement physician services and thereby reduce the physician man- power shortage. @IP-is also cooperating with other HS@ffiA programs in the preparation Of family nurse practitioners who will also augment the services of physicians. The North Carolina R@T, for example, is utilizing its linkages with the Regioilis practitioners to interpret the program to them and to encourage the identification of nurses for training from the co iti'es where the need exists. To provide a desirable legal structure for the utilization of the professional assistant, in terms of such problems as licensure and malpractice, the Region is supporting i,;orl,- 24 on the development of model medical manpower legislation. Improved Utilization of Existing @lanpoi%Ter Virtually all Regional @led'ical Procram have projects designed to augment the knoivledce and level of performance of health professionals and para- C) professionals. @,lany of these projects lead to improvements in the utili- zation of personnel. Per]-laps the greatest R@iP thrust in this.area is the training of coronary care unit nurses; over 7,000 registered nurseIs and licensed practical nurses have.been trained to date. The Nei-i Jersey @IP, i.n an' effort to improve manpower utilization, is supporting a program to standardize coronary care unit training program for licensed practical nurses, so that they can function with the same protection and legal sanctions as registered nurses. Given a high turn- over rate among coronary care unit trained registered nurses, their use as supervisors and.teacliers of licensed practical nurses may represent better utilization of professional nursing personnel. Other manpower and reclining activi.ties,,althougli basically designed to provide continuing education for professional and allied health personnel, have important spin-off benefits. A recently completed program to upgrade the quality of continuing education at a community medical center in Colu-ous, Georgia for example, has contributed to substantial groivth in the city's physician population and the establishment of the medical center as an aremvide continuing education resource for smaller neighboring hospitals. As the basis for the program, the medical center in Col@us established a regular-univer§it-.y-affiliated'teachin- program i..,ith the Emory University School of @ledicine. Local physicians ive-re sent to the University for a newly organized clinical training program, and then, on return to the medical center in Colupblis set up similar clinical and didactic trainina C, for their associates. As part,of its upgrading, the medical center at Columbus was selected by the Georgia R\IP as one of five community hospitals across the State which would become areaivide continuing education facilities. In addition, approximately 28 new physicians have been attracted to the town during two years of the project, while there had been no. increase in the previous eight years. -Area Health Education Centers As part of this effort to iTnprove manpower utilization and development Area Health Education' Centers will be a major new initiative. Grant funds at a level of approximately $7.5 million will be available in 1972 for initial organizational and development efforts and operational programs aimed at providing the necessary structural linkages among cooperating institutions. These Centers will provide a means to improve the distri-L bution, supply,,utilization and efficiency of health manpower in an effort to enhance the delivery of health care in remote or urban areas currently underserved.' Linkages between healtJi service organizations and educational institutions will be established to provide students both academic education and clinical practice appropriate to.theit discipline. Students will have the opportunity to learn their skills in settings which promote.the team concept of comprehensive health service. The network of institutions linked together to carry out the functions of the center will provide means of extending advancements in health to communities. By utilizing existing health care facilities i.n.combination with educational institutions to educate needed heal-L'ji@porsonnel, both the quality, ajid quantity of liealtj-l 26 care can be increased in undersoj@,od areas. A current effort in the l@atts-Willoi@brook project in Los Angeles generally reflects the type of program which could be developed. 'n-iis is an effort develop a nonacademic community which would function within an acute to general hospital, the Martin Luther King, Jr. General Hospital, in the deprived central area of Los Angeles County.. The primary aim is to improve the quality and quantity of health care in the connunity. Traininc, and educational components w.ill revolve around patient services and as a spin-off will provide outpatient and'inpatient health services to the area. The program includes undergraduate training and continuing education of community health practitioners. It is anticipated that the project will in.the near future include a community mental health center, a school of allied health professions, and a clinical research building with residence for house staff. The project also calls for the provision of technical assistance and resources to other educational and health care institutions in the llatts area for the purpose 'of developing additional training programs for' health care personnel. Regionalization and Institutional Linkages Regionalization and new organizational arrangements a.re major themes of Regional Medical Programs, 'llorking -relationships and linkaaes among com- munity hospitals and between such hospitals and medical centers are among the.prima-ry coffce@ -of the program.- The linking of less specialized health resources and facilities such as small community hospitals with more specialized ones is an important way of overcoming the maldistribution of certain resources,.and thereby increasing their availability and enhancing their accessibility. 27 1 and institutional Iiiil-a(yes The develop,-iicnt of regionalized professions C> aids in linking patient care with health research and education within an entire region to provide a mutually beneficial interaction. It also helps to emphasize the delivery of primary care at the local or community level, while promoting specialty care as the province of the medical center and larger community hospitals. In North Carolina, co@nit-), developmei -it of comprehensive' stroke program has been initiated, with a central coordinating unit at the Boi@,man Gray School of 1,@dicine. A broad ranae of activities is being undertaken, including publication of guidelines for community stroke programs, edu- cational activities such as traininc, program for nurses, annual stroke workshops, stroke consultation service for physicians through the cooper- ation of the neurological staffs of the three medical centers, and a family-patient education unit, designed to help patients and their families learn to cope with the long-term effects of stroke disability. Iklorki-ng relationships between community hospitals and the medical tenter or among community hospitals themselves can upgrade local capabilities, thus moving the delivery of semispecialized care closer.to the local leiel.' In Oklahoma, for example, continual electronic heart monitoring services comparable to those available in large urban hospitals are beingintro- I duced into small community and rural hospitals as a result of a State-ilide coronary care program initiated by the Oklahoma RNIP. Some 43 monitor- equipped beds for heart attack victims, or attack-threatened patients, in 25 -small community hospitals have been linked by special telephone lines to 10 c--nti--I,monitori-,qg hospitals. Q.--cially trained nurses in the 28 central monitoring unit help- monitor reiiiota,pi.tionts and i@lion an abnormality is detected confer with local staffs by telephone "hot lines." Kidney disease is one area in wli-icli the development of integrated regional systems can prevent the duplication which has diaracteri zed certain otjier specialized resources. It provides the opportunity for a planned and organized model of how such scarce resources can be linked together efficiently. In Wisconsin, the Regional @ledical Program and the Kidney Foundation of Wisconsin are supporting the development of a comprehensive renal disease pro ram. Each yea r in Wisconsin about 140 persons enter the final stages 9 of renal disease who are judged good candidates for kidney transplants or artificial kidney machine dialysis. Unti:L recently the I-atest-advances in the care of such patients were high in cost and not uniformly availa) e Statewide. The Wisconsin project is designed to develop a Statewide cooperative kidney transplant pro ram to -reduce expensive 'long delays in .9 transplantation and to prevent tissue mismatches. This comprehensive effort also'includes establishment of a program. of dialysis located within patients' homes and in strategic community hospital satellite units. A prevention and early detection program is tindeiiiay as well, providing local physicians with information and inexpensive testing kits for detecting kidney disease. e'rative Relationships with other Ile@ith Pro ms 'n-le,passage of P. L.. 91-SIS, the legislative extension of Regional @ledical Pro rams, Coff?i)rehensive Health Planning, the National @Cei-iter for Health @g, 29 Services Research and Develol);,,icpt, and othet-licaltli components, resulted in an increased emphasis on the need for improved coordination cmcl co- operation iiitli-ot)-ier health programs. Ex ,perieiace to date certainly suggests that tlae Regional @ledical Programs can best help to improve the overall effectiveness -of the' health care delivery system by worl-,iiig with and contributing to related Federal and other efforts at the local, State and regional levels. -C OiTpreliensive Health Planning One of the most important of these iii-iks is with the Comprehensive Health Planning agencies. Cooperation between Regional @ledical Programs and Comprehensive Health Planning agencies in particular is being fostered through emphasis on their complementary roles. Increasingly, the Re ional @,ledical- Programs, with their strong provi e-r g links, a-re being viewed and used as an important technical, professional and-data resource by State and A-reaiqide Comprehensive Health Planning agencies in their planning for personal health services. In turn,.Regional @ledical Programs are looking to Comprehensive Health Planning agencies to express the health needs of the total community from the consumer's point of view and in effect to help set priorities for the Regional @ledical Progr efforts. The legislative extension of both @,IP and GiP included changes designed to promote closer coordination between these programs. One change requires that the Regional Advisory Groups which .'advise the R%T s include rep-re- sentatives from health planning agencies. Similarly, the CfT agencies are required to httvc representation of R gional @ledical Programs on both State 30 and Arcaiqide CoiTI)rehensi@ro Health Planning Advisory Councils. To date, more than 800 individuals have beeii appointed to fulfill these require- ments of cross-re resentation. .p Another legislative change requires that Areaiqi.de Comprehensive Health Planning agencies have the opportunity for review and comment of Regional Medical Program applications before they are.al)proved by the Regional Advisory Group. Although this requirement applies only to the Are aiqide CliP agencies, there has been extensive cooperation in terms of review by the State CIIP agencies as well. Other areas of cooperation include joint data collection, processing or analysis, staff sharing or regular joint meetings, and sharing of equip- ment and facilities. In Kansas, for example, the RNIP and the State CHP agency have jointly funded botli a State data bank and a State Health Man- power Information Program. Currently they are also cooperating on the systems design for a Health Information System and on a Consumer Inventory Study in I\TorthA%,est Kansas. The @IP Core Research and Evaluation staff also provide consultation to CHP. Experimental Health Services Delivery Systems e p Another health program which involves clos P. coo eration is the ExTeri- mental Health Services Delivery System effort, funded by HS@,ff-l,%. The EH$DS program aim to test xvhether a coi ity management structure can improve the organization of tJie delivery system, and to determine i%,hether such an approach can achieve greater integration and coordination of Federal funds.. Regional @ledical Programs are closely involved in these @effort's in such places as Arkansas, Boise, Idaho, East Los Angeles, and 31. In Vermont the Northern New F-oicland @IP and the State CIIP agency jointly produced the successful application for an Expe@eiita-I Health Services Delivery System. Funded by the iNational Center for I-lealth Services Research and Deiclopment'at a level of $932,000 for a period of two years, the program involves the implementation and evaluation of a series of e'xteri- mental, regionally integrated co ity health systems in the geographic area of Vermont, and possibly contiguous are@s of New limiipshire and Nei%, York states. A variety of different tasks are being assumed by the agencies involved in Vermont. The State CHP agency, for example, is involved in defining the nature of public accountability in E-xpe@ental Systems, and defining the requirements of a regional plaiu-iing-manauenient system. The Regional @,ledical Program is determining hu,,i'various components of the community health system can be integrated into an experimental model. The RNffl will also provide a data base and health systems analysis capability. @,iP has established a data base which can describe health and Health care delivery in terms of demographic and socioeconomic characteristics of the communities being served; manpower, facility and dollar -resources available; utilization, supply and distribution aspects of the existing health care delivery process; and outcome, as measured by morbidity, mortality and patient satisfaction. Veterans Administration some 83 Veterans Admi.nistration hospitals are Currently involved in activities with Regional @-ledical Programs. This.includes 'participation on RV Regional Advisory Groups 'as well as operational activities. The 32 California Medical Television NetA@ork operating out of UCLA,, for example, is funded in part by the R\R3 and includes a packaae of 36 videotape programs distributed annually to 30 participating V.,@ installations in the western United States. Model Cities Regional Medical ProcTram also have working relationships with some of the @iodel Cities programs, includiiia technical and planning assistance and r> operational programs A Model Cities'Health and I\Iutrition Program has been developed by the Alabama R\-IP to--meet the nutritional needs of the chronically ill, dependent preschool children, and pregnant adolescents in the Tusl-,eg-ee-@lacon County Area. Tiventy nutrition al assistants, after completing a six months training course at the Tusk.egee Institute, will work with the -rural poor to implement the program objectives. These individuals will be trained to observe family nutrition practices, instruct and counsel in sound nutrition practices, assist in preparing teaching materials and make follow-up home visits to assist with menu planning, food buying and cooking skills. They will also assist with dietary surveys and work with community groups. In concert with the broad range of public and private health organizations and institutions, and other Federal, State and local health program , Regional Medical Programs ca@ work to provide an effective organizational framework for identifying and utilizing community health resources, so that continued innovations in health care planning.and delivery systems can be made. -@ibit I Budget and Grant History (Dollars in thousands) FY 1966 FY 1967 FY 1968 FY 1969 FY 1970 FY 1971. FY 1972 -000 000 .$120,000 Puthorization . . . . . . . . . . $50 $90 $200,000 $65,000 $125,000 $15.9,000 kppropriation: grants 24,000 43,000 53 900 56,200 73,500 991500 90,500 .1 A,Pount available for obligation*. 24,000 431934 48,900 72,365 78,500 70,298 135,000 - grants A,nount obligated, 2,066 27,052 43@635 72.9 365 78,202 70,29S.: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - --- - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Recrion-, in: Planning Status . . . . . . . . 7 44 41 14 1 1 1 Operational Status . . . . . . . 4 13 41 54 55 55 Total RMP's 7 48 54 55 55 56 56 Includes carryover amounts db LISTII\TG OF REGIONAL. MEDICAL PROGPAVS Exhibit II 'A ALABAMA ALBANY ARI ZON @SIGN.@%TION "")G CAL Al ab an, a Northeastern New York and con- Arizona L@D@TI tiguous portions of Southern Vermont and Western Massachusetts )PUL@Tioi,4 3,444,000 1,900,000 1,773;000 ;I i,%IATE @1971) !XDS ,.@IL@LE IN 1 052@@ 1,136 865 SC-U YEAR @/'l .(in 000's) ,@OGRk%l@ S. Richardson Hill, Jr., M.D. Frank M. Woolsey, Jr., M.D. Dermont W. Melick, M.D. C.RDIK-A,T0,RS Coordinator- Coordinator 'Coordinator Uabama Regional Medi'Cal'Program Albany Regional Medical Program Arizona Regional Medical Progr@ P.O. Box 3256 Albany Medical College' of University of Arizona 1108 South 20th-Street Union University College of Medicine -35205 Birmincham,-Alabama 47 Xciv Scotland Avenue 4402 East Broach,;,ay, Suite 606 Albany, I\Tcw York 12208 Tucson, Arizona 8S711 John M. Packard, M.D. Director Alabama Regional Medical Program P.O. Box 3256 1108 South 20th Street Birmingham, Alabama 35205 P,EGIO'\,.AL ARKANSAS BI-STATE CALIFORNIA DESIG.\'.@tTION' EOGIZ@P@IIC-@kL Arkansas Southern Illinois and Eastern California plus Reno-Sparks Missouri and Clark County (Las Ifecas), Nevada OPUT-@,TIOIN 1,923,000 4,700,000 19,953,000 STI@IATE (1971) @i.@,ILABLE IN 1,363 1,147 8,357 I,SC,%L YEAR 971@ (in 000,S) R iD G i@kN I Charles W. Silverblatt, M.D. William Stoneman III, M.D. Paul D. @Tard D-DRDIINATORS Coordinator Coordinator @Executive Director Nrkansas Regional Medical Program Bi-State Regional Medical Program California Committee on 500 University Tower Building 607 North Grand Boulevard Regional Medical P-Locrams 12th at University St. Louis, Missouri 63103 7700 Edgei@,ater Drive Little Rock, Arkansas 72204 Oakland California 94621 RE C I O,\TAL CENTRAL NBI YORK COLORADO-WYOiMING-" CO, L@CFICLJIT DESIG\!.@TION Syracuse, New York and 15 sur- ECC-IZI-',-PHIC-AL -rounding counties and Bradford Colorado and Wyoming Connecticut and Susquehanna counties in -Pennsylvania '."PUI.ATIO,\, 1,700,000 2,150,000 3,032,000 SI-I',I!kTE (1971) @,@IL;@I,E IN 896 1,123 1,514 ISC,@L Y'-PAR @'7'- (@@n 000's) Howard W. Doan, M.D. Henry T. Clark, Jr.', M.D. John J. Murray DORDI.NATORS Acting Coordinator, Central New Director Colorado-Wyoming Coordinator York Rouional Medical Program Regional Medical Prouram Connecticut Regional Medical Upstate Medical Center ranklin Medical Building 410 F Proaram State University of New York 2045-Frank-lin Street. 272 George Street 7SO East Ad@ Street Denver Colorado 80205 New Haven, Connecticut',06510 Syracuse, New York 13210 REGIO@"%L FLORIDA GEORGIA GREATER DELAIIARE VALLEY D -@'z I (, N,@T I ON EOC,IVIII@%L Florida Georgia. Eastern Pennsylvania, the southern.part.of @Neil Jersey an the entire State of Del@iiiare LI@F I ON 6,789,000 4,590,000 6,200,000 S-rI,@IA'fE (1971) i.@DS I L@P L E IN 1,448 1,983 2.1433 ISCAL YF-AZ 971 (in 000's) P,OGP-,@.4 Granville W. La@ore,- M.D. M. Charles Adair, M.D. Martin lvollmann, M.D. Do-.RDI,\,ATORS State Director Coordinator @'F-xecutive Director Florida Reaional Medical Program Georgia Regional Medical Program Greater Delaivare Valley 1 Davis BoulQvard, Suite 309 Medical Association of Georgia Regional Medical Prooram Tampa, Florida 33606 938 Peachtree Street, N.E. 551 last Lancaster Avenue Atlanta, Georgia 30309 Haverford, Pemsylvania 19041 J. Gordon Barrow, M.D. Director Georgia Regional Medical Program Medical Association of Georgia 938 Peachtree Street, N.E. Atlanta, Georgia 30309 RE-GION.,@ ILLINOIS INDIAI\TA DESIG.\7.,-kTIO\l Entire State of Hawaii, plus. Er.'(@11,VHJTC-,kL Arerica-.q Samoa, Guam, and the Illinois Indiana o@,E-,VIGE Trust Territory of the Pacific -Islands (Micronesia) @T "'PUL- @CN 970,000 9,100,000 4,200,000 @STT%',@ E (1971) UNDS 1 Lt@ L E I N 938 1,794 1,275 'r SC@1,L YEAR (4n OOOIS) 97.1- ROG,@ZA.M @lasato M. Hasegawa, M.D. Morton C. Creditor, M.D. Robert B. Stonehill'i M.D. C,ORDI@TKTORS Director Coordinator Coordinator Regional Medical Program of Hawaii Illinois Rcaional Medical Program Indiana Regional Medical Progi 1301 Punchbowl Street- 122 South Michigan Avenue Indiana University Harkness Pavilion- Suite 939 School of ',,"iedicine Honolulu, Hawaii 96813 Chicago, Illinois 60603 1300 West Michigan Street Indianapolis, Indiana 46202 RF-@G I O@, -U II\7FERYiOU.,NTAIN IOWA' D,--SIC\!.L%TIO.,N Kansas. EOC,R,ATi'IIIQ%L Entire State of Utah, and portions Iowa D'@TL-W@GE of Wyoming, Montana, Idaho, -Colorado and Nevada ")PUL,@Tio.,N 2,073,000 2)825,000 2)249,000 -TI@ @,LA.TE (1971) i'@DS @,.,'kILA3LE IN 3,383 754 1,869 I CkT ,D7.1 (in 000,S) Robert M. Satovick, M.D. Harry B. Weinberg, M.D. Robert W. Bro@-n, M.D. r @RDI,\T @ATOT .ZS Coordinator - Coordiqator Coordinato Intermountain Regional IO-AA Regional Medical Program Kansas Reaional Medical Proora Medical Program 308 Melrose Avenue 3909 Eaton Street 50 North Medical Drive Iowa City, Iowa 52240 Kansas City, Kansas 66103 Salt Lake City, Utah 84112 MAINE @IARYIAND PI G I O.,\, tu LOUIS@ ,ESIC,N.,kTIO.N Entire State o-L \Iaryland and OGP,AP.-iICAL Louisiana Maine York- County iiy Pennsylvania, i@,I-RikGE less enirlrons of Wash ,ton, D. and @,lontp-omeiv_ Col-m@, i%@i, _vlan@ 994 000 3 222 @PUL[k'lpioiN 3 1 %643 000 ,TI,@l,kTE (1971) 871 1,998 AILABLE IN 776 S C-AU YEAR @7". (in 000's) ,OGIQ-@ll Joseph A. Sabatier, Jr., M.D. Manu Chatterjee, M.D. Edward Davens, NI.D. @ORDI@14LTORS Director Coordinator Coordinator Louisiana Regional Medical Program Maine's Regional Medical Program Maryland Regional Medical Prog-I 2714 Canal Street, Suite 401 295 Water Street 550 North Broadivay New Orleans, Louisiana 70119 Augusta, Maine 04330' @Baltimore, Maryland 2120S REGIONIAL Nialpi-a s MROPOLITAN IVASHINGTON, D.C. @CMGAN DLTI:@IGN'.@TIO,N IVestern Tennessee, Northern ,@-OC.@,\J-:,IIC-AL Mississippi Eastern A@.ansas and District of ColLn@bia and contiguous Michigan 0 @,L- Pv@ G E land (2) and portions of Kentucky and Counties in Mary mi5souri Virainia (2) C)PUL.,%TIO,N 2,399,000 1,800,000 8,875,000 S-T. \,.-vrE C1971) IJ4\DS l@-,k I LAB L EIN .1@, 907 1,217 2.1292 IsIrl-i%T- 'YE6LIZ 971@ (in 000's) M.D. Gaetane M. Larocque, Ph.D. James W,.-Cijlbertson, M.D. Arthur E. Wentz, X,U I MTOTZS Coordinator - Coordinator 'Acting Coordinator Meirphis Regional Medical Program Metro-politan Washington, D.C. Michigan Association for 1300 iMedical,Center Towers Reaional Medical Program Recrional Medical Proar@ 969 Madison Avenue 2007 Eye Street, N.1l.. 1111 Michigan Averue, Suite 2( Verrphis, Tennessee.38104 Washington, D.C. 20006 East Lansing, Nlichigan,48823 MISSOURI MOUNLKIN STATFS REGIO:\'AL MISSISSIPPI i)ESICIN.@%TIO@N Missouri, exclusive of most of States of Id@o, Montana, IC-AL %Iississippi Metropolitan St. Louis Nevada and.'Alyoming 'OPUL,,%TTO.N 23,217,000 3,200,000 21228.1000 (1971) :LJNDS 1,168 2.9 282 1,764 @T,IILABLE IN :ISC-,@L YF--ATZ 1,971 (iq 000,S) Alfred M. Popma, M.D. Theodore D. L@ton, M.D. Arthur E. Rikli, M.D. Co rdinator and Regional Dire ,DOIU!NATORS Coordinator Coordinator 0 Mississippi Regional Medical Prograii Missouri Regional Medical Program Mountain States University of Mississippi 406 Turner Avenue L is Hall Regional Medical Proara-Tn ew Medical Center Columbia, Missouri 65201 305 Federal Way - P.O. Box.S7' "2500 North State Street Boise, Idaho 837OS- Jackson, Mississippi 39216 NASSAU-SUFFOLK NEBRASKA NEW JEPSFY' RE- G I OI\!AL Jersey :Or-7 nT'i-iIC-@kL Counties ol Nassau and Suffolk Nebraska New )@IEII.'kGE (Loncy Island) of the Stat of iNcw York )TI'llil@'ItTIO'N 2.1540 000 1,484,000 7,168,000 (1971) JNDS TikIb@LE IN 794 626 1,351 'SC,@L YF-,'LR )7.1 (in 000,S) Deane S. Marcy, M.D. Alvin A. Florin,,M.D. 'CG' , ilA,\' Glen E. Hastings, M.D. )@IINATORS Coordinator Coordinator Coordinator Nassau-Suffolk Regional Nebraska Regional Medical Program Neii Jersey Regional Medical Pri Medical Program, Inc. 700 CFU Building 7 Gleiwood Avenue 1919 Middle Country Road 1221 N Street East Orange, New Jersey 07017 Centereach, Nlew York 11720 Lincoln, Nebraska 68508 RE-GIO.@l,kL NEVV @ico NEW YORK MROPOLITAN NORTH CAROLIi@,k I)ESICIN.-@TIOIN iEOG,R-,'kt7ilIC:AL New Mexico New York City and Westchester, North Carolina 'O%,'E-R,kGE Rockland, Oranc,,e, and Putnam Counties, New York 9 266 000 5,082,000 Ul@'kTION 1,016,000 Ti'@,LA,TF-, (1971) .u.\DS ,@,.t4t!LABLE IN 1 337 2,706 2JI337 'ISCAL.YF--ATZ 07' (in 000's) ;ROG.3.k\l Jwnes R.-Gay M.D. I. Jay Brightman, M.D. F. M. S=ons Patterson, M.D. ,C)ORDIKNTORS Coordinator Director Executivb Director New M@exico'Regional Medical Program New York Metropolitan Association for the North Car( University of New Mexico Regional @iodical Prograin Reaional Medical Program Medical School The Associated Medical School@' 4019 North Roxboro Road 920 Stanford Drive, N.E. of Greater Now York Durham, North Carolina,27704 Building 3-A 2 East 103rd Street Albuquerque, New Mexico 87106 New York New York 10029 NoRrFMRiN i\'D- F-NGIAO NORTH DAKOTA NORTHEAST OHIO REGIOK-@L DE'zi I @i %T ION 12 counties in Northeast Ohio Ditire,State @f Vemont and ')EOGIZ-@IIC-,\L North Dakota three contiguous counties in 'O%,'ERAGE Northeastern in-cw York 618,000 4,llspooo 'OPUL,,XTION -STINL,%TE- (1971) u @l' @ljs 368 800 @@,T.'kILABLE IN 309 'I SC,,%L YEAR .971 (in 000's) John E. l@ennberg, M.D. Theodore H. Harwood M.D. David Fishman, M.D. ,@,,,Dj,\,ATORS Coordinator - Acting Coordinator Coordinator North Dakota Regional- I\Tortheast Ohio I\Torthern New England Rouional %Iedical Program Medical Program Regional Medical P'rogram C, 1512 Continental Drive 10525 Carnegie Avenue University of Vermont Grand Forks, North,Dakota 58201 Cleveland, Ohio 44106, - Colleae of Medicine 25 Colchester Avenue Dillard A. IVric,,ht, M.D. Burlington, Vermont 05401 Director North Dakota Regional Medical Program 1512 Continental Drive Grand Forks, North Dakota 58201 RE- G 1 0.@U NOR S NORTIBVESTERN OHIO OHIO DESI -@l,@tTTON Central and southern tiio-thiTc -r,OGIZk?IIICAL Minnesota 20 counties in No@western Ohio of the State of Ohio (61 count @OV'EIIAGE excluding Metropolitan Cincinnati area) ,-,PUI,A,Tjo\ 3,805,000 1,381,000 42660 31 000 STI,@.L@TE (1971) 431 360 @,%ILA3T,E IN 1,251 TSC,- TZ 971 (in 000Ts) "OG@ rx ANl IVinston R. Miller, M.D. C. Robert Tittle, Jr., M.D. William G. -Pace III, M.D. DORD I.- T@i OPXS Proarair Director Coordinator 'Coordinator Northlands Regional Nort@,,.vestern Ohio Ohio-State Recional Nledical Medical Program, Inc. Regional Medical Program. Program 375 Jackson Street 1600 Madison Avenue 1480 ',lest Lane Avenue St. Paul, Minnesota 55101 Toledo, Ohio 43624 Columbus, Ohio 43221 o@o@ OREGON REGIOi@tkL OHIO VALLEY DE'z,ICNP,TIO',\' @-.OC;%%DJIICAL Greater part of Kentuckyp.South- Oklahoma Oregon io@,'E-RACE west Ohio, and contiguous parts of Indiana and West Virginia 'O P ULA T I O.\T s 2 559,000 2,019,000 .$300,000 S- TT ,NLiVfE (1971) U,\' L) s ,@,'.i%IL,NBLE IN 1, 1-7@ 963 930 'I SCAL YF-ATZ CiT -I 0001-s) William.H. McBeath M.D. Dale Groom, M.D. J. S. Reinsdmidt, M.D. 11',OGR,44M :OORDI,@ Coordinator T,KTORS Director Director Ohio Valley Regional@ Oklahoma Regional Medical Program Oregon Regional- Medical Progn Medical Program University of Oklahoma University of Orecon P.O.@ Box 4025 Medical Center Medical School 'Lexington, Kentucky-40504 800 N.E. 15th StreQt' 3181 S.W. Sam Jackson Park'Ro@ Ok@oma City., Oklahoma 73104 Portland, Oreao,.i 97201' REGIO@U PUERTO RI CO ROCHESTER SOURH CAROLINA ,ESI @'.,%TIO.,N PJIT ,OGIZ,A I.C,@L Puerto Rico Rochester, New York.and 10 South Carolina surrounding'counties @PULtkTIO,N 2JI690,000 1,234,000 2IS91,000 ,I'I,@',,A,TE (1971) AILABLR- IN 938 611 1,478 SC,U YEAR 71- (in 000's) Ctistino R. Colon, M.D. Ralph C; Parker, Jr., M.D.- Vince @loseley, M.D. OGP,k'4 iC)F Regional Medical Program 110 East Wisconsin Avenue University of Pittsburgh Nlilwaukee Wisconsin 53202 1217 Scai-fe flall Pittsburgh, Pennsylvania 15213 Robert R. Carpenter, M.D. Director Western Pennsylvania Reuional Medical Program 3530 Forbes Avenue 501 Flannery Building Pittsburgh, Pennsylvania 15213 EXHIBI'F III CL-@CTERISTICS OF RE-GIC.@-V@ iIE-I)ICI-@ PROC-@ilt,-'@'IS D@i Y3G@kPHIC 17.,,\CTS There are 56 P,\.Ts i@b,icl-i coirer the entire United States and its trust territories. The Programs include the eiiti@e population of the United Stat@ (204 million) and vai-y considerable in their size and characteristics. LARGEST REGIO'.\T . In population: California (@O million) . In size: Vv'ashingtop./Alaska (638,000 square miles) S.\IALLEST RFGION . In population.: NTorth.ern Nei@ E-n,aleo-id (445,000) . In size: Metropolitan IVashington, D.C. (1,500 square miles) * SOIIE PEGIO'\S APX- YAII\TLY URB.AIN (]\T-D,T YORY, MY@'ROPOLITh\T), SO@E- RURAL (AIZKA,.@kS * GEOGRAPHIC BOUI\'D.ARIES: I\km,,ber of P,,egions ikThich * L-ncon.Tass single states . . . . . . . . . . . 33 * Encompass tivo or more states ... . . . . . . 4 * Are parts of sincle states . . ... . . . . . 11 * Are parts of two or more states . . . . . . . POPULATIO,'\: N@ber of Regions iv]-iic)-i ha,,@e . Less than I million persons . . . . . . . ... 5 . I million to 2 million . . . . . . . . . . . . . 2 million to 3 million . . . . . . . . . . . .14 . 3 million to 4 million . . . . . . . . . . . .8 . 4 million to S million . . . . . . . . . . 7 . Over 5 million . . . . . . . . . . . . . . .. . 11 RF@GTO,@.AJ, AIIVISop ,)r GPOUPS SIZE: * 1967 1849@Pei-sons (Total) 8 (Average p 3 Groti 1969 2324 Persons (Total) * 42 (Airerage Group) * 1970 2481 Persons (Total) 45 (Average Group) * 1971 2696 Persons (Total) - 48 (Pvera-ge Group) COM-MSITION OF P%F-,GIOXAL ADVISORY GROUPS FY 171 (10/71) FY t7O (4/70) NLutber Perc ent I\kml)er Percent Total 2696 00 481 100 Practicing Physicians 726 27 656 26 Hospital Acbpinistrators 376 14 327 13 @ledical Center Officials 217 8 259 10 Voluntary Auencies 200 7 212 9 Public Ilealtli Officials iso 6 134 @6 Other Health IVorl,-ers 298 11 216 9 Members of Public SS6 21 468 19 Other 173 6 209 8 TASK FORCES Aj\l) CO-@D4lT7EES ]\FIBER kND SIZE: 1969: 492 Committees in 54 Regions: 5,320 Total membership 1971: 410 Committees in 55 Regions: 6,379 Total. membership CO@NLPOSITION: Number Percent By Profession (1-969) (1971) Physicians 3273 3523 61 55 Nu-rses 486 S80 9 9 Allied Health 672 802 .13 13 Other* 889 - 1456 1.7 23 Total 3@2 0 3@7 9 10-0 10-0 Includes i-nen,@bers of the public, hospital administrators, and ot]-iers) TYPE OF TASK FORCE/CO',\I,\IITTEE: No. of Committees Percent Categ9l'y (1@69Y (1971) (1969) (1971 Heart 65 41 13 11 cancer 60 42 12 10 Stroke 54 36 11 9 Other Disease (includin,,,, Kicbiey) 39 30 8 7 Plaiminc, & Evaluation 30 27 6 8 Continuing Education & Training 4S 47 9 12 Health @lanpoijer 11 27 2 4 Other, 188 160 39 39 Total 492 410 100 IOU RE.Gjo,\IAL liE@"UA@FE-RS Coordinating Heacl'quarters Grantees 31 34 Universities (25) (27) Public 6) 7) Private Other 25 22 @ledical Societies ('4) 4) Nei-ily Organized Agencies/ Corporations (18) (15) Existing Corporations 3) 3) 'CORE STAFF REGIO,\IAL '\IEDICAL PROGia%,IS Core staff in the 56 Regional @ledical Progran'is are involved in project development' revleiq and management, professional consultation and com munity liaiso ba am dir ction and administration; planning studies n; Pr or 0 1 and inventories; feasibility studies; and central reuional services. DISTRIBUTION OF CORE STAFF BFFORT BY RIN(7FION . Project Development . . . . . . . . . . . ... 20% . Professional Consultation . . . . . . .. . ... 29% . Program.Direction . . . . . . . . . . . . . . 22% . Planning Studies . . . . . . . . . .. . . . . 14% . Feasibility Studies . . . . . . . . . . . 7% . Central Regional Services . . . . . . . . . . 6% . Other . . . . . . . . . . . . . . . . . .. . . 2% COI\TOSITION Core -Ml TOTAL 1,SS4 Physicians 184 Registered Nurses 63 Allied Ilealth 37 Other Professional/Technical 677 Secretaries 623 OPEPATIONI@ PROGPVIS The LEVEL OF FUINDING as of 1Ll-31-71 reflects the foll(xvij'lg program emphases: Operational Activity r-.ntpfi as i s Organization and Delivery.for Patient Services . . . . . . . . . .. . . . . . . . . . . . . . . 37% Training Existing Health Personnel in I\Teiv Skills . . . . . . . . . . . . . . 31 Training new Health Personnel . . . . . . . . . . . . 3% General Continui.-ig Education . . . . . . . . . . . . . . . . . . 20% Other activities, such as com=ications networks, improved patient record system', and coordination of services . . . .. . . . . . . . . . 9% Cate@orical asis An analysis of all'the operational grants m%,arded to date along cate- gorical lines indicates the folloiNrii'ICJ breakdown: Single Disease Heart .. . . . . . . . . . 22% Cancer . . . . . . . . . 12% Stroke . . . . . .. . . . 11% Kidney . . . . . . . . . 5% Related Diseases ... . . 7% Mu-lticategorical . . . . . 43% HOSPITAL PARTICIPATION IN REGIONAL @IE-DICAL PROGRK%IS Total # of Number Ni6)er shor-L-t--M, participating participating non-Federal in planning and in operational hospitals operational, activities - -activities only FY 1968 5 850 851 301 p FY' 1969 5,820 1,638 11246 FY 1970 5$8S3 2@084 1,471 FY 1971 (est.) s 880 .2,693 2,079