1 iwl iiii [1110@ it@@ t@llil8@l 9 I iw LES OF ACTIVITIES IN SELECTED REGIONAL MEDICAL PROGRAMS TABLE OF CONTENTS SUBJECT PAGE Coronary Care Training MOUNTAIN STATES . . . . . . . . . . . . . Coronary Care-Smal' Hospitals 2 INTERMOUNTAIN Watts-Willowbrook . . . . . . . . . . . . . a . . . . . 3 CALIFORNIA Manpower for Remote Mountain Community . . . . . . . . . 4 TENNESSEE-MID SOUTH Multiphasic Screening . . . . . . . . . . 6 . . . . . . 5 TENNESSEE-MID SOUTH Comments from Hospitals . . . . . . . . . . . . . . . . 6 OHIO VALLEY Better Training for More Students . . . . . . . . . . . 7 TENNESSEE-MID SOUTH Uterine Cancer . . . . . . . . . . . . . . . . . . . . . 8 WISCONSIN Cancer . . . . . . . 9 ALBANY Cancer . . . . . . . * . . . . . . . . . . . . 10 TEXAS Stroke . . . . . . . . . . . . . 6 . . . . . . . . . . . 11 MISSISSIPPI Rehabilitation . . . . . . . . .. 0 . . . . . . . . 6 . . 12 TEXAS Diabetes Consultation - o . . . . . . . 9 . . . . o - 13 NORTH CAROLINA Stroke 14 IOWA SUBJECT PAGE Thromboembolism. . . . . . . . . . 15 WISCONSIN 16 Respiratory Care . . . . . . . . . . . TEXAS WESTERN NEW YORK Cancer . . . . . .. . . . . . . . . . . l@7 CONNECTICUT 18 Cardiovascular MISSOURI Coronary Care Training Result . ... ... . . . . . . . . 19 INTERMOUNTAIN Coronary Care Training . .. . . . . . . . . . . . . . . . 20 WESTERN NEW YORK Allied Health, . . . . . . . . . . . . . . . . . 21 TEXAS Impro-Ving Health Manpower . . . . . 22 NEW YORK METROPOLITAN AREA Continuing Education 23 WASHINGTON-ALASKA Continuing Education . . . . . . . . . 24, PENNSYLVANIA Television Network,Study . . . . . . 25 LOUISIANA Continuing Education Meharry Medical College 26 TENNESSEE-MID SOUTH Educational Evaluation Training . . . 27 ILLINOIS, et al Nursing Continuing Education 28 ALBANY, WISCONSIN,,KANSAS CENTRAL NEW YORK Eighty percent of the hospitals in the Mountains States Regional Medical Program, Idaho, Montana, Nevada and Wyoming, have under 100 beds, Seventy percent have under 50 beds. Patients with coronary disease in these hospitals should have an opportunity for survival equal to that of persons living near medical centers. The PJVA long-range approach to reaching this goal is to establish ICC training centers in each of the four states. The immediate approach is to train registered nurses and physicians,to establish ICC facilities in small hospitals in Northern Idaho and Wyoming and Montana. Reinforcement of initial training is being planned from the start nursing and physician faculty visits.,. conference calls, special'symposia for physicians, and the development',of "standing orders" for any ICC facility. 2 Ninety percent@of the population in the Intermountain RMP will have access to specialized coronary care within two hours of onset of symptoms) once the last phase of the comprehensive program is underway, This last phase involves small hospitals in the widely separated a. To those'hospitdls with existing Facilities, the Regional communitie Medical Program will provide consultation, reserve equipment for loan when breakdowns occur, training of electronics maintenance men and training of physicians and nurses. To hospitals which have 'no. facilities the Regional Medical Program will provide consultation on renovation of space and financial assistance for monitoring equipment. The hospitals in turn will agree to participate to a study to determine optional and minimally acceptable;standatdo of nursing skills., to experiment with staff@and to collect data that may be compared with data from other units. . I I 3 The Watts Section, with a population density of@ 10,000 per square mile, is cut off from the mainstream of modern medicine in an affluent society. The backwardness of its existing delivery of medical care can be overcome only @@by bold imaginations, ingenuity and effort. An RMP Advisory Committee, divided into Task Forces, aided by a staff of personnel with high academic excellence and deep community motivation, could bring some order into the health service chaos now existing there. The medical schools of USC and UCLA and the Charles R. Drew Medical As n are,comm sociatio ited to this approach. A@485 bad hospital dua@to open in 1970 and a proposed Medical School are later phases of the bold plan. 4 a remote hospital is being built to In Tennessee, serve an area of approximately 30 square miles. The nearest hospital is 50 miles in either direction over winding mountain roads. The best hope for staffing the new extended care facility is by encouraging young people @in the area to enter the health field, The RMP is assisting by providing an educational director to work with area high school counselors to pro- mote interest in health careers, to plan work experiences, and to give up-to-date information on scholarships and career opportunities available. In addition, the educational director will seek out, and interest, homemakers whose roots are well established in the area# in practical nurse training. 5 Does comprehensive, familY-Oriented health care in a neighborhood health center coordinated with an automated multiphasic screening laboratory reduce morbidity and mortality, improve use of health facilities, and change health attitudes No one knows, but Meharry Medical College proposes to find out. Regional Medical Programs is providing funds for the multiphasic screening laboratory* OEO@for the Neighborhood Health Centers. This study will' not be completed for several years, but a large number of inner-city families will receive screening tests and the necessary follow-up diagnosis and treatment, 6 The Ohio Valley Regional Medical-Program, which encompasses most of Kentucky, parts of Ohio and Indiana, .@has made a substantial investment of time and effort in the development of a strong, viable, and active regional advisory group. The RAG has participated fully in developing criteria of a skeleton program for the region in which each participating hospital commits itself to I -related the creation of a "critcal mass" of inter education and training, patient care demonstration (at least 2) and health services,,research'activities. 7 Better Training for More Studcnts There is both an acute and chronic shortage of qualified X-ray technologists in the Tennessee Mid-South Rd-gion. As a result, the quality of medical practice is hampered. Several hospitals have attempted to start training programs in this field in order to meet the need; however, due to the lack of qualified instructors, space, and equipment, the majority of students have failed to qualify for their registration. By contrast, the performance on examination of students trained at Vanderbilt has been excellent. The university and the hospitals -have banded together through RMP to provide better training for more students, with Vanderbilt providing the academic instruction and the community hospitals, the clinical training. 8 A cooperative study program for uterine cancer therapy and evaluation is underway in Wisconsin which will link the special capabilities of the two university medical centers, cooperating hospitals and physicians, to improve the quality of uterine cancer. therapy in the region. New techniques for review and evaluation of current therapy and long-term results will be introduced. A common language for description of clinical data and the methods of collection will be uniformly developed so that joint review and anlysis will be meaningful. Computer techniques for collection, storage, easy retrieval -and statistical study will be available for ongoing evaluation* Cooper- ative arran ements will be phased as knowledge and interest in the study 9 increases throughout the state. The.long-range effect will be better patient care. . 1 i i .9 Recognizing that carcinoma of the cervix in all probability can be eradicated as a major cause of death if diagnosis is made and acted upon at an early'stage, the Albany RMP hascbveloped a comprehensive program of education, organization, record-keeping and close follow-up to accomplish this. During the first year, the program is being inaugurated in seven hospitals located in the regional periphery in New York and Massachusetts. New York State law requires Papanicolaou smears to be performed on all the hospital patients. Massachusetts does not. @The compulsory and the voluntary experience will be studied. In following years,, all hospitals in the regions will be involved. 10 Cancer not only brings suffering to the individual child, but hardship and emotional distress to all members of his family. The fact is that a with cancer is a threat to family life. Problems of transporting the child to and from treatment, care, food, crowded living conditions, become realities beyond the capabilities of many families to handle. Families need help; they need to know there are resources and trained people,available to help them during these emergency periods. is The M. D. Anderson Hospital in Texas, under RMP)planning to provide training for child welfare workers in psycho-social needs of the child with neoplasia and his family. Before October.1967 there were no hospital beds specifically for stroke patients in the State of Mississippi. Now, there are four made possible by the MQ. What good do four beds do? For one thing, patients are served. In somewhat over two months 12 patients have been admitted to the unit and 8 have been discharged. For another, the unit Serves as a training model for both physicians and nurses. A three-week practical course for stroke nursing management has begun with students from hospitals throughout the state. A continuing education program for physicians in cerebrovascular disorders@is planned. Each physician will spend time in either stroke unit as well as in the Neurology Service at the Medical Center. Other hospitals planning stroke units are learning from the four- bed experience. It s a start. Nothing was there before PXP.@I .12 A centrifugal effort is being planned in the Texas RMP to reach community hospitals and local rehabilitation resources in a community action@program. Three communities, each in concert with a different medical school, will develop and study rehabilitat:Ln functional units tailored to different medical settings to serve patients with heart disease, cancer and stroke. One community has a unit already in operation @-and will concentrate on improving and reaching the full potential of patients in the service area. Another community is now building a rehabilitation 'Uni,-- adjacent to a home for the aged, and has a paucity of both trained staff and equipment. Another community is planning rehabilitation services with specialist staff shared by two hospitals and home health care. The three communities and the-three medical'schools, will coordinate their goals and their experiences. 13 4% fcas4@bility study has convinced North Carolina that there is no one way to provide consultation and education on diabetes to physicians. The method must be tailored to local interests. The greatest receptivity to consultation clinics is in relatively small medical commun t es made up largely of general practitioners. Physicians in larger population centers tend to desire more formal educational programs rather than consultation clinics. The North Carolina Regional Medical Program is prepared to provide both kinds of programs, as well as special training for hospital nurses and public health nurses, other involved members of the diabetes team. 14 Tl,ic Iowa Regional Medical Program and the Iowa Heart Association have joined forces to plan a comprehensive stroke program for Iowa for the prevention, identification, n@anagement and rehabilitation of stroke patients. "L'he state will be divided into 12 areas. A stroke team of physicians, nurses and specialized physical therapy personnel will provide reh@',)4@li- tation services in institutions and nursing homes. One hospital in each community will provide for acute care and coordination of out-of- hospital services. Casefinding, continuing and refresher edication for health professionals, community education and data collection are other components of Iowa's comprehensive approach. 15 Pulmonary embolism is a common disorder frequently misdiagnosed and often fatal. Wisconsin has a higher mortality rate from thrombo@olism than does the Nlation. I .The Wisconsin RMP has in operation a demonstration of the techniques Lor diagnosis and management of patients with pulmonary -"@hrbn,zoe@olism. I-L- is a resource for increasing awareness of diagnostic criteria among physicians, it provides latIest diagnostic techna'.'a es; it provides for .,u patients the ootional therapy required to correct their clinical conditions; it provides rapid transportation for patients who need the diagnostic facility; it provides cooperative endeavor by both medical schools in basic research in.blood coagulation and --hromboembolic disease; and it provides continuing education and consultation for -P,@-vsicians. 16 Planning for area-w4-de total respiratory care is underway "'ew Yorl@ and Texas. A-,i impressive coalition in -,.7o re ions - Wes,@err, of c,iost physicians, hos-?-Ltals', -rio-dical schools, junior colleges and tuberculosis associations are all participating in planning for pu'ol@-Lc education, screening, training, diagnostic facilities and education in these regions. 1 7 Problei-as arise when radiation therapy centers proliferate through- out t.-,e hospital syste,7i. The two rost obv4@us are the need for relatively expensive equ-Lpve-,it and c", struction and "-he lack of people at all levels of professional and technical ability to suoDo--t -.he centers when they are built. The consequences for quality of patient care are equally obvious. The Connecticut RI.@ L i ,.as a task @orce studying these p-obleris in relation to 05 ge-,Ieral hospitals in the state. Other i@,vPs are awaiting their guidelines with grea@@ interest. @Tria@L-- originally began as 1-h .Dlann4nc, of- a corrl--,rche-,i- @ C S4Ve ca@-4ovascul-,r care fac,"@-@y in a s-ngle Spring4iold hospital has dove!-o,,2cd, with Regional ivedica'" Prograr,,, as the caL--alys--", into a -.Lcul@1--@lcdgcd Ozarks @eg-'ton attack on heart and b.Lood vessel disease. Grant mone,v was --P-@uesk"-ea pr-@ITtari-L-v for ,olanning a @7,odel 75-100 bed Tode'L demonstration un4L@@ but"- triggered regio na'L activities .ha-@ Srea .L-er reward than the building of any one -'aC4 li- : a ly effective publ,'-c inzo--nation -"Ss-sl-"a,.nce @"O SIX area hosp4-'L-al planning ur,4-ts, society of an Ozark Regional Adv4Lso-Ly -.o Fearl@- Disease, Carcer, Stroke and Related Diseases a,-id Lys-"cian and ru.-se edu 19 -Yionta-,ia, @,a had our br 4 -1""atio,-, occu.- 4Ln the unit last Saturday evelillr,,&. @A 65 year oia <,e,.atlcr.,.an was @-ast Myr,-.a Vnec-@i- (your s t u t ) h -1 d-'cast connected h@. to the mordto.- and started an 4-i@terc-"t'n when he went ven@@ricul-"r '4-br4-l-lation. She success- ful v hit with' one and he has a s4n-@ r,iyth,-, sirce then. We are very proud of a-,id of YOU, of the wonderful work you are do-Ln-, for the people of our ty. c 07Inu i-L -I 20 York a ?i -.@or coronary care tra4@@lliil-. I)hys-'c'ans and nurses CC, 0 WCZC -@ppoi-.itc.-d to develop the 4-aCL"Cy. "".ic @.car, space SC-,--Vc t4Lo-- provided @@eachin-, equip-iient lon-,-te=@L lo@n; the University classroom s?ace; i.--,ve Co-,T,,-.iurity hospitals Co-xz,-,ittod teac,,,irL- srace. Respo.-.se to news c.' the plaii-.i4r.@ became rbus it was necessary to dcvc7op and publicize a Strict so VI' aoi@ schedule based on ,eogra-)hy. S @,rds have 'Doer, awarded for this act4,.vity. The first class is ready to bez-@-ri. 2i @o.-w :d meeting the tremendous STOD dLfic--'t now the hcL,' 4-1--ralateci -ricids O'L -therapy, occupa p tional therapy, medical -,Olo, sica' d.4blog4C record and ra technology, with the develop,,,,,,it of '@as4-c new School of Allied I-lealth Science a,-- t e a 'or a @,2dical -,L"l Ga-,ve8torL, 'Lexas. Continuing Educa-@4-on is also 'D a -,I e d Similar Plans for health are underway in -V L- these prog, co@.pre@ie.,@4 c@ess o- -aris is unique in. Ta--.as as well as i.-ie Na-@-Lon. 22 s@vrposi-am will be held this April in NOW York City dedicated ---o the education of people in health careers in the innc---cit:y. Mhlc meeting was Inspired by the iv;anha,--@ten Boroiaoh President who sought cooperation from Columbia University. Throu@,. the PLviP, olanning now involves all seven universities and the community colleges of the fi e boroughs. The symposium will express ie.4a:L@ ways j@ e pabili-,.iez and responsibilities _,rado- and scala@-e -Lne ca health manpower. 23 '"lie -,,ain problem of the Alaska physician is isolation from other P.-Ofess4@or.als. There are 200 physicians in Alaska, 8o live in Anchorage. No otl-ier community has more than 12. With this situation, unusual techniques have to be found for obtaining medical advice. The Washington-Alaska @i, i@as developed with the Alaska physicians a pro-ram to alleviate the professional isolation, provide more frequent a,-Id more convenient opportunities Irom continuing education, and to make more advanced care available to the patients. Two-way visual instruction, videotapes, visits to Seattle for special training with coverage for their practice, hospital visits by consultants, training for allied health p6rso-,inel and library service. 24 T.@ purpose O'" continuing medical education is to meet the needs of patients. Physicians know this. Sometimes continuing n"ly do not. A hospital education planners appare in Pennyslvania is developing a un4Lque educational program .Based A@irs-%., on needs of @r patients and then ihe needs of icaaLns ,:no P,@,,ys' it niecting -he patients' needs. Priority 4 e@"Lor@L.s are being directed at those disease entiti;Zes which cause -,I,.e greatest amount of preventable disability %,f.iich is .not currently being prevented by the physician's actions or accomplishments. As the Director of Medical Education said at @-iuzLry Confe.-ence-Workshop, "Our approach is different. We have c7nanged some physician behavior. We have improved some patient care. Ve have had some successes atd some failures. We can document both." 25 A statewide TV network for hospitals has been installed in Louisiana by the Department of Hospitals. The Regional Medical Program is providing assistance in planning sub- stantive programming for the network. A RYIP task force of facu'@-,:y, physicians and other personnel will be assisted by special consultants from outside the state in a study of programming needs and potential for the network. 26 Many 4-t@egro physicians continue to identify with Meharry Medical College and look to it for continuing education even though hospitals in their communities may have continuing-education programs. They often find it impossible to attend courses of any length because there is no other physician to care for their patients. The Tennessee Mid-South RMP and Meharry are attempting to alleviate both of'these problems. Continuing education programs of one to two weeks being developed at \Ieharry are being related to courses to be offered in community hospitals. Joint sessions will be arranged to introduce Meharry student-physicians to the hospital settings and opportunities. In addition, senior residents will be sent to take care,of the physicians patients during the one to two week course. 27 Three medical schools have established new liaison with schools of medicine in thIeir own or nearby institutions to initiate training programs in medical education evaluation. The Office of Research in Medical Education at the University of Illinois was the first program to assist the Division in this training activity and has had three one-week courses, two six-week courses. In the past year 36 people from 24 Regional Medical Programs have received one-week orientation in educational evaluation. Eight of these Regions have sent more than one person for training. One Region has sent staff for the six-week training course. Other programs are being initiated at the University of Southern California and Ohio State University. 28 ,Many Regional Medical Programs have learned there is a. great thirst among nurses in this land for continuing education. Two-way communications programs originally planned for physicians in the Albany and Wisconsin regions have been extended to nurses after studies disclosed their high interest. The University of Kansas has sponsored educational programs for nurses at the Medical Center since 1948. Many nurses have it impossible to leave their place of employment and their families to attend. The Kansas RMP has developed a circuit course for nurses to serve this group. The first course was oversubscribed. The second course was planned for 75 nurses, but instead 204 nurses arrived, including a number of inactive nurses. The circuit course is being accelerated as a result of this experience. The Central New York Regional Medical Program discovered that many small hospitals in the region have no formal training program and no educational resources with which to develop them but--these small hospitals want additional training for their nurses and retraining for nurses in the community who have been inactive. The ready developed programs medical center clinical nursing service has al to update nursing skills in coronary care, intensive care, rehabilita- tion, etc. Through the RMP the university hospital resource--and the hospital needs are being joined. The patients in this region will benefit from this new alliance.