@, I i i i gin !"@ # 3 2 SL-LECn-.D VIGNL-TTL-S ON ACFIVITIES OF REGIONAL MEDICAL PROGRAMS JULY 1971 Department of Health, Educatim, and Welfare Health Services and Mental Health Aciministration Regional Medical Programs Service Office of @unications and Public Infomation PPEFACE 'Ihese vignettes on Pegional Medical Prograin activities were compiled essentially from material received from several of the Ws during February 1971. The imterial was submitted in response to a request for information on activities that represented innovative approaches::' @y of the vignettes to meeting regional health needs, des@ribe activities which depend on the skills of the W professional staffs representing investments of time and funds from the professional staff budgets rather than separately fimded projects. 11-ic brief sunmries which follow are intended to be anecdotal for purposes of illustration rather than to provide a full description of RW activities. For more detail@ information on the organization and activities of RNPS., the r@er should consult the Fatt'B6ok on Re&ional Medical Prb@ that has been prepared by e Regional Medical Progrwn Service. Many of the vignettes describe activities that fall within the scope:, of the President's national health strategy. The President's Health Message of February 18, 1971 outlined a six-point program to implement that strategy. The vignettes, therefore, are arranged under the four points of that program that are most relevant to RV. Many of the Activities relate to mre than one point, and in these instances the summaries are arranged according to the main emphasis in the vignette, not in the activity. An index is included which provides a further breakdown by subject. The selection of activities to be included in this compilation is somewhat arbitrary in that an equal or larger number of illustrations:. within these same sub'ect areas and within additional areas could have been drawn from other Regional Medical Programs. TABLE OF S Page Preface . . . . . . . . . . . . . . . . . . . . . . . . . . A. l@-ORGANIZING THE- DELIVERY OF SL-RVICE' of Care 1. Improved System for Delivery . . . . . . 2. Health Maintenance Organizations . . . . . . . . . 16 3. Efficient Use of Health Care Technology . . . . . . 20 B. MEETING THE SPECIAL NEEDS OF SCARCITY AREAS 1. Rural Health Programs . . . . . . . . . . . . . . .. 25 2. Neighborhood Health Centers and Clinics 32 3. Area Health Education Centers . . . . . . . . . . . 43 C. MEETING UM PERSONNEL NEEDS OF OUR GROWING MEDICAL SYSTEM 1. Improved Service by Existing Physicians, Nurses, and Allied Health Professionals . . . . . . . . . 45 2. Increased Utiliz Ty atim of New ,pes of Allied Health Professionals . . . . . . . . . . . . . . 61 D. ACTIONS TO PREVENT ILLNESS 1. Early Detection of Disease . . . . . . . . . . . . 72 2. Health Education and Information . . . . . . . . . 79 Index . . . . . . . . . . . .. . . . . . . . . . . . . . . . 83 -V- ARKANSAS I:Xl,L:Izfml:NI'Al, lffiAl;llf 1)11-'I,IVFRY SY.STIM A rural Arkansas County which is agriculturally rich but which has no physicians, will be one of the t:irgcts of aid under an Experimental': Health L)elivcry Project being administered by the Arkansas Regional Medical Program and the Arkansas Comprehensive Health Planning Program. Another project target is an area in southeast Arkansas with a population of 70,000 and a physician population of only 13. The project will' cover the entire state of Arkansas and will deal w five problem areas identified as health maintenance and preventive services- manpower recruitment, training and distribution; distribution of resources; emerging medical se-rvices, and quality of care. The experimental health delivery system will be built upon the regionally hospital concept which is currently being evolved in the State. This concept proposes the organization of eight geographical districts, .'each with a regional hospital center which will service the remaining hospitals within that district Status: Professional staff activity "Experimental Health Services Planning and Delivery Systems" Grant $1,064,000 (24 months) The Arkansas Regional Medical Program covers the entire State of Arkansas, and has been operational, since' February 1 $ 1969. @ Its commitment -level for FY 1970 was $887,506 and for FY 1971 was $1,20q-@, 251., These fmds were used in 1971 to support a total of 15 projects,. of education, 5 for training which 4 were in the area of general continuing i@ combination of pat@-bnt existing health personnel in new skills 1 3 for a coordination for health services 2 fo" and training services, I for R&D, and a number of core activities. MTSSOTTRT iiL.,AL,rii.si:jzvi(,i: I'IZOGIZAM A rehabilitation center has been constructed in a rural Missouri community as the result of a program of expanded medical services to the area supported by the Missouri Regional Medical Program. Intensive care services, rehabilitation services and a home health agency were ,set up in Smithville, which was without these services prior to the th-ree-year MORMP project. After these services were made available, the increased ability to provide patient care made it feasible for the COM=ity to raise $500,000 which was matched by Hill-Burton funds to construct the Spelman Rehabilitation Center. At the end of the three year Period, MoW was able to withdraw almost all of its funds from the actual operation of the services as they became self-supporting. It has now been a year since any Mopm funds have been e ended in @thville and these services continue XP to be self-supporting and of service to the ultimate consumer, the patient. Status: Operational as of 4/67 4/70 lst year $200,957 2nd year $141$473 3Td year $48,745 The Missouri RMP covers the State of Missouri, pxclusive of Metropolitan St. Louis,,and has.been operational since April 1, 1967. Its comitment FY 1970 was $S,074.,230,and for FY 1971 was $1,947,417. These level for funds were used in FY 1971-to-support a total of 29 projects, of which 1 was in the area of general continuing education I for train . .sz.existing ing ,,health personnel in new skills, 1 for.training new health persomel,- 7, for,patient-services Idemnstrations, 6 for a combination of patient services and training, 11 for. coordination for health services, 2 for,, R&D, and a number of core activities. -2- CALIFORNIA CO"ITY NIEDICINE In an effort to raise the quality of medicine in the Watts-Willowbrook .section of Los Angeles the California Regional Medical Program is fund- ing a Department of Commity Medicine in the new hospital the-re. As' part of the Charles R. Drew Postgraduate Medical School in the Martin, Luther King Jr. General Hospital, the department will develop a system of medical care to serve the commity's 400,000 medically indigent blacks and Nlexican-AmeTicarLs. Scheduled to open tllis winter, the hospital will be the first in Los Angeles County to @e an effort to place private practitioners on the staff. Local general practitioners have been encouraged to en-roll in,' an intensive course in family practice at the Drew Medical Scl-iool which i,vill make them eligible to pass the Family Practice Board. CR,4p and the University of Southern California are co-sponsoting the course. Ilic Departnent of Co@ty Medicine will have a privately funded health careers program to provide financial assistance to local resid6nts interested in health careers. Also included in the department will be a NEDEX program to train military ex-co-rpsmen, a school of allied health professions, a commity mental health center, and a clinical research facility. Status: Operational as of 7/68 lst year.- $211,375 2nd year $498,314 3rd year $441,338 The California RNP covers the entire State of California and two counties in Nevada, and has been operational since July 1, 1968. Its comdtment level for FY 1970 was $8,012,055 and for FY 1971 was $6,220,094. Th6se funds were used in FY 1971 to supIport a total of 24 projects, of which 3 were in the area of general continuing education, 4 for tra sting health personnel in new skills, 1 for training new health per for patient services demonstrations, 8 for a Combination of p services and training, 1 for coordination for health services R&D, and a number of core activities. -3- MULTIREGIONAL 19LITArff ASSISTANCE TO SAFETY AND TRAFFIC The use of military helicopters and corpsmen to provide assistance to civilian victims of traffic accidents and o@er medical emergencies is being tested with the cooperation of the Colorado-Wy@g, Nbmtain States, Texas and Washington-Alaska Regional Wdical Programs. Ihe W s brought together c ty providers of emergency medical services for the purpose.of organizing and implementing the Militaxy Assistance to Safety and Traffic (MAST) program in their Regions. The program uses existing persomel and equipment from rdlitary units in the area to transport patients -from the scene of the emergency to the appropriate medical facility or to carry medical specialists and equipment to the ewrgency scene. Interhospital transfer of critical patients is also handled by MAST. Ihe feasibility of the program is currently being tested in areas of Texas, Colorado, Washington, Arizona and Idaho. The-proiect is sponsored by eight government agencies and is administered by a project team from the Departments of Defense, Transportation,and Health, Education, and Welfare. Status: Professional staff activity -4- I K)ML-' CARE, PROGRAMS Five commity hospitals on the north shore of Massac-husetts have s of the TS@IP and the begun home care programs through the effort Massachusetts Hospital Association. Such provTams will provide con- tinuity of care for hospitalized patients aft@t discharge, as well as reduce the length of stay in the hospital. To date, one hospital has. achieved a fully coordinated home care program with excellent Multidisciplinary input. Three hospitals aye planning to hire full--time nurse coordinators and. a@e opened a much improved information interchange with the local Visiting Nurse Association. One hospital m.oved the V.N.A. right into the hospital building and also appointed a full-tim6 qualified nurse as coordinator. Status: Professional staff activity $2,500 contract The Tri-State RAP covers the entire States of Massachusetts, Rhode island, and New H@shire,, and 'has been'operatimal since February 1, 1969. Its commitment level for FY 1970 was $1,'4@67,436 and for' FY 1971 was $1 814,132. These funds were.used-in FY 1971 to support a total of 5 ects, of which' I was f6f- tr' aiiRing, existing health proi personnel in new skills, 2 for patient. services' demonstrations, 2 for a combination of patient services and training, and a number of core activities. MISSOURI SPRINGFIELD CO@TP@SIVE CARDIOVASCULAR CARE PIUJECR An improved survival rate following cardiac arrest, the building of an addition to a hospital, and the stimulation of similar programs throughout Missouri are three results of a cardiovascular project in ,Springfield. Springfield's progrwn of comprehensive admission-to-discharge care for all high-risk cardiovascular patients located in a single progressive care division has achieved a 30 percent survival rate following cardiac arrest and is credited with saving at least 100 lives over the last four years. A cardiovascular care nurse.training:p-rogram, which accepts applicants from all over the State, was started as part of this project. The project had been deadlocked due to lack of funds until 1967 when the Missouri Regional Medical Program funded it. The commity was then able to build, with private funds, a $10 million addition to St. John's Hospital which is to be completed by the end of this year. Another largely unexpected result is that similar cardiovascular programs have been started in smller comtmity hospitals in the Ozarks. At least 18 of 35 hospitals in this rural area now ave improved care facilities under construction or in the planning stages. Status: Operational as of 4/67 6/70 lst year $69,347 2nd year $153)978 3rd year $373 905 The Missouri RMP covers.the State of Missouri, exclusive of Metro@l itan St. Louis, and has been operational since April 1. 1967.@ Its comitnent level for FY 1970 was $3,b74,230 and for FY 1971 was $1,947.417. These,, funds were used in FY 1971 to. support a total of 29 projects, "Of which: in -rea of general continuing education 1 for training existing 1 was.' the a health personnel in new s,kills,'l for training new health personnel, 7 for patient services demonstrations, 6 for a combination of patient and training, 11 for coordination for health services, 2 for services R&D and a number of core activities. -6- ILLINOIS M[l)-,WMISIDE PLANNING ORGANlZKfION The most economically depressed section of Chicago will have a unified health care program to serve its 3SO,000 indigent persons. Local citizens formed the Mid-Southside flealth Planning Organization and c leted a comprehensive plan for delivery,of health care. The plans OMP turn the fragmented available services into a comprehensive program., Included in the pTQgram are the areals seven hospitals. Ilic organization was funded by the Illinois Regional Medical Program., Status: Professional staff activity lst year $18,432 The Illinois RMP covers the State of Illinois, with the exception of that part included,in the Bi-StatO RW, and has.been operational since 1970 was $1'58S 643. and February 1, 1970. Its comitment level for - 11 % I I for.@FY' 1971 was $1,@4;286. These ftmds were, &d in FY.'1971 to su-pport a total of 7 projects, of which 4,were for patient service',s,demon@tra',r' tions, 2 for coordination'fot health servi i for R&D, and a number ces, of core activities.. COLORADO/WYOMING RF-,GIONAI, STREPTOCOCCAL LABORATORY A new laboratory in the San Luis Valleyivill cut by at least one-third the amount of time@needed to diagnosis streptococcal infections. This valley in Southern Colorado has the highest strep rate in the nation, a rate four tines higher than the rest of the State. The population is 80 Percent low-income Spanish-American. In addition, there is a SUNMCT migrant farm worker population. Before the lab was set up, specimens from San Luis were mailed for diagnoses to Denver, a distance of more than 200 miles. The lapse of time occuring in the mail-in program often kept health personnel from treating patients soon enough to prevent serious complications such as rheumatic heart disease. The Colorado/Wyondng Regional Medical Program brought together nearly 4 half dozen groups to establish and fund the lab facility. Status: Professional staff activity $3,118 The Colorado-Wyoming Regional Nbdical Program covers the States of rado andwyming, and has been opera.tional since january 1, 1969. Colo Its condiment level for FY 1970 was $1,176,Z82 and,f6r,FY 1971 was, $963 @24. 'These funds'wete used in FY 1971'to supi*rt a total of 13 projects, of which I was in the area of general continuing education, 6 in the area of training existing health'peTsomel'ifi'iiew skills,:'l in training new health personnel, 3 in patie-nt'servi6es'demonst-rations, .a 1 in coordination for health services, 1 for R@D, and' numbet'of@core activities. WASIIINGrON/Al-ASKA WII,IAPA IV"R l@Tli SERVICES (:losing of the hospital in the isolated co ity of South Bond, Washington, and the drastic reduction in health care in the area that would have -resulted have been averted through tile efforts of the Wasliington/Alaska Regional Medical Program. Early in 1970, the Ad- niinistrator of Willapa Harbor Hospital contacted W/ARMP concerning an extreme shortage of physician manpower in the area which threatened to force the closing of his hospital. For nearly ten years tile community had been attempting unsuccessfully to recruit new physicians. W/ARW staff responded, spending many days over a period of months with local citizens and health providers. W/ARMP was instrumental in organizing community interest and resources and in introducing outside resources, such as the University of Washington Division of Community Development, the C3iP "B" agency, the County Health Department, and interested physicians from the nearest laree cities. As a -result of W/APW., activities, the first new physicians in years have now located in the CoTmnmitY., the County Health Department is providing additional services beyond those formerly offered, and several local health services previously not available have been arranged. The local hospital will not only survive but will be able to improve its -service. In addition, contacts initiated and encouraged by W/ARNP have resulted in the development of a new and promising relationship between the Virginia Mason Medical Center in Seattle and the Willapa Harbor Hospital. Regular visits of hospital personnel are occurring in both directions to improve the quality of care through consultation services and continuing education. Status: Professional staff activity Ilic Washington/Alaska RW covers the entire States of Washington and s February 1 Ala ka and has been operational since 1968. Their 'commit- ment level was $1,606,157 for FY 1970 and $1,447 8@S for FY 1971 These funds were used in 1971 to support a total of 22 projects, :of which 7 were for general continuing education, 3 for training existing health personnel in new skills, 2 for patient services demonstrations I for a combination of training and patient-service's, 3 for coordination for health services, 6 for R&D, and a number of core activities. -9- TEXAS Rl:(',IONAL ]?J@LABILITATIO@N PIZOGRAM Victims of heart.discase, cancer and stroke arc living useful and independent lives as a result of the establishment of the Ilharton Rehabilitation Center. The Center was set up-with the support of the. Texas IM to serve patients from the Caney Valley Memorial I-lospital, Gulf Coast Medical Center and other co ities of the surrounding seven counties where rehabilitative services were previously unavailable. Expertise in methodology and procedures to implement the rehabilitation program was provided by the Baylor College of Medicine at Houston. In addition to providing direct patient services, the program is coping with problems such as manpower needs for treatment and services, continuing education for physicians and allied health professions, and increased community involvement. The program's acceptance by the co ity has been assure d by the degree of participation by physicians, hospitals, social and fraternal groups and commmity agencies. A criteria of the p-rogram's success can also be measured by the recent proposal of co ity hospitals to assume, within a short period of time, the entire financial assumption of the Wharton Rehabilitation Program. The program has served as a prototype for the development of other such activities in various parts of the country. Status: Ongoing as of 7/l/68 ist year - $100,947 2nd year - $127,063 5rd year - $72,068 The Texas RNP covers the entire State of Texas, and has been operational since July 1, 1968. Its comitment level for FY @1970 was $2i220,891, and for 'r-Y 19@l was $1,158,696. These funds were used in FY 1971 to support a total of 20 projects, of which 4 were in the'area of'genetal continuing education, 4 for training existing health personnel iri new skillsi,'l for rvices demonstr training new health personnel, 5 for patient se ations- 2 for a combination of patient services and@training, 3 for coordination for health services, 1 for R&D, .and a number of core activities. SOURH CARDLINA IZI-,I)t)CTTON IN DTAni RATT-, OF STWIG.: PATIFNTS Ilic use of special stroke facilities and a Iteam ipproach is crodi-tod with a drop of almost a third in the death rate of stroke patients at the Columbia Hospital in central South Carolina. Before the institution of the stroke project,.sponsored by the South Carolina Regional Nledical Program, the death rate among patients hospitalized for stroke was 52 percent. After the opening of a special stroke unit in the hospital, the rate dropped to 19 percent. There is an extremely high incidence of acute cerebralvi7Lsciil,,qr (stake) in the central region of South Carolina. The stroke project 'k s attempt in the State to imp-rove di ma es the first cqjnprehen ive agnosis, management and rehabilitation of stroke patients. 'rhe stroke team includes nurses , a speech the-rapist, a discharge planner, and a public health nurse. The team approach has been found to speed diagnosis and management of patients and permits early rehabilitation. Intensive rehabilitation is started almost imediately after the patient is admitted and has shortened the average hospital stay from 21 days to 16 days. This has -reduced hospital costs nearly 25 percent. .Status: Operational As of 8/68 lst year.-- $108 652 p 2nd year $ 69@247 3rd year $ 62,906 -rolina, and The South Carolina W covers the'entire-State'of South Ca has been operational since August 1, 1968. 'Its comitinent level for FY 1970 was $988 082 and for FY 1971 was $958 340. @These funds were ed in.FY 1971 to support a total of 16 projects, of which 2 were@in us the area of general continuing education', 5 for training existing health personnel in new skills, '7 @for'pati'e'nt services demonstrations foT;" a combination of patient services and training, 1 for coordination for health services, and a number of core activities. WBSR VIRGINIA BERGENCY NEDICAL CARE lhd use of helicopters to transport victims of coronary attacks and other medical emergenci6s'and for the'delivery of medical ser'vices is being studied in a project supported by the"West Virginia Regional Medical Program. A statewide system is being developed to meet health transportation problems in a moxmtainnus ar.ea with a rural, dispersed population, poor hig@ system, and scarcity of health care resources. Various modes and mixes of modes of transportation will be 'analyzed as well as emergency facilities and c cations networks. The study is being conducted'by the West Virginia University College of Bngineering in cooperation with the UniveTsity's School of Medicine. Status: Operational as of .1/70 ist year - $22p3O8 2nd year,- $12,104 The West Virginia RMP covers the entire State of West Virginia, and has been operational since January 1, 1970. , Its commitment level for FY 1970 was $524,048 and for FY 1971 was @ $580,978. These funds were used in . FY 1971 to support a total of 4 Droi ects, of which 1 was for training existing health personnel in new skills, 1-foi@@-vatient services demonstrations. 2 for,R&D,,,and a nwber of cor6,a,ctivities. -12- ARKANSAS A COMPR]I[ENSIVE PROGRAM FOR KIDNEY DISEASE The control of renal disease is the aim of a network of -regional medical centers in Arkansas supported. by the Arkansas Regional Niedical Program. The centers will be linked.,to the LJniversity of Arkansas Medical CentIer in the central part of the State where treatment of kidney disease patients will be provided through programs of transplantation, dialysis and training for home dialysis. The system of satellite centers will provide not only backup dialysis for patients and training in home dialysis, but also will serve as procurement centers for transplantation at the Medical Center and as education centers for both the physicians and the lay public concerning kidney disease. Status-. Operational as of 5/71 lst year $201,800 The Arkansas RMP covers the'entire State of Arkansas, and has been operational since Februarv 1, 1969. Its comitment level for FY' 1970 was $887,506 and.for FY 197i was $1,209,251. These- funds were used 'in 1971 to support a total of 15@projects, of which 4.@-were in the area of general continuing education 5 for training existing' health personnel in new skills., 3 for acombination of;patient and@.training:services, 1 for coordination for health@ services, 2 for R&D, and a number of., core activities. -13- WRTII CAW)I,INA IZE-GTO,\'AI,IZATIOLN OF SERITICES A -regional laboratory has been established in one part of North Carolina with the aid of the North Carolina Regional Medical Program. Although no RMP funds we're put into the effort, NCPM staff collaborated with a group of practitioners and hospital administrators to establish a single laboratory that is presently serving three hospitals in North Carolina and two hospitals in South Carolina. The result his been improved pathology services with obvious savings in capital outlay. Status: Professional staff activity The North Carolina RMP covers the entire State of North Carolina, and has been operational since March 1, 1968. Its comitment level for FY 1970 was $2,047,486 and for FY 1971 was $I.,844,692. These funds were used in FY 1971 for a total of 21 projects, of which 10 were,in the area of training general continuing education, for for existing health persomelf@in new skills, 1 for training new health .,,,.personnel 1 @'for patient services demonstrations, 5 for a cmbina- tion -of patient -services and training, and a number of core activities. -14- @KANSAS II(M-1 F[FALITI CARE Patients who need health care but do not require hospitalization are being aided by a Home Health Care Agency formed in Barton County, Kansas, with the assistance of the Kansas RAP. The Agency, upon -request of a physician in the county, will supply social services nursing, physical therapy, occupational therapy and other assistance. S.tatus: Professional staff activity The Kansas RMP covers the,;entire State of Kansas, and has been -'1967." Its comituent level for FY 1970 operational since,Jme'l. 'FY,1971 @ $1 236 220., These funds were was, $il,3@46,744 and for to s@ a total of-10 pro" used in FY@1971@ l@rtt iects.@ok which 6 were in the areaIof gene inuing'educatii6,"3 fo'r training existing health personnel in new skills 1 for R&D, and a number of core activities. NOI@ill (AIZOI,INA (,'ONU)IU:Ill'.NSIVI-" lfl@Al,'Ill SII:RVICIL DI:LIVI:IZY I'L@OGIM A coinproliensivc health care systems incorporating the Health maintenance organization concept, is being developed in a 7-county Appalacliian area in the extreme western part of North Carolina known as the State of Franklin, with the aid of the North Carolina Regional Medical Program. The system will include nurse practitioner clinics, group practice in providing primary care services, back-up hospital services, and a 'pre-payment plan. NCRMP also has been assisting in tile funding of one of the satellite clinics in this system. The clinic in Canada Township is one of several located in mountain "coves" where little other medical service is available. With the assistance of the NCRMP,,the State of Franklin Health Authority applied for and received a IM planning grant of $40,000 from the Ifealth Services and Mental Health Administration, - St,itus: Professional staff activity The North Carolina RMP covers the entire State of North Carolina, and has been operational since March 1, 1968. Its comitment level for FY 1970 was $2,047,486 and for FY'1971 was $1,844,692. These funds were used in FY 1971 to support a total of 21 projects, of which 10 were in the area of eene-ral continuing education. 4 for training. existing health personnel in Inew skills. - 1 for tr'aininz neW, @health pcrsoiuiel, 1 for patient services demo@tTatio@s. -5@ fo-T a@ combination ce and ri numbe core activities of patient servi s t ining, and a r oi -16- WISCONSIN 1',XPERIMFNFAL IgiAL'fll MikINTENANCI-','ORCANIZATION A prepaid health care insurance program for the black-cotnmity of Milwaukeols inner city has been developed with the assistance of the Wisconsin Regional Medical Progrmn. The Cream City Co ity Ifoaltli Center has been established by nine black physic'ians who organized into a group practice to provide medical services for the health center clientele. Technical arid financial assistance were provided by the Wisconsin RMP for early planning of the Center. Grants funds were obtained from the Office of Economic Opportunity, with Wisconsin RN) assistance, to help support the first year of operation. The Center is working with 10edicaid, Blue Cross-Blue Shield and the Milwaukee County Medical Society to develop a completely self-supporting experi- mental health maintenance organization. Professional staff activity Status: The Wisconsin MT covers the entire State of Wisconsin and has been ational since September 1, 1969. Their comitment level was oper $i,098,429 for FY 1970 and $951,781 for FY 1971. These funds we're used in 1971 to support a total of 13 projects,, of which 4 were in g the area of general continuing education, 2 for training existin health 'perso'mel in new §.kills, 3 for patient services demnstratioTi, 1 for a combination of training and patient services, l for coordination for health services, 2 for R&D, and a.number of core activities. -17- @is I.IDDEL HEALni SERVICE SYSTENI A model health service system is being set up in a rural ten-comty area surrounding Corinth, Mississippi. The area has a low income population. The new system will be set up as a health maintenance organization modeled m the Kaiser Plan. The non-profit corporation will be using third party payors, computer reco-rd-keeping, and preliminary screening by paramedical personnel. The Memphis Regional Medical Program has been coordinating this program in cooperation with the Department of Housing and Urban Development and the Appalachian Regional Comission. Status: Professional staff activity The Wmphis Re ional Medical Program covers parts of Western Tennessee 9 Northern Mississippi.: Eastern Arkansas and portions of Kentuck y, and Missouri and has. been o--,nerational since July 1, 1968. Its commitment level for FY 1970 was $1 284,714 and for FY 1971 was $955,722.; These funds were used in FY 1971 to support a total of 13 pro ich jects, of wh 1 was in the area of t ting health personnel in new skills, 2 in patient services. ons, 7 in a combination of patient services and ti-aining.,@ 2 in coordination for health services, 1 for R&D, and a number of core activities. -18 NORTI I CAROIINA IUUIAM NE-IG-IBOPJIOOD IEUTI-I CENTER The black comwity of Durham has organized a neighborhood healtJi center based at Lincoln Hospital. The Lincoln Neighborhood fiealtJi Center will incorporate health maintenance organization concepts such as group practice and pre-payment. The 'North Carolina Reizional Medical Program helped the black leaders obtain State funding For the health center as well as non,-NCRNP fmcls for renovation. Among the c ity organizations involved in the clinic are the Health Service Research Center of the University of North Carolina Duke University I-lospital, Durham County Health Dopa@ent, Durham County Wntal.licalth Department, OEO and many others. Status: Professional staff activity The North Carolina RMP covers the entire State of North Carolina, and has been operational since March 1, 1968. Its camitment level for FY 1970 was $2,047,486 and for FY 1971 was $1,844,692. These funds were used in FY 1971 to support a total of 21 projects, of which iO were in the area of .general continuing education, 4 for training existing health personnel in new,skills, 1 for training new health personnel, 1 for patient services demonstrations S for a combination of atient services and training, and a number of core activities. p -19- MISSOURI AUI'OWfl-ID IlIfYSICIAN'S @SSI,';TAW In the rural town of Salem, Missouri, population 4000, the patient,,@ of general practitioner Dr. Billy Jack Bass are being treated in one of the most highly automated doctor's offices in the nation. fiere the "products" of three yea-rls development of eight Missouri Regional Medical Program's projects are combined in a physician's office -to demnstTate how these technological advances can provide better, more complete care of the patient and wre efficient use of the physician's time. This system, by means of computer terminals and special telephone lines, links the automated physical examination equipment and the personnel in Dr. Bass's clinic to a computer at the University of Missouri College of Engineering in Columbia and to the Medical Schoolls specialists. In brief, selected parameters such as EKG, spirometry, eye and hearing examination, blood pressures patient history, and laboratory and x-ray data, are automated and combined in a single computer print-out with the physician's physical findings. The system is such that all of the elements (except the laboratory and x-ray findings) are available to the physician when he sees the patient for the first time and the entire record may be called up at any later date. This insures a standardize more complete work-up for the use of the physician and begins to attack the problem of providing a standardized patient record permanently stored in a central location. The development of this project has, at one time or another, involved almost every school at the University of Missouri, several telephone companies, many practicing physiciansabout 20 community hospitals and is, to the best of our knowledge, the only system under development today specificall designed to meet the needs of the individual y practitioner as an Automated Physician's Assistant. ,status: Cooperative effort of 8 NBRW projects. Funding as Projoct #72 -- 7/l/71 - 6/30/72 $153,537 The Missouri RMP covers the State of Missouri, exclusive of Metropolita Ti ';t. Lou -rational since April 1, 1967. Its commitment is, and has been ope 1 1 for FY 1970 was $3',074,230 and for FY 1971 was $1 947,417. These eve .9 funds were used in FY 1971 to-suppor It a total of 29 projects, of which 1 was in the a-rea of general continuing education- 1 for training !existing f personnel in new skills, 1 for .traininz new health personnel, 7 health for patient services demonstrations, 6 for a combination of patient services'and training, 11 for coordination for health'services, 2 for' R&D, and a number of core activities. -20- KAN-SAS MANA(',IMNr OF I)JABI",TIC In -i feasibility study of cojiq)utorizcd iiiinagcmont of tlic. outpatient diabetic, change in insulin rccojmtcndod by tltc computer agreed witli those of the physician 98 percent of the tire, In no instance did the computer make hazardous recommendations. The project was funded by the Kansas Regional Medical Program and carried out at the Kansas University Medical Center with the use of allied medical personnel. Based on information obtained at patient visits and examples of physicians' prescriptions under similar tances, the computer Tecomended diet, insulin dosage, and CITCUMS dosage for orally administered drugs. It also specified when labora-, tory examinations and further consultation was necessary. Ihe project demonstrated that use of a computer in routine care of the ou6atient diabetic .would cut down on the physician's work load without sacrificing accuracy. Status: Professional staff activity The Kansas RMP covers the entire State of Kansas, and has been operational since June 1, 1967. Its ccmmi@ent level for FY 1970 was $1,346 744 and for FY 1971 was $1,236,220. These funds we re used'in FY 1971 to support a total of 10 projects of which@6 were -in the area of general continuing education, 3 for training existing health personnel in new skills, I for R&D, and a number o.f-core activities. -21- OKI,N IOMA lfe,irt patients in 42 small rural hospitals are monitored by health. personnel in nine major hospitals in a pro ject sponsored by the Oklahoma Regional Medical Program. Preliminary data from one participating hospital based on 73 remotely-monitOTed patients with confirmed acute myocardial infarction show@d a 12.5% reduction in the mortality rate from 22.1 to 9.6 percent. Telephone lines are used both to monitor the beds and for nurse conversations during emergencies. Each phone line can monitor' six beds. The line is split, with the first part being used for monitoring eauil)ment and the second part for emergency commica on ti s. The maximum nurftb;r of beds that one tecnician is alloiied to handle is 12. Participating in the project are the Veterans Administration, Indian Health Service, State and private hospitals in Oklahoma, Kansas and Arkansas. -,status: Operational as 5/68 Ist year - $420,000 2nd year - $414 500 i 3rd year - $3S4,000 The Oklahoma RW covers the entire State of Oklahoma and has been Operational since May 1. 1969. Its comitment level for FY 1970 was .$l 050,,145 and foriFY 1971 was $738,500. These funds were used in 'r-Y 1971 to support a total numbe-r.of 8 projects, of which 3-wpre in'the, area of general continuing education, 1 for training existing health personnel in new skills, 4 for a combination of training and patient,.i ities. services, and a number of core activ COIORAI)O/W)(OMING ])]VfAlIlIONT" A 1):jticitt. iii i-tirii (:olora(lo or Wyoiiiiii),. s(if.fering Frojii cliest [);iiii:; ito lt;ts to travel. -i I'(-,w JIUII(Ir.c(l iiii lc@-I to a city llosi)it@ll. for. ;ii-i clectroc;irdi.ogi-am, If the doctor is 1);irtici.l)ating in a I)Ilolic 7-iotwork linking the I-,CG equipment to a city Hospital, fie can take the pationt's l@C(-', in his office, and by means of special attachments to the phone , receiver, transmit the ECG pattern to the hospital. A machine in the hospital writes the ECG, and a specialist -reads it. The doctor is told the results over the phone. This network was established using Colorado/Wyoming Regional Medical Program seed money. The cost of the unit to tJie physician is $9S.' Units in rural physicians offices are linked to any one of several hospitals in faspe-r. Wyoming; Denver, Colorado Springs, Grand Junction, and Greeley, Colorado. Status: Professional staff activity $9 494 The Colo-rado-Wyoming Regional Wdical Pro the States of gram cov'ers Colorado and Wyoming, and has been operational since January 1, 1969. Its comitment level for FY 1970 was $1,,176,282 and for FY 1971 was $963,224. These funds were 'used, in FY 1971 to support a total of 13 .projects, of which I was in the area of general continuing education 6 in the area of training existing health personnel in new skills' 1 in training 'new health Personnel, 3 in patient se@@ices demo.nstratio:fts, I in coordination for health services, 1 for R&D, and a'number of core activities. -23- WAI;L I I N (.'I'ON /Al AS KA Finding out when to use COB]putcrs for medical purposes, andMien N(Yf to use tJiem is the goal of the Medical Computer Services Project supported by the Washington/Alaska Regional Medical Program. For example, one part of this project involves detemining which is the most effective way of gathering a patient's history, by feeding information to a computer, by giving the patient a form to fill out, or by letting the doctor interview the patient and take notes in the traditional way. Another phase of the project is determining the efficiency of computers in interpreting electrocardiogram. Through the project, a Regional Conference on Medical Computer Services was held in the fall of 1970. It was the first such meeting in tjie region, and one of the largest in the country. The conference had 278 participants and 22 exhibitors. The MCS project is sponsored by Washington/Alaska Regional Medical Program and the Washington State Medical Education and Research Foundation. Status: Operational as of 2/70 lst year - $35,000 2nd year - Core activity The'! shington@kdaska Regional Medical Program-@ covers the States of Wa Washington and Alaska and has been operational since February 1. 1968. Their condtinent level for FY 1970 was $1,606,157 and for FY 1971 was These funds were used in 1971 to support a,total of 22 pro- iects. 7 of which were for general continuing education, 3,fo-r training existing health personnel in new skills, 2 for patient services demon- .StrAtions@. 1 for a combination of patient and training services,.3 for coordination for Health services, 6 for R&D, and a number of core activities. -24- NORTH CAROLINA AIR TRANSPORTATION SYSFEM A Statc-wide medical air transportation system weekly flies a group of specialists to Ta-rboro, Wilmington and other outlying areas to participate in clinics providing medical care not otherwise available to the thousands of rural residents in these 'areas. The air trans- portation system has also flown kidneys and other organs for transplant from medical centers all along the Eastern Seaboard to university centers in the State. The small craft are also used in an education exchange of physicians. University of North Carolina medical school doctors are flown to the New Hanover Hospital in Wilmington one-morning a week. On the return trip practicing physicians from the Wilmington area travel to the university for continuing education courses. The rural physicians make a return flight home in the evening. Three planes make up the system which has logged rare than one million passenger miles in its first three years of operation. The air transportation system is part of the North Carolina Regional Medical Program's funded project in Education and Research in Co ity and Medical Care. Status: Operational as of 6/68 Component of "Education and Research in Co ity and Medical Care" Ist year $209,200 2nd year $201,119 3-rd year $240,993 4th year $ 74,000 The North Carolina RMP covers the entire State of North Carolina, and has been operational since'March 1, 1968. Its commitment level for FY 1970 was $2,047,486 and for FY 1971 was $li844,692. These flmds- were used in FY 1971 to support a total of 21 projects, of which 10 were in the@..area of general continuing education, 4 for training existing health personnel in@ new skills, 1 @ for training. new'. health personnei,-l for patient ser'vices demonstrations, IS for a combination of patient services and training, and a nmbe-r of core activities. -25- SEE/tUD-SOUrH HEALUI CARF, oc)NSORTIA dentistry, and Three to six teams of students of medicine, nursing existing t'ams of social work'are joining already e it is the hope working in urban and rural poverty areas this sumer. of Temessee Mid-South Regional Medical Program that students workdng . these teams will b :Ln e recruited to the region. The project is part of TIM' s health care 'consortia program. other consortia pilot projects will be helping a number'of rural Appalachian romramiiCies develop a cooperative health care system, and encouraging local nonprofessionals to participate in a.local rural heidth care progrm. A consortium app-roach--which may or may not be also a group actice-- has been'-adopted by the Region to help alleviate the shortage of health manpower. It is expected that each locality will adopt a type of c@Tehensive health care plan which best suits its needs. However, t@ tem approach', use of allied health pe-rsomel, and automated data nmagement will be included in each plan. The project' s goal is to compensate for the low patient/physician ratio in the Regio-n-which is 118 per 100,000. The national average is 141 per 100,000. Status: Professional staff activity 'Me@ Temessee Mid-Sout-h YW'coveTs the State of Temessee and parts of southwestern ince',February 1, 1968. @-:be6h operational s 1'97 $2.%12 110 and,for FY 1970 was Its comitment level for FY 0 v .89 $I,,747 3S2. These funds weie iised'.in 1971 for a total of 26 pTojects, of whidi 4.-wria -in the- area'of general continuing 6ducation, 7 for trainim existing, health persomel'l'n new skills, 3 for training new health 7 for patient services demonstration, 3 for a combiTu ient se ces and training, 2 for R&D, and a number of core activities. -26- (;I:OIZGIA EMERGENCY CARL gia and Northern Florida which has a staggering A rural. area of South Goor iiLmi)cr of serious iuto accidents will have round-tlie-clock- emergency service for the first time under a Georgia Regional Medical Program Project. in a typical year, Decerber 1, 1968, to December 31, 1969, there were 1,618 motor vehicle accidents on the section of fligl-lway I-75 which passes through this Florida resort area. At that time, all hospitals in the area were relying on practicing physicians to be called on a rotating basis for emergencies. Virtually the only aTrbul.ances available were those from local ftmeral homes, which, in most cases, did not meet medical standards. The population of 200,000 in a land area of 3,800 square miles is served by 96 physicians and ten hospitals with a capacity of 838 beds. The project will staff and equip rollmd-the-clock emergency TOOM in two of the larger hospitals -- Pineview General at Valdosta and Vereen . Memorial at bbultree -- and provide emergency ambulances with intensive care capabilities. In addition, Moody Air Force Base has agreed to pro- vide helicopter ambulance service in dire emergencies. The project has been coordinated with the Comdttee on Emergency Medical Services of the Medical Association of Georgia, the Highway Safety Bureau and Divisions of the State Departnents of Public Health and Education. Status: Professional staff activity The Georgia IM covers the State of Georgia and has been operational Thei t level was $1,922,571 for FY-1970 @ce July 1, 1968. r condtmen and $1,779,862 for FY 1971. These funds were used in 1971 to._suppo-rt 23 -Droiects of which 6 were in the area of eeneral continuing @'educatim, 6 :(or training existing health personnel in new skills ' 2 for training new health personnel, 3 for patient services demonst-ratim, 1 fo-r.a training and patient services, 5 for coordination-of combination of health services, and a nuker. of core activities. -27- IVI,@'ONSIN RIJRAL I]FAUIII SERVICES Better health services for people in rural areas have resulted from linkages between the Marshfield Clinic, a 400-bed multiservice group practice and research facility, and smaller group and solo practices in the sparsely settled North Central and Northwestern regions of Wisconsin. In addition, collaborating arrangements between rural hospitals and the @rshfield Clinic are now in operation in a number of rural co ities in the area. Through these arrangements, cardiologists, internists and other specialty -physicians provide consultation and clinical follow-up services for outlying physicians and health facilities on a scheduled basis. Plans are now underway to establish satellite health stations to be mamed by specially prepared nurses to work in. conimction with a small group of physicians who practice in Shell Lake where the-re is a small hospital. The Wisconsin RUP was inst-ru- mental in organizing and developing these linkages. Status: Professional staff activity The Wisconsin RW covers the entire State of Wisconsin and has been io'nal since September 1 1969. Their comitment level was operat' p $1,098,429 for FY 1970 And $951,781 for FY 1971. These funds were t a total of 13 projects, of which 4 were in used in 1971 to suppor the 'area of@general continuing education, 2 for training existing health personnel in new skills, 3 for patient services demonstration, r a combination of training and patient services, 1 for coordination for health services, 2-for R&D, and a number of co-te-activitiesI -28- MA,INB RURAL aaTli DELIVFRY SYSTEM being developed for the A better rural-health care delivery system is 25,000 residents of West Central Maine. The Maine RMP has aided the area planners by consultative services and liTnited financial support, -resulting in an OBO operational project grant for the Program. The areals plan is to approach the solution of medical-care d;livery by a gro practice method, comprehensive prepayment insurance and use of all@d health-oe-rsormel, as well as advanced teclmologies including two-way television and radio communication. Status: Professional staff activity The Maine PM covers the entire State of Maine, and has been operational since July 1, 1968. Its canitment level for FY 1970 was $956,904) and for FY 1971 was $814,42Z. These funds were used in FY 1971 to support a total of 6 projects of which 3 were in the area of general continuing education, 2 for training existing health ersonnel in new skills, 1 for n coordination for health services, and a nigber of core activities. -29@ GEORGIA SIUUT-D AI,I,ILD laMDI SL@RVICES llliysical therapists are workin in parts of rural Georgia where no 9 homc-carc physical therapy was previously available. The therapists are'-Dart of a Georgia Regional Medical Program project involving the pool@ of medical personnel to provide services to remote areas of the Ing State. In a demnstTation project, the physical. therapist assiilncd to the north- cast area of the State becomes self-supporting in less than three months. The population of 90,000 is served by six co@ii.ty hospitals, one nursing home, and one extended care faci.lity, i@itli 250 total beds. Only one hospital was providing iii-lio.,ipital -rehabilitation services. In the Southeast area, the workload for the original single tjierapist became so great that a second therapist was added. Die first therapist was self-s orting within six months. The population ot 100,000 UPP is served Dv seven co ity-hospitals, two nursing homes and one extended care facility, with 600 total beds. There were only minimal in-hospital rehabilitation services. Initially GRW paid tire salaries of the physical therapists who are responsible for providing services to medical facilities, as well as (,u-veloping home care program . Similar projects are planned with other types of allied healtli personnel. Status: OPOTational as of 5/69 lst year - $23,434 2nd year - $14,075 The Georgia RW covers the State of Georgia and has been operational since July 1, 1968. Their condiment level was $1,922,571 for FY 1970 and $1,770,862 for FY 1971.@ These funds we-re used in 1971 to support 23 projects of whicli 6 were in the area of general continuing education, 6 for training existing health personnel in new skills, 2 for training new health personnel, 3 for patient services demonstration, 1 for a, combination of training and patient services, 5 for coordination of health services, and a nwber of co-re activities. -30-- ALABAMA MODEL CITIES NURRITION PROGRAM A Niod el. Cities Health and Nutrition Program has been developed by the Alabama IW to meet the nutritional needs of the chronically ill, dependent pre-school children, and pregnant adolescents in the Tuskegee- Macon County A-rea. Twenty nutritional assistants, after completing a six months training course at the Tuskegee Institute, will work with the rural poor to implement the program objectives. These individuals will be trained to observe family nutrition practice s, instruct and counsel in sound nutrition practices, assist in preparing teaching materials and make follow- home vi.sits to assist with menu pl.anning, UP food buying and cooking skills, They will also assist with dietary:. surveys and work with community groups. Other components of the program. are directed toward establishing a program of continuing education in nutrition for physicians and allied health personnel, and evaluation of nutritional status of individuals served by the program. The program is being funded jointly by the Model Cities Program and the Alabama RMP, in cooperation with Auburn University, Tuskegee Institute, Tuskegee Veterans Administration Hospital, Comprehensive Elealth Planning (a) and (b) Agencies, and the Public Health Department. Status: Ongoing as of I/l/71 lst year(three months) - $26,000 2nd year - $104pooo The Alabama Regional Medical Program covers the entire State of Alabama and has been operational since April.1, 1969. 'Their comit- ment level for FY 1970 was $980,709 and for FY 1971 was $766,278. These funds were used in 1971 to support a total of 5 projects, 3 of which were for training existing health personnel in new skills and 2, for training new health persomel, and a number of core activities..- -31- TRI - STNII, IJIUIAN ]U',ALIII CAI@- The @ Fields Corner Neighbo-rhood I lealth Center is providing primary care for the urban ghetto population of the Dorcliester neighborhood of Boston, with support from the T-ri_ State @, the Permanent Cliarities of Boston, the Boston Department of Ilealth and Hospitals, and others. The center is run by an incorporated commity group called "The De- tcrinined Pe le of Dorchester" and provides care for the approximately OP 17,000 residents of the area. Status: Professional staff activity $15,000 contract The -state RMP covers the entire States of Massachusetts, Rhode Tri 'n Island, a d New-Ilampshire., and has been operational since February 1, 1969. Its canitnent level for FY 1970 was $i,,467,436 and for 1 FY@1971 was $1;814'132. These -funds were used in FY 1971 to support a total of 5 projects,:of which 1 was@for training existing health personnel in new skills, 2 for patient services demonstrations 2 for a,cmbination of patient services and training, and a number of core activities. INTE@IDUNTAIN SALT LAKE CITY NEIGHBORHOOD HEALTH CENTER A Neighborhood Health Center, which incorporates a multiphasic health screening facility, is becoming a reality for the population of one of Salt Lake City's largest poverty pockets. The Health Center will serve approximately 61,000 residents of a 25 square mile area which is characterized by a lack of medical facilities, private physicians, and inadequate public transportation routes which would enable citizens to reach health care in other areas. The Center is within a %del Cities area and an Office of Economic Opportunity target area. It involves conjoint funding by the Comunity Health Service, OrO, local 'resources, and the Intemomtain Regional Medical Program. These cooperative efforts were developed primarily through the TRW staff and its commity liaison representative, who will also assist in the Health Center's activities when it becomes operative in July, 1971. A member of the IW staff will be the full-time Multiphasic Screening Project Director and another member will serve part-time as physician director. IRMP funds will provide the equipment and personnel for the screening program and the computerization of all medical records at the Neighborhood Health Center. In addition to providing health care services, the Health Center resources will be expended in training. LPNs as screening aides, and other health assistants, who will, bi- from the area served by the facility. Status: Ongoing since 9/70 Ist year $203,184 2nd year $358,176 The Intermountain Regional Medical Program covers the State of Utah Wyoming Wntana, Idaho, Colorado and Nevada, and has and portions of $ been operational since April 1, 1967. Their commitment leV'el@ w@ as $2,582,727 for FY 1970 and $2 152,682 for FY 1971. These funds were used in 1971 to support a total of 14 projects, 2 of which we're for general continuing education, 5 for training existing health'persomel in new skills', 2 for patient services demonstration 3 for ii Combination of training and patient services, 2 for R&D, and a number of core activities. -33- 'FIZ 1. - STATF, OC)ORDINATTON OF SERVICES The city of Providence has nine neighborhood health centers that have been operative since 1968. Though the centers had well-quilifi.ed physicians, none had a continuing relationship with a hospital. The Tri.- State RMP becam involved in the development of linkage between the centers and the comunity hospitals. Contracts were awarded to two of the five hospitals in Providence to tie them to the centers in their respective sections of the city. in addition, a corporation was fomed to combine the centers. TRMP provided the assistance of a physician with experience in medical economics to develop a permanent method of financing care of the centers I patients. Third party pay- mbnts a-re being organized with welfare eligible patients on a capitation basis. All parties have agreed to a new approach and details are currently being worked out. These will be the first such centers in New England to be financed on this basis. Status, Professional staff activity Two contracts $47,000 and $20,000 The Tri-State PM covers the entire States of Massachusetts, Rhode nce Februar Island, and New Hampshire, and has been operational si y1, 1969. Its commitment level for FY 1970 was $1,467,436 and for V@Y 1971 was $1,814,132. These funds were used in FY 1971 to support ng'-existing health cq total of 5 projects, of which 1 was for traini p,ersomel in new skills, 2 for patient services demonstrations, 2 for a cmbination of atient services and training, and a number of core p activities. -34- INDLANA NETWORK OF CO@ITY HEAL'RI CENTERS A network of three commmity health centers in the disadvantaged, imer-city areas of Indianapolis is being supported by the Indiana Regional Medical Program and several other agencies. The Metropolitan I-lealth Council founded and operates the centers. The Council is a coalition of private, public and voluntary health interest, professional and consumers, that decided to extend existing frameworks for delivering Care. It has developed a system for bringing personalized, comprehensive care to thousands of families for whom, previously, access to care and knowledge about the availability of health care services had always been proble@. 'fl-ie Council pulled together physicians, nurses, other allied health personnel and developed a new type of workers, the trained neighborhood health aide. This team works together to get people into the system. Public acceptance of the centers has been excellent,, with 15,733 visits in 1969. About 80% of the patients seen return for follow-up care. Data and experience from this project are now being used to develop even broader cooperative arrangements. Status: Operational 1/70 - 12/70 1 year feasibility study $169,550 The Indiana RMP covers the entire State of Indiana, and has been rational since January 1, 1969. Its comdtment level for FY 11970 $1.,271,411, and for FY 1971 was $968,842. These funds were used in FY 1971 to support a total of 6 projects, of which 2 were in the area of general continuing education, I for training existin health 9 personnel in new skills, 1 for patient services demonstrations, 1 for -a combination of patient services and training, 1 for coordination'for health services, and a number o core activities.. ARK,kN@,SAS IfEn'llf CLINICS Two medical clinics, one requested by the citizens and the other st.atted by local physicians, have been set up in poor, rural areas of the State with the help of the Arkansas Regional @-ledical Program. In the black community of Wrightsville, 9 miles south of Little Rock, the clinic was requested by the townspeople who erected the clinic building and set.tip a token prepayment plan determined by ability to pay. The physician-less town is -receiving physician and laboratory support from the local Veterans Administration Flospital. Local people and personnel from the Office of Economic Opportunity work together in peIrforming clerical duties. Local physicians established the clinic at@ Jacksonville, a community with a 60 percent white, 40 percent black, population. The clinic offers family planning services once a week, and has an immunization program. It also has been developed with the assistance of the ARMP and OBO. St@atus: Professional staff activity The Arkansas W covers the entire State of Arkansas and has been ational since Feb ua 1, 1969. Their comitment, level was r,8'r7 S06 for FY 1970 randr$yl,209,2SI for FY 1971. These funds were used in 1971 to support 15 projects, of which 4 were,in the area of general continuing education, S for training existing health personnel in new skills, 3 for a combination of training and patient services, 1 for coordination for health services, 2 for R&D, and a.-hunber of core activities. -36- CALIFORNIA IX) VALLFY OUT-PATILNT ClkAOCS AN I -T-, RNA N Ilirce oiit-I)atieilt ciiiiics will be serving six disadvantaged coiTiiiunities in the northeast San Fernando Valley as a result of a study of the area undertaken by the California Regional Medical Program. The area is in need of additional health care facilities now due to the destruction of hospitals in the recent earthquake. Particularly needed i.,; a now method of transporting persons to the -remaining hospitals. A new local I)ti.,, transportation system for patients is to be set up as part of the project. Geared for future development into a health maintenance organization, the clinics will be staffed by commi.ty health aides. I'hc program will serve six co ities which are contiguous and disadvantaged, but which differ greatly from one another in character. For example, one group is composed of retired, middle-class whites living in trailers, while another is made up of elderly poo@ persons who are not ve mobile. A third contingent is a poor com=lty which is 80 percent Viack, 20 percent @lexican-American. Included in the project will be allied health career training programs involving local coll.egos and schools. Funds from the Office of EconomiLc Opportunity have been -requested to supplant CR4P monies. However, if OE-0 funds are not granted CRW will continue its financial support until other sources of funding can be found. Status: Professional staff activity The California RdP covers the entire State of California and two counties in Nevada, and has been operational since July 1, 1968. its comdtinent level for l-Y 1970 was $8,012,055 and for FY 1971 was $6,220,094. 'niese funds were used in FY 1971 to support a total of 24 projects, of wlilcJi 3 were in the area of geneIral continuing 6ducationi-4 for training existing health personnel in new skills, 1 for training new health personnel, 6' for pa-Clent services demonstrations, 8 for a combination of patient services and training, I for coordination for health services,'l for R&D, and a number of core activities. -37- ILLINOIS VALLEY CLINIC Al tilOLIgIl 'i t i S .1 ocitod adj acent to one of the iiicdical centers in the ivoi-l(t, Ciiicigo's "Villoyll had littl.o iiiodical cziro initil the opeiiinp, of ;i free niedical Clinic in 1969. 'Die population of 10,000 in -this low income area adjoining the West Side Medical Center is 95 percent black-. When the clinic started operating, its services were limited to acute care. Now, however, full clinic services are provided, including gynecological,pre-natal and post-natal care, emergency services, screening and diagnostic care, nutritional counseling, and social services. Dental and X-ray care are provided at a back-up institution. Seriously ill and injured persons are referred to the LJniversity Hospital and other nearby facilities. To date, 3500 patients have been treated. It is expected that this number will increase to 6000 in the next year. Pediatric team care is provided. Other teams are being formed in adult, Ynatemity, and co@ity care. The@IRMP provided initial funding and continues to fund the clinic's innovative aspects. The costs of routine care have been assumed by other agencies. StatiLc,., Professional staff activity $71,400 planning study The'Illinois RMP covers the State of Illinois, with the exception of that part included in the Bi-State IN', and has been operational since February 1, 1970. Its comitnent level for FY 1970 was $1,585,643, and for,FY 1971 was $1,524,286. These funds were used in FY 1971 to support a total of 7 projects, of which 4 were for patient services demonstra- tions, 2 for coordination for health services, 1 for-R&D' and a number of Core activities. -38- NEW JERSEY iiospiTAf, BASED @ULATORY CARE Indigent patients will be given private appointments with the same family physician each time they visit the hospital-based clinic being set up at Ntiddlesex General Hospital in New Brunswick. One of the goals of this project is to see if it is more efficient than the traditional neighborhood clinic arrangement where patients wait for the first doctor available, and then are referred to other clinics if they need specialists. Aiming at a team approach, in addition to general practitioners the Middlesex Hospital clinic will have obstetrician-gynecologists and other specialists. If a patient needs to see a type of specialist not Assigned to the clinic, he will be -referred to a specific physician on the hospital staff. Similarly, if he needs X-rays, lab work, or pharmcy services, he will be referred to hospital facilities. 'rhe clinic will serve apptoximtely 4,000 persons beginning in September 1971. Middlesex Hospital was chosen as the pilot site for this type of project because it is located in the middle of a low- income area. Rmding tltie project are Medicare, Medicaid, hospital resources, and the New @e-rsey Regional Medical Program. Status: Ist year $143.000 The New Jersey RMP covers the entire state of New Jersey and has been oderational-since April 1,@1969. Their commitment level was $1 237,781 for FY 1970 and $1,225,026 for FY 1971, Ihese funds were used in 1971 to support 11 projects, of which 4 were in the Area of general continuing education, 2 for training existing health personnel in new skills, 1 for patient services demonstrations, 1 for a com- bination of training and patient services, 2 for coordiantion for health services, 1 for R&D. and a number of core activities. -39- CALIMRNIA LIVINGSTON-STANFORD NEDICAL ALLIANCE As an outgrowth of extra care provided for migrant workers during the sumer, a community clinic has been established at Livingston in cooperation with the Stanford University School of Medicine and with the assistance of the California Regional Medical. Program. For the last 25 years, this rural community of 3,000 was served by only one physician. The physician's office also served as the clinic for migrant workers. After searching unsucessfully for years to find a -replacement, the doctor finally felt able to leave the community when the clinic took over health care re nsibilities. The clinic, which began operating last summer, is staffed by Stanford medical students and community residents. A heart specialist, pediatrician,, and an internist spend two clays each at the clinic. In addition, seven medical students and two student nurses work there on a full-time basis. The clinic is open to all Livingston residents 5 days a week and emergencies are handled on a 24-hour-a-day basis. Community residents initiated a fund-raising campaign to pay for supplies in the day-to-day operation of the clinic. They have formed several committees to work in conjunction with the clinic. These include: an outreach Rram using comunity aides to hel-D break down the language p arr3Ler anroio help citizens f b d ind -- and transport them to -- proper medical treatment in the area; a committee on the special problems of the ill and aged such as transportation, proper diet, and regular medical check-ups; ana a family planning committee. Status: Professional staff activity The California RMP covers the entire State of California and two counties in Nevada, and has been operational since July 1, 1968. Its commitment level for FY 1970 was $8,012,055 and for FY 1971 was $6,220,004. These funds were used in FY 1971 to support a total of 24 projects, of which 3 were in the area of general continuing education, 4 for training existing health e-rsomel in new skills, 1 for training new health personnel, 6 p for patient services demonstrations, 8 for a combination of patient services and training, I for coordination for health services, 1 for R&D and a number of core activities. -40- ll,kl;l ITNCrON/AIA';KA KINNTEGilTAPI INDIAN HEALTII CLINIC At their local pow-wows, Kinatechitapi Indians learn of health clinic service.-, available to them. Most of the meTrbers of the 20 to 30 small tribes in the Seattle area have -recently moved from their reservations to the city. Many are indigent. They do not know where to go for medical help. Therefore, the Kinatechitapi Indian Ilealth Clinic sends representatives to the tribal meetings to tell the Kinatechitapis about the clinic currently operating in space in the Public I-lealth Service Ilospital in Seattle. The clinic began functioning on shoestring funds from the Office of Economic Opportunity. It is now open three nights a week, serving from 20 to 30 patients a night. The Washi-ngton/Alaska Regional Medical Program hopes to expand clinic @rs and the number of persons served. The purpose of the clinic is to assist the urban Indian in learning how to use the existing system of medical and social services, rather than to provide a continuing separate health care facility for a minority group. It is a cooperative effort of the Bureau of Indian Affairs, OBO, the Washington Department of Health and Social Services, and the W/ArM. Status: Professional staff activity lst year begiming 1/72 $44,080 The Washington/Alaska Regional Medical Programs covers the States of ,Washington and Alaska and has been operational since Febr'uary.,l, 1968. Their cmdtmnt level'for FY 1970 was $1,606,157 and for FY'1971 was $1,447,885. These funds were used in 1971 to support a total of 22 projects, 7 of-which were for general continuing education, 3 for training existing health personnel in new skills, 2 for patient,@tervices demonstrations, 1 for a combination of-patient and training seiiices, 3 for coordination for health.services, 6 for R&D, and a number of ctivities. core a -41- SOURH CAIROLINA l@ CARF, FOR INDIGENR PERSONS Nine heart clinics provide diagnostic and follow-up care for indigent persons in South Carolina. The clinic at Spartanburg, which is funded by the South Carolina Regional Medical Program, is fairly typical. It is responsible for a three-comty area with a growing population of approximately 220,000. The clinic provides services--i-ncluding cardiac catherization--for indigent persons with congenital heart disease, vascular disease or othey'complex conditions. It also disseminates information to physicians in Spartanburg, Cherokee and Union counties. During a recent six-month period, the clinic treated 136 heart patients and recorded an average attendance of 24 physicians and nurses at the monthly clinic conferences. The clinic is sponsored in cooperation with the State Board of Health and the State Heart Association. Status: Operational as of 8/68 lst year $24i692 2nd year $24,220 3rd year $22,058 The South Carolina RW covers the entire State of South Carolina, and has been operational since August 1, 1968. Its'comitment level for FY 1970 was $998,082 and for FY 1971 was $958,340.. 'These funds were used in FY 1971 to support a total of 16 projects of@ which 2 @ere in the area of general continuing education, 5 for training existing health personnel in.new skills, for patient services'demonstrations, 1 for a combination of patient services .and training, 1 for coordination for health services, and a -number of core activities. -42- KANSAS I B-AUII I 1: CAT IIR(TI'O'IYIII-" ARL-A DU TON CENTL-R L)i-itrai.iied I)crsons were taking X-rays in smaller hospitals in the rural Great Bend area until the Kansas ]Zegional ',Iedical Ilrogram instituted aX-ray technology training program. Fou-rteenmodical technicians, nurses and other hospital personnel -- who Aere serving as X-ray technicians because there were no trained technicians, available -- participated in classes held at the Central Kansas Medical Center. Because the equipment used at the training course was not always like that at the trainees' hospitals, as the second phase of the course the radiologic technician from CKMC visited the smaller hospitals to assist the trainees in their own laboratories. Films of the. trainees at work before and after the course are being evaluated by MT. 'niis training program is one of several that are conducted as part of a prototype area health education center that has been developed by the KRMP in the Great Bend area. Status: "Great Bend Educational PrograjW Operational as of 5/69 lst year $105,757 2nd year - $105,757 3rd year - $105,7S7 4th year $105,757 The Kansas RNP covers the entire State of Kansas, and has been operational since June 1, 1967. Its comitnent level for FY 1970 was $1,346,744 and for FY 1971 was $1,236,220. These funds were@ used in FY 1971 to support a total of 10 projects, of which 6 were in the area of general continuing education, 3 for training existing health personnel -in new skills, 1 for R&D, and a number of core activities. -43- WA,SIIINGFON/ALASKA WAMI PFOGRAM Two heart ittack victi@ in the remote Alaska comunity of Sil)ti are alive today I)ccause their physicians participated in a reg@i.on-wide program of continuing medical education. in this program physicians had learned how to insert central transvenous pacemakers. This know- ledge saved the lives of the two stricken patients. The program in which the doctors participated, along with other physicians, nurses and other health professionals from remote areas, is-held through the Lhiive-rsity of Washington at several centers in the region. The centers include Seattle, Takoma, Anchorage, Yakima, Spokane,@a-nd Wenatchee. They provide a place for health personnel in remote areas to meet with their urban colleagues to discuss the newest methods of medical treatment. The centers are part o WAMI, a Tegion-wide program of medical educa- tion designed to provide more physicians for comunities in Washington, Alaska, Mo-ntana and Idaho (WAMI). The Washington/Alaska Regional @dical Program has played an important role in the development of the WAMI program. For example, W/ARNP provides support for regular visits of consultant-teachers from the centers to remote areas in Washington and Alaska. As a result of these visits, physicians in the outlying areas regularly commicate with those in the centers, andIthere is more frequent -referral of -rural p ctors in the cities, when their own physicians lack atients to do the resources to provide the best treatment. Status; Professional staff activity The Washington/Alaska RMP covers the entire States of Washington and Alaska and has been operational since February 1 1968. Their commit- ment level was $1,606,157 for 1-Y 1970 and $1,447 885 for FY 1971. These funds were used in 1971 to support a total of 22 projects, of which 7 were for general continuing education, 3for training existing health personnel in new skills, 2 for patient services, 3 for coordination for health services, 6 for R&D and a number of core activities. -44- WESTFRN PEWSYLVANIA IMPRC)VR-D DIACNO.-3TIC TECHNIQUES The use of renin issays to determine if a patient's high blood Dressure is surgically remediable has resulted in the cure of persons in rural area@ who otherwise would still be suffering from hypertension. The expanded use of this new Idiagnostic technique is. one outcome of a continuing education course for physicians held in 17 hospitals in the Cambria-Somerset area of Western Pennsylvania, with the support of the Western Pennsylvania Regional Medical Program. As another part of this program, physicians from the University Health Center in Pittsburtyh visit comunity hospitals, and with one of the local physicians as their guide, help in the -routine care of patients. if necessary, the'urban physician offers to take patients to the Health Center laboratory for tests. This expanded consultation and referral system between the c ity physician and Health Center specialists has resulted in the doubling of the use of more modern diagnostic techniques by local doctors.. Status: Operational as of 7/69 lst year - $34,000 2nd year _ $39,000 3rd year - $25,484 The Western Pennsylvania covers the city of Pittsburgh, and 28 surrounding counties. and has been operational since July. 1, 1969. Their comitment level was'$9340041 for FY 1970 and, $996,,338 for FY 1971. These funds weIre used-in 1971 to 11 support a total of 7 projects of which 2 were, in the' area of general .continuing education, 2 for trainiit existingg'health -pe@somel',in new skills,'2 for patient services demonstration, 1 for coordination for health services, and a number of core activities. -4S- KANSAS INSTITUFF' I;OR DIETITIANS only thirty registered dietitians serve a much greater nmber of small hospitals and nursing homes in rural Central and Western Kansas. Two of these dietitians organized a dietary center in Central Kansas @dical Center where they hold courses for the cooks who serve these institutions. With the help of the @as Regimal Medical Program, ei@ht classes for 80 cooks from 12 counties have been held. Subjects taught by the two registered dietitians included general principles of, dietetics, . sanitation and personal hygiene in the prevention of food poisoning, diabetic and fat-conttolled diets and the importance of sodium-balqnci-.d diets. Status: Operational as of 2/69 lst year $18,264 2nd year $12,836 The Kansas RMP covers the entire State of Kansas, and has been operational since June 1, 1967. Its comitnent'level for FY 1970 was $1,346,744 and for FY 1971 was $1,236,220. These funds were used in FY 1971 to support a total of 10 projects of which 6 were 1 on-tinui in the area of genera7 c ne education, 3 for training existing 1 in new skills, 1 for R&D and a number of core health personne activities. -46- WESTERN PFNNSYLVANIA TIZAINING ]--OR NTJP.SINC, IIOMT-, PERSONNE-L 'I'lic standards of patient care in the nursing homes of Wostcrn I-lennsylvani@i have been improved through a training project undertaken by that lzogion's RMP. As of February 1971, 42 homes, one-third of the nursing homes providing skilled care in the Region, have participated in a training project to improve the quality of their nursing and administrative services. An intensive 8-month course, planned and implemented with the support of specialists in hospital management and nursing education fr,),n tqe University Health Center in Pittsb h, has trained 137 nurses U,rg and administrators. Nursing practices in the participating homes have been si ificantly improved as have the social services provided by the . gn homes. Various administrative procedures have been improved through the development of such practices as prospective budgeting and personnel management. This project is also being studied as a means of providing alternatives to the more::expensive hospital inpatient care. Status: C4)erational as of 7/69 Ist year - $125,000 2nd year - $136.1000 3rd year - $22,000 The Western Pennsylvania RMP covers the city of Pittsburgh, and 28 surrounding countries and.-h '@ been. operational since July 1. 1969. Their comitment level was $934.,041 for FY-1970 and $996.338 f6r FY 1971. These funds were used in 1971-to support a total oi 7 i)roiects, of which 2 were in the area of general continuing education, 2 for training existing health personnel in new skills,' 2 for patient services :. demonstration 1 for coordination for health services, and a number of core activities. -47- INDIANA COMI'TNUTNG PulMNARY EDUCATION Five new lung function laboratories, two new inhalation therapy and rehabilitation centers, @d three new respiratory intensive care units have been established as a result of a continuing education project in pubnonary diseases for physicians sponsored-by the Indiana Regional Medical Program. The project consisted of a five-day intensive training course at the Indiana University Medical Center followed by (ine-day sympos:La throughout the year at the trainees' parent institutions. Du-ring the first year of the project, 12 physicians frm nine areas participated. Du-ring the second year, the n@er of trainees rose to 29 from 16 areas. After completing the course, the trainees trained other physicians in their locality in the care of patients with pulmonary disease. The ten,new respiratory facilities were devel 'ed at the local level by OP trainees and the physicians they trained. Status: Operational 1/70 12/71 --$15,873 The Indiana RMP covers the entire State of Indiana, and has been operational since January 1, 1969. Its comitment level for FY 1970 was $1,271,411, and for Fy 1971 was $968,842. These funds were used in FY 1971 to support a total of 6 projects of which 2 were in the area of general continuing education, 1 for training existing health personnel in new skills, 1 for patient services demonstrations 1 for a cmbination of patient services and training, 1 for coordination for health services, and a nmber of core activities. -48- CI-:OIZGIA i,;i)tj(:NriONAI, 'IV NI:IWOIU( The first educational television network devoted to serving the private physician and other Medical personnel has been established by the Georgia Regional @ledical Program. When the project began in 1968, six medical institutions were part of the network. Todayi the network has grown to 22 hospitals, doctors' offices and clinics. The Atlanta-based network broadcasts an average of 22 hours a week and has a tape library of more than 500 program. AltJiough the Georgia Regional Medical Television Network has ceased weekly State- wide broadcasts in favor of a tape lending library, it does produce and broadcast live and videotaped programs over an Atlanta Metropolitan Network. More than 44 percent of Georgials physicians and nurses, and nearly one-third of all the State's hospital employees are within the Ci@ broadcast range. Purther, 87 percent of all physicians, 80 percent of all nurses and 69 percent of all hospital employees in the State have access to either live broadcasts or videotape -recordings. To be responsive to professional needs, G@ is sending a list of 50 topics to all-medical personnel within the broadcast range for ranking in order of preference. The 2S most preferred topics will be selected for production. When program are broadcast, a sampling of viewer response will be taken. The project is a cooperative effort of Ewry University, the Medical College of Georgia, and GR4P. Status: Operational as of 5/68 lst year - $522,491 2nd year - $355,882 3rd year - $149,561 The Georgia IW covers the State of Georgia and has been operational since July 1, 1968. Their commitment level was $1,922,571 for FY @1970 -unds w re used in 1971 to sul)i)ort and $1,779,862 for FY 1971, These f e 23 projects of which 6 were in the area of general continuing education, 6 for training existing healtli personnel in new skills, 2 for training. new health personnel, 3 for patient services dmonst-rationp:l for @ ; on of training and patient services, S for coordination"of combinati health services, and a number of core activities. WASI IINGMN/@KA 'ri@ININ(. JN SlIZOla', Stroke pati.cnts arc getting out of bod sooner, are able to f@,d and dross themselves earlier, and haver fewer complications as a result of a basis continuing education program for nurses in Centralia, Was ingtoji, and the adjoining town of Chehalis. Centralia has a population of 10,000 and is located 90 ndles from Seattle. Local citizens and health personnel set up the program of restorative and rehabilitative nursing at Centralia Community College. Nursing homes and hospitals provided the initial funding for the project. The fund- ing matched by the Washington State Ileart Association an@ supplements in 1969 by Wasliington/Alaska Regional Medical Progrwn funds. Tedmiques acquired through the progrwn are used by the entire nursing team including registered nurses, practical nurses and nurses' aides in participating hospitals, nursing homes, and private homes. Status: Operational as of 7/69 lst year - $4,700 2nd year - $13,000 The Washington/Alaska Regional Medical Program covers the States of Washington and-Alaska and has been operational since F@ebruary 1, 1968. IliciT, comn'tment level for FY 1970 was $1,606,157 and for FY 1971 was $1 447,885. . These funds were used in 1971 to. support a total of 22 projects, 7 of which were for general,continuin education 3 for train- 9 ing 6xistin health personnel in new skills, 2 for patient:services 9 demonstrations l.for a combination of patient and trainin 3 )I 9 services, for coordination for health services, 6 for R&D, and a number of core activities. -50- SOUIII CAROLINA CARDIOPULMNARY RFSUSciTATION PRWECR Nbre than a quarter of all employed nurses in South Carolina received training in mouth-to-mouth resuscitation and closed chest massage during the first year of aSouth Carolina Regional Medical Trogram and IfeaTt Association project. The pilot program was held in Dorchester County lios ital. First, .p phusicians and nurses were trained in the methods used to revive victims of heart attack, suffocation, electric shock, and drowning. Then the training was broadened to include inhalation therapists, firemen, policemen and other emergency personnel. 'Fhe project has been extended to include 208 free training programs. In a n@ber of counties, all hospitals' staffs have had the training. Twenty-five of the forty-one counties in the State having at least one hospital, have had one or more hospital-based training programs. Status: Operational as of 8/68 lst year $42)774 2nd year $46,645 3rd year $40,341 The South Carolina IM covers the entire@ State of South Carolina, and has been operational since August 1, 1968. Its, comitment level for FY 1970 was $988,082 and for.F,Y 1971 was $958,340.. These funds were used in FY 1971,to rt a total .-of 16 projects, of which 2 were in the SUPPO area of general continuing education, 5 for.training existing health personnel in new skills, 7. for patient services demonstration, 1 for a cmbination of patient services'and training, 1 for,coordination for health services, and a number of core activities. NORNUMS SI-IORT-TEM RESIDENCIES FOR PRACRITIONERS General practitioners internists and surgeons are being trained for periods of one-three months in a speciality or combination of specialities at the Mayo Clinic,, under a regional postgraduate medical education program supported by the Northlands Regional Medical Program. 'fhe specialities available are neurology, hematology, gastroenterology oncology, and cardiovascular medicine. Eventually envisioned for state- wide articipation, the project initially invol ves physicians from p five southeastern Minnesota hospitals. Status: Professional staff activity The Northlands RMP covers the entire State of Minnesota, and has been operational since March 1, 1969. Its commitment level for FY 1970 was $1 676 227, and for FY 1971 was $1,157,524. These funds were used in FY 197i to support a total of 8 projects, of which 6 were in the area tinuing education, 1 for training existing health of genetal-con personnel in new skills, 1 for coordination for health services, and a number of core activities. NL-'W JERSFY LPN PROGRANI Standardized training for Licensed Practical Nurses will be accom- I)] islied by a training program for LPNs working in the States coronary care units. This project represe-nts-one of the first attempts in the Nation to offer standardized CCU training for LPNS. At present, New Jersey's LPNs have a variety of educational back- grounds, ranging from forma'1 training to license by waiver. One of the goals of the New Jersey Regional Medical Program-sponsored training is to insure that all LPNs working in coronary care units will have been adequately trained for the new duties they will be called upon to perform as Registered Nurses mve into supervisory roles. Another goal is to determine specifically what new duties the LPNs should be allowed to perform. Clinical experience will make up at least half of the course. Although the pilot course of the program will be given at Hackensack Hospital this fall, it is expected that after the initial two courses the program will be decentralized to 20 hospitals in Sussex, Warren, Bergen and Passaic counties. StAtus: Operational as of 4/71 Ist year $31,108 'nic New Jersey RW covers the entire state of New Jersey and has been operational since April 1, 1969. Their comitment level was $1,237,781 for 1--Y 1970 and-$1,225,026 for FY 1971. These funds were used in 1971 to support 11 projects, of which 4 were in tlle area of general con- tinuing education, 2 for training existing health personnel in new skills, I for patient services demonstrations, 1 for a combination of training and patient services, 2 for coordination for health services,, li for R&I), and a number of core activities. -53- KANSXS IU-'I'IZATNIN(; INA(7FIVE' @ES Inac tive nurses in the Greater Kansas City area are being retrained in six-week refresher courses supported by the Kansas Regional Medical Projzram. Classroom work is received at the KRW headquarters in Kansas Cit-' with clinical experience at any one of is area hospitals in y Kansas,Cit , Missouri; Kansas.City, Kansas or Independence, Missouri. The cou-rse@ oriented to retrain inactive-nurses who desire to maintain and extend their professional competence, is designed to stimulate self-confidence by updating nursing skills. The aim of the program is to return these nurses to active practice and thereby relieve the shortage of trained nurses. Approximately 75% of the nurses retrained to date have -returned to active practice. Status: Operational as of 5/68 lst year $60,416 2nd year $72,513 3rd year $36,802 4th year $36,802 The Kansas RMP covers the entire State of Kansas, and has bee n @operational-since June 1, 1967. Its commitment level for FY 1970 was $1,346,144 and for FY 1971 was $1,236,220. These funds were usedin@FY 1971 to support a total of 10 projects,."oIf which 6 were in the area of general continuing educatim,, 3 for training existing health personnel in new skills, I for R&D, and a numb6r of core activities. -54- INDIANA R13ACTIVATE-1) 'nllRAPISTS IN STROKE PROJECT Retired health personnel have been brought back to work to meet the need for trained therapists in Indiana, Vvlien tlle Indiana Regional Medical Program's stroke project began, only 35 out of.the 112 general hospitals in the State had physical therapy service, 15 had occupational therapy service, and onlv 14 hospitals had both. The project has placed team composed of a physical therapist , an occupational therapist, and a language therapist in each of five.areas in the State. Amng the therapists a-re many-who had essentially retired. After making regular visits to hospitals to help determine their needs the team develop training programs for nurses or lay personnel so that they can better care for stroke patients. A tlirec-bed demonstration teaching center, where patients in various states of cerebral vascular disease are diagnosed and treated, reinforces the IRMP stroke training program. After two years of project operation, there are only 39 hospitals which are without full therapeutic facilities. I-lowever, all of the 39 have at least one person who is trained in one of the three therapeutic .disciplines. Status: Operational as of 1/69 Ist year - $222,116 2nd year - $281,241 3rd year - $211,500 The Indiana RMP covers the entire State of Indiana, and has been operational since January 1, 1969. Its commitment level for FY 1970 was $1 271,411, and for FY 1971 was $968,842. These funds were used in F-Y 1971 to support a total of 6 projects, of which 2 were in,the' area of general continuing education, I for training existing health personnel in new-skills I for patient services demonstrations l,for a combination of patient services and training, 1 for coordination for health services, and a number of core activities. -55- GEORC@IA CONI'INIJIN(; I:I)UCATION Twcnty-six courses were offered Georgia's physicians this year in a program of continuing clinical education sponsored by the Georgia Regional @lcdical Prograin, The courses are taught at the Medical College of Georgia and the Emory University School of Medicine and include topics relating to kidney disease, heart disease, respiratory disease, gastrointestinal disturbances, endocrine disease, cancer,, internal medicine neurology,.liver disease and obstetrics and @polog)r@ Before the project began iii 1968, there was no organized plan by the two medical schools to.provide clinically-oriented continuing education sessions because the schools lacked funds. As of February 1971 40 physicians had participated in the program. Additional physicians and at least 60 nurses and other allied health professionals will participate in the near future. It is hoped that those taking part in this program will then serve as resources consultants to continuing education programs in their local hospitals. Status: Operational as of 5/68 lst year - $47,492 2nd year - $91,085 3rd year - $41,000 The Georgia RMP covers the State of Georgia and has been operational since July 1, 1968. 'Iheir comitment level was $1,922,571 for FY 1970 and $1,779,862 for FY 1971. These funds were used in 1971 to support 23 projects of which 6 were in the area of general continuing education, .6 for training existing health persomel.in new skills, 2 for training new health personnel, 3 for patient services demonstration, 1 for a combination of training and patient services, 5 for coordinate.on of health services, and a number of core activities. ALABAMA H-"I)](:AJ, INik)[MTION SI:RVJCE VIA I)Iiy.sici.His practicing in small towns and isolated rural areas of Alabama have instant access to specialists at the LJniversity of Alabama in Birminghm, through the Medical Information Service via Telephone-, known in Alabama medical circles as MI,3T. Calls can be placed free of charge from any point in Alabama, at any time of the day or night, on the MIST circuit. To. date, more than 750 of the State's 2,1200 practicing physicians had placed some 4,SOO calls re- questing the latest and best treatment for a variety of medical prob- lems. MIST switchboard operators are trained to locate specialists in all fields on split-second notice. The program was developed through the cooperative efforts of the Alabama Regional Medical Pro- gram ' the University of Alabama in Birmingham, and the American Medical Association's Education and Research Fund. It has served as a prototype for similar programs being developed in other Regions. Status: Ongoing since 4/l/71 Ist year - $21,000 carryover funds and $10,000 care staff funds 2nd year - unfunded will be core staff activity The Alabama Regional Medical Program covers the entire State of Alabama and has been operational since April 1, 1969. Their con,mit- ment I level for FY 1970 was $980,709 and for FY 1971 was $ 766,278. - @ @ These funds were used in 1971 to support a tota of 5 projects, 3 of which were for training existing health personnel in new skills and 2 for training new health personnel, and a number of core activities. -57- KANSJVS NE-I)LCAL LIBRARY NE-TWORK Kansas liealtJi professionals can place requests for medical information around the clock as part of the Kansas Regional Medical Programls .14edical Library System project. Calls can be made to the central library or its t@ce branches on a free telephone line. Trained medical librarians answer phones on weekdays and night calls are recorded and answered the following day. Froni July, 1969, to Noventer, 1970, 3,779 persons used the-. library, Of these 47 percent were physicians. During the second year of operation there was a 120 percent increase in requests, and an increase of 87 per- cent in the nmber of health professionals using the service. It was found that rural physicians use the service more than urban physicians. 'llic central office is located in the Clendening 1.4edical Library at the University of Kansas Medical Center. Branches are at Stonnont-Vail ' Hospital, Topeka; Wichita State University; and Central Kansas Medical Center, Great Bend. Among the services of the library are drug product infoxmiation, medical references, preparation of bibliographies alu in submitting requests in IEDIARS (Medical Literature Analysis) and photocopying and mailing journal articles. Status: Operational as of 2/69 lst ear $208,545 y -2nd year $88,889 .The Kansas RMP covers the entire State of Kansas, and has been opera-- tional since.-June 1, 1967. Its c(ymitment level for FY 1970 was 3 and for FY 19 $1$'46,744 71 was $1,236;220. These funds were used in FY 1571 to support a total of 10 projects, of which 6 were in the area of general continuing education, 3 for training existing health.personnel in new skills, I for R&D, and a number of core activities. -58- INDIANA I-,Xl'ANSION OF @RMICAL LIBRARY EXTLNSION SL-RVICE- Indiana physicians can call their local libraries for any medical -reference material and pick up a xeroxed copy of the material at the library wihtin the next day or two. Ilie local library teletypes the physician's request to the'jnedical library at the Iiid@lana University Medical Center in Indianapolis. The medical library then mails xeroxed copies of the requested material to the local library. The network reaches 150 commities and has 1,052 patrons, In an average month, 580 articles are supplied to Indiana physicians. In addition the project has conducted three seminars. f6r'a total ot 40 non-professional library personnel who work in hospital libraries throughout the region. The seminars were designed to grade the UP quality of service in hospital libraries. Status: Operational as of 1/71 Ist year - $26 ',197 2nd year - $21,800 The Indiana RW covers the entire State of Indiana, and has been operational since January 1, 1969. Its commitment level for FY 1.970 was $1,271,411, and for FY 1971 was $968,842. These funds were used in FY 1971 to support a total of 6 projects, of which 2 were in the area of general continuing education, I'for training existina health personnel in new skills, 1 for patient services demonstrations, 1, for' a combination of patient services and training, 1 for coordination for health services, and a number of core activities. -59- KANSAS NITGRAMR MEDICAL RECORDS SYSTEM Taking into account the lifestyle of the migrant worker, the Kansas Regional Medical Program has developed a method of putting the workersi medical records in a concise, durable, and easily available form. The method includes a central library system, an identification card, and ml educational program. The library houses comprehensive medical records for all migrants. The records are available on a 24-hou'r-a- .day basis to all physicians and institutions via telephone, TWX, or telegraph. Records are filed by nmber, and the numbers cross-filed twice by social security number as well as by name and date of birth. Because of the success of the Social Security Administration in convincing migrants to carry social security cards, KRNP expects the issuing of health identification cards to be readily accepted. The plastic-laminated card shows the patient's color photo, his name, social. security number, date of birth, Migrant Meaical Records number, and vital, medical information such as diabetes or antibiotic sensitivity. The back of each card carries instructions in both English and Spanish for -reaching the MM library. Participation is being encouraged through Migrant Health Service field workers, migrant schools and the development of a short audio-visual program, narrated in Spanish, for use at birth control clinics and migrant gatherings such as family nights. Status: Professional staff activity The Kansas PM covers the entire State of Kansas, and has been operational since June 1, 1967. Its comitnent level for FY 1970 was $1,346,744 and for FY 1971 was $1,236,220. These funds were used in FY 1971 to support a total of 10 projects, of which 6., were in the.area of general continuing education, 3 for training existing health personnel in new skills, 1 for R&D, and a number of core activities. -60- NORTII CAROLINA "IYSTCTA'i'S ASSISTANR PROGWI .'[he ability of physicians to serve niore, patients is being expanded through the Physician' s Assistant Ilrogrim being carried out at l@e University School of Mediciiae with support from the North Carolina @IP and from other sources. I'his program was one of the first of its kind in the nation and is being emulated nationally by many other programs. Physician assistant graduates are presently working .with local practitioners in the State of North Carolina and are functioning as a welcomed addition to the health care team. Status: Operational as of 7/l/70 Ist year $183,321 The North Carolina RMP covers the entire State of@North Carolina, and has been operational since March,l, 1968. comitment level for FY 1970 was $2,047,486 and for FY 1971 was $1,844-692. These funds were used in FY 1971 to su@port,a totcll,,6f 21 projects, of which 10 were in the area of general continuina@6Iducation' 4 for, training existing health 'Dersomel in new Skills" 1 for training new health personnel, 1 :Cor patient services' demonstrations, 5 for a combination of patient services and training, and a number of core activities. -61- WEST VIRGINIA lll:DIATRIC NLJRSE PRACTITIONERS llccauso of an acute shortaee of pediatricians in rural areas, a progr@ has been instituted to train pediatric nurse practitioners. The I)Yogram is supported by the West Virginia Regional @ledical Prograin in cooperation with tJie West Virginia University School of Nursing and the Department of Pediatrics at 'the University's School of Medicine. The concept has won the acceptance of pediatricians as well as the School of Nursing which made an exception to its policy by allowing nurses receiving pediatric training to be non-baccalaureate students. After four months of training, the nurses are placed in-g'rivate cl.inics in rural areas. Four nurses were trained the first yea@, with a more extensive program planned for the future. Status; Professional staff activity The West Virginia RMP covers the entire State of West Virginia, and has been operational since January 1, 1970. Its comitnient level for FY 1970 was $524 048 and for FY 1971 was $580,978. These funds were used in FY 1971 to support A total of, 4 projects, of which @'l was for training existing health personnel in'new skills, 1 for patient services demonstrations, 2,for R&D, and,a number of core activities.,: -62- INDIANA MAN@:]Z FOR KJITIIIIASIC SCREFNING A iiiultiplia.-,:Lc screening program supported by tJie Indiana Regional Medical Prograiii- has shown that relatively uneducated indigenous persons from the poverty area can be effectively trained to conduct the testing accurately. Today, 35 technicians, iiiany,of vA-Lom did not have a high school education,, have been trained. The project also has shown that it can pick up diseases. SaiVIing of screenees indicate that approximately 50% of these patients had a significant test abnormality of which they had no previous knowledge. The multiphasic screening progTa.n)s have been moved recently into neighborhood health center.-, which has -resulted in an excellent follow-up on screened patients. efforts are being made to screen large number of patients to bring the cost doivn to about $35 per patient for 22 tests. Status: Operational as of 12/68 lst year - $22S,000 2nd year - $265ilooo 3rd year $196iOOO The Indiana RMP covers the entire State of Indiana,, and has been operational since January 1, 1969. Its commitment level for FY 1970 was $1,271,41.1, and for FY 1971 was $968,842. These funds were used in FY 1971, to support a total of 6 projects'.. of@,which 2@were @in the area of general continuing,education,@l for training existing'helalth personnel.in new skills, 1 for patient-services demonsttations,'l for a combination of patient services and training 1 for coordination for. health services, and a number of core activities. -63- Nt)ItSI: i,itA(7i,j,rTONI:R IIIZOC)IM(; A Geriatric Nurse Practitioner program has been developed at the Cam- bridge Hospital (a municipal hospital) with the cooperation of the Boston University School of Nursing. The program will teach nurses to take over much of the care of older persons, particularly in nursing homesand extended care facilities. Support is being provided by the Tri-State RMP, the Commonwealth Fund and the City of Cambridge. ,Status: Core activity $9,000 contract A Ilediatric Nurse Practitioner program has been developed by the Massachusetts General Hospital with the aid of a TRMP contract. The course was developed in such a way that it could be given for credit at Northeastern University and become self-supporting on a tuition basis. Status: Professional staff activity $10,000 contract The Tri-State fM covers the entire States of Massachusetts, Rhode island, and New Hampshire, and has been operational since February 1, 1969. Its comitment level for F-Y 1970 was $1,467,436 and for FY 1971 was $1,814,132. These funds were used in FY 1971 to support aItotal of 5 projects, of which 1 was for; training existing health personnel in new skills, 2 for patient services. demonstrations, 2 for a combina- tion of patient services and training, and a number of core Activities. -64- [@Ill FVALUATION TECIINICIAN The health evaluation technician, a newly defined allied health professional, has been developed in connection with a Memphis-based mtiltipliasic screening project funded bv the Memphis RMP. The technician assists with physiological tests. Intially, seven techni- cians were trained, many of whom were ghetto residents whose rapport with clients.is of great advantage. Other technicians are also being trained in the operation of computer teminals usedlin the screening process. The project will annually screen about 20,000 persons for@heart disease, cancer, stroke and related diseases. Patients are drawn from the city of Memphis Hospital Out-Patient Clinic and Welfare recipients in the inner city. Status: Operational as of 5/70 Training :Ls component of project # 17, "Prevention Services - fleart, Cancer, Stroke and Related Diseases" lst year (16 months) $269$470 The Memphis Regional.Medical Program covers parts of Western Tennessee, Northern Mississippi, Eastern Arkansas and portions of Kentucky and Missouri and has' been operational since July li,@1968.:..@Its comitment level for'FY 1970 was $!',Z84,714 and.for FY 1971.wa8.$955"722. These funds were used in FY 1971 to support a total of 13tprojects, of which 1 was in' the:area'of training existing health personnel@in new skills 2 in patient services demonstrations, 7,in a combination of patient services and training, 2 in coordination for health services,,l for lt4D, and a number of core activities. -65- TRI - STATE MFDFX DEMONSTRATION.PROGRAM Former military medical corpsmen are being retrained as physician's. assistants to e' and the availability of primary medical care in rural XP New England. The NEDEX program is being sponsored by the New Hampshire Medical Society and the Dartmouth Medical School with-the assistance of the Tri-State Regional Medical Program. Each assistant will spend a year.working for a physician in private practice. Although he will maintain radio communications with the physician, the assistant will make house calls and visit nursing homes by himselfi He will also assist at surgery, apply and remove casts, and perform some laboratory work. In a recent survey by the New Hampshire Medical Society, doctors felt that between 11 and 12 percent of their cases could have been treated by a trained physician's assistant. Among general practitioners, it was felt that 14.5 percent of their cases could have been handled by a trained assistant. status: Professional staff activity The Tri-State.RW covers the entire States of Massachusetts, Rhode Island, and New Hampshire, and has been operational since February 1, 1969. Its commitment level for FY 1970 was $1 467 436 and for F-Y 1971 was $1;814,132. These funds were used.in FY 1971 to support a total of 5 projects, of which I was for training existing health personnel in new 5kills, 2 for atient services demonstrations p 2 for a combination of patient services and -training @.and a number of core activities. -66- MAINE NIRSII: ]'RACTITIONER PROGRAM Nurse.-,; loiniijig to assume many of the t@isks of tjie pediatrician wli@i.le working closely under his supervision in a-train'.'mg progr@i being sul)l)orted by the Maine Regional Meaical Program'. The 16-week Pediatric Nurse Associate course is'be'mg presented at the Maine Medical Centex in Portland, using local nurse and physician resources, Ilie first class of six nurses graduated 3n MircA 1970. These nurses a-re participating in Model Ciiies.areas of Lewiston and Portland, West Central Maine's Corprehensive Health Planning efforts, lioad 'Start PTOgraMS, Webber hospital Children's clinic and the Penobscot Bay Medical Center's health program. Status: Ongoing as of Decemb6r 1969 lst year - $18,000 2nd year - $10,000 contract The Maine RMP covers the entire State of,Maine', and has been operational since July 1, 1968. Its commitment level for FY 1970'was $956,904 and for FY 1971 was $814,422. These-ftmds were used in FY 1971 to support a total of 6 projects,@of which 3 were in'the area of general continuing education, 2 for training existing health personnel in new skills, I for coordination for health services, and a@ii@er of core activities. -67- WEST VIRGINIA TRAININ(', Ol-' AI,LIED l@Ill PERSONNFL A program to train S(-Iiool ficaltli Aides who will serve priiii@iri.ly is 1.@inks I)ctiveen school health prograjiL-, and fiiiiil.ics who have children witli Health problems is being developed w:ith the assistance of the West Virgini.a:RM". These Aides will also assist in the service and educational] progrwiLs in the schools. Other types of new heal.tli m@powor to I)c trained are Ilediatric Nurse Practitioners and Audit-Technicians. The latter will-be trained to glean pertinent information from patient care records, both in the pilysician's office and in hospitals. c)tatus: Profession al staff activity The West Virginia RNP covers the entire State of West,Virginia, and has been operational since January 1, 1970. -Its commitment level,. for FY 1970 was $524,048 and for FY 1971, was $580,978. These funds were used in FY 1971 to support a total.of 4 projects, of which-I was for training exis.tine health-,personnel in new skills, 1 for patient serv:Lces demonstraii@', -2 for R&D, and a number of @core activities. -68- IOWA PEDIATRIC CLINICAL ASSOCIATES A survey shows that parents a-re as well satisfied with examinations performed by newly-trained pediatric clinical associates as with those by physicians in a screening program for children with heart disease. The clinical associates are being added to the team o medical personnel in the Iowa Regional Medical Program project. The associates conduct initial and follow-up interviews, perform limited examinations, and counsel the children and their parents. As a part of their training, the associates are required to pass the junior medical class pediatric examination. CoinpaTis@ons between the Performance of the associates and that of pediatricians and pediatric cardiologists show that the two groups I judgments are in agreement at least 90 percent of the time. In the last year, more than 3300 children have been screened by the three pediatric clinical Associates trained thus far. Status: Operational as of 4/69 Component of "Diagnosis and Follow-up Care of Children with Heart Disease" lst year - $52@799 2nd year - $55,693 3rd year - $51,400 Ihe Iowa PM covers the entire State of Iowa, and has been operational .since July 1, 1968. Its comitment level for FY 1970 was $716 744, and for FY 1971 was $573,247. These funds were used in-FY 1971 to support Ia total of-7 projects, of which 4 were for training existing health personnel in new skills, 1 for trainin2 new health personnel, 1 for patient services demonstrations, 1 fo@coordination for health services, and a n@er of core Activities. -69- CALIFORNIA INDIAN CO@ttINITY lUiALIII AIDES Ilealtli Aides from within the Indian community are helping to create an awareness of proper health care in a mountainous region in northern California which previously has had almost no medical services. The several thousand Indians living in an isolated area the size of, ]Rhode Island are served by only five doctors. l@oldt ind Del Norte Counties, and part of T@ity County are included in this area. In the next three years, the Indi.an health aides will hell) set ut) an extensive health education program strcssin prevention and early de- 9 tection. Fostering an awareness of proper health care is an essential element of tJie program.. The health ai-des will stress such routine items as regular check-ups for babies, and pre-natal care. The University of California at Berkeley is cooperating with the California Regional Medical Program in this project. Status: Professional staff activity 'Ihe California RNP covers the entire State of Cal'fornia and two'counti.e_s in Nevada,,, and has been operational since July 11 1968. Its commitment level for @ 1970 was $8,012,OSS and for FY 1971 was, $6 220,094. Iliese funds were used in IFY 1971 to support a t otal of 24 projects of,which 3 were in the area of general continuing education 4 for tra % I inin.,Q @existing health personnel in new skills, I for training new health pers for patient services demonstrations omel, 6 8 for a combination of patient services and training, 1 for coordination for health services, 1 for R.&D, and a number of.core activities. -70- 1%,EST VIR6INIA S'RMY 01' STATE I @TH IAV ]Zcvision of the State's vague health laws will b considered by 40 health leaders during a tiio-year study of the health manpower laws funded by the West Virginia Regional Medical Program. The study will enable health experts to advise lawyers on specific -revisions or new law-, that will allow the State to cope more efficiently with its health personnel shortage problems. according to WVIMII officials, Ilic present laws, , are too vague., in(] leave too much to interpretation. For example, a law passed only rc- cently allows for the practice of nurse assistants but does not @i.licludo in this category, pediatric nurse practitioners who have recently been trained under another WVRMP project. It is expected that changes in the health manpower law will result in added flexibility -in the use of health manpower while maintaining or enhancing protection for the patient. It is also hoped that through these clianges, West Virginia will be encouraged to develop a flealtli Manpower Council. Status: Professional staff activity The West Virginia rW covers the entire State of West Vi inia, and rg has been operational since January 1. 1970. Its camitment level for FY 1970 was $524,048 and for FY 1971 was $580,978. 'These funds.were used in FY' 1971 to support a total of 4 projects, of which 1 was;for training existing health personnel in new skills, 1 for atient services p demonstrations, 2 for R&D, and a number of core activities. -71- NF-,IL Jl-"IZSFY S('IU',ENIN(', IN PAfl-IRSON NEIGII@M[OOD li@:MIll CLINIC Screening for sickle cell anemia and for lead poisoning will be two of the services offered by a neighborhood health clinic be] set up in Paterson with the combined funds of the Model Cities Program, the city Ileal.th Department, and the Family Planning Association of Passaic. The clinic is part of an experimental revamping of the city's health delivery program in which the New Jersey Regional @ledical Program is playing an important role. The aim of the program is to deliver direct services to low income patients. Among services to be offered arc medical examinations, TB screening, dental services, family planning, pediatric services and diabetes screening. Paterson is one of the nine Federally-designated Model Cities in the State which, on the invitation of the mayor, is provided with RMP planning staff. In addition, 21 State-designated Comunity Development Cities are also provided with RMP staff. Status: Professional staff activity 'flic New Jersey FM. covers the entire state of New Jorsey and has been o crational since April, 1, 1969. Ilicir commitment level. was p $1,237,781 for FY 1970 and $1.,225,026 for FY 1971. These funds were used in 1971 to support 11 projetts, of which 4 were in the area of general continuing education, 2 for training existing health personnel in new skills 1 for patient services demonstrations 1 for a cm- bi-nation of training and patient services, 2 for coordination for health services, l.for R&D,, and a n@ey of core activities. -72- CALIFORNIA SAIN JOAQtJIN VAI,IEY M131LE l@lli tJNIT Fiestas and church services are also times for health check-ups in the San Joaquin Valley. Under a program conceived by the San Joaquin @tedical Society and Foundation for Nledical Care, and funded by the California Regional Medical Program, a mobile health unit travels to migrant worker camps and other poverty pockets south of Stockton. Because many of these people are reluctant to seek preventive medical care, the mobile unit appears at places and occasions where tjio people will be already gathered. 'nic goal of the program is to screen 3,000 persons a year during the next three years. Multiphasic tests are given by a staff of bilingual doctors, registered nurses., and technicians in a mobile unit made up of three trailers. Facilities and personnel are made available by Health Facilities-flealth Testing Services of Berkeley. Organizations which helped formulate the program include the Black tJnity Conference, San Joaquin County Health Department, San Joaquin General Hospital, Stockton Co ity Action Council, Stockton Chamber of.Commerce, Mexican-American Political Association, South Stockton Parish, and Stockton Unified School District. Status: Operational as of 5/70 Ist year - $26,667 2nd year - $160,000 'Ihe California RMP covers the entire State of California and two counties in Nevadai and has been operational since July 1 1968. Its commitment level for FY 1970 was $8,012,055'and for FY 1971'was $6,220 ,094. ,"These funds were used in' FY 1971 to support a total of 24 projects, of which 3 ;ere in the area of general continuing education, 4 for training existing health personnel in new skills, 1 for training new health personnel '6 for patient services demonstrations, 8 for a combination of patient services and training, 1 for coordination for health services, l' for R&D, and a number of core activities, -73- M I @TJPT OPERATION III-BLOOD Over 1,200 high risk individuals for hypertension have been contacted and almost 500 hypertensives have been seen and brought under treatment through Operation Ili-Blood, centered at the OFO Wayne Miner Neighborhood Health Center in Kansas City. Programs for the physicians of the area are being developed. The training of new allied health personnel medical assistants and the development of outreach centers is well underway. Cooperating in these efforts have been a number of agencies, including the 14issouri Regional Medical Program. Status: Operational.as of 7/69 lst year $56,741 2nd year 1291985 3rd year 160,237 The Missouri RMP covers the State of Missouri, exclusive of Metropolitan St.. Louis, and has been operational since April 1, 1967. - its commitment level for r-Y 1970 was $3,074,230 and for FY 1971 was $1,947 ,417. These funds were used in FY 1971 to support a total of 29 projects, of which 1 was in the area of general continuing education, 1 for training existing health personnel in new skills; - 1. for training new healthpersomel 7,,: for patient se'rvices demonstrations, 6 for a combination o@ patie@nt, services and training, 11 for coordination for health serivces, 2for R&D, and a number of core activities'-. -74- TENNESSEE/MID-SOUnt NTJLTIPILASIC SCREENING PROGRAM Sixty patients a day from the inner city of Nashville are being screened in a TennesseeAlid-,South Regional Medical Program-funded project. Follow-up is carried out with the cooperation of an 0110 Neighborhood Ifealtli Center and the reorganized, coaprchensive out- patient department of Hubbard Hospital, the teaching -hospital of Moliarry @lcdical College, The screening and follow-up program i-s being extended to cover an entire rural poor population in the counties of Ilump@ey, Ilouston and Stewart in Mid-Tomessee at the request of co ity leaders. Status: Operational as of 2/68 lst year - $436,02S 2nd year _ $60S,906 3rd year _ $604,53S 4th year _ $307,897 T ,he Temessee Mid-South RMP covers the State of Temessee and parts of Southwestem.Kentucky and has been operational since February 1, 1968. Its commitment level for F)( 1970 was @2,128,110 and for FY 1970 was $1,747,352. Thes6 funds were used in 1971 for a total of 26 projects of which 4 were in the area of general continuing education, 7 for training existing health personnel in new skills 3 for training new health Personnel, 7.for patient services demonstrations, 3 for a combination of patient services and training, 2 for.-R&D, and a number of"core activities.- -75- missotil@l SCIU:INING lOR IEWR I)ISFASE Two.nty-five thousand children have been screened for heart disease in the Missouri Regional Medical program PhonoCardioScan Project. As of the beginning of 1971, 356 children with previously 'undetected iiiu-niurs have been referred to their physicians for fOllOw-UPP one of Whom required open heart surgery on an urgent basis, The screening is -rking through the being conducted by the Missouri Ilea-rt Association, wo school system, witJi an impressive aTnount of active involvement by persons in the Region. There have been 40,000 letters sent to parents, over 3,000 school officials and teachers have actively cooperated and over 10 000 hours have been put in by fleart Association Volunteers. Status: operational as of 4/69 ist year $S9,636 2nd year $34POSS 3rd year $18,000 The Missouri RNP covers the State of Missouri,, exclusive of Metropolitan st.,.Louis, and has been operational since April 1, 1967. Its comitment level for FY 1070 was $3,074,230 .and for FY 1971 was $1,947.,417. 'These f which funds were used in FY 1971 to support a total of 29 projects, o I was in the area of general continuing education; 1 for training existing health personnel in new skills., 1 for training new health personnel, 7. for@patient services demonstrations, 6 for a combinati6n,of patient for services and training, @'ll for coordination for health services, 2 R&D, and a number of core activities. -76- NASSAU-@ui,,I.,OI,K NASSAIJ-SUFFOI,K CLINICAL SOCIETY Eighty black physici@ and dentists lilve organized into a new entity called the Nassau-Stiffolk Clinical Society, with the assistance of the Nassau-Suffolk Regional Medical. Program. The Society was formed to deal with some of the major problems of low income blacks living in the area. Sixteen flealth Committees of this group have formed, having both provider and consumer representation. The first project to be undertaken is an education and screening program for sickle cell anemia. 'nic Society will then move into other health problems peculiar to blacks. Status: Professional. staff activity The Nassau-Suffolk PM covers the counties of Nassau and Suffolk (Lona Island, New York) and has been operational since June 18, 1971. Its camitment level for FY 1971 was-$794,494. These funds were 'used in FY 1971 to.support a total, of 7 projects, of which 1 was in the area of -general continuing education., I for training new health personnel @l ifor patient'services -demonstrations, 1 for a combination of patient services and training, 2 for coordination for health services, 1 for R&D, and a number of core activities. -77- IOWA SCRE@F14ING FOR DISEASE RISK FACTORS School children in Muscatine, Iowa, are being screened for early risk factors of coronary heart disease, hypertension, stroke, obesity, and diabetes. The 3700 children in grades three through 12 were examined as to height, weight; blood pressure, serum cholesterol, serum triqylceride and blood sugar. Of the first 160 students studied, 7.1 percent of the boys and 10 percent of the girls had high serm triglyce-ride, 1.1.1 percent of the boys and 10.4 percent of the girls were obese, and 11.4 percent of the boys and 12 percent of the girls had high blood pressure readings. Follow-up tests as well as counseling for families of children with high risk factors a-re scheduled for the sumer. In November of 1972, children in grades one through three will be tested. Students will be retested until c letion of the project. OMP Supporting agencies a-re the Iowa Regional Medical Program, the Research Center of the University of Iowa, and the National Institutes of Health. Status: Operational as of 7/68 lst year $88,790 2nd year $55p693 3rd year $51)400 The'lowa RW covers the entire State of Iowa, and has been operational since July 1, 1968.. Its comitment level for FY 1970 was $716,744 and for@FY 1971 was $573,247. Thes6-funds were used in FY 1971 to support a total.@of 7 projects, of which 4 were for training existing health personnel @ in new skills, I for training new health personnel , 1 for patient, services demnstrations, 1 for coordination for health services, and.a number of core activities. -78- WL-ST VIIZGINIA PRC)GRESSIVE- SCliODL IEURI PROGRAM A new school health program conducted by the West Virginia Regional N,Icdical Program is helping to compensate for the loss of medical services that accompanies general population loss in Upshu-r County.. The strongest remaining institution in this commity with a median economic level is the county school board. Working through the board, WVRMP is aiming its program at fifth, sixth, and seventh graders. The children will be taught physiology of the circulatory, respiratory, and nervous systems. A pediatric nurse practitioner, a school health aide, and a dental hygienist will help in the early detection of disease and preventive care. -An equal amomt of health manpower will be made available by the school system through its local option on the use of Title I educational funds. Status: Operational as of 6/71 lst year $37,267 The West Virginia RMP covers the entire State of West Virginia, and has been operational since January 1, 1970. Its, commitment level for FY 1970 was $524,048 and for FY' 1971 was $580,978. These funds were used in FY 1971 to support a. total of 4 DrOi ects of which 1 was for, training existin-Q health personnel in new skills, 1 for patient services@demonstratims, 2 for R&D, and a nmber of core activities. -79- (,E-ORGIA 1,L-'ARNING ];U".SOLJRCES SFRVI(E-S "Arc You IZeady To (',o l[OMO and is Your lloine ]@ea(ly I,'or You," a I)aq)lllct ainied at helping patients make a better t-ruisi.ti,on from hospital to home environment, has been produced by the State's Eastcy Scal. Society with the help of (;eorgia Regional Medical Prog-ram's l,carni.ng ]Zcsourcos Services. LITS production assistance has also been given to-a rehabi litation clinic for a somd/slide patient orientation program. In addition, GRMP personnel are helping develop a game idea to help nonreading diabetics learn about proper diet. The demonstration LRS is located in Atlanta. It provides assistance to medical educators in the development and effective use of audio-visual aids. It will also serve as a training facility fo-r'new audio-visual technicians. At present, there is no other means of training audio- visual personnel recruited from local areas. Status: Operational as of 9/71 lst year $20,000 The Oeorgia IW cove.rs the State of Georgia and has'been operational since July 1. 1968. Their commitment level was $1,922 571 for FY 1970 and $1,779,862 for FY 1971. These funds we-re used in 1971 to support 23 vroi6cts of which 6 were in the area of general;continu:'Lng education' 6 :Cor iraining existing health personnel in new skills. 2 for training new health personnel, 3 for patient services demonstration, 1 for a combination of training and patient services, 5 for coordination of health seT-vices,@and a number of core activities. -80- WISCONSIN IE-ALTli INI'-OR.IATION AND RE-FERRAL CWFER Sp-misli-spoiking citizens who live in the soutJiL inner city section of @lilwat&-ec are gaining access to medical care with the help of a lioziltli Information and Referral Center. Milwaukee County maintains very fine health care facilities for the indigent. Some find it difficult, however, to enter the system because of language or cultural barriers. With the assistance of the Wisconsin Regional. Medical Program the center is aiding the Spanish-spealing citizens of tlio area make use of the resources which are available to them and provide what are essentially satellite clinical activities within the nci@ihl-)or- lioods. Community health aides are being trained to staff the center. ,Status: I)rof-ossional staff activity The'Wisconsin RNP covers the entire State of Wisconsin and has been operational since September 1, 1969. Their commitment level was 098,429 for FY 1970 and-$951,781 for FY 1971. These funds were used in 1971 to support a total of 13 projqcts, of which 4 were in the area of general continuing education, 2 for training existin 9 'health'persomel in new skills, 3 for atient'services demonstration p I ' a 1 for dcombination of training and patient services, 1 for @oordintim @for'@health services, 2 for R&D, and a number of core activities. CALIFORNIA (XMMI ilY IZE-f,]'-IRRAI, AND INF-ORMAT10N SEIZVICT: (CRIS) A phone call to the Commity l@cforral lnd Informition Service (CRIS) brings Santa Ana residents infomation on health and other services available in the area. With support frm the California Regional Medical Program, CRIS began n May of 1970. It is staffed primarily by volunteers and operating i through receives 18 to 20 new clients daily--mostly phone calls. CRIS staff has on hand information from Orange County agencies concerned social services. if a caller -requests infoniation witli health and other which CRIS does not have, the staff makes every effort to obtain the information. Funding comes from CRW the American Cancer Society and a variety of in-kind contributions. Status: Professional staff activity $15,000 contract The California RW covers entire State of California and two co-unties m@ Nevada and has been operational since July 1 1968. Its comitnent - level for pFY 1970 @as $8 012 0655 and for FY 1971pwas $6,220,094 These ftmds were used in FY 1971 to support a total of 24 projects of which 3 were in the area of general continuing education, 4 for training existing health personnel in new skills, I for training new health personnel, 6 for patient ser@v:Lr-es demnstraiions, 8 for a combination of pati'ent services and training@, 1 for coordination for.health services, 1 -for R&D, and a mmber of core activities. -82- I N D E X @ergeiicy Medical Care . . . . . . . . . . . . . . . . .. . . . . 4, 12, 27 Health Education . . . . . . . . . . . . . . . . . . . . . 70, 77, 79, 80 [Ime Health Care . .. . . . . . . . . . . . . . . . . . . . . 2, 5, 15, 30 Indian Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 41, 70 Information and Referral Services . . . . . . . . . . . . . . . 57, 81, 82 Inner City Health Programs. -@3, 7, 17, 19, 327,35, 38, 39, 74, 75, 77, 81 Laboratory Facilities . . . . . . . . . . . . . . . . . . . . . . . . 8, 14 Library Services . . . . . . . . . . . . . . . . . . . . . . . . . 58, 59 Manpower Training and Development GeneAa Con,4nuing Education . .11, 9.1 10, 25, 31, 43-45, 48-50, 56, 74 Leg@@on . . . . . . . . . . . . . . . . . . . 71 New De6ined Heatth Ptoie.6.6ionaU . . . 3, 31, 33, is: '37', 61-70, 74; 81 R@ning 54, 55 Speciatty T@"ng . . . . . . . . . . . . . . . 3, 6, 13, 46, 47, 51 53 Medical Records System . . . . . . . . . . . . . . .. . . 20, 60 Migrant Health . . . . . . . . . . '8,'4'0, 60, 73 Model Cities . . . . ... . . . . . 31@ 33, 67, 72 Rehabilitation . . . . . . . . .. . . . . . ... . . . . . . . 2.% 10.4 11, 30 Rural Health lp 2, 6, 8, 12, 16, 18, 23P 25-31, 36, 40, 46, 57, 62, 75 Screening . . . . . . . . . . . . . . . . . . . . . . . .69, 72, 74, 76-78 MuMpha,6ic ScAe@ . . . . . . . . . . . . . . .. 33$ 63, 65$ 73, 75 -83-