IL I Om B&B ImFoRmikrtom & lm^=E M^N^BL-MENT 300 Voodoo &=Ituc#n WOULCVARD Up-pacit MAItLJBO$tmt PA^ 040 Z0772 11 USA 0 C201) 24WCI 10 DEPARTMENT OF HEALTH, EDUCATION AND WELFARE Health Services and Mental Health Administration Division of Regional N@ical Progr-ams Natioral Advisory Council on Regional @cal Programs Minutes of Meeting -Decenber 16-17, 1969 National Institutes of Health Conference Room 4 BU:LL@ 31 DEPA-,RF,,,@7 4T OF @'.rH, EDUCATION, AND IA@,ARE PUBTI'-' HEi=il 9ER@LC.E National Adviso2,y Council on Regional @dica-I Programs Minutes of the Eighteenth @eting 1/ 2/ December 16-17, 1969 The National Advisory Council on Regional Medical Programs 'convened for its eighteenth meeting at 8:30 a.m., @esday, December 16.,' 1969, in Conference Room 4, Building 31, National Institutes of Health Bethesda, island. Dr. Stanley W. Olson, Director, Regional @ledical Programs Service presided for the Administrator, Health Services and YL-ntal Health Administration, who was unable to attend the meting. The Council members present were: Dr. Michael J. Brennan Dr. Clark H. Millikan Dr. Bland W. Cannon Dr. Edmund D. Pellegrino Dr. Edwin L. Crosby (12/16 only) Dr. d M. Popma Dr. Michael E. DeBakey Dr. Russell B. Roth Dr. Bruce W. Everist Dr. Mack I. Shanholtz Dr. John R. Hogness (12/16 only) Mrs. Florence R. Wyckoff A listing of RF2 staff mnbers, and others attending is appended. I. CALL TO 0,RDER AND OP=G Doctor Olson called the rneeting to order at 8:30 a.m. II. JOINOUNCEMENTS It was noted that Doctor Ho@ess was meting with the Council for r the last tin-e prior to his resignation to accept a , appointmnt to a Co@ttee advisory to the Director of the National Inst-itutes of Health. 1/ Proceedings of metings are restricted unless cleared by the Office of the Administrator, M@. The restriction relates to all material submitted for discussion at the metings, the supplemental material, and all other official doc nts, including the agenda. 2/ For the record, it is noted that m@ers absent themselves from the meeting when the Council is discussing applications: (a) from their respective institutions, or (b) which a conflict of interest might UU@ ai6cussi0ii. . I, @!4 Page 2 III. CONSIDERATIOli- FUTURE I,=, Dil,x DATES The dates of @ch 31-Ppril 1, 1970 @ I)ecerrber 8-9, 1970 were conf@d. Tne July 14-15 date was changed to July 28-29, 1970. IV. COITSIDERATION. OF MI=S OF TTE AUGIJS,7 1969 !=ING The Council usly reco@nded approval- of the @st 26-27 1969, @eting as written. V. E=4SION OF LEGISLATION -- Proposed and In Pi Doctor Chadwick called the attention of the Council to the two legislative proposals for extension of Regional Medical Programs that have been introduced into the House of Representatives. These are House Bill-14284 introduced by Congressman Harley 0. Stagge@s (D. West Virginia) and House Biii 14486 introduced by Co@essman Paul G. Rogers (D. Florida). He reviewed briefly the contents of each, particularly as they mdify the current legislation. He also reported his understanding that Senator Ralph Yarborough (D. i@xas) is preparing still another proposal to be introduced into the Senate smet@ later in the session. Council was reminded of the forml recommendation, which it made at the time of the August meeting, that the scope of the authority of Title IY, be expanded to include Kidney Disease explici@ and that the expanded authority be administered under the Regional Medical Programs Service. Doctor Chadwick reported that this recommendation was forwarded promptly for consideration by the Administration in its own plans for developmnt of legislative proposals. He said that he had had several indications that such a plan was included in the legislative proposal being prepared by Senator Yarborough. VI. REGIONAL @ICAL PROG@IS IN FY 1970 AND BEYOND - SOME FUNDAIMENTAL ASS i=2IONS A. Projections of Available Resources -- 1970 and 1971 Doctor Olson reviewed @or the Council the current status of the' Appropriation legislation for FY 1970. The proposal currently under consideration in the @-enate had been forwarded by the House of Representatives with a substantial cut having been applied to the Adm-Lnistration's orig:Lial budget proposal. The net effect of the legislative process to date would allow $73.5 raillion for Regional Medical Program grants. Page 3 Doctor Olson exolain@-d that against this figure it is necessary to project a $69.1 million requirement for continuation Of On- going act,.-Vi'.ies-ir- the @.5 Regions, leaving a_ -11 e of slightly over $4 mile Ion to be used to fund operational programs in the Regions which still have only plar@- g7@@s. The Division estLmtes tha@ a total of approximately $6.5 million will be approved b-- the 14ational Advisory Council during FY 1970 for the initiation of operational grants in ten of the remining eleven Regions. 'This alloi,.@s no margin for inflation of costs or for never -fundirg of any supple,@ntal activities @ operational Regions. The-Council reconf@d its previously stated position by vo@ing unanLrwusly in s@port of Doctor Olson's stated intention to adopt, as first priority for FY 1970 and 1971-the funding of operational &@ts to all ',-,5 Regions as they are approved for such funding by the IA'ational Ad@;,isory Council. There was considerable discussion of a variety of proposals for reallocation of grant dollars.in order.to @e this funding possible. There was essential agree@nt that reallocation could have a favorable effect-only if priorities can be agreed upon for administration of the program. Doctor Pellegrino suggested the following five steps toward accomplishing these ends: (1) Each new initial request should be examined carefully to determine whether or not it qtll L@rove cooperative arrangemnts in the Region. (2) Careful attention should be given to the progress of Regional @.,L-dical Prograrm and their co@onent projects when they are reviewed for renewal. (3) Requests for purchase of major hardware should be closely examined, eliminating all but those which are absolutely essential and for which no other source of funding is available. (4) Atteri,,-t should be made to increase whenever possible, the concentration of program effort on the specifically related categorical disease. (5) Care should be taken to identify project activates which can serve as mdels and to avoid unnecessary duplication of these models amng anj-. v@11--hin individual Regions. B. Amiversary Review -- A Vlav to Look at Program Aspects of Based upon the foregoing discussion of budget limitations, both in the current year and as projected, Doctor Olson posed several questions regarding the continued development of Regional Yledical Programs-throughout the nation as organizational entities. (1) What kind of organizations should the 55 Regional Yledica-I Programs be? (2) What kind of pro should they plan for and institute? few years, it is apparp-nr, that project developmnt,.review, and implementation cannot represent the total, nor even the dominant activity of Regional 'radical Program core staffs. Doctor Olson Page 4 suggested an alter,@,-'=@,,e conc-- t of Regional 1,7iedical Programs p as I?c@@i-e agents." He related this concept to the need for operational and organization flexibility in each of the Regions rather th@ the stability which Regions have sought and continue to seek in operating a project grant program. 'Ihere is.a@ee,@nt on the part of all members that the Council nust continue to accept responsibility for setting broad PTational priorities for the program. They recognize the growing importance of the development of an arrangement by which they can assess the progress of individual Regions in-iuplem-nt@- these priorities and in actually affecting the patterns of delivery of care in @he areas they serve. Mrs. Phill@ s reviewed the Division's proposal for a system of ip IlAnniversary @eview" which has been studied and refined by an ad hoc SubcoimAttee of representatives of both the Review Committee and Council and has also been discussed by the Review Committee. There was general agreement with Doctor Millikan's assessment of the Anniversary Review proposal which he s ized as being generally meritorious but requiring extre@ care in its implemen- tation.11 He ointed especially to its potential for rewarding p Regional achievement but to the possibility, on the other hand.' of its serv to penalize Regions whose slower start resulted from the timing of their initial operational application. There was agreement that the implementation of a system of Anniversary Review will emphasize the need for the Council to have a set of well defined priorities against which they may evaluate Regional Medical Pro s both now and over time . Doctor Brennan warned against z@- a system of distribution of resources which came about by chance." Mr. Paul Ward who represented the Coordinator's Steering Committee at the Council meeting, pointed out the advantages and disadvantages of such a system to the chief administrative officers of Regional- @ledic@l Programs, noting especially their vulnerability to local pressures for allocation of "flexible mnies.11 Doctor DeBakey recommended caution in the development of restrictive guidelines vjhich co7)-ld stifle the whole concept of regionalization which he said was Visualized in the original legislation as the mechanism of carry-'L-,ig out the purposes of the program. It is his opinion that the should concentrate on the development of standards by mans of which regions' progress towards the programs objectives could be measured, rather than on attempting to change the basic program objectives. These, he reminded the group, were established by law. Final Council on th- ar@versa,-7v @-vi(-w T-)ro-,osal was Doslu-T)oned Page 5 Fbllowing the discussion of priorities (Item C below) the Council i,musly endorsed Doctor CannOn's original wtion returned to and unayi with ro@"al, in prin@- the anniversary revielI concept, for app' 'Lple, OL' lected regions a suggestion to staff that they begin to work with se these in the administrative organization of their Programs along lines, and with the further stipulation that the Guidelines for v and Criteria for AT)IDrOval sections of sary Re-viei%r docLL@nt tured in line with the findings of the council on lr priorities. C. National Priorities - How they will Affect and will be Affected gener agreemnt il recognized the necessity of reaching al The Counc s objectives before it would about the nature of the program and it be possible to consider a new prograM @chanism such as Anniversary Review. Ihere was-also, however, a considerable difference of opinion as to what kind of a proU= Regional @ical Progranis is, and is becoming. of the present legislation and Doctor DeBakey recalled the t the legislative history which urged the program's placeMnt within the NIH; since in s its @or purpose was carrying forward the work of NIH. It is his opinion that the-shift of the program into HS7,4M was for ease of organization and oemnt and not to change its goals or directions. Doctor Ho@@ess expressed general agre@nt with this position, stating that within the last six mnths he has been increasingly JTTR.essed with the @ortance of @taining Fdels unique capability to carry on activities'of this kind; especially as the efforts of other agencies are L---ing directed to the development of broad scale pro@ to met mL requirements for health care service of special population groups. Doctor DeBakey and Doctor Hogness both emphasized the increasing -importance of Regional !4ed:f&al Pmgrams concentre.@ its limited funding resources on the JiTprovement of the quality of care. TT,.ey cited the ex@le @of the- tre@ndous dol I ar :Lnvestmrt in MecUcare which has admittedly LTroved the delivery of care to over 65) but has one clearly defined group of individuals (those completely "tipped the balance in the system" at the expense of medical research training and education. While agreeing with the need for the development of program guidelines, they strongly reconmnd that Council attempt to keep them sufficiently flexible tr) advances arising from research and clinical, their in-plemncaTion. Doctor Roth cites the long way that Regional 14edical Programs has co@ since 1965 in what he considers its greatest contribution; ations among providers of nnp-,@ of--]-ines of communic Page 6 health care. Whether this has been as a result of "the farsightedness of the f--@@rs of t'..- iegislat4 on.or by serendipity," he believes that top priority Tri,@6t be given to maintaining and further encour@-- these cooperative arrangements and co=@ mications and that only secondary emhasis placed on the delivery of care . the develo@-nt or acquisition of hardware, or concentration on any specific disease entities. Doctor Brennan expressed another approach to the matter of program priorities. He viewed the mst successful Regions as being those which have developed effective core staff and operational mechanisms which are bringing about- change whether or not the changes are those "autho lazed" in He suggests that two kinds of "technology" must be employed: @i) the translation of "new* advances in health care" into "iTrproved resources for health care;" and (2) the use of those resources to bring about actual improvement in care. He used as an example the control of cervical cancer in a certain geographic-aiea. He stated that by the application oL' new advances we know "how" to control the disease, but that we still do not know exactly what are the costs and effects of various approaches to the use of this knowledge. It is his opinion that the development of this second "technology" is an important RDT function. -the opening of the afternoon session of the meeting, Doctor At Olson briefly reviewed the foregoing discussion. In response to -iotion the Council recommended that there be Doctor Pe-IleFrinc created a subco@. ttee on priorities which would include one or two members of the Rev-lew Co@ttee and at least one representative of the Regional Medical Programs Coordinators' Steering Comdttee. It was further agreed that there should be close working liaison between this subcommittee and the one previously convened to consider the matter of Anniversary Review. As a possible point of-departure for the deliberations of this group, Doctor Everist offered a series of four priorities which he follows in considering Regional Medical Programs: (1) Tne quality of the core program - the personal qualification oT-the staff members; their capability of developing and handling information b--tw-,-,,- - and amng the core staff -the cooperating agencies in the and the national level; (2) tie effectiveness of the core pro=, - which he believes can be judged almost solely on the extent, effectiveness, and pe ence of the cooperative arrangements which are developed and developing; (3) the accessibility of the core program - its responsiveness to needs for services and the degree of regionalization of services by means of @ project mnies and otherwise; and (4) the capacity of the core - to..,be judged by the continuing enlargement of the syste,@,n of both c@@-@ information in the Region. In view of the artance of the establishment of some priority miidelines as the r-@ mo@res in '-PY 171 and urfler ne,.@, or extended Page 7 legislative authority, the Council @ed on the necessity of a special meeting of the entire Council to review the recommendations of the subcommittee. Such a meting was tentatively set for Monday, 14arch 2. 1970. VII. CIMNIC DISEASE PROGRAr,',S Doctor Olson@reviewed for the Council the events leading to the @gamation of the Division of Chronib Disease with the Division of Regional Medical Pm to form the Region,, Dledical ProgranBService, and the subsequent discontinuance of five of the categorical programs which had been"part of the Chronic Disease Division. Doctor DeBakey as7ked that the Council consider seriously'the effect of the phase-out of these programs "as a further diminution of the grand total of all Federal funds available to fight the categorical diseases (including research, training, education, clinical studies, service demnstratio@-, etc.)." There was a general expression of concern and the Council requested that the staff prepare an analysis of activities of these programs and the Administration's plans for their continuation. They also requested that further discussion of this issue, based on their better understanding of the programs and the@ potential, be placed on the agenda of the next meting of the National Advisory Council. Brief progress notes from each of the three re program Branches (Clearinghouse for Nutrition and Health, Clearinghouse for Smoking and Health, and the Kidney Disease Control Program) were presented. Doctor-Olson reported briefly on the White Food, Nutrition, and Health and som of the House Conference on activities being planned by the Nutrition and Health program for carrying out so@ of the recommendations of the Conference. He mentioned specially the work on a series of ccn',racts for co ty nutrition demonstration projects to ascertain whether the capacity for dealing with malnutrition can be substantially increased by using a primary health care mechanism as an out- -he co ity. Close ties will be sought with local reach to 4L. Regional Medical Prouams to coordinate these efforts. R4P PARTICIPATION IN P G CW SIVE IMLTH SERVICE PROGRAMS The staff reported increasing nuTrbers of inquiries c.oncerning the appropriate role of individual Regional 14edi@ Program staffs, and utilization of He grant dollars, in caTprehensive co itV health service Dro After som discussion of ;seve-L-ai specii':i ex@;-- -Les, Fire to delegate to the Director, Regional Medical Programs Service, Page 8 the authority to administratively approve requests, which bear Regional Advis6-iy Group approval, for reallocation of Regional i%ledical Program resources (personnel and/or dollars) for participation in planning of comprehensive health service programs for co ties within the region. Such approval my not include or imply commit@nt for continuation beyond one year of planning nor involvement in the provision or financing of the services. VITI. REVIDL OF APPLICA7LIONS A. Issues requiring clarification and interpretation of policy guidelines 1. Cardigpulmo@ Resuscitation Training After hearing a report from Doctor Olson of his discussion of this matter with Dr. Canpbell Moses., Medical Director., American Heart Association, the Council was reassured that its-position in regard to FMP support of projects of this kind was entirely in keeping with the position of the American Heart Association. Council therefore voted unanimusly to restate, as a formal policy guideline, the position it had adopted at the tJme of the August meting in regard to a group of pending projects: Regional Medical Program grant funding for projects in cardiovascular resuscitation training is to be limited to training activities which are directed principally to mdical and allied health personnel who are employed in hospitals and in other in-patient facilities, or in out- patient or emrgency facilities operated by or directly related to institutions in which follow-up care is @diately available. 2. Kidnby Disease Applications from three Regional Yiedical Programs (Wisconsin, Neiv York_Metropolitan and Metropolitan Washington,.D. C.) propose expensive projects in various' aspects of end-stage care of chronic renal disease. In discussing these particular proposals, Council reconsidered' the policy guideline that it-adopted in 14ay 1969. It was agreed that the policy remains perfectly appropriate but it is becoming increasingly difficult to apply in the case of the very complicated and complex project applications I -- II,I Page 9 of the kind repm ;rated by these three and about eight mm of which, Council was informed by staff, are currently in the review process. Council discussed again the futility of atte@ting to provide, under the present and currently projected R4P budget, programs like these in all 55 of the Regions. They were a]-so reminded of the fact that it is possible that Ir-idney disease may be targeted for special consideration in extension of Regional Medical Program legislat@- .@,-ext year. After consideration of a number of options the Council recomended that action on the three specific proposals be defer-red at-this t@.- They also requested continued study of the iratter by staff and the preparation of proposed draft guidelines for Councills consideration at a later Acting. Categorical Relevance 3. Irfthis round of review the Review Co@ttee was unable to corn to a fin@l recommendation on a.nunber of projects ic the subjects h they felt were of questionable relevance to t@k purposes of Regional @dical Pro These were grouped under four headings and included the training for and @lemntation of Hom Health Aide programs (Western Pemsylvania @ and New York Metropolitan Re), training and demnstrations of perinatal mnitoring (California RMP and Indiana RMP), t for and implementation of a nutrition program for rurql poverty-groups (Ohio State TM), and production of a set of audio-visual aids principally for in-service training of radical students and house staff (Florida MT). In considering the matter of the "relevance" of 2@nent activities of -Regional Medical Program, the Cbuncil generally agre-u--- ,.ith Doctor Millikan's statement that rather than being a matter of its direct relationship to one of the disease entities mentioned in Title IX., a project should be reviewed according to five basic considerations: (1) is it a valid scientific exper@nt; (2) is it a mdel for educational- experience; (3) is it something other than a.-d@ct patient service; (4) will it open co cations.- channels for @aoved local and Regional arrangemnts that will help to rea@.1, the long range goal of the Regional Medical Program; @@-"'5) is it something that should be replicated in this or another Region9 These questions were C' C, Ie d 'lo t'4-@o s-re,-@c @nd rec.-- Page 10 4. Genetic Coun k'See Discussion of Western New Y6rk gegional P@dical Program) B. Recommendations for Action mLhe Council agreed to record their recomwndafions in the slightly altered format which was proposed by the staff . and already adopted by the technical panels and the Review Committee (Appendix I). ALAB,*riA REGIONAL =ICAL PROGRAM 12/69.1 - 22@tional Supplemnt - Approval with the specific conditions as detailed by the Review Committee. ol - $Z--42 238 02 - $136,035 ARKANSAS REGIOiNn MEDICAL PROGRAM 12/69.1 - Operational Supplenient - Approval with specific conditions as detailed by the Review Committee. ol $601621 02 $42.%102 03 $44 ol6 CAL@@ FBGIONAL MEDICAL PROGRAM 12/69.1 - Cperational Supplement Approval with specific conditions as follows: Project #41 Non-approval II = The revised application - to answer, as far as possible, the questions raised by the site visit team and the Review Committee,.@ to be studied by a special technical panel. Project #44@ Approval with the conditions specified by the Review Co@ttee. (Continued) 1/ All amunts are direct costs only and unless otherwise specified refer to 12 @ nth periods. designation 01, 02, etQ. relates to the first, second, etc., budget periods of the subject application, not necessarily the budget periods that will actually be supplemented. - - .1 -- 1. -- - ---- - ------- I- @ .-.---- - .@ I . @.. a @., @ @ Page 11 CALIFOIUITA REGIOII-AL YIEDICAL PROGRAM (Continued) Project #46 Approval with the conditions specified by the Review Cormiittee. Project #47 -Withdrawq. Project #48 -Approval with the conditions specified by the Review Corrmittee. Project #49 -Non-approval I. Project #50 - Approval I Project #51 -No@-approval I (the inappropriateness of this project for Regional Medical Program funding was 6ased on the Councills opinion that training of this kind is the legitimate concern of the'hospitals and clinical pathologists as a part of their regular in-service training activities.) Project #52 - Approval with the conditions specified by the Review Comdttee, and to be studied by the special technical panel. Project #53 -Non-approval II. 01 $569,776 02 $526,065 03@$520.,310 COIORADO/WYOMING REGIOIVL MEDICAL PROGRAM 12/69.1, 1216 .2, 12/69.3 - Operational Supplenient Approval 9 with specific conditions as follows: Project #15 - Approval with the conditions specified by the-Review Condttee. Project #16 Approval II = Council concurs with the Review Cormiittee and further reconmnds that the coordination functions proposed here t@ -carried out within the ex-l@sting core staff framwork. Project #17 @-Approval I with the conditions specified by the Review Co=Attee. Project #18 Approval with the conditions specified by the Review Co@ttee in the amunts considered appropriate by the staff. 01 $117,505 02 $127,714 03 $24,944 12/69.1 Operational Supplement (Including renewal of core sMMrt) (Continued) Page 2 FLORIDA REGIONAL MEDICAL PROGRAM (Continued) Approval with specific conditions as follows: Core - Approval I for one year as specified by the Review ConTnittee. Pro'ect #28 - Approval I. Project #29 - Non-approval II porject #30 - Non-approval II Project #31 - Non-appPoval I (the inappropriateness of this project for RMP funding is based nn the Councills opinion that this project is designed principally for the education of medical students and house staff and has no plan for regional outreach or for the encouragemnt of cooperative arrangements). Project #32 Non-approval- II ol $43,370 02 - $725,180 03 - $45,100 NOTE: The Council further concurred with the Review C@ttee in reccrywnding a site visit which is specially designed to assist the Region in assessing its entire Program and in balancing the activities in the three areas of the Region. HAWAII FMIONAL MEDICAL PROGRAM 12/69.1 - Operational Supplement Approval (of the core supplement only) with specific conditions as detailed by the Review Committee. Projects 12 through 16 Non-approval II Council further recommended that no additional funds beyond this presently appr\)ved core supplemnt be approved for this region until a site visit has been wade and there is some further delineation of a plan-both for Hawaii and for.the extension of programs into Guam and the Trust Territories. The site visit is also charged with specific investigation of projects #15 and #16 along the lines recommended by the Review Comdttee. .01 $87,387 02 $90,295 INDIANA REGIONAL YIEDICAL PROGRAM (Continued) Page 13 INDIANA REGIONA.L MEDICA-L P@'IOCTRAM (Continued Core St@ Supple@-@ient Approval Project #15 Approval, in principle, contingent upon the findings of a technical panel regarding this particular application of perinatal mnitoring in clinical pPactice; and upon the submission of better evidence of the relationship of the project to regionalization in 01 $2653445 02 $293,051 03 $143,048 OUNTAIN REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Rer-ewal - Approval with specific conditions as detailed by the site visit team and with the advice and guidance on the individual projects as detailed by the Review Co @ ttee. Council further reconnends that the Region be advised to undertake an ordf,---.7-., phase-out of the projects which are predominantly and be discouraged from further developmnt of "automated @-@try" aspects of the other projects. 01 - $21064 3229 02 - $23 145,656 03 $2,199,208 04 - $123,756 05 - $82,5o4 12/69.2 - Project #25 Approval with specific conditions, for three years, in amounts to be determined by staff but not in excess of the amunts requested. ol - $1653170 02 - $161,868 03 $174,130 NOTE: This v.,as not amng those held for further considera@.-'!-un of the kidney disease issue (see VIII, A, 2 of the-Minutes) because it had been revised to comply with the existing policy guidelines and built intothe cooperative arrangemnts framwork which is the basis of @. Also, it represents an opportunity for = to contribute to the operation of a complete and extremly high quality chronic disease service. -Page i4 LC)UIS@ REGIOIIAL MEDICAL '.DRCr,,RAJ4 12/69.1 - Operational Supplement - Disapproval. The Council concurred with the Review Committee in their assessmnt of this proposal. "Ihe Region's requested ,Vithdrawal was received after the application had'been distributed to the Council members. The Council agreed with the panels and the Review Committee that the current proposal is elaborately budgeted but weak and ill-defined and would require @or revision before it could be co.-"-,-dered for funding. The Council considered the Region's plan to withdraw the application as an opportunity for developing a revised proposal to be submitted for a complete review cycle, of which a site visit would probably be an appropriee part. @BIS REGIONAT, NMICAL PROGRAM 12/69.1 - Operatio nal Supplement - Approval with specific co@tions as detailed by the Review Co@ttee. 01 - $20@-@00, 02 $23,972 657 03 - $271 (See also I'@ecial Actions" at the end of this Section). M=OPOLTTAN WASHENGTON, D. C. REGIONAL MEDICAL PROGRAI,4 12/69.1 - Operational Supplement Approval with specific condition-r- as follows: Project 27 -Non-approval II. Project 28 - Approval with the contingencies specified by the Review ttee. Prpject 29 - Approval with the specified conditions described by the Review-Comnittee. P,@@ject 30 -Non-approval II. Project -31 -Deferral for further consideration (se@ Section VIII, A, 2 of the Minutes). ol $168,369 02 - $54,471 03 -'$55.9860 12/69.2 - Gr-@:@tional Supplerrent - Council concurred with the, reco@ndatibn.of the Review Comnittee for non-approval. 'Project 32 Non-appr-oval I. Page 15 MICHIGAN REGIONAL MEDICAL PROGRA-hl 12169.1 - Operational Supplemnt - Approval The Council agreed with the importance of the questions raised by the.Review Corrmittee all of which had also been identified in the process of review of this project at the local level. Answers to these questions, prepared.in response to the PR4P review process and subrdtted to the Division too late for consideration by the Review Co@ttee' were found to be 3 adequate by the Council. They therefore recomend approval of this project. 01 - $74JI400 02 - $77,139 MISSISSIPPI REGIONAL 14EDICAL PROGRAM l@/69.1 - Operational @ject Renewal Approval with the specific conditions described by the Review Co@ttee. 01--- $149,754 02 - $131,094 03 $141,623 (15 Months) MISSOURI lLvGIONAL MEDICAL PROGRAM 12/69.1 12/69.2 12/69.3 - Approval- with specific conditions. 3 National Advisory Council concurred with the reconmndation of the site visitors and the Review Co@ttee that the extension of the components of the Missouri Regional Medical Program be approved, as requested, for three months ending June 30, 1970.- ($995,152). Project #46.- Approval with the specific conditions recomended by the Review Co@ttee. Project-#47 - Non-approval II, according to the recommendations of the site visitors. 01 $155,995 02 $160,237 03 - $173,094 MOUNTADI STATES REGIOINAL @EDICAL PROGRAM 12/69.1 - Operational Sapplement - Approval with specific conditions detailed by the Review Coudttee. 01 t84,235 02 $109@071 03 $110 209 - - . @ - - - --,@ -7 Page 16 NDq JERSEY REGION@T-14MICAL PPOGRAIL 12/69.1 Operational Supplerrent Approval with the conditions detailed by the Review Co @ ttee. ol $6o 450 02 - $61 463 03 - $63,156 3 NEW YORK METROPOLITAN REGIOUAL DEDICAL PROGRAM 12/69.1 - Operatiollai Supple@nt - Approval"with specific conditions. Project #10 - Deferral for a site visit. If the visitors are persuaded that the project is (1) feasible and (2) relevant to the New York Metropolitan Regional Medical- Program (see Section VIII, A, 3 of the 'Minutes) the proposal should be revised accordingly and resubmitted. Project #11 - Approval I with the advice provided b y the Review Co @ ttee. Project.!".12 - Approval I with the advice provided by the Review Committee. Project "#13 Deferral for a site visit and possible revision (see Section VIII3 A 2 of the Minutes). 01 $144 446 02 $147,823 03 $156,501 NORIIH CAROLINA REGIONAL MEDICAL PROGRAM 12/69.1 - Operational Supplement Approval with specific conditions. @jec,-""24 Approval II. Council beli6ves that this can be done through the core staff without additional funds being assigned to a specific project. Project #25 Approval I. ol.- $43,443 -02 $44 3374 03 $45,309 NO S REGIO@-'@,U)ICAL PROGRAM -T)-c f@.c Project #'-Is Approval I. Project #12 Approval I with the advice provided by the Review Corrinittee. (Continued) I Page 17 Project Approval- I with the specific conditions detailed by the Feview Co,@ttee. Project @4 Approval I contingent upon the submission by the proposer of evidence satisfactory to staff that they are working with the American Academy of Opthamlogy, and the AMA Council on Education towards the developmnt of their curriculum and training.standards. 01 $2481670 02 - $219,512 03 $142.,953 NORTIRQESTEF&I OHIO REGIONAL MEDICAL PROGRAM 12/69.1 - Operatf-onal Supplement - Return for Revision. The Council concurred with the Review Co @ ttee in each of its recommendations. OHIO STATE RBGIONA.L NMICAL PROGRAM 12/69.1 - Operatic-- Supplement - Approval with specific conditions. Project 15 - Approval I with the contingencies detailed by the Review Committee. Project 16 - Non-approval II with the advice of the Review C@ttee. Project 17 Non-approval I. 01 $79,400 02 $67,500 03 $79,100 04 -,$59,200 PL= RICO RBGIC,-@A.-. @ICAL PROGRAM 12/69.1 - Initia7,-'. Operational - Approval with specific corxiitions. The Council concurred with the Review Co@ttee in its recommndations that this Region be awarded operational status,' and in their recommndations regarding each of the individual application components. dhe Council also requested that staff make very certair@'That the disapproval of Project #8 does not serve to discoura@@. developmnt of stroke activities in the Puerto Rico Re@ i,medical program. 01 $ 1,134,087 02 $ 1,190,760 03 $1,200,064 Page 18 ROC'HESTER REGIO,",@IAL T@IC-AL PROG@,L 12/69.1 Operational Renewal- (Core C2monent/@ Approval i-:ith specific condi@o@o. The Council concurred with the Review Co@ttee in appi-ovirg this application for one year only in the amint requested. $373,573 01 SUSQ T VALLEY REGIO@T IM)ICAL PROGRAM 12/69.1 - Operational Supplement - Approval with specific conditions (project #6rA only). The'Council concurred with all of the recomendations of the Review Co@ttee, both in regard to the individual projects and to the Region.as a whole. They further specified that the staff arrange for a site visit to this Region for purposes of assisting the Region in better organization and delineation -of its plans and organizational arrangemnts, and in the revision of Project #16. Council was @le to determine -raining components of this project precisely which of the were supportable and which were not. They were also interested in further informtion on the capability of the hospital to provide training of all these kinds and in this depth. Project #6R - Approval I. Projects 10 through 16 Non-approval II. 01 $26,978 02 $29,425 03 $31,551 TRI-STA-@ REGIONAL MEDICAL PROGRAM 12169.1 - Operational SulD-o2.ement (Core Staff and Planning Activities) - Approval. 'Ihe Council concurs with the recomendations of the Review Co@ttee and suggests that staff convey to the Region the need for greater detail and are specificity in future applications both in presenting progress to date plans for the future. 01 - $1,348,732 12169.2 - Operational- @pplerwnt Approval with specific conditions as follows: (Continued) Page 19 TRI-STATE FEGIOIIAL MEDICAL PROGFW4 (continued) Project #8 -,Approval with the advice specifically set forth by the Review Coii@ttee. ol $14,575 02 - $111,375 o@ $14,375 VIMDffA REGIO14AL MEDICAL PROGRAM 12/69.1 ional - Approval- with specific conditions. The Council concurred in the recomendation of the site visitors and the Review Comnit@e that this Region be awarded operat status. 9here were however som rather specific differences of opinion between the two bodies regarding individual components and the total to be awarded. The Council recommends as follows: Project #1,- Approval I with the specific conditions recoimnded by the Review Co@ttee. Project #2 Approval I as recomended by the site visitors with the condition that the project director be'apprised of the questions raised by the Cardiovascular Panel and seek the necessary consultation to find the answers. Project #3 Approval I with the specific conditions reco@nded by the Review Co@ttee. Project #4 Approval- I as recomeilded by the site visitors, contingent upon the necessary -certification of the extended care facility involved. Project #5 - Non-approval II as recomended by both the Review co@ttee and site visitors.' Project #6 - Non-approval II as recomended by both the Review Co@ttee and site visitors. Project #7 - Approval I with the conditions specified by the Review Com-nittee. 01 $345,695 02 - $330,776 03 - $337,375 WA 12/69.1 Operational Renewal Approval with specific conditions. @e Cnu-ncl.1 concurred with the Review Committee in its grant to this Region L)e L!@r.Lew@ I C)i, -t,.@L Z' a (i @&Ib (continued) Page 20 conditions specified in each case. ol - $1,494,586 o2 - $1,555,984 03 - $1,605,248 12/69.2 - Operational Supplenent - Approval with specific conditions. 'Ihe Council concurred with the Review Committee in regard to each of its recommendations or, each of the four slapplemntal projects. 01 - $1003,611 02 03 $48,570 WESTERN NE7AT YORK REGIOliAL P4EDICAL PROGRAM 12/69'.1 - Operational Supplement - Approval with specific conditions. The Council concurred with the reco=-ridations of the Review C@ttee on each of the three component requests. 01 - $276,522 02 - $81,644 03 $84,788 o4 - $54 954 05 - $57,859 3 12/69.2 - Operational Supplement Disapproval. After a great deal of consideration and review of the special information obtained by the staff at the request of the Council at its last meeting3 the Council decided that this project proposes the demonstration of a technique which has not yet been developed to the extent that it is of primary importance in patient care and one which is not sufficiently relevant to the problems of the categorical diseases. In recognition of the continuing.basic research and clinical investigation on this technique the Council has agreed to reconsider, two years from now, its applicability to direct patient care. WESTMN PFMQSYLVANIA RBGIONAL MEDICAL PROGRAM 12/69.1 - Operational Suppl.ei,-.ent Non-approval I. The Council considered this application very carefully in the light of the Review Condtteels@request for policy guidance on projects of this general nature. Although they agreed that under appropriate circumstances the training and demonstration of home health aide actively d be very relevant to Regional f@ical Programs (see Section VI=, A, 3 of the !vL-dical Progi@ nationally. They therefore reco@nded that other funds be sought for the pursuit of this program plan. @ge 21 @p IAI, ACTIONS s-oecia3- a Four requests for ctions by the council were presented by th(-, staff. MUTHIS REGIONAL @@ICPT" PROGRA-M The Council recommends approval of the continuation of the activities initiated under project #4, under the circumstances presented by the staff, for a sufficient time to allow the Region to submit a revised proposal for full operational project support for Revievi comdttee and Council consideration. KA/SOT@ DAKOTAPEGIONAL MEDICAL PROGRAM The Council recommends approval, without additional funds.$ of the reinstatement of the mobile unit aspect of project #4 as presented and explained by the staff. OHIO IJ-EY RF-RIONAL MICAL PROGFAM ruary 19.69 the Council approved, in principle, a proposal to In Feb establish a multiphasic screer,:fng activity in this region. The approval was contingent upon submission of evidence that the project, as conceived, could be accorviished within the limit of the budget rec@nded. The consensus of Council is that the revised proposal is acceptable, although the project is to be watched closely by staf f for assumeIe. that the-neces@-Y provisions are being made for patient follow-UP and that plans are being pursued for support of the continuity of this project beyond the two year lindt of this grant. The recomendation of approval is reaffirmed. wisc mic After further consideration of project #15 and of the entire issue of U.of projects related to control of Regional Medical Program suppor' chronic renal disease (see Section viii, A, 2 of the Minutes), the Council again deferred final action on this application. Page 22 X. ADJOURNMENT The meting was adjourned at 12:30 p.m. on December 17, 1969. I hereby certify that, to the best of nW knowledge,the forego@o- @utes are accurate and complete. ey so M. D. Director Regional @dical Programs Service Text of the statemnts and additional materials which were distributed at the meting are available in the Office of the Council Secretary. page 23 ,kT,ENDANCE AT NATIONAL PDVISORY COUNCIL @D\'G Docember 16-17, 1969 R4pS 3T@ A ING Dep@,y Director, Dfq4P Dr.' Donald R. Chadwick, office of organizational Liaison Mr. Cleveland Chambliss@ Dr. Veronica Conley., Continuing Education & Training Branch Chief, Heart Disease & Stroke Control Program I)r. Sam Fox, Director for Co cations Mr. Edward Friedlander, Assistant and Public Infon-nation Mr. &= Gilmr,.Programs AssistanQe Branch Mr. Charles Hilsenroth, Assistant Director for Managemnt Mr. Robert Jones, Chief, Programs Assistance Branch Mrs. Lorraine Kyttle, office of Grants Review Mr. Gregory Lewis, Chief,. Grants Manage@nt Branch Developmnt Dr. Richard manegold, Associate Director for @ Operations & Research & Systenz Analysis Branch Dr. Frank mark, Chief-, Operations & Evaluation Mr. Roland Peterson, Assistant Director for Planning ilips, Associate Director for Grant and'Contract PolicY Health @bxtha Phi Special Assistant to the Director for NutritiOn :.'@liloslav Rechcigl, cutive Officer, CDC Pa. Donald Riedesel., Exe 'Review fice of Grants Mr. Richard Rissell, Of ,Mrs. Judy Silsbee, Assistant Director for Grants Review Dr. Margaret Sloan, Associate Director for 0 @ zational Liaison Zizl'avsky, Programs Assistance Branch ATIENDING Dr. L. G. Christianson, Veterans Administration Dr. J. H. Dunlop, A. D. Little Inc. Dr. Frederick Featherstone, HSMHA/OA Mr. Charles Rosenberger, NCI Mr. John Pendleton, NCHS&19D Dr. R. A. walkington, NLM Dr. Eugene Veverka3 CHS Dr. William J. Zukel, N-HI. Page 24 RECORDL\TG OF RECOIZTMATIONS From the Panels to the Review Co @ ttee (On Project7s- y Technically sound and capably directed Feasible under specified conditions UnapProvable on technic,,,'---munds From the Review Co ttee to the National AdvisoEy Council (O,-i Projects Approval I - Additional funds recomended Approval II - No additional funds recomended Non-approval I - Inappropriate for DRMP funding Non-approval II - Revision required No action taken - Need additional information @:e visit Ne...j 't",-,,mcil decision (On Entire Applications) Approval Approval with specific conditions Deferral Return for Revision Disapproval Inappropriate for DF&M funding From the National Advisory Council to the Administrator (On Entlre Applicatior, Approval Approval with specific conditions (as recomended by the Review Committee or others) Deferral Return for Fevison Disapproval Inappmpriate -for DRMP funding NpPj- IOI\TAL AD7\T:F,-DORY COU14CIL ON I014AL i@ H=IC.AL P @is MILLIKUJ, Clark H. M.D. (72) BFR=I, Michael J., M.D. (72) President, @,,Lichigan Cancer Foundation Consultant in neurology 4811 joliln R Street Mayo Clinic Detroit, Michigan 48201 Rochester, L'@esota 55902 PELLT-7GRiNo, d D., M.D. (70) @6@,s-sor of Medicine Vice President for the Health Sciences Wayne State University and Director of the Center CAI,F,@,TON, Bland, W. , M.D. (7 3) State university of New York 910 Madison Avenue Stony Brook, New Yckrk 11790 Memphis, Tennessee 38103 POPMA, Alfred M., M.D. (70). Regional Director Division of lieurosurgery University of Tennessee College Regional Medical Program of Medicine 525 Viest Jefferson Street Boise, Idaho 83702 CROSBY, Fdwin L., M.D. (71) Director ROTH, Russell B., M.D. (73) Amrican'Hospital--Association 240 West 41st Street Chicago, Illinois 6o6ii Erie,.Pennsylvania 165o8 @j)eBAKEY, Michael E... M.D. (72) Vice Speaker of the House of President and Chief Executive Officer Delegates of the Arnerican Medical Baylor College of Medicine Association Hoi-iston, Texas 77025 SHAIIHOLTZ, Mack I., M.D.-(70) State Health Co@ssioner Professor and Chairman State Depart@nt of Health Department of Surgery College of Medicine Ric@nd., Virginia 23219 E\=ST., Bruce W., M.D. (71) TREEN, Mr. Curtis (71) Chief of Pediatrics United Fabber, Cork, Linoleum-and Green Clinic Plastic Workers of America 709 South Vienna Street 87 South High Street Ruston, Louisiana 71270 Akron, Ohio 44308 HOGI,ESS, John R., M.D. (70) Director Executive Vice President Pension and Insurance Departnr-nt University of Washington Seattle, Washington 98105 WYCKOFF., Mrs. Florence R. (72) 243 Corralitos Road Watsonville, California 95076 C AN Dr. JoF@rh EnFlish Rockville, Maryland 20853