likiiiii@li@ll@iiiiiiiiiii -77'- My thesis ... has been that the concept of a community trusteeship is the most viable element in our society, and Government must be willing to deal on a local basis with issues that can be identified and corrected locally. My responsibility is to make it possible for that to happen. I believe we should move away from Federally directed activities and towards really autonomous responsibilities on the part of the Regional Medical Programs. Harold Margulies, M.D. Acting Director, Regional Medical Programs Service from a talk on "Trends in Health Care," given at the Annual Meeting of the Iowa RMP on June 26, 1970. TABLE OF CONTENTS CHAPTER PAGE 1. OVERVIEWOFTHEREGION ........................................... 1 Features and Services .............................................. 2 Relationship with Neighboring Regions .................................... 2 Housing of RMP for WNY ............................................ 2 Geography .................................................... 3 II. RELATIONSHIPOFRMPFORWNYTOOTHERHEALTH-RELATEDORGANIZATIONS . . . . . . . 5 111. ORGANIZATION AND STRUCTURE ....................................... 7 The Volunteer's Contribution ........................................ 8 Regional Advisory Group ........................................... 8 County Committees .............................................. 8 Standing Committees ............................................. 8 Core Staff .................................................... 8 IV. CORESTAFFACTIVITIES ............................................. 13 Data Collection ................................................. 14 Community Health Information Profile Data System ........................ 14 Ambulance Service ........................................... 14 Kidney Disease Service, Facilities, and Programs in the United States .............. 14 Manpower Problems .............................................. 15 Buffalo Summer Student Program .................................. 1 5 Rural Externship Program ....................................... 15 Research and Evaluation ........................................... 1 5 Coronary Care Unit Nurse Profile ................................... 15 Telephone Lecture Network System Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Continuing Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 V. EVALUATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 VI. THEPROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 New Legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Grand Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Developmental Component . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 VII. PROGRAMOPERATION ............ ................................. 25 Finances .................. .................................. 26 Financial Management ......................................... 26 Financial Statement: March 1, 1970 - February 28, 1971 . . . . . . . . . . . . . . . . . . . . . 26 Proposal Review Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Operational Projects . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Funded and On-Going . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Component No. 1 - Telephone Lecture Netvvork . . . . . . . . . . . . . . . . . . . . . . . 27 Component No. 2 -Coronary Care Training Program . . . . . . . . . . . . . . . . . . . 29 Component No. 3 -Chronic Respiratory Disease Program . . . . . . . . . . . . . . . . . 29 Component No. 4 -Immunofl,.jorescent Service and Training Program . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Component No. 5 - Tumor Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Approved but Unfunded by Regional Medical Programs Service (Locally supported for one year through carryover or rebudgeted funds.) . . . . . . . . . . 30 Component No. 13 - Topical Chemotherapy Treatment for Precancerous Lesions and Cancer of the Skin . . . . . . . . . . . . . . . . . . . . 30 Component No. 14 - Information Dissemination Service . . . . . . . . . . . . . . . . . . 31 Component No. 16 - Hematology Center, Blood Coagulation Reference Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Status of Proposals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 TABLE OF FIGURES FIGURE PAGE 1. Regional Medical Program for Western New York Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2. RMP for WNY Relationship to Other Health-Related Organizations . . . . . . . . . . . . . . . . . . . . . . 6 3. Composition of Board of Directors of the Health Organization of Western New York, Inc . . . . . . . . . . 9 4. Board of Directors, Health Organization of Western New York, Inc . . . . . . . . . . . . . . . . . . . . . . . 10 5. County Committee Chairmen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 6. Standing Committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 7. Continuing Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 8. New Legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 9. Financial Statement: March 1, 1970 - February 28, 1971 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 10. Proposal Review Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 11. Status of Proposals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Overview of the Regior GO@ Features and Services The implementation of RMP for WNY has The estimated population of the nine-county coincided geographically with the establishment of area of RMP for WNY is two million. Over half of this three different Comprehensive Health Planning "b" population resides in Erie County (N.Y.), and agencies--Western New York, Rochester and one-quarter of the total population, or one-half Pennsylvania. Such overlap is inevitable since RMP million people, reside in the city of Buffalo and its has a flexible, regional perspective whereas "b" immediate suburbs. Personnel-population ratios are a agencies tend to be restricted within state boundaries dramatic illustration of the disparities in distribution and funding mechanisms. Also, the same planning of health personnel within the area. For instance, the area is not necessarily optimal for both organizations. number of staff nurses available varies from two We have made specific contacts with the CHP of Erie, nurses per 1,000 population in the metropolitan Pennsylvania and representatives of the adjacent Buffalo area to less than one-quarter of a nurse per Comprehensive Health Planning agencies overlapping 1,000 population in a disadvantaged area south of the our region. It is too early to give a detailed city. Rural areas lack personnel in many job description of this relationship, since these agencies categories, suggesting that residents of these areas have yet to define themselves operationally. However, must necessarily travel considerable distances for it is apparent that more formalized and tangible many health services. This variation in accessibility working relationships will be evolved in the near necessitates careful planning to insure better health future. care for all persons in the region. ACROSS THE STATE - Discussions with neighboring RMPs across the state have been very important to good inter-regional cooperation; these discussions can be extended through the Northeastern group of RMP Relationship with Neighboring Regions coordinators. TO THE NORTH - The southwestern penninsula of Ontario, including the two major towns of Hamilton and Toronto, is our nearest northern neighbor. Our Housing of RMP for WNY relationship with the Canadians is most cordial, The core staff is housed at 2929 Main Street in especially in the area of continuing medical Buffalo, New York. We now possess two conference education. The RMP for WNY's Nursing Program in rooms which are heavily used by committees of the Coronary Care has attracted many Canadian nurses. program, both official and ad hoc, and which have Sponsoring Canadian institutions have paid the full immeasurably improved our role as an enabling costs for their participants, foreshadowing a agency. self-supporting status for the nursing project. The Furthermore, core staff offices provide housing Telephone Lecture Network has received, though not for the Telephone Lecture Network (TLN). As the yet accepted, a number of applications for outlets vehicle for information, both academic and from Ontario hospitals. We seek to encourage this administrative, TLN has been the means of relationship which transcends artificial territorial maintaining continual community involvement. The borders. RMP headquarters now has the capacity through TLN TO THE SOUTH AND EAST - The Coordinator of to link with all communications media in the Western the RMP for WNY has maintained friendly, personal New York-Pennsylvania region. relationships with Dr. Ralph Parker and Dr. Robert Carpenter, his counterparts in Western Pennsylvania and Rochester. The Telephone Lecture Network has provided outlets in hospitals of both these neighboring regions. 2 THE REGIONAL MEDICAL PROGRAM FOR WESTERN NEW YORK LAKE ONTARIO TORONTO P-(DRT HAMILTON NIAGA A COUNTY' GEOGRAPHY FALLS GENESEE ROCHESTER The Regional Medical COUNT Program for Western New York (RMP for WNY) now includes @BA7 nine counties: Niagara, Genesee, Erie, Wyoming, Chautauqua, Cattaraugus, and Allegany counties in Western New York, NTY and Erie and McKean counties in Northwestern Pennsylvania. Our latest addition was McKean County, officially admitted in April 1970. DUNKIRK ALLEGANY TAUQUA CATTARAUGUS COUNTY COUNTY COUNTY RIE SA Al A JAMESTOWN A E RIE COUNTY BR FORD, PA. I MC KEAN COUNTY 1 219 '19 Leli@ L I ml]PX 0 FZI(,Z 5 VOLUNTARY HEALTH AGEN PROFESSIONAL SOCIETIES UNTY UNITED LTH HEALTH ,TIMENTS FOUNDATI .. . . ...... .......... . HEART ASSOCIATION OF WESTERN @:NEVV YORK INC Iowa AN SOCIETY RESPIRATORY AND TUBERCULOSIS ASSOCIA,TIO@ ORMAL RELATIONSHIP [3 WORKING RELATIONSHIP L GROUP 0 OTHERS - INFORMAL The relationship between VVor ki n g relationships Those organizations with v a r i o u sh e a I t h - related involve a continuing cooperation vvh i ch RMP has informal organizations and the RMP for in areas such as awarding relationships are a rather broad VVNY may be divided into three continuing education credit for group. Concerned agencies tend categories formal, working, and participation in TLN programs, to band together to deal with a informal. Formal status entails co-sponsorship of teaching days, particular program or problem. representation on the Board of or joint planning for community For example, the American Directors of RMP Is Regional health. Cancer Society, the Respiratory Advisory Group, the Health and TB Association, the Heart Organization of Western Nevv Association, and the Erie County York, Inc. (H.O.VV.N.Y.), as Health Department formed an mandated in the by-lavts of the Inter-agency Council to deal with Regional Medical Program. smoking. Figure 2. RMP for WNY Relationship to Other Health Related Organizations 6 Organization and Structure The Volunteer's Contribution The Board of Directors of H.O.W.N.Y. has met Volunteers from every part of the region, twelve times in the past twelve months. Meetings have serving on the Regional Advisory Group, its Board of averaged between four and five hours, and attendance Directors and county committees, as well as on RMP has, with one exception, always fulfilled the quorum standing committees, have contributed greatly to the requirements. grass-roots, regional character of the RMP for WNY. The Board has required the Coordinator of the Our sponsoring institution, the State University RMP to submit to them a monthly report. This is of New York at Buffalo, has extended help of every distributed to all Board members and county kind -- from audio-visual equipment, graphic arts and committee chairmen. It 1 ) documents the photography services, information services, and Coordinator's activities during those four weeks, 2) library facilities to the roster of experts who have explains new legislation pertinent to the RMP, 3) contributed their talents to Telephone Lecture provides a diary of projects, current and planned, and Network presentations. 4) lists a number of questions on which the Display space and meeting rooms have been Coordinator seeks the Board's advice. made available to RMP for WNY throughout the region. County Committees The voluntary agency is a valuable component The county committees have expanded their of the health care system. RMP for WNY has role and activity over the last year. All have now benefited from voluntary participation by the established bylaws consistent with those of the parent established agencies. Members of the Regional Regional Advisory Group, namely H.O.W.N.Y. These Advisory Group and core staff have been able to subregional components of the total advisory group reciprocate, enabling the kind of voluntary have provided substantial prereview for all projects by cooperation and interdependence which can most virtue of their committee reports to the Technical economically implement the best measures for the Advisory Committee (Proposal Committee) and the maximum number of people. Board of Directors of H.O.W.N.Y. The cumbersome Regional Advisory Group appearance of our Board review process is more than The Health Organization of Western New York, compensated for by the involvement it promotes in Inc. (H.O.W.N.Y.), Regional Advisory Group for the regionalization, education, and review process. The RMP for WNY, is responsible for defining program review process itself is now an important continuing objectives, determining priorities, implementing education device for both the committees involved policies, approving grant applications, and evaluating and the grant authors subjected in person to their ongoing projects. The membership of H.O.W.N.Y. is scrutiny. large, namely 228 members. We have encouraged, and Standing Committees will continue to recruit, those in the total region who Those who serve on H.O.W.N.Y. committees can provide comment, time, and interest in matters must hold H.O.W.N.Y. membership. pertinent to the Regional Medical Program for RMP committees, on the other hand, can utilize Western New York. the expertise of consultants who are interested in An organization of these dimensions requires an certain aspects of the program, but not necessarily in executive, which in our case is known as the Board of the program as a whole. Directors of H.O.W.N.Y. This body now numbers 29 people. A representative of the Veterans Administration will be included this coming year, in Core Staff conformance with the new legislation. Regional All members of the core staff are now full-time representation on this body is undoubtedly Regional Medical Program for Western New York dominant. employees. They are predominantly young and a well 8 D F A 3 M.D.'s from the 9 counties, representing the Medical Societies B 3 others as "county" members C 1member from Comprehensive Health Planning - the executive director D 1member from the State Health Department, currently the director of the six-county VVestern Nevv York area E 1member from the health department of the most populous county, currently the Health Commissioner of Erie County F 1member from the VVestern Nevv York Hospital Association G 2members from the State University of Nevv York at Buffalo H 2members from the Rosvvell Park Memorial Institute 1 3members at large vvho represent urban minority interests Figure 3. Composition of Board of Directors of the Health Organization of Western New York 9 BOARD OF DIRECTORS HEALTH ORGANIZATION OF VJESTERN NEW YORK November, 1970 Orgaf@izational County of Name Affiliation Residence or Occupation Lester H. Block Attorney at L-@,.% 1 Erie, N. Y. Theodore Bronk, NI.D. Niagara Coii-,,@ '.!ediull Society Niagara Evan Calkins, M.D. Chairman, F.@c@,j '@@ of Medicine, Erie School of Nl--d;c -a State Unive.,z -.@ o' New York at Buffalo L-aVerne E. Campbell, M.D. New York S"@--,e Departr-nent Erie (Treasurer, H.O.W.N.Y,) of Health Vincent Ciampa, M.D. Cuba Memorial Hospital Allegany William H. Ennis Administrator, Hanot Hospital Erie, Pa. (Secretary, H.0,VV.N.Y.) Irwin Felsen, M.D. Medical Society, Allegany County Allegany (President, H.O.VV.N.Y.) Father Cosmas Girard, O.F.M., Ph.D. St. Bonaven,,ure University Cattaraugus (Vice-President, H.O.VV.N.Y.) Rosario Guilo, M.D. Western Ne@,,., York Hospital Erie Association Herbert E. Joyce, M.D. Erie County %l@dical Society Erie Edward E. Kemble, M.D. Erie County @%ledical Society Erie, Pa. Martin E. Meier, F.A.C.H.A. Administrator, @@).C,A. Hospital Chautauqua John A. Mirmak Administrator, Bradford Hospital McKean, Pa. William E. Mosher, M.D. Commissioner, Erie County Erie Health Departrrent Gerald P. Murphy, M.D. Director, Ros,,%ell Park Erie Me mor la I I nsz i,, ut a Mrs. Mary Northington Component Manager for Health Erie and Social Service - Model Cities John C. Patterson, M.D. Roswell Park i%'emorial Institute Erie LeRoy Pesch, M.D. Dean, School or Nledicine, Erie State University of New York at Buffalo Fred 0. Rush Director, Gannon College Erie, Pa. Bayfront Neichborhood Development Center Mrs. Patricia Stopen, R.N. Director, Public Health Nursing Wyoming Harry Sultz, D.D.S., M.P.H. Department of Social and Preventive Erie Medicine, State University of New York at Buffalo H, Gregory Thorsell, M.D. President, Jamestown Medical Society Chautauqua Donald R. Watkins, M.D. McKean County Medical Society McKean, Pa. Charles Weliner Editor, Lockport Union Sun Journal Niagara Paul Welsh, M.D. Genesee County Medical Society Genesee R. T, Williams, M.D. Wyoming County Medical Society Wyoming Duncan VVormer, M.D. Cattaraugus County Medical Society Cattaraugus George Young, M.D. Genesee County rvledical Society Genesee Figure 4. Board of Directors, Health Organization of Western New York, Inc. I r) educated group, both academically and in terms of grant development, nursing and allied health affairs, Ri@v@IP concepts. Each staff member has a well-defined and research and evaluation. role in the organization and a voice in the A manager-nent assessment visit to the program development of the total program. According to his earlier in the year provided the Coordinator with a specific area of competence, each has an obligation to critical appraisal of his own role and that of staff one or more cooperating agencies. members. Subsequent increase in the staff has greatly Specific areas of staff expertise include business facilitated our change in emphasis towards an active and personnel, communications, scientific writing, enabler of health-related activities. systems development, planning, community liaison, COUNTY COMMITTEE CHAIRMEN Organizational Affiliation or Chairman Occupation County Irwin Felsen, M.D. Allegany County Medical Allegany Society Duncan C. Wormer, M.D. Cattaraugus County Cattaraugus Medical Society V)ilson Shaw, M.D. Chautauqua County Chautauqua Medical Society Max Cheplove, M.D. Erie County Erie, N. Y. Medical Society Vacant Erie, Pa. Vacant Genesee John A. Mirmak Administrator, Bradford McKean, Pa. Hospital J.C. Read, M.D. Niagara County Medical Niagara Society Harold Hinman, M.D. Commissioner of Health, Wyoming Wyoming County Health Department Figure 5. County Committee Chairmen 1 1 H.O.@N,N.Y. BOARD OF DIRECTO Constitution and Bylaws Executi\/e Search Proposals COUNTY RMP COMMITTEES OFHOWNY Standing Committees Coronary Care Cancer Stroke Allegany Nursing Stroke Education Cattaraugus Dialysis Chautaugua Pulmonary Planning Erie, N. Y. Erie, Pa. Genesee McKean, Pa. New Committees Niagara VVyoming Rural Health Manpower TLN Advisory Group RMP Evaluation Health Happening Figure 6. Standing Committees 12 Core Staf f Activities 1 3 Core staff activities this past year reflect an - the outpatient service of Children's Hospital, emphasis on a) obtaining data which permit to determine its effectiveness in providing identification of regional needs and assessment of services to the various subpopulations of the resources, b) manpower problems, c) research and area, particularly disadvantaged groups. evaluation, d) communications and e) continuing The 1970 census data, collected and presented education. on the block level rather than the census tract level, will be much more sophisticated and revealing than Data Collection previous census material. Methodology and tools Community Health Information Profile Data System appropriate to our area are being devised to deal with Baseline data provides both the justification of this new data. Continued support of the data bank RMP activities and a basis for evaluation of RMP will allow RMP for WNY to act in terms of regional impact. Core funds supported a program for diagnosis. establishing a community-data bank to provide a central regional service. This project was initiated July 1, 1970, for the purpose of establishing a data Ambulance Service base from existing sources and developing a system Problems of efficiency and overlap of for incorporating new data as it becomes available for ambulance service have been defined and improved health service planning and evaluation in the nine under the aegis of Buffalo city government and other county area of the Regional Medical Program for well-motivated groups in Erie County. RMP for WNY Western New York. An expert advisory committee is actively facilitating the defining, planning, and was composed of representatives of the major social, implementing of a unified ambulance service of high demographic, environmental, and community health standard. data sources to consult with the staff of the project who are working within the Community Services Research and Development Program, Department of Social and Preventive Medicine, School of Medicine, Kidney Disease Services, Facilities, State University of New York at Buffalo. A Dual and Programs in the United States Independent Map Encoding technique (DIME) has Participating in a national survey conducted by been developed for the Western New York region. the Regional Medical Programs Service, staff collected Computer technology is used to create maps showing information concerning facilities available in our the geographic linkage of data. These maps present region for the treatment of kidney disease. Both data in an easily grasped form which permits response detection and end-stage kidney disease programs in terms of planning. (including artificial kidney treatment and training Four community studies are benefiting from programs, kidney transplantation programs, and the data-handling capability of the DIME technique. tissue typing laboratories) were surveyed. Studied were: Information such as institution, name of director, ambulatory care services available in the training for home patients, beds in unit, and number emergency rooms and outpatient departments of transplants performed was obtained. Availability of the seven major hospitals serving residents of financial assistance and kidney donation for the of the inner city patient as well as plans to develop new kidney disease the service effectiveness of Meyer Memorial activities in our region were documented. Hospital for the care of diabetes patients Material for this survey was obtained from the utilization patterns and diagnostic variability RMP for WNY Dialysis Program document and an for childhood cardiac conditions, for the up-dating questionnaire. The Dialysis Program has Children's Hospital of Buffalo been approved but is, as yet, unfunded. 14 Manpower Problems Research and Evaluation Buffalo Summer Student Program In addition to the aspects of project and total This project sought to motivate students from program evaluation described in Section VII minority groups towards careers in medicine and the (Evaluation), two studies have been undertaken: allied health professions. Sixty students received Coronary Care Unit Nurse Profile classroom and laboratory instruction, supplemented A study was designed to determine the with clinical and community-health field experiences. coronary care unit nurse profile as opposed to that of Second and third year medical students supervised. the nurse working in other areas of nursing. A Evaluation of the direction and degree of change in questionnaire of approximately fifteen minutes in the students' knowledge, attitudes, and behavior length was used to interview thirty coronary care related to specific health careers has been undertaken. nurses and thirty nurses in other areas of nursing care A long-term follow-up to see if high school students located in fifteen hospitals throughout the area served enrolled in the program do actually choose careers in by the Regional Medical Program for Western New medicine and allied health professions is planned. York. The interviewing was conducted through the This project was based at the facilities of the School Telephone Lecture Network (a two-way telephone of Medicine, State University of New York at system). The questions were pre-taped on a Buffalo, and received fiscal and in-kind support from ten-minute cartridge which was automatically set to many agencies. stop after the completion of each question. This procedure allowed for probing of answers when deemed necessary. The following two papers have emerged from Rural Externship Program this study: The RMP for WNY participated in the - The Coronary Care Nurse Profile by Elsa R. organization and evaluation of the rural externship Kellberg (to be submitted to "Nursing program, which will place medical and allied health Research") students with preceptors in the rural areas of our A sub-unit has formed within the nursing region. profession with different attitudes about In the summer of 1970, the Student American nursing care. The coronary care unit nurse Medical Association (SAMA) Appalachia Student seems to have a different frame of reference Health Program placed eight students on rural than other types of nurses in respect to a externships in three of our counties--Chautauqua, higher aspiration level. She needs greater Cattaraugus, and Allegany. The purpose of this responsibility, opportunity for use of her program was to introduce medical and other health judgment, and challenge; she prefers a team students to the problems of the rural areas. The approach to patient care. students and preceptors were interviewed by RMP for - The TLN System - an Interviewing Technique WNY staff. Recommendations for improving the by Elsa R. Keliberg and Joseph Reynolds (to program were abstracted from these interviews. Based be submitted for publication) on the very worthwhile Appalachia Program A unique method employing the interview experience, the RMP for WNY staff, together with approach was utilized to collect data for a the Student Coordinator from SAMA, drew up a study whose purpose was to determine how proposal for extending rural externships to the entire nurses working in a coronary care unit RMP for WNY region. This program has received the perceive themselves in their profession. enthusiasm of both the students and the medical Interviews were conducted over the community. Possible sources of funding are presently Telephone Lecture Network system of the being investigated. RMP for WNY. Some advantages of this Interested groups have established the Rural technique are the verbal standardization and Health Manpower Committee under the aegis of RMP uniformity in asking of questions, the amount for WNY and the chairmanship of Dr. J. Warren of travel time saved by the interviewer, Perry, Dean of the School of Health Related reduced cost, and the much more efficient Professions, State University of New York at Buffalo. scheduling of interviews. 15 Telephone Lecture Network System Evaluation Brochtires.- Colorful and informative brochures After the Telephone Lecture Network (TLN) describe various aspects of the RMP program. A system had been in operation for two years, it was brochure on the total RMP for WNY program is decided to poll program participants for the purpose currently being produced. of gaining insight into effectiveness of presentation, RMP for WNY has always supplied the news direction programs should take, and the possibility of media with accurate and honest information on the self-support in the future. It will be possible to premise that good communication is the prerequisite continually reevaluate future programs by regular use to cooperative enterprises in it-nproving health care of questions directed to the participants. and eliminating duplication. RMP for WNY staff together with an Finally, the day-to-day personal contact of independent group, Survey Research, State University H.O.W.N.Y. members and RMP staff with the of Ne@v York at Buffalo, worked for four months to community numbers among our most valuable public complete this three-phase survey. The information relations assets. obtained is now being collated and analyzed, and an interim report was submitted to the TLN Evaluation Continuing Education Committee on November 17, 1970. This, together Through workshops and institutes, physicians, with critical visits by outside consultants familiar with communication mechanisms, will provide us nurses, and allied health professionals in the Western with a good frame of reference on which to base New York and Northwestern Pennsylvania area are financially independent operation of the network. kept abreast of the most up-to-date information about medical care. Core staff has actively cooperated with other agencies in the presentation of continuing Communications education programs, both over the Telephone Lecture Establishing a good image among our colleagues Network and in meetings held throughout the region. and the general public and keeping them RMP for WNY provides a forum for discussion well-informed about developments in our program of controversial, pertinent issues. A Group Practice require much personal contact and a variety of Symposium was sponsored by the RMP in approaches. conjunction with the Erie County (Pa.) Medical Newsletters: Twenty-one H.O.W.N.Y. Newsletters Society and Erie County (Pa.) Osteopathic have been published since the program was organized. Association. Approximately 80 persons--physicians, The mailing list has grown from 5,000 to administrators, insurance people, and approximately 13,000 names. others--attended the Symposium held on October 21, News Releases: News releases are prepared and 1970 in Erie, Pennsylvania. The RMP for WNY will continue to facilitate distributed to every newspaper, radio and television communication among all those involved in the station in the region. Feature articles about the RMP delivery of medical care, aiming programs at the for WNY have appeared in almost every daily multi-disciplinary audience. We seek to encourage newspaper. new programs for new needs in education. Television: Television coverage has been arranged for major RMP events: the H.O.W.N.Y. Annual General Meeting; the September 1970 visit o acting erector, Harold Margulies, M.D.; open house of the respiratory teaching lab; openings of the coronary and the respiratory training programs; and special TLN programs. Radio: Radio stations have extended the use of their facilities for region-wide announcements to encourage public participation in RMP functions and to enlarge public knowledge of RMP. Exhibits: Four different exhibits have been designed and displayed at conferences and meetings. 16 CONTINUING EDUCATION PROGRAM DATE LOCATION REGISTRANTS CO-SPONSORS Stroke t April 2, 1970 St. Jeromes Hospital 103 Heart Association of VV.N.Y., Inc., Continuing Medical Batavia, New York Education, State University of New York at Buffalo Stroke t February 11, 1971 Hotel Statier Hilton, Buffalo Heart Association of VV.N.Y., Inc., Continuing Medical Education, State University of New York at Buffalo Modern Concepts in Apri I 23, 24, 1970 Sisters of Charity Hospital, Buffalo 64 Continuing Medical Education, State University of Coronary Care t New York at Buffalo Modern Concepts in November 19, 20, 1970 Sisters of Charity Hospital, Buffalo 56 Continuing Medical Education, State University of Coronary Care t New York at Buffalo Geriatric Medicine t May 27, 28, 1970 Hotel Statier Hilton, Buffalo 78 Continuing Medical Education, State University of New York at Buffalo, The Rosa Coplon Jewish Home and Infirmary Fifth Annual Buffalo October 14, 16, 1970 Hotel Statler Hilton, Buffalo 216 Continuing Medical Education, State University of Pulmonary Disease New York at Buffalo Conference t Cardiac Clinics and February 1 1 - Sisters of Charity Hospital, Buffalo Continuing Medical Education, State University of Physical Examination July 22, 1 971 New York at Buffalo of the Cardiac Patient t (24 Thursday evenings) Family Management of the February 25, 1971 Statler Hilton Hotel, Buffalo Continuing Medical Education, State University of Chronically III New York at Buffalo Pulmonary Disease ttt January 15, 1970 Hamburg, New York 300 T.B. & Respiratory Disease Association of VV.N.Y. Pulmonary Disease ttt April 17, 1970 Canandaiqua, New Yorl< 200 T.B. & Respiratory Disease Association of VV.N.Y. I I I Al)iil 2@3, l@)70 Alt i (@(1, N(!vv Yot l@ 1 2!) 1 .11. Di@i!ii!@(! Associiitiorl t)f VV.N.Y., St@itt@ LJiiiv(!r!;ity (if Ni@w Yorl< Ac ric:ultur@il @iiici Tuchrii(@zil College, Alfred, New York Pulmonary Disease ttt May 22, 1970 Batavia, New Yorl< 200 T.B. & Respiratory Disease Association of VV.N.Y. PROGRAM DATE LOCATION REGISTRANTS CO-SPONSORS Pulmonary Disease ttt June 5, 1970 Jamestown Community College 100 T.B. & Respiratory Disease Association of VV.N.Y. Jamestown, New York Jamestown Community College Pulmonary Disease ttt October 9, 1970 Niagara Falls, New York 200 T.B. & Respiratory Disease Association of VV.N.Y. Spinal Cord Injuries tt October 22, 23, 1970 E.J. Meyer Memorial Hospital 200 E.J. Meyer Memorial Hospital Rehabilitation Buffalo, New York Department cancer Teaching Day December 2, 1970 Dunkirk, New York 234 Chautauqua County Unit, American Cancer Society Cancer Teaching Day March 7, 1970 Niagara Falls, New York 200 N.Y.S. Division of American Cancer Society, Niagara Falls Academy of Medicine Cancer Teaching Day t May 7, 1970 Jamestown, New York 57 N.Y.S. Division of American Cancer Society, Jamestown General Hospital Refresher Revitilization September 15 - Buffalo, Nevj York Total District Nurses Association of W.N.Y. Hospitals in Erie Courses tt (10 courses) November 17, 1970 697 County, New York Utilization of Allied April 16, 17, 1970 Buffalo, New York 300 School of Health Related Professions, State University Professions Assistants of New York at Buffalo, United Health Foundation in the Delivery of Health Care Currently planned Approximate number t Primarily for physicians ttprimarily for nurses ttt Primarily for nurses, inhalation therapists, and physical therapists Figure 7. Continuing Education I 1 q Evaluation Core staff in conjunction with the Regional Projects Advisory Group (RAG) is involved in evaluation of The staff member for evaluation sees all the over-all program as well as its specific components projects, at whatever stage they are initially presented Such as proposals and funded projects. The new to RMP, to separate means from ends and to insure annual review system places on the region ever greater inclusion of an effective evaluation component. An responsibility for self-evaluation. evaluation committee has been formed to advise on feasible and effective evaluation methods. The committee consists of ten multi-disciplinary professionals, and is being expanded to include an economist, a social psychologist, and a statistician. Together with the RAG, this committee is developing Program a rating system which will give stability to judgment Since September 1970, RMP for WNY has been without impractical rigidity. participating in an Information Support System (ISS) We have recently initiated a system of one or study conducted by the Harvard University Center two day site-visits to funded projects. Site-visit teams for Community Health and Medical Care. Interviews consist of two outside consultants, two members of with key people throughout the region have been the H.O.W.N.Y. Board of Directors, and one staff conducted. The purpose of this study is to develop a member. Their recommendations will assist the Board socio-political data base that will allow evaluation of in making decisions concerning future funding of the short-term and potential long-term effects of operational projects. Forms have been devised to aid RMP activities in terms of: team members in evaluating both the project and the 1 . Assessment of the status of a region procedure of the site-visit itself. 2. Identification of changes in the medical care system that have resulted from RMP activ- Studies ities In the past, studies such as the Manpower 3. Determination of those organizational pro- Study, Stroke Study, and Myocardial Infarction cesses which are most effective in promoting Study have supplied baseline information for support change. of future proposals. More studies of this type will be The ISS study will also be used to determine developed to supply data not only in support of similarities among RMPS, enabling comparison of the proposals but also as information necessary for the performance of the various RMPs and, in time, of establishment of regional program priorities. non-RMP health agencies. The site-visit as part of our project evaluation The Grand Design will be reviewed at least four system together with regular review of our overall times a year by the Board together with health program will 1) allow continuing reassessment of planning consultants. These one-day workshops, as priorities; 2) by involving outside consultants and well as information obtained from the ISS study, will competent regional opinion, assist in promoting help RMP for WNY retain flexibility and priorities intelligent participation in the RMP regionalization which are germane to the emerging needs of the process; and 3) protect against an inbred view of the region. RMP for WNY operation. ,)n The Program New Legislation quality, and 3) decrease cost of health services. Public Law 91-515, signed October 30, 1970 by To guide program planning and project President Nixon, extends and amends the legislation formulation towards the three overall goals, some of the Regional Medical Program as well as that of interim objectives have been developed: Comprehensive Health Planning, the National Center 0 RMP will encourage the development of specific for Health Services Research and Development, and inter-institutional and inter-professional relationships the National Center for Health Statistics. at all levels, for the purpose of more coordinated, The bill, collectively referred to as the Health efficient, and effective delivery of medical care. Services Improvement Act, incorporates several 0 RMP will sponsor efforts to increase the manpower important changes in emphasis for Regional Medical resources of the region, including physicians and Programs nationally, and reflects strong impetus for other health personnel. new directions and extended activities regionally 0 RMP will sponsor means of increasing the within the RMP for WNY area. effectiveness of regional manpower resources. * RMP will assist in defining and correcting Grand Design maldistribution of health personnel in the region. The Regional Medical Program for Western New & RMP will seek means to continually upgrade the York is presently undergoing an important transition abilities and training of the region's health from "concensus planning" to planning based on personnel--and to achieve more uniform quality in clearly defined regional needs; from project-oriented care. to total program planning. Entry into this new phase 0 RMP will promote improved access to specialized of coordinated planned response to regional problems diagnostic and treatment centers, while seeking to will be facilitated by the strengthening of the Western identify and discourage wasteful duplication where New York Comprehensive Health Planning Agency, additional services and facilities are not justified. by the growing amount of baseline planning data 0 RMP will encourage the development of emerging out of RMP support of the Center for family-centered comprehensive care, neighborhood Community Services Research and Development, and health facilities, and the increased availability and by the increased planning capabilities within the core utilization of primary and preventive care on an staff of RMP for WNY. The emerging data base ambulatory basis. concerning health needs and patterns of care in the 0 RMP will encourage and promote the development region will subserve RMP's delineation of program of comprehensive rehabilitation services and the objectives and their priorities. These priorities will be trained personnel needed for them to operate reflected in more selective project support. effectively. An initial attempt has been made to take a 0 RMP will promote efforts at continuity of care broad look at RMP for WNY in relation to some within the region, though coordination of preventive major goals for health care in the region. This outline medicine, diagnosis and treatment, rehabilitation, of major policy directions we have called the "Grand home-care, return visit follow-up, and other critical Design." It is intended as an emerging, flexible stages in the delivery of progressive patient care. response to changing regional needs and project * RMP will assist physicians with information and impact, as a guide to RMP efforts at achieving services of definite and demonstrable value to them in meaningful health care objectives in the RMP for their practice. WNY region. 0 RMP will encourage projects of patient education. RMP for WNY is concerned that primary as 0 RMP will seek to promote area-wide planning and well as specialized service be available to all persons in coordination of health services within the region, to the region. We seek excellence with equity. Overall assist in defining area-wide and community health program goals are to 1) facilitate access, 2) improve service needs, and in each case to identify the most feasible mechanism for solution. RMP for WNY is making the transition to a . RMP will promote projects designed to improve more aggressive role in project formulation. The the management of the health problems of the aged developmental component will allow exploration of in our society. project alternatives without a large or long-term commitment of funds. It could, in fact, be more successful than three-year funding in encouraging projects to think in terms of self-support. Developmental Component The developmental component is envisioned as RMP for WNY has applied for a ne@rv category responding to the immediate need to explore new of funding, initiated nationally to enhance the trend modes of health care delivery. Funds have already towards greater autonomy for each region. A sum been precommitted to a rural health manpower equal to 10% of the RMP for WNY's total annual project ($6,000). A continuing migrant health appropriation can be awarded to the program, as a program, ambulatory care in the region, ambulance developmental component. These monies @vould be service, and a regional disaster plan have been immediately available for short-term projects not to pinpointed as other areas that demand immediate extend beyond the one-year period, under regulation attention. of the local review processes and approval by the Proper use of developmental funds requires Board of Directors of H.O.W.N.Y. considerable pre-planning. It is the conviction of the One use of the developmental component will Coordinator of RMP for WNY that these funds must be to support those studies that can provide baseline be committed within the first three months, thus data for establishment and evaluation of program allowing enough time for planning and priorities. implementation of one-year projects. 23 NEW LEGISLATION SUBJECT PREVIOUS LEGISLATION NEW LEGISLATION P. L. 89-239 P. L. 91-515 Heart disease, cancer, stroke, and related Adds kidney disease, and other related MPHASIS diseases. diseases. r)DITIONAL Emphasis on making available the latest Promotes medical data exchange as well -@.'APHASIS advances in diagnosis and treatment, and as research, training, and demonstrations on cooperative arrangements for research, of patient care. training, and related demonstrations of patient care. Adds prevention and rehabilitation. Gives additional emphasis to regionalization of health care resources and services in order to strengthen and improve primary care and the relationship between primary care and specialized care. Concerned with increasing capacity as well as quality of health manpower and facilities. Directs RMP attention specifically to improvement of services in areaswith limited health services. ,"@t--LATIONSHIPS None specified in law. Requires that the appropriate regional, 0 COMPREHENSIVE metropolitan, or local area-wide i@"7-ALTH PLANNING Comprehensive Health Planning Agency 314(b), have an opportunity to consider operational grant proposals before the RAG may recommend approval. @JNDING Grants, with two-year availability of Adds contract authority as well as RMP ;@CHANISM funds. grant authority and permits regions to obtain services in-kind from federal agencies. One-year availability of funds. '@@GIONAL Composition: Requires official health and health .')VISORY There must be included practicing planning agency representation on such physicians, medical center officials, advisory groups; requires that public hospital administrators, representatives members include persons familiar with from appropriate medical societies, the financing of as well as the need for, voluntary health and other health-related services, and that such public members be agencies, and members of the public sufficient in number to insure adequate familiar with health needs. community orientation. Also includes a representative of the Veterans Administration as an ex officio member, if there is a VA institution in the region. Figure 8. New Legislation nA Program Operation 25 Finances Financial Management Financial Statement: Under the concept of level funding developed by the Regional Medical Programs Service about a March 1, 1970 - February 28, 1971 year and one-half ago, the Regional Medical Program For the year March 1, 1970 - February 28, for Western New York can anticipate no increase in 1971, the Regional Medical Program for Western Ne@,i funds. At present new projects can be financed only York was awarded $1,962,097, including carryover by making existing ones self-supporting or by phasing funds. out those that have achieved their purpose. Thus the From this total, the following projects were effectiveness of projects must be reviewed and budgeted: expenditures examined in relation to the program as a whole. It is the responsibility of the H.O.W.N.Y. Board to pass upon recommended transfers or to Core Program $569,884 initiate transfers of funds from one approved project Telephone Lecture Network 202,207 to another, in such a way as to best attain the goals of Coronary Care Training Program 191,041 the Regional Medical Program for Western New York. Chronic Respiratory Disease Program 743,tp,4D Proposal Review Process Immunofluorescent Service The author of a project idea or proposal may and Training Program 45,994 approach RMP via the county committees, Dr. John Tumor Registry 70,760 R.F. Ingall, or liaison staff. Alternatively, RMP may Topical Chemotherapy Treatment for invite the development of a proposal to redress a Precancerous Lesions and Cancer recognized deficit in the region. The entire core staff of the Skin 59,830 reviews the proposal to advise what is allowed under Information Dissemination Service 40,246 the new legislation and how well the proposal might Continuing Education 38,190 fit into priorities established by the Regional Advisory Group. A staff member then assists the $1,962,097 author in developing the letter of intent, a one-page lay summary which represents an understanding between staff and author of the intent of the proposal. Staff members continue to assist the author as he further develops and organizes his proposal, and The following were financed from Core funds or sees it through the RMP for WNY review process. re-distribution of project funds: The proposal begins its review process in the Hematology Center, Blood Coagulation county committees. The author must be prepared to Reference Laboratory $27,700 appear before the county committees to further their Community Health Information Profile understanding of his proposal. After a thirty-day Data System 58'667 aging process, county committee recommendations Ambulatory Care Services Study 15, 0 are forwarded to the Proposals Committee. Buffalo Summer Student Program 20,800 The Proposals Committee has become a very strong body representing the region at large, with liberal co-option of experts in areas under discussion. It benefits from the expertise of a number of outside Figure 9. Financial Statement: agencies as well as the independent review of the New March 1, 1970 - February 28, 1971 York State Health Department. Following the 26 suggestions of a federal site-visit team, RMP for WNY telephone to expand existing continuing education plans to bring in even more outside consultants to the programs at the Health Sciences Center, State Proposals Committee. These experts will be available University of New York at Buffalo. Fifteen to help the county committees in their deliberations. representative hospitals of the region were involved. Criteria for proposal evaluation include Twenty-six lectures were presented, seventeen for relevance to RMP, relation to a documented need in physicians and nine for nurses. the region, technical competence of the region to A telephone network appeared to be the most fulfill the proposal, lack of duplication, contribution suitable means of communication for the compressed to improvement of patient care, presence of an geographic area served by the RMP for WNY. The evaluation component, comparability with existing most distant location is approximately one hundred health-care patterns, promotion of regional miles from Buffalo, New York. cooperation, and possibility of becoming The Telephone Lecture Network, a dedicated* self-supporting. The proposal must be submitted in a network, became operational on September 17, 1968. forf,n that is amenable to federal review. Thirty-six hospitals were interconnected to participate in hour-long continuing education The Proposal Committee has revie@ved thirteen programs. proposals this year. Of these, six have been approved At the present time the network interconnects and recommended for new funds. Recommendations sixty locations in eight Western New York counties of the Proposals Committee are submitted to the and three Northwestern Pennsylvania counties. Each Board of Directors of H.O.W.N.Y. for final RMP for receiving location is provided with a loudspeaker and @VNY approval. a telephone handset. The loudspeaker amplifies the incoming program and the handset permits the listening audience to comment on the program or ask a question of the lecturer. Programs normally originate from studio facilities located in the Regional Medical Program for Western New York offices at 2929 Main Street, Operational Projects Buffalo, New York. However, programs can and do Our mission is to engineer change. The RMP for originate from locations on the network. Lectures can WNY is an "enabler," an organization that helps also be conferenced via a long distance telephone initiate projects and encourage cooperative connection. arrangements which will improve the delivery of Each lecture is accompanied by visual aids in health care in our region. Although certain categories the form of 35 mm slides and/or handout materials. of disease (heart disease, cancer, stroke, kidney Since the start of the Telephone Lecture Network, disease, and related diseases) are emphasized, we have over three hundred specially designed programs for always considered individual projects as part of our professional and technical personnel in health related total program. Inter-relation between projects and the fields have been presented by leading teachers and kinds of cooperative, regional arrangements which practitioners. they foster have been primary considerations. The network is currently involved in three Increasingly we stress our overall goals: to 1) types of educational programs: facilitate access, 2) improve quality, and 3) decrease 1. continuing education of health profes- cost of health services to all persons in our region. sionals 2. courses for academic credit 1. Funded and On-Going 3. patient, family, and community education. Component No. 1 - Telephone Lecture Network A number of our projects are now dependent The Telephone Lecture Network (TLN) is the on the TLN. Core staff and various committees have voice of the RMP for WNY program. The unique come to rely on it for surveys, meetings, and regional feature of the network is that it allows two-way conferences. The Telephone Lecture Network is the communication--what is said at one point is heard at communication mechanism that has underscored the all points. regional nature of the RMP for WNY. A Pilot study was conducted in the spring of 1968 to determine the feasibility of using the *Closed circuit audio network available 24 hours a day. 27 PROPOSAL REVIE@V PROCESS A AUTIOR WNY-RMP B Headquarters F- c County Committees D Proposals Committee As in the past, proposals vvill be considered in order of of H.O.W.N.Y. submission from steps A through E. However, effective November 1, 1970, proposals are processed as a group from steps F through H, once a year. E Board of Directors of H.O.W.N.Y. I F At State University of New York at Buffalo: Dean of School of Medicine, Provost of Health Sciences, Vice President for Research G Research Foundation of State University of New York at Albany I H Washington: Division of Regional Medical Programs, U.S. Department of Health, Education and Welfare Figure 10. Proposal Review Process 28 Component No. 2 Tuberculosis and Respiratory Disease Association of Coronary Care Training Program Western New York all cooperate in various facets of NURSES the project. The program seeks to develop skilled Sixteen thousand people were screened this approaches to patient and family care through the year at a cost of $40,000 or $3.00 per screening. synthesis of medical and nursing knowledge. The Hospital personnel are being trained in a general Coronary Care Training Program for nurses has been intensive care unit pending establishment of a model operational since March 1968. From March 1968 seven-bed pulmonary unit. The fully-equipped through December 1970, two hundred and sixty-one hospital pulmonary function laboratory trains registered nurses have completed the six week course students, physicians, and nurses of the entire area. on intensive care of patients with acute cardiac Outpatient service has stressed home inhalation problems. The basic format encompasses three weeks therapy. A home care program and an emphysema of classroom instruction and three weeks of clinical club were started in 1970. application of nursing principles and practical skills Education is a vital part of the project. An taught in Buffalo area hospitals. associate degree program in inhalation therapy has Objectives for 1970 were: been developed at Erie Community College. Six 1. Evaluation of the curriculum and the prac- different multi-disciplinary teaching days held in ticum outlying hospitals have attracted a total of 922 nurses 2. Increase in the number of courses presented and allied health personnel. Twenty-three of the yearly twenty-four nurses who participated in an intensive 3. Admittance of Canadian nurses to the teach- four-week course in pulmonary disease are working in ing programs in late 1969 and in 1970. the field. Forty additional nurses will complete the Goals include offering advanced programs in course by March 1, 1971. The program's scope has cardiac nursing care for registered nurses who have been enlarged to encompass preventive care and completed the basic courses of instruction. rehabilitation. A major accomplishment was the post-graduate PHYSICIANS course in emphysema, offered for physicians. Over Three separate programs in "Modern Concepts 200 physicians attended this year; a similar program in Coronary Care" were offered to physicians during will be offered again next year. TLN programs and 1969-70. Each program was greatly over-subscribed; support of two pulmonary fellows this past year and the third presentation was the result of requests and four fellows next year are also included in the over-subscription. A total of about 200 physicians continuing education program for physicians. and some medical students and nurses attended the Training programs, consultation, and regional presentations last year. At least 300 physicians have teaching days held under the aegis of this project been trained since the project's inception. provide a long-needed service and have contributed to improving the region's approach to respiratory The status of the extremely popular Coronary disease. Care Training Program is currently under discussion; it may become the first self-supporting project of the Component No. 4 RMP for WNY. lmmunofluorescent Service and Training Program Between three and six percent of all hospital patients within our region suffer from diseases for Component No. 3 which either the only, or the best, laboratory Chronic Respiratory Disease Program diagnostic tests entail FA (fluorescent antibody) Fully funded in July 1969, this many-faceted, analyses for tissue antibodies. One of the important comprehensive project has experienced rapid FA tests, the ANF (antinuclear factor is being development in the past year. Five physicians serve requested about twenty times per week per 1000 on the guiding committee, representing the five hospital beds. participating hospitals. The Erie County Health The project was first funded in June 1969. In Department (especially the Visiting Nurses), Erie addition to providing a regional laboratory service, Community College, the health-related departments project staff have been involved in teaching activities. of the State University, and the voluntary The education of physicians as to the diagnostic 29 utility of the project continues, as does the training extensive modifications of the original proposal prior of laboratory technicians from throughout the region to implementation. The registry is expected to be in procedures involving immunofluorescence. One functioning fully by the end of February 1971, and hundred persons were instructed in the use of self-supporting by February 1972. Twenty to immunofluorescent tests for tissue antibodies; ten twenty-five hospitals and 6,000 new cases are hospital technologists received individual bedside expected to be handled in the next year. The project instruction; two teaching programs for pathologists has regional hospital support and the assistance of the were presented, one at Pathology Society meetings Management Engineering Program of the Western and one over the Telephone Lecture Network; seven New York Hospital Association. pathologists and/or laboratory directors received personal conferences on specialized problems; 2. Approved but Unfunded by RMPS thirty-seven practicing physicians participated in (Locally supported for one year through carryover or clinical pathologic conferences. rebudgeted funds) Consultation with the laboratory staff is increasing as the program becomes better known. Component No. 13 Cooperative relationships are now starting to yield Topical Chemotherapy Treatment geographic coverage for tissue immunofluorescent for Precancerous Lesions and Cancer of the Skin test services and training. Direct service by the central reference laboratory is provided, as well as Each year in the United States four thousand cooperation with interested regional hospital people die from skin cancer. There is an annual laboratories in improving their own performance. incidence of 1 00,000 new cases of skin cancer and at least five to ten million cases of pre-malignant Component No. 5 - Tumor Registry karatoses. This project is seen as a major catalyst to Topical anti-cancer agents, which are about regionalization and a means of improving the quality 90% effective for treatment of pre-malignant of patient care. The overall objective of the Regional karatoses and 80% effective for superficial skin Tumor Registry is to improve cancer control in the cancers, have been developed at Roswell Park nine counties which are presently serviced by the Memorial Institute in Buffalo. Topical chemotherapy Regional Medical Program for Western New York. is diagnostic as well as therapeutic; it picks up the The objective will be accomplished by: very early lesions that are not yet recognizable 1. Promoting improved patient care through clinically. Replacing a laborous surgical procedure, regular, periodic follow-up application of cream containing an anti-cancer drug, 2. Assisting physicians in determining the topical 5-Fluorouracil, and cures skin lesions in four efficacy of treatment modalities weeks or less. 3. Providing a valuable resource for continuing Since this simple procedure is readily usable by cancer education. the community physician, the RMP for WNY is The Registry has accessioned approximately supporting a project funded as of March 1, 1970 to 300 patients. With this minimal case load it has disseminate the method and materials on a large scale already become apparent that the Registry will serve throughout our area, and through analysis of data as a valuable tool in determining areas where received, to develop this region as a model in skin continuous physician and allied health education is cancer treatment for the entire nation. needed. Review of these cases indicates the wide The project is to be developed in three phases: range of quality of medical care presently being given 1. The Buffalo-Rochester Dermatologic to cancer patients. The input to date is inadequate to Society has formed a "Liaison Committee" arrive at any meaningful statistics and the time lapse of six members. has been insufficient to warrant patient follow-up. 2. Liaison Directors are now being oriented to Completion of the Registry Abstract Form by link regional physicians with the Buffalo personnel in the participating hospitals has resulted in center. a general upgrading of the hospital charts of cancer 3. Although topical therapy as a treatment patients. method was to be deferred until the The project was compromised in its initial completion of phases one and two, a phase by constraints on funds and the need for number of physicians in various parts of the 30 region who already have specialized training Component No. 16 - Hematology Center, Blood with topical chemotherapy have requested Coagulation Reference Laboratory the materials and offered to provide the This project was started with partial funding on information required for evaluation. This September 1, 1970. A laboratory has been organized initial approach will be useful as a pilot which is capable of diagnosing all--including the project for providing information to guide rare--hemorrhagic and thromboembolic problems on a the more general implementation of phase twenty-four hour day basis. Between September 1 three. and December 29, diagnostic work-ups have been Implementation of the initially proposed plan is performed for 1 1 1 patients. In September, for proceeding more rapidly than envisaged, largely due example, a total of 662 blood coagulation studies to the interest and support of the physicians in the were carried out for the thirty-two patients referred RMP for WNY region. to the center. Two nurses care for patients who come to the Center and handle follow-up procedures. Physicians associated with the Center were available for consultation on hemorrhagic and thromboembolic problems twenty-four hours a day in person or through the telephone, and have participated in forty consultations during the past months. Research projects initiated in the Center include: Component No. 14 1 .Development of diagnostic methods to dif- Information Dissemination Service ferentiate between disseminated intra- This project was approved and funded for the vascular coagulation, fibrinolytic hemor- period of March 1, 1970 through February 28, 197 1. rhage, and combinations thereof The objective is to establish in the RMP for WNY area 2. Study of changes in the blood coagulation, an information dissemination service to provide fibrinolysin and kinin systems during attacks physicians and allied health professionals with printed of hereditary angioneurotic edema information from a broad spectrum of medical and 3. Development of diagnostic methods to pre- scientific journals and books, and to alert them to dict susceptibility in women to hyper- new developments in their field of interest through a coagulable states induced by oral contra- current awareness service. The existing Telephone ceptive agents Lecture Network is the communication link used to 4. Development of improved methods for the receive requests. The Health Sciences Library at the purification of human fibrinogen as a State University of New York at Buffalo is designated reagent for diagnostic tests to determine as the resource medical library. High speed members of the fibrinolysin system. duplicating machines provide copies of journal The Center trains both technicians and articles, which are sent by mail on request. Material physicians. Inexperienced technicians work several not available at the Health Sciences Library is secured weeks to months in the laboratory, being trained by through referral to other libraries. Although mailing the staff and involved in all laboratory activities. In of journal articles answers the bulk of requests, a addition, a one-week advanced refresher course will bibliographic service utilizing the facilities of the be presented in March 1971. SUNYAB Biomedical Communications Network is Physician training includes support of one also available. hematology fellow in the laboratory who cares for Seven thousand requests per year were patients and gives consultations in other hospitals. A originally envisioned. The project director's policy of postgraduate course for physicians will be given this personally visiting all institutions linked to the TLN, spring. Two film strips, Hemorrhagic Disease One and to acquaint them with services and means of Two, have been prepared. operation, has resulted in 5,000 requests for Reference standards and reagents not informational material in the period between June commercially available have been prepared for Center and November. Requests from nurses and allied use. The Center hopes to be able to provide these health personnel, as well as physicians, testify that standards and reagents free of charge to other the service is reaching the entire spectrum of medical hospitals and laboratories in the region. personnel. The deluge of requests indicates that the The Blood Coagulation Reference Laboratory Information Dissemination Service is meeting a serves as a continual contact and reference center for previous deficit in the community. the entire region. 31 OPERATIONAL PROJECTS TELEPHONE LECTURE NETWORK CORONA R Y CA RE TRA INING PI?OGRA M CHRONIC RESPIRA TOR Y DISEASE PROGRA M IMMUNOFL UORESCENT SEI? VICE TUMOR REGISTRY TOPICAL CHEMOTHERAPY INFORMA TION DISSEMINA TION SER VICE HEMOTOLOGYCENTER 32 STATUS OF PROPOSALS Sui)iyiitted Proposal No. Staf f H.O.W.N.Y. for Federal Title Author Work-up Review Review Amount Period No. 33 Cooperative Kidney and Dialysis Complete Approved Tentatively Approved Reduced to $250,000 3 years Dialysis Program Committee: -unfunded for the (Direct Costs) for W. Staubitz, M.D. first year initial budget period. S. Anthone, M.D. Amount of funding R. Anthone, M. D. not specified for J. Lasher, M.D. remaining two years. J. Hodson, M.D. J. Gerbasi, M.D. G. Murphy, M.D. et al No. 46 w Prevention and C. ArTibrus, M.D. Complete Approved Sel)teinl)er 1970 $388,534 3 years Treatment of the Respiratory Distress Syndrome Due to Hyaline Membrane Disease in Infants No. 47 A Model Program for E. Haynes, M.D. Complete Approved September 1970 $588,677 3 years Comprehensive Family Family Health No. 48 Computer-Based E. Gabrieli, M.D. Complete Approved November 1970 $437,017 2 years Area-Wide Health Data System No. 49 Demonstration C. Bishop, M.D. Complete Returned to Not applicable $206,234 3 years Laboratory author for Computer System major revision No. 50 Comprehensive E. Wagner, M.D. Complete Approved November 1970 $750,099 3 years Continuing Care E. Noble, M.D. for Chronic Illness No. 51 Health Planning and H. Patton Resources Complete Returned to Not applicable $906,193 Development author for 3 years major revision Choriocarcinoma and M. Hreshchyshyn, M.D. Complete Related Trophoblastic Approved November 1970 $210,758 Disease 3 years Screening of R. Moesch, M.D. Complete Returned to Not applicable $467,719 Indigent Hospital Dependent Women author for 3 years for Cervical Carcinoma major revision A Regional Bone E. Mindelf, M.D. Complete Approved November 1970 $205,317 3 years Pathology Laboratory Endoscopic L. Berman, M.D. Complete Returned to Not applicable $95,954 Techniques for the Diagnosis of author for 1 year Esophageal and major revision Gastric Diseases Hospital Based N. Courey, M.D. Complete Returned to Not applicable $657,429 Comprehensive Care Clinic for Women author for 3 years major revision Mobile Health Clinic V. Barker, R.N. Complete Returned to Not applicable $164,638 3 years for Allegany County author for mall Commu major revision Hospital Becot Regional Comprehen. 3 years sive Health Center: (Wyoming County) Allent Comm In Progress Pending Not applicable Center $150,000 3 years F: igur(, II Status of Proposals The Regional Medical Program for Western New York gratefully acknowledges the support of the Division of Regional Medical Programs Service, Health Services and Mental Health Administration, U. S. Department of Health, Education and Welfare. The findings and conclusions in this publication do not necessarily represent the views of the sponsoring agencies. 35