* 00 4 * ALABAMA REGIONAL MEDICAL PROGRAM INSTITUTIONAL SELF STUDY PROGRAM 1965-1973 Prepared by Frank 0. Hinckley, Associate Director Evaluation, Alabama Regional Medical Program February 1, 1973 TABLE OF CONTENTS METHODOLOGY AND ACKNOWLEDGEMENTS . . . . . . . . . . . . . LIST OF ILLUSTRATIONS . . . . . . . . . . . . . . . . . . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . RECOMMENDATIONS OF THE EXECUTIVE DIRECTOR . . . . . . . . 2 COMMENTS OF THE EXECUTIVE DIRECTOR . . . . . . . . . . . . 3 Program Objectives . . . . . . . . . . . . . . . . . 3 The Grantee Institution . . . . . . . . . 3 Legal Basis and Operational Concept of the Alabama Regional Medical Program . . . . . . . . . 6 Regionalization . . . . . . . . . . . . . . . . . . . 8 Historical Development of the Alabama Program Prior to Receipt of Planning Grant . . . . . . . . 9 The Regional Advisory Council . . . . . . . . . . . .13 THE ALABAMA REGIONAL MEDICAL PROGRAM . . . . . . . . . . .22 Early Efforts at Regionalization . . . . . . . . . .22 Program Staff Activities . . . . . . . . . . . . . .24 Current Approved and Proposed Program Activities 28 Cooperative Relationships With Other Organizations . . . . . . . . . . . . . . . . . . .30 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . .52 APPENDIX I. . . . . . . . . . . . . . . . . . . . . . . .54 APPENDIX II . . . . . . . . . . . . . . . . . . . . . . .55 APPENDIX III . . ... . . . . . . . . . . . . . . . . . . .60 STATISTICAL INFORMATION . . . . . . . . . . . . . . . . .62 BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . .77 TABLE OF CONTENTS METHODOLOGY AND ACKNOWLEDGEMENTS . . . . . . . . . . . . . LIST OF ILLUSTRATIONS . . . . . . . . . . . . . . . . . . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . (7,9,10,11)*RECOMMENDATIONS OF THE EXECUTIVE DIRECTOR . . . . . . . .2 COMMENTS OF THE EXECUTIVE DIRECTOR . . . . . . . . . . . .3 (1)Program Objectives . . . . . . . . . . . . . . . . .3 (2,B)The Grantee Institution . . . . . . . . . . . . . . .3 (2)Legal Basis and Operational Concept of the 6 Alabama Regional-Medical Program . . . . . . . . . Regionalization . . . . . . . . . . . . . . . . . . .8 (2)Historical Development of the Alabama Program Prior to Receipt of Planning Grant . . . . . . . .9 The Regional Advisory Council . . . . . . . . . . . .13 THE ALABAMA REGIONAL MEDICAL PROGRAM . . . . . . . . . . .22 Early Efforts at Regionalization . . . . . . . . . .22 (4,5)P rogram Staff Activities . . . . . . . . . . . . . .. 24 (3)Current,Approved-a.nd-Pr.oposed-Program Activities . . . . . . ... . . . . . . . . . . ... 28 (8)-Cooperative Relationships With Other organizations . . . . . . . . . . . . . . . . . . .30 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . .52 APPENDIX I . . . . . ... . . . . . . . . . . . . . . . . .54 CA.PPENDIX II . . . . . . . . . . . . . . . . . . . . . . .55 APPENDIX III . . . . . . . . . . . . . . . . . . . . . . .60 STATISTICAL INFORMATION . . ... . . . . . . . . . . . . .62 BIBLIOGRAPHY . . . . . . . . . I. . . . . . . . . . . . . .77 *Arabic numerals in left hand column refer to report items listed in memorandum from Director, Institutional Study Program dated August 18, 1972. METHODOLOGY AND ACKNOWLEDGEMENTS The primary source for this report was the Alabama Regional Medical Program files, including memoranda, corre- spondence, minutes, pertinent legislation and guidelines. The report was prepared and written by Mr. Frank 0. Hinckley, Associate Director for Evaluation, under the direction of John M. Packard, M.D., Executive Director of the Alabama Regional Medical Program, with the cooperation and contri- bution of other staff members including Mr. M. D. Plowden, Deputy Director; Dr. Laurene Gilmore, Associate Director, Manpower Development; Mr. Samuel R. Hernandez, Associate Director, Program Planning and Development; Mr. James L. Robertson, Associate Director, Program Management and Communications; and Dr. Charles M. Van Duyne, Associate Director, Health Care Services. Mr. John Kasberg, Evalua- tion Specialist, developed and prepared the illustrations. LIST OF ILLUSTRATIONS Figure 1--Per Cent of Actual RAC Membership by Group . . .15 Figure 2--ARMP Consultation Patterns 1972 . . . . . . . .26 Figure 3--ARMP Projects in the Health Planning Areas of Alabama . . . . . . . . . . . . . . . . . . .29 Figure 4--Key to Objectives for ARMP Projects . . . . . .31 Figure 5--ARMP Cooperative Relationships With Other Cities in 1972 . . . . . . . . . . . . . . . . .37 INTRODUCTION This report of the activities of the Alabama Regional Medical Program is part of an Institutional Study Program being conducted by the University of Alabama in Birmingham in preparation for an accreditation visit by the Southern Association of Colleges and Schools to be made in October 1973. It has resulted in a uniqpe opportunity for the management and staff of the Alabama Regional Medical Program to review its progress in relation to a number of factors: The original and extension Regional Medical Pro- gram legislation and guidelines. The change in national priorities, expecially the switch in program emphasis from categorical diseases to improved delivery systems dictated by the budget message for FY 71. The health care needs of the State of Alabama as perceived by the Program's governing body, the Regional Advisory Council The effectivene8s-of--Program activities.-@, The impact of currently funded project activities. A consideration of the cooperative relationships with other organizations. Recommendations of the Executive Director 1. No changes are felt necessary in the goal or objectives of ARMP. The Regional Advisory Council reviews and updates these at intervals. Current efforts to establish short term measurable;sub-objectives should be continued. 2. Ideally, a clearer set of measurable objectives should be established at the national level and used for evaluation. 3. The Program wQuld be easier to manage were it possible to have assured funding for intervals longer than one year. 4. "Earmarked" funds bhould be eliminated nationally. They are often disruptive of ongoing activities during the preparation of the request and in their administration if awarded. occasionally the earmarked funds relate to national goals which have low priority in Alabama and have proved to be a hindrance to overall goals. 5. If health revenue sharing should become a reality, the Regional Advisory Council would be a natural mechanism for setting priorities and allocating funds, since it has had three years experience in this. 6. It is impractical to provide the requested outline of specific plans and directions for the future of ARMP over the next ten years in view of the Administration's plan to phase out Regional Medical Programs. This intention fudy be reversed by Congress prior to June 30, 1973. 2 7. Present relationships of ARMP to UAB are spelled out in the section on Grantee Institutions. With a second state medical school now operational at Mobile, and medical education activities underway at Tuscaloosa and Huntsville it is recommended that consideration again be given to estab- lishing a non-profit corporation to be the grantee institution. Comments of the Executive Director Program Objectives The goal of the Alabama Regional Medical Program relates mainly to service: to improve the health of the citizens of Alabama. Program objectives relating directly to this goal are: To facilitate the delivery of health services so that (ideally) high quality medical services are available to, and utilized by, everyone in the Region. To support the provision of education (as deter- mined by delivery needs) that will increase the appropriate utilization, distribution, and num- ber of health manpower throughout Alabama. To encourage the prompt and effective incorporation of new knowledge and technology into the health care community. To promote health educational programs conducted by responsible agencies and organizations for the general public. To improve exchange of health care and health education information both among and between providers, consumers and government at all levels. The Grantee Institution Under RMPS guidelines the UAB, as grantee institution, is responsible for the fiscal and administrative integrity of the Program. In this regard, UAB is concerned with: The initial selection of RAC membership, its 3 chairman, and the ARMP chief executive officer. Starting in 1973, it will also appoint the RAC chairman following RAC nomination. The appointment of a Program staff upon nomina- tion by the chief executive'officer, and in accordance with UAB personnel policies. Receiving, administering and accounting for funds. It reviews the operations and activi- ties in light of their eligibility for funding in conformance with RMPS and federal funding requirements. It also assures that programs and projects are in conformity to state and UAB policies and directives. It assesses the affiliate's capabilities to manage funds. It also prescribes fiscal and administrative pro- cedures to safeguard the grantee against audit liabilities. Establishing indirect cost rates. The grantee institution negotiates indirect cost rates with the affiliate and provides those supportive services included in the grantee indirect cost rate.1 Because the UAB is the principal health science center in Alabama, it has served as a valuable resource in further- ing the goals and objectives established by the Regional Advisory Council, which sets policy for ARMP. Many hours of-- faculty and administrative staff time have been devoted to meetings of RAC and its committees and with innumerable pro- jects and studies. Much of this consultation is not reim- bursable as with direct or indirect costs. The ARMP has likewise made significant contributions to the UAB, especially in facilitating new educational pro- grams and in supporting a wide variety of outreach programs. Notable among the new educational programs are the development of the Regional Technical Institute with its 18 affiliated state junior colleges, and the impetus given to the surgeon's and physician's assistants programs. ARMP also 4 assisted in the adoption of the Problem Oriented Medical Record in the University and V.A. hospitals. Ongoing educational programs have benefited by the presence of faculty recruited by ARMP, expecially Drs. J. 0. Finney, Harold Schnaper and John M. Packard in the Department of Medicine and J. J. Mason, M.-@LD. Plowden and S. R. Hernandez in SCAHR. Cardiopulmonary resuscitation courses have been taught to second year students and incoming house staff using ARMP staff, equipment and audiovisual aids. ARMP audiovisual C.P.R. aids have been provided for a self-teaching room in University Hospital and in the School of Nursing. ARMP has supported continuing education programs in the Schools of Medicine, Nursing and Optometry through direct salary support, staff assistance and equipment, and by under- writing certain travel and consultant expenses. The medical student elective and house staff training program at Montgomery was initiated and has been partially supported by ARMP. The most notable among the outreach programs has been the Medical Information Service by Telephone (MIST), which has handled over 41,000 calls in its first three and a half years. The voluntary services donated by the faculty, plus the hardware, telephone lines and operating personnel provided by ARMP, VA and ARC have combined to produce a widely used and appreciated service to the health professionals in the state. In addition, ARMP has staffed and the Executive Director has chaired,the UAB Council of Community Health Services. The Executive Director also serves as Associate Dean for Community Health Affairs in the School of Medicine, providing an additional avenue for outreach. 5 A developing outreach program is the Radiation Dosimetry project which has extended the resources of the Radiation Therapy Department to a number of the larger cities in the state. The SAMA Clinic and the Central City Outreach Clinic of the School of Nursing have also received a small amount of support from ARMP. Finally, it should be mentioned that UAB has received over the past six years $553,763 in faculty salary support (exclusive of funded projects) and $868,714 in indirect cost payments for a total of $1,422,477. Legal Basis and Operational Concept of the Alabama Regional Medical Program Pertinent Legislation and Guidelines Recognizing a historical thrust toward regionalization of health resources, and the need to put into practical use knowledge produced by the large and productive national bio- medical research community, the Congress amended Title IX of the Public Health Service Act to authorize the establishment and maintenance of Regional Medical Programs. Public Law 89-239 was signed by the President on October 6, 1965.2 The Public Health Service Act amendment provided a vehicle to combat heart disease, cancer, stroke, and related diseases. The original Regional Medical Program Guidelines stated RMP was to be a cooperative arrangement among a group of public or nonprofit institutions or agencies engaged in research, training, diagnosis, and treatment relating to heart disease, cancer, or stroke. Regional cooperative arrangements among 6 medical schools, research institutions and hospitals were to be encouraged and assisted through federal grants in order to disseminate the latest advances in the diagnosis and treatment of these diseases to the medical profession and medical institutions in the nation. These arrangements were to improve generally the health, manpower, and facilities available without interfering with the established structure of health care financing, patient care, professional practice, or administration of hospitals.3 On October 30, 1970, the Congress extended the Regional Medical Programs.* In addition to increasing the amount of appropriations authorized, the-Congress expanded the role of RMP beyond concern.with categorical disease. The Act required promotion and fostering of regional linkages among health care institutions and providers as another means to improve the quality and enhance the capacity of the nation's health manpower and facilities.4 To facilitate interregional cooperation and develop, improved national capability for delivery of health services, the Secretary was authorized to use funds for programs, services, and activities involving two or more Regional Medical Programs in development or demonstration of methods for con- trol of categorical diseases, collection and study of epide- miologic data related to categorical diseases; and development of training specifically related to diagnosis, treatment and rehabilitation. This portion of the law has not been used to *As--6f February 1, 1973, there has been no further extension legislation. The present extension legislation, Public Law 91-515, expires June 30, 1973. 7 fund. Authorization was also provided for continuing programs where shortage of trained personnel would otherwise limit application of knowledge and skills important to the control of such diseases, as well as conducting cooperative clinical 5 field trials. An important section in the original law which directed categorization of hospitals as to quality of facilities to care for patients with categorical diseases was carried for- ward to the new law. Little action was taken-under this provision until -when the,jpint-commission _:September-1.97@,- on accreditation of hospitals started a survey. Regionalization The Regional Medical Program's goal to improve patient care is to be achieved through regional cooperative arrange- ments. These "arrangements" are better known as regionali- zation. In guidelines published by the Health Services and Mental Health Administration for Regional Medical Programs, regionalization was described as a continuous process rather 6 than a plan which is totally developed and then implemented. Regionalization as a cooperative arrangement has the following characteristics: it is both functional and geo- graphic; it provides a means for sharing limited health man- power and facilities; and it constitutes a mechanism for coordinating categorical programs with other health programs in the region.7 As a process, regionalization consists of the following elements: Involvement and commitment of individuals, organi- zations and institutions within,-.-,aigeograp@i6---@area- (region); 8 Identification of needs and opportunities regard- ing categorical diseases within a region; Assessment of resources in terms of function, size, number and quality; Definition of objectives to meet identified opera- tional needs and opportunities; Setting of priorities consistent with limited man- power, facilities, financing and other resources; Implementation of program objectives following from the base and imperative for action provided in the preceding steps; Evaluation which should provide for a continuous, quantitative and qualitative consideration of each planning and operation activity of the region as well as the overall regional program.8 As will be noted below under a discussion of the Regional Advisory Council, the Alabama Regional Medical Pro- gram was early concerned with an effective mechanism for achieving regional cooperative arrangements. It provided for health planning regions and funded health planners for each. Health planners are active in the following areas: Birmingham, Mobile, Gadsden-Anniston, Tuscaloosa, Montgomery, and Dothan. cooperative arrangements remain to be established in the Selma and Tennessee Valley areas. This arrangement is known as area-wide regionalization and provides the broadest base through which regional cooperation can be obtained. Historical Development of the Alabama Program- Prior to Receipt of Planning Grant Interest in a Regional Medical Program for Alabama developed early. In fact, it preceded passage of the law in October 1965. In June of 1965, in response to a request by the American Medical Association, the Medical Association o The State of Alabama appointed a special committee to make 9 recommendations concerning the Regional Medical Program as exemplified by Senate Bill No. S596. This distinguished committee was chaired by Dr. Tinsley R. Harrison. Other members were Drs. J. Garber Galbraith, Julius Michaelson, William Atkinson, Howard Walker, T. Joseph Reeves, and James G. McDonald, ex officio (President, Medical Association of the State of Alabama). Drs. Harrison, Galbraith and Reeves were full time at the Medical Center of the University of Alabama and the rest were physicians in active practice. In one meeting on August 16, 1965, the Committee agreed that there was a need in the state for improvement in teaching, research and patient care, not only in the field of heart diesase, cancer and stroke, but in the broad field of medicine. In this respect, they anticipated developments that were to occur much later in RMP history. The Committee expressed grave doubt that the proposed legislation was a reasonable and adequate mechanism by which existing deficiencies could be met. The Committee was concerned about a proposed regional distribution of federal funds. It proposed that a more logi- cal distribution would be along the lines of existing state boundaries.9 The Committee had a fundamental proposal which it felt was a major departure from the existing philosophy for admini- stration and distribution of federal monies as follows: Specifically, it is proposed that a more logical, workable, less wasteful mechanism could be devised by which a separate grant proposal is made by each state designed to meet its own peculiar and unique needs in the areas of health research, teaching and patient care .... This precise mechanism by which 10 each state would derive its requirements would be a function of the individual state. In the State of Alabama, and perhaps in all, it is proposed that a State Commission comprised of membership from the state medical college or colleges of that state, representatives of the active medical profession of that state, state public health officers and medical associations be formed.10 The Committee felt that the national policies should be broad, aimed at implementing the intent of Congress; that the discrete policies and decisions would be determined by the individual state.11 Public Law 89-239, as signed by President Johnson in 1965, reflected the wisdom and concern of the Committee. The Act provided sufficient latitude for definition of a geographic area as a state, and for each geographic area to make its own grant proposal. This mechanism was instituted for the RMP's in 1970, when the National Advisory Council delegated final approval for individual projects to the Regional Advisory Groups of "mature" RMP'S. The allocation of funds at the local level by a regional advisory group is different in operation from a proposed state commission, but essentially the same in concept. Local allocation of the funds is the key. During 1966, a Regional Advisory Committee for Heart, Stroke and Cancer was formed through the joint efforts of the University of Alabama School of Medicine, the Medical Association of the State of Alabama, and Governor George C. Wallace. This Committee was charged with advising the Univer- sity of Alabama School of Medicine in relation to the develop- ment of a regional program under the provisions of Public 11 Law 89-239.*1.2 The Committee held three critical meetings during 1966. As its first meeting on April 9, 1966, it agreed on the following general principles: Consistent with the legal guidelines the State of Alabama was defined as a geographic unit represent- ing cohesiveness in patterns of referrals of patients and professional interaction among a medical center, a research and training facility, and a network of cooperative hospitals and agencies concerned with the categorical diseases. The intent of the le-gis- lation was interpreted as an opportunity for coopera- tive arrangements to make available to the patients of physicians the latest advances in diagnosis and treatment of categorical diseases. Other aspects of the legislation would provide a more uniform standard of excellence of patient care. Education was recognized as the predominant characteristic of the Regional Programs. Finally, the Committee recom- mended that the University of Alabama be requested to prepare a grant application for planning regional research centers.** It was unanimously agreed that the University's Medical Center was the logical insti- tution to be designated as a responsible agent for plannin 13 g. At the second meeting of the Committee, on May 26, 1966, the opportunities and dangers presented in the development of a Regional Medical Program were discussed at length. Although the Committee report is silent on the nature of the these dangers,it was decided to expand the Committee by the appoint- ment of three additional laymen, to be nominated by the President of the Medical Association and appointed by Governor Wallace. The Governor indicated subsequent to this meeting that he believed his role was that of initiation of the Committee without further responsibility for its action or its continuity.14 * See Appendix I for membership of this committee. **Research centers were authorized in the Senate bill, but not in the final law. Unfortunately, discussion of the Senate bill raised expectations.-. 12 The third meeting was held on September 13, 1966. Three additional lay members were appointed to the Committee. They were Mr. Earl M. McGowin, Mr. James H. Crow, Jr. and Mr. Winton M. Blount. During this meeting the Committee also adopted policies regarding the Advisory Committee for Regional Programs which were, in effect, by-laws for its efficient operation. Recognizing the need to expand the Committee by making it more broadly representative of the region, the Committee recommended to the University the appointment of six additional members as follows: Dr. Julian Giles; Dr. Lucius H. Pitts; Dr. Harold T. Dodge; Dr. S. Richardson Hill; Dr. Herschel Hamilton; and Dr. Charles A. McCallum.15 On December 21, 1966, Senator Lister Hill announced that a grant award had been made for the first year, and there would be a two and a half year program to support planning activities for the Regional Medical Program.16 The Alabama Regional Medical Program became a legal entity and entered its first phase. The Regional Advisory Council* Description and Composition of the Regional Advisory Council From the seven member special committee of MASA, which met to make recommendations concerning Regional Medical Pro- grams, the Alabama Regional Medical Program's governing body, now known as the Regional Advisory Council, has grown to a potential membership of 62. From the beginning of the program *The Regional Advisory Group redesignated itself as a Council in September 1972. Reference to RAG or RAC indicates a time before or after that date. 13 members of the Medical Association of Alabama, the University of Alabama in Birmingham Medical Center and other professional health associations have been active in providing guidance and leadership to the Council in its direction of the Alabama Regional Medical Program. In recent years membership of the Regional Advisory Council has been appointed by the following groups: Medical Association of the State of Alabama University of Alabama Medical Center Alabama Dental Association Alabama Hospital Association Alabama State Nurses Association Alabama Heart Association Alabama Division of the American Cancer Society State Department of Health StateDepartm@nt--6f--Mental:Health Vocational Rehabilitation Service Veterans Administration CHP 314 (b) Agencies. In addition, the grantee organization has appointed members at large. The relative numbers of these organizations have tended to change over the years as illustrated by Figure 1. Successful areawide development by the Advisory Council accounts for most of the changes in trend. Membership in the Council had been relatively-_ptable since@1967.-@Subregionalization-efforts-of-the Council were effectively felt in 1971, with the addition of representation from the areawide advisory groups and an in- crease in the number of members at large. Development of Program Goals As discussed, the Regional Advisory Group was instrumen- tal in -the-historical development of the Alabama Regional Medical Program. With the approval of a planning grant availa- ble from January 1, 1967, through June 30, 1969, the Group 14 ReDresentation Trends of RAC Membersh4LD at LRMP Heart & Cancer Ass'n. CHP (b) agencie MASA EM- Univ. Ala. at B'Ham Vocational Rehabilitation Vet.rans Admin. Members at Large IM - Other Professional Ass'n. El- io@. 75% 00 rn 5M/ 0 (D 25%- Fig.1 turned its attention to the plans and possible mechanisms for implementation of the ARMP. During 1967, a series of meetings was held, during which time a constitution for the program was reviewed and approved. An annual statement of the evalua- tion and application for continuation of the original planning grant was approved and forwarded to the Division of Regional Medical Programs. 17 Specific objectives were also delineated in the follow- ing priority order: To provide retraining and continuing education for the entire health service team in relevant categories. To stimulate and support the creation of new health service manpower and to improve distribution and utilization throughout the region. To demonstrate in appropriate pilot projects the best and most recent developments in medical care as close to the patient's home and as close to the physician's practice as possible. To increase and improve total community involve- ment in both the problems of modern health care and the potential solution.18 During 1968, the overall ARMP strategy was revised to provide eventual decentralization of ARMP activities from Birmingham to an area.-6ffice--,in each-of-the-seveii-hospital-- regions as defined by the Alabama Master Hospital Plan. The concept was furthered in 1969, when the RAG supported the objective of developing comprehensive health care and demon- stration units. 19 A project to fund health planners in each of the regions was approved by the National Advisory Council 20 and funded in the spring of 1970. In the summer of 1970, the state was divided into eight multicounty planning districts 16 by Alabama Governor's Executive Order No. 23 and the RAG voted to follow this arrangement in September 1970. Also during the first operational-year'.-'-tht!@-RAG-,en- couraged a survey of health needs and resources county by county throughout the state. The results of the county surveys conducted earlier, along with coordination and coopera- tion with other state agencies gave the RAG a broader perspec- tive and insight into what was needed in the state.21 The period from January through October, 11970 was a critical one for ARMP. The first event was the resignation of the chief executive officer, Dr. Benjamin B. Wells, on January 3, 1970, to accept the position of Deputy Chief Medi- cal Director of the Veterans Administration in Washington. Over the next nine months many of the key staff changed with resultant changes in its interests and capabilities. In May 1970, the second critical event occurred: a site visit from RMPS which provided ARMP with the opportunity to review and categorize past activities into program areas. It became evident that the staff played a significant role in these programs and that feasibility studies and small grants were accomplishing many objectives, despite the manifest diffi- culties in having major projects receive approval at the Washington level. The third event was the decision to develop the capa- bilities of the Regional Advisory Group. The first step in the planned process took place at a two-day retreat in June 1970, at which RAG members and staff jointly identified and 17 proposed solutions for many issues involving ARMP. RAG mem- bers contributed significantly to the preparation of the Triennial Application which formulated plans for the next three years. The retreat was significant in that it contributed to improved understanding and better working relationships between the Advisory Group and the core staff and was a turning point in the development of ARMP. Consistent with the broader perspective, deeper insights and better working relationships, the RAG reaffirmed the Program's general goals, but modified the specific objectives as follows: To increase and improve total community involve- ment in both the problems of modern health care and their potential solution. To stimulate and support the creation of new health service manpower and to improve their distribution and utilization throughout the region. To provide a remedial and continuing education for the entire health service team in relevant categories. The goals and objectives which were developed during the June 1970, retreat continued in effect until September 1971. The present goal and objectives stated at the be- ginning of this paper were adopted at the Councills January 1973 meeting. Development of Priorities In the early years of the Alabama Regional Medical Program, objectives were generally stated in priority order. In 1968 and 1969, an effort was made to rank individual pro- jects as well as objectives in accordance with a given set 18 t proposals of criteria. Decisions to recommend or rejec offered to the ARMP were based on the following considera- tions: Basic eligibility under the law. Basic administrative controls. Relevance to objectives of the Alabama RMP. Relevance to national objectives of RMP. Relevance to local needs. Community involvement. Provisions made for evaluation. Evidence of obtainability and viability. Using the above criteria, a priority score was assigned to each project using a simple numerical scale ranging from 100 as "an outstanding project" to 500 as "deferred because of major reservations or incomplete information."22 Each project proposal was reviewed by one or more professional groups--the appropriate county medical society and the Board of Censors of the Medical Association of the State of Alabama-- before being processed by the ARMP staff. Under coordination of the core staff, project proposals were considered by a categorical committee for professional and scientific review and a development committee for technical review, feasibility determination and delineation of the evaluation mechanism. Each project was also reviewed and approved by the Coordinator of Research Grants and the Research Administration Office of the University of Alabama in Birmingham to assure conformance with University fiscal policy and procedures and coordination with the existing efforts of plans of the University in re- lated fields. Favorably considered proposals were then pre- sented to the Advisory Group for final review and approval or disapproval action. Having run this gauntlet of priority reviews, 19 the Division of Regional the projects were then forwarded to Medical Programs in Washington, D.C., for further processing and presentation to the National Advisory Council for final decision. Consistent with an assessment of the project's worth and funding availability, the project was approved and funded, returned for revision, or disapproved. 23 Following the submission and approval of its Triennial Application, ARMP joined the ranks of "mature" regions and has been awarded bloc grants. Local decision making by RAC has sharpened the development of priority setting for indi- vidual projects. The project review process remains essen- tially the same, but more formalized, with appeal mechanisms available. Project relationship to appropriate county medical societies now involves more coordination than formal approval. Review of projects has been afforded to the appropriate 314(b) Agency prior to its requirement under HEW guidelines in 1971. Medical societies are involved in this process. 24 Current health need priorities assigned by the Regional Advisory Council are as follows: Alleviate health personnel shortage. Coordinate health care agencies. Devise alternative health financing methods. Develop health educational facilities. Promote Emergency Medical Services. Aid health services to poor. Increase preventive care. Speed latest medical knowledge to practitioners. Increase consumer participation. Stabilize health care cost. 25 Emphasize environmental health. Decisions to accept or reject proposals made to the ARMP are now based on the following considerations. The proposer should: 20 Present justification 0-fl@the.nee-d for-action. Define specific objectives which are subject to subsequent evaluation. Relate its objectives to one or more ARMP objectives. Improve care of patients suffering from heart disease, cancer, stroke or related conditions. Include precise methods of procedure and a reasonable time frame for their accomplishment. Be practical. Represent new or expanded activities relatively dependent upon some ARMP support. Be a cooperative effort. Activate a regional approach to health care problems. Have evaluation which is directly related to project objectives with evaluation methodology clearly described. Give due consideration to continuation support. Be appropriate for funding under RMPS guidelines and be in line with national priorities.26 The current ARMP review process is located at Appendix II. Regional Advisory Council Committees The Council uses a functional committee structure to do its work. Types of committees have not varied substantially during the years. Following is a current list of committees: Executive Board Committee on Cancer Developmental Component Committee Evaluation Committee Finance and Budget Committee Health Manpower Committee Committee on Heart Disease and Stroke Long Range Planning Committee Subcommittee on Educational Institutions Committee on Rehabilitation Renal Disease Committee Review Committee. 21 The Alabama Regional Medical Program Early Efforts at Regionalization During its first two planning years the Alabama Regional Medical Program concentrated on interests which would further the concept of regionalization through cooperative arrange- ments as required by Public Law 89-239. Three activities illustrate these efforts. Health Planning Surveys Each survey was initiated at the request and under the authorization of the county medical society. The first of 20 health planning surveys was initiated in November 1967, through the Bureau of Research and Community Services, School of Health Services Administration, U.A.B.- As originally planned, the surveys would tabulate demographic and health statistical data in each of Alabamals 67 counties. To be included were numbers and types of health professionals, and number of hospi- tals and other health institutions in each county. The project reached its high mark in the Spring of 1969, when 47 county studies had either been completed, were under way or planned. ARMP had provided funding support for 37 of these projects; the Appalachia Regional Commission, the Comprehensive Areawide Health Planning Agency, and the Office of Economic Opportunity. In recent years county studies have been provided by the Com- prehensive Health Planning Agency (314(a)). 27 The Comprehensive Health Care Demonstration Units The Comprehensive Health Care Demonstration Units had been proposed as the major functional element for implementation by the Alabama Regional Medical Program. The units were proposed 22 as a multidisciplinary teaching and health care demonstration facility which would bring together into a single administra- tive element most of the ARMP efforts in the field of cate- gorical disease. The units were also to serve as a channel of communication, bringing the most recent and effective methods of modern medicine as close as possible to the prac- ticing physician and to the members of his allied health service team.28 These proposed7demonstration units were identical in concept to the Area Health Education Centers proposed by the Carnegie Commission in its report of October 1970. Mobile and Decatur were selected as initial sites because of available resoL irces and evidence of interest. A proposal for a unit at Mobile was included in the first opera- tional request grant. The project was withdrawn from consid- eration by the local sponsors when it was determined that' necessary construction could not be funded. A related pro- ject provided the basic tools for a radioisotope service in the Decatur General Hospital. It was hoped that this single element could be expanded into a full comprehensive health care demonstration unit. After withdrawal of the Mobile unit project and in the absence of a full time medi- cal educator, there was little'hope for a demonstration unit.29 Reqional Technical Institute for the Health Occupations The Institute was designed to provide needed skilled health service workers for the state's hospitals and related health facilities at the sub-baccalaureate level, provide technical instructors for similar health manpower programs -in the junior colleges and vocational technical schools of 23 the region, and provide a university demonstration model for new and experimental ways of training technical health per- sonnel.30 A request for almost $580,000 for the Institute was denied by RMPS in Washington. The following year, a portion of the original project involving a statewide mechanism for training of allied health personnel was funded in the amount of $39,365. Continual funding was obtained (for five years) from the Kellog Foundation. A number of other important and useful projects were funded during the first operational year. But none were as broad in scope or potential impact as the Comprehensive Health Care Demonstration Units or a Regional Technical Institute for health occupations. Program Staff Activities During the planning and first operational years, ARMP c6ntidued to concentrate on individual project activities. Later, program staff activities evolved to become a large regionalization activity within itself. With increased activity came a need for a more sophisticated approach to management of its affairs. Since 1970, this development has been along classic management process lines: that is, there is a planning activity, an organizing or "doing" activity, and a control activity. This type of organization may be noted in the Triennium Application where the relationship of ARMP core or program staff to projects is divided in terms of development, implementation and monitoring. 31 Cutting across these basic processes are three major program staff 24 activities:* Program direction and administration. Project development review and management. Professional consultation, community relations and management.** In 1971, the percentages of time spent in these areas respectively were 33, 27, and 40. In 1972, the percentages were 35, 38,aand 27. In 1973, the percentages were 20, 12, and 68 (est.). The figures for 1973 were estimated during a period of non-project activity and are subject to modifi- cation. The figures also do not include activities of area- wide coordinators funded by ARMP. A system is being developed to more accurately reflect these activities. Some of the program staff activity carried on throughout the state is illustrated in Figure 2, depicting the visits made in 1972 by the program staff in support of the three program areas cited above. Feasibility and Planning Studies Some program staff funds are used to support feasi- bility and planning studies and certain activities which are not of sufficient size to warrant the full project status. Following are some of the activities. * As defined by the Regional Medical Program Service. ** An outstanding example of this activity is a series of health manpower conferences sponsored by the program staff. As a result of these conferences health providers, citizens, and state officials have increased their insights into health manpower problems. Conferences were held in 1971, 1972 and one is planned for March,1973.,. 25 --ARI.IIP-Consultat@-on Patterns--For-1972-- of Visits DALE MADI Plot-* nce -1 1-3 FRANKLI N:)RGAN 4 Ile i)IICornp el WINSTO cu mEAOKE 'to 38 (1-i4 to II WALKE &- I to 11 CLA e-Z to 5 to PICKENS TUSCALOOSA ToAscairL-sct SA CHOCTAW ECL +lvk BALDW -Flor.zl ir f or Lawrence County Health Care Project Special Evaluation Through use of time-share computer system and use- oriented programming, a data analysis methodology is to be developed as applicable to the evaluation of health care delivery systems. Project location is Lawrence County with Lamar County as a control unit. The Evaluation methodology is being applied to a pro- ject whose long range objectives are to cause and demonstrate a positive change in the health care status of residents of Lawrence County through implementation of an improved health care system. If the evaluation design warrants, it will be applied to oth6r--rural-health'-.care--ddliVery-;-systibms4-. Comprehensive Study--Jefferson Tuberculosis Sanatorium Study is designed to determine alternative uses of the Jefferson County Tuberculosis Sanatorium. The Jefferson facility is one of seven TB sanatoriums in the State of Alabama. The statewide requirements for TB facilities is now being considered by the Health Study Commission. Study money will not be used to determine the number of TB beds needed in Jefferson County, but will study alternative uses which will have statewide application. .,..,;----The West@:Aldbama@Comprehbn8ive Hbalth@'Planning Agency is working to consolidate and regionalize the capabilities which exist in each of the region's seven county health departments. The Alabama Regional Medical Program has given impetus to the program through a $3,500 grant. The School of Community and Allied He<h Resources, U.A.B., is studying the feasibility of an interdisciplinary approach to instruction among its programs. ARMP is assisting this effort with a $2,400 grant. Supportive Activities for Health Care Education in the State of Alabama $10,000 supplied to the Alabama Commission on Higher Education to determine the number of health care personnel needed in the state. -,$l.---500 provided (1969) --Lo--dbvelop heal-Eh--curr-icula--for grades K-12. $3,000 provided to assist in implementation of the health education curriculum guide. $3,000 provided for consultant fees used in an educa- tion program for medical students and other medical personnel at Montgomery. 27 ontinuing $2,400 provided for support of four nursing c education programs at the School of Nursing of the University of Alabama in Birmingham. Supportive Activities in the Health Services $15,00 used to identify legal constraints in the devel- opment of health maintenance organizations within the state. The study is a survey of existing Emergency Medical service facilities in the State of Alabama and the develop- ment of a statewide plan to meet these needs. Survey and planning development are proceeding. Office of Audio-visual Communications, Broadcasting of Medical Grand Ro nds and Tumor conferences The Television Center of the UAB supports the broad- casting of Medical Grand Rounds and tumor conferences. The Center provides broadcast schedules for physicians and others in the UAB Medical Center. It also loans them to remote hospitals in the state out of broadcast range. Financial support purchased additional tape to maintain programs in inventory for longer use. Health Careers Council, A Special Telephone System Consisting of a Toll Free in-coming e for Use by the Counselors for Informat on The phone system has enabled the Health Careers Council to provide information concerning health careers to high school and junior college guidance counselors, students and hospital personnel. During the period June 1, 1972 to August 31, 1972, the phone system recorded over 745 differenent contacts. As a result of these contacts,-Council.-members-have appeared on radio talk shows, given lectures to graduate students,-enrbll6d in-couns6lor-6ducation-dlasses@ahd parti@ cipated in secondary and college level workshops.32 current @provbd-and Proposed Project Activities The largest share of ARMP fudds is allocated to formal project activity.* The historical relationship of requests, project and staff funding is found at Appendix III. ARMP project activities are not uniformly distributed throughout Alabama (see Figure 3). The concentration of projects Approved and proposed in this context refers to funded and unfunded. 28 A.R.M.P. Projects in the MADISON Health Planning Areas of Alabama Funded Unfunded 0 314- b Agencies A& Statewide Projects El m El RANDOLPH I @@ GOAL & OBJECTIVES OtBa COOSA CHAMBEF @ Goal: To improve the health of the citizens of Alabama. Objectives: 1. To facilitate the delivery of health services so that (ideally) high quality medical services are available to, and utilized by, everyone in the Region. (D 2. To support the provision of appropriate education (as determined by delivery needs) that will increase the utili- zation and number of health manpower throughout Alabama. E 3. To encourage the effective incorporation of new knowledge and technology into the health care com- COVINGTON munity. CAMB,A 4. To promote health educational programs conducted by GENEVA responsible agencies and organizations for the general WIN public. 5. To improve exchange of health care and health education information both among and between providers, con- sumers, and government at all levels. Color-keys the project location on the map to the objec- tive to which project relates. Some projects may involve more than one objective; in this case, the project is keyed to its Ellco primary objective. are a rough measure of the effectiveness of ARMP's areawide regionalization efforts. Regions II, III, IV, V and VIII have very active Comprehensive Health Planning (314 (b)) Agencies which are supported from ARMP program funds. Figure 3 also shows a location of funded and unfunded projects throughout the state. Figure 4 and its attachments represent the key to this impact map. The key is coded to the individual project and indicates the project's objectives, location, title, status, project director, purpose,, impact, and status of ARMP funding. The Developmental C nent In its Triennium Application (1970), ARMP requested $100,000 annual funding of a Developmental Component. The request was subsequently approved and funded in 1972, at 10 per cent of the previous year's budget ($81,000). The plan for use of developmental funds was based on two prin- ciples: close control and involvement of the RAC in seeking improvement in the quality of delivery of health services; and rapid implementation of worthy proposals. 33 Cooperative Relationships With Other Organizations One of the strengths of the Alabama Regional Medical Program is its cooperative relationships or linkages with other health care organizations. Figure 5 illustrates the location of organizations with which ARMP has currently or recently maintained cooperative working relationships. Following the figure are the corresponding data sheets for each location on the map. Data sheets are from Annual Report and Request: 05 Year. 30 KEY TO OBJECTIVES FOR ARMP PROJECTS Objectives: 1. To facilitate the delivery of health services so that (ideally) high quality medical services are available to, and utilized by, everyone in the Region. 2. To support the provision of appropriate education (as determined by delivery needs) that will increase the utilization and number of health manpower throughout Alabama. 3. To encourage the effective incorporation of new knowledge and technology into the health care community. 4. To promote health educational programs conducted by responsible agencies and organizations for the general public. 5. To improve exchange of health care and health education information both among and between providers, consumers, and government at all levels. Fig. 4 Location an Title and Stal ical lnformati, Purpose via Telephone Provide instantaneous medic Impact Funding ed Project to health Providers in Al more than I ective: 3,1 irector: Margaret telephone. to 12-3i- KlaPper, M.D. 0 an three year 1,933 c ftation on patient 4-1-71 to 3.31 - a in Birmingh rv 90% of calls 520 25 Aud from rural areas. To date 37,000 calls have bc o 4-30 7 processed affecting more than 6,000 patients. 690 Real Fun( enable much wider diss, Furnishes audiovisual materials to train health 783 itY orientation training th to deliver this specialized patient care. o 4-30-73 Obje e. personnel who cannot attend resident cours provide a supportive health I RO techniques, thus increasing number avail lasses 1-1-71 to 3-31-7 ct n County e capability of combining enrollees graduating. $26,104 ed ect Direct alth resources to meet the nu for termination. 4-1-71 to 3-31-72 ctive: 2,3 idine Tolbert the people in Macon County i 94,196 to 4-30-73 onal Radiation ingham, Ala. 0,000 ooperative TrE ewide project nef it annually to 3-31-72 ning and Do! ct Directors: o ert cat( s.involved, 33 6,000 ect h, M.D. & John R. ians. o 4-30-73 ed ant, M.D. 478 ctive: 1,3 - MASA unica- ffice of Continuin 72 to 8-31-73 ed uing medi- MASA is providing a Program responsive to C $25,000 tive: 3,5 physicians needs of physicians. inated Servic( cola, Fla., and Mon- To increase effeciency and econo savings of $140,000 shared by 68,980 patients 7-1-71 to 4-30-72 Conecuh, Escambia shared purchasing and patie n 19 different hospitals. Also a life-long learning $10,623 d Baldwin Counties, among hospitals. rogram has been instituted for employees of the 4 tive: 3,1 pitals. -30-72 to 4-30-73 t Director: John $27,107 the Lid Off the LPN Phil Cc ut of 23 students graduating from first cl Northv 3-31-72 cessfully passed the state RN examination, a 000 ive: 2 t r program. students are currently enrolled in another cla 4-30-73 563 ing Educatio gham, Ala. de through continuing e( Optometrists completed 1-week residency pi 3-31-72 ss Prevention ide project edge and skills of the optometrists gram. 9 Participants monitored 5 weeks befc 88 Director: Hen a in detection and identific inars reported 63 patients with potential 4-30-73 e: 3, 1 O.D. ially blinding conditions ding conditions; in 5 weeks following prograr 600 eye. ptometrists found 235 such conditions. e and vv pu c ditional Isuppot 1 tive: I reside e ucat onal resources ere also held. for production of more health manpower Palachia Regio and demonstrate methodology for delivery f improved health care. mm. r cal Safety in gomery, research and develop recommendations Will Produce recommendations for uniform speci- -30-7 Care Units atewide projec mbining and reconciling conflicing codes fications regarding the design and operation of ed roject Direc d opinions related to electrical engineering electrical components for coronary care units and tive: 5 Dean patient safety in coronary care units. thus reduce electrical hazards for patients and technicians. 41 Mobile Infirmary Multi- - sensory Media ty to 72 to 4-30-73 d ector: L. H. ir ski $25,878 tive: 4,3 ngham, Ala. To est proximately 200 EMT's will be trained by IE h Area III Moun 12 area hospitals and 6 fire departments a 8-31-73 ct Director: Alan medica ed. Approx. 4,200 heart and auto accide '000 k, M.D. ness ar ims will be helped each year. educati of Regional III as project matur( ama Emergency Ala. prove state emergency medical s ut 20,000 various accident victims wil to 8-31-73 cz ervices Project Statewide project tablishing a sound statewide d each year. Contracts in effect as of Jan, $150,000 Funded Project Director- to plan, develop, coordinate, 73 will train 164 EMT'S. Other negotiationsfor Objective: 2,1 Dean local EMS components to ntracts underway. e fatalities and facilitate publi tion in EMS. 44 'Area H ornery, Ala. To provide additional and better trained Wil stem Planning Area V health manpower for the Montgomery area for ,5 t Director: J. J. through a cooperative arrangement among cen nfeld, M.D. educational agencies and institutions. mai con a ion or health perso ee Area HE n Center--A om- Macon 3 health programs are in pr( Based Educa fogy, I in nutrition, and I in $335,286 r ing social workers in health sett students are presently enrolled ir 2,3,5 uate social worker program in C( the Tuskegee Institute. h Therapy Pr Project Direct, gee, Ala. on County Impact ctive: 4,1 County Maco for the estimated 800 stu roject Director: C. Profe n Y, Who have speech Problems opper, M.D. mun ty with modern speech L,rapy; E ucate consumers as to the fre- uency Of such disorders; and inform rents of the importance of language in ildhood development. 48 Medical FacultY-Rural Tuskegee, Ala. Ti Community Phys con County ti( o return to a change Program ject Director: C. ti( ew proceedur( Objective: 3 Pper, M.D. hi! ber replaces h Professional pe cu Y staff. achieved by both should improve qualit Alabama Commu- Huntsville, Ala. organize, develop, and IrT to patient. Based 4w Educational Health Planning Ai mmunity Based Education a nature t Project Director: t will assist in alleviating the lack of Posed healt tives: 2,3,5 McCalister quate manpower in the area. the area to deter- Power needs, and n for a Community Based Educational Project that will be geared erican Manag ntgomery, Ala toward obtaining local committment. ociation Cours ewide project rogram will help identify supervisory abilit, ded ect Dir@Ctor:t ospital personnel and will upgrade managen to 4-30-7,@ ective: 3 ounced. evelopment. '000 thwest Ala ile, Ala. To co rgency Medical mbia, Baldwin and gency stations, 42 EA Project ile counties. disaste ation systems ctive: 1,2 ct Director: Jeff into 1552 EMT'S ey Ms. otivational Update Birmingham, Ala. date and increase involvem VVill prepare community pharmacists for practi for Pharmacists Statewide project pharmacists in health ca in nursing homes, hospitals, H.M.O.'s, etc., an Objective: 3 Project Director: tc continuing education pro 0 announced. vide a crash program for pharmacists, who rve as preceptors for pharmacy students under te law. 53 al Alabama y, Ala. Medical Ser- ee, Elrr n to train 500 people in Fii ike, Butler, adapti able of EMT's for each of the 47 area ,2 ry, Macon, evalua@ realistic tiotis, and Provide communicate, 11, Bullock and bility. counta- tal emergency room. aw counties. t Director: David ter St Alabama I Project Direci Y Medical S( caloosa, Ala. prove, uP-grade, and coor, em ar, Green, Fa e e, aspects of existing Emergency Me undin(4 ective. 1,2 Pickens, Tuscaloosa, vices Systems in order to reduce fatalities VE Hale and Bibb counties. and prevent further injuries. Project Director: Eliza. beth Cleino, Ph.D. rgency Medical Ser- vice Program for Dis- organize and establish a trict IV Objective: 2,1 elgency Medical Service 4 hospitals, organize Ise EMS manpower and Prory and train 150 EMT's tY and areawide involvem hambers co Program. ture vehicles. roject Dire, Brown tY Orientati( Project caloosa, Ala tive: 3,1 tewide project ovi ject Director: t( prov( 9, 334 traii nced. d dis orientate ducation in a- Birmingham, Ala. ditional 69 Mellitus ewide project c tive: 1,4 devel 0 ooperative arrangements are expected fro ect Director: Dr. Buris subje phone and util' oshell Ity companies as well as the Au natin univ. Agriculture extension divisions. ding Primary are Mon develop ng programs. ral and Urban Poor Mon as t Relates to m je nal, post. I s n ilY Plan- s d maternal nursing ive: 3,4 hrough a r ouncil the indigent a I Based n ty in family plan. h Program e:3 anced cardiac nd reduce wai Career Mobility Rainsville, Ala. LPN to RN Northeast Alabama the health manpower shortag( e:2 Project Director: to be an. bama by Providing for upw nroll and train 30 students per year t, nOUnced. tY from Licensed Practic Ns. o Registered Nurse. Title and St, Project Direc ination of Ca n County kegee, Ala. ctive: 1,4 on County conduct a demonstration undiii(I prove that cooperative efforts of I Project Director: Hugtl and Paramedical personnel in a r Shingleton, m .D. can markedly reduce the mortality rate from cancer of the cervex and detect breast and other cancer in early Potentially curable 62 S t L es. Pro mprove and maintain the hea sum a citizens. ill consult with health professionals to deterr ObjE eeds, devise TV broadcasts for Presentatior labama Educational TV network. Auburn L duc. TV Dept. will participate. ening Program lie Cervix ile, Ala. provide educational and med ctive: 1,4 County Lrning cervical and breast car creen approximately 10,000 women and pro% j( Direcior: C female Population of Mobi@ ppropriate proposals. htsey iatric Pulmona caloosa, Ala. Ith Planning Ar ov,,er the neonatal and infa Will improve prenatal care for the area and i ctive: 1,3 ject Director: throughout the West Alabi mortality rates. is ARMP's COOPERATIVE RELATIONSHIPS WITH OTHER CITIES IN 1972 LIMESTONE MADISON JACKSON CULLMAN EROK WALKER FAYE ST C CLEB P..4E PICKENS TUSCALOOSA ALLAPOOSA RENGO AS LC MONROE WASH114 A L GENEVA of w,,xfco Fig 5 --- IVL C(j[@L ,Oj [- !@,'% @ W[Til OTliER ORGAt4lZATIONS a Health non D. Knight, Director ox 4533 le, Alabama 36604 Summary of lnt(riocking Board or Committee tacmberships or Other [3oard Level Relationships (b) Advisory Group serves as RMP Subregional Advisory Group. CHP CliP (b) Advisory Group elects two consumer representatives to R-AC. Members of Areawide Advisory Group serve on various ARMP categorical committees. Area Coordinator serves on A@IP Ad hoc Planning Committee for Manpower Conference. ARMP staff attends CHP (b) Council meetings when expedient. Summary of Cooperative Efforts Relating to Data Collection, Processing or Analysis Areawide utilizes data collected by both A-RMP and CHP. Project de- velopment reflects use of data mutually gathered-. Summary of Staff Sharing and Staff Contacts (Exclude Staff Sh,3rinq a.,id Contacts With Grantee Organizations) (b) Agency staff and council members are regul'ar participants in A@IP Conferences and Programs Chairman of Areawide CIIP Council are invited to attend meetings of RAC. Staffs cooperate closely in local Project development and program planning ARMP staff gives consultation in the region upon invitatio n. Summary of Equipment and Facilities Sharing Summary of Cooperative Mechanisms For Review of Grant Applications, Activity Proposals, Etc. All @IP grant submissions relative to this area are submitted to area- wide agency for review comment. Areawide shares their Projects with -ARMP for review and comment. Summary of Other Joint or Cooperative Activities and Relationships ARMP's assignment of Areav7ide Coordinator within-(b) Agency provides for continued close planning and cooperation between agencies. 38 colir- CC)OI,Ellfkl lvt: a V@ITII OTliEt', or'%G/k[QI7-ATIO.@S Acfdi(ss Om '.IcCaskey, Executive Director Comprehensive Area- t4r. T r Health Care in the P. 0. Drawer 2007 Wiregrass Area, Inc. (CAPHI%7A) Dothan, Alabama 36301 Summary of Interloci@irig Board or Cornn-iittec t@iembcrship-, or Oilicr tioard Lcvcl ficlationsilips During the-year , Advisory Council serves as RMP Subregional Advisory Group. This perhaps will change in 1973. Advisory Council elects t@.;o consumer representatives to RAC. Chairman of CHP Council serves on ARMP Regional Advisory Council and the Executive Committee. ..Nlembers of Areawide Council serve on various ARMP categorical committees. Summary of Coopcrative Efforts Relaticig to Data Colicclion, llroccssing or Analysis Areawide Coordinator utilizes data collected by both CHP and A@4P. All data is mutually shared. Summ3ry of Slz:f f litiaring and Staff Contacts (ExciLjcfc Staff S!13f illg a-id Contact-, V@'itti Grantec Oi-g?nizations) Staff and CIIP Council members have been regular participants in AMAP conferences and programs. Chairman of Areawide Advisory Group is invited to attend selected meetings of RAC. Summary of Ecluipmci)t and Facilitics S,iaring An office for the A@lp coordinator is provided by the (b) Agency. ARMP materials resources made available to area staff. APJ@IP has placed ROCOM Software in this office for'distribution. Summary of Cc)cjpcrative Iviecliaiiisms For F'evic%,v of Grant Applications. Activity Ili oposals, Etc. All grant submissions relative to this geographic area are shared for-' review and comment-by both agencies. Stininiary of Oilicr Joint or Coor)crative Activitics and Relationshil)s ARMP's assignment of Areawide Coordinator to (b) Agency provides for continued close p@anning and cooperation. Cooperative efforts in man- Power development are increasing and consultations to educational stitutions are promoted. in- 39 y f?. COIIECOOIIEII[KTIVE- 2ELATIOI-JSIIIPS Alabama WIT[I OTliER Or,,GAf4li@-ATIOI14S @iT8- i@l 1 7=2 1) I Community Serv ce Council, Inc. Mr. Albert Rohlinq, Ex,active Dir. Community Health Plannlng Commission 3600 So. 8th Ave. (CHP (b) Agency) Birmingham, Alabama rd Level Rcla @onships ,3rd or Committee tlcmberships or Other Poa ti rector, @lember of Advisory Council. ARMP Executive Director and Deputy Director members of Committee on Health Service to Poo'r of (b) Agency. One membe-r ARIAP staff is member of.Health Research Committee of (b) Aqency. One A@IP st:aff member of (b) Agency Home Health Care.Committee. Areawide Advisory Council elects two consumer representatives to ARMPts RAC. Members of Advisory Council on A@IP categorical committees. Summary of Cooperative Efforts Relating to Data Collection. Processing or Analysis -AFIIP has assisted with distribution of "Directory of Community Services" compiled through joint efforts. There is mutual sharing of all data. ARMP selected staff members have participated in designing and conducting .of local studies as members of (b) Agency committees. Stirnmpry of Staff Sharing and Staff Contacts (EXCILide Staff S!i3ririg a-id Contacts With Grantee Organizations) Executive Director frequent guest at RAC meetings. S-taff has APJAP Area- wide Coordinator as liaison person within the (b) Agency office space. ARNIP staff encouraged to attend (b) Advisory Council meetings. (b) Agency staff and council members have been regular participants i.n A-MP conferences and programs. ARMP staff members. have contributed to planning toward Home -Health Care Plan for area through committee participation. Summary of Equipment and Facilities Sharing Staffs have cooperated in development of printed materials such as stationary. ARMP materials resources are made available to the (b) 'Agency staff. Summary of Corpcrative kleclianisms For Review of Grant Applications, Activity Proposals. Etc. Projects affecting area are shared for review aftd comment by both agencies. Staffs have cooperated extensively in local prjoject development and pro- gram planning. ARMP has funded some efforts to give a preliminary survey to some projects such as the Family Health Center Project at Roosevelt City Summary of Other Joint or Cooperative Activities and Relationships ARMP Area Coordinator Membership within (b) Agency staff has resulted in closer planning, coordination, cooperation, and understanding.- 4 40 f C;O,@ j- C.U @i, 1 V ti L t- f\T I Alabama %%IITII OTliEll O[IGAt4iZATIC),\!S 2 f 8Ici@j C, Addt(5s Dr. Elizabeth Cleino WeEt Ala am@ Comprehensive Health Director, Box 1468 planning council Tuscaloosa, Ala. 35401 (a C.H.P. (b) A'ency) 9 Sun)ma(y of Intcrloclzirig Boird or Committee tlcmbcrstiips or Other floar(I Level Relationships one member of the Executive Committee represents this agency appoint Two members of CHP Council are members of A@IP's RAC (Council s Representatives two consumer r to'RAC) Advisory Council serves as subregional Advisory Council'm ember of Advisory Committee on A.R.M.P. Categorical Committees. Stimriiary of Coojocrative Efforts Rciatirig to Data Collection, Processing or Anzilysis ..Util!2e data from both CHP and A@IP. AfLvP Staff has acted as con- sultants in designing data collection i'nstruments and interpreting of data for local application. Basic data from the National Health Service Corps Questionnaire will enhance future actions. Stimniaty of Staff Stiai-ing znd Staff Contacts (E>:CILICIC "Itzff S!ioriiig @.-)d Contacts V,itli Grantee O,.-ganiz.-tions) During the year Director and CHP Council Chairman are invited to attend RAC meetings Staff are frequent participants in APJIP Conferences and Programs Staff cooperate closely in-local project development and program planning (b) Agency staff has A@IP Areawide Coordiriator for liaison between agencies A@IP Area Coordinators are housed in CIIP (b) Office facilities. Suniniary of Ecluipi-nciit and Facilities Sliaring Alabama Regional Medical Program has placed kOCOM software in (b) Agency Office for distribution. Staffs have cooperated in design and reproduction of stationary simple supplies. A.R.M.P. materials resources are made available to (b) Agency staff for distribution. Stimmary of Cooperative I,,Iccliaiiisms For ftevicav of Grant Applications, Activity Proposals, Etc. Both Agencies share.all local projects for review and comment. Surnmaty of Otlicr Joint or Cooperative Activities anc; Belationsfiips Jointly share activities in Emergency Medical Services, and the develop- ment of Manpower Systems or health services-education activities. Jointly share consultation services to selected educational institutions. 41 0 l'i c C) 0I-i I v A, abama 14an 0 of otgz)nization Addfcss Mr. David lq. Carter, Director Montgomery Regional Medical P. 0. Box 11292 Foundation, Inc. Montgomery, Alabama 36111 Sumniary of Interlociing Board or Committee t@iernt)crships or Other i@oard Level Relationships CIIP (b) Advisory Council serves as RMP Sub@egional Advisory Group. Advisory Group 'elects two consumer representatives to RAC. Director serves asmember of Ad hoc AWIP Committee to plan Manpower Conference. Sumt-nM of Coopcritivc Efforts Relating to Data Collection, Processing or Analysis Areawide utilizes data collected by b6th APd4P and CHP. SL'Mmary of Sti;ff Sharing and Staff Contacts (Exciticle Staff S!iiritig a.-id Contacts With Grantee Organi2ati,ons) Staffs cooperate closely in project deVelonment and program planning. T@v..,o meetings 3ointly sponsored by CHP-@@IP for areawide planners. Mem- bers of (b) Agency Council on various APJ4P categorical committees. Area Coordinator and Chairman of Areawide Council are invited to attend meetings of RAC. ARPIP staff gives consultation in ETIS and Manpower Development where indicated. .@viiiri)ary of Equipniciit and Facilities Shz:ring Area Coordinator is provided office space in the (b) Agency suite. Stimmary of Cocpciative (,,iecliaiiisms For fi'cvic%,v of Grant Applications, Activity Proposals. Etc. All RMP grant submissions relative to this area are submitted to area- wide agency for comment. Areawide shares their projects with ARMP for review and comment. -iC, Relationships Suniriiary of Other Joint or Cooperative Activities a. AP,14P's provision of Area Coordinator to areawide agency necessarily re- sults in closer planning functions as well as better cooperation and understanding of each other's mission. 42 I, L- coo!, i' LA -f If! "S AI abama WITif OTIIER OP@GAt4l-@'ATIC)i@S @2 uarrke of 019,)Ilizltion Acfdrcss Alabama Division of the Mr. Jack Gurley, Exec. Vice-Pres. American Cancer Society 2160 Green Snrings Hi.gl-i@.7ay Birminqham, Alabama 35205 Summary of lnicrloclzing Poard or Committee tlcmbcrships or Otiler t'joard Level ficl6Lion,,Ilips ARMP's Associate Director for Cancer and the Chairman of A.@MP's Cancer Committee serve on the Board of the Alabama Cha-)ter as does the Director of APd4P:project !t27 in Members of this o c Dosimetry. r.,janization serve on A@IP's Cancer Committee. Two representatives also serve on RAC. @ummary of Coopcrativc Efforts Relating to Data Collection, Processing or Analysis ARMP has assisted in dissemination of information as requested. Appro- priate data is being compiled and analyzed in relation to Project 427- Dosimetry. Summary of Stz;f f Creating znd Staff Contacts (Exc[Ltcle Staf I SI)3riiig alid Contacts Witli Grantee Orgz:nizations) As described in committee activities. i,lorked cooperatively in continuing education efforts. Summary of Equipniciit and Facilities S'lating AR?-IP is supporting the video-taping of U A. B. "Cancer Conferences"' for inclusion in information exchange. @IIST -project.provides for con- sultation in care of cancer patients. Materia-Is resource-, related to cancer are disseminated through APMP. SLIMMary of Coc,,,)CiatiVe I,,'ICCII@niSMS For F,(,vic%,v of Grant Applicatiois, Activity Iltopc)sals. Etc. Both groups share in implementation of ARMP Project 427 - Regional Radiation Treatmen@ Planning Dosimetry. ReDresentatives of both groups worked cooperatively in development 'Of'2 projects in screening for cancer of the cervix. Representatives of the Alabama Chapter as members of ARMP Cancer Committee participate in technical review of ARMP projects related to cancer. S;tjmniary of Other Joint or Cooperative ActiviLics and Refitionsilips Further development of hospital coordinators to improve knowledge of hOsDital and medical staff in care of cancer patients. A@IP has sup- poried efforts toward development of the Lurleen B. Wallace Cancer Treatment Hospital. 43 COIIE C00i'ER[kTIVF- Alabama WIT[I OTliER OP-,GA[414@-ATIC)i,.'S Name of ofgjiiiivlion Addi(ss f@).iss Margaret Cotton, E):e-cutive Dir. Alabama IT-eart Associa-tion P. 0. Box 31085,7061-2 So., 29th St. Birmingham, Alabama Summary of Intcriocting Po3rd or Committee llemliciships or Oil.1cr floarci Level Relation,,Iiips Executive Director is an active member ar.d Chairman of the Cardio Pulnonar, Resuscitation - Fmergency Care Cont-qittee for Alabama Ileart Association. Four representat4 @ves o.f this organization serve as Members of RAC. One of these is the President of Alabdma Heai-t Association. Mrs. Grooms, Nurs Consultant for Alabama, is an active niemh)er of Alr,-IP's Health Manpower Co,-n- IT mittee. Several Program staff members ai-e members of the eart Associa- tion. Sumniary of Coo,-)crativc Efforts P-,clating to Data Collection, Processing or Analysis Cooperative efforts to disseminate information related to data as approdri ate and requested. Referral of information as appropriate regarding train ing or continuing education-programs. Stimrnar@,ofStz;ffSti3rinqzndStafiContaCIS(EXCILideSt,)I'f,Yiayiii z-idContactsl'@littiGrantecOrganiz@-tions) The Executive Director of A@.IP has been a leader and'active participant in development of emergency care Plan for Legion Field Stadium through the Alabama Heart Association. The two agencies continue to cooperatively support the graduate program in "Cardio-Dhvsicalogical Nursing" as the U.A.B. School of iqursing. AR!.IP staff pariiciDate in Ca'rdio Pulmonary Resuscitation Programs sponsored by Alabama Heart Association for physi- cians and nurses. Surilniary of Ecluipnici)t and Facilities @. aririg There has been continued sharing of materials resources, i. e. cardiac tes'%-- set, Diomedical Field Phobe, films, etc. Resusci-Ann both manual and electronic and other appropriate materials from-ARMP utilized in C.,P. R. courses. Stimmary of Cocperative klccliaiiisms For f)'evienv of Grant Applications, Activity Propos3ls, Etc. Members oi the Heart Association have been involved in the stimulation' and/or development of some A@IP projects. Summary of Otticr Joint or Coc>pcrative Activit;cs and Rel3tionships The two agencies have cooperated in lending leadership to development of emergency medical personnel through the University Medical Center and elsewhere. 44- 3 - 4 1 1 (t, CoRr- COOPF-RATIVE- II[- LATIO@-JSti',PS ma @7) " WITII OTlit:R OPGAIQIZATIO,@S t? I Ft l@ I Addf(,ss Mr. John A. Brown, EXE@C; Dir. 109-South-8th Street Association Gadsden, Alabama '@1590 hips or Other tioard Level ficiationships CIIP (b) Council serves as RMP Subregional Aavisory-Group Advisory Groupelects two consumer representatives to RAC- Staff sh'a-red in development of meetings, etc. mmaiy of Cooperative Efforts Relating to Data Collection, Processing or Analysis Areawide-utilizes-data collected by both ARMP and CHP. Stimniary of Staff Sharing and Staff Contacts (EXCILICIC Staff Stioriiigind Contacts k,Viiii Grantee Organi7ations) Two meetingq jointly sponsored by CHP-RMP for areawide 21anners. Health Planner and Chairman of Areawide-Advisory Group are invited to attend meetings of RAC.- Sunimary of Equipniciit and Facilities Siaring Stimrnary of Cocperative I-,Iecliaiiisms For Revic%v of Grant Applications. Activity Ilroposals. Etc. All RMP grant submissions relative to this area.are submitted to ar6awide agency for-comment. Areawide shares their projects with AlaiP for review and-comment. consultation on mutually developed projects especially Emergency Medical Service. Health service activities are mutually shared. St)mniary of Other Joint or Cooperative ActiviLics and Relationships AIOIP's provision of Area Coordinator to areawide agency results in closer planning. activities. 45 COTIE COOI'ERATIVI: f@[:@-A WiTli OTtiER ORGAr4lZATIONS Alabama Addrc 5s t4.,Me Cf Organization Tuskegee, Alabama ,Model Cities ard or Committee t@lcmber-hips or Otlier Board Level ,relationships Summary of Intcriock-ing Bc Model Cities Director, i-s a member of Central Alabama Berman Franklin, (Montgomery) Ar'eawide Health Planning Council (AR@IP Subregional Local Advisory Group). Model Cities and ARMP has membership on the Tuskegee Area Rea:lth Education Center. Summary of Cooperative Efforts Relating to Data Collection, Processing or Analysis ARMP Project #26, "IIodel Citi-es-@IP Nutrition Project, Tiiskegee, Alabama," was based on community data drawn together-by an ARMP staff member. Summary of Staff Sharing and Staff Contacts (Exclude Staff Shzifing;@.-Id Contacts VVith Grantee Organizatio ns) Model Cities staff has contributed to the proj ect development in Emergency Medical Services in certain areas. Summary of Equipment and Facilities Stiaring Project #26 is an ARMP effort to participate in a part of the Tuskegee Model Cities total health plan. Summary of Corperative tilechanisms For Review of Grant Applications. Activity Proposals, Etc. A@iP's subregional-office and advisory group is the A-95 review agency for the Tuskegee Model Cities and, as such, reviews grant applications. Summary of Oilier.loint or Cooperative Activities aid Relations[iips Besides API.IP and Model Cities, this project has the support of the VA Hospital, the Tuskegee Institute Hospital, the County Health Department, the County Medical Society, Auburn University, CHP (a) and (b) agencies, University of Alabama Division of Nutrition, and local government officials. Other: Cooperation and sharing with the M6'del Cities Program has no.t been,as extensive as desired. 46 k P.1 11 t, c,. P.% y FR. CORE COOPERATIVE RELATIO@JSIIIPS l(i-,?) (: WIT[I OTtiER ORAGANIZATIONS Alabama rfc-8 1 Name C)t Org3nization Address Preston Blanks, Acting Director Alabama Comprehensive Health Comprehensive Health Planning Planning State Office'Bldg., Montg.,Ala. 3610, Summary of Interlock-ing Board or Committee @.lembersh@ps or 0ttier Board Level Relationships ARMP Executive Director is ex-officio meff@ber CIIP (a) Agency Advisory Counc. CHP Acting Director ex-officio member RAC State Mental Health Commissioner is a member of both,Advisory groups ARMP Executive Director member of.CHP Manpower Committee Ex-officio chairman CIIP (a) Agency Council is member of RAC (b) Agency Councils act as local RMP Advisory groups also CHP staff member on ARMP Long-range Planning Committee Stimm@ of Cooperative Efforts Relating to Data Collection, Processing or Analy@,is By mutual agreement, data collection, processing and analysis is the' responsibility of the CHP (a) Agency with A@14P acting in a cooperative or advisory capacity. There is mutual sharing of data and rE!gUlar meetings and contact on this subject. Suggestions related to data needs are frequently transmitted to CIIP.' ARVIP staff have been involved in planning a statewide data bank through CHP (a) Agency. Summary of Staff Sharing and Staff Contacts (Exclude Staff Stiiring a.,id Contacts V@ith Grantee Organizations) All (b) agencies now have A@%IP areawide coordinators'separate and apart from the (b) agency staff and supported by APJ@P to act'as liaison between AILMP and CHP (b) Agency activities. The staffs of ARMP and --he (b) agencies have cooperated in local project development consultation as well as program-development. Both staff-groups have re presentation at meetings. Summary of Equipment and Facilities Sharing N/A Summary of Cooperative Mechanisms For Review of Grant Applications. Activity Proposals, Etc. All project proposals are shared for review and comment prior to sub- mii3sion. A liaison-staff member has historically been a member of the ARYIP Project Review Committee. Summary of Other Joint or Cooperative Activities and Relationships .API,IP subregionalization effort and support has 1) provided for extensive and comprehensive cooperation with the previously existing (b) agencies in D'ham, Mobile,'and Montgomery, 2) been instrumental to the develop- ment of offices in Tuscaloosa, Gadsden, and Dothan as approved (b) agencies. Cooperative efforts continue toward the establishment of similar agencies..in the two remaining areas of the state not served at present. 47 c6nr- cooi,r-. IIATIVE RE-LATior@isliips Alabama %IIITII OTItEll ORGAt4l-d-'ATIOtNS @@@l 7@ l@ c of organization Addicss Mr. L. P. Patterson, Executive Dir. The Medical Association of 19 South Jackson Street State of Alabama Montgomery, Alabama 36104 Summary of Interlocking Board or Committee klemberships or Other tioard Level Relationships The Executive-DirecL@-or of ARMP serves on the Interspecialty Committee of MASA while the Chairman of the Board of Censors, members of the Board of Trustees, the Chairman of the fledical Education Committee and members of the Bbard of Censors serve on @he Regional Advisory Council. Two physicians who are members of MASA serve-on the A@14P Executive Committee. in addition, PAC members also serve as-local (county) Censors and officers of County Societies. Summary of Cooperative Efforts Relating to Data Collection, Processing or Analysis Analysis of data related to the Medical information via Telephone is a continuous part of that project funded by AP@IP continuing education needs, number, nature and geographical distribution of information exchange through this service are documented and analyzed. Summary of Staff Sharing and Staff Contacts (Exclude Staff Sharing and Contacts With Grantee Organiz,2tions) The Executive Director and the Assistant Director for Audiovisuals have participated in the circuit courses for physician continuing education throughout the state. APJ4P has assisted-in support of some travel and materials production for these courses. Summary of Equipment and Facilities S,'Qring Educational software and hardware have been shared by A@"IP for physician continuing education programs. ARMP is building additional collection of television and other non-book learning materials for distribution and utilization for physician continuin education. Assistant Director for Audiovisuals has'assisted in taping programs, cancer conferences, and others for distribution. Summary of Cooperative Nlechanisnis For Revic%v of Grant App fications, Activity Proposals, Etc. All A@IP projects must include approval by the-appropriate m--clical, societies. Sumniary of Other Joint or Cooperative ActiviLics and Relationships ARMP project 428 will provide opportunity for the creation of an office of Director of'Continuing Medical Education for MASA which will further enhance the identification of continuing education needs of physicians in Alabama.and the translation of these needs into effective programs throughout the state. 4 8 y R. CORE COOP[- RATIVE RELATIONS@F[PS (3-41 1(5-G) 17 - VI@l-rH OTtiER ORGANIZATIONS Alabama 1L 7 tl,,me of org,3nization Lowndes County, Alabama OEO Summary of Interlocking Board or Committee tviembersliips or Other Board Level Relationships Lowndes County OEO Program Director H. II. Meadows, M.D. is a member of ARMP's Regional-Advisory Council. Dr. Meadows also serves on-the East Central Alabama Health Planning Council. (ARMP's subregion and -p