i I iiiii@l li@@ I l@l @tilli@l * i R. BLANTON DISTRICT 7 - JACKSON TENNESSEE MID-SOUTH REGIONAL MEDICAL PROGRAM The Tennessee Mid-South Regional Medical Program was one of the first regional programs to enter the operational phase. A large regional advisory group in conjunction with the decentralized staffing at Chattanooga, Knoxville and Hopkinsville assures the broad involvement of all regional interests. The program is currently being funded in the amount of $2,155,042. Several of the operational projects will provide the necessary .Ixperience for greater insight into the development of improved patient cl,i:@-,@ for in rural areas. These operational projects include increased tra@- radiology and continuing education for medical personnel. (D Dr. Stanley Olson is Program Coordinator and Dean D. T. Rolfe of Meharry Medical College and Dean Randolph Batson of Vanderbilt are on the Advisory Committee. The program is characterized by innovation and,variety. For example, one pro4ect aims at improvement of patient care in a remote mountain community; a Meharry Medical School project studies the effective- ness of multiphasic screening in on urban population group served by an OEO Neighborhood Health Center. Another imaginative project experiments with the training of a medical "stewardess" to take over the non-clinical duties of a nurse to get more effective utilization out of health manpower. More specific information on the Tennessee Mid-South Regional Medical Program follows. March-1968 R. BLANTON DISTRICT 7 - JACKSON Tennessee Mid-South Regional Medical P-czram REGION: Eastern a@@, Central Tennessee and contiguous parts of Southern Kentucky and Northern Alabama COORDINATING HE TERS: Vanderbilt University Nashville Tennessee STARTING DATE: July 1, 1966 FUNDING: .Current Award: $2,155,042 .Current Request: Projected Next Year $2,400,000 AHPERATIONAL STATUS: Received an operational grant on February 15, 1968 (list of projects is attached) PROGRAM COORDINATOR Stanley W. Olson, M.D. ADVISORY GROUP: 1. Chairman: Thomas P . Kennedy 2. Membership: Total 58- Practicing physicians 8, Medical Society Representatives 5., Medical Schools 7, other university officials 2, hospital administrators 8, Hospital Association officials 1, Hospital Planning Association 7, Cancer Society Representatives 1, Heart Society 1, State Health Officers 1, other Public Health officials 2 Nurses 4, Dentists 2 other health professionals 1. Bussinessm 1, labor 1, other public representatives 4, elected officials 3. Preplanning activities were carried out during the period February through June, 1966 at which time an application grant was forwarded to the National Institutes of Health. During that time various individuals who later were appointed to the gional Advisory Group, including Dean D.T. Rol'Le, M.D. of Meharry Medical College Wand Dean Randolph Batson, M.D. of Vanderbilt University School of Medicine, participated in conferences and discussions to determine policy, decide on the boundaries of the region and clarify problems. *nnessee Mid-South -2- ORGANIZATION AND STAFFING: The program has offices in six locations. The core staff consists of the Program Coordinator and the Sections of affiliated Health Science, Community Health, Hospital Planning and Administration, Nursing, Biostatistics, and Education Research. Personnel for planning and operations are also located at Meharry Medical College, Vanderbilt University, Hopkinsville, Chattanooga, and Knoxville. Interested groups have been formed in each of these areas and are working.closely with program staff. Planning has proceeded rapidly and intensively. Goals and priorities were formalized and an operational application has emerged and a grant awarded. REGIONAL ADVISORY GROUP: The Regional Advisory Group is a relatively large one with 58 members representing the key health interests and the public in Mid-South region. SUBREGIONALIZATION: Aftubregionalization consists of the area offices in Hopkinsville, Chattanooga, and qwoxville. A Project Coordinator is located in each of these offices. PLANNING ACTIVITIES: Planning thus far the Program has concentrated on developing the operational projects for which an award has been given. Other planning studies and data gathering activities are being carried on in the fields of medicine, nursing and hospitals. A sub-contract was negotiated with the Institute for Social Research of the University of Michigan to study the possiblity of developing and implementing an improved patient tare model at Vanderbilt University Hospital and one or several community hospitals. RELATIONSHIP TO COMPREHENSIVE HEALTH PLANNING (P.L. 89-749: The Tennessee Department of Public Health has recently been designated the official agency of the state of Tennessee to carry out the comprehensive health planning authorized by the Congress in P.L. 89-749. The Tennessee M4@d-South Regional Nledical Program will work closely with the agency and will utilize the data that emerges from its planning activity. SUMMARIES OF TENNESSEE MID-SOUTH OPERATIO@NAT- PROJECTS 1. Continuing Medical Education--Meharry Meharry Medical College proposed to inform Negro Physicians in the region about more effective techniques for treating heart disease, cancer, and stroke. Teams of physicians will teach 2-week courses in the three areas at the Medical Center,, using various audio-visual aids and, where feasible, programmed instruction. One of this plan's interesting provisions is sending a senior resident from Meharry to care for the physician's practice W'-.Iile he is attending the course. 2. Continuing Education--Vanderbilt in contrast to Meharry's approach of bringing the physicians to the Center, Vanderbilt proposes to establish continuing education centers at community hospitals. Libraries and information centers at the local hospitals will bring Vanderbilt's information resources tothe local physician. The program,though planned and coordinated by Vanderbilt, will function through the local centers and emphasize bringing information to the physician at the times he needs it. 3. & 4. Hopkinsville Education Center and Chattanooc,,a Education Center These are the first of the local continuing education centers specified in the Vanderbilt plan. At each hospital, a full-time Director with an appointment at Vanderbilt and an assistant director will supervise resident and physician education in their area. Their services will be available to physicians at smaller community hospitals in each area, as will the enlarged hospital- library facilities. 5. Special Training for Practicing Radiologists--Tlanderbilt This plan focuses on developing practicing radiologists' skills in vascular radiology, but might later be broadened to include all Aspects of diagnosis and therapeutic radiology. Two post-graduate educational methods will be used. One to three month courses for technologists will be offered. In addition, eminent radiologists will preside at two-hour monthly seminars to which all radiologists in the region will be invitc@d. Cardiac Nurse Training Program--Mid-State Baptist Hospital Nashville The key factor in reducing mortality from cardiac is the immediate availability of a knowledgeable person to initiate -resuscitation. Mid-south Baptist proposes to instruct cardiac nurses in new -,resuscitation techniques by holding 3 four-week courses. -2- 7. School of X-Ray Technology-Meharry Meharry plans to establish a ttwo-year program for training at least 10 X-ray technologists per year. The faculty will be the Meharry Radiology Staf' Feasibility studies for establishing nuclear medicine and radiotherapy progr s will be conducted. 8. Radiology Technologist Training Program-Vanderbilt Vanderbilt proposed to increase the number of X-ray technologists, improve the quality of their training, and increase their opportunities for continuing education. Three small hospital training programs in the area will be discontinued as separate entities and subsumed by a new school of X-ray technology at Vanderbilt. Practical clinical experience will be gained both at Vanderbilt and the smaller hospitals. 9. Nuclear Medicine Training Program--Vanderbilt A new series of courses designed to increase the skill of physicians and tech- nologists in nuclear medical techniques. When possible the physician and his technologist will spend some training time together to work out procedures 'ted to their situation. Trainees will be accepted from smaller hospitals sul planning to establish to improve nuclear medicine services. 10. Expansion of School of Medical Technology--Baroness Erlanger Hospital-- Chattanooga To augment medical technology capabilities in the area, this plan makes two proposals: (1) Expand the Baroness Erlanger program for medical technologists; and (2) establish a school for certified lab assistants who free technologists from more routine work for more complex procedures. 11. Vanderbilt Coronary Care Unit This project's purpose is to establish a network of coronary care units with adequate equipment, staffed by well trained personnel. Vanderbilt will be the training and information center for the region; a demonstration unit there will rpovide a focal point for continuing education. In addition, communication systems will be set up to facilitate the flow of information from Vanderbilt to the community hospitals. Studies are being made to see if the small hospitals connected with Vanderbilt can become centers for local networks of coronary care facilities in still smaller hospitals. 12. Franklin Coronary Care Unit--Williamson County Hos-pital--Franklin This is one of the subsidiary units mentioned in the Vanderbilt prODosal. This is primarily a pilot project to study the feasibility and usefulness of establisning a center in a small community hospital. -3- 13. Hopkinsville Coronary Care Unit--Jennie Stuart Memorial ital-- Hopkinsville, Kentucky This plan is similar to the Franklin plan, except that it mentions establishing links to smaller community hospitals by helping set up smaller care units in them. 14. Clarksville Coronary Care Unit---Clarksville Memorial Hospital As is the case with the Franklin program, this project is a subsidiary of the Vanderbilt proposal. Since this hospital has been operating a unit, the p an calls for its expansion, continuing education and a phone hook-up to Vanderbilt. 15. Nashville General Coronary Care Upit--Nashville Metropolitan General Hosoi tal See the Franklin plan. Nurses here will be included in the inservice training programs initiated throughout the participating hospitals. 16. Meharry Medical College Coronary Care Unit Meharry intends to establish a demonstration unit of coronary tare facilities which will serve as a continuing education center for smaller hospita s in its region. 17. -Murray Coronarv Care Unit--Murray--Call-oway (Kentucky) Countv Hospital Murray-Calloway County Hospital, the training center for Murray State Univers4-ty School of Nursing, will serve as a demonstration center for the'sub-region. Direct phone communication will be established with Vanderbilt, which will send consultants from its school of continuing education. 18. Chattanooga Coronary Care Unit- -Baroness Erlanger Hospital Baroness Erlanger plans to establish a coronary care unit in a cooperative program of cooperation with Vanderbilt. Both telephone communications and electronic maintenance systems connected with Vanderbilt will be installed. This unit will serve as a center for the smaller hospitals in Chattanooga. 19. Baptist HosDital Coroparv Care Unit--Mid-State Baptist Hospital, Nashville This plan is similar to the others included in the Vanderbilt plan. Baptist Hospital will expand its present facilities and aid in the establishment of smaller centers at Tullahoma and Crossville, Tennessee. Direct telephone lines will be established for consultations. The unit director will have a clinical faculty appointment at Vanderbilt. He will devote approximately 25% of his time to the unit. -4- 20. Crossville Coronary Care Unit--Uplands Cumberland Medical Center Crossville This project has two purposes: (1) to establish a two-bed coronary care unit in the hospital; and (2) to determine the feasibility of operating acute coronary care units in rural areas. The hospital will cooperate with Mid- State Baptist Hospital and Vanderbilt. 21. Tullahoma Coronary Care Unit-Harton Memorial Hospital, Tullahoma, Tennessee See Baptist Hospital Program. 22. Meharry Super-voltage Therapy Program This project is aimed specifically at improving cancer therapy for a large indigent population. Meharry will use its funds to obtain a cobalt 60 High Energy Source for therapy and a.computer hook-up with Vanderbilt These facilities will also be used to improve undergraduate and graduate radiology training programs at Meharry. 23. Proposal to Improve Patient Care in a Remote Mountain Co Recruiting and Training Health Aides for a New Extended Care Fac @t Scott County Hospital--Oneida, Tennessee Manpower shortage in this isolated mountain hospital is critical. Personnel to man an extended care facility now under construction will be obtained by two methods: (1) in-service training for.hospital personnel (2) an educational director (an RN) to serve as a liaison to the high schools to encourage young people to enter the medical field and come back home to practice. In addition a training program leading to the LPN would be initiated. Clinical training will be supervised by the Educational Director while local high schools provide basic training. 24. Health Evaluation Studies on a Defined Population Group--Multiphasic Screening--Meharry Medical College Meharry will determine the effectiveness of a comprehensive health program and multiphasic screening examinations in early diagnosis of heart disease, cancer, stroke and their precursors. To run this experiment, a neighborhood medical center supported by OEO will serve a selected population of 18,000. The test population and a control population will be evaluated with reference to morbidity, changes in health attitutes and ut ilization pattens, effectiveness of the screening procedure, and the Cost per patient diagnosed or treated. 25. Experin@ent to Test and Implement a Model of Patient Care--Vanderbilt University Hospital This is an attempt to define a new structure for patient care. New personnel called stewardesses will be trained to take over nursest non clinical duties. Nurses would then be free to spend more time with the patient and to keep up their specialized skills. After the model is refined at Vanderbilt -5- it will be tested'in community hospitals--specifically Baptist and St. Thomas. 26. Patient Care Models--St. Thomas Hospital (See # 25) 27. Patient Care Model--Mid-State Baptist Hospital (See # 25 and- # 26) 28. A Medical Surgical Nurse Specialist Graduate Program to Improve N@rs@ Cate of Patients with Heart Disease, Cancer, and Stroke--Vanderbilt Un-Lversity School of Medicine Vanderbilt is developing a program to train medical surgical nurse specialists to improve nursing care of heart, cancer, and stroke patients. It will be a master's degree program, staffed by physicians and clinical nurses (i calendar year) plus 1 year of clinical experience half at Vanderb 4lt and half at a community hospital. Stipends will be provided during the first year only. 29. College Biomedical Science Summer Program--Meharrv Medical College This Cooperative program between Metiarry and Fisk University is aimed at interesting culturally disadvantaged students in health careers and providing them appropiate educational background. Thirty freshmen students from Fisk will attend enriched science and humanities courses for 3 summers at Meharry and Fisk. Counselling will also be provided. At the end of the program the students will be eligible hopefully, to attend Meharry or any other professional school. 30. Medical Data Processing--Vanderbilt University Hospital Vanderbilt Hospital will establish a central., computerized data bank continuing lab, physical and medication reports on each patient. This will provide easy access to data for the physician, prevent duplication and aid in early detection of diseases. ADVISORY COMMITTEE FOR PLANNING FOR REGIONAL MEDICAL PROGRAMS IN TENNESSEE MID-SOUTH Chairman Thomas P. Kennedy Health and Hospital Planning Nashville, Tennessee Dr. William Vaughan Tennessee State Medical Association Nashville, Tennessee B. A. Phillips Vanderbilt University School of Medicine Nashville, Tennessee Leslie Vantrease Metropolitan General Hospital Nashville, Tennessee Dr. Addison Scoville Health and Hospital Planning Council Nashville, Tennessee Harrison Hein Health and Hospital Planning Council Nashville, Tennessee Walter Robinson Health and Hospital Planning Council Nashville, Tennessee John Sloan Vanderbilt University Medical Center Nashville, Tennessee Robert Taylor Tennessee State Senator Nashville, Tennessee David K. Wilson Health and Hospital Planning Council Nashville, Tennessee Dr. William F. Meacham Nashvil'Le Acader:iy of Medicine Nashville, Tennessee 2 Dr. Harrison H. Shoulders Mid-State Baptist Hospital Nashville, Tennessee Dr. Eugene Kilgore Pan-Dental Association Johnson City, Tennessee Dr. Frank A. Perry Volunteer State Medical Association Nashville, Tennessee Dr. Charles A. McGinnis R. F. Boyd Medical Society Nashville, Tennessee Dr. D. T. Rolfe Meharry Medical College Nashvillel Tennessee Dr. Randolph Batson Vanderbilt University School of Medicine Nashville, Tennessee Dr. Harold D. West Meharry Medical College Nashvillel Tennessee Dr. Lloyd H. Ramsey Vanderbilt University School of Medicine Nashville, Tennessee Dr. Gadson Jack Tarleton, r.. Meharry Medical College Nashville, Tennessee Alma E. Gault Vanderbilt University School of Nursing Nashville. Tennessee Mrs. Marie Jones Nor@uh-Central Tennessee League for Nurses Nashville, Tennessee Dr. Joseph Bistowish MetroDolitan Nashville Health Department Nashville, Tennessee Dr. Laurence Grossman Tennessee Heart Association Nashville, Tennessee