4,676,501 Consumers 7,099 Physicians 2,239 Dentists 23,307 Registered Nurses 15,000 Licensed Practical Nurses 10,000 Other Health Professionals 183 Hospitals 5 Medical Schools 1 State Division of Health 95 County Health Departments and Nursing Services 2 U. S. Senators 10 U. S. Representatives 34 State Senators 163 State Representatives 180 HSA Governing Body Members al Our mission Our process 4 Plans in action Access: Where to go for help 6 Education: Reyond the classroom 9 Resources: The spirit of cooperation 12 Services: Emergency! 14 Gift of life: Timmy and "Herbie" 16 The future: Dr. Wyeth Hamlin 18 Credits 20 0 On one end of the scale are doctors, nurses, tech- nicians, health institutions and agencies who have d resources for providing health care. the talents an On the other end of the scale are the people of Missouri who need this care. At the scale's fulcrum for the past ten years has been MORMP, encouraging formation of cooperative arrangements in the health field to bring the best possible health care to Mis- sourians at the lowest cost. When P.L. 89-239 was signed into law in 1965, regional medical programs were dedicated to educa- tion, research, training and demonstration in heart disease, cancer, stroke and related diseases. Over the last 10 years, the federal government has altered RMP orientation, directing the programs to approach health problems common to the treatment of all these diseases. Through grants and contracts, MORMP has sup- ported demonstration models and innovative proj- ects designed to improve the organization and deliv- ery of patient services and the productivity and distri- bution of health manpower. Along the way, MORMP has had many successes and a few failures. But a great deal about implementing health care plans has been learned. In this brief brochure, MORMP hopes to share some of this hard-earned knowledge. Bringing consumers and providers together to translate health care plans into action is the rationale behind the MORMP process. At the heart of this process is our Regional Advisory Group. Composed of up to 60 representa- tives of both consumer and provider interests, this volunteer group annually consults state health planners, volunteer health agencies and interested consumers to assess Missouri's health needs. This democratic process produces a set of priorities which forms the framework for MORMP activities. The MORMP process is not a "one-way street." Adhering to Regional Advisory Group priorities, we may solicit program proposals from health pro- fessionals designed to improve local health services. For example, if it has been determined that some of Missouri's rural health facilities are'unevenly dis- tributed, we may contact and work with local hos- pitals to help them share resources. Or health pro- viders may approach us with program ideas. Because Regional Advisory Group members and consultants live in all areas of the state, there is ample oppor- tunity for communication between MORMP and health personnel and consumers. No matter who approaches whom, MORMP works closely with health providers to create and imple- ment effective local health programs. To date, we have been involved with 167 such programs. Each of these has been carefully monitored by our staff and technical advisers to make sure original goals are being met and that Missouri's health needs are being satisfied. The MORMP process of review, selection, im- plementation and evaluation unites providers, con- sumers and administrators to make health programs responsive to the people of Missouri. Behind the scenes of each of our cooperative health programs described on the following pages lies this time- tested process. c The three-room apartment in metropolitan Kansas Ci is small and dark. On the TV set in the crowded ty living room stand photos of grandchildren, some religious pictures and a collection of knickknacks. This is the home of Flossye Carter, 54, and her beloved cat, Tom Dooley. "I talk to Tom Dooley. That's why he's as smart as he is. It's just me and Tom Dooley." Seven years ago, Ms. Carter visited the federally- subsidized Wayne Miner Neighborhood Health Center. A staff doctor discovered that Ms. Carter had hypertension, a condition in which higher than normal pressure is exerted against the blood vessel's inner walls. Medication now stabilizes her blood pressure. "I don't think I would be here if it weren't for the Wayne Miner people and Project Hi-Blood," Ms. Carter says. Undetected hypertension can lead to heart attack, stroke and related diseases. In the late 1960's, medical researchers were expressing concern over the high incidence of hyper- tension in the black population. In 1968, Wayne Miner staff members, who serve a predominantly black neighborhood, worked with MORMP to develop a blood pressure screening and treatment program for area residents. The project began in 1969. Since most blacks were unaware of the potential Project Hi-Blood provides hypertensive patients problems of hiah blood pressure, the project access to preventive medical care. Making health care staff's problem was one of communication. Their accessible, responsive and affordable to people in solution - personalized home visits by trained Kansas City and to all Missourians has been a major neighborhood personnel. MORMP concern. Because the medical field is highly Since 1969, Project Hi-Blood has screened over technological and its services expensive, health 40,000 persons for high blood pressure through resources are necessarily limited and unevenly home, church and school visits, neighborhood distributed. Communities, especially those in rural mobile units or the Wayne Miner clinic itself. Of areas, can attract and support only so many health those screened to date, approximately 25 per cent professionals, clinics and hospitals. But local were found to be hypertensive. Follow-up screenings residents may not know what services are avail- and home visits by staff members make certain able and how to use them. Here are four MORMP- these patients consult their physicians regularly and supported programs that have brought health ser- follow prescribed treatment. vices and patients together. o In Sedalia, the Missouri Chapter of the Ameri- o The Sedalia-centered program brings preven- can Academy of Pediatrics supports a traveling tive health care to rural families. Another program in clinic for children. Some rural Missouri patients, who Boone County, sponsored by Older Americans find medical expenses steep and health care facilities Transportation Service (OATS) provides transporta- inaccessible, fail to seek preventive medical help tion for the elderly to medical facilities. Cooperation for their children. Some of these children reach between OATS and MORMP extended the service to school age without being properly immunized or the handicapped. A small fleet of vans now provides receiving periodic medical examinations. To over- a transportation service for nearly 5,000 handicapped come this problem, a medical staff visits churches, and elderly area residents. For a small fee, passengers town halls, schools, or other public buildings in a can ride to and from doctor's offices, hospitals 13-county area and offers its services for a minimal and clinics. fee, based on the family's ability to pay. For two o In Dunklin County, strong community support years, MoFiMP worked @vitli the clinic to provide and assistance from MORMP led to the establish- "out-reach" workers who maintain follow-up coni- ment of a volunteer blood bank. Thirteen hundred munication ivith the families to make sure children and twenty-five residents' blood types are recorded, continue visits and receive prescribed treatment. and donors are called when the need arises. Before the bank was organized, Dunklin County Memorial Hospital had to purchase expensive blood from com- mercial agencies. Hospital statistics showed that blood from volunteer donors is less apt to cause hepatitis than blood purchased from commercial agencies. o Problems of accessing health care are not always physical in nature. They can be problems of communication. Two MoRMP-supported programs at Kansas City General Hospital led to a highly successful consumer advocacy service. Many patients were bewildered by medical terminology, dissatisfied with services and confused about pre- scribed treatment. Busy hospital staff members were unable to devote enough time to patient com- munication. Several nonprofessional community residents, with whom patients could easily identify, were trained to interview patients and provide liaison between them and hospital staff. The program has helped patients understand what services are avail- able to them and how best to use these services. The hospital has benefited by smoother relations between staff and patients. The problems of accessing health care are two- fold. Missouri's health resources are concentrated in larger population centers. People who live in smaller communities or those who have economic or physical limitations may find it difficult to reach health facilities that can give them the best care. Even if health resources are within reach, people may not know how to access them. Neighborhood hypertension screenings, traveling child health clinics, community blood banks, transportation services for the elderly and handi- capped and consumer advocacy programs are only a few of the ways in which MORMP has cooperated with local agencies to bring health resources and people together. MORMP believes that using health resources to their full advantage prevents waste in manpower and facilities, loxvers medical costs and brings better health care to more people. Julia Smith bends over baby joshua's crib to stroke his tiny back. As he sleeps peacefully, Mrs. Smith reflects on the strugcle, only a month earlier, to save his life. Joshua was born prematurely in January 1976 at St. Elizabeth's Hospital in Hannibal. Only hours after his birth, doctors diagnosed hyaline membrane disease, a frequent lun@ malfunction in premature Many premature babies born in Missouri's smaller babies. %Vhen Joshua experienced total respiratory rural hospitals cannot get the specialized care they failure, he was immediately placed on a respirator need unless transported to a medical center, a risky and administered life-support treatment. In 12 hours, process. It was the dream of the obstetrics and Joshua was pronounced stable. In 16 days, he was pediatrics staff at St. Elizabeth's to improve their sleeping in his own crib at home. capacity to care locally for problem newborns. "%Ve were so helpless. If it hadn't been for the The hospital purchased expensive life-saviiia C) marvelous staff at the hospital and the Lord's equipment and altered their facilities for an intensive guidance, we wouldn't have our priceless babies," care nursery. MORMP worked @vith the staff to Mrs. Smith says. The Smith's dau-hter, joy, was born develop a middle risk education program for St. prematurely with hyaline membrane disease at St. Elizabeth's staff and interested regional health care Elizabeth's only 14 months earlier. Both Smith babies personnel. O%ve their lives to the development of a middle risk Since 1974, a contagious dedication to education infant nursery at the Hannibal Hospital. has spread through the entire hospital, and the iiii- proved staff skills has significantly reduced St. Elizabeth's infant morbidity rate. But the hospital's success story reaches beyond its own walls. Health care professionals travel as far as 90 miles to visit the model nursery, attend classes and share nenv or nearby colleges. Without these programs, many information. professionals Nvould have had to leave their jobs and With the mass of medical knowledge doubling patients to receive training at distant educational every ten years, health professionals are faced with institutions. the challenge of keeping abreast of new technology. MORMP efforts to improve professional skills This is a particular problem for health professionals extend beyond individual classrooms. Fulfilling its practicing in isolated rural areas. role as an implementer of health plans, MORMP rec- Helping to brid-e this information -ap and brine ognized the value of state-wide efforts to equalize the benefits of new medical knowledge to all and standardize health education opportunities. Missourians is one of MoRMP's primary functions. o To help all Missouri nurses maintain and up- Over the past five years, MORMP has served as a date their skills, MORMP worked with the Missouri catalyst for more than a hundred health manpower Nurses Association to develop a state-wide con- education programs, like the one in Hannibal, which tinuing education program. have improved services in Missouri's hospitals, o In conjunction with the Missouri Nursing nursing homes, pharmacies and laboratories. Home Association, the Missouri Department of Bringing the classroom to the student is the con- Education and six state universities, MORMP tackled cept behind hospital education programs. More than the problem of improving the quality of nursing home a thousand health care professionals have corn- care. Through this program, over 100 persons have pleted training sessions in intensive care, emergency been trained as food handling supervisors. And services, hospital administration and other skills in administration has been made easier by state-wide MoRMP-coordinated programs in local hospitals instruction for medical records personnel. I Mis- These are just a few examples of MoRMP's To relieve manpower shortage in rura man efforts to increase the number and effective- souri, MORMP, in conjunction with the Missouri y Hospital Association, supported a high school health ness of health mani)ower in Missouri. Only through career recruitment program desipned to locally train continued education, can doctors, nurses and tech- th care professionals. A direct "hot iiicians give patients like Joshua and joy Smith and employ heal lized care they deserve. Knowl- line" to over 3,000 high school counselors brin-s the immediate, specia p health career information to thousands of potential edge means progress and progress means life. ith savs it best. "In the 14 months doctors, nurses and technicians. Mrs. Sm o To update and standardize services in rural between the time joy and Joshua were born, I could pharmacies, MORMP worked with the School of Phar- tell that the nursery staff was even better prepared. macv at the University of Missouri-Kansas They knew more. Why, Joshua was more ill than City @to develop an operating manual. The manual is joy, but his recovery was s@eedier. There isn't enough no being tested in several rural hospital pharmacies I can say about the doctors and nurses at St. and will soon be distributed throughout the state. Elizabeth's." o Toovercomethelackofformaltrainingofmany laboratory technicians, MORMP sponsored a primary education program in urban and rural areas. To date, over 59 technicians have received training. @IA "There's that Dr. Cofer!" beams the nurse. Dr. At Hedrick Medical Center, Dr. Cofer parks the Cofer smiles and waves acknowledgei-nent as he car and winds his way through hospital corridors breezes from the corridor into his Chillicothe office. to the coronary unit. He is here to visit 71-year-old "What have xve cot here?" Appointment book in Delbert Stephenson, a Waverly farmer, for whom he hand, the receptionistexplains thathe is scheduled to installed a pacemaker the week before. perform an electrocardiogram. Dr. Cofer recognizes Dr. Cofer is an internist and cardiologist. In his patient and calls him by name into the examining addition to his private practice, he serves five of the room. The door closes. A co-,A,orker pokes her head 12 member hospitals of the Green Hills Cooperative, into the office to confirm a speaking engagement. a non-profit corporation formed in 1972 to share Yes, Dr. Cofer will speak on dru- abuse to a sixth health services, education and personnel. grade class next week. Before Dr. Cofer came to the cooperative, most The examination is over. Dr. Cofer explains he area heart patients who needed pacemakers had to must be at Hedrick Medical Center ("Gotta blast!") travel to Kansas City for the operation, a hardship and hops into the family car, His larae frame and for a patient like Delbert Stephenson. good natured disposition fit comfortably into the Dr. Cofer says he thinks the Green Hills Coopera- station waoon littered with children's school tive is a good concept. It attracts specialty services, drawings. like the one he provides, lowers medical costs to Dr. Cofer is a busv man. But he likes his work, patients and facilitates hospital administration. the town of Chillicothe and its people. His exu- MORMP was instrumental in initiating the Green berance is infectious. Hills Cooperative and has given it support over the last four years. The member hospitals have pooled resources to sponsor in-service training and con- tinuing health education programs, to cut supply costs through a group purchasing plan, to alleviate nurse recruitment problems by establishing a school of nursing at Trenton junior College, to form an inter-hospital communications system and to share personnel. Sharing health resources has brought better health care to the people of the rural Green Hills area whose hospitals were plagued by rising costs and health manpower shortages. MORMP has worked with many healtl-i agencies to build similar coopera- tive efforts in other areas of the state. The followin- three programs are good examples. sou@Morethaniosmallruralhospitalsinthestate's west region are sharing the services of two physical therapists. Visiting hospitals, nursing homes and patients'homes, the therapists administer direct patient care and conduct training sessions for nursing staffs. MORMP served as the catalyst for this cooperative effort. 9 At the Kirksville College of Osteopathic Medicine a cooperative regional pathology labora- tory was established among five area hospitals. rne alone None of these rural hospitals could have be the burden of supportiyig a well-equipped laboratory and trained pathologists. In about one and a half years, this regional laboratory performed over 64,000 valuable tests. MORMP paid a portion of the labora- tory's personnel and travel costs for over a year. With MORMP funding ended, the laboratory con- tinues to serve the area, its costs shared by member hospitals. o For the past two years, MORMP has helped the city of Independence conduct a health survey. House-to-house volunteers are making local citizens aware of available health care resources and are collecting information needed to plan future area health services. Preliminary results of the survey are being submitted to the city of Independence for r view and action. The local health department was so impressed with the survey that they decided to contribute support to its completion. Two-thirds of the city had been canvassed by December 1975. Cooperation is the key to sharing health resources. It was only through the cooperation of health institu- tions and professionals that these valuable services, at reduced costs, were made available in these Mis- sourl regions. But many Missourians, especially those living in rural areas, still lack the services of a cardiologist like Dr. Cofer, the skills of a physical therapist or the advantages of having a sophisticated laboratory close at hand. Health resources are not evenly distributed over Missouri's cities and countryside. Through regional health surveys, like the one in Independence, Missourians can find out just what health services are and are not locally available. And through the MoRMP-tested concept of regional health resource sharing, they can overcome service shortages by sharing health personnel, facilities and equipment. MORMP demonstration models prove that coopera- tion in health care works. Five weeks later, James Crossgrove was released from the hospital. He cannot remember his accident or the care he received from the four EMTs at the accident site, but, according to his physician Dr. Edward Herrmann, he owes his life to their skill and composure. "If James had not received the expedient treatment he had at the site of the accident, his injuries would have been more difficult to treat, if not fatal." James Crossgrove was fortunate to be attended by Shortly before 9 a.m. on a Saturday in early trained EMTs who were backed up by direct radio January, James Crossgrove, 19, left his home near hospital communication and a well-equipped Kirksville to return to college in Oklahoma. Minutes ambulance. If he had had his accident three years later, he lost control of his car and drove into a bridge earlier, he might not have been so lucky. abutment. The car left the road, crashed into a Before 1974, most emergency patients, especially ravine, and James was pinned inside, the motor those in rural areas, were transported to hospitals in pressed against his lecs. funeral hearses or private cars. These vehicles 0 were not staffed by trained emergency medical In exactly six minutes after the Kirksville personnel, had no emergency equipment and no Hospital of Osteopathic Medicine was notified of the radio communication. A farmer, injured in a chain accident, two Emergency Medical Technicians saw accident, might have had to ride to a distant (EMTS) were on the scene. Charles Gulley climbed hospital in the bed of a pickup truck. Although into the back seat of the Crossgrove car and put most city residents enjoyed the service of ambulances traction on James' neck. He kept the air passage and attendants, no laiv existed to regulate their clear while encoura-ina his patient to talk to prevent 0 0 operation. blood from getting into the lungs. James' palette In 1974, the state legislature passed Senate Bill was split, and he had a fractured jaw and multiple 57, and Missouri emerged from the "dark ages" of facial injuries. One luna had collapsed, and his spleen was lacerated. a emergency medical care. Senate Bill 57 requires all While Gulley tended his patient, Mike McKim bec,an to pry the motor loose from James' le-s. A wrecker could not make it down into the ravine, so McKim radioed the hospital for t@vo more EMTS, Randy Lewis and Jay McClintock. With the help of three Missouri State Highway Patrolmen and passersby, the four EMTs managed to free James from the car. They placed him on a back board, put his leg in a splint and continued suctionin- blood out of his mouth. At exactly 9:35, only 37 minutes after they had arrived, the EMTs were in the ambulance with their patient, headed for the hospital. But their job did not end at the hospital doors. All four EMTs continued to tend James in the emergency room for an hour and a -/Z/ half until he went into surgery. id ambulances to be licensed, specially equipped and equipped ambulance with a communication system, staffed by certified, trained EMTS. chances for his survival are much greater than if he To help communities comply with the new law, makes the same trip in a funeral hearse or private MORMP helped organize 18 EMT training courses, vehicle. Helping communities make the costly transi- procure emergency ambulances and equipment and tion from minimal emergency service to a state- establish locally-integrated emergency systems. licensed service has been an important MORMP o Project RESQU, covering 33 counties in south- goal. But the task has only begun. More ambulances western Missouri, offers the 81-hour Department of and more EMTs are needed. And, most importantly, Transportation EMT course. MORMP provides public and professional awareness of the emerging training equipment and instructor compensation. ambulance services and their cooperation with Over 543 EMTs have successfully completed this trained EMTs is needed to coordinate local efforts course and are certified by the Missouri Bureau of into a state-wide emergency medical system. Emergency Medical Services. In response to requests from local communities, RESQU also helped or- ganize 13 area tax-supported ambulance districts. These districts and commercial and hospital ser- vices now provide the southwest area with 75 ambu- lances. With MORMP aid, RESQU helps many of these ambulance services procure equipment and vehicles. * In northeast and north central Missouri, the College of Osteopathic Medicine sponsors an MoRiNIP-supported emergency medical services pro- gram. In 1971, according to the Emergency Medical Services Plan for the State of Missouri (1973) quality emergency medical service was virtually unavailable in this predominantly rural region. The 10-county area was served by only four qualified ambulances and 26 trained personnel. Only one of the seven surrounding hospitals had communication facilities besides the telephone. Today, with MORMP help, a total of 18 licensed ambulances serve the area with the aid of a new com- munication system. And over 255 persons have com- pleted the 81-hour EMT course. MORMP also helped desic,n a regional EMS plan. o In Missouri's southeastern Bootheel region, there were no ambulances before 1974. Emergency patients were transported to one of the six area hos- pitals, a distance of up to 35 miles, in funeral hearses. There were no qualified EMTS. Noiv over 200 EMTS, trained through an MORMP project, are qualified for emergency service, and local communities are es- tablishing ambulance districts and services. i\lissouri's emer-ency morbidity rate has been greatly reduced in just the last two years. If an emer- a.ency victim is. quickly treated by a qualified atten- dant and transported to a medical facility in a well- 017 C-/ Who is Timmy? Timmy Kissel is a tow-headed program with these funds. Since 1968, MORMP has seven-year-old in the first grade at Maddox Elemen- administered, at no cost to the state, the more than tary School in St. Louis who can't wait for the Little $4 million allocated for Missouri's renal program, League baseball season to start. making all funds available for direct patient care. Who is "Herbie"? "Herbie" is Timmy's name for The number of the state program's dialysis and his new kidney, the gift of life that allows him to transplant facilities has risen from the initial two to attend school, play with his friends and lead the 10 in 1976. Seventeen patients were treated in 1968; active life of a healthy child. more than 1,200 patients have been treated since Timmy and "Herbie" were urtited in a six-hour then. transplant operation in September 1975 at Barnes With MORMP help, the state has taken steps over Hospital in St. Louis, The transplant culminated the last seven years to facilitate transplantation. Timmy's struggle with polycystic kidney disease, Dialysis can run as high as $30,000 a year, while the two years of dialysis at St. Louis Children's Hospital average cost of a transplant is $15,000. Success- and numerous hospitalizations for treatment related ful transplants save lives and reduce treatment costs complications. Timmy's successful transplant is also per patient, making more state funds available for the a hallmark in the progress of Missouri's kidney pro- increased patient load. Recently, the federal govern- cram. ment extended Medicare to kidney victims, but with Before 1968, an end stage renal disease (ESRD) certain restrictions. Payment begins only after the patient in Missouri had to rely on private funds or patient has been on dialysis three months and then public donation to pay for dialysis on an artificial only covers 80 per cent of the costs. Transplant kidney machine, an expense which runs into thou- costs are entirely covered. sands of dollars a year. To help ease the financial In 1969, kidney disease was added to the list of burden of the ESRD patient and to develop needed categorical diseases for which RMPs had specific dialysis facilities, the Missouri legislature began directives. Since then, MORMP has helped establish appropriating funds in March 1968 for a state kidney public and professional education programs, a program. computer data bank, a laboratory quality control The legislature, impressed with MoRMP's proven system and the development of a three-state kidney mechanisms for reviewing proposals and monitorin- network in cooperation with the Department of 0 grants, asked MORMP to develop a state dialysis Health, Education and Welfare. Educational programs of ESRD patients from Missouri and the surrounding Most ESRD patients cannot live indefinitely on eight-state area. Results of laboratory tests on the dialvsis; they need new kidneys. But many obstacles donor kidney are quickly and efficiently matched stand between the ESRD patient and the donor kidney with a compatible recipient by the computer. An that may save his life. Donor kidneys are scarce; MoRMP-supported laboratory quality control system people do not know of the desperate need for trans- maintains standards for these laboratory tests. plantable kidneys. To overcome lack of public ESRD Network #9 awareness, MORMP supports educational programs When the Social Security Act was amended to sponsored by two Missouri kidney foundations. With brochures, films, slide shows, media make ESRD patients eligible for Medicare, the federal campaigns, and the distribution of organ donor cards, government made provisions to set up regulatory the kidney foundations reach thousands of Mis- networks to supervise renal disease care. RMPs 'Souri citizens. Through the efforts of these two educa- were asked to help establish the developing tional programs, it is estimated that approximately networks until funding applications were approved. 292 kidneys will be available in 1976-77 for trans- MORMP has been closely involved with the devel- plantation. opment of Network #9 which includes all of Kansas Besides public education, efforts are also made by and Missouri and part of southern and central the foundations to educate professionals to the Illinois. The network coordinating council, com- pressing need for organ donation and the techniques posed of representatives of Medicare-approved of retrieving cadaver kidneys. health care facilities, will be responsible for ESRD quality control assurance and peer review. Computer bank and laboratory quality Over the last seven years, MORMP has been instru- control mental in helping Missouri become a national leader in the treatment of kidney disease. But the story does Another obstacle that stands between the ESRD not end here. Approximately 835 Missourians will patient and a compatible donor kidney is time. A need dialysis and eventual transplantation in 1976. cadaver kidney is only viable a few hours. To speed To assure these and future ESRD patients of ade- the process of matchinc, the donor kidney with a quate medical care, no link in the cooperative chain of suitable recipient, MORMP supports a computer direct patient care, public and professional educa- operated by the Midwest Organ Bank, Inc. of Kansas tion, tissue typing laboratory control and com- City that stores the names and relevant medical data puterized patient registry can be broken. It is satisfying to report that Flossye Caiter's hypertension is stabilized, that James Crossgrove is on the road to recovery, that Timmy Kissell has his new kidney, that little Joshua Smith has fully re- covered from the sudden illness which threatened his life, and that the heart patients of rural north- @vest Missouri continue to benefit from the special- ized skills of Dr. Tom Cofer. After all, these are some of the hoped-for end results of the Mis- souri Regional Medical Program process. Important as these are, they are just the tip of the iceberg. Not so apparent are the thousands of heart disease victims across the state whose lives have been saved in cardiac intensive care units staffed by specially trained personnel, the victims of kidney failure whose lives have been productively extended through an effective dialysis and transplant program, or the countless others who have benefited from any of the 167 programs, all products of cooperative planning and enterprise between the MORMP and providers who looked beyond their oivn many individuals and institutions intent on im- interests to those of the community. proving health services for the people of Missouri. On June 30, ten years to the day since it received Recognizinc, the specific health needs of a corn- its first grant, MORMP ivill cease operations. In munity, determining innovative solutions and keeping with the provisions of Public La@v 93-641, bringing together human and material resources to responsibility for health services development @vill implement those solutions are the components of then belong to the newly organized Health SN,stems the Missouri Regional Medical Program process. Agencies (HSAs). From the vantage point of observer and partici- These agencies will be responsible for health pant in that process, as a member of our Regional planning and regulation in their respective areas. Advisory Group over the past few years, I have They will face the demandin- tasks of a-enc\l oroani- concluded that the MORMP process has been success- zation and gaining community participation in the ful because: development of comprehensive health plans for their it has been entirely voluntary, areas. It appears that only minimal resources will be it is built on cooperative arrangements between i-nade available to them for these purposes. No funds health providers and institutions, and will be available for health services de%,elopnient it has depended on the direct involvement of before July 1977, at the earliest. Too oitc,,n, ilivu,,,- --@ Since 1967, %Iissouri Reoional Viedical Prolir@lly, most of their energies to 0investment of over $28 agencies must devote ut has been responsible for the developing plans and not enougl-l to carrying o million in federal funds and over $4 million in state funds to improve health services for the people of these plans. it is through effective ii-nplementation of Missouri. As MORMP leaves the scene, we are programs that Flossye Carter's hypertension was especially concerned that vital programs which we detected and James Crossgrove's injuries treated. have fostered may be forced to terminate for lack of We sincerely hope that these concerns are ground- appropriate transitional support, We are concerned less and that early and appropriate action will be that the already large investment of time, energy and taken so that transition froi-n the old to the new can be resources in HSA organization may be eroded accomplished without undoing the advances in through underfunding. And we are concerned that program and process @vliich have been so hard won. some of the knowledge and skills acquired in ten The lives of future patients like Joshua Smith years of helping communities improve their health and Tii-nmy Kissel depend on it. services ma be overlooked as the ne@v agencies y Dr. Wyeth Hamlin, M.D., Hannibal, Mo., is chairman of attempt to cope with problems of organization, the Regional Advisory Group. Arthur Rikii, M.D., Coordinator Fred Frazier, Communications Director Melissa Thoinus, Editor William Heivev, Photo-rapher Additional photos by J. Greer, Nloniiy Neiv,Tnan. This brochure is published by the %Iissouri Regional Medical Pro-ram, 406 Turner 0 Avenue, LetA,is Hall, Colu.-nbia, Missouri 65201 iWoRMP is funded through the Division of Regional Medical Pro-raiiis, U.S. Department 0 of Health, Education and Welfare. The views expressed herein do not necessarily represent those of the supportin- o-eiicies. la Postage paid at Columbia, Missouri. Printed May 1976. rallied a I i 1 ' . - r. =is' WIMMM. I - 11 - ----