9* 0 0 0 iil'fr' Varia,--ion@, c),i 5 id prov@i-de a the accomplishment of L"ic -,-";Itivc WC)U s t,ic establishment -"i-@)men(latioiis O' L cancer and stroke Of @L national net-wOr" for Ll-a' objectives of the !,,,i a manner wL,,ic'ii would seek to acli-@ev,2 Rei)ort but would also utilize tiie estai)).-L@;iicd rc'at:-onsliips throu,-,h L which the Federal Government deals witii t'iie i,,ni.versity, medical schools r(-, @) institutions on the c.)i)ct h--nd, iiid state and local agencies @@lie OLil@@. In essence, the first recommendations of L,ie Pr(,,,;ident's Coira-,@ission Report deal Llic concc@pt of a national network of centers and stations, (2) the dcvelopuicnt of centers of strength in respect to research,, teaching and specialized services, (3) an arr@-ty of diagnostic and 'treatment st--a-t-Lo-s engaged primarily in the provision of services but serving also an educational ind informational function at the local level. The Report envisages a close working between the centers and stat-;-oi-is. The accomplishment of these basic objectives could be brought about through the following arrangements: 1. The establishment of a national advisory group to the Public Health Service to undertake, in conjunction with the PHS and through consultation with the', ttie development ot a framework I or service are@is for the Nation. This framework of service would constitute the basic grid within which the efforts to ,@-@d diagnostic treatment stations would 2 Lhe Collunission's rh advisory group The regions Of sion of recommendations and 2 Al@cport in iLS discus -.--rvice areas developed through this rncchani!;rl woul(,l be individual states, parts-of sLates, Metropolitan areas or i,,roup,,@ of two or more states, 't),,t3ic determinant of ex"-sting teaching and research facil iti(@,,, population distribution and the pattern of normal economic, and governmental relationships. 2. Given this national -,rid or fraTncwork of service areas,responsi- then could be placed upon an appropriate state governmental agency in each state to (a) carry out the nec(--ssary state, interstate, and intrastate planning to determine the location of diagnostic and treatment stat@ions in the state; (b) identify the most suitable and appropriate relationships between these stations and -i-eg--c.nal centers of research, teaching, and specialized services; ind (c) to oversee the operations of the network as it relates to the provision of 'ne4iith services and the conduct of extension education. 3. The conduct of this state and loca'A. planning activity would envisage the establishment of an advisory group or commission for each area made up of representatives of the centers of research, training and service in the state, practicing physicians, and the public at larile, to assist in the determination and coordination of these activities. 3 4 GovernTncrit would work di.rectly with the major 'i'Ct@carch teaching and centers of medical activity in the enhancement 1-it'id .!nlargement of these centers as an ov(@x-z@.i,l framework of nationa resources in research, education, and 1-ilgli quality services as an end in i.@sclf. In addition a special program of grants would be available to encourage and support the activities of those centers directed toward regional relationships with the framework of diagnostic and treatment facilities in the provision of specialized professional assistance and e tension education services to such stations. In providing support for the regional service and educational activities of these institutions, a criteria of award would be the extent to which such proposals conform to and implement the regional plan developed under 2 and 3 above. Through these arrangements the Federal Government would undertake: 1. To provide for the development of an overall national plan for improving a-,id extending the quantity and quality of services available for heart disease, cancer and stroke and tLie reg-Lonal.framework within which this would be accomplished. 2. To utilize a framework of state, interstate,.and intrastate mechanism-- or regional planning relating to the establishment and operation of diagnostic treatment stations and the relato.(-,-@iship of these stations in respect.to health service and educational activities to centers of research and education. 3@ ilro*ide support for the construction, equipping and opoi,, tion of diagnostic and treatment stations to ctie ex@,*v*4 ou,*o ovo@006#4* plan. 4 vice 4 To prov4lde funds to major research, teaching and ser .Lnstituti.ons to serve im centers in the I)rovi.s-l@on of specialized services, @Iii,@@,-Iti@-,@,:@@ i.irictions, and to extend professional assistance and educa- .1@-,@-rvices to the regional framework of diagnostic and treatment stations, a criteria for such support being the extent to which the ,tctivities proposed confom with the regional plan.