ini 11 @. I OA@ll Profile: Northern New England Regional Medical Program Grantee: University of Vermont College'of Medicine 25 Colchester Avenue Burlington, Vermont 05401 (Telephone: 802/864-4511 ext.- 777) Program Coordinator: John E. Wennberg, M.D. Originally Prepared By: Spencer Colburn Operations Officer Ori,@inal Date: September, 1969 Updated: The Northern liew England Regional Medicil Program encompasses the State of Verraont and the three northeastern es: ,14ew York counti' Clinto-.i, Franklin, and Essex. The Veritont State Legislature designated the University of Vermont as a planning a eiit for n regional liedical Program and appropriated funds for the purpose of preparin- a planning grant application. &tit; IV DEIII.OCPAPHY Populatiori.:. The population for this region is estimated to be 542,000. a) 35% urban b) 98% i@,iite c) liedian age: 29..3 years S.. average 29.5) 2) Land area: 13,846 squ3re miles 3) Rea*lth statistics: a) Ifortaility rate for heart diseases 446/100 000 (high) b) Rate for cancer -- 185/100,000 (high) c) Rate for C@IS vascular lesions 129/100,000 (high) 4) Facilities statistics: a) There is one medical school, University of Vermont, t,7ith approxi- mately 188 students. b) There are five schools of nursing and only one is hospital based. c) There are two schools of medical technology. d) There are no schools of cytotechnology. c) There are 30 non-federal hospitals, five are longterm and 25 are short,term. There is a total of 2,734 beds in the lort, term hospital and 1,826 beds in the short-term hospitals. There is one federal hospital with 188 beds. 5) Personnel statistics: a) There are 646 I-ID's (164/100,000) and 39 I)O's (10/100,000) for Vermont. In the three counties of New York, there are 194 tM's (127/100,000). b) In Vermont there are 2,815 nurses (716!000,000) of T,,,hich 1,815 (470/100,000) are active. Ill. POLITICS 1) Governor Dean C. Davis (R) 1968-1970 .2) Senr,,tort3 George D. Aiken (R) 1940-1974; Agriculture and Forestry, Foreign Relations, Joint Coi-Liiiittee on Atomic Energy b) Winston L. Prouty (R) 1950-1970; Co@.,nerce) District of Columbia, Labor and Public Ilelfare, Special Cormittee on Aging 3) Representatives Armed Services Robert T. Stafj'ord (11,) 1960-1970 IV. HISTORICAL REVIEW 'January, 1965 Meeting with,Governor Philip Hoff, State Legislators (Chairmen of House & Senate Health Committees), State Government Department Heads, Commissioner of Public Health and Dean Slater to explore ways-by which the citizens of the Vermont region might profit from the intent of the federal -disease, legislative programs pending on heart cancer and'stroke. February, 1965 Report submitted to the Governor outlining a proposed planning organization for a regional medical program. March, 1965 University of Vermont College of Medicine Faculty Meeting - Pending federal legislation on heart,disease, cancer and stroke discussed with the faculty. Meeting with representatives of the State Medical Society and the State Department of Health regarding the heart disease, cancer and stroke legislation. Council of the Vermont State Medical Society 'Meeting - Council passes a resolution establishing a committee to study the federal legislation and a resolution which approves in principle S.30, a Bill submitted to the Vermont State Legislature to create frame- work for preparing a planning grant request. April, 1965 Vermont State Hospital,Association - Executive Committee unanimously votes "full support and enthusiastic endorsement" of Vermont Bill S.30 and nominates a representative to sit on the Advisory Board proposed in this bill. May, 1965 Covernor Philip Hoff signs bill passed by Vermont Legislature calling for establishment of an Advisory Board appointed by the Cover- nor to assist the University in preparing an. application for federal funds. June, 1965 Appointment by Governor Hoff 6f members of the Advisory Board for Health Programs which will be responsible for submitting an appli- cation for regional medical program funds. University of Vermont position paper on the DeBakey Commission Report and the pending federal legislation appears in the Con- gressional Record - Senator Aiken speaks on Vermont's planning efforts on the floor Of the Senate. July, 1965 Dean Robert J. Slater and Dr. Benjamin Clark (representing the State Medical. Society) t-estify before the House Committee on Int&r- state and Foreign Commerce to explain Vermont's approach to regional medical planning. August, 1965 First meeting of the Advisory Board for Health Programs. November, 1965 Dean Slater holds several meetings to discuss RMP and how it relates to others interested in the delivery of health care. December, 1965 President Johnson announces appointment of Dean Slater to the National Advisory Council on Regional Medical Programs. New Hampshire-Vermont Committee on Health Care meets to discuss how this private non- profit corporate body might complement the work of the Governor's Advisory Board in regional medical planning. Meeting in Hanover, New Hampshire between representatives from the Dartmouth and University of Vermont Schools of Medicine to discuss cooperation between the University of Vermont and Dartmouth in regional medical planning. Second meeting of Advisory Board for Health Programs - Status of national, regional and local plannin- reviewed. Meeting of an ad hoc New England Planning Committee on regional medical'progranis in Boston Attended by Massachusetts Commissioner of Public Health, representatives of four Massachusetts medical schools, Massachusetts Medical Society, and Massachusetts Hospital Association; Brown University, and University of Vermont - Discussion centered around the feasibility of combined planning and application for federal funds for the New England States. New England Conference for Regional Medical Program Planning called by Governor John A. Volpe of Massachusetts. Representatives of the governors of the New England States discuss possible approaches to coordinated New England Planning for regional medical planning. January, 1966 Regional Medical Needs Board (Vermont, Maine, New Hampshire) meets at Concord, New Hampshire to discuss how to relate the activities of this Board to Regional Medical Program planning. New England Oovernor's Conference for Regional Medical Program planning meets in Boston. Resolution proposed by Vermont is adopted which calls for independent planning by I'medical centers" within.tlie framework of the federal legislation. At the same time an all- New England Committee is proposed to coordinate overall New England planning. TRW, Inc., a systems engineering firm is C, brought in to study the feasibility of applying the technique of systems analysis to the development of PIT. February, 1966 New England G6vernor's Conference for Regional Medical Program Planning - Agreement of cooperation among the New Etigl.and-States drawn up and Committee established to carry on the work of coordi.natin- planning of the six New England States. March, 1966 New England Committee for Regional Medical Programs - Meets to continue discussions on the organization required for coordinating New England reaional programs. Fourth meeting of the Advisory Board for Health Programs - Preliminary review of University of Vermont's application for a planning grant. College of Medicine Executive Committee of the Faculty Meeting - The application for a planning grant is reviewed by the Committee. April, 1966 Planning grant I S02 RM 0003-01 is received ($537,254). Robert J. Slater, M.D.,, Dean, University of Vermont College of Medicine is identified as the Program Coordinator. June, 1966 01 Planning Award - $191,698 DC.- $225,000 for TRW contract is omitted. October, 1966 R. W. Coon, M.D., becomes Program Coordinator (60% time) and program planning begins. Noveraber, 1966 Site Visit: Dr. O'Bryan, Mr. Anderson, Mr. Coffin, Mr. Peterson, Mr. Odoroff, and Dr. Dyson. Plans for a cardiac registry is discussed. December, 1966. Earnest planning begins on two major activi- ties: a) developing a master plan for achieving program objectives and b) identi- fying and integrating into the plan various projects that will be pertinent to the aims of the program. April- 1967 @01 Suppl emental Planning Award $17,109 DC. Awards for 3 month period and is to plan a heart disease inventor for program y development. June, 1967 02 Planning Award $290,940 DC. July, 1967 John E. Wennberg, M.D., became Program Coordinator (100% time). The progressive coronary care project was discussed. Major emphasis on this project is intensive coronary care and prevention. During FY 68 the RMP accomplishments were: 1) Participated in development of the Connecticut Valley Health-Compact whose @overall goal is to examine the possibili- ties for the provision of total health care in the Connectucut Valley Health Com- pact region. 2) A physician attitude study is initiated. '3) Heart inventory is completed. 4) A survey was made of existing medical records to evaluate time involved in history taking and recording of data from physicians examinations and to determine the quality of the data from the viewpoint of completeness and retrievability. 5) A state-wide education program is conducted in external cardiopulmonary resuscitation. 6) Possibilities of a cervical cancer screening program are explored. 7) Involvement with three projects related to information systems. 03 Planning Award - $496,527 First Operational grant request received ($2,221,392). This application requested support of four projects as follows: Project #1 - RMP office Project #2 - Progressive Coronary Care Project #3 - Emergency Health Care Project #4 - Continuing Education for Health Professionals. In early September a project #5 - Evaluation Protocol for Coronary Care System Inclusive of Emergency Health Services was submitted and added to this operational request. October, 1968 Site Visit to discuss 01 Operational request: Dr. Proger, Dr. Storey, Robert Lawton, R. Russell, A. Strochocki. Novei-lib.er, 1968 Council'conclirs with site visit team and rev'ew committee and 01 operational grant 3- is deferred for additional information and clarification. December, 1968, Dr. We-nnberg request (granted) permission to meet with D@12 to discuss Noveiuber Council's recommendation. He asked for permission to revise the operational application And be allowed to submit it for the January- February 1969 review cycle. His justification for requesting this was that a delay to the April-May cycle would be extremely detrimental to NNE/RNP. February, 1969 - council approves operation request. April, 1969 - 01 operational award of $670,677 DC for funding project #1 - RNP Office, #2 'Progressive Coronary Care, and Y@4 - Continuing Education for Health Professionals. V.- CORE STAFP 1) Core Staff-is located at.th6 University of Vermont in Burlington. 2)- Most of Core Staff are affiliated with the University of Vermont. The exceptions are Mr. R. Dunn, Operations Research consultant, and lir.@' A. Gittelsolin, Biostatistician consultant. 3) The next page diagrams the key members of Northern New England's Core Staff,. and their.percent time with PIIP. DMINISTRA.L-LVE PROG@ A SUPPORT De Mer.,'ll GRANT RECIPIENT, UVILM O-RF.YCE INF Prs. L. Rowell* Miss B. Guidi Dr. E. Andrews, Dean [_Dr. J. Mazuza As Dean SECR-ETAR'AL SERVICES 50% C. Dawson miss t DIRECTOR v-ngli sh 6 0 C I @E -D IR E T@O.R' 0i J. WennberZ %rs. B . -Ruehli PROJECT DEVETIopiv2NT Open Mr. D L son til-nie help r '@AGERS rOP P"@6JEET HEALTH SCIENCES SUPPO RT@l VET-'OPtv,E'qT vr. P. Watts r COMMUNi-a-TI@ON,S-i EPIDEMIOLOGIST i I i PROJECT PLANNIN,G Open EfqGl,@EER PCC Dr. Waller 40% i AND E%7ALUATiot\l I ,%MDICAL SO%--IOT-OGIS@, Dr. J. Forsvth--50%. Open 'IVEDICAL EDLICATOR @S E @,@S C@. !SR. FIE'R D .01.)en Mrs. Lloy4 1 Yr. J. Senninql i OOen 1410STATISTICIAN D Z.S,"-P \AGER oen di !'DUCAT'@'C)P,' PROJ'2,CT Provo Z,&D',IISOR 'C,-N'SJr.TANTS i%rs. C. Stewart Mr. R. DunrL I t - -T'. - - -'?RUG IASS 2'BIOSTATISTYLCIAN i 1,FIFLD 114v--S@ qohni PAS CVF.C Dr. A. Git@.tel :ARE PROJECT PROJECT ADVISOR it, or)e. Onan De-roches Dr. R.'Bouchard' Ot)en TE/ *NO CHARGE TO N&N P" AS O.q 10/30/69 BIOGRAPILICAJ, INFOP,@IATION 1) John E. WeniLberg, M.D. a) Born June 2, 1934 b) B.A. 1956, Stanford University' C) M.D.-, 1961 McGill Medical School d) MPH@.1966, John Hopkins e)@ Positions held: 1961-62 - Internship D..C. Ceneral Hospital 1962-63 - Assistant Residency in Medicine, John Hopkins 1963-@64 - Renal Disease Fellowship, John Hopkins 1964-65 - Pharmacology Fellowship - John Hopkins 1966'-67 - Resident in Chronic Disease - Baltimore City Hospital April 66 - Consultant to Maryland State Department of Health to July 67 for the evaluation of medical care in nursing homes 2) Donald J. Danielson a) Bdrn Wisconsin - January 26, 1936 b) B.S. 1959 - Wisconsin State College c) M.T. (ASCP) 1959 - St. Mary's Hospital, Duluth, Minnesota d) IIHA - University of Michigan e) Pos@iti'ons held: 1958-59 - Med. Tech. - St. Joseph's Hospital, Superior, Wisconsin 1959-63 - Clinical Lab Officer - U.S. Army 1963-64 - Supervisor Clinical Lab Service University Hospital, University of Wisconsin 1965-66 - -Administrative Resident, Children s Hospital of Michigan Detroit 1966-69 - Assistant Administrator Henry Ford Hospital, Detroit 3) Darwin G. Merrill a) Born Idaho December 14, 1933 b) B.S. 1959 - Psychology - Utah State University c) )I.S. 1964 - Human Factors, Purdue University d) Positions held: t 1959-64 - Training Officer USAF 1962-'63 - Administrative Advisor USAF 1964-67 - Bellavio:cal Scientist USAF Peter Morgan Watts a) Born July 8, 1931 b) B.E.E. 1953 - Rensselaer Polytechiiical Institute C) Positions held: 1953 - Electronic Engineer, C.E. 1953-55 - Electronic Scientist, USAF 1955-61 - Project Engineer, C.E. 11962-64 - Systems Engineering Manager, Litton Industries, College Park, Maryland 1964-65 Program Manager, Fairchild ililler'Corp., Bayshore, N.Y. VI. ORG.PNIZATION Ltgional Advisory 1) There are-27 members and ttLey are appointed by the presidents University of Vermon,@o 2) Term is for two yearr,; hox,,aver, uicriil,)ers may be reappointed. 3) Representation is as folloi-7s:, iYedical @chool 1,, other health educational schools 1, other University departments or schools - 1, lledical Society 2, hospital associations 1, other health professionals 3, health Oractitioner - 1, all other hospitals - 1, Cancer Society 10 'Heart Association - 1, Government Public Health A-encies 3, 'father Go-vernrqent a@ncies - 2, Health Insurance Industry 1, -consumer representation - 8. 4) The Cli8irnia,,i is Edward C. Andrewo, Jr., 14.D.; Dean, College of Medicine, Uiiversity of Vermont. 5) 1-ioctings are quarterly. 6) @runct Oils: :8) revie-t.,,s and acts upon Phase I and 11 project recor,-a-ar-datioiis as forwarded by study section. (See review Process Section VII) Revie-v7s longterm planning 'act-Lvitier,.' Revici.;r, operational project implementation. d) Subirtits an annual evaluation report in accordance with DRI...:? guidelines. 7 @e) Grants applications requesting funds for planning or operational projected, submitted to the U.S. Pul%,-L,-,.c Health St--rvice, shall be accompanied by a i.,ritten state,-aeit of cppro,,lal by PAB, signed by the Chrir,-iin. Studv Section 1) axis group has seven mei-itbors, four of vlioi-,@i ire @sroci,-.Itcd i-7ith the health care syster-@i, three N..-Ilo --,re not. 2) -They are appointed by the Chairir,-:aii of and apl)rc-,,red b7 th-L menil)ership. 3) Functions: rcvie-,,s- Ph,-,o.2 1 l'i'. to (SC a i@C@L I @v"ff b) -lionitors.progrcss ol operatioiiil projects. c) Approves candidates., nominated by the Program Director, for project advisory positions. Lon an@ illaniiin- Advisory Co,,-..@iittee 1) There are eicylit T,.ieL-abers. Six members are from rAB; four of i,7hom chair ttie staiidin- coi--nittees anl tNio members x.,,ho also are on C> the Vermont Comprehensive Health Planning Advisory Board. 2) Functions: To rieet at least quarterly i-7ith pro-ram staff to revici.7 long- term planniiic, activities to insure the Program objectives are being met and that plannin- efforts are actuall coor- y dinated x.?ith other area planners. -i nd inp, St. CoL.-mittoes '.l.) This Pegion has standing cbrunitteas for: Disease Prevention, Ambulatory Care, Education, Extended Care, Hospital Care, and Medical EconoLiics. 2) Each cor@llaittee has approximately eight members. Vil. REVIM@L PPOC-@-'S c-, .1 tL -i@ lio@ c-@.Cnts IL --ttten De c@-@p@-c)n _(A S ch l,@ In this region.the review.? process is explained in coordination x-iiti-i project de-,7eloprrcnt -.,',rich is divided into four phases. -ilic first three phns6s of development receive rev3.eiys, Phase I - Probleip. Identification - During this phase idens for project development ire received (usually at coordinating head- quarters). Thcse ideas are usually expressed in broad terc-i and are reviex,-ed by core staff-, standing coririiittees and other sources v7ith expertise in tiic '-iL'ca" areas. The resultia-it ra-3terinl is sent on to the IttiB Study Section. 'ne Study Section makes rec",- to the full Advisory Board on iihich problc,-a areas should receive Phase 11 processing. Phase 11 - Probl.nip m@nt. Duripg this phase the project originators c@,pand on the recot.,-Tiien- dations of R/iB. A Project Advisory Co,,-aittee L-ay be established (if not at this stage the co@-ccittee full be fo"..ied in Vhase III). This coiLaittee is convened to insure active participation of the appropriate individuals institutions, and regionnl organizations ,ent of the projects. in the detailed develop= Core staff provides a project maiingor and other assistance x.:itliin its resources to better develop this projec' I-Ihen the projects' planning has reached a s4-gnifican,6- level of achiev--innnt, it is again submitted to the PA3 t'ilroLo"i the Study Section for a liaison as to %71-iether or not to proceed to Phase 111. Phase III - Detailed Proiect D@velopLi3-@it. During this phase the efforts of all concerned with the developiqent of the project are intensified. 'the completed project is no-.,@, submitted to R.AB for final approval. Phase IV @ r@ .@-t ion and e.va lua tion. This plil se is that of inplcTz.@ntation if fuiids are successfully acqi.tircd... FLO@,!i blAGRAM: PROJECT' r-_LOPMENT F>ROGRAi%4 PLAN -RATIONAL PROJECTS IDEA OFyc REVIEW Ow PROBLEM IDENTIFICATION I R,@n'P CONI@.IfTi-EES V@-UNTARY HEALTH ASSOCIATIONS > IDEAS FOR T @,.'CrV!DUALS PROJECTS TO DV! ==> PROFESSIONAL GROUPS SOLVE HEALTH CIVIC GROUPS OTHER ORGAi%'iZATIONS PROBLEMS COMMENT ORGANIZED BY By STANDING RMP STAFF COi@.,'.1.1wITTEE RECOilAfAENDAT!ONSa A) I BOA.9 PH@E 11 REVIEW OF PHASE- 11 PHASE t:r[ANALYSIS REVIEW OF PHASE IV PRELI%41NARY , DETAILED PROJECT PHASE III PROJECT ' IT DEVELOPMEN i DEVELO@RAENT P,ROJECT PROJECT REVI'z"Vi By ADVISORY ADVISORY 3-i .jDY SEC-1 iON O' CO'l.,&MITTEE CONIMITTEE L i RMP STAFF AND pklp PRO'ECT PROGRA?,'@ ADVISOR I M P L EN @l AT I O,\' -STAFF ADVISORY BO (00 E RA-. I 0 @4 @'\ L C 0,M?,,i I T TE @CT) Figure 1 -CIS'ON PROCt7SS R&@-GIO,,@AL D@ RF-GIONAL ADVISORY BOARD (RAS) -,Y o@ PROJECT TION ADVISORY cll- F'LC AB 'C' CO.N,"MITTEE R R Co FE STA7F El L@V--L OF CA@[-: CO", :-rTEE PHASE PROJf'-C' 3 K 0 SION ?NING m P.Z-.M LONG-Tr-_ OTHER PLA,% R t/i F'FZALTH PLANi%,!i%-G PLANi\'!.N( COW,,'VITTEE F-Lgure Co PI S. A.,- FUI\TDED OPERATIONAL PPOJEUTS f2 PROGRESSIVE CORONARY CARE Objectives:, Proposes to establish a system of coronary care units which certain innovations related to the exigencies of- rural medical care. Project implementation will essentially complete the process of regionalization for treatment of this disease durina the acute phase. The immediate project.goal is to reduce ih-hospital mortality from acute myocardial infarction by one third. t4 CONTII\TUING EDUCATION FOR IIEALTH PROFESSIONALS objectives: Proposes to establish a regional system of Educational Coordinators in community hospitals to establish and maintain direct liaison with the communities for educational programs. The overall objectives: motivate health professionals toward self-developinent, encourage communications and cooperation to improve coordination of educational pro@rams, improve the effectiveness of C> programs, and increase recruitment of health care personnel.