Ili 1111111 *m P R 0 F I L E NORTHLANDS REGIONAL MEDICAL PROGRAM RM 00021 GRANTEE: Northlands Regional Medi.cal Program, Inc. COORDINATOR: Winston R. Miller, M.D. :Originally Prepared by; Sam 0. Gilmer, Jr. Operations Officer Original Date: July 1969 Updated: NORTHLANDS REGIONAL MEDICAL PROGRAM, INC. PROFILE Table of Contents 1. GeographLy II. Demography III. Governmental Consi.derations IV. Historical Review V. Core Staff VI. Organization Vii. Operational Projects History 'Appendix Additional Projects History Project Review Flow 2 July 1969 NO S REGIONAL MEDICAL PROGRAM I* GEOGRAPHY 'Ihe boundaries of the Region are those of the State of Minnesota, although earlier plans for the Region envisioned the possibility of involvement of parts of adjacent States, coinciding with the Ninth Federal Reserve System boundaries. The initial grant, for plaming., was made for two and one half years, to begin in January 1967. The Minnesota State Medical Association was the @tee agency for the planning award and the Mayo Foundation was listed as the fiscal agent. Most activities dur@o- the first year of planning the result of volunteer committees - specific planning studies were devel- oped by available resource persons. As a result of this approach to plan- ning, in the second year continuation application the Region requested an expansion in the level of c@tted support to pay for plaming.studies as well- as core staff which had been recruited. The continuation award for the second year was for $527,250, plus $81,200 from unexpended funds. It permitted support of five studies: 1. Regionwide Intensive Coronary Care Prograrn 2. Rwal Health Care Study 3. Study of Postgraduate Education in Pediatric Cardiology 4. Proposal for-Financial Support of L<)cal Medical Doctors Being Trained for Horne Dia@is 5. Study to Dete@e Feasibility for Collecting Data and Integrating-Care of.Pediatric Solid TLoor patients 7b the April-May 1968 Review Cycle, the Region presented a Supplementary Plaming Grant Application requesting support for four additional studies. One, the St. Paul Heart Cancer and Stroke Project, was recaTmended for by the Review Comdttee, which requested clarification of the relation between the existing pl o- group (this was originally a PHS-C-FS grant) and Northlands. The other three proposals were not recommended for funding. To the January-February 1969 Review Cycle the Region subrdtted its initial operational grant application, consisting of a request for the funding of eleven projects, six of which were L--corrmended for fundi@a-. The other five were not considered appro-,oriate for funding (detail follows in section relating to projects and their history). Prior to this Review Cycle aSite Visit had been made to the Region (Decerrber 16-17, 1968), for details of which see ',Regional Chronoloa. In April 1969 the Region submitted clarification of its organizational structure, one which is delineated in the sections which follow. '@uly 1969 NORTHLANDS REGIONAL 14EDICAL PROGRAM: PLANNING AREAS WMH RE IONAL HOSPITAIS ;!'orks THE I"-!: OALL Crool.@;3ton Ben LO rd r L CLIC o; t Major 16 Fplls Littl --ners C@ oil, li.3 %.)Sioux Fells j@'1969 DEMOGRAPHY Area: State of Mimesota - 803009 square miles population: (in thousands) 1960 -1965 'Tbtal 3.414 3,554 co-@ties: 87 Densi 42.7 per square mile ty Metropolitan Areas: (1960) 1.,865 (in thousands) Duluth - Superior., ?4im.-Wis. 277 Fargo - Moorhead . N. Dak. 106 Mi .meapolis - St. Paul, Minn. :6482 Percent Urban: 62% @e of Population: (1960 U.S. Mimesota Median Age 29.5 28.6 Mimesota Nunber Percent in Thousands Under 15 1.,122 33 -.311 446 13 15 , 25-44 816 24. 45-64 676 20.. 65 and over 354 10 Total 3.,414 100 Race: Nurrber 'Percent in Thousands Total 3,414 100.0 White 33372 98.8 Negro 22 1.2 Other 20 July 1969 D HY (continued) 'Vital Statistics: (1964) Death Rates per 100.,OOO U.S. Mimesota 'All Diseases 940 940 Diseases of the Heart 3@ 355 Malignant Neop:.asms 151 156 Vasc@ Lesions, CHS 104 126 General- Arteriosclerosis 19 23 Diabetes Mel]-itus 17 15 Other Diseases of Cir. System 14 15 Facilities: Medical Schools: University of Minnesota Medical School @oLlmnt 590 Mayo Graduate School of Medicine 673 (Univ. of Mim.) Rochester, ivam. Schools of Nursing: 27 - 10 are college or university based Schools of Medical Technology: 13 - 1 at University of Mimesota hospitals Other @pes of Paramedical Trai@: Cytotechnology: 1 - Rochester, Mayo Clinic X ray Technology: 37 - 6 give college credits; 2 degree grart@0- Physical Therapy-. 2 - 1 University of Mimesota; other at I,:ayo C@--c Med. Record Librarians 1 - Dulurki, College of St. Scholastica. ,'Hospitals Total Ijmg Term Short Tem Hospitals Total 2L!2 'Rederal 6 (including 1 V.A. Hospital) Non-Federal 196 21* 179 *7 are long term and other special Beds Total 34,969 Federal 2;475 (V.A. gen.'1,014 beds) Non-Federal 32 494 2,964* 19,656 i .*@- terfn and other special 6 1969 DEMOGRAPHY (0@ir-uad) es Physicians and Nurs Physicians and Osteopaths (1967) Number' per 100,000 llbtal 5,148 147.4 Pbysicians* 5.,073 145.3 Osteopaths 75 2.1 *Physicians and Osteopaths** in private practice 3,303, ratio 93 (1965 PHS data). **NRMP in special survey report dated Dec. 1968., stated there are about 42 Osteopaths in the State with one on RAG. Nurses (i962) Nurrber per 100,000 Total 17.,361 497.4 Active 1,3.,346 382.4 7 69 19 AL CONSIDE.MTTONS: 'Ihe State of i@esota, whose boundaries comprise those of Northlands .Regional Medical Prograin, is made up of eighty-seven counties and eight Congressional Districts. The Governor of the State, elected to serve to January 1971, is Republican, the Honorable Harold LeVander. 'Tb the 9:Lst Congress, Mimesota elected to send the following: B. Senators: ..Honorable Eugene J. McCarthy, D. (1959-1971) St. Paul; Social Scientist; Finance; Foreigh Relations; Select C@ttee on Standards and Conduct. Honorable Walter F. Mondale, D. (1964-1973) Minneapolis; I-awyei-; Aeronautical and Space Sciences; Agriculture and Forestry; Banking and Currency; Special Condttee on Aging. Representatives: (All returned to office in 1968 elections) 1. Honorable Albert H. Quie, R. (1958-1971) Dennison; @er; Education and Labor; House Administration. 2. Honorable Ancher Nelsen, R. (1959-1971) Hutchison; Fanner; District of Colunbia; Interstate and Foreign CaTmerce. 3. Honorable Clark MacGregor, R. (1961-1971) Plymouth; Trial ]Lawyer; Judiciary 4. Honorable Joseph E. Karth, D. (1959-1971) St. Paul; Dlim. M. & M. Co.; Merchant Marine and Fisheries; Science and Astronautics. 5. Honorable Donald M. Fraser, D. (1963-1971) Mimeapolis, Attorney and Fonner State Senator; District of Colurrbia; Forei@ Affairs. ,6. Honorable John M. Zwach, R. (1967-1971) Walnut Grove; State Representative and Senator; Agriculture; District of Colunbia. 7. Honorable Odin Langen, R. '(1959-1971) Kennedy; Farmer; Appropriations, C.hairman, House Minority Task Force on A@iculture. 8. Honorable John A. Blatnik, D. (1947-1971),Chisholm; Teaching and School Administration; Govenment g2erati n@s; Public Works. 8 iu:Ly 1969 D. Congressional IpSuiries Date Fran Action 4/21/65 ConUessman John Blatnik Inquiry of Senator Walter F. Mondale Re: Informtion on the applicability FM to Minnesota Of X/6/66 Senator.Mondale (Memo) Referred to Mr. Cohen, for consider- ation for grant 1126166 Wilbur J. Cohen's letter to Senator Mondale Exp@tion of DRMP to Mondale's inquiry 5/16/67 Phone call frm YT. Tomt Interested in progress of construc (Office of Rep. Karth) tion activities of RMP 1/31/68 Senator Mondale to Dr. Study@'of Memorial Hospital, Duluth, on re: health facility planni@- project and requesting comments 12/16/68 Reply @an Dr. Olson to Inquiry on operations of NRMP inquiry from Co@ss- man- MacGregor -rent 1/27/69 Letter fran Dr. Olson to Inquiry answered about cur Rep. Nelson availability of MT funds 216169 Phone call from Mr.. Inquiry on when NR4P would receive Sege k (Office of operational award Rep. Nelsen) 2112169 Letter from Dr. Chadwick Information concerni@, temoorary to Rep. Odin Langen "freeze" of RMP -f@s 2112-.169 Letter frcm, Dr. ChadvT!ck to Reply to '-.etter cf 1/28/69 in iihich Rep. Donald M. Fraser they urge a-,oproval of operations V?ant request in NRMP 2/12/69 Letter fran Dr. Chadwick to Irrorzatio,-i concerning temporary Sen. Walter Mondale "freeze" of RMP funds 2/14/69 call from Rep. MacGregor Inquiry about a reduced funding for the NFW application 2/24/69 Letter from Dr. Olson to Inquiry concerning current status Rep. Ancher Nelsen of initial operations grant request of RMP Ju3Y 19 69 Date Prom Action 2126169 Letter to Senator McCarthy Reference to letter.of 2/18/69 in fran Dr. Olson which Senator McCarthy requests every appropriate consideration .5/20/69 Letter from Dr. Olson to Reply to letter of inquiry of Congressnan Nelsen 5/8/69 619169 Call fran Eric Nathanson Requested brochures exp ng RMP Representative Praser's-office 6/11/69 Letter frcm Dr. Olson to Concerning the F&T and Com.Drehensive Representative Nelsen H6alth P questioM ,-,v --- July. 1969 -HISTORICAL REVIEW Oct. 63 1965 President signs PL 89-239 Jul. 1,, 1965 Dr. Robert B. Howard, Dean, University of Minnesota College of Medical Sciences, Mimeapolis, called at NIH Director's office to discuss proposed program of medical complexes, as related to the "Mimesota State Plan for Hospitals, Public Health Centers and Related Medical Facilities." Dec. 23, 1965 In a letter to the Surgeon General, Dr. J. Minott Stickney (as President of the r4imesota State Medical Association and of the Committee to Tmpleinent PL 89-239 in Minnesota) advised that the Minnesota State Medical Association had been requested by officers of the Minnesota Departmnt of Health., University of Minnesota College of Medical Sciences .11 Mayo Clinic and Foundation Minnesota Hospital Association to.:'serve as the organization to coordinate the p ng fQr iMle,-n--ntation of PL 89-239 in the State of Minnesota. cmdttee of representatives fran each o:t the above organizations formed to proceed with this planning. Invitations to additional representatives for this Conynittee were extended to Minnesota Heart Association Minnesota Chapter, American Cancer Society Awrican Rehabilitation Foundation and to those radical associations of States in the region which do not plan to establish similar groups within their own states. This plamirZ comdttee was to then begin the selection of a regional adv--.sory group and prepare a.planning grant application. May 17, 1966 Initial P Grant Application received in DPYT; it received review by a Special ad hoc Review Group in early June and Council review toviard the end of the month. The consensus was that the application could not be recommended for approval; @o-r revision seemed indicated, with staff communication and a project site visit (by DRMP staff). It was a deferral action. or July - 1969 Jul. 2.1, 1966 Because of an airlines strike Councills recarmendations and deferral for iiore information was by telephone conference between: DRMP NRMP Drs. Marstori Dr. Stickney Sloan (Minnesota Medical Association Fdn.) Brewer Dr. Frantz Hazen (University of Minnesota) Mr. Coffin Dr. 'Whisnant (Mayo Clinic) Areas or topics discussed: 'urther efforts to delineate the region 1. F 2. Broadening advisory group 3. Cornpensation of participants fran institutions as personnel rather than consultants 4. rfRW Systerris-Analysis be eliminated or @ted in approach ($200,000). 5. Budget needs phasing 6. Legal status of applicant organization Mirmesota Medical Association Foundation 7. Institutional salary schedules apply to personnel budget 8. Clarify relationship between Program Coordinator, Program Director and Advisory Group 9. Budget items need justification 10. Evidence that individuals from University-of Minnesota and Mayo Clinic will indeed participate as listed 31. Information about existing health resources for diagnosis and treatment of heart disease cancer and stroke effort to involve community and rural 12. Make explicit hospitals, health institutions and orgarizatioris,, working together. Sep. 27, 1966 Revised application received in DRMP; it was considered by Review CamLittee on 10/17-18/66 and recorrrrended for deferral for project site visit to clarify many many points; it considered this application as an improvement over the original. Nov. 14, 1966 Carbined Council and Review C@ttee Project Site' Visit was made by following: July 1969 Council Dr. Hogness and Mr. Cumming ttee - Drs. Kemey, Popma and Rogers. 'DRMP Staff - Mr. Whaley and Dr. Hazen ..he visitors recwmnded approval with some concerns stated specifically. Council concurred in its meeting on Novenber 27-29, 1966 Jan. 1 1967 @tial P rrant Awarded Year Direct Costs Only Period 01, $344,998 I/-I/67 12/31/67 02 469,o8o 03 234,700 A negotiation meeting was held on January 17, 1967, at the Washington Hilton Hotel,-involving fiscal and program representatives. Mayo Foundation to act as fiscal agent until a new corporation could be for-@ned (probably within six months). Apr. 20, 1967 - Drs. O'Bryan, Dyson, Husted and Mr. Anderson made a "progress visit" to Aug. 28, 1967 - Dr. Winston R. Miller appointed full time ProUam Director, "primarily responsible for the pl coordination ard administration of the Regional ProUam and its relations'--lip to other regional program. 11 Assumes duties in Noverber. Dec. 15'.. 1967,'- Site visit to @ by Dr. O'Br-yan and Mr. Anderson prior to review of renevial planning grant application (02 year) by DMT staff on 12/21/67. 'Dec. 213 1967 Staff recommended $549,643 in direct costs for 02 plan-@ wal; this allowed-use of carryover funds and was ,nor-- than comitted amount so authorization was so@rit from February 1968 Council. Council concurred and above 12/31/68. amount awarded for period 1/i/68 Feb. 12-13., 1968 -Dr. Miller and Mr. Wilkins visited Da'14p, because their Executive Co@ttee and RAG were much disturbed abouu the disallowance of carryover funds from 1967 year for funding essential elemerts of NRMP accomolished durL-@o its first year. They were aware of the bud.-et presentation 13 1969 for their program to be considered by Council on Febnjary 26-27. They reminded the DRMP officers that IR'AP is in the process of "self-renewal" organizational revision, -including separate incorporation, fonmlation of complete by-laws, and revision of the RAG. Feb. 26, 1968 - NRMP Executive Camdttee set the goal of June 1 for submission of an operational grant request. Feb..28., 1968 NRMP @mitted to DRMP a supplemental planning grant request for four studies: 1. Telephonic Transndssion and Computer Analysis of Multi-chamel Electrocardiograms 2 Coronary Artery Disease Proposal 3: ng Food Habits and Senun Cholesterol Levels 4. St. Paul Heart, Stroke., Cancer Project Apr. 18-19, 1968- Review Committee found this p supplement to be four distinct projects (the first three appear to be more clearly operational projects , and not presented as plan. This application seems to be a deviation fro.-a the real purpose of the plaming grant which was to develoo the base for a regional medical program. It recamnended the St. Paul Heart, Stroke and Cancer Project pendi@- clarification of the relationship of the-existing plar@ group and NRMP. Jun. 18, 1968 Council concurred with the Review Condttee's recommenda- tion on the supplemental planning request and an award for $27,849 d.c.o. was made for the St. Paul project. Aug. 1, 1968 -n,-eral;ioy'i@.:L grant application received in DR24P; it consisted of eleven projects, including core support, and requested about $2.5 million d.c.o. It is pendi@o, final recommendation by February 1969 Council. Aug. 7, 1968 - Plr. Kinser and Mr. Koontz visit NRMP for planning study. Oct. 161 1968 - Telephone conversation - Dr. Clark Millikan and Mrs. Martha Phillips,(Chief, Grants Review Brarch) about status Of Oct. 21, 1968 Associate Director -,lisits DF&M about delayed review and continuity of proUam funding after Decenber 31, 1968. 14 1-969 Nov. 27., 1968 Associate Director requests extension of NRMP-02 plaming year two additional months to February 28., 1959., without additional funds. Request granted by letter of 12/16/68. Dec. 1968 Mr. G. W. Lewis and Miss. Joyce Fimegan visit NRMP for financial accounting of new nonprofit organization. Dec. 16-17, 1968- Project site visit to NRMP to review Operational Grant Application; visitors were Dr. J. Gordon Barrow, Chairman; Drs. Gersten, Paul., and Allen, consultants; iMrs. Phillips and Miss Dona Houseal as staff. 15 V. CORE STAFF c ddress: ore Staff a Northlands Regional Medical Program, Inc. Fifth Floor - Farm Credit Banks Building 375 Jackson Street St. Paul, Minnesota 55101 Phone Area 612 224-4771 July 1969 HR14P,, Inc. onal Adviso-iy C. IT Trust!.esj ITRAL ADII!IPIISTR,@TIOl CEt-, Coot-e-inatioli -lanageiront FiscalI Communications FUNDED OPEPATIONAL Corrmi t'Lee Support PROJECTS Project Develcogient Pro'ec,4 Directors Categorical Disease Support CORE COUNCIL Program Directo- Associate Directolls: Central , University and M-ayo -DU'- 'AL PP-O'PA'l SERVICE PROCRAi'-'i EVALUP@i!O@l '-N OPIETIT (Cen,$Llrz,, I IT DPVELOP;ir (t@iayo) D'R_VEL i ,c C. i k, I u v i s s o c- i,@ tP,-Il-ectoi-, l@,Rl'.IP Associate Director, NP,.",iP I-ILI rs i no, Assoc. Dir. Rehab. Coo&-d. Director A.R.F. 'OOMINATOR Cooi,dir-ato,., 1 Allied @lealth Researcii Associa'Le M.SXIOL. Secreta@v- Assoc. Dir. Secretary- Med. Pract. Div. Res--arch Assislan'@ )F.P-ICE OF EDUC. Libr,-trian--I Assoc. Dir. @Secretarv 3EC@.kRY Secretary- CoTm. Xeal-t"h Div. Assoc. Di r. I,iayo Asso!--. Dir. A# Coiii.iii,j-iiig Edu-c.'-' 'Reg. Lab. Facility @-Secre-'i.-ary C I :S OF LI L:'@, TH CATEGOID.ICAL DIS@ Fk.)@-CSSTtO@l'.LS INLirs 1 iiq Associations OL@ h:!,[, s 17 July 1969 VI. ORCtu'iizkT-IOIi ORGA[IIZAT'LON C!!ART 'S REGIO,'@IAL ik-1,EIITCAI. PRO(iRAi-i NORT[ILAi-'.O NINE lf!G ORGAtlIZ;IrIONS R.'-!P, l@1C. R"VGIONAI. ADVISO,')Y GROUP BOARD OF TRUSTEE I'@ (11 rl @l (9 Vot@ir:g Member PROGRt'%M Dl't'%FCTOR ,,EGIOTIAL @-IEDICP@i- PPOGP\Ai,l A.SSOCIAFE DIRECI'OL@ C 0 M.14 1'r S AT CE14TERS C-ETITRAL STAFF V!-: P% s -if y A,') I I 0 C r1,1, T'f ES 0 R i,l jL STAtiDl,'ICi Cu!!i- n,.VEI."#PI.ir-?IT 01: OPtl--',@AT@olll!.,'.L G,:,A,"i-i IIEART PERsorill CAti!CE.R t.: 0 1.1 I I! AI !,:I G ST IIOKR L COi@ITINUII@i&-@ -L 0 11 I", T I 0 N Src-RVICES 18 July .1969 TION: OMANIZ'ATION AND OPERATION CHART Central A@st arm of the Board of ration is the executive. @tees and the Regional Advisory Group. It es the opera- tiOnal and Planning Progr-am.(core activities). 2.. lihe Central St aff includes: a. Personnel for overall administration (1) coordinat ion, (2) fiscal nt, (3) carinunications b. Personnel to Support NRMP PersOnriel Operating in the Center (1) Educational Progr-am Development (headed by an MW Associate Director at the University of Mmesota) (2) Service Progr-am Development (headed bv an NW Associate Director at Mayo institutions) C. Persomel to develop' progr@ in eva for the W4p region. luation and data collection 3. The "Core Council" is a joint gement mechanism to coordinate and e the continued planning and development efforts of the Core CcMPonents. It is comprised of the Program Director, plus NRMP Associate Directors at Central Office, University and Mayo institutions. The MW Associate Directors at University and Mayo imtitutions are the pri-ri@ administrative directors for @ activities within'the respective institutions. Additionally, they are members of the Core Council for Joint management of Core activities. 19 July 1969 VII. OPERATIONAL PRojEcrs HISTORY .1. Core Projects Central Core: Reviewers thought tbLe core,staff request generally reasonable. The excep- tions included the assistant director of planning in 1969; medical directors for heart disease, cancer and stroke; the commercial artist and printer and the part-time directors of continuing education. Since it is unrealistic to expect to get quality people without university affiliation, the medical directors for the categorical diseases would be better utilized at the University. The regional coordinators would probably be better suited at the central level. Concomitant cuts were recommended in equipment and supplies. Reviewers also felt tbLat evaluation sblould be supervised by the central core staff, assisted by staff of the other institutions and outside consultants. Continuing evaluation should be established to provide indirection of the need for modifications in the project.% as they, progress The need is recognized for expertise in operations research, computers or biostatis-tics on the core staff in order to strengthen the systems analysis portions of the various biostatistician should be provided to projects,. but a job description for the insure his proper utilization. To keep the major institutions responsible to regional needs and interests, a strong core staff and central administration &blould be fos-tered. University of Minnesota Core: Perhaos earlier, the University- group was "center-oriented", but have evolved into one more education-oriented. The University's role is seen as more significant in the allied health sciences. Committee membership has been broadened to include allied health interests other than nursing. There appears a changing orientation of the Medical School from faculty "bench-type research." to more community contact. This institution apparently sees core staff as educators with a home base at the University and involved with the central office in a number of ways less than explicit. Again, the relationship of the core projects to the other contin- uing education projects and the need for three different "sets" of administra- tion,. including thirteen full-time people in the core alone is not easily answered. In order to strengthen the leadersMp and planning capability, reviewers recommend that a full-time professional person be employed who would be located in the Office of the Associate Dean but responsible in planning to the Program Director of NRMP. This person would be responsible for providing 20 July 1969 liaison between the ibiversity and central staff. The Program Director might have more planning responsibility. Reviewers objected to the use of funds in the "Other" category for services and consultation-from the Audiovisual Education Service, the Department of Radio and Television and the graphic and illustration services on campus on the basis that-this would allow the initiation of operational activities by the core sta ff without RAC approval. Reviewers were concerned also, that the School of Public Health was not represented and recommended its involvement, as well as the Schools of Dentistry, Nursing and the Clinical Department of the Medical School. In line with these concerns, it was recommended that personnel costs be ..reduced to $50,000, an amount which would enable the staff to develop a proposal which would indicate the planning directions the University would take. Mayo Core: Mayo sees its primary contribution to RNP in continuing education and improving health services, and will stimulate and carry out projects along this line. Reviewers.questioned the relationship of the Mayo core staff to the Mayo Clinic and RMP core staff. The Mayo core staff would be responsible to the central Mayo RMP committee, which is an arm of the Board of Governors of the Clinic, and not to the PbT central core staff. In order to @e this more responsive to the central staff, it is recommended that it be understood that in the area of planning, the Mayo personnel are responsible to the'Director of RMP. There were objections to the use of planning staff to initiate operational activities in the core portion without RAG approval. Because only three full-time associate directors were deemed sufficient, it was recommended that personnel costs and office equipment be reduced accordingly. American Rehabilitation Foundation Core: The Foundation's.function in RMP is to get at the distribution problem in the organization of rehabilitation services, and in the ceneral areas of 0 continuing education and training of personnel who provide such services. Reviewers questioned the necessity for the coordinator to have a separate office rather than be a member of the central core staff w-ttere more effective liaison might be maintained. There is also the danger that in establishing this separate core, a precedent iray be established for other voluntary health agencies. 21 1969 (I. Core Project discussed separately.) 2. MultidisciplinEy Improvement in Medical Care of Myocardial Infarc-. tion in Minnesota There was evidence of cooperative arrangements with hospital admin- istrators, nurses and practicing physicians, and the Heart Association. budget was realistic with no large equipment requests. Stipends were for subsistence which would not be paid unless the trainee must leave hon-e. The local hospitals would continue nurses' salaries. Besides training physicians and nurses and teaching the limitations of certain drugs, the project would engender enthusiasm among the hospitals ICCU team members. A recorrinended reduction was in the personnel category for lag in recruit- ment. Postgraduate Education in Pediatric Car-dio@ The aims: (1) to improve the effect of teaching methods by utilizing patient demonstrations, case conferences, exhibits, and fo--ml didactic lectures; (2).to improve cooperation in ostgraduate education; and (3) p to involve the physician in the co ty in pediatric cardiology. This last had been the most difficult to acc lish.- The eight Pediatric OMP Cardiology Clinics, already given, reached in a limited way the general- lst and internist in peripheral areas where there are no pediatricians. The prograTn is regional in character with evidence of planning and strengthened dialogue among the local doctors, nurses and welfare workers. The knerican Association of General Practice acce-,oted the program for continuing education credit. A su stion was for a program director at not less than half time. gge 4. A Collaborative Basic Regional Information Netviork for Education and Clinical h-valua-uion Applied to Coronary Artery Disease This project sou@t to develop a mathematical model of coronary artery disease to be used for clinical evaluation and comparison of a cardiac patient with a large number of other patients with the same diagnostic classification. The immediate value of this project might be to peripheral hospitals thro @ the personal c@tmnt and resources of ,the center., but the project appears weak and iginative. 14ore 3" consultation is recomded. This project -s still in the research phase, far from providing any direct help in the care of cardiac patients. RecoTmended: No funds for all years. -22 it4y 1969 Diabetes Regional Center This would extend an existing center to two hospitals (Methodist in Mimeapolis, and Miller in Saint Paul).. The program, already begun with experienced personnel, would require minimal funds for expansion. It could be a prototype for'education programs for patients with other chronic diseases. There was concern over the proportion of W funds (as they represent' the degree of commitment) to the total assets of the corporation. .Questioned was $4,000 in the "Other" category for tuition (80 in-service directors and students). These costs are said to represent the course costs., not per them living expenses. There was concern that much of the personnel costs of the two hospitals were charged to the grant. Therefore, funds for the Directors of Medical and Nursing Education and the Directors of the School of Nursing should be deleted. 6. Northlands Regional Service@iented Cancer RegistnL The purpose sought to assess the standard of care in order to improve it. This was a one-year request because the director-felt he would have difficulty getting approval for five years from local c@ttees which had expressed skepticism earlier a:oout the "systems approach." The community hospitals were to pay for the medical records technician. Personal follow-up by the project director of patients who have moved was questioned as to whether it is a realistic one. If ever resubmitted u ., the projec' should be rewritten as a three-year proposal with broader support and evidence of involvement beyond that of one man. Administration of the project by the central RMP office is inappropriate. It should be co-sponsored and perhaps located in the offices of some other service-oriented groups, such as the Minr@sota Chapter of the Cancer Society or the State Board of Health. There was concern over the amount of money requested. It was recomended that the project director consider demonstrating the effectiveness of the registry for only a limited number of types of tumors or in only a few counties on a pilot basis. Recamended: No funds for all years. 7. Improving Slu-roke Rehabilitation thro a Regional Pro@am of Continuing Education Concern was noted about the elaborate budgeting, particularly the laroe amount of staff requested and the per-student cost. Such &-i inter-si-v-- course for nurses and social workersv,,as believed unnecessary a 2,3 July 1969 with follow-up consultation for the participants shorter course Evaluation Cf the courses would be in order. The Might be preferable. and detection emphasis on rehabilitation, rather than On Prevention does not reflect priority setting, but rather that the resources in ready for the operational stage. The reccmen- rehabilitation are more dation., therefore, was to reduce the personnel to $50,000. 8. Pilot Program of Regional Postgraduate Medical Education There were questions raised about staffing. Because there has never really been any coordination of the postgraduate continuing education at Ma p, support for a full-time director Was requested Joint with FM-Mayo support. SoMe reVi--@T@l,s felt that this project could be co- ordinated out of Mayo pore staff. Tne alternative of sending Mayo representatives to the periphery may wax-rant an attempt after the pilot phase. Apparently physicians were interested. This was the subject of a questionnaire. Use of teaching cubicles was caimended. The project needed better evaluation and followup from its peers hospitals arid, the commmity. There should.be better region-wide coo "ion of all continuing education activities. 9. Postgraduate Education in Diseases of Cardiovascular and Nervous S ystem and Neoplastic Disease in ChildhocKi 'Ihis a continuing education project within the De-,oartment of Pediatrics of the University of I-limesota, would utilize faculty in the University Hospita7@. and others with which they are affiliated. Personnel costs based on the number of staff to be added to the University of Mimesota in order to replace the tJme of those involved in this project. NOTE: Final review yielded recamendation that neither Project 8 or 9 be funded. If they are resubndtted, there should be evid&nce of coordination of each with the other, with the continuing education programs at each institution and with the FVM Core Program. Allied health group -ient should be evidenced. In s Mayo and the involver University should work toward a joint proposal reflecting NR4P's over- all approach to continuing education. 10. Teleohone Dial Access Medical Library A revised budget, based on more realistic cost expenditures, which reflected the increased demand for the service, was subndtted to the site vi,5it tea'm at the time of the visit. It included an increase in the of -Une Wisconsin Recional Medical Proo?am; in the costs of shared costs the publishing brochures; the purchase of cartridges and --Ltidiotapes; tape production costs; studio recording service and the addition of an unlindted Band One for In-wide Area Telephone Service. 2 JVly 1969 @16. (Continued) This system, an extension of the'one in Wisconsin, would provide needed information and is in use by the physicians now. There is a possibility that two years of use may warrant establish@- a tape library in Minnesota, which will also take into account nursing and allied health needs. All tapes are reviewed at least annually and suggestions and evaluation concerning them will go before a special board canposed of representatives of Mayo, the University of Minnesota, the State Medical- Society, the Academy of General Practice and the practicing physicians. Reviewers felt this project was worthwhile and should be supported at the $29,000 level required in the revised budget. 11. -Ihe De-,.relop-,nent of a Stroke Rehabilitation cement Si-mlator The project would determine, by use of the simulator, if the patient will recover; how much he will recover and how soon. Although models can be of great value in assisting the physician to make a prognosis in the cormlex problems with which rehabilitation is concerned, the nature of this project was such that no imediafe benefits to patients could be visualized. Also, because the scientific mrit is weak, re- viewers reco@-nded no funds. Agencies which focus more on the research approach m-loit more appropriately be involved. Recmmnded: No funds. Forego@o- based on Review Cycle January-February 1969 APPENDIX -W FLOW PROJECT -as Su Sucji C-1 t n v o -ru.F.,,'4:ces Opel (4) felt!t le Holet EC)- Prior-ity to -):oj.,r;t ti-oiial f-.-c c- Dev T, -Lo.1 ol:y for P). y Appi:ove Re. c C, Group via p--og-ccss rr@,@