i                  1
                                                                   t
                                                                   @i   *f"l'          * t'@ #


                       AUTOMATED MULTIPHASIC HEALTH TESTING
                                     AND THE
                            REGIONAL MEDICAL PROGRAMS

             Introduction

             In November, 1970, the National Advisory Council requested
             that RMPS examine its activities in the area of automated
             multiphasic health testing (AMHT).  Accordingly, a subcommittee
             of the Council was formed, and the status  of  RMPS  supported
             AMHT projects was reviewed.  The observations of the sub-
             committee were presented in the  report  entitled,  "Automated
             Multiphasic Health Testing and the Regional Medical Programs  ,
             May 11, 1971.  The following conclusions were reached:
                 1.  RMPS supported projects had not been in operation
                     for a sufficient time to allow for an adequate evalu-
                     ation of their experience.

                 2.  Automated health testing is very costly.

                 3.  The influence of the projects on the regional
                     deployment and utilization of  health  care  resources
                     was highly unpredictable and its value remained
                     speculative.
                 4.  Many important questions pertaining to cost of the
                     systemsi proven health care benefits,  and  impact  on
                     existing health care delivery system remained unanswered.

             Council accepted the following recommendations:
                 1.  That no new projects featuring automated health
                     testing be funded.
                 2,. Inter-agency consultation and investigation be
                     instituted in or er  o--

                     a.  Provide market and financial analysis and advice
                         to avoid loss of postarant operations of projects.


                                        2

                     b. Build into RMP and other projects base line data,
                        defined goals, and measures of progress.
                     c. Utilize systems analysis and available epidemiologic
                        data to study the natural histories of diseases
                        and identify those for which secondary prevention
                        might be feasible and acceptable in cost.
                     d. Conduct multi-variate analyses of the results of
                        multiphasic testing.
            Subsequently, Council requested that RMPS acquire additional
            information concerning the status of twelve AMHT projects that
            had received RMPS funding.  Project directors were asked to
            submit progress reports for the year 1971.  In addition, the
            project directors and their representatives were invited to
            attend an RMPS hosted meeting in Rockville, Marylan  on
            March 8-9, 1972.  The specific objectives of this meeting
            included:
                1.   To identify data currently being collected by the
                     ongoing AMHT projects.
                2.   To determine parameters for use in the evaluation of
                     RMPS funded projects by a retrospective study, a
                     prospective study or both.
                3.   To determine the commonality of the data already
                     collected.
            The present report summarizes the conclusions reached at    this
            meeting.  The suggestions of the participants are presented,
            along with RMPS recommendations with respect to future RMPS
            involvement with AMHT projects.

                 of Data Currently Collected
            Selected information available from project progress reports
            is summarized and attached to this report.  There is a paucity
            of current data dealing with:


                                      3

                    a.  Actual cost per subject and per test procedure.

                    b.  Total cost of operation.
                    c.  Effects of test abnormalities upon overall costs.
                    d.  Related parameters necessary for detailed cost
                        analysis.
                    e.  Cost savings attributable to early disease detection.
                    f.  Valid indicators of AMHT influence on health status
                        of screenees.
                    g.  Measurements applicable for the determination of
                             influence on existing patterns of health care
                        delivery.
                    h.  Data concerning the value of AMHT as an effective
                        access point into the health care system.
                    i.  Data indicating that AMHT expands the capabilities
                        of health care providers.
                    j.  Data indicating the effects test results have on
                        medical care provider decisionmaking.
            The meeting participants expressed two general sentiments
            with respect to the absence of the above mentioned information.
            Firstly, the original project proposals did not address them-
            seves to these questions.  Primary attention had been directed
            towards establishing the feasibility of the AMHT concept;
            i.e., X number of people can be subjected to Y number of tests
            in a manner that is more efficie nt than encountered in existing
            practice.  All agreed that AMHT feasibility in this sense had
            been demonstrated.  Much less-attention had been given to
            problems related to the costs of and the usefulness of AMHT.
            They agreed that such information is indispensable for an
            adequate evaluation, and were unanimous in their desire to
            pursue this area of investigation.


                                      4

            The second general consensus of the project directors was
            that accurate parameters capable of measuring the usefulness
            of AMHTS, and their influence upon the health care system
            were lacking.  Though experimental evaluative models exist,
            their applicability was questioned. They agreed,  however,
            that acceptable criteria could be cooperatively formulated.

            Commonality of Data
            The project directors were unanimous in their agreement that
            a meaningful retrospective evaluation of the RMPS funded AMHT
            projects would be most difficult.  The major obstacle to such
            a task was the lack of commonality among the projects.  It
            was noted that the projects differed significantly with respect
            to:

                1.  doals and objectives.

                2.  Definition of terms and measurements.

                3.  Types of populations screened.

                4.  Mechanisms for entry into the system.

                5.  Variety of tests performed.

                6.  Differences in testing procedures.

                7.  Mechanisms of patient retesting and follow-up.

                8.  Referral patterns.

                9.  Linkages to health care'delivery systems.

                10. Variations in types of data collected.
            The magnitude of disagreement was exemplified by the inability
            of those present to establish an acceptable definition  of
            automated multiphasic health testing.  Furthermore, it was
            obvious that some of the projects went beyond the role  of
            disease detection, and engaged in patient evaluation,  and
            management.  It was the group's opinion, therefore, that
            retrospective and evaluation of the RMPS supported projects
            would be of little value.


                                       5

            Evaluative Process
            The need for, and the desirability of, an evaluation of AMHTs
            designed to answer questions related to cost effectiveness,
            influence on health status of participants, and compatibility
            with existing medical resources was, therefore, established.
            The project directors felt that such information could be
            obtained through a planned prospective study of RMPS supported
            programs.  It was proposed that:
               1.  An interconvertible data base, i.e., data obtainable
                   from and applicable to all projects, be derived.
               2.  A specific protocol for a prospective evaluation be
                   developed.
               3.  The protocol should include adequate and acceptable
                   definitions of all terms and measurements, standardiza-
                   tion of testing procedures, and delineation of quality
                   control mechanisms.
               4.  Participation in such an evaluation should be on a
                   voluntary basis.
            Project Directors' Recommendations to the National Advisory
            Council
            The participants recommended that no change be instituted
            with respect to the existing RMPS moratorium on funding new
            AMHT projects as demonstration or feasibility models.  They
            agreed that multiphasic health testing, as a process, was
            achievable.  However, many questions concerning its utility
            remain unanswered, including:  AMHT cost variables, its
            ability to integrate with and expand the capabilities of the
            current health care delivery system, and its influence on the
            health status of utilizers.


                                        6

            All future RMPS funding of AMHT projects should be directed
            at programs designed to examine evaluative and per ormance
            parameters so that the necessary information in the areas
            mentioned may be obtained.
            The group suggested that RMPS support a prospective study of
            currently funded RMPS AMHT projects to deal with the  questions
            raised.  It was felt that RMPS should assist in developing
            an evaluative methodology and apply it to AMHT projects  within
            RMPS. The potential for wider application of the  protocol  was
            recognized.

            RMPS Conclusions and Recommendations
            1.  Many of thelconcerns identified in the previous RMPS
                paper on AMHT systems persist.  Little is known about
                the total economy of AMHT systems, the influence of such
                programs on consumer systems, or their effects on  patterns
                of health care delivery.
            2.  Because of the potential costs of AMHT systems, both in
                terms of dollars, and in manpower, there exists a  pressing
                need to analyze in detail currently operating programs.
            3.  Such a study should be directed towards establishing the
                degree of usefulness of AMHT systems both with respect
                to subscriber benefit, and to their impact on utilization
                of health resources.
            4.  A protocol should be developed for the purpose of:
                a.  Standardization of terms, definitions, procedures
                    and measuremen s.

                b.  Collection of a common data base.
                c . Agreement on parameters capable of indicating the
                    effects of AMHTs in the areas mentioned.
                d.  Prospective evaluation of currently functioning
                    AMHT projects.


                                      7

           5.  Design and implemehtion of such a protocol should be a
               combined effort employing the resources of all interested
               Federal agencies including-NCHR&D, CHS, and NCHS, as well
               as RMPS.
           @6. RMPS funding of new AMHT projects in the absence of a plan
               for cooperative prospective evaluation is inappropriate
               at this time.  Furthermore, an evaluative study of existing
               projects must be limited to those which the appropriate
               Regional Advisory Groups are.willing to continue without
               supplementary funding.


         E,ML U iC A.N 1) U iVi
                                                           PUBI'TC
                                             HEALTII Sl;,I@VICES ANI) -NIENT,%L III",AI,Tll ADi\fINIS'I'RA'I'ION

                                                                DATE:  May  8,  1972
               @IPS Staff
               Dr. Gordon lIcLeod
               Director, IDIOS

     FRO',\l   Deputy Director, @IPS

     SUBJECT:  Materials for the June 5-6 Council Meeting

               For your information, Mr.  Kenneth Bat@ will be on annual leave
               for the next two weeks.  In his absence, Mrs. Eva Handal will
               be 'the contact point for preparing for the June Council meeting.
               Please give her your complete cooperation relative to the meeting.

               Materials to be Included  in the Council Books:
               Please provide to  Mrs. Handal,by close of business on May 15,
               80 copies of each  item, properly assembled and punched for  4
               3-ring notebooks.  'Materials not available at that time cannot
               be included in the Agenda books which are to  be  mailed  to  Council
               members in advance  of the meetina.  Any item which is not available
               by May 15 shoulu' be supplied to       Handal as soon  thereafter  as
               possible for inclusion in 'the folders provided at  the  meeting  for
               staff and Council use.

                         From Mr. Peterson

                         Evaluation Plan for FY 1973
                         Grantee-RAG-Coordinator Relationship Statement

                         From Nlr. Robins

                         I-atersociety CoT=ission Report

                         From Mr. Croft

                         Contract Proposals FY- 1972,

                         From Dr. Hinman

                         Multiphasic Health Testing


                                               2

                         From Mr. Gardell

                         Discretionary Authority of IUIPS

                         From Dr. @IcLc..od  tu@40s)

                         Sin-mnary of MIOS reviex,7 process

                If you have any questions, please let me knoig.

                                                    Ilerbert B. Pahl, Ph.D.


                                       RMPS CONFERENCE ON    VITIES
                              MULTIPHASIC HEALTH TESTING ACTI

                                         CAPSULE SUMMARY

               Region:  California  Area III
               Project #46:  Multiphasic                     and Rural
                             Poor in San Joaquin Couiit-v
               Prepared by:  Virgil J. Gianelli, M.D. - March 8, 1972-

               The screening programs administered by Health Facilities Foundation,
               including the San Joaquin "Health Check-up," are somewhat unique in
               their emphasis on measured participation. Most  screening  programs
               report participation in terms of so many people per day, week or
               month. -Our interest is in the number of persons screened out of  a
               given population:  a cannery, Indian reservation, or (as in the case
               of San Joaquin) a given census tract.
               Experience has shown that multiphasic screening as a part of the daily
               operation of a clinic or hospital, does not achieve a verv high Dercen+,--
               age of participation.  This is not to say that screening should not be
               done in a permanent setting, but rather that the emphasis is then dif-
               ferent.  In a fixed, daily setting, the advantages of multiphasic
               screening relate primarily to the automation aspects; saving the time
               of the physician, etc. Most of the examinees are persons  who  have
               come to the clinic or hospital for a reason other than a periodic check-
               up.  The mobile setting, however, permits a screening program to move
               deep into the neighborhood areas, emphasizing case-finding and the pre-
               ventive aspects of screening.
               The San Joaquin program thus takes advantage of the fact that it is
               only in the community for a few weeks; but during those weeks a great
               deal of effort is placed on involving.as many people as possible in
               each census tract.  The annual "health fair" notion simply attracts
               more people to preventive care-than an on-going screening  service.
               High participation (limited only in San Joaquin by the funding available)
               makes it possible to develop a significant "health profile" and data
               bank for the community, valuable not only in determine the priority of
               health needs., but also in defining the population for health maintenance
               organization purposes.


              Page 2   Capsule Summary/California

              Concentrated, mobile screening does not mean that the community is
              ignored the rest of the year.  In San Joaquin, the screening program
              initiated and supported the development of a Consumer Health Council
              (year around), promoted the growth of one neighborhood clinic (now
              in its third year), and the imminent development of two additional
              clinics.  Manpower-training, information and referral, and consumer
              advocacy have become established in the community.


                                       P,IIPS CONFERENCE ON
                              14ULTIPHASIC IIEALTH TESTING ACTIVITIES

                                         CAPSULE S@MRY

              Region:  Florida

              Project #I:  Community Multitest Health Screening Center
              Prepared by:  Ewen M. Clark, M.D.  - March 8, 1972

              The Gainesville *IHT Center performs a standard series of  tests; only
              minor changes have been made since the original selection was made.
              The unique feature of the Center is ha ving the majority of tests on-
              line to the computer, resulting in three major benefits:

                   1.  Minimal data transcrip tion error
                   2.  Rapidity of report generation
                   3.  Great reduction in personnel operation costs
              In retrospect, both strengths and problems in the development of the
              program are evident. Included in the strengths are  a  detailed  descript-
              ion of +-he Center's operating capabilities and performance.  Descriptions
              of the systems response to stress loadings, instrument and computer fail-
              ure resulting in an actual back-up system.  Precise validation of test
              instrument accuracy, reproducibility, standardization and calibration
              have resulted in a hiah level quality control program to  insure  adequate
              instrument and system performance.
              In regard to problem areas, many have been encountered, some have been
              solved and the solution to others sought.  Almost all problems  stem  from
              the difficulty of integrating the AMHT system into the general health
              delivery system.  These problems fall into three general categories:
                   1.  Conservative attitude of physicians and health administrators
                   2.  Lack of common medical record system
                   3.  Equivocation by 3rd party payers
              These considerations have led to a shift in emphasis of goal  setting  and
              priorities for attempting to achieve these goals.


             Page 2   Capsule Summary/Florida

             Since completion of the granting period, the financial status of the
             Center is precarious.  However, it appears that the patient load is
             adequate for the project to be self-supporting.  We have a flow of
             patients which includes referrals from scheduled hospital admissions,
             migrant health programs ( grant supported), city employee health
             program and outpatients referred by private physicians and the rural
             community health clinics.  We anticipate a slow but steady increase
             in patient flow from these sources as the program continues to become
             more fully integrated into the existing delivery system.  The inte-
             grative process with the rural community health clinics is occurring
             quite rapidly due to the introduction of a medical record.system
             totally compatible with the clinic and the AMHT Center.


                                        RMPS CONFERENCE ON
                              MULTIPHASIC.IIEALTH TESTING ACTIVITIES

                                          CAPSULE SUMMARY

               Region:  Illinois
               Project #2:  Multiphasic Screening in Chicago Area Industrial
                            Plants to Detect Coronarv Prone Persons  and  Individuals
                           with Sub-Clinical Heart Disease

               Prepared by:  James Schoenberger, M.D.

               Approximately 32,000 individuals have been screened since  the  program
               started in November, 1967. The feasibility  of  multiphasic  screening
               in Industry has been established and the efficiency of  the  procedure
               has been improved by automation of data handling, etc.  At  the  present
               time, 46-50 individuals can be screened by a four-person team at a real
               cost of $14 per screening. Intensive follow-up by letter  and  phone  call
               has been developed in order to accomplish maximal referral of  those  at
               risk to medical care. In the final year of  @  support,  the  project  has
               two objectives:
                    1.  evaluation of the impact of screening and referral on risk
                        status by a large scale re-screening examination
          r         2. investigation of alternate sources of  financial  support  for
                        continuation of screening activity
               The screening examination was designed to identify those  at  increased
               risk of developing coronary heart disease, as well as those  with  sub-
               clinical disease, by assessment of : (1)  relative  weight,  (2)  supine
               blood pressure, (3) electrocardiogram,(4) serum cholesterol,  (5)  serum
               uric acid, (6) plasma glucose one hour after a 50 gm. ural  load  and,
               (7) cigarette smoking status.
               Analysis'of the data in the first 22,929 screening examinations reveals
               a high yield of (1) previously undetected hypertension, hypercholesterol--
               emia, hyperglycemia and abnormal electrocardiogram, (2)  a  significant
               yield of those with multiple risk factors and hence at high  risk  for
               CHD, (3) generally poor control of major disease problems such  as  hyper-
               tension. Preliminary evaluation of follow-up indicates  that  over  50%
               of those referred do actually see a physician; analysis of  actions  taken
               by the physician are currently underway.


                                       RMPS CONFERENCE ON
                             MULTIPIIASIC HEALTH TESTING ACTIVITIES

                                         CAPSUTE SLZMARY

              Region:  Intermountain

              Project #26:  Health Information Testing Center
                           Demonstration Project in Multiphasic Screening

              Prepared by:  Mr. Ray Miller  -  March .8, 1972

              The Intermountain Regional Medical Programs proposal for a multiphasic
              screening project was the last to be funded - September 1970.  The
              target date for initial operation is March 18, 1972.  In implementing
              the project, the task.is to develop an automated MPS instead of a
              "turn-key" operation. Characteristics of the project follow:
                   1.  Potential Population:  M.D. referral basis only

                            a.  Private sector
                            b.  Employer and  labor  groups
                            C.  Neighborhood Health Center - socioeconomic disad-
                                vantaged
                            d.  ACF from the medical center

                   2.   Stand alone unit - capable of testing 20,000 per year.
                        Area occupied = 7,500 square  feet.
                   3.   Medical Assistants, with minimal medical background,have been
                        trained to conduct all of the tests offered at the center.
                        Each medical assistant spends approximately 2 weeks in a
                        physician'-- office learning how to conduct individual tests,
                        i.e. 2 weeks pap smears, laboratory, dental, etc.

                   4.  "Automated on-Line Tests"         "Mannual"

                        EKG                               mammography
                        Blood Pressure                    Chest x-ray
                        Spirometry                        Panorex
                        Height/Weight                     Oral Cavity
                        History                           Laboratory
                                                           (28 Chem., 6 hematology,
                                                            urine, VDRL)
                                                          Pap smear
                                                          Instruction on self-breast exam.
                                                          Vision acuity
                                                          Tonometry
                                                          Audiometry


             Page 2 - Capsule Summary/Intermountain

                  5.   Consultant Services - X-ray, laboratory, mammography.
                       The information is picked up daily at 5:00 p.m. and returned
                       by 12 noon the next day.  This profile is then sent to the
                       referring physician - within 24 hours after the patient's
                       visit to the Center.

                   6.  Establishing a base for a Data Collection Program and also an
                       evaluation program to answer specific questions relative to
                       morbidity, reduction in time required by physicians, use of
                       outpatient services, hospital admissions   length of stay, etc.


                                       RMPS CONFERINCE ON
                             MULTIPHASIC HEALTH TESTING ACTIVITIES

                                         CAPSULF, SIDMRY

              Region:  Maryland
              Project #44:  Comprehensive Screening Program for School-Age
                            Indigent Children
              Prepared by:  Oscar C. Stine, M.D. -  March 8, 1972

              We have developed and tested a multiphasic health screening program
              for school-age children in low income neighborhoods, who are  eligible
              for a health maintenance organization.  The program offers a way for
              children to enter the health care system to achieve a designation  as:
              (1)  well child with all needed immunization (2)  well child treated
              for a correctable problem (3) child with a defined  problem  receiving
              long term care.

              The characteristics of the program include: (1)  integration  of  screen-
              ing activities in terms of staff and information system into an  existing
              health maintenance organization (2)  reduction of physician time to
              problem definition, diagnosis, decision making, treatment and referral
              (3) anticipation of need for diagnostic tests (4) calculation  of  the
              child's risk of developmental failure by discriminant analysis of  multi-
              ple parameters (5) calculation of excess frequency of  disease  requiring
              program development by the health maintenance organization.
              The program obtained cooperation of the schools, parents and children.
              It designated important proportions of children in need of services by
              nutrition.,- social work, psychological and long term medical supervision
              within the organization.


                                        RMPS CONFERENCE ON
                               MULTIPIIASIC-HEALTH TESTING ACTIVITIES

                                          CAPSULE S@RY

               Region:  Memphis
               Project #17:  Prevention Clinic - Demonstration  Program in Preventive
                             Services for Heart Disease, Cancer, Stroke and Related
                             Diseases
               Prepared by:  Dean F. Davies:, M.D.  - March 8, 1972

               The Prevention Clinic at the University of  Tennessee  Medica   Center
               has several objectives including preventive services  to  its  largely
               low-income and indigent clientele; demonstration  and  evaluation  of
               the components of 8 chronic disease detection program; establishment
               of a health data base for clientele; reduction of  costs  of  medical
               care; extension of the effectiveness of health  care  without  increasing
               physician shortage; and others.
               The Clinic served 10,000 plus persons during the  calendar  year  1971
               and ant4-cipatcs levelling off at 18-20,.OOO registrants.  Unique
               features of the Clinic include avoidance of over-refertal through
               secondary testing; a problem directed print-out  coded  by    nc
               indicated action and health index; and a  seperate  health maintenance
               clinic.
               Cost experience was examined  for nine procedures  carried out for  a
               full year and an additional six (20 tests) for part  of  a year.   Equip-
               ment was amortized. Contributions of  non-RMP  costs  were included except
               that no arbitrary cost was assigned to rental of  space  ( an  in-kind
               contribution for emoloyee screening); for hidden costs  of  some  follow-
               up services of health department; or for  indirect  costs.  On this basis
               the cost per person registered was $8.68 for  measurable  costs.  A  more
               reasonable estimate for the full complement of  tests,  allowing  for
               hidden expenses is roughly $20.  Automation and a higher flow rate will
               keep this stable.
               Among on-going evaluations is one which examined reasons for attendance
               and non-attendance of the Clinic by recipients of public welfare. 'the
               study was made by interview.  Preliminary results showed that a high
               level of acceptability was found among those who had attended the clinic,
               a finding consistent with the experience in rural northeast Mississippi.


              Page 2   Capsule Sunnary/Memphis

              Obesity, hypertension, iron-deficiency anemia, diabetes and hyper-
              cholesterolemia are among the most common conditions found, all of
              them controllable and insidious in onset.  Five of the six are high
              risk factors for cardiovascular accidents.


                                       RMPS CONFERENCE ON
                              MULTIPHASIC HEALTH TESTING ACTIVITIES

                                         CAPSULE SLZTIARY

              Region:  Memphis

                                                                 North,-E
              Project #18:  Mobile Multiphasic Health Screening',       ast Mississippi

              Prepared by:  Harry Cosby, Jr., M.D. -  March 8, 1972

              The purpose of this project is to upgrade the health of the people  by
              detecting disease and disease prone persons and to create health  aware-
              ness so that medical care will be sought.

              The rationale and aims of the mobile health trailer are similar but  not
              identical to those of the Prevention Clinics of the City of Memphis
              Hospitals.  For comparative and evaluative purposes the tests and pro-
              cedures will be the same as those carried out in the Prevention  Clinic;
              the same methods and quality control systems being used as this is
              essentially a field project prototype for mobile health clincics to be
              established in other parts of the region.

              The main differences will be the mobility of the Clinic and the pop-
              ulation served. Because of the rural distribution of  the  population,
              the trailer will stay a minimum of one week in a single location,  the
          r   duration depending on the population density.  The entire adult pop-
              ulation of the medical trade areas of the applicant hospitals will  be
              served with no financial restrictions.  The design of the trailer allows
              for 100 or more persons to be screened per day and it is anticipated that
              20,000 persons can be screened each year.
              The services provided on the trailer will include a questionnaire  and
              measurements of height, weight and blood pressure, chest x-ray, electro-
              cardiogram, spirometry, cervical and vaginal cytology, urinalysis, blood
              chemistries, white blood count, hematocrit, hemoglobin  electrophoresis,
              tonometty, instruction in breast self-examination, and health information.
              Tests for occult blood in stool will be carried out with consent of  the
              client.


               Page 2 - Capsule Summary/Memphis, No. East Miss.

               We are obtaining increased  '(1) health awareness, and in (2)  inventory
               of chronic disease.  Our screening unit has been able to act as a catalyst
               to obtain EEA funds for our county, in which we have one registered nurse
               and one LPN in our county schools daily discussing and teaching health and
               behavior patterns. We have been able to aid in  the  founding  of  State
               Comprehensive Health Planning for our designated counties and have assist-
               ted the Appalachian Committee in developing Health Services for Child-
               hood Growth and Development.Project.  Our Tishomingo County Health
               Department Building is being expanded, and the staff  has  increased  by
               one health nurse, one assistant sanatarian and one clerk,  which  is  an
               increase of one hundred percent in staff.  All  physicians  of  Tishomingo
               County are actively involved with the Health  Department  Family  Planning
               Program, and serve weekly terms in rotation.
               We believe that the multiphasic testing has created a  large  amount  of
               interest in health awareness and chronic disease maintenance, by the fact
               that the first year's testing was accomplished on 11,544  persons  out  of
               a population of 15,000 in our county. These  were  voluntary  patients  as
               our target area is not a close  group.


                                       RMPS CONFERENCE-ON
                                                    TING ACTIVITIES
                              MULTIPHASIC HEALTH TES

                                         CAPSUIE SUMMARY

               Region:  North Carolina
               Project #35:  Adult Screening and Referral Program for Signs
                            7f Hypertension, Heart Disease, Possible Impending
                            Stroke, Diabetes and Anemia
               Prepared by:  Robert N. Headley, M.D.  -  March 8, 1972

               The Adult Screening and Referral Program of the North Carolina Regional
               Medical Program commenced actual testing on January 21, 1972 in indus-
               trial sites.  The tests being administered are:  (1) Single lead electro-
               cardiogram (Electrocardiometer) (2) Blood su-ar (Dextrostix) (3) Hema-
               tocrit (M@icrocentrifuge) (4) Arterial blood pressure (Roche automated
               unit) and (5) Auscultation for carotid bruit (Questionnaire and Phono-
               cardioscan).  The tests were specifically chosen to provide a high
               yield of indicators of potential disease states which may be amenable
               to therapeutic intervention.  Non-paid volunteers are utilized to conduct
               the testing and provide follow-up which effectively reduces the unit cost
               and spares valuable professional effort.
               As of February 29, 1972, 2,903 people have been screened and of this
               number, 1,063 were referred for further evaluation.- Preliminary re-
               sponses indicate physician confirmation of the abnormality in 40% of
               referrals. Hypertension, abnormal electrocardiogram and anemia  were
               the most frequent basis for referral.
               On March 20, 1972,screening will begin in the inner city area of Forsyth
               County (predominantly indigent black).  The activity will shift to a rural
               area of the County in mid May, 1972.  It is anticipated that the current
               rate of screening will continue, i.e. 100-175 screened per 5 hour period
               time required for each screenee is 15 minutes.


                                       RMPS CONFERENCE ON
                              MnTIPIL4SIC HEALTH TESTING ACTIVITIES

                                         CAPSULE SUMMARY

              R6gion:  Ohio Valley

              Project #7:  Multiphasic Screening Demonstration Project

              Prepared by:  George F. Shields, M.D.

              This is a cooperative program between Good Samaritan Hospital and
              Cincinnati General Hospital. The Good Samaritan unit  was  established
              in the latter half of 1970 and has served as a system design  and  train-
              ing base for the Cincinnati General Hospital unit.

              Good Samaritan began operation in August, 1970 and screened at  the  rate
              of 20 per day, (5,000 per year) during 1971. In  the  morning,  referrals
              from private physicians, neighborhood health clinics, inner-city  high
              school students and hospital employees were screened.  In the afternoon,.
              the unit performed pre-admission tests for scheduled elective adult
              admissions.

              Since expiration of RMP funding in December, 1971, the GSH unit has
              become self-supporting at a price of $29 for the standard battery of
              tests. Other tests may be added. A variety of  medical  histories  are
              being formulated so that the testing may fit a number of  needs.  Pre-
              admission testing, offered on an individualized basis, has resulted
                                                                                   i ol
              length of stay an average of 10 days for neurological patients and  fr
              one to three days for medical admissions.  The program also has helped
              pinpoint ways in which quality control of automated  laboratory  services
              could be strengthened and has been one of the factors  precipitating  the
              laboratory computer system now being installed.

              The Cincinnati General Hospital MHT trained at GSH for two months  and
              then began receiving patients at CGH in April, 1971.  After  operating
              well below capacity during the summer, patient flow rates  have  improved
              and 1.,200 patients were tested during 1971. It is planned that  the  CGH
              unit will become self-supporting during the fall of 1972.  New  clinic
              patients, specialty clinic referrals and referrals of chronic patients
              for periodic review are the groups served at CGH.  High  school  students
              and employees are also referred for testing.


                                       RMPS CONFERENCE-ON
                                                     TING ACTIVITIES
                              MULTIPHASIC HEALTH TES

                                         CAPSULE SUMMARY

               Region:  Rochester

               Project #7:  Early Disease Detection Unit
               Prepared by:  Barbara Bates, M.D.  -  March 8, 1972

               The Early Disease Detection Unit, funded by the Rochester Regional
               Medical Program, is based half-time at the university hospital and
               operates satellite visits one or two half days per week in 2  neigh-
               borhood health centers and one community hospital. Access  is  by
               physician referral.  When screening was fully grant supported, the
               unit saw 800 patients per month and had developed a 3 month  waiting
               list. At a charge of $35, it is down to 200 patients  per  month.

               Evaluation studies support the following conclusions:
                    1.  The most important reason underlying M.D. reluctance  to
                        order a screening test is lack'of clinical signs or symptoms.
                    2.  Most M.D.,'s, most of the time, ignore most of the reported
                        abnormalities.  This pattern does not seem to be highly cor-
                        related with M.D. specialty, age, type of practice or  a
                        number of patient variables e.g. age, sex, race, socioeconomic
                        status. Eventual impact upon morbidity and mortality, although
                        not documented, must be correspondingly low.
                    3.  Screening and clinical evaluation by a physician pick up dif-
                        ferent kinds of problems:  there is only a 17% overlap in
                        problems identified by the 2 systems. Hence  screening  and
                        traditional medical evaluation are not readily interchangeable.

                    4.  Patient satisfaction is high.

               Our greatest present problem is economic. An  undocumented  but  reasonably
               educated guess related to factors involved is stated as  follows:  As  long
               as the patient must pay $35 for screening, the patient would just  as  soon
               pay the M.D., especially if he has to see him anyhow; the M.D.  would  just
               as soon collect the money himself.


                                        RMPS CONFERENCE ON
                              MULTIPHASIC HEALTH TESTING ACTIVITIES

                                          CAPSUIE SMIARY

              Region:  Tennessee Mid South

              Project Y@ 28:  Meharry Multiphasic Health Testing Service

              Prepared by:  Leonard B. Victor, M.D. -  March 8, 1972

              The Meharry Automated Multiphasic Health Testing Service  is  primarily
              aimed at the urban disadvantaged but is not.geographically limited.
              About 85% are black, 2/3 women, age 18 and over.  The daily rate averages
              25, and the project has been in operation for approximately l-,  years.

              Approximately 53 tests/procedures are commonly administered, and-the
              results entered on mark sense cards for batch computer processing; the
              print-out and ori-inal data (i@TS keeps a microfilm record) are then
              in the referring M.D. or clinic office within 5 working days.

              Patients are referred primarily by the OEO neighborhood health center,
              .the Comprehensive Health Service Clinics, who reimburse under contract.
              Private M.D. referrals are charged the estimated operating cost of $35,
              which is invariably not reimbursed b
                                                   y insurers,

              Recruitment has been carried on by television, radio, fliers and community
              health aides.  State and local health officials, M.D.'s families and
              community leaders are invited to come through free.

              The follow-up is over a 36 week period by letter and phone to  try  and
              be sure that the patient is not lost to the health system of  the  com-
              munity.

              A good many questions have been raised, among these are:

                      data validity
                      intercomparibility of data in the patient record
                      medical record linkage
                      ranges (peer group)