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                                                                                                                                                                                                                                                                                                                                            VP


                                                                                  The theme of this  year's  Annual  Report  is  best
                                                                               reflected by the word CHANGE.

                                                                                  By  nature,  Regional  Medical  Programs  are  con-
                                                                               stantly  changing  to  meet  the  challenges  of   new
                                                                               goals, directions and new ideas.

                                                                                  The  year  of  1972  has  seen  some  of  the  most
                                                                               dramatic changes in the  history  of  the  Lakes  Area
                                                                               Regional Medical Program, Inc.

                                                                                  The  CHANGES  have   strengthened   the   structure
                                                                               and operation of the  program.  It  has  meant  "quick
                                                                               response" in dealing  with  recommendations  suggested
                                                                               by a federal site visit team as well as  changing  the
                                                                               emphasis  from  heart  disease,  cancer   and   stroke
                                                                               activities to a more inclusive area  of  activity  and
                                                                               interests as they relate to improving the quality  and
                                                                               availability of health care to all residents in the region.

                                                                                  The  ability  and  attitude  toward   meeting   the
                                                                               responsibilities of these changes is  a  fine  example
                                                                               of  the  dedication  and  efforts  put  forth  by  the
                                                                               volunteers and  staff  who  make  up  the  Lakes  Area
                                                                               Regional Medical Program, Inc.


                                     Among the many letters of protest sent to legislators and the President by those associated with the
                                             egional Medical Program, Inc. concerning the Administrations order to phase out Regional
                                Lakes Area R
                                Medical Programs, is a communication from Dr. Irwin Felsen, President of the Lakes Area Regional
                                Advisory Group, Inc.

                                     Part of the letter follows:


                    Dear Mr. President:
                         Unfortunately the results of the endeavors of health programs  cannot  simply  or  clearly
                    be evaluated in terms of "output" measurements.
                         In regard to Regional Medical  Programs,  much  confusion  has  surrounded  its  evaluated
                    success.  Unfortunately,  the  old  metaphor  of  "comparing  apples  and   oranges"   emerges.
                    It would be impossible to evaluate each  R.M.P.  program  and  its  projects  through  a  rigid
                    field study design.
                         The  fact  remains  that  R.M.P.'s  have  focused  on  changing   "process".   Few   would
                    disagree that the health advances of the "ivory tower" were not finding  their  way  to  remote
                    communities. Few  would  disagree  that  health  care  delivery  was  duplicative,  fragmented,
                    and inefficient. Few would disagree  that  most  health  providers  jealously  protected  their
                    domains.  Few  would  disagree  that  many  communities  were   without   many   basic   health
                    services. Health power figures had no political force to serve as an  /.ncentive   for    communl.-
                    cation, cooperation, and action. R.M.P.  provided  this  force.  With  its  meager  budget,  it
                    could not singlehandedly erase a generation of inefficient  and  ineffective  health  delivery.
                    It could not simply provide direct services for those communities without them.  It
                    no authority to force "power figure" to do anything.
                         However, it was an incentive,  a  monetary-social  force  that  stirred  health  political
                    figures into action. The medical schools listened  to  the  consumer  from  the  remote  commu-
                    nity. The practicing surgeon listened to the  social  scientist  from  the  university.  "Ivory
                    tower" virologists instructed practical nurses in the rural  areas.  Top  internists  consulted
                    with generalists. It was a force for social  change.  It  was  not  the  ultimate  answer,  but
                    certainly a force more responsive than the hackneyed state  and  local  political  institutions
                    that have proven their impotence in regard to  bringing  about  social  change  in  the  health
                    field. To dismantle this force appears unconscionable. What will take  its  place?  Traditional
                    political institutions? Doubtful, such institutions have proven  their  ineptness  in  bringing
                    about  such  change.  They  are  plagued  with   more   pressing   problems-housing,   welfare,
                    schooling. Even with new revenues, the basic  political  structures  and  institutions  do  not
                    change.
                         There is no way to "prove" that  R.M.P.'s  efforts  in  promoting  coordination,  coopera-
                    tion and actions by health power forces has  resulted  in  any  "output  gains"  One  can  show
                    progress  in  reducing  fragmentation,  duplication  and  inefficiency.  One  can  show   input
                    by consumers in the decision-making progress.  Do  these  actions  result  in  "output  gains'.
                    e-g-, has health status been improved? However, it  appears  that  such  actions  and  coopera-
                    tion is organizationally logical. Perhaps, we should be compelled to use the least used of  all
                    senses to answer this question-common sense.

                                                                Sincerely yours,

                                                                Presiden t
                                                                Lakes Area Regional Advisory Group, Inc.


                                                    a word from the ... EXECUTIVE DIRECTOR

                                                       The future of the  Lakes  Area  Regional  Medical  Program,
                                                    Inc. is threatened  by  the  current  crisis  in  health  care
                                                    legislation. Caught in a struggle between the Legislative  and
                                                    Executive  branches  of  our  government,   regional   medical
                                                    programs have come  under  scrutiny  by  our  lawmakers.  This
                                                    scrutiny has  revealed  what  we  have  known  all  along-that
                                                    regional medical programs have created  an  effective  process
                                                    which enables  those  mandated  and  professionally  competent
                                                    to develop and  implement  health  care  services-to  do  this
                                                    and disseminate their product to the  profit  of  the  public.

                                                                                   John R. F. lngall, M.D.
                                                                                   Executive Director
                                                                                   Lakes Area Regional Medical
                                                                                     Program, Inc.

                                                                   iv


                                   A

                                                                                                                                      Page

                          THEME                            .........................................................................
                             Dr. Felsen's Letter to the President                  .................................................
                             A Word f rom th e E xecu tive D i rector                 ................................................   iv
                          HISTORY OF RMP'S      ......................................            -         ........................     1
                             The  Grantee   Institution ...........................................................                      1
                             The Enabling Role                       ...............................................................     2
                          REGIONAL ADVISORY GROUP             .....................................................                      2
                             Board  of  Directors  List ...........................................................                      4
                          CANCER       RELATED       ACTIVITIES                  ....................................................    9
                             Tumor Registry  ................      ;                ................................................     9
                             Cancer  Teaching   Days  .............................................................                      9
                          LAKES AREA REGIONAL MEDICAL PROGRAM, INC. GOALS AND OBJECTIVES                                ............     10
                          LAKES AREA REGIONAL MEDICAL PROGRAM, INC. STATEMENT OF
                          REVENUES, EXPENDITURES, ENCUMBRANCES AND FUND BALANCES                                 ................... 12,13
                          PROGRAM             COMMITTEE ...........................................................                      14
                          OPERATIONAL PROJECTS                             .........................................................     15
                          DEVELOPING A GRANT PROPOSAL                              .................................................     23
                             Proposal  Review   Process                    ..........................................................    24
                          EVALUATION       ...........................        I             ........................................     25
                             Evaluation     Workshop .............................                     ...............................   25
                          STATUS      OF      PROPOSALS                    ..........................................................    27
                             Proposals Submitted to Washington                     .................................................     28
                          PROGRAMS IN CONTINUING EDUCATION - 1972                             ......................................     29
                          EMERGENCY MEDICAL SERVICES SYSTEM                               ..........................................     31
                             Emergency Medical Services Workshop                     ...............................................     31
                          INNER CITY HEALTH PROBLEMS                              ..................................................     31
                          LAKE AREA HEALTH EDUCATION CENTER                                .........................................     32
                          ALLEGANY COUNTY MOBILE HEALTH UNIT                               .........................................     33
                          RURAL EXTERNSHIP PROGRAM                               ...................................................     34
                                                                                                                                         35
                          LIBRARY PROGRAM          .............................................................
                                                                                                                                         35
                             Hospital Library Consultation Service  ..............................................
                          COMMUNICATIONS                             ...............................................................     35
                          VOLUNTEER'S              CONTRIBUTION                  ....................................................    36
                          LAKES AREA REGIONAL MEDICAL PROGRAM, INC                               ...................................     37
                             Professional and Support Staff   .....................................................                      37
                                                                                                                                         38
                             Project Personnel ..............................................................

                                                                                 v


                            Figure                                                                                                   Page

                            1   Counties That Make Up the Map of The Lakes Area Regional Medical Program, Inc           ........      vii
                            2   Composition of the Board of Directors of the Lakes Area Regional Advisory Group, Inc.                   3
                            3   List of Board of Directors - Lakes Area Regional Advisory Group, Inc   .       .................        4
                            4   Lakes Area Regional Medical Program,    lnc.'s Goals and Objectives         ....................      10
                            5   Lakes Area Regional Medical Program,    Inc. Statement of Revenues, Expenditures,
                                Encumbrances and Fund Balances                    ..............................................  12, 13
                            6   Proposal Review Process                    .....................................................      24
                            7   Status of Proposals                    .........................................................      27
                            8   Proposals Submitted to Washington                   ............................................      28
                            9   Programs in Continuing Education - 1972                 ........................................      29
                            10  Volunteer's Contribution                    ....................................................      36

                                                                              vi


                                                                                                                                FIGURE 1

                                                                                                The Lakes Area Regional Medical Program, Inc.  Area
                                                                                                  The  LARMP  is one of 56 federally funded,
                                                                                                                                                      locally
                                                                                                controlled programs in the  United  States.  The  Lakes  Area
                                                                                                Regional Medical Program, Inc. is made up of  nine  counties:
                                                                                                Niagara, Genesee,  Erie,  Wyoming,  Chautauqua,  Cattaraugus,
                                                                                                and Allegany  in  Western  New  York,  and  Erie  and  McKean
                                                                                                counties in Northwestern Pennsylvania.     It covers an  area
                                                                                                of 7100 square miles with a population     of   approximately
                                                                                                2,020,000 According to the 1.970 census.

                                                                                         vii


                     HISTORY OF RMP'S                                                    Focus Changes

                                                                                               During   1972   the    emphasis    of    RMP's    has
                                                                                         expanded  from  projects  dealing  with  specific  diseases
                     Legislation                                                         to regional  programs  benefiting  entire  health  systems.
                           Regional   Medical   Programs   began   in    October               Noting  the  importance  of  close  coordination   of
                     1965   under   Public   Law    89-239.    Originally    the         activities  with  other  groups,  RMP's  have   worked   in
                     legislation   was   concerned    almost    entirely    with         concert     with     areawide     Comprehensive      Health
                     specific diseases  -  heart  disease,  cancer  and  stroke.         Planning agencies  as  well  as  other  local,  state,  and
                     Kidney  disease  was  later   added   by   legislation   in         regional  groups  in  planning  activities   that   achieve
                     October,  1970  under  Public  Law   91-515.   RMP's   were         RMP goals and avoid duplication of efforts.
                     urged to speed application of  research  to  the  patient's
                     bedside.                                                            The Grantee Institution

                           Since  signing  of  the  law,  56  Regional   Medical               The  Board   of   Directors   of   the   Lakes   Area
                     Programs    have    emerged    as    autonomous     regions         Regional  Medical  P  rogram,  Inc.  was   established   in
                     covering the United  States,  Puerto  Rico  and  the  Trust         February,   1972    to    assume    functions    previously
                     Territories.  The  56  programs  vary  in  population   and         performed  by  the  Research  Foundation   of   the   State
                     size - 33 programs  cover  entire  states,  four  encompass         University of New York.
                     two or more states, 1 1 are parts  of  single  states,  and
                     eight are parts of two or more states.                                    As  the  grantee   institution,   the   LARMP   Board
                                                                                         of  Directors  receives,  administers,  and  accounts   for
                     Regional Medical Program.Purposes                                   Federal  grant  funds  in   a   manner   which   implements
                                                                                         the  program  established  by  the  Lakes   Area   Regional
                           Regional  Medical   Programs   seek   to   strengthen         Advisory  Group  V   and   in   accordance   with   Federal
                     and  improve   the   nations   health   care   system   and         regulations and policies.
                     making  quality  health  care  more  easily  accessible  to
                     all persons.                                                              Under  the  able   leadership   of   Chairman   Allan
                                                                                         Korn,  Professor,  State  University  College  at   Buffalo
                           Unlike   many    federal    programs,    the    RMP's         and  the  valuable  efforts   of   his   four   colleagues:
                     operate   primarily   under    local    direction.    Their         Herbert  Bellamy,  Inner  City  Businessman  an
                     strength lies in  the  "grassroots"  participation  by  the         Community     leader;     Norman     Slawinski,      Branch
                     many  devoted  volunteers  who  make  up   their   regional         Manager,  Marine  Midland   Bank;   Irwin   Felsen,   M.D.,
                     advisory   groups.   Each    Regional    Medical    Program         President,  Lakes  Area  Regional  Advisory  Group,   Inc.;
                     works    locally    to    stimulate     cooperation     and         and  Richard  A.  DiVita,  Certified   Public   Accountant,
                     innovation  among health service providers.                         the   Board    of    Directors    stimulated    significant
                                                                                         reductions  in  the  administrative  (overhead)  costs   of
                           The  parent  organization  is  the  Regional  Medical         managing   the    multi-million    dollar    LARMP    Grant
                     Programs Service, which is  part  of  the  Health  Services         Award.  Administrative   costs   dropped   to   less   than
                     and Mental  Health  Administration,  a  unit  of  the  U.S.         10%,  in  1972  as  compared  to  over  25%   in   previous
                     Department  of  Health,   Education   and   Welfare.   Each         years. This figure is well below prevailing  indirect  cost
                     RMP  is  funded  by  HEW  to  help  meet  regional   health         rates    experienced    locally    and    nationally     by
                     needs.                                                              institutions performing similar functions.


                            With    regret,   Mr.    DiVita    announced    his               LARMP   has   been   successful    in    attracting
                     resignation from the  Board  of  Directors  at  the  close        additional  monies  to   RMP   -   supported   activities:
                     of the 1972 fiscal  year.  Mr.  Maynard  Parker,  recently        voluntary  agencies  and  other  groups   have   committed
                     retired    executive    with    the    Hooker     Chemical        monetary  investment  to   what   otherwise   would   have
                     Corporation  of  Niagara  Falls,  New  York  was  selected        been   exclusively   RMP   operations;   county    medical
                     as Mr. DiVitA s successor.                                        societies  and   hospitals   contribute   funds   to   the
                                                                                       LARMP  advisory  group  to  meet  expenses   that   cannot
                                                                                       be  paid  by  federal  funds;  RMP's  investment  in   the
                                                                                       Lake  Area  Health  Education  Center  led  investment  in
                                                                                       the  center  by  the  Boards  of  Trustees  of  two  Erie,
                                                                                       Pennsylvania       hospitals    and    the       Veteran's
                                                                                       Administration;  and   the   Rural   Externship   project,
                                                                                       which  attracted  private  contributions  from  hospitals,
                                                                                       physicians and local governments.
                     A Name Change
                     Lakes Area Regional Medical Program, Inc.                         Regional Advisory Group

                           On  March  1,  1972  the   new   name   Lakes   Area
                     Regional Medical Program,  In  .  came  into  being.  This           The  Regional  Advisory  Group,  Inc.  consists  of   a
                     change  reflects  the  programs  intent  to  clarify   the        group  of   over   350   persons   from   throughout   the
                     relationship of the  two  Pennsylvania  counties  of  Erie        nine-county   Lakes   Area   Regional   Medical    Program
                     and  McKean,  that  are  part   of   the   region.   These        region.  This  includes  all  those  who  serve  on   each
                     counties have become  quite  active  in  the  program  and        of  the  county   committees,   usually   meeting   on   a
                     the  new  name  was  chosen,  in  part,   to   acknowledge        monthly basis.
                     their membership.                                                   The  Regional  Advisory  Group's  Board   of   Directors
                                                                                       is  a  group  of  43   members   who   meet   monthly   to
                    The Enabling Role                                                  direct   the   program's   operation   and    development.
                                                                                       Within  the  past  year,  the  RAG  revised  its   by-laws
                          Over the years the Lakes Area Regional       Medical         and   made   some   changes   in   provisions   for   both
                    Program has taken  particular  pride  in  its  designation         delegate and at-large membership.
                    as an "enabler."
                                                                                         The  Upstate  Medical  Alliance,  a   group   of   black
                          The  LARMP  staff  emphasizes  its  brokerage   role         health  professionals  including   physicians,   dentists,
                    whereby help is given  where  it  is  required.  If  LARMP         and others was added  to  the  list  of  institutions  and
                    cannot   help,   other   appropriate   organizations   are         groups  with  permanent   representation   on   the   RAG.
                    contacted.  The  LARMP  staff  continues  to  keep  up  to         Also  added  was   the   Comprehensive   Health   Planning
                    date on  other  funding  sources  and  agencies  that  can         "b"  agency  in  Pennsylvania,  increasing   the   member-
                    be of help in solving a particular health problem.                 ship in this area of representation to two.

                          Another  aspect  of  the  enabling  role  has   been           An   expanded   number   of   public   health   members-
                    insistence  that  projects   have   a   viable   marketing         at-large  have  been  appointed  to  form  a   RAG   which
                    strategy.  LARMP  resources  are  invested      as    seed         will  represent  all  elements   of   the   provider   and
                    monies for activities that  can  be  integrated  into  the         general  population  with  attention  given  to  involving
                    health-care pattern of the region.                                 minority  group  members,   labor   leaders,   businessmen
                                                                                       and women.

                                                                                   2


                                                      FIGURE 2

                 Composition of the Board of Directors of the
                 Lakes Area Regional Advisory Group, Inc.

              100-

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          -r  35 -
          U)
          cc
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          uj  30-

          iC) 25 -
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              15 -

              10-

                5-

                   A      B      c      D      E      F      G      H       I             K      L      m
                                              COMPOSITION OF THE BOARD

                                A.   9 M.D.'s representing the nine county medical societies
                                B.   9 members representing the nine county committees
                                C.   2 members representing the Faculty of Health Sciences,
                                     State University of New York at Buffalo
                                D.   1 member representing Roswell Park Memorial Institute
                                E.   1 member representing Western New York Hospital Association
                                F.   2 members representing Comprehensive Health Planning Council
                                     of Western New York, Inc.; Comprehensive Health Planning
                                     Council of Northwestern Pennsylvania, Inc.
                                G.   1member representing the Upstate Medical Alliance
                                H.   1member representing the Regional Health Director,
                                     New York State Health Department
                                1.   1member representing Erie County, New York, Health Commissioner
                                J.   1member representing the Veterans Administration
                                K. 13 community members - at large
                                L.   1 legal counsel
                                M.   1 to be named                           43 TOTAL MEMBERSHIP

                                                             3


                                                                            FIGURE 3
                                             LIST OF MEMBERS OF THE REGIONAL ADVISORY GROUP
                                                      AND STEERING OR EXECUTIVE COMMITTEE

                      Name and Address                                Institution and/or                       Categories of
                                                                      Occupation                               Representation

                      CHAI RMAN:

                      **Irwin  Felsen,   M.D.                         private practice                         private physician/
                        Wellsville, New York                                                                   Allegany County Medical
                                                                                                                  Society

                      VICE-CHAIRMAN:

                      **Father Cosmas Girard, OFM, Ph.D.              Sociologist-Anthropologist               member  of  the  public/
                        St. Bonaventure, New York                     St. Bonaventure University               Cattaraugus County
                                                                                                                  Committee

                      SECRETARY:

                      **Theodore T. Bronk, M.D.                       physician                                Niagara County Medical
                        Mt. St. Mary's Hospital                       Director of Laboratories                    Society
                        Lewiston, New York

                      TREASURER:

                      **John C. Patterson, M.D.                       Roswell Park Memorial                    Roswell  Park  Memorial
                        Buffalo,  New   York                            Institute                                 Institute

                      OTHER         MEMBERS:

                       *Hugh   Allen,   M.D.                          physician                                Erie County County Medical
                        Erie,   Pennsylvania                          Hamot Medical Center                        Society

                       *Sister Bernadette Armiger, R.N., Ph.D.        Dean, School of Nursing                  Niagara County Committee
                        Niagara   University                          Niagara University
                        Niagara Falls, New York

                       *Virginia Barker, R.N., Ed.D.                  Dean, School of Nursing                  member of  the  public/
                        Alfred    University                          Alfred University                        Allegany County Committee
                        Alfred,   New    York

                        Lester H. Block                               Attorney                                 legal counsel
                        Buffalo,  New   York

                        LaVerne Campbell, M.D.                        New York State Health                    official health agency
                        Buffalo,  New   York                          Department - Regional                    New York  State  Health
                                                                        Health Director                           Department

                          Indicates new member since May 1, 1972 submission
                          Indicates member of Executive Committee

                                                                                  4


                       Name and Address                                Institution and/or                        Categories of
                                                                       Occupation                                Representation
                          Max Cheplove, M.D.                           physician                                 Erie County, New York Medical
                          Buffalo,   New   York                                                                     Society
                         *Mrs. Ramona Charles                          Tonawanda Indian                          Tonawanda Seneca Indian
                          Basom,    New    York                           Reservation                            Reservation and Community
                                                                                                                    House

                         *Mrs.   Carolyn   Daughtry                    Erie County Department                    Erie County, N.Y. Health
                          Buffalo,   New   York                           of Mental Health                          Department
                         *Wiliam H. Ennis                              Hamot Medical Center                      Erie County, Pa. Committee
                          Erie,    Pennsylvania                        Executive Director
                         *Dominic  Falsetti,   M.D.                    physician                                 Niagara County Medical
                          Niagara Falls, New York                                                                   Society
                         *John Foster                                  Family Planning Director                  Erie County, Pa. Committee
                          Erie,    Pennsylvania                        Martin Luther King Center
                                                                          Erie, Pennsylvania

                          William Gaiter                               Director                                  member of the public
                          Buffalo,   New   York                        BUILD Organization
                                                                       Buffalo, New York
                         *Larry  J.  Green,  D.D.S.                    State University of New                   Upstate Medical Alliance
                          Buffalo,   New   York                        York at Buffalo, School
                                                                          of Dentistry
                         *Robert Haith, Jr.                            Director                                  Veterans Administration
                          Erie,    Pennsylvania                        Veterans Administration
                                                                       Hospital, Erie, Pennsylvania
                         *William Hilger                               United Auto Workers                       member of the public
                          Lockport, New York
                          Herbert Joyce, M.D.                          physician                                 member-at-large
                          Buffalo,   New   York                                                                  Past President, RAG
                          Bert  Klein,   D.P.M.                        podiatrist                                Chautauqua County Committee
                          Jamestown,    New    York
                         *Ed,@iard F. Marra, M.D., MPH                 physician                                 State University of New York
                          Buffalo,   New   York                                                                  at Buffalo, School of Medicine
                         *Murray S. Marsh                              W.C.A. Hospital                           Chautauqua County Committee
                          Jamestown,    New    York                    Administrator

                            Indicates new member since May 1, 1972 submission
                            Indicates   member   of   Executive   Committee

                                                                                   5


                         Name and Address                                Institution and/or                       Categories of
                                                                         Occupation                               Representation

                           *C.   Conrad    Monroe                        Banker                                   member of the public/
                            Corry, Pennsylvania                          Vice-President, Marine                   C.H.P./N.W.Pa.
                                                                         Midland Bank

                           'Elizabeth Moore                              Director, American Red Cross             member of the public
                            Batavia,   New   York                        Chapter Genesee Unit

                            William E. Mosher, M.D.                      Commissioner, Erie County                Erie County Health
                            Buffalo,   New   York                        Health Department                           Department

                            F. James Murphy                              Administrator - Genesee                  President  -
                            Batavia,   New   York                        Memorial Hospital                        Western New York
                                                                                                                  Hospital Association

                            Gerald P. Murphy, M.D., D.Sc.                Director, Roswell Park                   Chairman - LARMP
                            Buffalo,   New   York                        Memorial Institute                       Cancer Committee

                           *Robert Harris                                Director, Western New York               Western New York
                            Kenmore, New York                            Hospital Association                     Hospital Association

                           *Joseph Paris                                 Director, Veterans Administration        Veterans Administration
                            Buffalo,   New   York                        Hospital, Buffalo, New York

                           *J. Warren Perry, Ph.D.                       Dean, School of Health Related           Faculty of Health
                            Buffalo,   New   York                        Professions, State University            Sciences, State University
                                                                         of New York at Buffalo                   of New York at Buffalo

                            Edward Roche, Jr., M.D.                      physician                                McKean County Medical
                            Bradford, Pennsylvania                                                                   Society

                            Harry A. Sultz, D.D.S.                       Professor, School of Medicine            Erie County, N.Y.
                            Buffalo,   New   York                        State University of New York                Committee
                                                                         at  Buffalo

                            Patricia Stopen, R.N.                        Wyoming County Health                    Wyoming County Committee
                            Warsaw,   New    York                        Department
                            George E. Taylor, Jr., M.D.                  physician                                Allegany County Medical
                            Cuba, New York                                                                           Society

                            Paul Welsh, M.D.                             physician                                Genesee County Medical
                            LeRoy,    New    York                                                                    Society

                            Richard T. Williams, M.D.                    physician                                Wyoming County Medical
                            Warsaw,   New    York                        Wyoming County                              Society
                                                                         Community Hospital

                              Indicates new member since May 1, 1972 submission
                              Indicates member of Executive Committee

                                                                                    6


                      Name and Address                               Institution and/or                      Categories of
                                                                     Occupation                              Representation
                        *Gene Wilczewsky                             Director, Comprehensive                 C.H.P./W.N.Y.
                         Buffalo, New York                           Health Planning Council of
                                                                     Western New York, Inc.

                         Duncan C. Wormer, M.D.                      physician                               Cattaraugus County
                         Portville, New York                                                                 Health Organization
                         Professor Earl N. Stopfel and Mr. Norman C. Berg were elected as at-large members to the RAG in March, 1973.

                         Indicates new member since May 1, 1972 submission
                         Indicates  member  of   Executive   Committee

                                                                               7


                          REGIONAL ADVISORY GROUP ALTERNATES

                          Mr. Gerald Farmer, Director                                              (Representing Mr. Conrad Monroe)
                          Comprehensive Health Planning
                          Erie,    Pennsylvania

                          Craig  Fisher,   M.D.                                                    (Representing Dr. Dominic Falsetti)
                          Niagara Falls, New York

                          Mrs. Fleeta Hill                                                         (Representing Mr. William Gaiter)
                          BU I LD Organization
                          Buffalo,   New   York

                          Robert   A.   Jackson                                                    (Representing Mr. Robert Haith, Jr.)
                          Chief of  Prof.  Services
                          Veterans Administration Hospital
                          Erie,    Pennsylvania

                          Dana Lundquist, Associate Director                                       (Representing Mr. William Ennis)
                          Hamot   Medical    Center
                          Erie,    Pennsylvania

                          Roland Miller M.D.                                                       (Representing Dr. Hugh Allen)
                          Chief of Am@'Ulatory Care
                          Hamot   Medical    Center
                          Erie,    Pennsylvania

                          Ms. Marguerite Nolan                                                     (Representing Dr. Edward Roche)
                          N.W. Pa. TB and Respiratory
                             Disease    Society
                          Bradford,    Pennsylvania

                          Rev. David Pettit                                                        (Representing Mr. John Foster)
                          Associate    Director
                          Martin Luther King Center
                          Erie,    Pennsylvania

                          Mr. Gerald Schofield                                                     (Representing Dr. Gerald Murphy)
                          Deputy Director for Administration
                          Roswell Park Memorial Institute
                          Buffalo,   New   York

                                                                                     8


                      Cancer Related Activities                                     Cancer Teaching Days

                            During   the   twenty-four    month    period    of           Seven   Cancer   Teaching   Days   were   conducted
                      January  1,  1971  to  December  31,  1972,   the   Lakes     during 1972.  These  were  usually  co-sponsored  with  a
                      Area  Regional  Medical  Program,  Inc.          expanded     local  American  Cancer  Society   unit   and   held   in
                      $1 18,250 for cancer activities. Of  this  total  approx-     conjunction with Roswell Park Memorial Institute.
                      imately  90%  represents  project  activities   and   10%
                      core staff activities.                                              Program  topics  included  "Current   Advances   in
                            Lakes  Area     Regional   Medical    Program    is     the   Treatment   of   Leukemia,"   "Cancer    and    the
                      directly involved  in  education,  training  and  service     Psychology  of  Adolescent   Smoking,"   "Diagnosis   and
                      programs   (demonstration    projects).    The    primary     Management   of   Head   and    Neck    Cancer,"    "Oral
                      thrust of cancer related activities has featured  support     Pathology  -   Detection,   Diagnosis   and   Treatment,"
                      for  efforts  in  prevention,   manpower   training   and     "Cancer  of  the  Colon,"  "Cancer  of  the  Uterus"  and
                      specific  research   activities.   During   1972   13,120     "Carcinoma  of  the  Colon,   Changes   and   Status   in
                      persons were served by individuals  trained  in  projects     1972."
                      sponsored   by   the   Lakes   Area   Regional    Medical
                      Program. This shows  an  increase  over  the  1971  total           A total  of  1,054  registrants  including  nurses,
                      of 1 1,860 persons served.                                    physicians, therapists  and  other  health  professionals
                                                                                    attended these programs.

                     Tumor Registry

                           The   Tumor   Services   Registry   project   which
                     began  in  1971  continued  operation  throughout   1972.
                     Its primary objective is to  improve  cancer  control  by
                     promoting   improved   patient   care   through   regular
                     periodic   follow-up.    This    aids    physicians    in
                     determining  the  efficiency  of  treatment   modalities,
                     and  provides  a   valuable   resource   for   continuing
                     cancer  education.  The  Tumor  Registry  presently   has
                     twenty  participating  hospitals.  In  1972  there   were
                     2,819  cancer  cases  diagnosed   by   the   service   as
                     compared to 1,293 in 1971.

                           Registry activity within  the  central  office  and
                     member hospitals has resulted  in  specific  training  of
                     fifty-five   registry    personnel.   This   has     been
                     accomplished   through   workshops,   hospital    visits,
                     telephone conferences, and direct supervision.

                           In   addition   the   LARMP   previously   provided
                     initial    funding    and    support     for     "Topical
                     Chemotherapy  for   Precancerous   Lesions   and   Cancer
                     of  the  Skin."  This   project   introduced   practicing
                     physicians  in  the  Western  New  York  region  to  5-FU
                     (5-Fluorouracil), a highly effective topical  anti-cancer
                     agent.

                                                                                9


                                                                          FIGURE 4
                              LAKES AREA REGIONAL MEDICAL PROGRAM, INC.'S GOALS AND OBJECTIVES
                    Goal No. 1. To stimulate and promote preventive services in health maintenance.

                              OBJECTIVES
                              1.  To continue defining the need for additional or new preventive  services  in  each  sub-regional  area,
                                  based on a data profile of resources and services, an assessment  of  the  community's  characteristics
                                  and health problems, and on the acceptability of the service to the community.
                              2.  To encourage delivery of preventive services through sources of  primary  care  with  emphasis  on  the
                                  role of allied health personnel.
                              3.  To encourage coordination among government,  voluntary,  and  private  agencies  to  (a)  maximize  the
                                  impact of preventive services and lb) assist public health agencies in responding to  community  needs.

                              4.  To encourage expanded programs in health education.

                     Goal No. 2. To develop and improve primary care services.

                              OBJECTIVES
                              1.  To continue defining the need for additional altered or new primary care services in each  sub-regional
                                  area, based on a data profile of resources and services, an  assessment  of  community  characteristics
                                  and health problems, and on the receptability of the pattern of services to the community.
                              2.  To maximize the role of existing health personnel in delivering primary health care  by  (a)  improving
                                  distribution of  health  personnel,  (b)  encouraging  the  expansion  of  ambulatory  care  within  or
                                  associated with community hospitals, (c) using inter-disciplinary approach to the delivery  of  primary
                                  care, (d) encouraging the development and evaluation of innovative methods  of  health  care  delivery,
                                  and (e) promoting improved referral patterns to assure continuity of care.
                              3.  To encourage general and family practice and other forms of primary health care.
                              4.  To stimulate development of already defined new roles of health personnel.
                              5.  To seek feasible solutions to the problems of distance  and  lack  of  transportation  as  barriers  to
                                  utilization of primary care, preventive and rehabilitation services.
                              6.  To promote consumer education regarding availability and utilization of existing health services.
                      Goal No. 3. To encourage the development, expansion and integration of rehabilitation  services  to  the  continuum
                      of medical services.

                              OBJECTIVES
                              1.  To continue  defining  the  need  for  additional  altered  or  new  rehabilitation  services  in  each
                                  sub-regional area, based on a data profile of resources and services, an assessment of the  community's
                                  characteristics and health problems, and on the  acceptability  of  the  patterns  of  service  to  the
                                  community.
                              2.  To promote the continued development of a variety of facilities and programs  to  assure  placement  of
                                  patients at the appropriate level of care.

                                                                               10


                                                                           FIGURE 5
                                                  LAKES AREA REGIONAL MEDICAL PROGRAM, INC.
                                                     STATEMENT       OF       REVENUES,       EXPENDITURES
                                                        ENCUMBRANCES AND FUND BALANCES
                                                      FOR    THE    YEAR    ENDED     FEBRUARY     28,1973
                                                                         (unaudited)

                                                                        Federal              TLN          Special         Total
                                                                        Funds             Funds           Funds           All Funds
                         Fund Balances at March 1, 1972                 s  --             $    --         $               $   --

                         Revenues:

                            Grants Awarded                               2,435,567                                         2,435,567

                            Service Fees                                   --                87,084                             87,084

                            Contributions                                  --                  --            12,106             12,106

                            Miscellaneous                                      1,148           335                7             1,490

                            Total Revenues                               2,436,715           87,419          12,113        2,536,247

                         Expenditures                                    1,303,843           14,614           3,682        1,322,139

                         Encumbrances                                          22,565          ---                              22,565

                            Total   Expenditures,    Encumbrances        1,326,408           14,614           3,682        1,344,704

                         Excess  of  Revenues  over  Expenditures
                         and  Encumbrances  and   Fund   Balances
                         at February 28,1973                           $1 110 307  -      $72    805      $  8  431       $1,191,543

                                                                                GRANTSAWARDED
                         Grants from the Department of Health Education and Welfare for the period March 1, 1972 through
                         April 30, 1973 amounted to $2,435,567 allocated by components as follows:

                            Core Program                                                 $   906   452
                            Rural Extern                                                       30:950
                            Comprehensive Health Information Profile                         133,126
                            Telephone Lecture Network                                        132,384
                            Chronic Respiratory Disease Program                                69,709
                            Tumor Service Registry                                             85,783
                            Information Dissemination Service                                  58,848
                            Model Program for Comprehensive Family Health                      63,747
                            Allegany County Mobile Health Clinic                               88,007
                            Master Plan for Planning & Articulation of                         18,857
                             Allied Health Education
                            Comprehensive Continuing Care for Chronic Illness                217,704
                            Emergency  Medical  Services   System                            275,000
                            Lake  Area  Health  Education  Center                            355,000
                                                                                            $2,435,567
                                  At February 28, 1973, $1,434,900 of the grant funds had been received. In April 1973 a  revised
                                  grant of $3,156,103 was awarded to LA.R.M.P.,  Inc.  for  the  period  March  1,  1972  through
                                  February 14, 1974 in connection with the phase-out of the Regional Medical Program as directed by
                                  the Executive Branch of the United States Government.

                                                                             1 2


                                                  LAKES    AREA    REGIONAL     MEDICAL     PROGRAM,     INC.

                                                                      BALANCESHEET

                                                                 AT FEBRUARY 28,1973
                                                                         (unaudited)

                          ASSETS                                     Federal              TLN               Special        Total
                                                                     Funds                Funds             Funds          All Funds

                          Cash                                       $    131,132         $45,777           $8,431         $     185,340

                          Federal Grants Receivable                   1,000,667                                 --             1,000,667

                          Accounts Receivable                                 527            27,028                               27,555

                          Deferred Charges                                  1,066                               --                 1,066

                          TOTAL ASSETS                               $1,133,392           $72,805           18,431         $1,214,628

                          LIABILITIES, RESERVES,
                          AND SURPLUS

                          Withholding Taxes & Insurance              $        520         $                 $              $         520

                          Reserves for Encumbrances                        22,565                                                 22,565

                          Unappropriated Surplus                      1,110,307 (1)          72,805            8,431           1,191,543

                          TOTAL LIABILITIES,
                          RESERVES AND SURPLUS                       $1,133,392           $72,805           $8,431         $1,214,628

                              (1)   Unused grant awards allocated to projects listed on page 12 of this report.  Regional
                                    Medical Program Services has advised that these funds will remain available through
                                    August 31, 1973.

                                                                               13


                    Program Committee

                         A  program   committee   composed   of   Regional
                    Advisory  Group  (RAG)  members   was   organized   in
                    1972  for  the   purpose   of   providing   continuous
                    assessment of all  operational  projects  and  program
                    staff activities. The committee examines these efforts
                    in terms  of  their  relationship  to  present  goals,
                    objectives,  and  priorities  of  LARMP.   The   group
                    usually meets each month, prior  to  the  regular  RAG
                    meeting. The formal charge to the  committee  is:  (a)
                    assesses goals, objectives, and priorities  of  LAR  P
                    and  make  recommendations  regarding  these   matters
                    to the RAG, (b)  in  the  context  of  objectives  and
                    priorities, review and evaluate on-going projects  and
                    activities  to  determine   effectiveness   and   make
                    recommendations to the RAG.

                         It is  expected  that  this  group  will  be  the
                    principal   RAG    sub-committee    for    short-term,
                    intermediate, and long-range program planning.

                                                                            14


                                                               OPERATIONAL PROJECTS

                               During the period of March 1, 1972 to February 28, 1973, eleven projects  were
                         supported by the LARMP.

                         Project No. 1 - Telephone Lecture Network (TLN)

                                           Primary Purpose: General Continuing Education

                                           Health Care Focus: All types of health care

                                           Target Groups: All health professionals, special groups, i.e. parents  of  diabetic  children,
                                                              asthma chapter, other chronic  illness  groups,  health  educators  (ASHET)

                                           Area Served: Western New York and Northwestern Pennsylvania

                                           Objectives: To  meet  the  educational  and  training  needs  of  health  care  personnel  and
                                                              enable them to  provide  better  patient  management  in  the  hospital  as
                                                              well as in the home

                         PROGRESS REPORT:
                                           There are currently 35 hospitals on the network. During  the  past  year,  project  activities
                                           have  been  expanded  to  include  general  continuing  education  for  anesthetists,  medical
                                           librarians  and  mental  health  therapists.  A  monthly  Family  Practice  Conference  and  a
                                           Pediatric Journal Club, as well as  a  Pharmacy  Journal  Club  were  also  introduced  during
                                           this period. The network offered a total of 20 different lecture series  in  cooperation  with
                                           29  educational  institutions,  government  health  agencies  and  professional  associations.
                                           Attendance  exceeded  20,000  and  certification   of   8,042   continuing   education   hours
                                           provided.

                                           Three college level courses for students preparing for entry into health  related  professions
                                           were offered.

                                           On  April  18,  1972,  the  network  was   instrumental   in   helping   a   Meadville   City,
                                           Pennsylvania physician save the life and restore complete physical  and  mental  health  of  a
                                           moribund patient with herpes  encephalitis.  Well  over  one-third  of  patients  with  herpes
                                           encephalitis die.    Fortunately,  a  week  earlier,  the  network  had  tied  into  the  Drug
                                           Information  Center  operated  by  the  School  of  Pharmacy   (SUNY)   and   was   vigorously
                                           promoting the service. With the information  obtained  over  the  network  the  physician  was
                                           able to obtain an antiviral drug that was undergoing clinical tests in California. The  lapsed
                                           time from the initial call for help and when the drug was  received  from  California  by  the
                                           physician - 12 hours.

                                           This project, designed to foster  information  exchange  by  providing  an  easily  accessible
                                           communication system, was  cited  in  the  September  19,  1972  issue  of  the  Congressional
                                           Record for its role in providing  communications  for  the  Veterans  Administration  Hospital
                                           in Bath, New  York  during  the  tropical  storm  "Agnes"  which  struck  on  June  21,  1972.
                                           The subsequent flooding  disrupted  local  telephone  service  and  the  network  was  pressed
                                           into service, thereby supplying the only  means  of  communication  for  that  hospital  until
                                           June 29, 1972.

                                                                               15


                                              The system  provided  direct  access  to  such  services  as  the  Drug  Information  Service,
                                              Information  Dissemination  Service  and  Laboratory  Information  Service.  These  average  2
                                              to 3 calls a day via the network when scheduled programs are not in progress.
                                              Six programs for those who live with and care  for  relatives  with  a  chronic  disease  were
                                              presented.  These  programs  not  only  dealt  with  the  medical  programs  associated   with
                                              chronic disease, but also the psychological impact it has on the family.
                                              Approximately  $75,000  in  non-federal  funds  have  been  generated  to  help  support  this
                                              project during the past 12 months.

                           Project No. 2 - Information Dissemination Service

                                              Primary Purpose: Provide library service to health professionals and health institutions

                                              Health Care Focus: All types of health care

                                              Target Groups: Health Institutions, health professionals

                                              Area Served: Western New York and Northwestern Pennsylvania

                                              Objectives: Provide library services to health professionals; encourage hospital libraries  to
                                                                develop  their  own  services;  provide  consultation  service  to  hospital
                                                                library personnel

                          PROGRESS REPORT:
                                              The Information Dissemination Service  began  providing  service  in  June  1970.  During  the
                                              first year of operation a total of 12,393 requests were received and processed.

                                              During the period  of  December  1,  1971  to  November  30,  1972  the  IDS  provided  health
                                              professionals with the following library services.

                                                Photocopy requests for Journal Articles - 27,800
                                                Loan of bound journals - 495
                                                Books loaned - 2,557
                                                Bibliographic searches - 769
                                                Reference requests - 245

                                              Consultation services in relation to library  management  included  responses  via  telephone,
                                              Telephone  Lecture  Network,  and  personal  visits  by  the   component   director   to   the
                                              hospital libraries.

                                              Workshop Held

                                              A workshop was held on August 31, 1972 whi       ch  included  discussions  on   acquisitions,
                                              cataloging,  reference,  periodicals  and  inter-library  loans.  The  discussions  emphasized
                                              basic procedures and problems involved in library management.

                                              A librarian was appointed to  the  program  staff  of  LARMP.  One  of  her  functions  is  to
                                              acquaint people in the region with the services available and assist  them  in  the  operation
                                              and development of their libraries.

                                                                              1 6


                         Project No. 3. - Chronic Respiratory Disease Program

                                           Primary Purpose: Education and health care facilities development

                                           Disease Category: Pulmonary

                                           Health Care Focus: Treatment, rehabilitation, comprehensive care

                                           Target Groups: nurses, allied health professionals, physicians, families of patients

                                           Area Served: Western New York and Northwestern Pennsylvania

                                           Objectives:  Provide  home  care  and  rehabilitation  programs  for   patients;   provide
                                                             educational programs for nurses, patients and families  of  patients  in
                                                            chronic respiratory disease.

                         The following components of the program were previously instituted: (not necessarily in 1972)

                                              Screening Program                           Pulmonary Function Laboratory
                                              School of Respiratory Therapy               Respiratory Therapy Service
                                              Pulmonary Physical Therapy                  Home Care Program
                                              Continuing Education for Nurses             Rehabilitation Program
                                              Continuing Education for Physicians
                                              Model Pulmonary Care Facility
                                              Respiratory Intensive Care Unit

                         PROGRESS REPORT:
                                           In 1972, 50 new patients were enrolled in the rehabilitation  program,  34  of  whom  were
                                           able  to  complete  the  8-week  program.  All  but  two  of  these  patients  experienced
                                           substantial symtomatic improvement  as  well  as  objective  evidence  of  improvement  of
                                           exercise capability. Thirty-eight patients completed the rehabilitation program  and  were
                                           invited to enroll in a rehabilitation clinic in 1972. These patients are seen every  three
                                           months and are encouraged to continue their activities following the formal program.

                                           Nine hundred sixty-two nurses participated  in  35  teaching  programs  during  1972.  The
                                           educational programs were an important aspect of the program.

                                           A pamphlet that deals with chronic respiratory disease was  developed  and  published  for
                                           the purpose of assisting in teaching patients and families more about the disease and  how
                                           to handle it on a day to day basis. Over 3,000 of these pamphlets  have  been  distributed
                                           and have received enthusiastic acceptance.

                         Project No. 4 - Emergency Medical Services System

                                           Primary Purpose: Part Training and Part Patient Services

                                           Disease Category: Multicategorical

                                           Health Care Focus: Diagnosis and Treatment

                                           Target Groups: Multiprofessional; Patients

                                                                            1 7


                                      Area Served: Erie County

                                      Objectives:  To  document  emergency  medical  needs  and  to   develop   an   appropriate
                                                        emergency medical services system throughout the nine county region.

                    PROGRESS REPORT:
                                      Researchers have surveyed 18 Erie County  Hospitals  and  4  in  Niagara  and  Cattaraugus
                                      Counties; 53 volunteer fire ambulance/rescue and 3  emergency  first  aid  squads.  Survey
                                      data on commercial and hospital based ambulances has  been  obtained  from  the  New  York
                                      State Department of Health.

                                      Based   on   data   collected,   recommendations   were   made   to   the   Communications
                                      Sub-committee as to  placement  of  radio  equipment.  This  sub-committee,  comprised  of
                                      several  communications  experts,  designed  and  developed  bid  specifications  for  the
                                      Emergency Medical Communication Network.

                                      Training Courses Held

                                      Medical En-ergency Technician training  began  in  October  with  two  courses  completed,
                                      thirteen in process, three beginning in March, 1973, and five  more  beginning  in  April,
                                      1973. Educational materials, equipment, supplies and training aids are secured.  The  Erie
                                      County Medical Society has assisted in  recruiting  physician  instructors.  Several  area
                                      hospitals are providing the emergency room observation sessions.

                                      In depth research  on  emergency  cardiac  care  projects  was  completed.  Based  on  the
                                      accrued data, a cardiac care project was developed with a Buffalo hospital  and  ambulance
                                      service.

                                      Emergency  Medical  Care  Committees  have  been  formed  in  Niagara,  Cattaraugus,   and
                                      Chautauqua counties. Committees are anticipated in the  remaining  five  counties  of  the
                                      Lakes Area Regional Medical Program, Inc.

                    Project No. 5 - Tumor Service Registry

                                      Primary Purpose: Part Training and Part Patient Services

                                      Disease Category: Cancer

                                      Health Care Focus: Comprehensive Care

                                      Target Groups: Medical Records personnel, physicians, cancer patients

                                      Area Served: Western New York and Northwestern Pennsylvania

                                      Objectives: To provide better care to cancer patients by improving (1) quality of care  by
                                                        hospital  and  physician  and  (2)  access  to  care  through  follow-up
                                      procedures.

                    PROGRESS REPORT:
                                      Continuous operation of the  registry  was  maintained  with  processing  of  input  data,
                                      publication and distribution of periodic reports and further expansion  of  the  follow-up
                                      program.

                                                                          18


                                            Hospitals participating increased from 18 to 20, with a hospital  bed  increase  from  3,017
                                            to 3,817. Five workshops were held for continued training of hospital registry  secretaries.
                                            All participating hospitals were visited during this period for purposes  of  individualized
                                            instruction and actual assistance in abstracting hospital records. The basic  abstract,  the
                                            hospital  follow-up  and  the  physician  follow-up  forms   were   revised   with   several
                                            improvements; adequate supplies of each were obtained.

                                            New computer programs have been written to retrieve stored data  in  a  well  organized  and
                                            meaningful   form.

                         Project No. 6 - Lake Area Health Education Center

                                            Primary Purpose: Coordinate area-wide health care education

                                            Target     Groups:  Health   care   providers,   consumer   groups    with    emphasis    on
                                                                Spanish-speaking and Black migrant workers.

                                            Area Served:  Pennsylvania  Counties  of  Erie,  Crawford  and  Warren;  Chautauqua  in  New
                                                             York and Ashtabula in Ohio.

                                            Objectives:  To  provide  area-wide  education  and  training  programs  for  providers  and
                                                             consumers.

                        PROGRESS REPORT:
                                            Programs  are  being  conducted  in  the  areas  of  -  continuing  education  in  medicine,
                                            pharmacy,  dentistry,  clinical  pharmacy,  clinical  pastoral  education,  medical  program
                                            development and  medical  education  coordination,  therapeutic  drug  information  service,
                                            training of nursing personnel in geriatric care, training of activity leaders for  long-term
                                            care facilities, basic health care education for underserved migrants, Sickle  Cell  disease
                                            education program, planning, evaluation and analyses of health manpower needs.

                                            Other  programs  under  consideration  deal  with:  nursing  institute   (coordination   and
                                            development of all area programs in nursing, at all training and academic levels); nutrition
                                            education (a similar program for  dietitians,  nutritionists  and  most  food  workers  with
                                            perhaps an out-reach touching the education of specific lay groups in nutrition  and  career
                                            opportunities  through  health  education  for  regional  employment  -  COHERE,  a  program
                                            designed to recruit, education and place manpower in health services.)

                        Project No. 7 - Allegany County Mobile Health Unit

                                            Primary Purpose: Part Training and Part Patient Services

                                            Disease Category: Multi-categorical

                                            Health Care Focus: Prevention and Screening

                                            Target Groups: Rural Population; Health Professionals

                                            Area Served: Rural Allegany County

                                            Objectives: To make health education classes  available  to  citizens  of  Allegany  County;
                                                             and to provide health assessment programs for all ages.

                                                                               19


                       PROGRESS         REPORT:
                                         A custom designed self-contained multi-purpose mobile health unit  was  purchased  in  June
                                         1972. During  the  summer  months  an  extensive  orientation  program  was  conducted  for
                                         both  health  professionals  and  consumers  concerning  the  purpose  of   the   unit.   A
                                         driver-secretary was employed as of May 1, 1972.

                                         The unit has been operating on a  three-day,  two-day  alternate  week  operation  covering
                                         five sites. A total of 54 individuals have received health assessments as of  November  30,
                                         1972. So far, 24 persons, or 44% have been referred to  a  physician  for  follow-up  of  a
                                         suspected deviation from health. Two of these people have been  hospitalized.  The  age  of
                                         clients has ranged from 15 to 78 years. The list  of  problems  has  reflected  the  health
                                         problems of the general public (cancer warning signals, circulatory disturbances,  elevated
                                         blood pressure, etc.).    As of  March,  1973  over  145  persons  have  visited  the  unit
                                         for service.
                       Project No. 8 - Comprehensive Continuing Care for Chronic Illness
                                         Primary Purpose: Research and Development

                                         Disease Category: All Chronic Diseases

                                         Health Care Focus: Prevention, screening, diagnosis, treatment, rehabilitation

                                         Target Groups: Health Care Team, Inner-city Poor

                                         Area Served: Buffalo Inner-city Area

                                         Objectives:  To  develop  a  model  demonstration  program  which   would   implement   and
                                                           evaluate a comprehensive continuing approach  to  the  care  of  patients
                                                           with chronic illness.

                       PROGRESS         REPORT:

                                         1.  Recruitment of full staff

                                         2.   Completion of research instrument

                                         3.   Development of research instrument

                                         4.   Creation of problem oriented clinic charts for experimental patients

                                         5.   Graduation of Home Health Aides from training course.

                                         6.   Several site visits made to locations at which programs  similar  to  ours  are  being
                                              developed

                                         7.   Development and implemation of pilot study

                                         8.   Completion of data collection for retrospective chart review of  100  chronically  ill
                                              E. J. Meyer Hospital patients

                                         Data from the pilot and  retrospective  studies  are  being  analyzed  to  achieve  a  good
                                         estimate of patient behavior to pretest methodology and  data  gathering  instruments,  and
                                         to refine clinical practices.

                                                                             20


                         Project No. 9 - Model Program for Comprehensive Family Health

                                           Primary Purpose: Part Training and Part Patient Services

                                           Disease Category:  Multicategorical

                                           Health Care Focus: Prevention, screening, diagnosis, treatment and rehabilitation

                                           Target  Groups:  Multi-professional

                                           Area Served: Buffalo Metropolitan Area

                                           Objectives: To identify community health  needs  and  meet  these  needs  through  the  team
                                                             approach;  to  develop  a  model  to  demonstrate  the  effectiveness   of
                                                             family physicians.

                         PROGRESS REPORT:
                                           A computer terminal facility has been developed and is  now  in  operation.  Record  systems
                                           have been modified to provide the  basis  for  adequate  data.  Encounter  forms  have  been
                                           created to provide  a  reasonable  basis  for  making  this  data  computer  adaptable.  The
                                           necessary personnel to achieve this have been engaged.

                                           Alternate sources of support for the  program  at  the  Family  Practice  Center  have  been
                                           generated to support the educational  aspects.  These  funds  are  being  derived  from  the
                                           federal government  under  the  Health  Manpower  Act  of  1971  and  from  the  development
                                           of a new Department of Family Medicine at  the  School  of  Medicine,  State  University  of
                                           New York at Buffalo. The project, in its entirety, was initiated and is being subsidized  by
                                           Deaconess Hospital.

                         Project No. 10 - Master Plan for Planning and Articulation of Allied Health Education

                                           Primary Purpose: Coordination of Health (training) Services

                                           Disease Category:  Multicategorical

                                           Health Care Focus: Comprehensive Care

                                           Target Groups: Allied Health Professions

                                           Area Served: Western New York and Northwestern Pennsylvania

                                           Objectives: To identify manpower needs, training  programs  presently  in  operation,  roles
                                                             and  responsibility   of   RMP-CHP;   to   develop   advantages   of   and
                                                             mechanisms  for  cooperative  regional  planning;  and  to   construct   a
                                                             master-plan

                         PROGRESS REPORT:
                                           An  Advisory  Committee  was  appointed  to  provide  necessary  leadership.   The   initial
                                           meeting of the Council was called to discuss coordinated regional planning. An  analysis  of
                                           the  region  with  respect  to  current  manpower  needs  and   educational   programs   was
                                           accomplished.

                                                                             21


                                        It was determined that the region is currenti  oversubscribed with allied health programs
                                                                                   y
                                                                            eds. Coordinated regional planning should prevent
                                        with respect to health manpower ne
                                        unnecessary duplication of educational programs and overproduction of manpower.

                     Project No. 1 1 - Community Health I nf ormation Prof ite
                                        Primary Purpose: To identify problem areas for the Lakes Area Regional Medical Program,
                                                        Inc. and other health agencies.

                                        Disease Category: Multi-categorical

                                        Health Care Focus: Data Collection and analysis

                                        Target Groups: Allied Health Professions
                                        Area Served: Western New York and Northwestern Pennsylvania
                                        Objectives: To provide a data base covering the health care systems of Western New  York
                                                         and Northwestern Pennsylvania.

                      PROGRESS REPORT:
                                        Profiles have been completed for Cattaraugus and Allegany counties, New  York;  for  the
                                        aging in Erie County, New York; and ambulatory care  services  for  the  inner  city  of
                                        Buffalo. A profile of Family Planning in the seven counties of Western New York will  be
                                        completed in February, 1973. Data collection has begun  on  the  profile  of  Chautauqua
                                        County.
                                        These reports have had wide distribution  nationally  and  have  become  the  model  for
                                        similar studies elsewhere.

                                                                              22


                    DEVELOPING A GRANT PROPOSAL

                    Letter of Intent                                               Regional Advisory Group Review
                          A letter of intent is the first  step  in  develop-             Comments   of   the   county    committees,    the
                    ing a proposal for submission to  LARMP,  Inc.  It  is  a      Proposal  Committee,   and   the   Comprehensive   Health
                    brief summary  of  the  project  concept.  R  MP  program      Planning  Councils  are  forwarded  to  the  Lakes   Area
                    staff  and  county  committee  chairmen  use  the  letter      Regional  Medical   Program   Regional   Advisory   Group
                    of intent to determine if the idea is  pertinent  to  the      (RAG). The RAG is the  final  review  and  the  decision-
                    ,goals and objectives of  LARMP,  Inc.  Results  of  this      making body.       It   considers   the   recommendations
                    review  are  communicated  to   the   author.   He   then      provided by  all  other  review  groups,  and  makes  the
                    decides if the  proposal  warrants  further  development.      final  decision  on  approval  of  projects.  The  author
                          The letter of  intent  should  be  a  one  or  two-      is specifically  requested  to  attend  the  RAG  meeting
                    page, single-spaced, typed letter addressed to:                at which his proposal is being considered.
                              Executive Director                                          The  actual  funding  is  dependent   upon   RAG's
                              Lakes Area Regional Medical Program, Inc.            priority  ranking  of  approved  projects  within  LARMP,
                              2929 Main Street                                     Inc. goals and objectives, subject  to  the  availability
                              Buffalo, New York 14214                              of funds.

                          It must include:
                    o  a brief statement of what is proposed                       The LARMP review mechanism promotes
                       and by whom                                                        involvement of the sub-regional groups
                    o  documentation of the need                                          education of author and reviewers
                    m  what is to be accomplished-the objectives                          equity of review.
                    0  how it is to be accomplished-the methodology                The proposal author  is  in  personal  contact  with  the
                    N  anticipated cost over requested funding period
                                                                                   series  of  groups  who  review  his  proposal.        In
                    0  plans for measuring the effect of the project-              particular,  he  must  be  prepared  to  explain  to  the
                       evaluation component.                                       county  committees  his  concept  and  its  applicability
                                                                                   to their  particular  situation.  The  Regional  Advisory
                    Review Criteria                                                Group  has  final  authority  for   both   approval   and
                          The letter of intent  is  reviewed  by  the  county      funding decisions.
                    committee  chairmen  to   determine   if   an   idea   is
                    pertinent to  the  goals  and  objectives  of  the  Lakes
                    Area  RMP,  Inc.  The   Comprehensive   Health   Planning
                    Councils are provided copies of  the  letters  of  intent
                    for their  staff's  review  and  comment.  Special  forms
                    are  used  by  the  county  committee  chairmen,   LARMP,
                    Inc. staff, and CHP-staff, to review letters  of  intent.

                                                                               23


                                                    FIGURE 6

                                           PROPOSAL REVIEW PROCESS

                                                  Author 1

                                                LETTER  0

                                 LARMP                                  CHP Staff
                                Headquarters                       Review and Comment
                              Staff Assessment

                                               COUNTY COMMITTEE
                                              CHAIRMEN ASSESSMENT

                                                        I

                                                  Author develops
                                                PROPOSAL DRAFT

                                                      LARMP
                                               Staff Review & Comment
                      Technical Review                                       Evaluation Committee

                                                   Author develops
                                                  FINAL PROPOSAL

                                             FINAL PROPOSAL DISTRIBUTED
                                                                                 CHP Council
                         County                    To Review Bodies
                        Committees                                            Review and Comment

                                                      Proposal
                                                     Committee

                                                         24


                     EVALUATION

                            Evaluation  tools  have  been  developed  to   assure              All  proposals  submitted  to  LARMP  for   possible
                     that  health  activities   goals   and   objectives   remain       funding,  are  screened  to  insure  the  presence  of   an
                     flexible  and  respond  to  the  documented  needs  of   the       effective   evaluation    component.    All     operational
                     region.  These  tools  also  measure  the  contributions  of       projects   are   monitored    by    a    newly    developed
                     activities to the programs  goals  and  objectives  and  the       quarterly  reporting  system  which  includes  site  visits
                     activities themselves to  see  if  they  are  well-conceived       and informal visits by LARMP staff members.
                     and well carried out.

                            Information  derived   from   measures   of   program
                     effectiveness is used periodically  to  reassess  goals  and
                     objectives, determine  the  level  of  support  for  ongoing
                     activities, and  seek  out  projects  and  activities  which
                     address themselves to as yet unmet objectives.

                            During 1972 an attitudinal survey of a         sample
                     of  consumers  in   Allegany   County   was   conducted   to
                     determine  attitudes  towards  health,   health   care   and
                     perceived health needs as  reported  by  residents  of  this
                     rural county.

                            Interviews  of  the  same  sample   population   will
                     be  conducted  this  summer   to   determine   any   changes
                     in attitudes and  whether  or  not  the  recently  installed
                     Allegany   County   Mobile   Health   Unit   has   had   any
                     effect on these changes.

                            An   Evaluation   was   conducted   on   the    Rural
                     Externship  project  to  determine  changes   in   attitudes
                     of  health  science  students  towards  rural  health   care
                     delivery  systems.  Revision  of   the   Telephone   Lecture
                     Network  evaluation  methods  resulted  in   a   change   of
                     programming   more   suited   to   the    needs    of    the
                     participants.

                            A  study  is  currently  underway  to  determine  the       EVALUATION WORKSHOP
                     usage   patterns   of    the    Information    Dissemination
                     Service. A site visit  of  the  Tumor  Registry  took  place       Process of Program Evaluation
                     in April, 1972.
                                                                                              An   evaluation    workshop    sponsored    by    the
                            A  survey  of  the   LARMP's   official   newsletter,       Lakes   Area   Regional   Medical   Program,    Inc.    and
                     Forum, was  carried  out  to  determine  the  visibility  of       featuring talks  by  Dr.  John  Cassel,  Chairman,  Depart-
                     the   program   throughout   the   region   as    well    as       ment   of   Epidemiology,   School   of   Public    Health,
                     attitudes   toward   the    newsletter.    A    number    of       University   of   North   Carolina   and   the    Honorable
                     LARMP      sponsored      workshops      and      continuing       Elliot   Richardson,   Secretary   of    U.S.    Department
                     education   programs   for   health    professionals    were       of  Health,  Education  and  Welfare,   was   held   Novem-
                     evaluated  to  determine  their   effect   on   participants       ber  2,  1972  at  the   Treadway   Inn,   Niagara   Falls,
                     and to assist in planning for future programs.                     New  or

                                                                                    25


                          The  purpose  of  the   workshop   was   to   acquaint       evaluation.   Those   who    participated    realized    the
                   those  persons  associated  with        the   Lakes      Area       importance    of    evaluation,    and    demonstrated    an
                   Regional  Medical   Program,   Inc.   with   the   evaluation       increased  appreciation  of   its   relevance   to   program
                   mechanism,  its  complexity,   and   the   need   for   overt       goals  and  objectives.     The      workshop       produced
                   commitment   to    its    implementation.    Evaluation    is       rationales  for  'why'  evaluation  is  necessary  in  terms
                   considered to  be  an  essential  component  in  all  of  the       of  planning  and  outcome.  It   forced   people   to   ask
                   Lakes  Area   Regional   Medical   Program's   projects   and       basic  and  direct  questions  about   the   need,   motive,
                   program  activities.  It  is  a   mechanism   that   promotes       and  direction    behind    projects.   It   lead   to   the
                   sound  planning,   productive   operation,   and   innovative       clarification of individual goals,    demonstrating      the
                   replanning.    Evaluation    efforts    depend    upon    the       need for relevant, workable, and      specific   objectives.
                   cooperation   of   project   sponsors   and   administrators;
                   and   cooperation    depends    upon    understanding.    The             In an  attempt  to  evaluate  particular  projects  of
                   workshop  proved  to  be  a  workable   way   to   accomplish       LARMP,       participants     were      confronted      with
                   that   understanding,   for   both   project   and    program       evaluation  problems.  They  found  that  as   they   shaped
                   people.                                                             evaluation,   they   reshaped   the   project.    Evaluation
                                                                                       began as  an  idea  and  emerged  as  a  functional  process
                          It   was   generally   agreed   that   the    workshop       that   required   work,   understanding,   and   unqualified
                   brought  about   a   positive   attitudinal   change   toward       commitment from every facet of every program.

                                                                                                                                    -7,

                                                                               26


                                                                               FIGURE 7

                                                                       STATUS OF PROPOSALS

                            Thefollowingproposals wentthrough thelakes Area Regional Medical Program review process during 1972.

                                                                                                                Results   of
                            Title                                     Author                                    RAG Review             Period

                            A Public Health Nutrition                 Ruth E. Kocher                            Approved               3   years
                            Program for Chautauqua and
                            Cattaraugus Counties
                            Continuation Proposal for                 Phyllis F. Higley, Ph.D.                  Not Approved           2   years
                            Development of a Master
                            Plan for the Planning and
                            Articulation of Allied
                            Health Education in the
                            Western New York Region
                            Improving Medical Laboratory              Sara Marie Cicarelli                      Approved               2   years
                            Services in Rural and Small
                            Hospitals
                            Development of a Homemaker                Health Association of                     Not Approved           3   years
                            Service in Niagara County                 Niagara County, Inc.
                            Dial Access for Cancer                    Edwin A. Mirand, Ph.D., D.Sc.             Tabled                 3   years
                            Information Service
                            Emergency Medical                         Erie County Department                    Approved               1 year
                            Services System                           of Health

                                                                                  27


                                                                      FIGURE    8

                                Proposals Submitted to Washington as part of Lakes Area Regional Medical Program, Inc.
                                Triennial Grant Application for September 1, 1973-August 31, 1974.

                                 Title                                                   Coordinator

                      Telephone Lecture Network                                 Joseph Reynolds

                      Chronic Respiratory Disease Program                       John Vance, M.D.

                      Tumor Service Registry                                    John Patterson, M.D.

                      Model Program for Comprehensive Family Health             Ernest Haynes, M.D.

                      Allegany County Mobile Health Unit                        Virginia Barker, R.N., Ed.D.

                      Comprehensive Continuing Care for Chronic                 Evan Calkins, M.D.
                      Illness

                      Improving Medical Laboratory Services in                  Sara Marie Cicarelli
                      Rural and Small Hospitals

                      Public Health Nutrition Program for Cattaraugus           Ruth E. Kocher
                      and Chautauqua Counties

                      Emergency Medical Services System                         James H. Cosgriff, Jr., M.D.

                      Lake Area Health Education Center                         Michael Carey

                                                                         28


                                                                                              FIGURE 9

                                                                         PROGRAMS IN CONTINUING EDUCATION, 1972

                          DATE                    PROGRAM                              LOCATI ON                            REGISTRANTS             CO-SPONSORS

                          February 24             Cancer  Teaching   Day               Wyoming County Community                    110              American  Cancer   Society
                                                  "Current Advances in the             Hospital                                                     Wyoming County Unit
                                                  Treatment of Leukemia"               Warsaw, New York

                          March 1 1               Cancer  Teaching   Day               Niagara Falls Memorial                      152              American  Cancer   Society
                                                  "Cancer and the Psychology           Center                                                       Niagara County Unit
                                                  of Adolescent Smoking"
                                                                                                                                                    Lakeside Laboratories

                          April 6                 Cancer  Teaching   Day               David A. Howe Memorial                         90            American  Cancer   Society
                                                  "Diagnosis and Management            Library                                                      Allegany County Unit
                                                  of Head and Neck Cancer"             Wellsville, New York

                          May 3                   Cancer  Teaching   Day               Holiday Inn Downtown                        175              American  Cancer   Society
                                                  "Oral Pathology - Detection,         Erie, Pennsylvania                                           Pennsylvania Division, Inc.
                                                  Diagnosis and Treatment"                                                                          Erie County, Pa. Unit

                                                                                                                                                    Pennsylvania Department of Health
                                                                                                                                                    Cancer Control Division

                          June 1                  Cancer  Teaching   Day               Castle Restaurant                           210              American  Cancer   Society
                                                  "Cancer of the Colon"                Olean, New York                                              Cattaraugus  County   Unit

                          June 15                 Aging Seminar                        Jamestown Community                         300              Study Commission, Problems of
                                                  "Understanding the Aging             College                                                      the Aging
                                                  Process"                                                                                          Jamestown, New York

                          October 1 1             Health Guides Workshop               Parkway Ramada Inn                             70            Lakes Area Regional
                                                  "Communication - Process             Niagara Falls, New York                                      Medical Program, Inc.
                                                  and Problems"

                                                                                                                                                    (continued)


                           DATE                       PROGRAM                            LOCATION                             REGISTRANTS                         CO-SPONSORS

                       October 19               Cancer   Teaching    Day              Holiday Inn                                   213              American Cancer Society
                                                "Cancer of the Uterus"                Batavia,  New   York                                           Genesee County Unit

                       November 2               Evaluation      Workshop              Treadway Inn                                  120              Lakes Area Regional
                                                "A Workshop - The Process             Niagara Falls, New York                                        Medical  Program,   Inc.
                                                of Evaluation"

                       November 8               Heart Teaching Day                    Holiday Inn                                   335              Heart Association of Western
                                                "Live Longer Electrically,            Batavia,  New   York                                           New York
                                                with a Pacemaker"                                                                                    Genesee and Wyoming Counties
                                                                                                                                                     Units

                       November 15              Aging Seminar                         Hotel Jamestown                               366              Study Commission, Problems of
                                                "Understanding the Aging              Jamestown, New York                                            the Aging
                                                Process - Part I I"                                                                                  Jamestown,   New    York

                       November 16              Cancer   Teaching    Day              Cameo     Restaurant                          104              American Cancer Society
                                                "Carcinoma of the Colon,              Wellsville, New York                                           Allegany   County   Unit
                                                Changes  and  Status  in
                                                1972"

                       November 29              Sickle Cel I Seminar                  1490 Jefferson Avenue                            70            Niagara Frontier Association
                                                "Community Involvement in             585 Michigan Avenue                                            for Sickle Cell  Disease
                                                Combating  Sickle   Cell              Buffalo,  New   York                                           Lakes Area Regional
                                                Disease"                                                                                             Medical  Program,   Inc.

                                                                                                                                    1,054


                      Emergency Medical Services System                                 nurses,  public  health   personnel,   volunteer   firemen,
                                                                                        Civil  Defense,  Red   Cross,   ambulance   and   emergency
                            Emergency   Medical   Services   on    the    Niagara       squad  members,   hospital   administrators   and   others.
                      Frontier got a big  boost  in  1972  when  the  Lakes  Area
                      Regional  Medical  Program,  Inc.  working  with  the  Erie             One  thing  the  participants  had  in   common   was
                      County    Emergency    Medical    Care     "Blue     Ribbon       their interest in  solving  the  problems  associated  with
                      Committee"  (this  group  serves  as  the   advisory   body       the delivery of safe,  efficient  and  effective  emergency
                      to   the   Erie   County   (N.Y.)   Health    Commissioner)       health services.
                      developed  an  Emergency  Medical  Services   project   for
                      the area.                                                         Inner City Health Problems

                            The  project  received  $250,000   from   the   Lakes             Inner   city   problems   in   Niagara   Falls,   and
                      Area  Regional  Medical   Program,   Inc.   on   June   28,       Buffalo, Ne@v York  as  well  as  Erie,  Pennsylvania  have
                      1972.  The  EMS  system   provides   a   radio   communica-       received   continued   attention   and   surveillance    by
                      tions network  that  links  all  police  and  fire  depart-       LARMP.
                      ments, fire base stations, hospitals  and  transit  author-
                      ities for emergency services in  the  county.  The  project             During   1972   a   LARMP   staff    member    worked
                      also  includes  a  Medical  Emergency  Technician  Training       closely  with  many   action   agencies   such   as   Model
                      program   for   5,000   ambulance    and    rescue    squad       Cities,    Community    Action    Organization,     Niagara
                      attendants over a 3-year period.                                  Community     Action     Program     (NIA-CAP),      Family
                                                                                        Service  Reach  Out,   etc.   In   addition   he   provided
                      Emergency Medical Services Workshop                               consultation,    technical    writing    and    information
                                                                                        gathering   skills   to   small   groups   and   government
                            The   First    Annual    Regional    Conference    on       agencies  operating   in   these   areas.   The   community
                      Emergency  Medical  Services   held   February   1   -   3,       groups  include  the  Family   Life   Consortium,   Niagara
                      1973   in   cooperation   with   the   Emergency    Medical       Frontier  Association  for  Sickle  Cell   Disease,   Perry
                      Care   Committee,   Erie    County    Health    Department,       Valley     Community     Health     Center,      Lackawanna
                      was highly successful and    brought  together   a   number       Health  Center  and  the  Erie,  Pennsylvania  Sickle  Cell
                      of persons interested  in  EMS      such   as   physicians,       Society.

                                                                                                                           I=

                  ft@ @                    @-M                                                                 U74vl&j

                                                                                    31


                             The     LARMP's       continued       emphasis       on                              LAHECisanon-profitcommunitycorporation,
                       combating  the  categorical  disease,   Heart,   Cancer   and       whose  goal   is   to   serve   as   a   community-based   and
                       Stroke  resulted  in   further   cooperative   efforts   with       operated   regional   system   of   education   and   training
                       medical  and  lay  groups  in  a  community-wide  effort   to       for   health   manpower,   providing   them   with    "basic,"
                       develop  a  program  for   screening,   education,   referral       "continuing,"     and     "innovative"     programs.     LAHEC
                       and  treatment  of  persons   with   hypertension.   Involved       coordinates  and  develops  area   resources   and   potential
                       in  this  effort  were   representatives   of   the   Upstate       in  order  to  meet  area  needs  in   health-care   manpower.
                       Medical  Alliance,  an  organization  of  black   physicians,       The      area  served      is  primarily    Erie       County,
                       dentists  and  podiatrists;  as  well  as  members   of   the       Pennsylvania,    with    its    quarter-million     population
                       National  Medical  Association,  a  similar  national   black       along   with    a    second    quarter-million    from    four
                       group.                                                              contiguous  counties       in  a    tri-state    distribution:
                                                                                           Crawford   and   Warren   in   Pennsylvania;   Chautauqua   in
                             Community    leaders    representing    the    Bayfront       New  York;   and   Ashtabula   in   Ohio.   Additionally,   as
                       Community   Center,   Booker   T.   Washington   -   Erie   I       specific   need   arises,   other   counties   may   and    do
                       Center,  and  the  John  F.  Kennedy  Center,  all  of  Erie,       participate.
                       Pennsylvania   have   participated   and    provided    their
                       support  in  dealing   with   problems   related   to   their              LAHEC's   board   of   directors,   their   panel    of
                       areas.                                                              consultants,   and   their   numerous   program    committees,
                                                                                           who   represent   a   comprehensive   cross-section   of   the
                             The     BUILD     organization      (BUILD,      Unity,       area's   health-care   manpower   and   their   clinical   and
                       Independence,    Liberty    and    Dignity)    has     sought       educational  settings   are   currently   directing   a   wide
                       assistance  from   the   LARMP   in   developing   a.proposal       range   of   activities   that   not   only    maintain    the
                       for  hospitals  to   use   community   health   aides/patient       competence   of   but   also   introduce   breakthroughs    in
                       advocates  as  a  means  of  changing  existing   utilization       knowledge    and    new    techniques    to     the     area's
                       patterns  of  hospital  facilities  within   the   community.       health-care    professionals;    furthermore,    they    offer
                                                                                           certain   groups   of   lay   persons   the   opportunity   to
                                                                                           become    more    pragmatically    informed    about    health
                       Lake Area Health Education Center -                                 and health care.
                       Erie, Pennsylvania
                             The  Lakes  Area   Regional   Medical   Program,   Inc.              This  fiscal  year,  LAHEC's  activities   are   funded
                       has pioneered  a  precedent-setting  activity  supporting  it       (cash)   61%   by   the   Lakes    Area    Regional    Medical
                       fiscally  and  philosophically  along  with  the  Erie  (Pa.)       Program,   Inc.   37%   by   the   Veterans    Administration,
                       Veterans  Administration  Hospital.  Some   60   hea   t   or       and  2%  by  local  contributions.  If  in-kind  services  are
                       health-related  organizations  in   the   LAHEC   area   also       translated  into  dollars,  then  the   proportions   are   as
                       supported   the   LAHEC   concept   and   have    contributed
                                                                                           follows:   54%    LARMP,    32%    VA,    and    14%    local.
                       funds and in-kind service.
                                                                                           Twelve  programs  are   the   core   of   LAHEC's   activities
                             The   concept   of   the   "area    health    education       since   July 1, 1972. The programs are:
                       center"  was  introduced  nationally  in  October   1970   in               1  .Continuing Education in Pharmacy
                       the Carnegie      Commission       report    on       "Higher               2.  Clinical Pharmacy
                       Education   &   The    Nation's    Health:    Policies    for               3.  Drug Information Service
                       Medical    &     Dental     Education"     (McGraw     Hill).               4.  Continuing Education in Medicine
                       LAHEC,    however,    is     a     pioneering     "community"               5.  Medical    Program    Development    &     Medical
                       variant  of  the   "university"   model   proposed   by   the                   Education Coordination
                       Carnegie report.                                                            6.  Continuing Education in Dentistry

                                                                                      32


                           7. Clinical-Pastoral Education                            Allegany County Mobile Health Unit
                           8. Training of  Nursing  Personnel  in  Geriatric
                              Care                                                        A mobile  health  unit, designed       to    provide
                           9. Training  of  Activity   Leaders   for   Long-         health assessments and health education    to    Allegany
                              Term-Care Facilities                                   County  residents,  was  purchased   with   LARMP   funds
                         10.  Basic   Health-Care   Education   for   Under-         in  mid  1972.  It  was  fully  equipped  and  put   into
                              served Migrants                                        service on October 4, 1972.
                         11.  Sickle Cell Disease Education Program
                         12.  Planning' Evaluation, &  Analysis  of  Health-               During the  first  five  months  of  operation  the
                              Care-Manpower Needs                                    unit  made  regular  weekly  stops  at  Angetica,  Alfred
                                                                                     Station,  Caneadea,  Richburg  and   Whitesville   seeing
                   Three other programs are under consideration:                     141 persons at an average visit of  one  each  hour.  The
                         13.  Nursing  Institute  (coordination  and  devel-         maximum number  of  persons  that  can  be  seen  in  one
                   opment of all area programs in nursing - at all  training         day, ten, has been achieved. Of  the  141  persons  seen,
                   and academic levels).                                             who range between the ages of  15  -  85,  55  are  males
                         14. Nutrition  Education  (a  similar  program  for         and 86 are  females.  Seventy-nine  of  the  141  persons
                   dietitians, nutritionists, and most food-workers  -  with         seen were referred to family physicians  or  to  the  two
                   perhaps   an   outreach   touching   the   education   of         hospitals in the county  for  further  examination.  Five
                   specific laygroups in nutrition).                                 were    hospitalized    including    one    person    who
                         15.    COHERE--Career     Opportunities     through         underwent surgery for a precancerous condition.
                   Health   Education   for   Regional   Employment   -   an               Of  the  141  persons  seen,  19  had   no   family
                   ambitious  program  to  recruit,   educate,   and   place         physician.  Twelve  of   these   were   referred   to   a
                   manpower  in  health  services  within  the  LAHEC  area.         physician of their choice.
                         The  total  cash  budget  for  this  year's  twelve               Types  of  referrals   included   persistent   sore
                   programs was  well  over  half  a  million  dollars  (and         tongue, chest  discomfort,  shortness  of  breath,  edema
                   close to two-thirds of a million if in-k inds are  added).        of   extremities,   flaking   mole,   long   period    of
                                                                                     hoarseness,   frequent   indigestion,   abnormal    blood
                                                                                     pressure and increase in blood glucose.

                                                    RSIT
                                                      OEALTfl UNIT

                                                                                 33


                    Rural Externship Program                                              Nursing                                           4
                                                                                          Dentistry                                         2
                          First  hand  living  experience  and  exposure   to             Hospital Administration                           1
                    rural health delivery services in small  communities  are             Medical Technology                                1
                    the  essence  of  the  Rural  Externship  Program.   This             Podiatry                                          1
                    project has begun to  demonstrate  its  effectiveness  in             Social Work                                       1
                    directing  more  health   manpower   toward   underserved                      Total                                   34
                    rural areas. Besides  the  participation  of  thirty-four             While  each    student   was   assigned   to    one
                    health science students  in  the  1972  summer,  program,       principal preceptor, in actual practice he  received  the
                    working in thirteen  small  communities  in  the  region,       benefit  of  working  with  a  number  of  other   health
                    the project has  resulted  in  a  substantial  change  in       professionals,  so  that  over  sixty   preceptors   were
                    attitude  among  these  participants.  Before   beginning       involved in the program. Since there were  several  sites
                    their externship, the students indicated  that  20.8%  of       where  students  representing   a   variety   of   health
                    them  were  planning  a  rural  health  career  following       disciplines were located, they  had  the  opportunity  to
                    graduation. At the end  of  their  1972  experience,  the       share experiences with on another and  participate  in  a
                    number planning such a  career  increased  to  38.1%,  or       "team" approach.
                    almost double the earlier figure.                                     The 1972 program lasted  for  eight  weeks.  It  is
                          Direct exposure  to  primary  care  and  to  health       expected that the  1973  operation  will  also  be  eight
                    care settings  not  currently  a  part  of  their  formal       weeks and will include forty  students.  Externs  receive
                    clinical  curriculum  occurred  for   students   in   the       a stipend of $1 00.00  per  week.  The  Rural  Externship
                    following disciplines and number in each:                       Program  has   been   sponsored   by   the   Lakes   Area
                                                                                    Regional Medical Program,  Inc.  since  1970  and  funded
                          Medicine                                        1 2       by  the  Appalachian  Regional  Commission   and   volun-
                          Physicial Therapy                                 7       tary  contributions  from  the  various  communities   as
                          Pharmacy                                          5       well as by the  Lakes  Area  Regional  Medical   Program,
                                                                                    Inc. itself.

                                                                               34


                     Library Program                                                   applications.  A   series   of   four   Telephone   Lecture
                                                                                       Network  programs  for  hospital   library   personnel   is
                           The  total  Lakes  Area  Regional   Medical   Program       now  underway  and  have  been  well  received.  A   packet
                     Library  program  since  September,  1972,   has   operated       of  library  management  reprints  has  been  sent  to  ten
                     in  two  phases:  the  in.house  informational  system  and       institutions.  Plans  are  being   made   for   a   one-day
                     the hospital library consultation service.                        workshop for librarians late in 1973.
                                                                                             Local  consultation  efforts  are  coordinated   with
                           A newly appointed librarian for       the       LARMP       the   educational   programs   of   the   Medical   Library
                     began  her   duties   by   developing   a   collection   of       Association and the Regional Medical Library.
                     monographs,   journals   and    pamphlets    for    program
                     staff  use.  The  monographs  are  being   cataloged   with       Communications
                     the  National   Library   of   Medicine   scheme.   Current             The  variety   of   activities   conducted   by   the
                     awareness  needs   of   program   staff   are   served   by       Lakes   Area   Regional   Medical   Program,    Inc.    are
                     circulation  of  journal  title  pages  and  lists  of  new       brought to the  attention  of  special  target  groups  and
                     library materials.                                                the general  public  through  effective  use  of  the  news
                                                                                       media,exhibits   displayedat    conferencesand    meetings,
                           Photocopy   and   bibliographic   service   of    the       brochures  for  special  programs  and  published  articles
                     LARMP    funded    Information    Dissemination     Service       in the many health-related journals.
                     have been used extensively.
                                                                                             Television  and  radio  have  been  used   often   to
                           Basically   the   hospital    library    consultation       cover  program   activities.   The   "Forum,"   the   LARMP
                     service  is  designed  to  help  health   care   facilities       newsletter,  brings  news  of   important   LARMP   events,
                     establish and manage  a  library  for  professional  health       to over 13,500 on the LARMP mailing list.
                     personnel.
                                                                                             Maintaining  a  flow  of  reliable   information   to
                           Among  the  services  provided  are:           assist       the  news  media  has  resulted  in  extended  coverage  of
                     hospitals  in  building  and   maintaining   an   effective       our  activities.  Feature  stories  about   some   of   our
                     library service  for  a  viable  collection;  consultations       operational  projects  have  appeared  in  almost  all   of
                     with    hospital     administrators     concerning      the       the daily newspapers in the region.
                     establishment of a library service in their  hospital;  use
                     of   the   Telephone   Lecture   Network   to   communicate             The  media  has  provided  good  local  coverage   to
                     with  library  personnel  for  training  program  purposes;       our   continuing    education    programs    for     health
                     conduct  workshops  for  the  library  personnel;   provide       professionals  in  the  various   communities   where   the
                     assistance in completing  forms  to  obtain  federal  funds       programs were held.
                     (resource grants) for library collections.
                                                                                             The  LARMP   subscribes   to   almost   every   daily
                     Hospital Library Consultation Service                             and weekly newspaper in the region.

                           Eighteen      institutions  have            requested             News   clippings   from    these    newspapers    are
                     consultation    services.    Many    community    hospitals       clipped,  and  copies  circulated  to   area   legislators,
                     were  found  to  have  minimal  collections  and  expressed       RMPS,     and     appropriate     LARMP      staff      for
                     interest    in    submitting    NLM    improvement    grant       informational exchange.

                                                                                  35


                                                                                  FIGURE 10.

                        Volunteer's Contribution
                                                                                                   In    1968,    community    time     volunteered     to
                              A  study  was  conducted   in   1968   by   the   Lakes       LARMP  showed  that  for  every   federal   dollar   received,
                        Area  Regional  Medical  Program,  Inc.  to  find  out   what       23   cents     was     provided     by     the     volunteer's
                        was   being   contributed   to   the   LARMP   operation   in       contributions of time, efforts     and  other  resources.   In
                        terms   of   money   by   the   many   dedicated   volunteers       1971  this figure rose to 40      cents  for   every   federal
                        who take part in its activities.                                    dollar.

                              This  included   the   use   of   such   resources   as              In 1973 the  figure  is  66  cents  for  every  federal
                        meeting  rooms,   services,   workshops,   and   time   spent       dollar.    By    1974,   it   is    projected    that    local
                        in  meetings  on  RMP  business   along   with   other   such       participation  will  increase  to   about   68   cents/federal
                        f actors.                                                           dollar.

                              7(V  -

                        cc

                              6(9  -
                        0

                              50i  -
                        cc
                        ui
                        0
                        Lu    40@  -
                        U-
                        o:
                        LU
                              30e-

                        z
                        Z)
                        0     20@  -
                                                    L

                                            1968                          1970                            1972                           1974

                                                                                         YEAR                          PROJECTED  M

                     COOPERATIVE CONTRIBUTIONSTO LARMP
                     PER FEDERAL DOLLAR EXPENDITURE 1968-1974

                                                                                       36


                                             LAKES AREA REGIONAL MEDICAL PROGRAM, INC.

                                              PROGRAM STAFF:

                                              Professional -

                                              John   R.F. lngall, M.D. - Executive  Director
                                                     James J. McCormack, Ph.D. - Associate Director
                                                     Robert J. Miller, M.B.A. - Executive Assistant to Director
                                                     Patricia Shine Hoff, R.N., M.A. - Assistant Director - Nursing & Allied Health
                                                     Benjamin  Morgan,  B.S.  -  Comptroller
                                                     Marion  Sumner,  M.B.A.  -   Consultant
                                                     Anthony Zerbo, B.A. - Assistant Director - Communications
                                                     Robert Beebee, M.B.A. - Staff Associate
                                                     Helen Brown,  M.A.  -  Staff  Associate
                                                     David Buck, M.R.P.  -  Staff  Associate
                                                     William D. Crage, M.S.W. - Staff Associate
                                                     Janet Gelsinger, B.A. - Staff Associate
                                                     Jean Hanna, M.P.H.  -  Staff  Associate
                                                     Michael Miller, B.A. - Staff  Associate
                                                     Diane Pinchoff, M.A. - Staff Associate
                                                     Joan Philipps, B.S. - Staff Assistant
                                                     Gary Smith, B.A. - Staff Assistant
                                                     Teresa Wang, B.A. - Accountant

                                              Support -

                                                     Julianna Bednarz
                                                     Alice Bragg
                                                     Carol Butcher
                                                     Hazel Cunningham
                                                     Elizabeth Eberl
                                                     Karen Harper
                                                     Charlene Kane
                                                     Mary King
                                                     Bonnie Kirisits
                                                     Marcia Moule
                                                     Rosemary Meyers
                                                     Rosetta Parker
                                                     Diane Williams
                                                     Urban Batt
                                                     Richard Raeihie

                                                                               37


                        PROJECT PERSONNEL

                        TELEPHONE LECTURE NETWORK                                              MOBILE HEALTH UNIT

                                     Joseph Reynolds - Director                                      Dean Virginia Barker - Director
                                     Bob    Mathiebe                                                 Ray         Meacham
                                     Doris Unger
                                     Marge    Witkop                                           ALLIED HEALTH
                                     Robyn Atkinson                                                  Phyllis Higley - Director
                                                                                                     Monica      Stenson
                        COMMUNITY HEALTH INFORMATION PROFILE                                         Robert Barak
                                                                                                     Janet Love
                              Harry Sultz, D.D.S. - Director
                              Frank Rens                                                       CHRONIC           ILLNESS
                              Ruth     Grabenstetter
                              Lynn Goris                                                             Evan Calkins, M.D. - Director
                              John Nelson,                                                           Donald       Snyder
                              Lorraine Heh                                                           Andrea       McKown
                              Donald McGreevy                                                        Sandra      Kennuth
                              Julia Varnish                                                          Mary Brogan
                                                                                                     Subhash      Narula
                        TUMOR           REGISTRY                                                     Howard       Strong
                              John Patterson, M.D. - Director                                        Charlene     Norman
                              Freda Honig                                                            Sally Rollek
                              Dolores     Gamble                                                     Dominica Limburg
                              Joy      Greenwood                                                     Lavada Davis
                              Alice Pfonner                                                          Lola Bishop
                              Angelika     Saxer                                                     Minnie        Brown
                              Mary      Penkacik                                                     Lillian     Peeples
                                                                                                     Jacqueline   Levitt
                        INFORMATION DISSEMINATION SERVICE                                            Mary   Lou    Olson
                                                                                                     Sharon      Dittmar

                              Jean Miller - Director
                              Joanne     Nichter                                               RESPIRATORY
                              Ruth Hyman
                              Thomas      Garvin                                                     John Vance, M.D. - Director
                              Geoffrey Stearns                                                       Frances      Cirbus
                                                                                                     Barbara     Edelman
                        FAMILY          PRACTICE                                                     Ruth      Frederick

                              Ernest Haynes, M.D. - Director                                   LAKE AREA HEALTH EDUCATION CENTER
                              Joyce Fais
                              Suzanne Manson                                                         Michael Carey - Director
                              Timothy     Kittle                                                     Robert     Corrigan
                              Norma       Montagnino                                                 Mary   Ann    Henry
                              Brenda     Willson                                                     Anthony    Silvagni
                              Margaret Bennett
                                                                                                     Edward       Taylor
                              Nancy Harti                                                            Victor Vidal

                                                                                  38


                     EMERGENCY MEDICAL SERVICES

                           James Cosgriff, M.D. - Director
                           Roger Fenlon
                           Thomas Allen
                           George Ball
                           Sandra Bogdanowicz
                           David Clowes
                           Sandra  Colligan
                           Mary Beth Cosgriff
                           Samuel Drago
                           Robert   Enggist
                           Glen Fosdick
                           Sam Fried
                           Geoffrey Gibson
                           Susan Haber
                           Jeffery Lacey
                           Cooper   Lansing
                           Cathy Rohrer
                           Lucia Shealy
                           Nancy Sobierajski
                           Dorothy    Stone
                           Allen Stone
                           Nicholas Vastola
                           Michael  Walters
                           William Wutz
                           Gregory Photiadis

                                                                          39


                                                  Director of the Regional Medical Programs Service
                                                               Harold Margulies, M.D.

                                        Executive Director for the Lakes Area Regional Medical Program, Inc.
                                                               John R. F. Ingall, M.D.

                                                      Lakes Area Regional Medical Program, Inc.
                                                      2929 Main Street
                                                      Buffalo, New York 14214
                                                            Telephone: (716) 835-0728

                                                                       40