likiiiii@li@ll@iiiiiiiiiii


                                     -77'-


                                                      My thesis ... has  been  that  the  concept  of  a
                                                community trusteeship is  the  most  viable  element  in
                                                our society, and Government  must  be  willing  to  deal
                                                on a local basis with issues that can be identified  and
                                                corrected locally.  My  responsibility  is  to  make  it
                                                possible for that to happen. I believe  we  should  move
                                                away from  Federally  directed  activities  and  towards
                                                really autonomous responsibilities on the  part  of  the
                                                Regional Medical Programs.
                                                           Harold Margulies, M.D.
                                                           Acting Director, Regional Medical
                                                                 Programs Service
                                                           from a  talk  on  "Trends  in  Health  Care,"
                                                           given at  the  Annual  Meeting  of  the  Iowa
                                                           RMP on June 26, 1970.


                            TABLE OF CONTENTS

                            CHAPTER                                                                                                                                PAGE

                             1.  OVERVIEWOFTHEREGION                      ...........................................                                                    1
                                         Features    and     Services                                                  ..............................................    2
                                         Relationship     with     Neighboring     Regions                                       ....................................    2
                                         Housing of RMP for WNY           ............................................                                                   2
                                         Geography                                                               ....................................................    3
                            II.   RELATIONSHIPOFRMPFORWNYTOOTHERHEALTH-RELATEDORGANIZATIONS                                                          . . . . .  .  .     5
                            111.   ORGANIZATION AND STRUCTURE                                                                .......................................     7
                                         The Volunteer's Contribution                                                       ........................................     8
                                         Regional Advisory Group          ...........................................                                                    8
                                         County Committees          ..............................................                                                       8
                                         Standing          Committees                                                  .............................................     8
                                         Core     Staff                                                          ....................................................    8
                            IV.                   CORESTAFFACTIVITIES                                                  .............................................  13
                                         Data Collection                                                           .................................................  14
                                                Community Health Information Profile Data System                                            ........................  14
                                                Ambulance Service         ...........................................                                                 14
                                                Kidney   Disease   Service,    Facilities, and Programs    in the  United   States                    ..............  14
                                         Manpower Problems          ..............................................                                                    15
                                                Buffalo     Summer     Student     Program                                        ..................................  1  5
                                                Rural Externship Program                                                     .......................................  15
                                         Research and Evaluation          ...........................................                                                 1  5
                                                Coronary   Care   Unit    Nurse    Profile                                       ...................................  15
                                                Telephone Lecture Network          System    Evaluation    . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  16
                                         Communications        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  16
                                         Continuing         Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  16
                            V.   EVALUATION            . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  19
                                         Program      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  20
                                         Projects     . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  20
                                         Studies   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  20
                            VI.              THEPROGRAM  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  21
                                         New Legislation       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  22
                                         Grand Design      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  22
                                         Developmental            Component . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  23


                          VII.  PROGRAMOPERATION                   ............                                                  .................................   25
                                        Finances    ..................                                                          ..................................   26
                                               Financial Management           .........................................                                              26
                                               Financial     Statement:      March 1, 1970 -  February   28,  1971     . . . . . . . . . . . . . . . . . . .  .  .   26
                                        Proposal Review Process        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   26
                                        Operational Projects       . . . . . . . . . . . . . .  I . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .   27
                                               Funded and On-Going            . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .   27
                                                       Component No.       1  - Telephone Lecture Netvvork        . . . . . . . . . . . . . . . . . . . .  .  .  .   27
                                                       Component No.       2  -Coronary Care Training Program            . . . . . . . . . . . . . . . . . . .       29
                                                       Component   No.   3    -Chronic Respiratory Disease Program             . . . . . . . . . . . . . . .  .  .   29
                                                       Component   No.   4    -Immunofl,.jorescent Service
                                                                               and Training Program       . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .   29
                                                       Component No. 5 - Tumor Registry             . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .   30

                                               Approved but Unfunded by Regional Medical Programs Service (Locally supported for one year
                                                                                           through carryover or rebudgeted funds.)            . . . . . . . . .  .   30
                                                       Component No. 13 - Topical Chemotherapy Treatment for Precancerous
                                                                                 Lesions and Cancer of the Skin          . . . . . . . . . . . . . . . . . .  .  .   30
                                                       Component No. 14 - Information Dissemination Service                  . . . . . . . . . . . . . . . .  .  .   31
                                                       Component   No.   16    - Hematology Center, Blood        Coagulation
                                                                                 Reference Laboratory       . . . . . . . . . . . . . . . . . . . . . . .  .  .  .   31
                                        Status of Proposals      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   33

                                                                                    TABLE OF FIGURES
                          FIGURE                                                                                                                                 PAGE
                           1.    Regional Medical Program for Western New York Map                  . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .     3
                           2.    RMP for WNY Relationship to Other Health-Related Organizations                      . . . . . . . . . . . . . . . . . . . .  .  .     6
                           3.    Composition of Board of Directors of the Health Organization of Western                   New   York,   Inc . . . . . . . .  .  .     9
                           4.    Board of Directors, Health Organization of Western             New   York,   Inc . . . . . . . . . . . . . . . . . . . .  .  .  .   10
                           5.    County Committee Chairmen             . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   11
                           6.    Standing Committees         . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   12
                           7.    Continuing Education          . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   17
                           8.    New Legislation       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   24
                           9.    Financial Statement: March 1,         1970 - February 28, 1971         . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .   26
                          10.    Proposal Review Process         . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   28
                          11.    Status of Proposals       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .   33


                     Overview of the Regior

                   GO@


                        Features and Services                                                       The   implementation   of   RMP   for    WNY    has
                              The   estimated   population   of   the   nine-county          coincided  geographically  with   the   establishment   of
                        area of RMP for WNY is  two  million.  Over  half  of  this          three  different   Comprehensive   Health   Planning   "b"
                        population   resides   in   Erie   County    (N.Y.),    and          agencies--Western     New     York,     Rochester      and
                        one-quarter  of   the   total   population,   or   one-half          Pennsylvania.  Such  overlap  is  inevitable   since   RMP
                        million people, reside in  the  city  of  Buffalo  and  its          has  a  flexible,   regional   perspective   whereas   "b"
                        immediate  suburbs.  Personnel-population  ratios   are   a          agencies tend to be  restricted  within  state  boundaries
                        dramatic illustration of the  disparities  in  distribution          and  funding   mechanisms.   Also,   the   same   planning
                        of health personnel within  the  area.  For  instance,  the          area is not necessarily optimal  for  both  organizations.
                        number  of  staff  nurses   available   varies   from   two          We have made specific  contacts  with  the  CHP  of  Erie,
                        nurses   per   1,000   population   in   the   metropolitan          Pennsylvania   and   representatives   of   the   adjacent
                        Buffalo area to  less  than  one-quarter  of  a  nurse  per          Comprehensive   Health   Planning   agencies   overlapping
                        1,000 population in  a  disadvantaged  area  south  of  the          our  region.  It  is  too  early  to   give   a   detailed
                        city.   Rural   areas   lack   personnel   in   many    job          description of this  relationship,  since  these  agencies
                        categories,  suggesting  that  residents  of  these   areas          have yet  to  define  themselves  operationally.  However,
                        must  necessarily   travel   considerable   distances   for          it  is  apparent  that  more   formalized   and   tangible
                        many  health  services.  This  variation  in  accessibility          working  relationships  will  be  evolved  in   the   near
                        necessitates  careful  planning  to  insure  better  health          future.
                        care for all persons in the region.                                  ACROSS  THE   STATE   -   Discussions   with   neighboring
                                                                                             RMPs  across  the  state  have  been  very  important   to
                                                                                             good inter-regional  cooperation;  these  discussions  can
                                                                                             be  extended  through  the  Northeastern  group   of   RMP
                        Relationship with Neighboring Regions                                coordinators.
                        TO THE NORTH - The southwestern            penninsula    of
                        Ontario,  including  the  two  major  towns   of   Hamilton
                        and  Toronto,  is  our  nearest  northern   neighbor.   Our          Housing of RMP for WNY
                        relationship  with   the   Canadians   is   most   cordial,                 The core staff is housed at  2929  Main  Street  in
                        especially   in   the   area    of    continuing    medical          Buffalo,  New  York.  We  now   possess   two   conference
                        education.  The  RMP   for   WNY's   Nursing   Program   in          rooms  which  are  heavily  used  by  committees  of   the
                        Coronary  Care  has   attracted   many   Canadian   nurses.          program,  both  official  and  ad  hoc,  and  which   have
                        Sponsoring  Canadian  institutions  have  paid   the   full          immeasurably   improved   our   role   as   an    enabling
                        costs   for    their    participants,    foreshadowing    a          agency.
                        self-supporting  status  for  the  nursing   project.   The                 Furthermore, core  staff  offices  provide  housing
                        Telephone  Lecture  Network  has   received,   though   not          for  the  Telephone  Lecture   Network   (TLN).   As   the
                        yet  accepted,  a  number  of  applications   for   outlets          vehicle    for    information,    both    academic     and
                        from  Ontario  hospitals.  We  seek   to   encourage   this          administrative,   TLN    has    been    the    means    of
                        relationship  which   transcends   artificial   territorial          maintaining   continual   community    involvement.    The
                        borders.                                                             RMP  headquarters  now  has  the  capacity   through   TLN
                        TO   THE   SOUTH   AND   EAST   -   The   Coordinator    of          to link with  all  communications  media  in  the  Western
                        the  RMP  for  WNY  has   maintained   friendly,   personal          New York-Pennsylvania region.
                        relationships  with  Dr.  Ralph  Parker  and   Dr.   Robert
                        Carpenter,  his  counterparts   in   Western   Pennsylvania
                        and Rochester.
                               The   Telephone   Lecture   Network   has   provided
                        outlets in hospitals of  both  these  neighboring  regions.

                                                                                        2


                                                             THE REGIONAL MEDICAL PROGRAM
                                                                           FOR WESTERN NEW YORK

                                                                                                                                  LAKE ONTARIO

                                                      TORONTO

                                                                                                                           P-(DRT

                                                                 HAMILTON
                                                                                        NIAGA                         A COUNTY'
                                        GEOGRAPHY                                          FALLS                                       GENESEE                         ROCHESTER
                                              The    Regional     Medical                                                                         COUNT
                                        Program  for  Western  New   York
                                        (RMP  for   WNY)   now   includes                                                             @BA7
                                        nine counties: Niagara,  Genesee,
                                        Erie,    Wyoming,     Chautauqua,
                                        Cattaraugus,     and     Allegany
                                        counties  in  Western  New  York,                                                                            NTY
                                        and Erie and McKean  counties  in
                                        Northwestern  Pennsylvania.   Our
                                        latest   addition   was    McKean
                                        County,  officially  admitted  in
                                        April 1970.

                                                                  DUNKIRK

                                                                                                                                                   ALLEGANY
                                                                                   TAUQUA               CATTARAUGUS COUNTY                           COUNTY
                                                                                     COUNTY

                                                           RIE                                           SA Al                 A
                                                                           JAMESTOWN                                                   A            E

                                                RIE COUNTY
                                                                                                                      BR FORD, PA.
                                                                                                                             I
                                                                                                                       MC KEAN COUNTY
                                                                                                                            1
                                                                                                                         219


                         '19          Leli@
                         L I                ml]PX

                 0     FZI(,Z

                                   5


                                                                                  VOLUNTARY HEALTH AGEN

                                                                                       PROFESSIONAL SOCIETIES

                                                               UNTY
                                                                                                                                     UNITED
                                                               LTH
                                                                                                                                      HEALTH
                                                               ,TIMENTS                                                              FOUNDATI

                                                                                                                                         .. . . ...... .......... .

                                                                                                                                        HEART
                                                                                                                                     ASSOCIATION
                                                                                                                                           OF
                                                                                                                                      WESTERN
                                                                                                                               @:NEVV YORK INC
                                                                                            Iowa
                                                                       AN
                                                                       SOCIETY

                                                                                            RESPIRATORY AND
                                                                                   TUBERCULOSIS ASSOCIA,TIO@

                                                                                                                                                    ORMAL RELATIONSHIP
                                                                                                                                               [3  WORKING RELATIONSHIP
                                                                                                     L GROUP                                   0  OTHERS - INFORMAL

                                        The     relationship     between                VVor  ki  n   g   relationships                    Those     organizations     with
                                   v a r i o u sh e a I t  h  -  related          involve  a   continuing   cooperation              vvh i ch  RMP      has        informal
                                   organizations   and   the   RMP   for          in    areas    such    as    awarding              relationships  are  a   rather   broad
                                   VVNY  may  be  divided   into   three          continuing   education   credit   for              group.   Concerned    agencies    tend
                                   categories   formal,   working,   and          participation   in   TLN    programs,              to  band  together  to  deal  with   a
                                   informal.   Formal   status   entails          co-sponsorship  of   teaching   days,              particular   program    or    problem.
                                   representation  on   the   Board   of          or  joint  planning   for   community              For     example,     the      American
                                   Directors  of  RMP     Is    Regional          health.                                            Cancer   Society,   the    Respiratory
                                   Advisory    Group,     the     Health                                                             and   TB   Association,   the    Heart
                                   Organization    of    Western    Nevv                                                             Association,  and  the   Erie   County
                                   York,    Inc.    (H.O.VV.N.Y.),    as                                                             Health    Department     formed     an
                                   mandated  in  the  by-lavts  of   the                                                             Inter-agency  Council  to  deal   with
                                   Regional   Medical   Program.                                                                     smoking.
                                                        Figure 2.      RMP for WNY Relationship to Other Health Related Organizations

                                                                                                      6


            Organization and Structure


                    The Volunteer's Contribution                                               The  Board  of  Directors  of  H.O.W.N.Y.  has  met
                           Volunteers  from  every   part   of   the   region,           twelve times in the past  twelve  months.  Meetings  have
                    serving on the  Regional  Advisory  Group,  its  Board  of           averaged between four  and  five  hours,  and  attendance
                    Directors  and  county  committees,  as  well  as  on  RMP           has, with one  exception,  always  fulfilled  the  quorum
                    standing  committees,  have  contributed  greatly  to  the           requirements.
                    grass-roots,  regional  character  of  the  RMP  for  WNY.                 The Board  has  required  the  Coordinator  of  the
                           Our sponsoring institution,  the  State  University           RMP  to  submit  to  them  a  monthly  report.  This   is
                    of New  York  at  Buffalo,  has  extended  help  of  every           distributed   to   all   Board   members    and    county
                    kind -- from  audio-visual  equipment,  graphic  arts  and           committee   chairmen.    It    1    )    documents    the
                    photography   services,    information    services,    and           Coordinator's activities  during  those  four  weeks,  2)
                    library facilities to  the  roster  of  experts  who  have           explains  new  legislation  pertinent  to  the  RMP,   3)
                    contributed   their   talents   to    Telephone    Lecture           provides a diary of projects, current  and  planned,  and
                    Network presentations.                                               4)  lists  a   number   of   questions   on   which   the
                          Display  space   and   meeting   rooms   have   been           Coordinator seeks the Board's advice.
                    made   available   to   RMP   for   WNY   throughout   the
                    region.                                                              County Committees
                          The  voluntary  agency  is  a   valuable   component                The   county   committees   have   expanded    their
                    of   the   health   care   system.   RMP   for   WNY   has           role and activity  over  the  last  year.  All  have  now
                    benefited   from   voluntary    participation    by    the           established bylaws consistent with those  of  the  parent
                    established   agencies.   Members    of    the    Regional           Regional  Advisory   Group,   namely   H.O.W.N.Y.   These
                    Advisory  Group  and  core  staff  have   been   able   to           subregional  components  of  the  total  advisory   group
                    reciprocate,    enabling    the    kind    of    voluntary           have provided substantial prereview for all  projects  by
                    cooperation   and   interdependence   which    can    most           virtue  of  their  committee  reports  to  the  Technical
                    economically  implement  the   best   measures   for   the           Advisory   Committee   (Proposal   Committee)   and   the
                    maximum number of people.                                            Board  of  Directors   of   H.O.W.N.Y.   The   cumbersome
                    Regional Advisory Group                                              appearance of our  Board  review  process  is  more  than
                          The  Health  Organization  of  Western   New   York,           compensated  for  by  the  involvement  it  promotes   in
                    Inc.  (H.O.W.N.Y.),  Regional  Advisory  Group   for   the           regionalization,  education,  and  review  process.   The
                    RMP  for  WNY,  is  responsible   for   defining   program           review process itself  is  now  an  important  continuing
                    objectives,    determining    priorities,     implementing           education  device  for  both  the   committees   involved
                    policies, approving  grant  applications,  and  evaluating           and the  grant  authors  subjected  in  person  to  their
                    ongoing  projects.  The  membership   of   H.O.W.N.Y.   is           scrutiny.
                    large,  namely  228  members.  We  have  encouraged,   and           Standing Committees
                    will continue to recruit, those in the  total  region  who                Those   who   serve   on    H.O.W.N.Y.    committees
                    can  provide  comment,  time,  and  interest  in   matters           must hold H.O.W.N.Y. membership.
                    pertinent   to   the   Regional   Medical   Program    for                RMP committees,  on  the  other  hand,  can  utilize
                    Western New York.                                                    the  expertise  of  consultants  who  are  interested  in
                          An organization  of  these  dimensions  requires  an           certain aspects of the program, but  not  necessarily  in
                    executive, which in our case is  known  as  the  Board  of           the program as a whole.
                    Directors  of  H.O.W.N.Y.  This  body   now   numbers   29
                    people.    A    representative     of     the     Veterans
                    Administration will  be  included  this  coming  year,  in           Core Staff
                    conformance   with   the   new    legislation.    Regional                All members of the  core  staff  are  now  full-time
                    representation    on    this    body    is     undoubtedly           Regional   Medical   Program   for   Western   New   York
                    dominant.                                                            employees.  They  are  predominantly  young  and  a  well

                                                                                 8


                                                                        D           F

                            A   3 M.D.'s from the 9 counties, representing the Medical Societies

                            B   3 others as "county" members
                            C   1member from Comprehensive Health Planning - the executive director
                            D   1member from the State Health Department, currently the director of the six-county VVestern Nevv York area
                            E   1member from the health department of the most populous county, currently the Health Commissioner of Erie County
                            F   1member from the VVestern Nevv York Hospital Association
                            G   2members from the State University of Nevv York at Buffalo

                            H   2members from the Rosvvell Park Memorial Institute

                            1   3members at large vvho represent urban minority interests

                                Figure 3.   Composition of Board of Directors of the Health Organization of Western New York

                                                                                      9


                              BOARD OF DIRECTORS                     HEALTH ORGANIZATION OF VJESTERN NEW YORK                                         November,      1970

                                                                                                      Orgaf@izational                                                  County of
                                 Name                                                                 Affiliation                                                      Residence
                                                                                                      or Occupation

                           Lester H. Block                                                        Attorney at L-@,.% 1                                                 Erie, N. Y.
                           Theodore   Bronk,   NI.D.                                              Niagara Coii-,,@ '.!ediull Society                                   Niagara
                           Evan Calkins, M.D.                                                     Chairman, F.@c@,j '@@ of Medicine,                                   Erie
                                                                                                  School of Nl--d;c -a
                                                                                                  State Unive.,z -.@ o' New York
                                                                                                  at Buffalo
                           L-aVerne E. Campbell, M.D.                                             New York S"@--,e Departr-nent                                        Erie
                           (Treasurer,      H.O.W.N.Y,)                                           of Health
                           Vincent   Ciampa,    M.D.                                              Cuba Memorial Hospital                                               Allegany
                           William H. Ennis                                                       Administrator, Hanot Hospital                                        Erie, Pa.
                           (Secretary,     H.0,VV.N.Y.)
                           Irwin Felsen, M.D.                                                     Medical  Society,   Allegany   County                                Allegany
                           (President,     H.O.VV.N.Y.)
                           Father Cosmas Girard, O.F.M., Ph.D.                                    St. Bonaven,,ure University                                          Cattaraugus
                           (Vice-President, H.O.VV.N.Y.)
                           Rosario Guilo, M.D.                                                    Western Ne@,,., York Hospital                                        Erie
                                                                                                  Association
                           Herbert   E.   Joyce,   M.D.                                           Erie County %l@dical Society                                         Erie
                           Edward   E.   Kemble,   M.D.                                           Erie County @%ledical Society                                        Erie, Pa.
                           Martin E. Meier, F.A.C.H.A.                                            Administrator, @@).C,A. Hospital                                     Chautauqua
                           John A. Mirmak                                                         Administrator,   Bradford    Hospital                                McKean, Pa.
                           William  E.   Mosher,   M.D.                                           Commissioner, Erie County                                            Erie
                                                                                                  Health Departrrent
                           Gerald   P.   Murphy,   M.D.                                           Director, Ros,,%ell Park                                             Erie
                                                                                                  Me mor la I I nsz i,, ut a
                           Mrs.    Mary     Northington                                           Component Manager for Health                                         Erie
                                                                                                  and Social Service - Model Cities
                           John  C.   Patterson,   M.D.                                           Roswell Park i%'emorial Institute                                    Erie
                           LeRoy Pesch, M.D.                                                      Dean, School or Nledicine,                                           Erie
                                                                                                  State University of New York
                                                                                                  at Buffalo
                           Fred 0. Rush                                                           Director, Gannon College                                             Erie, Pa.
                                                                                                  Bayfront Neichborhood
                                                                                                  Development Center
                           Mrs. Patricia Stopen, R.N.                                             Director, Public Health Nursing                                      Wyoming
                           Harry Sultz, D.D.S., M.P.H.                                            Department of Social and Preventive                                  Erie
                                                                                                  Medicine, State University of New York
                                                                                                  at Buffalo
                           H, Gregory Thorsell, M.D.                                              President, Jamestown Medical Society                                 Chautauqua
                           Donald R. Watkins, M.D.                                                McKean   County    Medical    Society                                McKean, Pa.
                           Charles Weliner                                                        Editor, Lockport Union Sun Journal                                   Niagara
                           Paul Welsh, M.D.                                                       Genesee   County   Medical    Society                                Genesee
                           R.  T,   Williams,   M.D.                                              Wyoming County Medical Society                                       Wyoming
                           Duncan     VVormer,     M.D.                                           Cattaraugus County Medical Society                                   Cattaraugus
                           George    Young,     M.D.                                              Genesee  County   rvledical   Society                                Genesee
                                                        Figure 4.       Board   of   Directors,   Health Organization of Western New York, Inc.

                                                                                                        I r)


                      educated  group,  both  academically  and   in   terms   of         grant  development,  nursing  and  allied  health  affairs,
                      Ri@v@IP concepts. Each  staff  member  has  a  well-defined         and research and evaluation.
                      role   in   the   organization   and   a   voice   in   the                A  manager-nent  assessment  visit  to  the  program
                      development  of  the  total  program.  According   to   his         earlier  in  the  year  provided  the  Coordinator  with  a
                      specific area of competence,  each  has  an  obligation  to         critical appraisal of  his  own  role  and  that  of  staff
                      one or more cooperating agencies.                                   members. Subsequent  increase  in  the  staff  has  greatly
                            Specific areas of staff  expertise  include  business         facilitated  our  change  in  emphasis  towards  an  active
                      and   personnel,   communications,   scientific    writing,         enabler of health-related activities.
                      systems   development,   planning,    community    liaison,

                                                                 COUNTY COMMITTEE CHAIRMEN

                                                                                      Organizational
                                                                                     Affiliation  or
                                          Chairman                                    Occupation                                       County

                       Irwin Felsen, M.D.                                     Allegany County Medical                                Allegany
                                                                              Society

                       Duncan C. Wormer, M.D.                                 Cattaraugus     County                                 Cattaraugus
                                                                              Medical Society

                       V)ilson Shaw, M.D.                                     Chautauqua      County                                 Chautauqua
                                                                              Medical Society

                       Max Cheplove, M.D.                                     Erie County                                            Erie, N. Y.
                                                                              Medical Society

                       Vacant                                                                                                        Erie, Pa.

                       Vacant                                                                                                        Genesee

                       John A. Mirmak                                         Administrator, Bradford                                McKean, Pa.
                                                                              Hospital

                       J.C. Read, M.D.                                        Niagara County Medical                                 Niagara
                                                                              Society

                       Harold Hinman, M.D.                                    Commissioner of Health,                                Wyoming
                                                                              Wyoming County Health
                                                                              Department

                                                              Figure 5.   County Committee Chairmen

                                                                                  1 1


                                                                H.O.@N,N.Y. BOARD OF DIRECTO

                                                                        Constitution and Bylaws

                                                                               Executi\/e

                                                                                 Search

                                                                                Proposals

                                                                                                                           COUNTY
                                   RMP                                                                                   COMMITTEES
                                                                                                                          OFHOWNY

                                                       Standing Committees

                                                       Coronary Care

                                                       Cancer
                                                       Stroke                                                Allegany
                                                           Nursing Stroke Education                          Cattaraugus
                                                       Dialysis                                              Chautaugua

                                                       Pulmonary Planning                                    Erie, N. Y.

                                                                                                             Erie, Pa.

                                                                                                             Genesee

                                                                                                             McKean, Pa.
                                                          New Committees                                     Niagara
                                                                                                             VVyoming

                                                       Rural Health Manpower

                                                       TLN Advisory Group

                                                       RMP Evaluation

                                                       Health Happening

                                                                 Figure 6.    Standing Committees

                                                                                   12


                                                                                                Core Staf f Activities

                                                                                                              1 3


                            Core staff activities  this  past  year  reflect  an                 - the outpatient  service  of  Children's  Hospital,
                       emphasis   on   a)   obtaining    data    which    permit                  to  determine  its   effectiveness   in   providing
                       identification  of  regional  needs  and  assessment   of                   services to  the  various  subpopulations  of  the
                       resources,  b)  manpower  problems,   c)   research   and                   area, particularly disadvantaged groups.
                       evaluation,   d)   communications   and   e)   continuing                 The  1970  census  data,  collected  and   presented
                       education.                                                          on the block level rather than  the  census  tract  level,
                                                                                           will  be  much  more  sophisticated  and  revealing   than
                       Data Collection                                                     previous  census  material.  Methodology  and        tools
                       Community  Health  Information  Profile  Data   System              appropriate to our area are being devised to deal     with
                            Baseline data provides  both  the  justification  of           this new data. Continued support of the data          bank
                       RMP  activities  and  a  basis  for  evaluation  of   RMP           will allow RMP  for  WNY  to  act  in  terms  of  regional
                       impact.   Core   funds   supported    a    program    for           diagnosis.
                       establishing  a  community-data   bank   to   provide   a
                       central regional  service.  This  project  was  initiated
                       July 1, 1970, for the  purpose  of  establishing  a  data                             Ambulance Service
                       base  from  existing  sources  and  developing  a  system                 Problems    of    efficiency    and    overlap    of
                       for incorporating new data as it  becomes  available  for           ambulance  service  have   been   defined   and   improved
                       health  service  planning  and  evaluation  in  the  nine           under the aegis  of  Buffalo  city  government  and  other
                       county  area  of  the  Regional   Medical   Program   for           well-motivated  groups  in  Erie  County.  RMP   for   WNY
                       Western  New   York.   An   expert   advisory   committee           is  actively  facilitating  the  defining,  planning,  and
                       was composed of  representatives  of  the  major  social,           implementing  of  a  unified  ambulance  service  of  high
                       demographic,   environmental,   and   community    health           standard.
                       data sources to consult with the  staff  of  the  project
                       who   are   working   within   the   Community   Services
                       Research   and   Development   Program,   Department   of
                       Social  and  Preventive  Medicine,  School  of  Medicine,                     Kidney Disease Services, Facilities,
                       State  University  of  New  York  at  Buffalo.   A   Dual                     and Programs in the United States
                       Independent   Map   Encoding   technique    (DIME)    has                 Participating in  a  national  survey  conducted  by
                       been  developed  for  the  Western   New   York   region.           the Regional Medical  Programs  Service,  staff  collected
                       Computer  technology  is  used  to  create  maps  showing           information  concerning  facilities   available   in   our
                       the  geographic  linkage  of  data.  These  maps  present           region  for  the  treatment  of   kidney   disease.   Both
                       data in an easily grasped  form  which  permits  response           detection   and   end-stage   kidney   disease    programs
                       in terms of planning.                                               (including  artificial  kidney  treatment   and   training
                             Four  community   studies   are   benefiting   from           programs,    kidney    transplantation    programs,    and
                       the  data-handling  capability  of  the  DIME  technique.           tissue     typing     laboratories)     were     surveyed.
                       Studied were:                                                       Information  such  as  institution,  name   of   director,
                               ambulatory  care  services   available   in   the           training for home  patients,  beds  in  unit,  and  number
                               emergency  rooms   and   outpatient   departments           of  transplants  performed  was   obtained.   Availability
                               of the seven major  hospitals  serving  residents           of  financial  assistance  and  kidney  donation  for  the
                               of the inner city                                           patient as well as plans to  develop  new  kidney  disease
                               the  service  effectiveness  of  Meyer   Memorial           activities in our region were documented.
                               Hospital for the care of diabetes patients                        Material for  this  survey  was  obtained  from  the
                               utilization patterns and  diagnostic  variability           RMP   for   WNY   Dialysis   Program   document   and   an
                               for  childhood  cardiac   conditions,   for   the           up-dating  questionnaire.   The   Dialysis   Program   has
                               Children's Hospital of Buffalo                              been approved but is, as yet, unfunded.

                                                                                    14


                       Manpower Problems                                                 Research and Evaluation
                                 Buffalo Summer Student Program                                 In addition to the aspects  of  project  and  total
                              This  project  sought  to  motivate  students  from        program  evaluation        described   in   Section    VII
                       minority  groups  towards  careers  in  medicine  and  the        (Evaluation), two studies have been undertaken:
                       allied  health  professions.   Sixty   students   received                   Coronary Care   Unit Nurse Profile
                       classroom   and   laboratory   instruction,   supplemented               A   study   was   designed   to    determine    the
                       with  clinical  and  community-health  field  experiences.        coronary care unit nurse profile as  opposed  to  that  of
                       Second  and  third  year  medical   students   supervised.        the  nurse  working  in  other   areas   of   nursing.   A
                       Evaluation of  the  direction  and  degree  of  change  in        questionnaire  of   approximately   fifteen   minutes   in
                       the   students'   knowledge,   attitudes,   and   behavior        length  was  used  to  interview  thirty   coronary   care
                       related to specific health careers  has  been  undertaken.        nurses and thirty nurses in other areas  of  nursing  care
                       A long-term follow-up  to  see  if  high  school  students        located in fifteen hospitals throughout  the  area  served
                       enrolled in the program  do  actually  choose  careers  in        by  the  Regional  Medical   Program   for   Western   New
                       medicine  and  allied  health  professions   is   planned.        York.  The  interviewing   was   conducted   through   the
                       This project was based at the  facilities  of  the  School        Telephone    Lecture   Network   (a   two-way    telephone
                       of   Medicine,   State   University   of   New   York   at        system).     The   questions   were   pre-taped    on    a
                       Buffalo, and received  fiscal  and  in-kind  support  from        ten-minute   cartridge  which  was  automatically  set  to
                       many agencies.                                                    stop   after the  completion  of   each   question.   This
                                                                                         procedure    allowed   for   probing   of   answers   when
                                                                                         deemed necessary.
                                                                                                The  following  two  papers   have   emerged   from
                                      Rural Externship Program                           this  study:
                              The   RMP   for    WNY    participated    in    the               - The  Coronary  Care  Nurse  Profile  by  Elsa  R.
                       organization  and  evaluation  of  the  rural   externship                 Kellberg   (to   be   submitted    to    "Nursing
                       program,  which  will  place  medical  and  allied  health                 Research")
                       students  with  preceptors  in  the  rural  areas  of  our                 A  sub-unit  has  formed   within   the   nursing
                       region.                                                                    profession   with   different   attitudes   about
                              In  the  summer  of  1970,  the  Student   American                 nursing  care.  The  coronary  care  unit   nurse
                       Medical    Association    (SAMA)    Appalachia     Student                 seems to have  a  different  frame  of  reference
                       Health   Program   placed   eight   students   on    rural                 than other  types  of  nurses  in  respect  to  a
                       externships  in   three   of   our   counties--Chautauqua,                 higher  aspiration  level.  She   needs   greater
                       Cattaraugus,   and   Allegany.   The   purpose   of   this                 responsibility,  opportunity  for  use   of   her
                       program  was  to  introduce  medical  and   other   health                 judgment,  and  challenge;  she  prefers  a  team
                       students  to  the  problems  of  the  rural   areas.   The                 approach to patient care.
                       students  and  preceptors  were  interviewed  by  RMP  for               - The  TLN  System  -  an  Interviewing   Technique
                       WNY   staff.    Recommendations    for    improving    the                 by Elsa  R.  Keliberg  and  Joseph  Reynolds  (to
                       program  were  abstracted  from  these  interviews.  Based                 be submitted for publication)
                       on    the    very    worthwhile     Appalachia     Program                 A   unique   method   employing   the   interview
                       experience,  the  RMP  for  WNY   staff,   together   with                 approach was  utilized  to  collect  data  for  a
                       the   Student   Coordinator   from   SAMA,   drew   up   a                 study  whose  purpose  was   to   determine   how
                       proposal for extending rural  externships  to  the  entire                 nurses  working   in   a   coronary   care   unit
                       RMP  for  WNY  region.  This  program  has  received   the                 perceive   themselves   in   their    profession.
                       enthusiasm  of  both  the   students   and   the   medical                 Interviews    were     conducted     over     the
                       community.  Possible  sources  of  funding  are  presently                 Telephone   Lecture   Network   system   of   the
                       being investigated.                                                        RMP   for   WNY.   Some   advantages   of    this
                              Interested  groups  have  established   the   Rural                 technique  are  the  verbal  standardization  and
                       Health  Manpower  Committee  under  the   aegis   of   RMP                 uniformity in asking  of  questions,  the  amount
                       for  WNY  and  the   chairmanship   of   Dr.   J.   Warren                 of  travel  time  saved   by   the   interviewer,
                       Perry,   Dean   of   the   School   of   Health    Related                 reduced  cost,  and  the  much   more   efficient
                       Professions, State University  of  New  York  at  Buffalo.                 scheduling of interviews.

                                                                                   15


                        Telephone Lecture Network System Evaluation                      Brochtires.-   Colorful    and    informative    brochures
                           After   the   Telephone   Lecture   Network    (TLN)          describe  various  aspects   of   the   RMP   program.   A
                    system  had  been  in  operation  for  two  years,  it  was          brochure  on  the   total   RMP   for   WNY   program   is
                    decided  to  poll  program  participants  for  the  purpose          currently being produced.
                    of gaining  insight  into  effectiveness  of  presentation,                RMP  for  WNY   has   always   supplied   the   news
                    direction programs should  take,  and  the  possibility  of          media  with  accurate  and  honest  information   on   the
                    self-support  in  the  future.  It  will  be  possible   to          premise  that  good  communication  is  the   prerequisite
                    continually  reevaluate  future  programs  by  regular  use          to cooperative  enterprises  in  it-nproving  health  care
                    of questions directed to the participants.                           and eliminating duplication.
                           RMP    for    WNY    staff    together    with    an                Finally,  the   day-to-day   personal   contact   of
                    independent  group,  Survey  Research,   State   University          H.O.W.N.Y.   members    and    RMP    staff    with    the
                    of  Ne@v  York  at  Buffalo,  worked  for  four  months  to          community  numbers  among   our   most   valuable   public
                    complete   this   three-phase   survey.   The   information          relations assets.
                    obtained  is  now  being  collated  and  analyzed,  and  an
                    interim  report  was  submitted  to  the   TLN   Evaluation          Continuing Education
                    Committee   on   November   17,   1970.   This,    together                Through  workshops   and   institutes,   physicians,
                    with  critical  visits  by  outside  consultants   familiar
                    with   communication   mechanisms,    will    provide    us          nurses, and allied health  professionals  in  the  Western
                    with  a  good  frame  of  reference  on   which   to   base          New  York   and   Northwestern   Pennsylvania   area   are
                    financially independent operation of the network.                    kept  abreast   of   the   most   up-to-date   information
                                                                                         about medical care. Core  staff  has  actively  cooperated
                                                                                         with other agencies  in  the  presentation  of  continuing
                    Communications                                                       education  programs,  both  over  the  Telephone   Lecture
                           Establishing  a  good  image  among  our  colleagues          Network  and  in  meetings  held  throughout  the  region.
                    and    the    general    public    and     keeping     them                RMP  for  WNY  provides  a  forum   for   discussion
                    well-informed   about   developments   in    our    program          of  controversial,  pertinent  issues.  A  Group  Practice
                    require  much   personal   contact   and   a   variety   of          Symposium    was    sponsored    by     the     RMP     in
                    approaches.                                                          conjunction   with   the   Erie   County   (Pa.)   Medical
                    Newsletters:     Twenty-one     H.O.W.N.Y.      Newsletters          Society    and    Erie    County     (Pa.)     Osteopathic
                    have  been  published  since  the  program  was  organized.          Association.   Approximately    80    persons--physicians,
                    The   mailing   list    has    grown    from    5,000    to          administrators,        insurance        people,        and
                    approximately 13,000 names.                                          others--attended  the  Symposium  held  on   October   21,
                    News   Releases:   News   releases   are    prepared    and          1970 in Erie, Pennsylvania.
                                                                                              The  RMP  for  WNY  will   continue   to   facilitate
                    distributed  to  every  newspaper,  radio  and   television          communication   among   all   those   involved   in    the
                    station in the  region.  Feature  articles  about  the  RMP          delivery  of  medical  care,  aiming   programs   at   the
                    for   WNY   have   appeared   in   almost    every    daily          multi-disciplinary  audience.   We   seek   to   encourage
                    newspaper.                                                           new programs for new needs in education.
                    Television:  Television  coverage  has  been  arranged  for
                    major   RMP   events:   the   H.O.W.N.Y.   Annual   General
                    Meeting;  the  September  1970  visit  o  acting   erector,
                    Harold Margulies, M.D.; open house of the  respiratory
                    teaching  lab;   openings   of   the   coronary   and   the
                    respiratory   training   programs;    and    special    TLN
                    programs.
                    Radio: Radio  stations  have  extended  the  use  of  their
                    facilities  for  region-wide  announcements  to   encourage
                    public  participation  in  RMP  functions  and  to  enlarge
                    public knowledge of RMP.
                    Exhibits:  Four  different  exhibits  have  been   designed
                    and displayed at conferences and meetings.

                                                                                  16


                                                                                                                  CONTINUING EDUCATION

                                                PROGRAM                         DATE                                 LOCATION                        REGISTRANTS                                     CO-SPONSORS

                             Stroke t                                April   2,   1970                  St. Jeromes Hospital                                   103              Heart Association of VV.N.Y., Inc., Continuing Medical
                                                                                                        Batavia, New York                                                       Education, State University of New York at Buffalo

                             Stroke t                                February      11, 1971             Hotel  Statier   Hilton,   Buffalo                                      Heart Association of VV.N.Y., Inc., Continuing Medical
                                                                                                                                                                                Education, State University of New York at Buffalo

                             Modern    Concepts    in                Apri  I  23,  24, 1970             Sisters of Charity Hospital, Buffalo                      64            Continuing   Medical   Education,   State   University   of
                             Coronary Care t                                                                                                                                    New  York   at   Buffalo

                             Modern    Concepts    in                November 19, 20,     1970          Sisters of Charity Hospital, Buffalo                      56            Continuing   Medical   Education,   State   University   of
                             Coronary Care t                                                                                                                                    New  York   at   Buffalo

                             Geriatric   Medicine   t                May 27, 28, 1970                   Hotel  Statier   Hilton,   Buffalo                        78            Continuing   Medical   Education,   State   University   of
                                                                                                                                                                                New York at Buffalo, The Rosa Coplon Jewish Home
                                                                                                                                                                                and Infirmary

                             Fifth    Annual    Buffalo              October 14, 16, 1970               Hotel  Statler   Hilton,   Buffalo                     216              Continuing   Medical   Education,   State   University   of
                             Pulmonary Disease                                                                                                                                  New  York   at   Buffalo
                             Conference t

                             Cardiac Clinics and                     February  1  1  -                  Sisters of Charity Hospital, Buffalo                                    Continuing   Medical   Education,   State   University   of
                             Physical       Examination              July  22,  1  971                                                                                          New  York   at   Buffalo
                             of  the  Cardiac   Patient t
                             (24    Thursday    evenings)

                             Family     Management     of the        February 25, 1971                  Statler  Hilton   Hotel,   Buffalo                                      Continuing   Medical   Education,   State   University   of
                             Chronically III                                                                                                                                    New  York   at   Buffalo

                             Pulmonary    Disease     ttt            January 15, 1970                   Hamburg, New York                                      300              T.B.  &  Respiratory   Disease   Association   of   VV.N.Y.

                             Pulmonary    Disease     ttt            April  17,   1970                  Canandaiqua, New Yorl<                                 200              T.B.  &  Respiratory   Disease   Association   of   VV.N.Y.

                                                    I I I            Al)iil 2@3, l@)70                  Alt i (@(1, N(!vv Yot l@                               1 2!)            1 .11.                Di@i!ii!@(! Associiitiorl t)f VV.N.Y., St@itt@
                                                                                                                                                                                LJiiiv(!r!;ity (if Ni@w Yorl< Ac ric:ultur@il @iiici Tuchrii(@zil
                                                                                                                                                                                College, Alfred, New York

                             Pulmonary    Disease     ttt            May   22,    1970                  Batavia, New Yorl<                                     200              T.B.  &  Respiratory   Disease   Association   of   VV.N.Y.


                            PROGRAM                               DATE                              LOCATION                     REGISTRANTS                                    CO-SPONSORS
                   Pulmonary   Disease    ttt          June 5, 1970                     Jamestown Community College                        100            T.B. & Respiratory Disease Association of VV.N.Y.
                                                                                        Jamestown, New York                                               Jamestown Community College
                   Pulmonary   Disease    ttt          October 9, 1970                  Niagara  Falls,  New   York                        200            T.B. & Respiratory Disease Association of VV.N.Y.
                   Spinal  Cord  Injuries  tt          October 22, 23,   1970           E.J. Meyer Memorial Hospital                       200            E.J. Meyer Memorial Hospital Rehabilitation
                                                                                        Buffalo,   New    York                                            Department
                   cancer Teaching Day                 December 2, 1970                 Dunkirk,   New    York                             234            Chautauqua County Unit, American Cancer Society
                   Cancer Teaching Day                 March 7, 1970                    Niagara  Falls,  New   York                        200            N.Y.S. Division of American Cancer Society, Niagara
                                                                                                                                                          Falls Academy of Medicine

                   Cancer  Teaching   Day   t          May 7, 1970                      Jamestown, New York                                   57          N.Y.S. Division of American Cancer Society, Jamestown
                                                                                                                                                          General Hospital

                   Refresher   Revitilization          September 15 -                   Buffalo,   Nevj   York                             Total          District Nurses Association of W.N.Y. Hospitals in Erie
                   Courses  tt  (10  courses)          November 17, 1970                                                                   697            County, New York
                   Utilization of Allied               April 16, 17, 1970               Buffalo,   New    York                             300            School of Health Related Professions, State University
                   Professions Assistants                                                                                                                 of New York at Buffalo, United Health Foundation
                   in the Delivery of
                   Health Care

                      Currently planned
                      Approximate number

                      t Primarily for physicians
                    ttprimarily  for   nurses
                   ttt Primarily for nurses, inhalation therapists, and physical therapists

                                                                                                  Figure    7.    Continuing       Education


                                                   I

                                                                1 q


                     Evaluation
                         Core   staff   in   conjunction   with   the   Regional         Projects
                     Advisory  Group  (RAG)  is  involved   in   evaluation   of             The   staff   member   for    evaluation    sees    all
                     the over-all program as well  as  its  specific  components         projects, at whatever stage they  are  initially  presented
                     Such  as   proposals   and   funded   projects.   The   new         to  RMP,  to  separate  means  from  ends  and  to   insure
                     annual review system places  on  the  region  ever  greater         inclusion  of  an  effective   evaluation   component.   An
                     responsibility for self-evaluation.                                 evaluation  committee  has  been  formed   to   advise   on
                                                                                         feasible   and   effective    evaluation    methods.    The
                                                                                         committee    consists     of     ten     multi-disciplinary
                                                                                         professionals,  and  is  being  expanded  to   include   an
                                                                                         economist,  a  social  psychologist,  and  a  statistician.
                                                                                         Together  with  the  RAG,  this  committee  is   developing
                     Program                                                             a rating system  which  will  give  stability  to  judgment
                         Since  September   1970,   RMP   for   WNY   has   been         without impractical rigidity.
                     participating  in  an  Information  Support  System   (ISS)              We  have  recently  initiated  a  system  of  one   or
                     study  conducted   by   the   Harvard   University   Center         two day site-visits to funded  projects.  Site-visit  teams
                     for  Community  Health   and   Medical   Care.   Interviews         consist  of  two  outside  consultants,  two   members   of
                     with  key  people   throughout   the   region   have   been         the  H.O.W.N.Y.  Board  of   Directors,   and   one   staff
                     conducted. The purpose  of  this  study  is  to  develop  a         member.  Their  recommendations  will  assist   the   Board
                     socio-political data base that  will  allow  evaluation  of         in  making   decisions   concerning   future   funding   of
                     the  short-term  and   potential   long-term   effects   of         operational  projects.  Forms  have  been  devised  to  aid
                     RMP activities in terms of:                                         team  members  in  evaluating  both  the  project  and  the
                          1 . Assessment of the status of a region                       procedure of the site-visit itself.
                          2.  Identification of  changes  in  the  medical  care
                              system  that  have  resulted   from   RMP   activ-         Studies
                              ities                                                            In  the  past,   studies   such   as   the   Manpower
                          3.  Determination   of   those   organizational   pro-         Study,  Stroke  Study,  and  Myocardial          Infarction
                              cesses  which  are  most  effective  in  promoting         Study  have  supplied  baseline  information  for   support
                              change.                                                    of future proposals. More studies  of  this  type  will  be
                     The  ISS   study   will   also   be   used   to   determine         developed  to  supply  data  not   only   in   support   of
                     similarities  among  RMPS,  enabling  comparison   of   the         proposals  but  also  as  information  necessary  for   the
                     performance  of  the  various  RMPs  and,   in   time,   of         establishment of regional program priorities.
                     non-RMP health agencies.                                                  The site-visit as  part  of  our  project  evaluation
                           The Grand Design  will  be  reviewed  at  least  four         system  together  with  regular  review  of   our   overall
                     times  a  year  by   the   Board   together   with   health         program  will   1)   allow   continuing   reassessment   of
                     planning   consultants.   These   one-day   workshops,   as         priorities;  2)  by  involving  outside   consultants   and
                     well as information  obtained  from  the  ISS  study,  will         competent   regional   opinion,   assist    in    promoting
                     help  RMP  for  WNY  retain  flexibility   and   priorities         intelligent  participation  in  the   RMP   regionalization
                     which  are  germane  to   the   emerging   needs   of   the         process; and 3) protect  against  an  inbred  view  of  the
                     region.                                                             RMP for WNY operation.

                                                                                   ,)n


                      The Program


                     New Legislation                                                          quality, and 3) decrease cost of health services.
                            Public  Law  91-515,  signed  October   30,   1970   by                 To    guide     program     planning     and     project
                     President  Nixon,   extends   and   amends   the   legislation           formulation   towards   the   three   overall   goals,    some
                     of  the  Regional  Medical  Program  as  well   as   that   of           interim objectives have been developed:
                     Comprehensive   Health   Planning,   the    National    Center           0   RMP   will   encourage   the   development   of   specific
                     for   Health   Services   Research   and   Development,    and           inter-institutional   and   inter-professional   relationships
                     the National Center for Health Statistics.                               at  all  levels,  for  the  purpose   of   more   coordinated,
                            The  bill,  collectively  referred  to  as  the  Health           efficient, and effective delivery of medical care.
                     Services     Improvement     Act,     incorporates     several           0  RMP  will  sponsor  efforts  to   increase   the   manpower
                     important   changes   in   emphasis   for   Regional   Medical           resources   of   the   region,   including   physicians    and
                     Programs  nationally,  and   reflects   strong   impetus   for           other health personnel.
                     new   directions   and    extended    activities    regionally           0   RMP    will    sponsor    means    of    increasing    the
                     within the RMP for WNY area.                                             effectiveness of regional manpower resources.
                                                                                              *   RMP   will   assist    in    defining    and    correcting
                     Grand Design                                                             maldistribution of health personnel in the region.
                            The  Regional   Medical   Program   for   Western   New           &  RMP  will   seek   means   to   continually   upgrade   the
                     York   is  presently  undergoing   an   important   transition           abilities   and    training    of    the    region's    health
                     from   "concensus   planning"    to    planning    based    on           personnel--and   to   achieve   more   uniform   quality    in
                     clearly  defined   regional   needs;   from   project-oriented           care.
                     to  total  program  planning.  Entry  into  this   new   phase           0  RMP   will   promote   improved   access   to   specialized
                     of  coordinated  planned   response   to   regional   problems           diagnostic   and   treatment   centers,   while   seeking   to
                     will be  facilitated  by  the  strengthening  of  the  Western           identify   and   discourage   wasteful    duplication    where
                     New    York    Comprehensive    Health    Planning     Agency,           additional services and facilities are not justified.
                     by   the   growing   amount   of   baseline   planning    data           0   RMP     will     encourage     the     development      of
                     emerging   out   of   RMP   support   of   the   Center    for           family-centered     comprehensive      care,      neighborhood
                     Community   Services    Research    and    Development,    and           health  facilities,  and  the   increased   availability   and
                     by  the  increased  planning  capabilities  within  the   core           utilization   of   primary   and   preventive   care   on   an
                     staff   of   RMP   for   WNY.   The   emerging    data    base           ambulatory basis.
                     concerning  health  needs  and  patterns  of   care   in   the           0   RMP   will   encourage   and   promote   the   development
                     region   will   subserve   RMP's   delineation   of    program           of   comprehensive    rehabilitation    services    and    the
                     objectives and their  priorities.  These  priorities  will  be           trained    personnel    needed    for    them    to    operate
                     reflected in more selective project support.                             effectively.
                            An  initial  attempt  has   been   made   to   take   a           0  RMP  will   promote   efforts   at   continuity   of   care
                     broad  look   at   RMP   for   WNY   in   relation   to   some           within  the  region,   though   coordination   of   preventive
                     major goals for  health  care  in  the  region.  This  outline           medicine,    diagnosis    and    treatment,    rehabilitation,
                     of  major  policy  directions  we  have  called   the   "Grand           home-care,  return  visit  follow-up,   and   other   critical
                     Design."   It   is   intended   as   an   emerging,   flexible           stages in the delivery of progressive patient care.
                     response   to   changing   regional    needs    and    project           *  RMP   will   assist   physicians   with   information   and
                     impact,   as   a   guide   to   RMP   efforts   at   achieving           services  of  definite  and  demonstrable  value  to  them  in
                     meaningful   health   care   objectives   in   the   RMP   for           their practice.
                     WNY region.                                                              0  RMP  will  encourage   projects   of   patient   education.
                            RMP   for   WNY   is   concerned   that   primary    as           0  RMP  will  seek   to   promote   area-wide   planning   and
                     well as specialized service be available  to  all  persons  in           coordination  of  health  services  within  the   region,   to
                     the  region.  We  seek   excellence   with   equity.   Overall           assist   in   defining   area-wide   and   community    health
                     program  goals  are  to  1)  facilitate  access,  2)   improve           service  needs,  and  in  each  case  to  identify  the   most


                   feasible mechanism for solution.                                      RMP  for  WNY  is  making  the  transition  to  a
                   .  RMP  will  promote  projects  designed  to  improve         more  aggressive  role  in  project   formulation.   The
                   the management of the  health  problems  of  the  aged         developmental  component  will  allow   exploration   of
                   in our society.                                                project  alternatives  without  a  large  or   long-term
                                                                                  commitment  of  funds.  It  could,  in  fact,  be   more
                                                                                  successful  than  three-year  funding   in   encouraging
                                                                                  projects to think in terms of self-support.
                   Developmental Component                                              The  developmental  component  is  envisioned   as
                         RMP for WNY has applied  for  a  ne@rv  category         responding  to  the  immediate  need  to   explore   new
                   of funding, initiated nationally to enhance the  trend         modes  of  health  care  delivery.  Funds  have  already
                   towards  greater  autonomy  for  each  region.  A  sum         been   precommitted   to   a   rural   health   manpower
                   equal to  10%  of  the  RMP  for  WNY's  total  annual         project   ($6,000).   A   continuing   migrant    health
                   appropriation can be awarded  to  the  program,  as  a         program,  ambulatory  care  in  the  region,   ambulance
                   developmental  component.  These  monies   @vould   be         service,  and  a  regional  disaster  plan   have   been
                   immediately available for short-term projects  not  to         pinpointed  as  other  areas   that   demand   immediate
                   extend beyond the one-year  period,  under  regulation         attention.
                   of the local review  processes  and  approval  by  the               Proper  use  of   developmental   funds   requires
                   Board of Directors of H.O.W.N.Y.                               considerable pre-planning. It is the conviction  of  the
                         One use  of  the  developmental  component  will         Coordinator  of  RMP  for  WNY  that  these  funds  must
                   be to support those studies that can provide  baseline         be  committed  within  the  first  three  months,   thus
                   data  for  establishment  and  evaluation  of  program         allowing    enough     time     for     planning     and
                   priorities.                                                    implementation of one-year projects.

                                                                             23


                                                                      NEW LEGISLATION

                        SUBJECT                          PREVIOUS LEGISLATION                                       NEW LEGISLATION
                                                                  P. L. 89-239                                           P. L. 91-515

                                                 Heart  disease,  cancer,  stroke,  and   related         Adds  kidney   disease,   and   other   related
                   MPHASIS                       diseases.                                                diseases.

                   r)DITIONAL                    Emphasis  on   making   available   the   latest         Promotes  medical   data   exchange   as   well
                    -@.'APHASIS                  advances  in  diagnosis   and   treatment,   and         as  research,  training,   and   demonstrations
                                                 on  cooperative   arrangements   for   research,         of patient care.
                                                 training,   and   related   demonstrations    of
                                                 patient care.                                            Adds prevention and rehabilitation.

                                                                                                          Gives       additional       emphasis        to
                                                                                                          regionalization  of   health   care   resources
                                                                                                          and  services  in  order  to   strengthen   and
                                                                                                          improve  primary  care  and  the   relationship
                                                                                                          between   primary    care    and    specialized

                                                                                                          care.

                                                                                                          Concerned   with   increasing    capacity    as
                                                                                                          well  as  quality  of   health   manpower   and
                                                                                                          facilities.     Directs      RMP      attention
                                                                                                          specifically  to  improvement  of  services  in
                                                                                                          areaswith limited health services.

                 ,"@t--LATIONSHIPS
                                                 None specified in law.                                   Requires   that   the   appropriate   regional,
                   0 COMPREHENSIVE                                                                        metropolitan,      or      local      area-wide
                   i@"7-ALTH PLANNING                                                                     Comprehensive    Health     Planning     Agency
                                                                                                          314(b),  have  an   opportunity   to   consider
                                                                                                          operational   grant   proposals   before    the
                                                                                                          RAG may recommend approval.

                   @JNDING                       Grants,   with    two-year    availability    of         Adds  contract  authority  as   well   as   RMP
                   ;@CHANISM                     funds.                                                   grant  authority   and   permits   regions   to
                                                                                                          obtain   services    in-kind    from    federal
                                                                                                          agencies.  One-year  availability   of   funds.

                   '@@GIONAL
                                                 Composition:                                             Requires    official    health    and    health
                   .')VISORY                     There    must     be     included     practicing         planning   agency   representation   on    such
                                                 physicians,    medical     center     officials,         advisory   groups;   requires    that    public
                                                 hospital     administrators,     representatives         members   include   persons    familiar    with
                                                 from     appropriate     medical      societies,         the financing of  as  well  as  the  need  for,
                                                 voluntary  health   and   other   health-related         services,  and  that  such  public  members  be
                                                 agencies,   and   members    of    the    public         sufficient  in  number   to   insure   adequate
                                                 familiar with health needs.                              community orientation.

                                                                                                          Also   includes   a   representative   of   the
                                                                                                          Veterans  Administration  as  an   ex   officio
                                                                                                          member,  if  there  is  a  VA  institution   in
                                                                                                          the region.

                                                                    Figure  8.  New   Legislation

                                                                                 nA


                        Program Operation

                           25


                 Finances
                                  Financial Management                                                    Financial     Statement:
                       Under  the  concept   of   level   funding   developed
                 by  the  Regional   Medical   Programs   Service   about   a                     March  1,  1970  -  February  28,   1971
                 year  and  one-half  ago,  the  Regional   Medical   Program                 For  the  year  March   1,   1970   -   February   28,
                 for  Western  New  York  can  anticipate  no   increase   in             1971, the  Regional  Medical  Program  for  Western   Ne@,i
                 funds.  At  present  new  projects  can  be  financed   only             York was   awarded    $1,962,097,    including    carryover
                 by  making  existing  ones  self-supporting  or  by  phasing             funds.
                 out  those  that  have  achieved  their  purpose.  Thus  the             From   this   total,   the   following    projects    were
                 effectiveness   of   projects   must   be    reviewed    and             budgeted:
                 expenditures examined  in  relation  to  the  program  as  a
                 whole.  It  is  the   responsibility   of   the   H.O.W.N.Y.
                 Board   to   pass   upon   recommended   transfers   or   to
                                                                                          Core Program                               $569,884
                 initiate  transfers  of  funds  from  one  approved  project             Telephone Lecture Network                    202,207
                 to another, in such a way as to best  attain  the  goals  of             Coronary Care Training Program               191,041
                 the  Regional  Medical  Program  for   Western   New   York.             Chronic Respiratory
                                                                                             Disease Program                           743,tp,4D
                 Proposal Review Process                                                  Immunofluorescent Service
                      The  author  of  a  project  idea   or   proposal   may                and Training Program                      45,994
                 approach  RMP  via   the   county   committees,   Dr.   John             Tumor Registry                               70,760
                 R.F.  Ingall,  or  liaison  staff.  Alternatively,  RMP  may             Topical Chemotherapy Treatment for
                 invite  the  development  of  a  proposal   to   redress   a                Precancerous   Lesions   and   Cancer
                 recognized deficit in the  region.  The  entire  core  staff               of the Skin                                59,830
                 reviews  the  proposal  to  advise  what  is  allowed  under             Information Dissemination Service            40,246
                 the  new  legislation  and  how  well  the  proposal   might             Continuing Education                         38,190
                 fit   into   priorities   established   by   the    Regional
                 Advisory  Group.   A   staff   member   then   assists   the                                                    $1,962,097
                 author in  developing  the  letter  of  intent,  a  one-page
                 lay    summary    which    represents    an    understanding
                 between  staff   and   author   of   the   intent   of   the
                 proposal.  Staff  members  continue  to  assist  the  author
                 as he further  develops  and  organizes  his  proposal,  and        The following were financed from Core funds or
                 sees it through the RMP for WNY review process.                     re-distribution of project funds:
                     The  proposal  begins  its   review   process   in   the             Hematology   Center,    Blood    Coagulation
                 county  committees.  The  author   must   be   prepared   to               Reference Laboratory                     $27,700
                 appear  before  the  county  committees  to  further   their
                                                                                          Community   Health    Information    Profile
                 understanding  of   his   proposal.   After   a   thirty-day               Data System                                58'667
                 aging    process,    county    committee     recommendations             Ambulatory Care Services Study               15,     0
                 are forwarded to the Proposals Committee.                                Buffalo Summer Student Program               20,800
                    The   Proposals   Committee    has    become    a    very
                 strong  body  representing  the  region   at   large,   with
                 liberal co-option of  experts  in  areas  under  discussion.
                 It benefits from  the  expertise  of  a  number  of  outside                   Figure  9.  Financial   Statement:
                 agencies as well  as  the  independent  review  of  the  New                March  1,  1970  -  February   28,   1971
                 York    State    Health    Department.     Following     the

                                                                             26


                    suggestions of a federal  site-visit  team,  RMP  for  WNY          telephone  to   expand   existing   continuing   education
                    plans to bring in even more  outside  consultants  to  the          programs   at   the   Health   Sciences   Center,    State
                    Proposals  Committee.  These  experts  will  be  available          University   of   New    York    at    Buffalo.    Fifteen
                    to help the  county  committees  in  their  deliberations.          representative hospitals  of  the  region  were  involved.
                          Criteria    for    proposal    evaluation    include          Twenty-six  lectures   were   presented,   seventeen   for
                    relevance  to  RMP,  relation  to  a  documented  need  in          physicians and nine for nurses.
                    the  region,  technical  competence  of  the   region   to                 A  telephone  network  appeared  to  be  the   most
                    fulfill the proposal, lack  of  duplication,  contribution          suitable  means  of  communication  for   the   compressed
                    to  improvement  of   patient   care,   presence   of   an          geographic  area  served  by  the   RMP   for   WNY.   The
                    evaluation   component,   comparability   with    existing          most  distant  location  is  approximately   one   hundred
                    health-care    patterns,     promotion     of     regional          miles from Buffalo, New York.
                    cooperation,     and     possibility      of      becoming                 The  Telephone  Lecture   Network,   a   dedicated*
                    self-supporting. The  proposal  must  be  submitted  in  a          network,  became  operational  on  September   17,   1968.
                    forf,n that is amenable to federal review.                          Thirty-six    hospitals     were     interconnected     to
                                                                                        participate    in    hour-long    continuing     education
                          The  Proposal  Committee  has   revie@ved   thirteen          programs.
                    proposals this year. Of  these,  six  have  been  approved                 At  the  present  time  the  network  interconnects
                    and   recommended   for   new    funds.    Recommendations          sixty  locations  in  eight  Western  New  York   counties
                    of  the  Proposals  Committee   are   submitted   to   the          and  three  Northwestern   Pennsylvania   counties.   Each
                    Board  of  Directors  of  H.O.W.N.Y.  for  final  RMP  for          receiving location is  provided  with  a  loudspeaker  and
                    @VNY approval.                                                      a  telephone  handset.  The  loudspeaker   amplifies   the
                                                                                        incoming   program   and   the   handset    permits    the
                                                                                        listening audience  to  comment  on  the  program  or  ask
                                                                                        a question of the lecturer.
                                                                                               Programs    normally    originate    from    studio
                                                                                        facilities located in the  Regional  Medical  Program  for
                                                                                        Western  New   York   offices   at   2929   Main   Street,
                    Operational Projects                                                Buffalo,  New  York.  However,   programs   can   and   do
                          Our mission is  to  engineer  change.  The  RMP  for          originate from locations  on  the  network.  Lectures  can
                    WNY  is  an  "enabler,"   an   organization   that   helps          also  be  conferenced  via  a  long   distance   telephone
                    initiate    projects     and     encourage     cooperative          connection.
                    arrangements  which   will   improve   the   delivery   of                 Each lecture  is  accompanied  by  visual  aids  in
                    health care in our  region.  Although  certain  categories          the  form  of  35  mm  slides  and/or  handout  materials.
                    of  disease  (heart  disease,   cancer,   stroke,   kidney          Since  the  start  of  the  Telephone   Lecture   Network,
                    disease, and related diseases)  are  emphasized,  we  have          over  three  hundred  specially  designed   programs   for
                    always considered  individual  projects  as  part  of  our          professional and technical  personnel  in  health  related
                    total program. Inter-relation  between  projects  and  the          fields  have  been  presented  by  leading  teachers   and
                    kinds  of   cooperative,   regional   arrangements   which          practitioners.
                    they   foster   have    been    primary    considerations.                 The  network  is  currently   involved   in   three
                    Increasingly  we  stress  our   overall   goals:   to   1)          types of educational programs:
                    facilitate access, 2) improve  quality,  and  3)  decrease                 1.   continuing   education   of   health   profes-
                    cost of health services to all persons in our region.                         sionals
                                                                                               2. courses for academic credit
                    1. Funded and On-Going                                                     3. patient,  family,   and   community   education.
                      Component No. 1 - Telephone Lecture Network                              A  number  of  our  projects  are   now   dependent
                          The  Telephone  Lecture   Network   (TLN)   is   the          on  the  TLN.  Core  staff  and  various  committees  have
                    voice  of  the   RMP   for   WNY   program.   The   unique          come to rely on it for  surveys,  meetings,  and  regional
                    feature  of  the  network  is  that  it   allows   two-way          conferences.  The  Telephone  Lecture   Network   is   the
                    communication--what is said  at  one  point  is  heard  at          communication   mechanism   that   has   underscored   the
                    all points.                                                         regional nature of the RMP for WNY.
                          A  Pilot  study  was  conducted  in  the  spring  of
                    1968  to  determine   the   feasibility   of   using   the          *Closed circuit audio network available 24 hours a day.

                                                                                 27


                                                              PROPOSAL REVIE@V PROCESS

                                      A                        AUTIOR

                                                              WNY-RMP
                                      B                      Headquarters
                                                                    F-

                                      c                  County Committees

                                      D                  Proposals Committee                                 As in  the  past,  proposals
                                                                                                        vvill be considered in  order  of
                                                            of H.O.W.N.Y.                               submission from steps  A  through
                                                                                                        E.  However,  effective  November
                                                                                                        1, 1970, proposals are  processed
                                                                                                        as a group from steps  F  through
                                                                                                        H, once a year.
                                      E                   Board    of Directors

                                                            of H.O.W.N.Y.
                                                                    I

                                      F           At State University of New York
                                                   at Buffalo: Dean of School of
                                               Medicine, Provost of Health Sciences,
                                                    Vice President for Research

                                      G            Research Foundation of State
                                                      University of New York
                                                              at Albany
                                                                    I

                                      H          Washington: Division of Regional
                                               Medical Programs, U.S. Department
                                                 of Health, Education and Welfare

                                                            Figure 10. Proposal Review Process

                                                                             28


                                        Component No. 2                                Tuberculosis  and  Respiratory  Disease  Association   of
                                 Coronary Care Training Program                        Western New York  all  cooperate  in  various  facets  of
                     NURSES                                                            the project.
                            The    program    seeks    to    develop    skilled               Sixteen  thousand  people   were   screened   this
                     approaches  to  patient  and  family  care   through   the        year at a cost of $40,000 or $3.00 per screening.
                     synthesis  of   medical   and   nursing   knowledge.   The               Hospital personnel are being trained in a  general
                     Coronary  Care  Training  Program  for  nurses  has   been        intensive care unit  pending  establishment  of  a  model
                     operational   since   March   1968.   From   March    1968        seven-bed    pulmonary    unit.    The     fully-equipped
                     through  December  1970,   two   hundred   and   sixty-one        hospital    pulmonary    function    laboratory    trains
                     registered nurses  have  completed  the  six  week  course        students, physicians, and nurses of the entire area.
                     on  intensive  care  of  patients   with   acute   cardiac               Outpatient service has  stressed  home  inhalation
                     problems.  The  basic  format  encompasses   three   weeks        therapy.  A  home   care   program   and   an   emphysema
                     of classroom  instruction  and  three  weeks  of  clinical        club were started in 1970.
                     application of nursing  principles  and  practical  skills               Education is a  vital  part  of  the  project.  An
                     taught in Buffalo area hospitals.                                 associate  degree  program  in  inhalation  therapy   has
                            Objectives for 1970 were:                                  been   developed   at   Erie   Community   College.   Six
                            1. Evaluation  of  the  curriculum  and  the  prac-        different  multi-disciplinary  teaching  days   held   in
                               ticum                                                   outlying hospitals have attracted a total of  922  nurses
                            2. Increase in  the  number  of  courses  presented        and  allied  health  personnel.   Twenty-three   of   the
                               yearly                                                  twenty-four  nurses  who  participated  in  an  intensive
                            3. Admittance of  Canadian  nurses  to  the  teach-        four-week course in  pulmonary  disease  are  working  in
                               ing programs in late 1969 and in 1970.                  the field. Forty  additional  nurses  will  complete  the
                            Goals  include  offering   advanced   programs   in        course  by  March  1,  1971.  The  program's  scope   has
                     cardiac  nursing  care  for  registered  nurses  who  have        been  enlarged   to   encompass   preventive   care   and
                     completed the basic courses of instruction.                       rehabilitation.
                                                                                              A  major  accomplishment  was  the   post-graduate
                     PHYSICIANS                                                        course  in  emphysema,  offered  for   physicians.   Over
                            Three  separate  programs   in   "Modern   Concepts        200 physicians attended  this  year;  a  similar  program
                     in  Coronary  Care"  were  offered  to  physicians  during        will  be  offered  again  next  year.  TLN  programs  and
                     1969-70.  Each  program   was   greatly   over-subscribed;        support of two  pulmonary  fellows  this  past  year  and
                     the third presentation was  the  result  of  requests  and        four  fellows  next  year  are  also  included   in   the
                     over-subscription.  A  total  of  about   200   physicians        continuing education program for physicians.
                     and  some  medical  students  and  nurses   attended   the               Training  programs,  consultation,  and   regional
                     presentations last year.  At  least  300  physicians  have        teaching days  held  under  the  aegis  of  this  project
                     been trained since the project's inception.                       provide a long-needed service  and  have  contributed  to
                                                                                       improving   the   region's   approach   to    respiratory
                            The  status  of  the  extremely  popular   Coronary        disease.
                     Care  Training  Program  is  currently  under  discussion;
                     it may become the first  self-supporting  project  of  the                           Component No. 4
                     RMP for WNY.                                                        lmmunofluorescent Service and Training Program
                                                                                              Between three and  six  percent  of  all  hospital
                                                                                       patients within  our  region  suffer  from  diseases  for
                                        Component No. 3                                which  either  the  only,   or   the   best,   laboratory
                              Chronic Respiratory Disease Program                      diagnostic  tests  entail   FA   (fluorescent   antibody)
                            Fully  funded  in  July  1969,  this  many-faceted,        analyses for tissue  antibodies.  One  of  the  important
                     comprehensive    project     has     experienced     rapid        FA tests, the ANF  (antinuclear factor          is  being
                     development  in  the  past  year.  Five  physicians  serve        requested  about  twenty  times   per   week   per   1000
                     on  the   guiding   committee,   representing   the   five        hospital beds.
                     participating   hospitals.   The   Erie   County    Health               The project was first  funded  in  June  1969.  In
                     Department  (especially   the   Visiting   Nurses),   Erie        addition to  providing  a  regional  laboratory  service,
                     Community   College,   the   health-related    departments        project staff have been involved in teaching  activities.
                     of   the   State    University,    and    the    voluntary        The  education  of  physicians  as  to   the   diagnostic

                                                                                 29


              utility of the project  continues,  as  does  the  training         extensive  modifications  of  the  original  proposal  prior
              of  laboratory  technicians  from  throughout  the   region         to  implementation.  The  registry   is   expected   to   be
              in    procedures    involving    immunofluorescence.    One         functioning  fully  by  the  end  of  February   1971,   and
              hundred   persons   were   instructed   in   the   use   of         self-supporting    by    February    1972.     Twenty     to
              immunofluorescent  tests   for   tissue   antibodies;   ten         twenty-five   hospitals   and   6,000    new    cases    are
              hospital   technologists   received   individual    bedside         expected to  be  handled  in  the  next  year.  The  project
              instruction;  two  teaching   programs   for   pathologists         has regional hospital support  and  the  assistance  of  the
              were  presented,  one   at   Pathology   Society   meetings         Management    Engineering    Program    of    the    Western
              and  one  over  the  Telephone   Lecture   Network;   seven         New York Hospital Association.
              pathologists   and/or   laboratory    directors    received
              personal    conferences    on     specialized     problems;         2. Approved but Unfunded by RMPS
              thirty-seven   practicing   physicians   participated    in         (Locally  supported  for  one  year  through  carryover   or
              clinical pathologic conferences.                                    rebudgeted funds)
                    Consultation   with   the   laboratory    staff    is
              increasing   as   the   program   becomes   better   known.                           Component No. 13
              Cooperative  relationships  are  now  starting   to   yield                   Topical Chemotherapy Treatment
              geographic   coverage    for    tissue    immunofluorescent            for Precancerous Lesions and Cancer of the Skin
              test services and training. Direct service by  the  central
              reference   laboratory   is   provided,    as    well    as                Each  year  in  the  United  States   four   thousand
              cooperation    with    interested     regional     hospital         people  die  from  skin   cancer.   There   is   an   annual
              laboratories in improving their own performance.                    incidence of 1 00,000  new  cases  of  skin  cancer  and  at
                                                                                  least  five  to   ten   million   cases   of   pre-malignant
                       Component No. 5 - Tumor Registry                           karatoses.
                    This  project  is  seen  as  a  major   catalyst   to                Topical   anti-cancer   agents,   which   are   about
              regionalization  and  a  means  of  improving  the  quality         90%    effective    for    treatment    of     pre-malignant
              of patient care. The  overall  objective  of  the  Regional         karatoses   and   80%   effective   for   superficial   skin
              Tumor  Registry  is  to  improve  cancer  control  in   the         cancers,   have   been    developed    at    Roswell    Park
              nine  counties  which  are  presently   serviced   by   the         Memorial  Institute   in   Buffalo.   Topical   chemotherapy
              Regional   Medical   Program   for   Western   New    York.         is diagnostic as  well  as  therapeutic;  it  picks  up  the
              The objective will be accomplished by:                              very  early  lesions   that   are   not   yet   recognizable
                    1. Promoting   improved    patient    care    through         clinically.  Replacing  a   laborous   surgical   procedure,
                       regular, periodic follow-up                                application  of  cream  containing  an   anti-cancer   drug,
                    2.   Assisting   physicians   in   determining    the         topical 5-Fluorouracil,  and  cures  skin  lesions  in  four
                       efficacy of treatment modalities                           weeks or less.
                    3.  Providing  a  valuable  resource  for  continuing                Since this simple  procedure  is  readily  usable  by
                       cancer education.                                          the   community   physician,   the   RMP    for    WNY    is
                    The   Registry    has    accessioned    approximately         supporting  a  project  funded  as  of  March  1,  1970   to
              300  patients.  With  this  minimal  case   load   it   has         disseminate the  method  and  materials  on  a  large  scale
              already  become  apparent  that  the  Registry  will  serve         throughout  our  area,  and   through   analysis   of   data
              as   a   valuable   tool   in   determining   areas   where         received,  to  develop  this  region  as  a  model  in  skin
              continuous  physician  and  allied  health   education   is         cancer treatment for the entire nation.
              needed.  Review  of  these   cases   indicates   the   wide                The project is  to  be  developed  in  three  phases:
              range of quality of  medical  care  presently  being  given                1.      The      Buffalo-Rochester       Dermatologic
              to cancer patients. The input  to  date  is  inadequate  to                   Society   has   formed   a   "Liaison   Committee"
              arrive at any meaningful  statistics  and  the  time  lapse                   of six members.
              has  been  insufficient  to  warrant   patient   follow-up.                2. Liaison  Directors  are  now  being  oriented   to
              Completion   of   the    Registry    Abstract    Form    by                   link  regional   physicians   with   the   Buffalo
              personnel in the participating hospitals  has  resulted  in                   center.
              a general  upgrading  of  the  hospital  charts  of  cancer                3. Although   topical   therapy   as   a    treatment
              patients.                                                                     method   was   to   be    deferred    until    the
                    The  project   was   compromised   in   its   initial                   completion   of   phases   one    and    two,    a
              phase  by  constraints  on   funds   and   the   need   for                   number of  physicians  in  various  parts  of  the

                                                                           30


                                region  who  already  have  specialized   training             Component No. 16 - Hematology Center, Blood
                                with   topical   chemotherapy    have    requested                     Coagulation Reference Laboratory
                                the  materials  and   offered   to   provide   the                 This project  was  started  with  partial  funding  on
                                information   required   for   evaluation.    This          September  1,  1970.  A   laboratory   has   been   organized
                                initial  approach  will  be  useful  as  a   pilot          which   is   capable   of   diagnosing   all--including   the
                                project  for  providing   information   to   guide          rare--hemorrhagic   and   thromboembolic   problems   on    a
                                the   more   general   implementation   of   phase          twenty-four   hour   day   basis.   Between    September    1
                                three.                                                      and   December   29,   diagnostic    work-ups    have    been
                             Implementation of  the  initially  proposed  plan  is          performed  for  1   1   1   patients.   In   September,   for
                      proceeding  more  rapidly  than   envisaged,   largely   due          example,  a  total   of   662   blood   coagulation   studies
                      to the  interest  and  support  of  the  physicians  in  the          were  carried  out  for  the  thirty-two  patients   referred
                      RMP for WNY region.                                                   to  the  center.  Two  nurses  care  for  patients  who  come
                                                                                            to   the   Center   and    handle    follow-up    procedures.
                                                                                            Physicians  associated  with  the   Center   were   available
                                                                                            for   consultation   on   hemorrhagic   and    thromboembolic
                                                                                            problems   twenty-four   hours   a   day   in    person    or
                                                                                            through  the  telephone,  and  have  participated  in   forty
                                                                                            consultations    during    the    past    months.    Research
                                                                                            projects  initiated in the Center include:
                                         Component No. 14                                          1 .Development   of   diagnostic   methods   to   dif-
                                Information Dissemination Service                                     ferentiate     between     disseminated      intra-
                            This  project  was  approved  and   funded   for   the                    vascular    coagulation,    fibrinolytic     hemor-
                      period  of  March  1,  1970  through  February  28,  197  1.                    rhage, and combinations thereof
                      The objective is to  establish  in  the  RMP  for  WNY  area                 2. Study  of  changes  in   the   blood   coagulation,
                      an   information   dissemination    service    to    provide                    fibrinolysin  and  kinin  systems  during   attacks
                      physicians and  allied  health  professionals  with  printed                    of hereditary angioneurotic edema
                      information  from  a   broad   spectrum   of   medical   and                 3. Development   of   diagnostic   methods   to   pre-
                      scientific  journals  and  books,  and  to  alert  them   to                    dict   susceptibility   in    women    to    hyper-
                      new developments  in  their  field  of  interest  through  a                    coagulable   states   induced   by   oral   contra-
                      current   awareness   service.   The   existing    Telephone                    ceptive agents
                      Lecture  Network  is  the   communication   link   used   to                 4. Development   of   improved   methods    for    the
                      receive  requests.  The  Health  Sciences  Library  at   the                    purification   of    human    fibrinogen    as    a
                      State University  of  New  York  at  Buffalo  is  designated                    reagent   for   diagnostic   tests   to   determine
                      as   the    resource    medical    library.    High    speed                    members of the fibrinolysin system.
                      duplicating   machines    provide    copies    of    journal                 The    Center    trains    both    technicians     and
                      articles, which  are  sent  by  mail  on  request.  Material          physicians.   Inexperienced    technicians    work    several
                      not available at the  Health  Sciences  Library  is  secured          weeks  to  months  in  the  laboratory,  being   trained   by
                      through  referral  to  other  libraries.  Although   mailing          the staff and  involved  in  all  laboratory  activities.  In
                      of  journal  articles  answers  the  bulk  of  requests,   a          addition,  a  one-week   advanced   refresher   course   will
                      bibliographic  service  utilizing  the  facilities  of   the          be presented in March 1971.
                      SUNYAB     Biomedical     Communications     Network      is                 Physician   training   includes   support    of    one
                      also available.                                                       hematology  fellow  in   the   laboratory   who   cares   for
                            Seven    thousand    requests    per     year     were          patients  and  gives  consultations  in  other  hospitals.  A
                      originally envisioned.  The  project  director's  policy  of          postgraduate  course  for  physicians  will  be  given   this
                      personally visiting all  institutions  linked  to  the  TLN,          spring.  Two  film  strips,  Hemorrhagic  Disease   One   and
                      to   acquaint   them   with   services    and    means    of          Two, have been prepared.
                      operation,   has   resulted   in    5,000    requests    for                 Reference     standards     and      reagents      not
                      informational  material   in   the   period   between   June          commercially  available  have  been   prepared   for   Center
                      and   November.   Requests   from    nurses    and    allied          use.  The  Center  hopes  to  be  able   to   provide   these
                      health  personnel,  as  well  as  physicians,  testify  that          standards   and   reagents   free   of   charge   to    other
                      the service is  reaching  the  entire  spectrum  of  medical          hospitals and laboratories in the region.
                      personnel.  The  deluge  of  requests  indicates  that   the                 The    Blood    Coagulation    Reference    Laboratory
                      Information   Dissemination    Service    is    meeting    a          serves as  a  continual  contact  and  reference  center  for
                      previous deficit in the community.                                    the entire region.

                                                                                      31


                                           OPERATIONAL PROJECTS

             TELEPHONE LECTURE NETWORK                        CORONA R Y CA RE TRA INING PI?OGRA M

        CHRONIC RESPIRA TOR Y DISEASE PROGRA M                  IMMUNOFL UORESCENT SEI? VICE

                 TUMOR REGISTRY                                   TOPICAL CHEMOTHERAPY

        INFORMA TION DISSEMINA TION SER VICE                      HEMOTOLOGYCENTER

                                                 32


                                                                                                STATUS OF PROPOSALS

                                                                                                                                    Sui)iyiitted
                                Proposal No.                                             Staf f                H.O.W.N.Y.           for Federal
                                     Title                        Author               Work-up              Review                    Review                          Amount                    Period

                           No.   33
                           Cooperative                   Kidney and Dialysis            Complete            Approved             Tentatively Approved          Reduced to $250,000            3   years
                           Dialysis Program              Committee:                                                              -unfunded for the             (Direct Costs) for
                                                         W. Staubitz, M.D.                                                       first year                    initial budget period.
                                                         S. Anthone, M.D.                                                                                      Amount of funding
                                                         R. Anthone,    M. D.                                                                                  not specified for
                                                         J. Lasher, M.D.                                                                                       remaining two years.
                                                         J.   Hodson,    M.D.
                                                         J.   Gerbasi,   M.D.
                                                         G. Murphy, M.D. et al

                           No.   46
     w                     Prevention and                C.  ArTibrus,   M.D.           Complete            Approved             Sel)teinl)er   1970           $388,534                       3   years
                           Treatment of the
                           Respiratory Distress
                           Syndrome Due to
                           Hyaline Membrane
                           Disease in Infants

                           No.   47
                           A Model Program for           E.   Haynes,    M.D.           Complete            Approved             September      1970           $588,677                       3   years
                           Comprehensive Family
                           Family Health

                           No.   48
                           Computer-Based                E.  Gabrieli,   M.D.           Complete            Approved             November       1970           $437,017                       2   years
                           Area-Wide Health
                           Data System

                           No.   49
                           Demonstration                 C.   Bishop,    M.D.           Complete            Returned to          Not applicable                $206,234                       3   years
                           Laboratory                                                                       author    for
                           Computer System                                                                  major revision
                           No.   50
                           Comprehensive                 E.   Wagner,    M.D.           Complete            Approved             November       1970           $750,099                       3   years
                           Continuing Care               E. Noble, M.D.
                           for Chronic Illness


                                No. 51
                                Health Planning and       H. Patton
                                Resources                                            Complete          Returned to      Not applicable             $906,193
                                Development                                                           author for                                                             3 years
                                                                                                      major revision
                                Choriocarcinoma and       M. Hreshchyshyn, M.D.     Complete
                                Related Trophoblastic                                                   Approved        November 1970             $210,758
                                Disease                                                                                                                                      3 years
                                Screening of             R. Moesch, M.D.            Complete         Returned to       Not applicable             $467,719
                                Indigent Hospital
                                Dependent Women                                                      author  for                                                            3 years
                                for Cervical Carcinoma                                               major revision
                                A Regional Bone         E. Mindelf, M.D.           Complete          Approved         November 1970              $205,317                   3 years
                                Pathology Laboratory
                                Endoscopic              L. Berman, M.D.           Complete          Returned to       Not applicable            $95,954
                                Techniques for the
                                Diagnosis of                                                        author for                                                             1 year
                                Esophageal and                                                      major revision
                                Gastric Diseases
                                Hospital Based         N. Courey, M.D.            Complete          Returned  to     Not applicable             $657,429
                                Comprehensive Care
                                Clinic for Women                                                   author for                                                             3 years
                                                                                                   major revision
                                Mobile Health Clinic   V. Barker, R.N.           Complete          Returned   to     Not applicable            $164,638                   3 years
                                for Allegany County
                                                                                                   author for
                                mall Commu                                                         major revision
                                Hospital Becot
                                Regional Comprehen.                                                                                                                      3 years
                                sive Health Center:
                                (Wyoming County)
                                Allent
                                Comm                                            In Progress       Pending           Not applicable
                                Center                                                                                                        $150,000                   3 years

                                                                                       F: igur(, II Status of Proposals


                                         The Regional Medical Program for Western New
                                         York gratefully acknowledges the support of the
                                         Division of Regional Medical Programs Service,
                                         Health Services and Mental Health Administration,
                                         U. S. Department of Health, Education and
                                         Welfare. The findings and conclusions in this
                                         publication do not necessarily represent the
                                         views of the sponsoring agencies.

                                                               35