I *


       1973-74 Annual Keport

       Lakes Area Regional Medical Program, Inc.


                                                                               Contents

                                                                            1  Theme

                                                                            2  Faith and Fortitude Meet the Challenge!
                                                                            3  A Word from the Executive Director

                                                                            4  Goals and Objectives
                                                                            5  Origin of RMP s
                                                                            6  Enabling Role, Talking Toget er
                                                                               The Grantee Institution, Regional Advisory Group
                                                                            7  Health Services Development Unit
                                                                               Program Committee
                                                                            8  Central Management Services

                                                                            9  Library Serv ces

                                                                          1 0  Evaluation

                                                                          1 2  Financial Report
                                                                          14   Developing a Grant Proposal
                                                                          15   Programs in Continuing Education
                                                                          17   Cancer Teaching Days and Task Force
                                                                          18   Inner City Health Activities
                                                                          19   Status of Projects

                                                                          20   List of Members

                                                                               Projects
                                                                          23   Emergency Medical Services System
                                                                          25   Nine County Medical Laboratory Improvement
                                                                          26   Telephone Lecture Network
                                                                          27   Rural Externship
                                                                          28   Allegany County Mobile Health Unit
                                                                          29   Lake Area Health Education Center
                                                                          31   Lakes Area Regional Tumor Service Registry
                                                                          32   Ambulatory Care Services Model
                                                                               Niagara County Ambulatory Medical Care Study
                                                                               SHARECO
                                                                          33   Information Dissemination Service
                                                                          34   Community Health Information Profiles (CHIP)
                                                                               Chronic Respiratory Disease Program
                                                                          35   Planning and Articulation for Allied Health
                                                                               Model Program for Comprehensive Family Health
                                                                               Two County Nutrition Program
                                                                               (Cattaraugus and Chautauqua Counties)
                                                                          36   LARMP Staff Listing

                                                                          April, 1974


                                                                           Theme

                                                                           An appropriate theme for the  Lakes  Area  Regional  Medical
                                                                           Program, Inc. in 1973 can best  be  described  by  the  word
                                                                           dedication.

                                                                           The National scene in 1973 was eventful and traumatic.
                                                                           Regional Medical Programs across the country were
                                                                           threatened by  peremptory  exclusion  from  the  President's
                                                                           budget followed by phase-  out orders from  the  Administra-
                                                                           tion.
                                                                           Instructions were given to terminate staff and project
                                                                           support without Congressional authority to do so. The
                                                                           Regional  Medical  Program  process  had,  however,   become
                                                                           stable. The results of its efforts were measurable, and
                                                                           searching hearings by Congress  culminated  in  the  passage
                                                                           of extension legislation. The bill, introduced by
                                                                           Congressman James Hastings, was passed by a resound-
                                                                           ing 372-1 in the House of Representatives. A similar bill
                                                                           passed by a vote of 94-0 in the Senate.
                                                                           Our efforts had been favorably identified and received
                                                                           constituency support.
                                                                           The National Association of Regional Medical Programs,
                                                                           Inc. came into its own and sought legal  assistance  in  the
                                                                           release of  appropriated  but  impounded  funds.  Meanwhile,
                                                                           the Lakes  Area  Regional  Medical  Program  continued  with
                                                                           assigned tasks and funded 13 projects  at  a  sum  exceeding
                                                                           $1 million.

                                                                           Acknowledging the uncertainties but carrying out regular
                                                                           business required a great deaf of dedication on the part of
                                                                           RMP staff, Advisory Groups and RMP constituents.
                                                                           A civil suit filed by the Lakes Area Regional Medical
                                                                           Program,  Inc.  along  with  the  Medical  Care  Development
                                                                           Inc., fiscal agent for the Maine  Regional  Medical  Program
                                                                           on behalf'of all RMPS, sought to release funds both
                                                                           authorized and appropriated by Congress, but impounded
                                                                           by the Administration. As a result of this civil action, funds
                                                                           were released by the Administration for RMPS.
                                                                           We are proud of our achievements, our staff, the Regional
                                                                           Advisory Group and its Board of Directors and all those  who
                                                                           stood by us in this period of crisis.


             Faith and Fortitude Meet The Challenge!

            The year 1973 was filled with tension, pressure and
            spirited challenges for all the Regional Medical Programs
            throughout  the  nation.  Our  own   Lakes   Area   Regional
            Medical Program,  Inc.  faced  the  multi-phased  challenge  of
            dissolution with faith and fortitude.

            All of those involved in our organization especially the
            officers  and  members  of  the  Regional  Advisory   Group,
            which  represents  every  sector  of  our  nine-county  region,
            gave unstintingly of  their  time  and  talents  in  determined
            efforts to keep RMPs alive.
            Keeping faith in our essential  purposes  and  basic  objec-
            tives,  our  dedicated  county  committee   members   and   our
            competent  professional  staff  met  the  challenge  with  a
            collaborative and cooperative  action  on  a  united  front.
            One of the weapons  employed  by  the  Administration  was  its
            morale  destroying  maneuvers  which  consisted  of   piece-
            meal, short-term  allocation  of  minimum  funds.  It  demanded
            faith and genuine fortitude  to  remain  steadfast  and  confi-
            dent that our cause would prevail. At the end of the
            calendar year 1973 we won  the  victory  in  the  courts.  This
            assured us of receiving the full funding intended by  the  U.S.
            Congress  for  the  development  of  an  equitable  national
            health delivery system on a regional basis.
            Throughout our nation today  there  is  a  new  and  dominating
            interest in the health care of  the  American  People.  In  our
            own  geographical  area  there  is  a  common   and   consuming                                                       Father Girard
            interest in the kind of health care actually available  to  our
            citizens. What abilities and facilities can be brought to  bear
            on  our  health  problems?  The  challenge  of  the   immediate
            future appears to be the role we  are  willing  to  play  in
            cooperation with our  lawmakers  to  supply  the  in-put  which
            Will create the delivery system our communities are
            demanding.  This  means  that  the   Lakes   Area   Regional
            Medical Program must accept a large share of the
            responsibility for  the  development  of  a  community  life
            which is alert and active in solving our health problems.
            It means we must utilize to the utmost the riches, the
            humanities, the sciences, and especially the health
            sciences  which  have  been  made  available  to  modern   man.

                         Father Cosmas Girard, OFM, Ph.D.
                         President, Regional Advisory Group
                         Lakes  Area  Regional  Medical  Program,   Inc.

            2


                    a word from the . . . Executive Director

                   The events of  last  year  have  presented  many  moments  of
                   anguish for regional medical  programs  across  the  country.
                   The Administration's directives to  phase-out  our  programs,
                   followed by congressional action to the contrary,  namely  to
                   continue our work, taxed our staff and credibility almost  to
                   the limit. A large group of dedicated  persons  who  are  in-
                   terested  in  continuing   the   regional   medical   program
                   process provided strong constituency support.
                   Your National Association of Regional Medical       Programs,
                   Inc., won a civil action in the courts which  released  funds
                   appropriated by Congress but impounded by the Ad-
                   ministration.

                   We look forward to a new and exciting future.  We  will  con-
                   tinue striving to make quality health care  delivery  systems
                   in our region effective and available to everyone.

                                                                                                                                         Dr. Ingall
                                                       R. F. Ingall, M.D.
                                                 Executive Director

                                                 Lakes Area
                                                 Regional Medical Program, Inc.

                                                                                                                                               3


            Goals and Objectives

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

                                                                                    Objectives
                                                                                    1 .To continue defining the  need  for  additional,  altered  or
                                                                                       new  primary  care  services  in  each   sub-regional   area,
                                                                                       based on  a  data  profile  of  resources  and  services,  an
                                                                                       assessment   of   community   characteristics   and    health
                                                                                       problems, and on the receptivity of the pattern of
                                                                                       services to the community.
                                                                                    2. To maximize the role of existing health personnel in
                                                                                       delivering primary health care  by  (a)  improving  distribu-
                                                                                       tion of  health  personnel,  (b)  encouraging  the  expansion
                                                                                                                      associated   with    community
                                                                                       of ambulatory care within or
                                                                                       hospitals, (c) using an inter-disciplinary approach to
                                                                                       the delivery of primary  care,  (d)  encouraging  the  devel-
                                                                                       opment  and  evaluation  of  innovative  methods  of   health
                                                                                       care delivery, and (e) promoting improved referral
            Goal No. 1                                                                 patterns to assure continuity of care.
            To stimulate and promote preventive services in health                  3. To encourage general and family practice an  ot er
            maintenance.                                                               forms of primary health care.
                                                                                    4. To  stimulate  development  of  already  defined  new   roles
            Ob   ectives                                                               of health personnel.
            1 . To continue defining the need for additional or new                 5. To seek  feasible  solutions  to  the  problems  of  distance
                preventive services  in  each  sub-regional  area,  based  on          and lack of transportation  as  barriers  to  utilization  of
                a data profile  of  resources  and  services,  an  assessment          primary  care,  preventive   and   rehabilitation   services.
                of  the  community's  characteristics  and  health  problems,       6. To  promote   consumer   education   regarding   availability
                and on the acceptability  of  the  service  to  the  communi-          and utilization of existing health services.
                ty.
            2@  To encourage delivery of preventive services through
                sources  of  primary  care  with  emphasis  on  the  role  of       Goal No. 3
                allied health personnel.                                            To  encourage  the  development,   expansion   and   integration
            3.  To encourage coordination among government, volun-                  of rehabilitation services to the continuum of medical
                tary, and private agencies to  (a)  maximize  the  impact  of       services.
                preventive  services  and  (b)  assist  public  health  agen-
                cies in responding to community needs.                              Objectives
            4. To encourage expanded programs in health education.                  1 .To continue de  fining the need for additional,  altered   or
                                                                                       new  rehabilitation  services  in  each  sub-regional   area,
                                                                                       based on  a  data  profile  of  resources  and  services,  an
                                                                                       assessment   of   the   community's    characteristics    and
                                                                                       health problems, and on the  acceptability  of  the  patterns
                                                                                       of service to the community.
                                                                                    2.  To  promote  the  continued  development  of  a  variety  of
                                                                                       facilities and  programs  to  assure  placement  of  patients
                                                                                       at the appropriate level of care.


                    Origin of RMPs

                    Legislation                                                         By these means, the program attempts to improve the
                    Regional Medical Programs were established by                       quality  and  enhance  the  capacity  of  the  health   manpower
                    Congressional  action  in  1965  under   Public   Law   89-239.     and facilities available to the region  and  to  improve  health
                    Under this  legislation  categorical  emphasis  was  placed  on     services for persons  residing  in  areas  with  limited  health
                    the three  major  killers-heart  disease,  cancer  and  stroke.     services.
                    In 1970 this legislation was amended to include kidney              The program  attempts  to  accomplish  these  ends  without  in-
                    disease and  other  related  diseases  as  Public  Law  91-515.     terfering with the patterns  or  the  methods  of  financing  of
                    The legislation promotes  through  grants  the  development  of     patient care or professional practice, or with the ad-
                    regional   cooperative   arrangements   among   the    nation's     ministration of hospitals, and in  cooperation  with  practicing
                    health  professions  and  institutions  in  order  to   improve     physicians, medical center officials, hospital ad-
                    regional organization of  health  resources  and  services  and     ministrators,  and  representatives  from   appropriate   volun-
                    to enhance health care  by  supporting  the  providers  at  the     tary health agencies.
                    community level.

                    There are currently 53 Regional Medical Programs
                    covering the United  States  and  its  trust  territories.  The                                             c
                    programs vary considerably in their size and
                    characteristics. However, each program has       been                                                      A
                    organized through local initiative and cooperative
                    arrangements. Unlike many federal programs, the        RMP    s                                           BUF
                    operate primarily under local direction.  Their  strength  lies
                    in  the  "grass  roots"  participation  by  the  many   devoted
                    volunteers  who  make  up  their  regional   advisory   groups.                                      I E COUNTY,
                    LARMP Purpose                                                                                UNKIRK
                                                                                                                        CATTARAUGUS COUNTY ALLEGANY
                    The Lakes Area Regional Medical Program, Inc. is                                        IAUTAUOUA                       COUNTY
                    designed  through  grants  and  contracts  to   encourage   and                          COUNTY
                    assist in the establishment of regional cooperative                                           0    SALAMANCA
                                                                                                             JAMESTOWN             OLEAN   WELLSVILL
                    arrangements among medical schools, research in-
                    stitutions, and hospitals for the  promotion  of  research  and           IE CC                                rORD
                    training,  medical  data   exchange   and   demonstrations   of
                    patient care in the fields  of  heat  disease,  cancer,  stroke                                                AN COUNTY, PA.
                    and kidney disease, and other related diseases.
                    It strives to improve the personal health care  system  in  the
                    nine-county region  It  represents  in  Western  New  York  and     The Region
                    Northwestern,  Pennsylvania.  The  program   affords   to   the     The LARMP is one  of  53  federaly  funded,  locally  controlled
                    medical  profession  and  medical  institutions,  through  such     regional medical programs in the United States.
                    Cooperative arrangements, the opportunity of making
                    available to their patients the latest advances in the  preven-     Nine  counties  comprise  the  region,  seven  in  Western   New
                    tion, diagnosis, treatment and rehabilitation of  persons  suf-     York  and  two  in  Northwestern  Pennsylvania.   The   counties
                    fering from  these  diseases.  It  also  promotes  and  fosters     are:   Allegany,   Cattaraugus,   Chautauqua,   Erie,   Genesee,
                    regional  linkages  among  health  institutions  and  seeks  to     Wyoming  and  Niagara  in  Western  New  York,  and   Erie   and
                                                                                        McKean in Pennsylvania.
                    strengthen  and  Improve  primary  care  and  the  relationship
                                                                                        The region covers an area of 71 00 square miles with a
                    between specialized and primary care.
                                                                                        population well  over  two  million  people.

                                                                                                                                                       5


             The Enabling Role                                                    The Grantee Institution
             Over the years the Lakes Area Regional Medical Program               The Board of Directors  of  the  Lakes  Area  Regional  Medical
             has taken particular pride in its designation as an  "enabler".      Program, Inc., was  established  in  February  1972  to  assume
             The LARMP staff emphasizes its brokerage role whereby                functions  previously  performed  by   the   Research   Founda-
             help is given where it is required.  If  LARMP  cannot  provide      tion of the State University of New York.
             direct assistance, other appropriate organizations are               This board  receives,  administers  and  accounts  for  Federal
             contacted. The  LARMP  staff  continues  to  keep  up  to  date      Grant  funds  used  in  implementing  programs   to   be   sup-
             on other funding sources and  agencies  that  can  be  of  help      ported by the Lakes Area Regional Medical Program
             in solving a particular health problem.                              according to federal regulation and policies.
             Another aspect of the enabling role has  been  insistence  that      The Board's membership Includes-
             projects have a viable marketing strategy. LARMP
             resources are invested  as  seed  monies  for  activities  that      Chairman- Allan Korn, Associate Professor,
                                                                                                Environmental   -   Consumer   Studies    Depart-
             can be integrated into the health care pattern of  the  region.
                                                                                                ment, State University College at Buffalo.
             LARMP has  been  successful  in  attracting  additional  monies                    Herbert Bellamy, Buffalo, New York
             to RMP-supported  activities:  voluntary  agencies  and  ot  er                    Businessman and Community Lea er.
             groups have committed monetary investment to what
                                                                                                Irwin Felsen, M.D., Past President Lakes
             otherwise  would  have   been   exclusively   RMP   operations;
                                                                                                Area  Regional  Advisory  Group,  and  a  private
             county medical societies  and  hospitals  contribute  funds  to                    physician from Wellsville, New York.
             the  LARMP  advisory  group  to  meet  expenses   that   cannot
             be  paid  by  federal  funds'  RMP's  investment  in  the  Lake                    Maynard  Parker,  Retired  executive   previously
             Area Health Education Center led  to  investment  in  the  cen-                    with the Hooker Chemical Corporation of
             ter by the Boards of Trustees of two Erie, Pennsylvania                            Niagara Falls, New York.
             hospitals and the Veteran's Administration; and the Rural                          Norman   Slawinski,   Branch   Manager,    Marine
             Externship project attracted private contributions from                            Midland  Bank  -  Western,  Buffalo,  New   York.
             hospitals, physicians and local governments.

             Talking Together                                                     Regional Advisory Group
             One of the strengths of the LAR MP has been its ability to           The Regional Advisory Group assists in planning,
             encourage health professionals at all levels to talk  together.      development, and coordination  of  all  projects  in  the  area
                                                                                  supported  by  the  Lakes  Area   Regional   Medical   Program.
             Very often more than just money is necessary if patients
             are to receive the care they need and deserve.                       This 43-member group is broadly representative of the
                                                                                                  as  and  social  groups  served  by  LARMP.  It
                                                                                  geographic are
             In order for a system of care to work there must be a
                                                                                  includes  practicing  physicians,  medical  center   officials,
             cooperative effort on the part of all  concerned  to  see  that
                                                                                  hospital administrators, representatives from medical
             health care needs of people are identif led and ways  to  solve      societies,  health  and  related  professions,  voluntary   and
             related problems  are  carried  out.  By  cooperating  together
             in clarifying health  needs  and  the  resources  available  to      public agencies, and representatives of other
             meet these needs the LARMP has helped to foster a bond               organizations, institutions, and agencies as well as
             of cooperation among health care providers.                          members of the public concerned with the need for
                                                                                  services provided under this program.
             Often the solution to a health problem lies within the               The expanded membership-at-large was undertaken to
             community itself and LARMP acts  as  a  catalyst  to  help  the      represent all elements of  the  provider  and  general  popula-
             community realize its own powerful resources.                        tion with attention given to Involving minority group
                                                                                  members, labor leaders, businessmen and women.
                                                                                  The group  usually  meets  on  the  second  Thursday  of  every
                                                                                  month at 7:30 p. m. at the LARMP  offices,  2929  Main  Street,
                                                                                  Buffalo,   N.Y.

             6


                    The Health Services Development Unit                               Program Committee
                    The Health Services Development Unit of the Lakes Area             A program committee composed of Regional Advisory
                    Regional Medical Program serves in a  liaison  capacity  with      Group (RAG) members was organized in 1972 for the
                    all of the nine counties that comprise the LARM P region.  In      purpose  of  providing  continuous  assessment  of  all  LARMP
                    addition, members of the unit help with  the  development  of      operational projects and program staff activities. The
                    proposals that may arise from the individual counties.             committee examines these efforts in terms of their
                    Keeping  good  communication  lines   open   between   county      relationship to present goals, objectives, and  priorities  of
                    committees, other constituents  or  interested  organizations      LARMP. The group  usually  meets  each  month,  prior  to  the
                    and the LARMP central office is one of the unit's main             regular RAG  meeting.  The  formal  charge  to  the  committee
                    functions. Helping to develop ideas for  proposals  that  are      is: (a) assess goals,  objectives,  and  priorities  of  LARMP
                    aimed at improving the availability and quality of health          and  make  recommendations  regarding  these  matters  to  the
                    care in these areas is another prime function.                     RAG, lb) in the context of objectives  an  priorities,  review
                    The HSDU is also working toward promoting a regional               and evaluate on-going projects  and  activities  to  determine
                    approach in the  development  and  implementation  of  health      effectiveness and make recommendations to the RAG.
                    services with special regard to  specific  diseases  such  as      This group has been the principal RAG sub-comm ttee  r
                    heart disease, cancer, stroke, kidney and  related  diseases.      program planning.
                    Members of the HSDU and their assigned counties are:
                         Robert Beebee, Niagara and Genesee
                         William Crage, Erie, New York
                         Patrick Egan, Cattaraugus; southern part of
                         Chautauqua County; and McKean, Pennsylvania
                         (except EMS project).
                         Suzanne Manson, Allegany and Wyoming
                         Jean Hanna, Northern Chautauqua and Erie,
                         Pennsylvania
                         Michael Miller, Inner City Representative

                                                                                                               Health Services Development Unit

                                                                                                                                                      7


               Central Management Services

               Organizationally, the LARMP,  Inc,  is  divided  into  two  inter-       Communications
               related yet distinct  functional  areas.  The  principal  function       Keeping  key  target  groups  and  the  public  informed  on   the
               consists  of  program  staff  activities.  The  second  functional       activities  and  accomplishments  of   the   Lakes   Area'Regional
               area  is  Central  Management  Services.  This   provides   direct       Medical  Program  is  achieved   with   extensive   use   of   the
               support to program staff activities.                                     mass media.
               CMS is divided into five categories - Comptroller, Per-                  Television and radio have been utilized effectively for
               sonnef,   Purchasing,   Communications    and    Printing.    This       special  interviews,   press   conferences   and   news   coverage
               arrangement   offers   a   mechanism   to   provide   direct   ad-       of  LARMP  activities.  News   releases,   and   newsletters   are
               ministrative  support  to  program  staff  activities  and  funded
               projects.                                                                also  used  as  vehicles  for  dissemination  of   LARMP   related
                                                                                        information. Feature  stories  as  well  as  day  to  day  program
               CMS serves both LARMP program staff and all funded                       activities have appeared in almost all of the daily
               project activities. It has contributed significantly to        the       newspapers  in   the   region.   The   communications   department
               reduction  in  administrative  overhead   costs   from   over   48       prepares  a  monthly  newsletter,  FORUM,  for   distribution   to
               percent in early 1972 to  the  current  administrative  cost  rate       approximately 15,000 health professionals, other in-
               of approximately  8  percent.  Taking  note  of  this  accomplish-       dividuals and institutions. In addition, brochures,
               ment,   other   Regional   Medical   Programs   have   begun    to       pamphlets,  booklets  and  the  Annual  Report  are  prepared   by
               establish   central   management   services   within   their   own       this unit. A well maintained mailing list assures the
               organizations patterned after LARMP.                                     continual flow of pertinent program information,
                                                                                        The media has provided good local coverage to our
               Comptroller                                                              continuing   education   programs   for    health    professionals
               The Comptroller's office deals with grants management,                   throughout  the  region.  Additionally,   items   of   significant
               budgets, and contracts. This office also prepares and                    community interests such as the Telephone Lecture
               maintains  all  financial  transaction  records  formerly   under-       Network's role in providing needed telephone com-
               taken by the Research Foundation.                                        munications   during   Hurricane   Agnes    and    the    Allegany
                                                                                        County  Mobile  Health  Unit,  which  played  a  significant  part
               Personnel                                                                in saving a  life  in  Allegany  County,  are  brought  to  public
               Personnel administration is concerned with recruitment                   notice.
               and placement, salary administration and payroll,
               employee relations and support staff training.                           Health Information Systems Unit
                                                                                        The Health Information Systems Unit is a derivative of
               Purchasing                                                               the  Community  Health   Information   Profile   (CHIP)   a   pro-
               Purchasing  undertakes  such  functions  as   inventory   control,       ject which previously received financial support from
               supply  acquisition,  and  pricing.  The   purchasing   department       the Lakes Area Regional Medical Program, Inc.
               has significantly contributed  to  the  overall  lowering  of  the       The  Unit  provides  assistance  to  projects  and  is  the   data
               administrative expenses required to operate LARMP                        analysis for the central Lakes Area Regional Medical
               program  activities  and  funded  projects.  All   equipment   and       Program   administration;   for   program    development,    plan-
               supplies are properly inventoried and accounted for.                     ning,   project   evaluation;   and   special   purpose   research
               Likewise,  termination  of  RMP  funding  of  a  project  requires       and  analysis  for   other   community   agencies   and   institu-
               that  ownership  of  project   equipment   either   remains   with       tions.  Computer  based  files   of   sociological,   demographic,
               LARMP or is transferred upon suitable request and                        economic and health related information available to
               justification to the institution continuing the project      after       Health  Information   Systems   users   provide   Important   data
               RMP support is terminated.                                               for  sound  planning  and   evaluation.   The   Information   sys-
                                                                                        tems  within  the  unit  have   been   designed   to   meet   both
               Printing
                                                                                        general  and  specific  data  collection,  storage  and   analytic
               Contributing to  the  lowering  of  administrative  costs  Is  the       needs.
               LARMP   Printing   Department,   which   prints   and    assembles
                                                                                        Since  the  inception  of  the   CHIP   project,   computer   pro-
               nearly  90   percent   of   all   LARMP   publications.   Formerly
                                                                                        grams  have  been  developed  to  handle   a   variety   of   data
               contracted   to   private   commercial   organizations   at   con-
                                                                             ated       processing  functions  for  analysis  of  data  provided  by   the
               siderable expense, this "in-house" service has gener
                                                                                        user  or  with  data  available  from   the   Health   Information
               about $20,000 in annual publication cost savings.
                                                                                        Systems Unit.
               8


                       Library Services

                       Since 1972 the Lakes Area Regional Medical Program's                      By action of the Regional Advisory Group of LARMP,
                       Library  Program  has  continued  to   operate   in   two   phases:       $5,000 in developmental funds were allocated to two
                       in-house informational system and the hospital library                    Allegany county hospitals to share equally in the improve-
                       consultation service.  The  staff  professional  librarian  divides       ment of their respective libraries. The hospitals will adhere
                       her  time  equally  between  that  of  general  staff   Information       closely to NLM grant guidelines and the library managers
                       Specialist,  Librarian  for  the  in-house  library,  and   Library       will each receive "mini-courses" in basic library skills.
                       Consultant  to  the  56  health  care  institutions,  other  health       Development of the staff library has proceeded with
                       agencies and colleges in the LARMP nine county area.                      acquisition of a Health Care basic collection and current
                       Visits have been made to most of the institutions in the                  informational materials. The library receives 50 current
                       region.  In  many  cases  there  have  been  repeated   visits   to       periodicals, 47 newsletters, and all other RMP newsletters.
                       meet  with  library  committees,  assist  in  National  Library  of       The library is now open to area students and health
                       Medicine  (NLM)  grant   applications   and   to   assess   library       professionals.
                       collections.  Three  institutions  in  the  region  are   presently       Information services utilize a variety of networks and
                       considering Project Grant Applications.                                   resources to answer staff questions concerning drug
                       At initial visits with administrators or library managers the             information, biographical, legislative, and manpower data
                       consultant  reviews  a  packet  of  reprint  material  compiled  to       as well as other information. The expanding Emergency
                       encourage  and  assist  library   development.   The   concept   of       Medical Services and Hypertension Projects place in-
                       shared library development has been promoted on a                         creasing demands on the in-house system. The staff of
                       geographic  basis   both   with   individual   administrators   and       LARMP and others rely heavily on the excellent services of
                       the librarian.                                                            IDS in photocopy, book loan and computer searches of the
                       The library program staff is assisting in the formation of a              MEDLARS data base. The Information Dissemination
                       Western  New   York   Health   Sciences   Librarians   Association.       Service searches are edited and reprinted for distribution at
                                                                                                 LARMP teaching days.
                       In 1973 the Telephone Lecture Network programs for
                                                                                                 Current awareness services consist of circulation of journal
                       librarians  were   planned   by   the   Information   Dissemination       title pages, compilation of selective bibliographies and
                       Service - State University of New York at Buffalo and                     servicing informational needs.
                       LARMP.  A  new  series  for  1974  will  feature  nationally  known
                       personalities in Medical   .Librarianship made available
                       through the TLN teleconference capabilities. For these
                       monthly lectures, groups of students and librarians will
                       meet  at  LARMP  headquarters.  The  lecture   will   be   followed
                       by professional organization meetings.
                       A two-day workshop was held in Buffalo, New York in
                       August, 1973. It was well received and attended by 60
                       librarians from around New York State and Southern
                       Canada.  In  1974  the  Regional  Medical  Library  and   the   new
                       steering committee will assist in planning for another
                       workshop,
                       LARMP through its consultant receives directional Input
                       and program assistance from NLM; Medical Library
                       Association,  Office  of  Education:  Regional   Medical   Library,
                       New     Yo'rk Academy of Medicine; and SUNYAB Health
                       Sciences Library.

                                                                                                                                                                  9


            Evaluation

            A major function of the Evaluation Section is to assist                 Evaluation of
            proposal  authors  in  the  selection  and  design  of   an   ap-       Operational Projects
            propriate methodology for their projects. Such a
            methodology  includes:  identification  of  the  target   popula-       Information Dissemination Service
            tion, documentation of the extent and degree of         the             In February 1973, the Information Dissemination Service,
            problem,  statement  of   project   objectives   in   operational       in  conjunction  with  LARMP,  initiated  a  detailed   evaluation
            terms,  description  of  project  activities   corresponding   to       and  analysis  of  IDS  utilization.  This  study  was  undertaken
            each  objective,  establishment  of   success   criteria   before       to assess the resource needs of the SUNYAB Health
            commencement  of  project   activities,   and   quantitative   or       Sciences Library  and  participating  health  care  facilities  in
            objective measurement of project results. -                             the region. It will provide the  basis  for  improving  the  State
            A well conceived evaluation  design  is  related  to  each  phase       University of  New  York  at  Buffalo's  Health  Sciences  Library
            of project  activity.  It  consists  of  a  measuring  device  or       as it functions as a resource library. It will  also  provide  the
            instrument  which  assesses  the  effect  of  project  activities       basis for improving the journal  holdings  of  hospital  libraries
            on the target population in  such  a  way  that  results  can  be       throughout the region.
            compared   with   some   previously   established   standard   or
            criterion of success.                                                   Emergency Medical Services
            Evaluative effort aims to study change, specifically the                NFL Stadium Survey
            change effected by a project on either the  health  status  of  a       A survey of all NFL stadia, conducted in the fall of 1973,
            group of people  or  the  effectiveness  and  efficiency  of  the       grew out of the EMS project's involvement in planning
            health care delivery system. The evaluation process                     emergency medical services at Erie County's Rich
            provides   a   greater   understanding   and   documentation   of       Stadium.  This  survey  was  conducted  to  collect  data  on  the
            LARMP's  impact  on  the  region,  thus  enabling   the   program       facilities, services and medical personnel available to
            to continue responding  to  the  changing  health  needs  of  the       persons requiring medical treatment while attending a
            community.                                                              sporting  event  at  stadia  used  by  National  Football   League
            Part of this evaluation effort is the Quarterly Activities              teams. Survey data are now being tabulated.
            Reporting  system.   Reporting   forms   summarizing   activities       Rural Externship Project
            and progress during the quarterly reporting period are
            completed  by  each  project   director.   Summary   reports   on       An evaluation of the 1973 Rural Externship Project was
            the progress  and  problems  of  each  project  are  prepared  by       conducted to determine changes in attitudes of health
            the Evaluation Section and provided to the Program                      science students towards rural health care delivery
            Committee for review and program planning.                              systems  and  their  Intentions  towards  practicing  In  a  rural
                                                                                    setting.
            Evaluation of                                                           Sickle Cell Information and Education Project
            Teaching Days and Workshops                                             Under the sponsorship of the Niagara Frontier Association
            The many teaching days and workshops sponsore            y              for  Sickle  Cell  Disease,  Inc.,  numerous  sickle  cell  educa-
            LARMP  are  systematically   evaluated   through   the   use   of       tion meetings took place  in  the  inner-city  of  Buffalo  during
            evaluation  forms  completed  by  program   participants.   These       the latter part  of  1973.  The  purpose  of  these  meetings  was
            forms are analyzed to determine the impact of each                      to  provide  members  of  the  community   with   basic   Informa-
            program in  meeting  the  needs  of  participants.  A  report  is       tion about sickle cell disease and to answer questions
            submitted  to  the  program  planning  committee  to   aid   them       which the public might have had regarding the disease.
            in  the  planning  of  future  teaching   days   and   workshops.       Tests were administered  to  meeting  participants  prior  to  the
                                                                                    educational presentation and following each program to
                                                                                    determine  the  effectiveness  of  the   program   In   Increasing
                                                                                    knowledge of sickle cell disease. Staff support was
                                                                                    requested for tabulation and analysis  of  the  results  of  these
                                                                                    pre and post tests.

                                                                                                                                           (continued)
            10


                   Fvaluation

                                                                                       Nurse Practitioner Program
                                                                                       The State University of New York at Buffalo School of
                                                                                       Nursing has been considering  the  possibility  of  developing
                                                                                       a nurse practitioner program in  several  clinical  areas  and
                                                                                       formed  a  committee  to  make  recommendations  in  1972.  At
                                                                                       the  same  time  the  Lakes  Area  Regional  Medical   Program
                                                                                       was considering a study of all aspects of the nurse
                                                                                       practitioner concept. As  a  result,  two  surveys  were  con-
                                                                                       ducted within  the  seven  New  York  State  counties  in  the
                                                                                       LARMP region during the summer of 1973. The first
                                                                                       involved all hospitals, nursing homes and health
                                                                                       departments and the second  was  sent  to  all  physicians  in
                                                                                       the region. The  purpose  of  the  surveys  was  to  determine
                                                                                       acceptance of the nurse practitioner concept and
                                                                                       willingness of  respondents  to  employ  nurse  practitioners.
                                                                                       The analyses of both the  institution  and  physician  surveys
                                                                                       have been  completed  and  were  presented  to  the  committee
                                                                                       for use in its  planning  processes  in  the  health  manpower
                                                                                       area.

                                                                                       Migrant Dental Education Project
                   Collaborative/Joint Agency Efforts                                  During the summer  of  1973  a  program  of  dental  education
                   During 1973 several surveys were conducted to document              was  introduced  in  Niagara  County   whereby   children   of
                   the current status and determine the  changing  health  needs       migrant workers were instructed in basic  dental  health  care
                   of various sectors of the professional and  lay  populations.       by a dental hygienist. To determine the effectiveness  of  the
                                                                                       project, tests on  dental  health  were  administered  to  the
                   Lackawanna Community Health Center                                  children prior to the education class and at the  end  of  ten
                   A  household  survey  concerning  the   Lackawanna   Communi-       weeks.  Pre  and  post  test  scores  were  recorded  and  the
                   ty Health Center was carried  out  in  conjunction  with  the       results were sent to the New York State Education
                   Erie County Health Department  during  the  summer  of  1973.       Department which funded this project.
                   Data from this survey will be used to facilitate  access  and
                   appropriate referral to existing health services and to  help       Consultative/Community   Group   Activities
                   plan for future activities better suited to the needs of  the
                   community served by the Center.                                     West Side Health Center
                                                                                       Early in 1973, the West Side Health  Center  in  Buffalo,  New
                                                                                       York  requested  assistance  in  evaluating  various   clinics
                                                                                       sponsored by the Center.  Staff  support  was  given  to  help
                                                                                       determine user attitudes toward these clinics  and  to  assist
                                                                                       the Center staff in planning for future clinic activities.

                                                                                       Comprehensive Home Care Survey
                                                                                       In March,  1973  a  survey  was  conducted  to  determine  the
                                                                                       extent to  which  social  service  agencies  In  Erie  County,
                                                                                       Pennsylvania are involved In the home care delivery
                                                                                       system. The results of the survey were subsequently
                                                                                       analyzed and  presented  to  the  Blue  Ribbon  Committee  for
                                                                                       its use In future planning'processes.


                                   Lakes Area Regional Medical Program, I nc.
                                                      Balance Sheet
                                                         February  28,  1  974
                                                            (unaudited)

         Assets

                                                          Federal   Fund     Income     Fund     Special    Fund              Total

         Cash                                                $    90,647         $    93,746         $    10,306      $     194,699
         Federal grant receivable (Note 1)                     844,420,                 -                   -               844,420
         Accounts receivable                                       8,481               7,929                -              16,410

         Due from Income Fund                                     11,403                -                  6,395           17,798
              Total assets                                   $954,951            $101,675            $    16,701      $1,073,327

         Liabilities, Reserves and Fund  Balances

                                                          Federal   Fund     income     Fund     Special    Fund              Total

         Liabilities:
         Due to Federal Fund                                 $                   $    11,403          $     -         $    11,403
         Due to Special Fund                                                           6,395                -                 6,395
         Employee withholding deductions                           1,305                -                   -                 1,305
         Other accruals                                           20,522                -                   -              20,522
             Total liabilities                                    21,827              17,798                -              39,625

         Reserves:
         Reserve for encumbrances                              345,569                                                      345,569
         Fund Balances                                         587,555                83,877              16,701            688,133
             Total liabilities, reserves and fund balances   $954,951            $101,675                $16,701      $1,073,327

         12


                                                Lakes Area Regional Medical Program,  Inc.
                                                    Statement of Revenues, Expenditures,
                                                      Encumbrances and Fund Balances
                                                                    Year ended February 28, 1974
                                                                               (unaudited)

                                                                          Federal       Fund    Income       Fund     Special      Fund              Total

                      Fund Balances at February 28, 1973                       $1,110,307                 $76,765           $     9,731         $1,196,803

                      Revenues:
                      Grants awarded                                           1,535,036                        -                  -         1,535,036
                      Service fees                                                         -            56,393                     -                56,393
                      Contributions                                                                             -              8,405                 8,405
                      Miscellaneous                                                        -                  953                  59                1,012
                              Total Revenues                                   1,535,036                57,346                 8,464         1,6001846
                      Expenditures                                             1,712,219                50,234                 1,494         1,763,947
                      Encumbrances                                                   345,569                    -                  -               345,569

                      Total expenditures
                      and encumbrances                                         2,057,788                50,234                 1,494         2,109,516
                      Fund Balances at February 28, 1974                       $     587,555              $83,877               $16.701      $     688,133

                      Note I                                                               Note 2
                                                                                     nd    Effective  March  6,  1974  an  additional  award  of  $133,403
                         Grants from the Department of Health, Education, a
                      Welfare  for  the  period  March  1,  1973   through   June   30,    was received. Simultaneously, the grand period was ex-
                      1974  amounted  to  $1,535,036   allocated   by   components   as    tended from June 30, 1974 to June 30, 1975.
                      follows:
                          Program Staff                                        $607,537
                                                                                           Note 3
                          Rural Extern Program                                 72,204
                          Comprehensive Health Information Profile             19,425      A substantial grant award is expected for the  period  July  1,
                          Telephone Lecture Network                            95,042      1974 through June 30, 1975. This is the result of a suit  filed
                          Chronic Respiratory Disease Program                  10,787      in Federal  Court  by  the  National  Association  of  Regional
                          Tumor Service Registry                               76,292      Medical  Programs,  Inc.  The  court  directed  the   Executive
                          Model Program for Comprehensive                                  Branch   of   the   United   States   Government   to   release
                                              Family Health                    38,047      Impounded   1973   and   1974   funds   appropriated   by   the
                          Allegany County Mobile Health Unit                        941    Congress.
                          Emergency Medical Services System                    216,111
                          Lake, Area Health Education Center                   149,021
                          Ambulatory Care Facilities Study                     .99,726
                          Rural Laboratory Improvement                         25,000
                          Two County
                                       Nutrition Program                       10,000
                          SHARECO                                              25,000
                          Ambulatory Care Study (Niagara County)               25,000
                          @Regional Hy ertension Education                     64,90
                                       p
                                                                             $1,535,036

                                                                                                                                                         13


                Developing a Grant Proposal

                Letter of Intent                                                                              Regional Advisory Group Review
                A letter of intent is the first step in developing a proposal  for                            Comments of the county committees, the Proposal
                submission to  LARMP.  It  is  a  brief  summary  of  the  project                            Committee,   and   the   Comprehensive   Health   Planning   Coun-
                concept. A copy of this letter must go to the LARMP                                           cils are forwarded to the Lakes Area Regional Medical
                Executive  Director.   RMP   program   staff   and   county   com-                            Program  Regional  Advisory  Group   (RAG).   The   RAG   is   the
                mittees use the letter of intent  to  determine  if  the  idea  is                            final review  and  the  decision-making  body.  It  considers  the
                pertinent to  the  goals  and  objectives  of  LARMP.  The  author                            recommendations  provided  by  all  other   review   groups,   and
                may  receive  consultation  and  assistance  in   preparation   of                            makes the final decision on approval of projects. The
                the  letter from the RMP staff. The letter must include:                                      author  is  specifically  requested  to  attend  the  RAG  meeting
                   v a brief statement of what is proposed and by whom                                        at which his proposal is being considered.
                   9 documentation of the need                                                                The actual funding is dependent upon RAG's priority
                   o what is to be accomplished - the objectives                                              ranking of approved projects within LARMP goals and
                   o how it is to be accomplished - the methodology                                           objectives, subject to the availability of funds.
                   o anticipated cost over requested funding period                                           The LARMP review mechanism promotes:
                   0 plans for measuring the effect of the project-                                              0 involvement of the sub-regional groups
                     evaluation component.                                                                       El education of author and reviewers
                                                                                                                0 equity of review.
              Review Criteria                                                                                 The proposal author is in personal  contact  with  the  series  of
              The letter of  intent  is  reviewed  by  the  county  committees  to                            groups  who  review  his  proposal.  In  particular,  he  must  be
              determine if an idea  is  pertinent  to  the  goals  and  objectives                            prepared  to  explain  to  the  county  committees   his   concept
              of   the   Lakes   Area   RMP.   The   two   Comprehensive    Health                            and its applicability to their particular situation. The
              Planning  Councils  in  the  region,  are  provided  copies  of  the                            Regional Advisory Group has final authority for both
              letters of intent for their staff's review and comment.                                         approval and funding decisions.
              Special  forms  are   used   by   the   county   committees,   LARMP                            The proposal, if approved here, then goes to Washington
              staff, and CHP staff, to review letters of intent.                                              for  their  approval  and  confirmation  and   eventual   funding.

                           Proposal Review Process

                                                C.H.P. Staff       Allied Health
                                                Review &           Committee                                                 County
                                                Comment            Comments                                                  Committees

                                                                                           L.A.R.M.P.
                                                                    uthor             Staff
                                                                             L        Review &                                                  RAG
                                                                                      Technical                                                 Review
                                                                                           Assistance

                                                County                                                                    2. Proposals
                                                Committee                                                                    Review
                                                Chairmen                                                                     Committee
                                                Assessment                                                                   (3  task
                                                                                                                             forces)

                                                                                                                                           "3 Task Forces:
                                                               '(Consultation available with                                               1. Health Manpower Resources
                                                                  Health services Development                                              2. Education and Training
                                                                 Staff)                                                                    3. Health Services Development

              14


                     programs in Continuing Education 1973

                     Date                 Program                             Location               Registrants Co-Sponsors
                     January 31           EMS Conference                      Statler  Hilton   Hotel        206          New York State
                     February 1,2,3       "First Annual Conference            Buffalo,    New    York                     Department of Health
                                          on Emergency Medical
                                          Services"
                     January 25           Cancer Teaching Day                 Kenwell      Auditorium        120          Millard  Fillmore   Hospital
                                          "Changing Evaluation                Millard   Fillmore
                                          and Treatment of Lymphomas          Hospital                                    American    Cancer     Society
                                                                              Buffalo,    New    York                     Erie County Unit
                     February 15,16       Communications Workshop             Executive   Motor   Inn        90           Continuing Education Committee
                                          "Interpersonal Relations            Buffalo,    New    York                     School  of  Health   Related
                                          Pathway to Improved                                                             Professions
                                          Communications"                                                                 State  University  of  New   York
                                                                                                                          at Buffalo
                     March 15             Cancer Teaching Day                 Buffalo   General   Hospital  55 Approx.    Continuing    Dental    Education
                                          "Oral Cancer from the               Buffalo,    New    York                     School of Dentistry
                                          Dental Practitioner's                                                           State  University  of  New   York
                                          Viewpoint"                                                                      at Buffalo
                                                                                                                          Buffalo   General   Hospital
                                                                                                                          American    Cancer     Society
                                                                                                                          Erie County Unit
                     March 24             Cancer Teaching Day                 Memorial Medical Center        211          Niagara   Falls   Academy   of
                                          "Carcinoma  of   the   Breast"      Niagara  Falls,   New   York                Medicine
                                                                                                                          American        Cancer.Society
                                                                                                                          Niagara County Unit
                     March 28             Health Guides Workshop              Parkway Ramada Inn             79
                                          Part  11   "Communications   -      Niagara  Falls,   New   York
                                          Process and Problems"
                     April  4             Cancer Teaching Day                 Gannon     College             180          American    Cancer     Society
                                          "Viral Factors in Cancer"           Erie,      Pennsylvania                     Erie       County-Pennsylvania
                                                                                                                          Unit
                     May    3             Cancer Teaching Day                 W.C.A.    Hospital             114          American    Cancer     Society
                                          "Current Management of              Jamestown, New York                         Chautauqua    County    Unit
                                          Gynecologic       Malignacies"
                     May    5             Nutrition Workshop                  Campus      School             134          Center  of   Disease   Control
                                          "Coffee, Herb Tea&                  Buffalo,    New    York                     U.S.  Public  Health   Service
                                          Vitamin E"
                     May 17               Aging Workshop                      Rusch's      Restaurant        177          Comprehensive Health Planning
                                          "Meeting  the  Needs  of   the      Dunkirk,    New    York                     Council of Western
                                          Elderly through County                                                          New York, Inc.
                                          Organization"
                     June 8.9             Dialysis Workshop                   Treadway Inn                   200          Kidney Foundation of
                                          "Human Aspects of                   Niagara  Falls,   New   York                Western New York Inc.
                                          Renal Disease"                                                                  American   Association    of
                                                                                                                          Nephrology Nurses & Technicians

                                                                                                                                                (continued)    15


            Programs in Continuing Educationg 1973

            Date               Program                             Location               Registrants             Co-Sponsors

            June   13          Aging Workshop                      Jamestown Community            350             Study  Commission   on   the
                               "Death    and    Dying"             College                                        Problems of the Aging
            June   14          Aging Workshop                      St. Bonaventure U.             165
                               "Alternatives to                    Olean, New York
                               Institutional   Living"
            June   21          Cancer    Teaching    Day           Castle Inn                     131             American   Cancer    Society
                               "Skin Cancer & Malignant            Olean, New York                                Cattaraugus County Unit
                               Melanoma"
            June   28          Cancer    Teaching    Day           Moonwinks                      102             American   Cancer    Society
                               "Current  Concepts   in   the       Cuba Lake, New York                            Allegany County Unit
                               Management & Treatment of
                               Hodgkins       Disease"
            August 15,16       Hospital Library Workshop           Lord Amherst                   60              Information Dissemination Service
                                                                   Amherst, New York                              Health Sciences Library
                                                                                                                  State University of New York at Buffalo
            September 19       Stroke Workshop                     Sheraton Motor Inn             270             In cooperation with the
                               "The  Three  R's  of   Stroke       Lockport, New York                             staff of Mount View Hospital
                               Care: Referral, Restoration                                                        Lockport, New York
                               and     Rehabilitation"
            October 3,4        Nursing    Home     Personnel       Erie County Home               173-(Oct. 3)    Supported by a contract
                               Program ,                           and Infirmary                  170- (Oct. 4)   with the Department of
                               "Rehabilitative and Restorative Alden, New York                                    Health, Education and Welfare,
                               Nursing Skills"                                                                    Region II, Health Services and
                                                                                                                  Mental Health Administration,
                                                                                                                  New York, New York
            October 12         First   Annual   Neonatal           Sheraton-East                  170             Department of Pediatrics
                               Workshop                            Buffalo, New York                              State University of New York at Buffalo
                               "The Critically III Newborn"                                                       and Regional Intensive Care
                                                                                                                  Nursery of WNY
            October 25         Heart   Teaching    Day             Holiday Inn                    101             Heart Association of
                               "Live  Longer   Electrically,       Bradford, Pennsylvania                         Western New York, Inc.
                               with    a    Pacemaker"                                                            Genesee and Wyoming County Units
            October 26         Aging Program                       Jamestown Community            392             Study Commission on the Problems of
                               "Mental Status of the Elderly"      College    Jamestown,    New    York           the Aging   Jamestown, New York
            November 1         Cancer    Teaching    Day           Cameo Restaurant               92              American   Cancer    Society
                               "Diagnosis and Treatment            Wellsville, New York                           Allegany County Unit
                               of Genitourinary Malignancy
                               1973"
            November 8         Cancer    Teaching    Day           Holiday Inn                    164             American   Cancer    Society
                               "New  Concepts   in   Earlier       Batavia, New York                              Genesee County Unit
                               Diagnosis of Malignancy-1973"                                                      Batavia, New York
            November 29        Health Care Delivery System         Rusch's Restaurant             164             Western  New   York   Public
                               Program                             Dunkirk, New York                              Health Association - An
                               "Current Status of the Health                                                      Affiliate of the New York State
            16                 Care  Delivery   System   ...                        Total                         Public Health A   ssociation
                               Expectations for the Future"                         Registrants 4070


                      Cancer Teaching Days

                      Nine  Cancer  Teaching  Days  were  conducted  during   1973.
                      These are usually  held  in  co-sponsorship  with  the  local
                      American Cancer Society Unit in the county where the
                      program is being held, and Roswell Park Memorial
                      I nstitute.
                      Program  topics  included  "Changing  Evaluation  and  Treat-
                      ment of Lymphomas", "Oral Cancer from the Dental
                      Practitioner's Viewpoint", "Carcinoma of the Breast",
                      "Viral Factors In Cancer", "Current Management of
                      Gynecologic Malignancies", "Skin Cancer and Malignant
                      Melanoma", "Current Concepts In The Management and
                      Treatment of Hodgkins Disease", and "Diagnosis and
                      Treatment of Genitourinary Malignancy-1973".
                      Over 1, 1 69 nurses, physicians, therapists and other  health
                      professionals attended these programs.
                      Dr. Gerald P. Murphy, Director, Roswell Park Memorial
                      Institute, serves as chairman of the LARMP Cancer
                      Committee  which  schedules   all   Cancer   Teaching   Days.

                      Cancer Task Force

                      Chairman:
                      Gerald P. Murphy, M.D. - Director             E. Douglas Holyoke, M.D.                      John P. Shutt, M.D.
                      Roswell Park Memorial Institute               Chief, General Surgery                        Brooks Memorial Hospital
                      Buffalo, New York                             Roswell Park Memorial Institute               Dunkirk, New York
                                                                    Buffalo,  New   York                          Alfred Stein, M.D.
                      Charles Barranco, M.D.
                                                                    Leo  D.  Moss,  M.D.                          Buffalo, New York
                      Salamanca, New York
                                                                    Olean General Hospital                        Paul Welsh, M.D.
                      Theodore T. Bronk, M.D.                       Olean, New York                               LeRoy, New York
                      Director of Laboratories                      Thomas Petrick, M.D.                          Richard T. Williams, M.D.
                      Mount St. Mary's Hospital                     Genesee Memorial Hospital
                      Lewiston, New York                                                                          Wyoming Community Hospital
                                                                    Batavia,  New   York                          Warsaw, New York
                      Gerald J. Diesfeld, M.D.                      Steven  Piver,  M.D.
                      O'Dell Medical Center                         Roswell Park Memorial Institute               LARMP Staff:
                      Arcade, New York                              Buffalo,  New   York                          Mrs. Patricia Shine Hoff, R.N.
                      Giles Hamlin, M.D.
                      Olean, New York

                                                                                                                                                    17


                Inner City Health  Activities

                Hypertension
                Particular attention has recently been focused on                                            ciooa pressure
                hypertension  -  high  blood  pressure,   both   nationally   and                      'the silent killer'
                locally.  Studies  show  a  high  incidence  of  deaths,  strokes
                and  heart  attacks  within  black   communities   due   to   the
                disease.
                To help combat the problem in this region, LARMP,
                through  its  Hypertension   Task   Force,   has   undertaken   a
                massive   Public   Information/Education    program    to    make
                persons  more  aware  of  the  dangers  of  the  disease.   These
                efforts are designed to support already established or
                proposed screening efforts by other groups such        as     the
                Heart  Association  and  the  Health   Departments.   No   actual
                screening  is  done  by  LARMP.  The  emphasis  by  LARMP  is  to
                alert the public  to  the  dangers  of  uncontrolled  high  blood
                pressure  and  encourage  them  to  have  their  blood   pressure
                checked regularly.
                Coordinators of public information and education efforts
                have  been  appointed  in  Erie  County,  New   York   and   Erie
                County,  Pennsylvania.  Eventually   the   hypertension   project
                will develop into a totally regional endeavor.                          As part of the Public Education aspect of the project,
                                                                                        Professional Education Teaching Days have been planned
                A great number of organizations and individuals at many
                                                                                        for physicians, nurses, and allied health professionals. Lay
                levels are involved in the public information/education
                aspect of the hypertension project. They include:                       Education sessions for community organizations, schools,
                                                                                        churches, and block clubs have also been planned.
                Medical Organizations:                                                  Publicity has been provided to support existing screening
                   Upstate  Medical  Alliance,  Inc.,  Medical   Advisory   Group       activities and public education.
                   to  the  United  Organization  of   Neighborhood   Facilities,
                   Inc.,  The  Health  Association  of  Niagara   County,   Inc.,       Also under development is a Regional Hypertension
                   Practical  and  Registered   Nurses   (Black   Nurses)   Club.       Screening, Follow-up and Treatment proposal, which will
                                                                                        include curriculum development for training hypertension
                Community Organizations:
                                                                                        technicians, patient evaluation and treatment and program
                   Niagara Frontier Association for Sickle Cell Disease,
                                                                                        evaluation models.
                   BUILD of  Buffalo,  Inc.,  1490  Jefferson  Enterprises,  Inc.
                   (Community  Center),   Buffalo,   New   York,   Urban   League       Other areas of LARMP involvement have been the Family
                                                                                        Life Consort
                                                                                                     ium; Perry Valley Health Center (a community
                   of Buffalo, Community Action Organization of Erie
                   County New  York,  Tract  I  I  Community  Center  of  Niagara       planning group); BU I LD of Buffalo; Erie County Health
                   Falls,  New  York,  Nia-CAP,  Community  Center   of   Niagara       Guide Program of the Erie County Health Department;
                   Falls, Planned Parenthood of Niagara Falls, Martin                   United Organization of Neighborhood Facilities, Inc. which
                   Luther   King   Community   Center,   Booker   T.   Washington       includes the Booker T. Washington Erie I Center; Martin
                   Community  Center,   John   F.   Kennedy   Community   Center,       Luther King - Bayfront Center; and the John F. Kennedy
                   Hamot Medical Center, St. Vincent Hospital, Doctor's                 Community Center, NATO 1; all of Erie, Pennsylvania; and
                                  ospital (all of Erie, Pennsylvania).                  the Model Cities Transportation Committee.
                   Osteopathic H
                Public and Voluntary Agencies:                                          LARMP also has worked closely with the Erie County
                   Erie County New York Health Department, Heart                        Health Department, the Lackawanna Health Center, State
                   Association  of  Western  New   York,   The   Kidney   Founda-       University of New York at Buffalo, Department of Medical
                   tion  of  Western  New   York,   Erie   County,   Pennsylvania       Sociology, Niagara Frontier Association for Sickle Cell
                   Health   Department,   Visiting   Nurses   Association,   Erie       Disease and the Consortium for Allied Health, which
                   County,  Pennsylvania,   Veterans   Administration   Hospital,       includes Buffalo area colleges, who are all working toward
                   Erie,  Pennsylvania,   Heart   Association   of   Northwestern       the inclusion of Blacks, Spanish surname, American
                   Pennsylvania,  Mayor's  Office  of  Community  Affairs,  Erie,       Indians, and poor whites In the allied health professions in
              18   Pennsylvania.                                                        Western New York.                                  0


                    Status of Projects (Those active and completed)

                    The following projects received funding from the Lakes Area Regional Medical Program
                    during 1973:

                    Project                                                  Status                                            Coordinator

                    Telephone Lecture Network                                self-sustaining after 12/31/73                    Joseph Reynolds
                                                                             (LARMP will fund on deficit  basis)
                    Chronic Respiratory Disease Program                      Completed     8/31/73                             John Vance, M.D.
                    Tumor Service Registry                                   Funded   to   6/30/74                             John Patterson, M.D.
                    Information Dissemination Service                        Funded   to   6/30/73                             Jean Miller, R.N.
                                                                             (grants from hospitals, etc. now)
                    Model Program for Comprehensive                          Funded  to   12/31/73                             Ernest Haynes, M.D.'
                    Family Health                                            (continuing with other funds)
                    Allegany County Mobile Health Unit                       Funded   to   6/30/74                             Virginia Barker, R.N., Ed.D.
                                                                             (Alfred University thereafter)                    Margaret Connelly, R.N., B.S.
                    Planning and Articulation for                            Completed     5/31/73                             Phyllis Higley, Ph.D.
                    Allied Health
                    Comprehensive Continuing Care for                        Completed     4/30/73                             Evan Calkins, M.D.
                    Chronic Illness
                    Regional Hypertension                                    Funded   to   6/30/74                             Michael Miller
                                                                             (and thereafter if funds available)
                    Emergency Medical Services                               Funded   to   6/30/74                             James H. Cosgriff, Jr., M.D.
                                                                             (and thereafter if funds available)
                    Lake Area Health Education Center                        Funded   to   6/30/74                             Michael Carey
                                                                             (and thereafter if funds available)
                    Ambulatory Care Services Model                           Phase I - completed 12/31/73                      Richard Chalmers
                                                                             Phase I I - funded to 6/30/ 74                    Gunter Schmitz
                    Ambulatory Care Study for Niagara County                 Funded   to   6/30/74                             Peter Forster
                    Nine County Medical Laboratory                           Funded   to   6/30/74                             Sara Marie Cicarelli
                    Improvement                                              (to   be   completed)
                    SHARECO - Genesee and                                    Funded   to   6/30/74                             John Sifling
                    Wyoming Counties                                         (to   be   completed)
                    Two County Nutrition Program -                           Funded   to   6/30/74                             Ruth Kocher, R.D.
                    Cattaraugus and Chautauqua Counties                      (to   be   completed)
                    Comprehensive Health Information Profile                 Funded   to   6/30/73                             Harry Sultz, D.D.S.
                    Health Services Information Unit -                                                                         Frank Rens
                    successor to Community Health Information
                    Profile and part of Core Program
                    Rural Externship Program                                 Will be continued if funds are                    William Crage
                                                                             available after 7/l/74

                    'Dr. Haynes resigned 8/31/73.
                     Current acting director is John Robinson, M.D.

                                                                                                                                                         19


               List of Members of the Regional Advisory Group
                                                           and Steering (Executive) Committee

                                                                       c:
                                                                       E

                   ML

                                                                                                       cr                              0
                                                                       >
                                                                                                                                      r

                                        LL
                                                                       Institution and/or Occupation                   Categories of Representation
               Name    and    Address

               Chairman:
               Father Cosmas Girard, OFM, Ph.D.**                      Sociologist-Anthropologist                      Cattaraugus County
               Olean, New York                                         St. Bonaventure University                      Committee

               Vice-Chairman:
                                                                                                                       Niagara County
               Theodore T. Bron k, M.D.*                               Physician
               mt. St. mary's Hospital                                 Director of Laboratories                        Medical Society
               Lewiston   New    York

               Secretary:
                                                                       Podiatrist                                      Chautauqua County
               Bert  Klein,   D.P.M."
               Jamestown, New York                                                                                     Committee

               Treasurer:
               John C. Patterson, M.D."                                Physician                                       Roswell Park Memorial
               Buffalo,   New    York                                                                                  I nstitute

               Other Members:
               Hugh Allen, M.D.                                        Physician                                       Erie County Pa.
                                                                                                                       Medical Society
               Erie,     Pennsylvania                                  Hamot Medical Center
                 ter Bernadette Armiger, R.N., Ph. D.                  Dean, School of Nursing                         Member  of   the   public
               Sis
                                                                       Niagara University
               Niagara     University
               Niagara Falls, New York
                                                                                                                       Member  of   the   public
                                                                       Dean, School of Nursing
               Virginia Barker, R.N., Ed-D.
               Alfred University                                       and Health Care
               Alfred, New York                                        Alfred University
                                                                       Executive Director                              Member  of   the   public
               Norman Berg*
               Jamestown, New York                                     Lutheran Social Services
               Lester H. Block                                         Attorney                                        Legalcounsel
               Buffalo,   New    York
                                                                                                                       Member  of   the   public
               Mrs. Charlotte Bruner'                                  Tonawanda Indian
                                                                            rvation
               Basom,    New     York                                  Rese
                                                                                                                       Official  health   agency
                                                                       New York State Health
               LaVerne Campbell, M.D.
               Buffalo,   New    York                                  Department - Regional                           New York State Health
                                                                       Health Director                                 Department
               max Cheplove, M.D.                                      Physician                                       Erie County, New York
               Buffalo,   New    York                                                                                  Medical Society
               Mrs. Ramona Charles                                     Tonawanda Indian Reservation                    Member  of   the   public
               Basom,    New     York
               Mrs. Carolyn Daughtry                                   Erie County Department                          Erie County N.Y.
               Buffalo,   New    York                                  of Mental Health                                Health Department
               William   H.    Ennis*                                  Hamot Medical Center                            Erie County Pa.
                                                                       Executive Director                              Committee
               Erie,     Pennsylvania

                                                                       Indicates new member since May 1, -1 973
               20                                                      Indicates member of Executive Committee


                     List of Members

                     Name   and   Address                                 institution  and/or  Occupation                 Categories of Representation
                     Irwin Felsen, M.D."                                  Physician                                       Past  President,   RAG
                     Wellsville, New York                                                                                 Allegany County
                                                                                                                          Medical Society
                     Dominic Falsetti, M.D.                               Physician                                       Niagara County
                     Niagara Falls, New York                                                                              Medical Society
                     John Foster                                          Martin Luther King                              Member of  the  public
                     Erie,   Pennsylvania                                 (Bayfront NATO) Center
                     William Gaiter                                       Director                                        Member of  the  public
                     Buffalo                                              BU I LD Organization
                                                                          Buffalo, New York
                     Larry J. Green, D. D.S.                              State University of New                         Upstate Medical
                                                                                                                          Alliance
                     Buffalo,  New   York                                 York at Buffalo,
                                                                          School of Dentistry
                     Robert Haith, Jr.                                    Director                                        Veterans Administration
                     Erie,   Pennsylvania                                 Veterans Administration
                                                                          Hospital, Erie, Pennsylvania
                                                                          United Auto Workers                             Member of  the  public
                     William Hilger*
                     Lockport, New York
                     Herbert Joyce, M.D.                                  Physician                                       Member at large
                                                                                                                          Past  President,   RAG
                     Buffalo,  New   York
                     Edward F. Marra, M.D., MPH                           Physician                                       State University of New
                                                                                                                          York at Buffal6
                     Buffalo,  New   York
                                                                                                                          School of Medicine
                     Murray S. Marsh                                      W.C.A. Hospital                                 Member of  the  public
                     Jamestown, New York                                  Administrator
                     C.   Conrad   Monroe                                 Banker                                          C.H.P./N.W. Pa.
                     Corry, Pennsylvania                                  Marine National Bank
                                                                                                                          Member of  the  public
                     Elizabeth Moore                                      Director, American Red
                     Batavia,  New   York                                 Cross  Chapter,  Genesee   Unit                 Erie County Health
                     William E. Mosher, M.D.                              Commissioner, Erie County
                     Buffalo,  New   York                                 Health Department                               Department
                     Gerald P. Murphy, M.D., D.Sc.                        Director, Roswell Park                          Roswell Park Memorial
                     Buffalo,  New   York                                 Memorial Institute                              I nstitute
                     Robert Harris                                        Director,  Western   New   York                 Western New York
                                New York                                  Hospital Association                            Hospital   Association
                     Kenmore,
                                                                                                                          Veterans Administration
                     Joseph Paris                                         Director, Veterans Administration
                                                                          Hospital,  Buffalo,  New   York
                     Buffalo,  New   York
                                                                                                                          Faculty of Health
                                                                          Dean, School of Health Related
                     J, Warren Perry, Ph.D.
                     Buffalo,  New   York                                 Professions,  State  University                 Sciences, State University of
                                                                          of New York at Buffalo                          New  York  at  Buffalo
                     Edward Roche, Jr., M.D.                              Physician                                       McKean County Medical Society
                     Bradford, Pennsylvania
                     Professor Earl Stopfel*                              Chairman,   Medical    Services                 Member of  the  public
                     Alfred,   New   York                                 Department   State   University
                                                                          New York, Agriculture and                                    (continued)     21
                                                                          Technical College


              List of Members

              Name   and    Address                                Institution and/or Occupation                     Categories of Representation

              Harry A. Sultz,  D.D.S.                              Professor, School of Medicine                     Erie County, New
              Buffalo,   New   York                                State University of New York at Buffalo           York Committee
              Patricia  Stopen,  R.N.                              Wyoming County Health Department                  Wyoming County
              Warsaw,   New    York                                                                                  Committee
              George E. Taylor, Jr., M.D.                          Phy'sician                                        Allegany County
              Cuba,    New     York                                                                                  Committee
              Donald  Watkins,   M.D.                              Physician                                         McKean County Medical
              Bradford, Pa.                                                                                          Society
              Paul   Welsh,    M.D.                                Physician                                         Genesee County
              LeRoy,    New    York                                                                                  Medical Society
              Richard T. Williams, M.D.                            Physician                                         Wyoming County
              Warsaw,   New    York                                Wyoming County Community Hospital                 Medical Society
              Eugene     Wliczewski                                Director, Comprehensive Health                    C.H.P./W.N.Y.
              Buffalo,   New   York                                Planning Council of Western
                                                                   New York, Inc.
              Duncan C. Wormer, M.D.                               Physician                                         Cattaraugus County
              Portville,  New  York                                                                                  Medical Society

              Regional Advisory Group Alternates
              Gerald Farmer, Director                                                       (Representing Conrad Monroe)
              Comprehensive Health Planning
              Erie,    Pennsylvania
              Craig   Fisher,   M.D                                                         (Representing Dr. Dominic Falsetti)
              Niagara Falls, New York
              Mrs. Fleeta Hill                                                              (Representing William Gaiter)
              BU I LD  Organization
              Buffalo,   New   York
              Robert   A.   Jackson                                                         (Representing Robert Haith, Jr.)
              Chief of Professional Services
              Veterans Administration Hospital
              Erie,    Pennsylvania
              Dana Lundquist, Associate Director                                            (Representing William Ennis)
              Hamot  Medical   Center
              Erie,    Pennsylvania
              Roland  Miller,  M.D.                                                         (Representing Dr. Hugh Allen)
              Chief of Ambulatory Care
              Hamot  Medical   Center
              Erie,    Pennsylvania
              Mrs.   Ray   Crumbley                                                         (Representing John Foster)
              'Martin Luther King Center
              Erie,    Pennsylvania
              Gerald Schofield                                                              (Representing Dr. Gerald Murphy)
              Deputy Director for Administration
              Roswell Park Memorial Institute
        22    Buffalo,   New   York


                 Pro ects

                 Emergency Medical Services System

                 A  Blue  Ribbon  committee,  comprised  of  providers  of  health
                 services, private  and  volunteer  agencies  involved  in  health
                 and  safety,  community   leaders   and   general   health   con-
                 sumers was  appointed  in  April,  1971  by  Erie  County  (N.Y.)
                 Health  Commissioner   Dr.   William   Mosher.   Dr.   James   A.
                 Cosgriff, Jr.,  a  Buffalo,  N.Y.  surgeon,  was  named  chairman
                 of  this  Erie  County  (N.Y.)  committee.  The  committee  works
                 toward   recommendations   for   improvement   In   four    basic
                 areas of emergency service: communications, trained
                 emergency   personnel,   emergency   vehicles    and    emergency
                 facilities. Its broadly based membership assures
                 community-wide participation in the decision making
                 process.
                 The  Emergency   Medical   Services   Project   was   inaugurated
                 with  Lakes  Area  Regional  Medical  Program,  Inc.  funding  in
                 the  Spring  of  1972.  Its  purpose  is  to  improve   emergency
                 health care in the nine-county LARMP region by re-
                 searching  the  existent  system,   establishing   an   Emergency
                 Medical   Radio   Communication   Network,   and   training   am-
                 bulance and rescue squad attendants.
                 The project was originally developed in Erie County, New
                 York, so as to better determine the feasibility of  extending  it
                 throughout the entire region, and ultimately New York
                 State. However,  when  the  possibility  of  funding  termination
                 arose  in  May,  1973,  the  project  immediately  expanded   its
                 efforts regionally. In an attempt  to  solidify  this  expansion,
                 an  Emergency  Medical  Care   Committee   was   established   in
                 each of the counties.  They  are  responsible  for  planning  and
                 coordinating local Emergency Medical Services. A
                 Regional   Emergency   Medical   Services   Coordinating    Coun-
                 cil was also developed.
                 The  Regional  Council  consists  of  two  representatives   from
                 each  of  the  nine  counties  in  the  LARMP  region,  and   one
                 each  from  the  New   York   State   Health   Department,   Com-
                 prehensive Health Planning Councils of Western New
                 York  and  Comprehensive  Health  Planning  Council   of   North-
                 western Pennsylvania.
                 Subcommittees include: Training - all nine training coor-
                 dinators   from   the   LARMP   region;   Communication   -   one
                 advisor  from  each  of  the  nine  LARMP  counties-,  Bylaws   -
                 five  members.  The  Coordinating  Council  is  responsible   for
                 planning, developing and coordinating the emergency
                 medical services activities in all nine counties.

                                                                  (continued)

                                                                                                                                                      23


             Emergency Medical Services System

             The Blue Ribbon Committee that developed the EMS
             proposal and submitted it to  LARMP  for  funding  lists  four
             major objectives. They are:

             1. Education
             EMT Training - a major element  of  EMS  is  properly  trained
             emergency medical  personnel.  Article  31  of  the  New  York
             State Public Health Law mandates EMT training for all
             commercial  ambulance  attendants;  however,  this  does   not
             apply to members of  volunteer  agencies.  To  date  the  pro-
             gram  has  conducted  training  courses  for   800   Emergency
             .Medical  Technicians  of  volunteer  and   commercial   units
             throughout the region. This is equivalent to 20% of the  total
             certified in  New  York  State.  About  800  more  technicians
             are expected to be trained by  June  30,  1974,  bringing  the
             total  number  trained  to  about  1600.  Development  of  EMT
             Instructor program is also underway. Special EMT
             refresher courses have also been conducted over the
             Telephone  Lecture  Network.  A  standardized   training   kit
             including basic supplies  needed  to  conduct  a  course  have
             been  made  available  to  EMT  Instructors.  These   supplies       The project is also developing a demonstration project
             are provided to the counties by the Project.                         dealing with a digital ambulance-to-base  data  transfer.  This
                                                                                  is a method of transmitting patient  information  by  means  of
             2. Research                                                          an electronic code to reduce radio  transmission  air  time  in
                                                                                  dealing with accident  victims.  This  application  is  being
             The research and evaluation component of this project is             addressed directly  to  the  Department  of  Transportation  In
             being conducted  by  a  qualified  staff.  This  component  is       Washington.
             directing regional surveys intended to provide  baseline  data
             for the region and local areas to  help  bring  about  changes
             necessary to establish a fully  integrated  and  more  respon-       4. Public Information
             sive emergency  care  system.  The  Erie  County  (NY)  survey       There has been significant publicity  of  the  LAEMS  Project
             is  now  in  the  hands  of  appropriate   subcommittees   who       throughout   the   LARMP   region   and   beyond.   Newspaper
             together with hospital administrators are developing                 coverage has taken place in all  municipalities  in  the  area.
             recommendations.  The   county   committees   throughout   the       "Emergency Lifelines", the project's  official  newsletter,  Is
             region will similarly process their own surveys in the               distributed to over 4,500 persons and  the  mailing  list  will
             interests of determining recommendations and activity                be expanded  in  1974.  In  addition,  Public  Service  Tele-
             areas.                                                               vision sports are in final form to provide  public  information
                                                                                  in various  elementary  aspects  of  EMS  access  and  utilize-
                                                                                  tion.  Also  under  development  are  an  EMS  brochure  and  a
             3. Communication
                                                                                  regional EMS access directory.
             The  Medical  Emergency  Radio  System  (MERS)  will  soon  be
             installed in Erie County, New York. This system  will  tie  10       The EMS  project  is  receiving  support  from  many  concerned
             hospitals, 50 ambulance units and  1  1  service  coordinators       political and professional health interests  of  the  region,
                                                                                  thereby  greatly  enhancing  its  chance  for  successful   lm-
             into a functional communications system. Cost of the
                                                                                  plementation.
             equipment  Is  $160,000.   Communication   coordinators   out-
             side Erie County, New York  are  meeting  with  the  New  York
             State Communications  Coordinator  to  confer  on  a  regional
             EMS communications network.                                                                                              (continued)

             24


                Emergency Medical Services  System

                First Annual Regional Conference                                        Staff
                on Emergency Medical Services                                           James H. Cosgriff, Jr., M.D.    Project   Director
                The First Annual Regional conference on Emergency                       Gerald J. Surette               Deputy    Director
                Medical  Services  was   held   February   1-3,   1973   at   the       Ronald Roche                    Staff   Supervisor
                Statler Hilton Hotel in Buffalo, New York.
                Sponsored  by  the   Lakes   Area   Regional   Medical   Program,       Gary Canfield                   Staff Associate &
                the  New  York  State  Department  of  Health,   and   the   Erie                                          Regional EMT Coordinator
                County   Department   of   Health's   Emergency   Medical    Care       Geoffrey Gibson                 Research Consultant
                Committee,  its  objectives  were  to  motivate  individuals   to       Roger Fenlon                    Public Information
                develop   greater   concern   about   Emergency   Medical    Ser-                                         Consultant
                vices;  to  promote  the  establishment   of   well   coordinated
                county  committees;  and  to  develop  interest  in  and  support       Michael Walters                 EMT     Consultant
                for Emergency Medical Services                                          Robert Barnes                   Ass't. Research Director
                The  conference  brought  together  nurses,  physicians,   public       Gregory Photiadis               Research Associate
                health  personnel,  volunteer  firemen,  Civil  Defense  and  Red
                Cross   representatives,   ambulance    and    emergency    squad       Cathy Rohrer                    Research Associate
                members,  hospital  administrators,  police  officers  and  other       Steve Ramspacher                Staff Aide
                interested  persons,  who  exchanged  their  ideas   and   exper-
                tise in a combined  effort  to  establish  ways  to  improve  the       Connie Heineman                 Staff Secretary
                emergency health care system.
                Officials  were  pleased  with  the'good  mix'of  interested
                participants  who  opened  up  timely   and   important   avenues       Nine  County   Medical
                of  dialogue  in  trying  to  find  ways  to  improve   Emergency
                Medical Services.                                                       Laboratory Improvement
                Dr. James H. Cosgriff, Jr., Director of the Emergency                   Improving health care in rural or small hospitals by
                Medical  Services  Project,  called  for  a  sweeping  change  in       improving the performance of clinical laboratory personnel
                philosophy  on  the  part   of   all   concerned   in   emergency       is the main focus of this LARMP supported project. It is
                health  care  delivery.  "To  be  operational,   appropriate            also designed to provide accurate data for diagnosis,
                legislative   changes   and   training   programs   are    needed       treatment and health maintenance of patients.
                along  with  reassessment  of  the  roles  for  each  member   of       One of the major objectives is to develop short term
                the  emergency  care  team.  The  responsibility  for   solutions       courses in compensory education such as workshops
                cannot rest alone with  isolated  groups  -  it  must  be  multi-       covering the topics of bacteriology, hematology, clinical
                disciplined", Dr. Cosgriff noted.                                       chemistry  and   blood   banking.
                A long list of national, state, county, State University  of            Remedial courses of four days duration have been offered
                New York  at  Buffalo  officials  as  well  as  local  ambulance.       on autoanalyzer techniques used in clinical chemistry,
                medical  and   agency   officials   participated   as   speakers.       blood banking techniques followed by a three-five  ay
                A complete report on the  conference  is  available  in  the            course in instrumentation.
                publication "Emergency Medical Services Regional                        The educational programs will eventually Include all clinical
                Conference"  -   February,   1973.   For   copies   contact   the       laboratory personnel In the LARMP's nine counties
                Director  of  Communications,   Lakes   Area   Regional   Medical       Priorities have been established according to need. The
                Program, Inc.                                                           first programs are In compensatory education. The par-
                                                                                        ticipants have been identified as personnel In rural or small
                                                                                        hospital clinical laboratories whose performance has barely
                                                                                        met standards and whose needs are most urgent.
                                                                                        Project Director
                                                                                        Sara M. Cicareill, Associate Professor, Associate Chairman
                                                                                        Medical Technology - School of Health Related Professions
                                                                                        State University of New York at Buffalo                       El 25


             Telephone Lecture Network

               The  Telephone  Lecture  Network  is  a  closed  circuit   system
               that broadcasts,  via  a  telephone  line,  continuing  education
               programs  to  members   of   the   professional   community   and
               allied  health  occupations  scattered   to   its   39   regional
               network locations.
               The primary purpose of TLN is to make first rate, non-
               commercial,   hospital   wide   continuing   education   programs
               available  to  all  hospitals  and  other  health   related   in-
               stitutions.
               During 1973 thirty-five  institutions  actively  participated  in
               the hospital-wide  education  service  provided  by  the  TLN.  A
               new  weekly  series  of  lectures  for  Food  Service   Personnel
               was introduced in the Fall of 1973.  The  School  of  Nursing  at
               Niagara  University,  the  District  1,  New  York  State  Nurses
               Association,   the   W.N.Y.   Diabetes   Teaching    Association,
               and   the   Nursing   Inservice   Department   of   the   Millard
               Fillmore Hospital  joined  with  the  School  of  Nursing,  State      I n cooperation with the State University of New York,
               University  New  York  at  Buffalo,  in  developing  the   year's      Agricultural and  Technical  College  (Alfred,  N.Y.),  a  three
               lecture  series  for  nurses.   Twenty-eight   other   sponsoring      (3) quarter,  credit  bearing,  college  level  course  covering
               institutions,   agencies,   and   organizations   cooperated   in      an Introduction  to  Anatomy  and  Physiology  1,  11,  and  III
               program development during the year.                                   was conducted. Total enrollment for all three courses
                                                                                      exceeded 120 students.
               The regular lecture schedule included 187 programs
               offered  in  a  wide  variety  of  lecture  series  attended   by      Thirty Emergency Medical Technicians were recertified
               members  of  over  28  disciplines  providing  health   care   or      following a refresher training course offered over the
               health care support.                                                   network  by  the   Lakes   Area   Emergency   Medical   Services
                                                                                      project.  An  estimated  35  persons  audited  this  course   at
               Reported  attendance   (approximately   75%   of   actua   atten-
               dance)   was   16,743.   Requests   for   continuing    education      various locations.
               certification totaled 10,359.                                          The Buffalo State Hospital  Staff  conducted  a  special  series
                                                                                      of 12 hour-long  sessions  for  physicians  at  several  network
               In the last 24  months,  74  guest  lecturers  from  outside  the      locations in  Preparation  for  Certification  by  the  American
               Lakes  Area  region  have  been  conferenced   from   24   states
                                                                                      Board of Psychiatry and Neurology.
               in the U.S.A. and Canada.
                                                                                      On six occasions  the  Parents  of  Diabetic  Children  and  the
               Twelve  components   of   the   Lakes   Area   Regional   Medical
                                                                                      Niagara  Frontier  Asthma  Chapter  of  the   American   Allergy
               Program,  the   Lakes   Area   Regional   Advisory   Group,   and
                                                                                      Foundation,   conducted   community   health   information   and
               other cooperating agencies conducted a total of 31
                                                                                      education  programs  for  their   membership   and   other   in-
               conferences/meetings   on   the   Telephone    Lecture    Network
                                                                                      terested persons over the TLN.
               in 1973.  During  this  period,  the  TLN  provided  audio/visual
               support  at  thirty-three  (33)  seminars  (43  days)   conducted      Approximately  $58,000  in  non-federal  funds   was   generated
               by the LARMP and cooperating organizations.                            in this period toward project support.
               Beginning In September 1973, the network broadcast
                                                                               ts on  Staff
               schedule   was   expanded   to   provide    regular    rebroadcas
               Friday of any lecture given during the week.                           Joseph L. Reynolds, Coordinator
                                                                                      Robert Mathiebe
                                                                                      Doris Unger
                                                                                      Marjorie Witkop
                                                                                      Susanne Fimiani
                                                                                      Leslie Solomon              n

               26


                  Rural Externship Program

                                                                                          The  eight-week  Summer  Rural  Externship  project  (June   18
                                                                                           August  10,  1973)  provided  health  sciences  students  with
                                                                                          first  hand  living  and   working   experiences   which   were
                                                                                          designed to expose them to  the  delivery  of  health  care  in
                                                                                          rural  areas  of  the  Lakes  Area  Regional  Medical   Program
                                                                                          region. Close working relationships were developed
                                                                                          between  the  principal  preceptors  and  their  students.  For
                                                                                          some, the experience pointed  to  a  future  career  away  from
                                                                                          large cities. The program's structure permitted  a  great  deal
                                                                                          of flexibility which allowed  the  student  to  decide  how  to
                                                                                          spend part of  his  time  according  to  his  own  individually
                                                                                          developed interests.  Externs  were  paid  a  stipend  of  $100
                                                                                          per week.
                                                                                          A modest beginning in  the  summer  of  1970  saw  nine  health
                                                                                          sciences  students  participate  in  the  project.  The  number
                                                                                          jumped to 55 in 1973.
                                                                                          The project enabled students to participate in an inter-
                                                                                          disciplinary "team" approach to  health  care,  based  in  many
                                                                                          cases on a rural or semi-rural hospital  setting.  It  provided
                                                                                          exposure to rural health care delivery and the life style of  a
                                                                                          rural  community.   Students   also   became   aware   of   the
                  Rural Externship Program-Summer, 1973                                   characteristics  and  problems  of   rural   health   practice.
                  Externs by Discipline                                                   The diversity of  experience  afforded  the  externs  was  most
                       Medical                        1  6       29%                      extensive. In addition to having  contacts  with  all  hospital
                       Dental                            4         7%                     departments,  most  of  them  went  out  Into   the   community
                       Pharmacy                       1  3       24%                      under supervision of various preceptors an  en oye
                       Nursing                           8       15%                      enriching  experiences  in  many   aspects   of   health   care
                                                                                          delivery and delivery of health related services. This
                       Physical Therapy                  6       1   1%                   occurred in  rural,  semi-rural,  and  small  urban  areas  and
                       Medical Technology                3         5%                     included patients from each of these areas. The ap-
                       Dietetics                         1         2%                     proximate cost of  this  project  in  1973  was  $53,190  which
                       Hospital Administration           3         5%                     was funded by the LARMP.
                       Podiatry                          1         2%                     As a result of the  8-week  summer  experience,  three  of  the
                                                        @5        1-00%                   55 externs accepted positions  in  rural  or  semi-rural  areas
                                                                                          after completion of their studies.  Others,  32.7%,  definitely
                  William D. Crage, Project Director                                      planned on rural health practice following graduation.
                                                                                          This project received good publicity and  visibility.  A  large
                                                                                          number of feature stories regarding the pro-
                                                                                          gram's activities appeared In the local newspapers of
                                                                                          the region. The project also was carried on the wire
                                                                                          services. Articles included several  feature  stories  of  per-
                                                                                          sonal Interviews  with  externs  and  preceptors.  Accounts  of
                                                                                          the project  were  also  heard  on  radio  broadcasts.  Letters
                                                                                          were written to area legislators concerning  the  project.  One
                                                                                          local   congressman   delivered   a   commendation    statement
                                                                                          on the floor of Congress and placed this  and  samples  of  the
                                                                                          newspaper accounts In the Congressional Record.               0

                                                                                                                                                        2
                                                                                                                                                        7


              Allegany County Mobile Health Unit

              A mobile health unit, designed to provide health
              assessments  and   health   education   to   Allegany   County
              residents  was  funded  by  the  Lakes   Area   Regional   Medical
              Program,  Inc.  in  mid  1972.  The  unit  is  sponsored  by   the
              Alfred University  School  of  Nursing  and  Health  Care  and
              the  Allegany  County  Board  of   Legislators   through   the
              County Public Health Nursing Service.
              During  1973  the  Allegany  County  Public   Health   Nursing
              Service,  which  is  operating  the  unit,  assessed  329  adults.
              Of this number  203  were  referred  to  family  physicians  or  a
              physician of the client's choice for one or multiple
              problems.  This  is  a  referral  rate  of  62%  compared  to  the
              initial assumption that  there  would  be  a  40%  referral  rate.
              Each  person  referred  was  also  provided  with   follow-up   by
              agency  nurses   to   insure   that   all   recommendations   were
              followed and to lend assistance whenever needed.
              The educational  effort  in  connection  with  the  Mobile  Health
              Unit actually consisted of two phases. One is client
              education  conducted  by  the  Public  Health   Nurses   and   the
              student  nurses  on  the  Unit.  The  second  phase   is   the
              education  of  the  health   professionals   themselves,   whether       Well Child Conference Project
              it be the nurse  practitioner  or  the  student  in  the  bac-           The Allegany County Public Health Nursing Service also
              calaureate  program.   At   present   group   education   of   the       operates a Well  Child  Conference  Project.  This  is  funded  by
              clientele in the county is  met  in  the  area  of  the  expectant       the   Appalachian   Child   Development   Commission.   Three   of
              parents classes. Additional education classes were                       these  conferences  per  month  are  held  in  the  Mobile  Health
              planned to begin in the spring of 1974.                                  Unit.  Children  clients  are  assessed  by  a  team   of   nurses
              Officials note that one of the real strengths  of  the  Mobile           from  the  Allegany  County   Public   Health   Nursing   Service,
                                                                                       ' eaded by a Pediatric Nurse Practitioner, who is also
              Health  Unit  has  been  the  one-to-one  health  counseling   and       n
              health  education  carried  on  within  the  Unit  by  the  Public       employed by the nursing agency. Since the well child
                                                                                       project  began  on  August  27,  1973,  a  total  of  87  children
              Health  Nurses  and  the  student  nurses  with   the   individual       were assessed in the unit. The referral  rate  is  18%.  There  Is
              members  of  the  society  as  they  come   through   the   Mobile       also follow-up by nurses for these referrals.
              Health  Assessment  Program.  This  has  been   attested   to   by
              letters  of  support  received  from  county  residents  who  have
                                                                                       Beyond The Call Of Duty
              availed themselves of the services of the Unit.
                                                                                       On January 31, 1974 the mobile unit during a regularly
              The introduction of the Mobile Health Unit in Allegany                   scheduled  visit  in  Bolivar,  New  York,  became   involved   in
              County  has  opened  up  learning  experiences  for  students   in       providing first aid  and  oxygen  to  three  victims  of  a  major
              Alfred  University's  baccalaureate   nursing   program.   As   of       fire that  destroyed  four  buildings.  Nurses  aboard  the  unit,
              September  1973  all  seniors  in   the   nursing   program   were       which was parked across the street, administered the
              required  to  serve  on  the  unit.  Beginning  in  February  1974       service to the victims during  the  height  of  the  blaze,  whose
              all  sophomore   students   received   rotation   assignments   on       flames were  fanned  by  40  mile  per  hour  winds.  No  injuries
              the unit. This is a reflection of the trend  of  the  University's       were reported. An account  of  the  unit's  participation  In  the
              nursing  curriculum  toward  the   development   of   the   Family       fire appeared in local area newspapers.
              Nurse  Practitioner   Program   at   the   undergraduate   eve   .
              The project received honors from the New York State                      Co-Project Directors
              Nurses   Association   as   an   Innovative   development   in           Virginia Barker, Ed.D., Dean, Alfred University School of
              nursing practice  which  Is  changing  the  health  care  delivery       Nursing and Health Care, Alfred, N.Y.
              pattern In  a  particular  area.  The  Association  saw  it  as  a       Mrs.  Margaret  Connelly,  R.N.,  Director  of  Patient  Services,
              means of demonstrating an effective role for the                         Allegany County Public Health Nursing Service, Angelica, N.Y.
              professional nurse in meeting today's health needs.
                                                                                       Reynard Meachum, Driver Secretary.
                                                                                       Alfred Station, N.Y.


                  Lake Area Health Education Center

                  The Lake Area Health Education Center is a non-profit                   because  of  LAHEC  staff's  promotion  of  its  use,   or   how
                  corporation  based  in  Erie,  Pennsylvania.  As  a   community-        many   persons   have   benefited    from    the    LARMP-funded
                  based regional system of educational and training                       Information  Dissemination   Service,   the   Drug   Information
                  programs (basic and continuing) it coordinates and                      Service and the VA-funded Medline.  It  would  be  difficult  to
                  develops  area  resources  in  order  to  meet  area  needs   in        attain   accurate   statistics   concerning   the   numbers   of
                  health-care  manpower.  Presently  LAHEC  relates  to  the  five        laypersons   who   have    been    reached    through    LAHEC's
                  contiguous  counties  of  Astabula   (Ohio);   Chautauqua   (New        educational  programs  in   health   for   the   non-health-pro-
                  York); Crawford, Erie and Warren in Pennsylvania. The                   fessional  community   (reached   via   face@to-face   contacts,
                  consortium's activity  has  no  strict  geographical  boundaries        and  pamphlets  as  well).  Each  person  within  the   region's
                  and accepts all responsibilities and affiliations,  all  working        half-million-and-more  population  is  receiving   better   care
                  and formal relationships that further its aim of regional  self-        because of the up  dated  professionalism  of  its  health-care-
                  sufficiency in health care manpower.                                    man-and-woman-power  at  a   cost   of   about   a   penny   per
                  Funds to support LAHEC's regional activities come from                  person.
                  three  sources:  (a)  Lakes  Area   Regional   Medical   Program        Minority Health Education
                  lb)  Veteran's  Administration,  through  the  VA  hospital   in
                  Erie, Pennsylvania and (c)  diverse  local  contributions,  both        The  Minority   Health   Education   Delivery   System   (NHEDS)
                  in cash but chiefly in kind, from the healthcare and                    relates  to   the   Spanish-speaking   migrant   and   sedentary
                  educational facilities and institutions from all five  counties,        populations along the tri-state shores of Lake  Erie.  Bilingual
                  and  the  professional  health  manpower  societies  within  the        health  advocates  visit  migrant  camps  and  inner-city  areas
                  same region.                                                            in order to reach their Spanish communities with
                  These funds vary from year to year.  It  is  LAHEC's  intent  to        educational  and  testing  programs.  The  needs  of  people  of
                  become generally  free  from  federal  support  by  1980.  Since        all  ages  are  identified,  The  health  advocates  themselves,
                  June 1971, when the first LAHEC staff person was                        through Villa Maria  College  of  Erie,  are  given  paramedical
                  employed,  the  consortium  has  received   over   one   million        training.  A  30-hour  course   touches   upon   a   medley   of
                  dollars  of  support,  with  approximately  75%   derived   from        subjects  including  nutritional  practices,   water   supplies,
                  federal sources  and  the  remaining  25%  from  local  sources.        childhood  diseases,  care  of  infants  at  home,   first   aid
                  LARMP  awards  are  about  80%  of  the  federal   contribution.        techniques, methods  of  assessing  health  needs,  etc.  Health
                  Erie's  St.  Vincent  Hospital  and  Hamot  Medical  Center  are        advocates  teach  migrants   and   residents   how   to   obtain
                  the chief cash contributors among the local donors.                     proper  medical   treatment   by   using   available   community
                                                                                          families and teach  them  preventive  health.  Ladies  from  the
                  First Two Years                                                         Erie Council of Churches  make  up  first-aid  kits,  which  are
                  IIn its first two operational years, LAHEC has sponsored,               distributed to Spanish homes with  instructions  in  their  use.
                  promoted   and/or   administered   twenty-five   programs    for        St. Martin's Center in Erie is  serving  as  a  hub  for  multi-
                  numerous health disciplines, thereby helping to maintain                media  programs   which   have   been   provided   for   Spanish
                  the  competence  of  thousands  of  health  professionals,  both        teenagers  on  topics  such   as   alcohol,   drugs,   and   sex
                  within  and  outside  the  LAHEC  area.  At  least   two   dozen        education. Adults  attend  sessions  on  first-aid  -  all  con-
                  counties in the tri-state area previously mentioned are                 ducted   in   Spanish.   As   MHEDS   develops,   classes   will
                  represented  among  the  participants  in  programs  offered  by        expand to provide  instruction  in  nutrition,  pre-natal  care,
                  LAHEC.                                                                  and  caring  for  babies  at  home.  Pamphlets  and   films   in
                  Over 1200 professionals have registered at LAHEC                        Spanish  have  been  distributed  and  shown.  A   glossary   of
                  seminars,  workshops,  etc.  There  is  no  way  of  determining        common  health  terms   is   in   preparation.   Three   college
                  the number of professionals reached through LAHEC's                     seniors joined  MHEDS  during  the  winter  semester  for  their
                  local library program, or LAHEC's speaking and con-                     practicum:   one   is   a   community-development   student   in
                  sultative efforts on state and  national  levels.  There  Is  no        health planning; the other two are nursing students.
                  practical way of taking a census of  those  who  now  listen  to
                  the Instructional LARMP Telephone Lecture Network

                                                                                                                                               (continued)

                                                                                                                                                         29


              Lake Area Health Education Center

              New programs are envisaged to help solve needs in the
              LAHEC area. New funding sources for programs barely
              underway are also needed. LAHEC is investigating the
              health-educational potential of supra-regional cable TV, a
              nurse-practitioner program and a yet to be developed
              nursing institute.

              LAHEC continues to develop its two-dozen-plus programs
              throughout the area. It is now looking to other problems to
              solve - again, on a voluntary basis. There is a need
                0 to produce more managers and administrators
                * to develop health professionals at all levels
                o to nurture mutual understanding among institutional
                  members of the LAH EC consortium (there are close to
                  150 of them)
                o to re-educate health professionals
                o to catalyze community participation
                * to describe career mobility opportunities
                a to produce innovative educational processes and
                  curricula
                o to evaluate and gather current data necessary for
                  sound planning
                o to promote interinstitutional and interdisciplinary
                  education
                  to be the ferment for total collaboration

              Planning Staff
              Michael C. J. Carey, MA, MPH   Executive Director
              Linda L. Arnold, BS            Administrative Assistant
              Kathleen A. Bennett, BA        Research Assistant
              Clara M. Burleigh, BA          Secretary
              Robert F. Corrigan, EdD        Planning & Evaluation
              Diane M. Hrach, BS             Secretary
              Robert J. Olszewski, BS        Planning Assistant
              Sylvia A. Payne                Receptionist
              Paul E. Pazerski, BA, MPH      Planning Assistant
              Janine Powell, BA              Administrative Assistant
              Gloria E. Rogosky              Administrative Secretary
              Edward L. Taylor               Office Manager

              30


                  Lakes Area Regional Tumor Service Registry

                  The Lakes Area Regional Tumor Service Registry has
                  completed its fourth year of  operation  and  has  during  that
                  time experienced a steady  and  healthy  growth.  As  time  and
                  experience  have  indicated,  modifications  to  basic  systems
                  and  procedures  have  been  implemented   so   that   the
                  registry nearing maturity, will soon  achieve  its  statistical
                  goal  of  producing  "end-results"  and  "survival"   analyses.
                  The Tumor Service  Registry  was  designed  to  serve  the
                  hospitals, physicians and cancer patients of  the  nine  county
                  region  of  the  Lakes  Area  Regional  Medical  Program.  This
                  service is presently  shared  by  21  hospitals  now  par-
                  ticipating in the program, representing 40%  of  all  hospitals
                  within  the  region.  The  data  bases  include   approximately
                  8500 cancer cases and are being expanded at an in-
                  creasing rate with  the  continual  enrollment  of  new  member
                  hospitals. The data,  which  is  coded  from  source  documents
                  prepared by hospital  tumor  registrars,  is  maintained  at  a
                  high level of accuracy through  a  rigorous  system  o  qua  ty
                  control,  including  multiple  case  reviews,  telephone   con-
                  sultation  and  periodic  training  programs.   Recently   made
                  program  revisions  have  enabled  diverse  analytical   repor-
                  ting of these data reflecting  incidence  by  primary  site  of
                  disease, sex,  age,  stage  of  disease  and  first  course  of
                  treatment  for  an  individual  year  or  any  number  of  con-
                  secutive  years.  Many  such  reports  have  been  prepared  in
                  response to  specific  requests  from  physicians  or  In-
                  stitutions as well as for general distribution and  educational
                  programs.
                  To keep pace with  this  increasing  caseload,  cancer  patient
                  follow-up,  and  expanded  scope  of  activities  it  has  been
                  necessary to employ additional  registry  personnel.  Dr.  John
                  C. Patterson@ Project Director, oversees  the  daily  clerical,       STAFF
                  statistical, and data processing efforts of his staff.                Dr. John  Patterson, Project Director
                  Modification  and  development   of   computer   programs   are       Dolores Gamble
                  also carried out.
                  The ultimate goal of this tumor registry continues  to  be            Joyce Greenwood
                  service - service  to  the  cancer  patient  by  promoting            Freda Honig
                  continuity  of  care  through  yearly  requests  for  follow-up       Mary Penkacik
                  data, service to the physician by enabling  evaluation  of  all       Kathleen Franz
                  forms of cancer therapy on  the  basis  of  survival  and  end-       Angelika Saxer
                  results analyses, and  service  to  the  community  by  collec-       John O'Day
                  ting  data  which  may  assist  in  cancer   epidemiology   and       (part time consultant, data processing)
                  development  of  improved  methods  of  cancer  detection   and
                  prevention.

                                                                                                                                                   31


              Ambulatory Care Services  Model                                       Niagara County Ambulatory
                                                                                    Medical Care Study

              Phase I
              In December of 1972 the School of Architecture and                    This project is concerned with conducting a study of
              Environmental  Design,  State  University  of   New   York   at       ambulatory care needs in Niagara County.
              Buffalo, began an analysis of  ambulatory  care  services  with       The Health Association of  Niagara  County,  Inc.  is  gathering
              the intent of  planning  new  hospital  based  facilities.  The       the pertinent existing data  relating  to  the  ambulatory  care
              project   was   conducted   in   conjunction   with   Deaconess       needs in Niagara County.
              Hospital of Buffalo, which hopes to  use  the  results  of  the
              study  in  planning  its  new  ambulatory  care  facility.  The       Under study are the ambulatory  care  needs  in  the  county  as
              project was divided into two phases.                                  they relate to physical debility, including: pediatrics,
                                                                                    general medicine, obstetrics, surgery  (limited  to  out-patient
              Under a five month grant from the Lakes Area Regional
                                                                                    surgery), family practice and geriatrics.
              Medical  Program   a   model   of   ambulatory   care   service
              delivery was developed. The model in  the  first  phase  output       The results of this study (a first for Niagara County) is
              of  a  two-phase  project  aimed  at  enhancing  the  decision-       necessary  in  assessing  the  ambulatory  care  needs  and  the
              making capabilities of professionals in the health care  field.       delivery and scope  of  present  and  projected  services,  both
              The model  provides  hospital  administrators,  architects,  or       quantitatively and qualitatively, in Niagara County.
              health program  supervisors  with  information  about  detailed
                                                                                    The  project  was  launched  on  July  11  1973  and   scheduled
              workings of an  ambulatory  care  facility  so  they  can  make
                                                                                    for completion by June 30, 1974.
              sound  decisions  concerning  such  things  as:  (1)  ways   to
              improve health care delivery, (2) criteria  for  designing  new       Peter L. Forster is director of this project.
              ambulatory care  facilities,  (3)  ways  to  evaluate  existing
              health care  services.  The  model,  operated  by  means  of  a
                                                                                    SHARECO
              computer  program,  stores  and  retrieves  detailed   informa-
              tion  about  the  costs  incurred,  the  time   expended,   the       SHARECO is a plan designed to facilitate the continuing
              personnel utilized, and  the  space  required  for  every  task       and in-service education efforts of its cooperating
              performed in an ambulatory  care  facility.  The  user  of  the       members  particularly  through  the  sharing  of  all  types  of
              program can employ  this  information  in  order  to  attain  a       educational  resources.  Participants  include   Genesee   Corn-
              better understanding of the way an AC facility  works,  and  in       munity College, Batavia, New York and the following
              order  to  make  intelligent  judgments  concerning   ways   in       hospitals:  Genesee  Memorial,   St.   Jerome,   Veteran's   Ad-
              which ambulatory care can be improved.                                ministration,  all  of  Batavia;   Wyoming   County   Community,
              Structure of the  Model:  the  value  of  the  Ambulatory  care       Warsaw,  New  York;  Arnold  Gregory,  Albion,  New  York;   and
                                                                                    Medina Memorial, Medina, New York.
              Services Model is derived directly from the level of detail  of
              the data  it  stores:  the  more  detailed  the  information  a       A  $25,000  grant  from  the  LARMP  launched  the  project   on
              decision-maker  has  to  work  with,  the  better  his  ability to    December 12, 1973. SHAREGO has completed an
              make  sound  decisions.  The   data   stored   by   the   model       educational needs inventory  in  the  area  upon  which  it  has
                                                                                    based its program planning. A consolidated listing of
              describing the internal workings of  an  AC  facility  is  much       educational resources slated for distribution  to  participating
              less aggregate, much more  detailed  than  is  the  data  which
              hospital  administrators  and  hospital  architects   presently       institutions, has been compiled.
              have to work with.                                                    In  an  effort  to  expand  educational   programs,   videotapes
                                                                                    are  being  made  to   supplement   certain   programs   and   a
              Phase 2                                                               distribution system is being set up. Also available Is
                                                                                    assistance  in  arranging,  upon  request,   instructors,   lec-
              Intends to improve a  simulation  model  of  ambulatory  health       turers and guest speakers.
              care services developed by Phase 1.                                   The project is aimed  at  increasing  the  quality  of  programs
              ACMS-Phase 1-John P. Eberhard, Dean, Principal                        already   offered   by   making   available   more   educational
                                   Investigator; Gunter Schmitz,                    resources to participating Institutions. This  Includes  sharing
                                   Associate  Professor,   Project   Director       of  audio  visual  equipment,  media  and  personnel  expertise.
              ACMS-Phase    2-Gunter    Schmitz,     Associate     Professor,       The project also calls for developing  programs  of  general  or
                                   Principal  Investigator;  Scott   Danford,       special  interests  which  can  be  presented   In   a   central
                                   Project Director                                 location,  such   as   Genesee   Community   College,   In   the
                                                                                    hospitals or video taped for distribution to  the  participating
                                                                                    institutions.
              32
                                                                                    John P. Sifling is coordinator of the project.


                   Information Dissemination Service

                   The Information Dissemination Service is designed to
                   improve library services  in  the  nine  county  area  of  LARMP
                   by distributing health related information quickly and
                   directly to all members of  the  health  professions,  including
                   physicians, nurses, physiotherapists, occupational
                   therapists, podiatrists, dieticians, medical record  librarians,
                   aids, and other allied health professionals.
                   The Health Sciences Library  at  the  State  University  of  New
                   York at Buffalo is the medical resources library.         e
                   resources of medical  libraries  across  the  state  and  nation
                   are available to the users of IDS through established
                   avenues  for  inter-library  loans.   Means   of   communication
                   for receipt and  transmission  of  requests  include  the  LARMP
                   Telephone Lecture Network, U.S. Mail, telephone,
                   teletypewriter (TWX), and the SUNY Biomedical Com-
                   munications  Network.   Xerox   2400   and   7000   high   speed
                   duplicating machines provide copies  of  journal  articles.  The
                   computer facilities of the SUNY Biomedical Com-
                   munications Network provides users with subject
                   bibliographies  and  a  current   awareness   service.   Conven-
                   tional medical  reference  service  and  consultation  regarding
                   library management is also provided.                                    Services
                   A Medical Librarian is  assigned  responsibility  for  operation        Photocopy requests         9,331
                   of the Information Dissemination  Service  and  is  assisted  by        Pages provided            81,279
                   a library technician and  clerk-typist.  The  Librarian  of  the
                   Health Sciences Library supervises the project.                         Journals loaned               96
                   The IDS offers the following library services to all health             Booksloaned                  699
                   professionals in the region: photocopy and mailing of                   Bibliographic searches       525
                   journal articles and mailing of books,  preparation  of  subject        References requests          119
                   bibliographies in the areas of  interest  designated  by  users,        In addition, the IDS has kept detailed records of hospital
                   medical  reference  service  and  library  consultation  service        utilization over its period of funding.
                   to hospital libraries.
                   During the period of January 1973 to June 1973, the IDS                 As of July 1, 1973 the IDS became self-supporting. The
                   has  provided  health  professionals  in  the  LARMP  area  with        budget for the program receives support from the SUNYAB
                   the following services:                                                 Library Service (60%) and a fee-for-service contribution
                                                                                           from participating hospitals in the region to approximate
                                                                                           90% of present costs.

                                                                                           STAFF
                                                                                           Miss Jean Miller, Project Director
                                                                                           Ruth Opler
                                                                                           Joanne Nichter

                                                                                                                                                       33


           Community Health @
           Information Profiles (CHIP)

           Community Health  Information  Profiles  (CHIP),  which  has      The support provided by LARMP has given the CHIP
           been  supported  by  the   Lakes   Area   Regional   Medical      program of this area recognized national leadership in this
           Program since 1970, has continued in its efforts to  develop      health planning technology. In addition to the LARMP,
           a health-related data base. This has involved obtaining  and      CHIP provides data and services on an ad hoc basis to t e
           integrating vast amounts of data  from  a  wide  variety  of      U.S. Department of Health, Education, and Welfare,
           sources and developing  and  testing  computer  technologies      Comprehensive Health Planning Council of Western New
           and presentation formats. Such a  data  base  is  considered      York, Inc., Erie County Department of Health, Niagara
           to be a prerequisite to reliable health-planning  decisions.      County Department of Health, New York Urban Develop-
           The range of activities required to  produce  this  body  of      ment Corporation, as well as to hospitals, universities, and
           information for a county is characterized as  a  small  area      professional societies in the region.
           profile  and  for  special  groups  within  communities   or      Project Director
           regions as categorical  profiles.  CHIP  of  LARMP  produced
           several of each type of profile in 1973.                          Harry A. Sultz, D.D.S., M.P.H.
                                                                             Department of Social and Preventive Medicine
           Small Area Profiles                                               State University of New York at Buffalo
           Profiles for Allegany  County  and  Chautauqua  County  were
           completed in 1973. Both of these reports detail the
           population, demographic,  and  economic  characteristics  as
           well as vital statistics for the county. Also part  of  each      Chronic Respiratory Disease Program
           profile is  a  comprehensive  description  of  the  county's      This many-faceted, comprehensive project featured
           health resources which include institutions,  manpower,  and      screening for evidence of chronic respiratory disease,
           services and a measure of their  utilization.  The  profiles      continuing education for nurses and physicians, a model
           identify the  gaps  in  service,  the  projected  needs  for      pulmonary care facility, a respiratory Intensive Care Unit,
           service,  and  the  overlapping  of  services.  County  com-      an Associate Arts degree program in Inhalation Therapy
           mittees  are  now  at  work  developing  solutions  to  some of   and a Home Care Program. The project became
           the problems.                                                     operational in March 1972.
           Categorical Profiles                                              Each year approximately 16,000 people have been
           A  Community  Health  Profile,  Family  Planning  Needs  and      screened for chronic respiratory disease in the region in
           Services  in  Western  New  York,  completed  in   February,      cooperation with the American Lung Association of
           1973, documented the population at  risk  to  the  need  for      Western New York's mobile unit operation. This program
           organized family planning services, the  services  currently      became totally self-supporting In March 1972.
           available, and the knowledge  and  attitudes  around  family      The School of Respiratory Therapy at Erie Community
           planning of a specified  group  of  disadvantaged  women  by      College, which trained inhalation therapists, also became
           means of a home interview.  A  second  categorical  profile,      totally self-supporting In March 1972, receiving funding
           Factors Affecting the Utilization  of  Maternal  and  Infant      from Erie County (NY).
           Care Services of the  Department  of  Health,  Erie  County,      All elements of the Model Pulmonary Care Facility, except
           New York, identified populations at risk  to  the  need  for
                                                                             the Home Care and Rehabilitation programs, are now
           maternal and infant care services, the  populations  served,      self supporting.
           and the attitudes toward and knowledge of  services  from  a
           home interview of a sample of users and controls.                 The Millard Fillmore Hospital of Buffalo, N.Y. has assumed
           A  definitive  statement  on  community  health  Information      the major financial support of the Chronic Respiratory
                                                                             Disease Program.
           profiling was the subject  of  a  technical  paper  entitled
           Pertinent Concepts,  Content  and  Output  Formats  of  Com-      Project Director
           munity Health Profiles, published  and  distributed  by  the      John Vance, M.D.
           Community Profile Data Center, HSMHA.                             Millard Fillmore Hospital
           A paper  entitled  "Community  Health  Information  Profile:
           Prerequisite to  Planning  or  Exercise  In  Futility?"  was
           presented before the 101st'Annual Meeting of the
           American  Public  Health  Association  In   San   Francisco,
           California, November 7, 1973.
           34


                                                                                           Model Program for
                    Planning and Articulation for Allied Health                            Comprehensive Family Health

                    This project  was  concerned  with  developing  a  voluntary           This program,  designed  to  identify  community  health  needs
                    coordinating council for allied health education.                      and  meet  these  needs  using  the  "health  care   team
                                                                                           approach,"  became  operational  in  1972.  This  involves  the
                    The project sought to  identify  present  and  projected  allied       well-trained family physician, family practice  nurse  and  the
                    health manpower needs, and current and projected                       modern  social  worker,  all  working  in  concert  to  "expand
                    enrollment .s in present vocational  -  technical  allied  health      the arms of the physician", thereby  providing  more  time  for
                    programs in the region.  It  also  involved  the  comparison  of       his main role  of  diagnosis  and  treatment.  It  also  allows
                    the pros and cons of  regional  planning  and  articulation  for       more people to obtain better  medical  care  more  efficiently,
                    allied  health  vocational  technical  education  and  the  con-       effectively and economically.
                    struction of a master plan for this  special  education  in  the
                    region.                                                                The Health  Care  Team  has  been  developed  to  provide
                    A  major  accomplishment  of  the  project  was  the  establish-       service to the patients registered  with  the  Family  Practice
                    ment  of  a   viable   communication   network   among   persons       Center.  It  has  also  developed  a  system  of  census  tract
                    responsible  for  planning  and  developing  allied   health           filing, morbidity coding and general assessment.
                    education  programs.  Persons  responsible   for   institutional       The Lakes Area RMP provided funding to underwrite the
                    planning with respect to the need to develop in-                       costs  of  research,  assessment  and  evaluation  o  t   e
                    terinstitutional cooperative  efforts  in  meeting  regional           program as it relates to the practice of  family  medicine  and
                    manpower  needs  were  made  more   aware   of   their   respon-       the  development  of  the  health  care  team   approach.
                    sibilities through this interaction.                                   Deaconess Hospital of Buffalo,  New  York  initiated  the
                    Institutional representatives  have  reported  a  number  of           program in 1969 and subsidizes it to @ major degree.
                    instances where  their  planning  has  been  influenced  by  the       The motto of the family practice center is "To Create
                    information  which  was  shared  at   coordinating   council           Family Physicians By Intent and Not By Default."
                    meetings.  Two  participating  institutions  reached  a   mutual
                    conclusion of who should initiate  long  range  planning  for  a       Project Director
                    program to prepare therapeutic radiologic technicians.                 Ernest R. Haynes, M.D. (resigned)
                    Another institution began a feasibility study on  a  program  to
                    prepare clinical dietitians.
                    This project has also  resulted  in  making  available  accurate       Two County Nutrition Program
                    data  on  existing  programs  in  allied  health  education,
                    current  and  projected  enrollments  and  a  survey  of   those       Cattaraugus and Chautauqua  Counties
                    programs which are now in the planning stage.                          This project involved joint funding  from  the  LARMP  and  the
                    This study has also highlighted the  need  for  some  agency  to       Appalachian  Regional  Commission  to  support  a  nutritionist
                    assume  responsibility  for  providing  reliable  data  in  man-       position  to  be  shared  between  Cattaraugus   and   Chautau-
                    power trends.                                                          qua counties.  This  extends  nutrition  services  to  all  age
                                                                                           groups in  both  counties,  and  greatly  enhances  the  oppor-
                    Project Director                                                       tunity to study feasibility and cost/effectiveness of this  new
                    Phyllis Higley, Ph.D.                                                  service. It would  also  develop  a  program  of  nutrition
                    Department of Health Sciences                                          education for the public.
                    Education and Evaluation                                               Evaluation of the program will be based on  utilization  of
                    State University of New York at Buffalo                                nutrition services, costs  of  services  (both  direct  and
                                                                                           indirect), and changes in nutritional status of selected
                                                                                           patients  receiving  services.  The  ultimate  success  of  the
                                                                                           program would be establishment of a  permanent  nutr  t  on  st
                                                                                           position In the county budgets.
                                                                                           Project Director
                                                                                           Miss Ruth E. Kocher, R.D.
                                                                                           Regional Public Health Nutritionist
                                                                                           New York State Department of Health
                                                                                           Miss Kathy Child (as of January 15, 1974)         11         35


           Professional Staff
           John R. F. I ngall, M.D. - Executive Director
           James J. McCormack, Ph.D. - Deputy Director
           Robert J. Miller, M.B.A. - Executive Assistant to the Director
           Patricia Shine Hoff, R.N., M.A. - Assistant Director - Nursing & Allied Health
           Benjamin Morgan, B.S. - Comptroller
           Anthony Zerbo, Jr., B.A. - Assistant Director - Communications
           Robert J. Beebee, M.B.A. -Staff Associate
           Helen Brown, M.A. - Staff Associate
           John B. Clark, B.S. -Accountant
           William D. Crage, M.S.W. - Staff Associate
           Patrick M. Egan, B.S., M.B.A. - Staff Associate
           Janet Gelsinger, B.A. - Staff Associate
           Jean Hanna, M.P. H. -Staff Associate
           Suzanne K. Manson, M.S.W. - Staff Associate
           Michael Miller, B.A. - Staff Associate
           Diane Pinchoff, M.A. - Staff Associate
           Joan Philipps, B.S. -Staff Assistant
           Gary Smith, B.A. - Staff Assistant

           .Support Staff

           Urban Batt
           Alice Bragg
           Carol Butcher
           Curtis Oashmore
           Hazel Cunningham
           Elizabeth Eberl
           Karen Harper
           Charlene Kane
           Bonnie Kirisits
           Janet Knauf
           Brigette Kunzeck
           Mary Mietus
           Marcia Moule
           Rose Parker
           Richard Raelhie
           Diane Williams
           Mary Yadav

           36