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                                     Regioiaal Medical Programs
                                 Report to Congress -- P.L. 91-515

          1.  IHTRODUCTION AND SL,-\L\IARY

                  The initial concept of Regional Medical Programs  was  to  provide  a
              vehicle by which scientific knowledge could be more readily transferred
              to the providers of health services and, by so doing, improve the
              quality of care provided with a strong emphasis on heart disease,
              cancer, stroke, and related diseases.  The mission of Regional Medical
              Programs-as originally conceived was, broadly stated, to assist the
              health professions and  institutions of the-Nation in  thei@  efforts  to
              improve.the quality of  care and to organize and develop preventive,
              diagnostic, and treatment services directed toward the control of
              heart disease, cancer, stroke,  and other related diseases.  This
              original mission strongly reflected the program's origin, namely the
              President's. Conm-Lission-on Heart Disease, Cancer and  Stroke.  In   its
              report, that Commission recommended that A major national effort be
              mounted to reduce the toll from   these diseases which account for 75

              of all the deaths in America.  During the legislative process an
              awareness of the need to-involve all health,providers    and institutions
              in an attack upon this problem, and a recognition of the potential
              which regionalizatiot of service patterns and   education would bring
              led to the concept of regional "cooperative arrangements" among pro-
              viders as the principal means (or mechanism) to be employed in the

              pursuit of that end.

                   The implementation and experience of KT over the past    six  years,


                                              -2-

                                         of
              coupled with the broadening   the initial concept especially as
              reflected in the most recent legislation extension (P.L. 91-515),
              has clarified the operational premise on which it is based -- namely
              that the providers of care in the private sector, given the opport'un-
              ities, have both the innate capacity and the will to provide quality

              care to all Americans.

                 The concept and the.reality of the Regional Medical Program has
              -evolved and changed considerably since the enactment of the initial
              authorizing legislation (P.L. 89-239) in October 1965o  Its goals have
              been broadened considerably; and there is every reason to believe that
              these goals.will be expanded and altered in future years as the major
              health problems and needs of the Nation change.

                 It is RMP's approach rather than its goals (or mission) which is
              unique.  For RMP, as a  echanism, has and continues to be a functioning
              and action-oriented consortium of providers responsive to-health needs
              0
              and problems.  It is aimed at doing things which must-be done to

              resolve those problems.

                 RMP is a framework  or organization within. which all providers can
              come together to meet health needs that cannot be met by individual
              practitioners, health professionals, hospitals and other institutions
              acting alone.  It also is a structure deliberately designed to ta e
              into account local resources, patterns of practice and referrals, and


                                              -3-

              needs.  As such it is a potentially important force for bringing

              about and assisting with changes in the provision of  personal  health

              services and care.

                 RMP also is  a way or process in which providers work  together  in
              a structu re which offers them considerable flexibility  and  autonomy  in
              determining what it is they will do to improve health care  for  their
              communities and patients, and how it-is to be done.  As.such,  it  gives
              the health providers of this country an opportunity to exert leadership
              in addressing health problems and needs and provides them with  a  means
              for doing so.  RMP places a great corollary responsibility upon
              providers for the health problems and needs which they must help meet
              are of concern to and affect all the'ppople.'

                  Insofar as mission is concerned, it has become clear that  KIP  shares
              with al 1 health groups, institutions, and programs private  and  public,
              the broad., overall goals of (1) increasing availability of care,  (2)
              enhancing its quality, and (3) moderating its costs    making the   organ-

              ization-of services and delivery of care more efficient.

                  Among government programs @IP is unique in certain  of its salient
              characteristics and particular approaches.  Specifically that (1)   it
              is primarily linked to and N4orks through providers, especially practic-
              ing health professionals,which means the private sector largely;  (2)  RMP
              essentially is a voluntary approach drawing h@vil-y  upon  existing:health
              resources; and     though RMP continues  to have a categorical emphasis,


             to be effective that emphasis frequently  uiust be subsumed within or
             made subservient.to broader and more comprehensive approaches.

                 IUIP's more specific mission.and objectives, as outlined and
             discussed below,  are.the pr6duct of the above broad, shared goals on
             the one hand and  its unique characteristics and approaches on the other.


                                               s

              LEGISLATIVE AI\TD ADNIINISTIZATIVE BI@CKGIZOUND

                   In addition to extending the l@\,IP legislative authority through
             June 30, 19731 P.L. 91-515 made a number of changes  in  that  authority.

             Among  them:
                   (1)  Explicit contract as well as grant authority was provided.
                   (2)  "Kidney disease" was specifically added as a categorical

                        disease concern- of RMP.
                   (3)  The scope of the program in non-categorical terms was consid-
                        erabl.y broadened.  Specifi cally the attention of RMP was

                        directed to
                        (a)  "Strengthen and improve primary care and the relationship
                             between specialized and primary care."
                        (b)  "Improve generally the quality and enhance the capacity.
                             of heal th manpower and facilities available to the

                             nation."
                        (c)  "Improve health services for persons res iding  in  areas
                             with limited health services."
                   (4) Requirements with respect  to  Regional.Advisory  Group  compo-
                        sition were expanded.. Nbst importantly,  RAG  membership  had
                        to include representatives of "health planning agencies.11
                    (5) Required a-reai%Tide CEIP agency review and cement on RNIP appli-
                        cations prior to their final  consideration by Regional,
                        Advisory Groups (ivhich must approve all PNIP operational pro-
                        posals) and submission to RNLPS.


                                                 6

                   (6)  ExTanded National Advisory Cowicil on Regional Medical
                        Programs membership to 20, with specific provision made,

                        for

                        (a) "One person outstanding in the  study  or  health  care  of
                             persons suffering from kidney disease."

                        (b)  Four public members.
                        (c)  The Cliief.@ledical Director of the Veterans Administration

                             as an ex-officio member.

                        The so-called lfultiprogram Services authority wider Section 910
                        was significantly broadened to allow grants to public or non-
                        profit or private agencies (includin  but not limited to R\lPs)
                                                              9

                        to
                        (a)  "Assist in meeting the costs of special projects    for
                             hTroving or developing new means for the delivery of
                             health services concerned with  the  diseases  with  which

                             this title is concerned."
                        (b)  "Support  research studies, investigations,   training, and
                             demonstrations designed to maximize the   utilization   of

                             manpower in the delivery of health services."

                   The  above changes have been or are in the process of being ii-aple-
             mented administratively and/br reflected programmatically-

              Kidn2Z  Disease

                   Since  the categorical scope of R\ffl was broadened to  specifically
              include  kidney disease, a growing number of Regions have   submitted pro-


                                                  7

              posals in this  disease area.  Kicbicy disease. treatment capabilities
              now are being expanded in 20 Regioiis.  'fl-ie current annual level of
              RMP grant fundii-i to these R%iPs  for  kidne                     is   about
                              .9                          y disease activities
              $2.1 million, which is  roua,]-ily.double'the level of funding prior'to
              the enactment of  P.L..91-515@ a-.little over  one year ago.  New awards
              made (or pending. final action), durina that period have equalled $.8
              million.  (In addition,  P@IPS is continuing to support by contract home
              dialysis., transplantation, and other demonstration and training pro3ects
              -relating to kidney disease,'at a current   annual  level  of  approximately

              $4 million.)

                   Recognizing beforehand that      requests and approvals  very   probably
              would exceed RNIPS' ability  to  fund  kidney disease  activities,   specifi-
              cally end-stage treatment programs, the National Advisory Council early
              on adopted-a policy according top funding priority to those proposals

              which in
                        effect build upon and/or link up.with existing resources and
              programs for end-stage.treatment of kidney disease.  The aim is to
              expand present capacity and services thus making treatment available
              to increased numbers-of people over larger areas of the country; in
              short, to maximize the number of additional people served and treated

                                   -unds and other resources, such as spec
              within the limited f                                           ialized

              facilities and trained manpower, presently available.

                   Thus, proposals funded   generally have fallen into one or another
              of two broad categories.  Specificall),, (1) those where a modest
              increment has allowed the extansion,in     the capacity of existing integrated


                                                  8

              dialysis-traiisplantatioii programs or (2) those that i@Totild help  provide
              the element(s) presently missing but needed (e.g., tissue typing lab-
              oratory) in order to put together a comprehensive program f6r end-stage
              treatment of high quality.  Particular encouragement is     being  given  to
              programs of an inter-regional character, those serving or linking
              several (or parts of several) Regions, so that the duplication of
              expensive facilities and services may be avoided, scarce manpower might
              be better used, and the patient suffering from renal failure might

              reCeive optimal treatment and care.-.-'-

              Scope of Program

                   The categorical disease emphasis of R\IP has in recent years been a
              major issue; and in the  1970  legislative  6xtension  the  explicit  broad-
              ening of the-program's scope to  include  all  "other  major  diseases"  was

              proposed.

                   Although this expanded language  was  not  retained  in  the bill finally
              enacted  P.L. 91-515 did broaden R@IP's scope significantly.     For as already.
              noted  the  amended  legislation  incorporated  specific  changes with respect-
              to strengthening primary care, improving services for those     presently
              underserved, developing new  means  for  the  delivery-of  health  services,
              and maximizing the utilization of  health  manpower  as  part  of    Is

              mandate.

                   Quite apart from these legislative cliange's,   e-\Perience in  reLent
              years and the directions increasingly pursued by most Regions  clearly
              indicates that the categorical emphasis on heart disease, cancer, stroke,
              and kidney  disease  is,  operationally  aIt"lcast, viewed  as  an  important


                                                  9

             focus rather than   a narrow program restraint or limitation.  Though
             the issue perhaps   is not entirely a nioct one, the following si-,ggests
              that it largely overlooks what Regions have actually been doing.

                       Connecticut's continuing central thrust towards regionalizatioii
                       of services, comprehensively defined, around the community

                       hospitals in that State.
                       The early efforts of the California   RMP in the  l@atts-Willoivbrook
                       area of Los ktojes   and, more recently, their efforts which
                       have been instrumental in leading   to OEO funding  of community

                       health networks in San Francisco and Los Angeles.
                   *   New Jersey's continuing efforts to help with the health
                       problems of poor urban blacks iv]-iich.have entailed working
                       closely with and supporting llodel Cities  programs  in  many  cities

                       in that State.
                   *   Goorgials concern with imp@oving and linking emergency care
                       services generally  in an eleven-county area in the southeastern

                       part of that State.
                       The technical assistance,  feasibility  studies,  and  other  support
                       provided by the @letro New York, Ohio Valley, and IVest Virginia
                       @lPs this past year to--groups and  communities interested in

                       developing l@10s.
                       The iriajor 'Contributions made by the Arkansas, @lountain States,
                       and Northern New @gland @lPs    to the development of  Expe  @  ental

                       Systems proposals funded last   year.
                                                       nd assisting with the development
                       Ma,ine's efforts in  promting  a.


                                            10

                   of a medical school in.that State.
                   The pilot'sickle cell anemia programs funded recently by the
                   Michigan and IVestern Pennsylvania D-IL3s.

                 This reality and the broadened legislative mandate are, it will be
             seen below rIeflected in the "neiv directions" and priorities of Regional
             Medical Programs at both the nation al and rdgional levels.

             Relationships with aip

                 The changes made by P.L. 91-515 have served to reinforce the relation-
             ships and cooperation between Regional Medical Programs and Coinprel-iensive

             Health Planni-ng.

                 The new legislative requirement tl,-at DIP Advisory Groups include
             health planning agency representatives was interpreted to mean representa-
             tives of S@atcoand areai,7ide CHP.agencies specifically and implemented
             accordingly.  IN'hile most ]@Gs previously included CI-IP representatives, such
             cross-over.representation has increased significantly.  There are, based
             upon the most recent information available  149 State CI-IP representatives
             on @IP Advisory Groups and 124 areawide CIIP representatives.  In addition,
             the-re are over 250 CHP representatives on other @,IP working committees and
             task forces.  (Conversely there are 850 @IP representatives serving on the
             Advisory Councils and other'conimittees of both State and areawide CI-IP aaencies.,

                 The review and comment requirement was implemented effective May 1,
             1971. As'of that date all RMP applications submitted had to include the
             comments of the appropriate areaivide CliP agencies.  Information available

             at that time indicated that cooperative..-revicii mechanisms had already been


              established with 107 funded arcaiiide agencies and with wi additional 69
              such agencies not yet funded by Cf-Ul. Furthermore, 46 l@lps. also i-,@.re
              providing State.Cl@' agencies with the opportunity to re view their proposal-@.

                   It is still too early to determine what the effect of this-review ar@d
              comment by CI-IP agencies will be It certainly should help over time to
              insure that activities and efforts proposed by @ff's are consonant with
              the local needs and problems as perceived by communities and expressed
              through their CIIP areai-jide planning efforts and priorities.

              Decentralization to Regions

                   One salient characteristic of the RNT mechanism is the large degree
              of regional (or local) autonomy which Regions have had and exercised.
              Singular legislative-expression of this is that all operational proposals
              submitted to R\,PS for,Council review and recommendations must be approved

              by that R69ionts Advisory Group.

                   Another major step in this direction was taken in mid-1971 with the
              decentralization of project review and funding authority and responsibil-
              ity to the 56 PNIPS.  Now Regions are,. if their own review processes meet
              defined minimum standards, given primar
                                                     y responsibility for deciding (1) the
              technical adequacy of proposed operational projects and (2) which proposed
              activities are to be funded within the total amount available to them.

                   Although it is assumed that the review process of all Regions meet
              the prescribed standards  or can with minimal changes- or adaptations, PINIPS
              is verifying this through a series of staff visits  and examinations of


                                                  12

              their review processes.  It is-anticipated this verification procedure
              will have been largely completed by June 30, 1972.

              National Review Process and Selective Fundina

                   The Council and national review process noi%r are  assessing  RviPs  laraely
              in terms of their overall program and progress. I\To longer  is  the  t6c]-inical
              adequacy of individual projects or discrete, singular activities the

              primary focus or concern..

                   This change  from  project  to  program review has led to, and indeed
              necessitated,  the  development  of  program review criteria, aimed'at
              assessing each  Region's (1) performance   to date, (2) the process and
              organization that has been established,    and (3) its proposal for future
              activities.  These criteria and a corollary scoring system have been used
              on a trial basis over the past six months, found operationally adequate
              and ivorkable, dnd are being  iiicorp.orated as an integral part of the national

              review process.

                   As a result, Regions   are now being  ranked or grouped in terms of
              quality     (A)  those  which have demonstrated the greatestmaturity and
              potential,  (B)  those  which are generally satisfactory in their performance
              and progress,  and  (C)  those which are below average.  This  in  turn  has  per-
              mitted @ff'S to  implement  astronger policy of selective funding.

                   Under this selective   funding policy, which  was  formally  initiated  this
              fiscal year, those Regions which have demonstrated outstanding maturity
              and potential and whose proposals are most nearly congruent with the
              expanded lt%IP mission-and national priorities,  are  being  awarded  proportion-

              ately greater increases.


                                               13

             PROGRA@L DIRE-CrIO,'@S A\TD ACCO,\IPLISI@- IEN7S

             The broadened concept of Regional @ledica-1 Programs, with its emphasis on
             improving the availability, efficiency and quality of care,  sets  the
             frameivork within i..Thich specific objectives and program priorities are
             developed.  Within this framework, Regional @ledical Programs have
             identified four areas of program concentration, the principal objectives

             of which are to:
                        Promote and demonstrate among providers at the local  level
                   (1)
                        both new techniques and innovative delivery patterns for
                        improving the accessibility, efficiency, and effectiveness of
                        health care. This might include, for  example,  encouraging
                        provider acceptance of and extending resources  supportive  of
                        Health Maintenance Organizations.  In relation to new compre-
                        hensive health care systems, emphasis i@,ill be placed on
                        assistance in developing and implementing.iiiecl-ianisms that
                        provide quality control and improved standards of  care,  such
                        as performance review mechanisms.
                   (2)  Stimulate and support those activities that will both  help
                        existing health manpower to proviao.-more and better care  and
                        will result in the more effective utilization of new  kinds
                        and combinations of health manpower.  @ther, to.do this in
                        a way that will insure that professional, scientific, and
                        technical activities of all kinds (e.g., informational,
                        trainin,a,) do indeed lead to professional growth and develop-
                        ment and are appropriate]  placed within the context of
                                                 y


                                                 .14
                         medical practice and the community.  At this time emphasis
                         will be on activities  which most  effectively  and  immediately
                         lead to provision of care in urban  and  rural  areas  presently

                         underserved.
                   (3)   Encourage providers to accept and  enable  them  to  initiate
                         regionalizatioii of health facilities,  manpcn@r,  and  other
                         resources so that more appropriate'and better care will be
                         accessible and available at the-local and regional levels.

                         In fields where tllere are marked  scarcities  of  resources,
                         such as kidney disease, particular stress  will  be  placed  on
                         regionalization so that the costs of such care may be   moderated.
                   (4)   Foster close cooperation and coordination  witli  other  health
                         programs.  Experience  to date has.sboi@,n that the  Regional
                         @ledical Program can best help to improve the overall of  ctive-
                         ness of the health care delivery system  by  ivorkin  with  and
                                                                            9
                         contributing to related Federal and other efforts at the
                         State, local and  regional  levels.  Cooperative  linkages  with
                         the Comprehensive Health Planning agencies and the   Experimental
                         Health Services Deli-kTei-y Systems of ]\'ClISR&D are prime targets
                         to provide effective organizational'.f-rameivorks for identifying
                         and utilizing community health resources.-
              During 1970 and 1971  the Regional Medical Programs may  be  said  to  have
              become fully  operational  in  atib mpting to meet these objectives.
              Indeed, of the 56 Regional Nledicdl Programs  that  were  establislied,for
              planning purposes, 55 are now operational, with the 56th region


              moving  toward operational  stMis.             As -.such for varying

                                                               to only a
              periods of  time ranaiiig from over four years             feiv.mont-lis,
              these programs are now involved in    activities  especially  designed  to

              meet the health  needs of their own   Regions.

              The approach of  these Regions,is reflected   in certain broad   areas  of
              acc    lislment which are being realized around the country.
                  ODP
                  All'operational Regions, the now as well as those ivliicji made    earlier
                  starts, have developed a base for  'effective  regional  planning  and
                  decisionmal,-ing throu  broad representation and participation of health
                                       gh
                  institutions, organizations and individuals on the plannina committees,
                  .and the Regional Advisory Gro  s of each Reaioii.
                                                UP

                  The Regional Advisory Groups,-whicli serve as the policy-maldng body
                  of each Region, and are -responsible for  the  selection  and  content  of
                      osals sent forward for funding, have grown to include 2,700
                  prop

                  individuals.

                  In addition, each Region also' has a variety of task forces and
                  planning committees  designed to  en-sure  broaa-based  participation.
                  Some 12,000 health professionals and public-representatives are on
                  Regional @ledical Program planning  committees and local action groups.
                  Those represent a variety of  health  and  healtli-related  institutions-,
                  including all medical  schools, every state medical society, health
                  departments, cancer and  heart  associations,  many  other  voluntary  and
                  public agencies, and over 2,100 hospitals.     This-widespread,
                  voluntary participation in MT by, literally    tjious.ands of health

                                  'd'hwidreds of health inst
                  :professionals an                           itutions is  an  important


                                                16

                strength and characteristic  of  the  Pr.ogrmi.

                The 56 Reg ions are moving in a variety of ways to achieve their
                objectives. Perhaps one of the most -important roles  is  played  by
                the professional (or core) staff  in  each Region.  These have developed

                to include over 1,500  full-time  persons.

                A primary role of  the  professional  st affs is to serve as a facilitator
                for cooperative planning and joint programming.  Because o     ts net-
                work of relation-ships, the RNT staff can serve as a convenor of
                multiple-inte-rest groups to solve local problems.

                'The staff may encourage health groups to develop joint efforts
                rather than institute autonomous programs.  'fl-iis involves development
                of regional li@,agies which demonstrate methods of institutional
                planning to avoid duplication of effort, and  sharing  of  resources
                and facilities to improve efficiency, such as  joint  employment  of

                                        -r c             -ry services.
                certain professionals  o   onnon  laborato

                The professional staff has played another ii.Torta nt role in serving
                as'a technical -resource and providing consultation services  to health
                organizations such as hospitals, Comprehensive Health Planning
                agencies, educational insti-iiitions, @iodel Cities, OEO, and others.
                Professional staff also support many central   regional resources)
                such as data systems., evaluation resources,  information  networks,

                and parts of the manpower training system.


                                                   orRilig to improve the health care
                The Regional @-ledical Programs are iq
                system directly through opeydtional projects as well.  'flee movement
                toivard -redirection of grant funds is reflected in the areas of
                program enThasis of tlie'nearly 600 operational activities.  Activities
                emphasizing organization and delivery of patient services and the
                training of new types of personnel are increasing, while funds for
                continuing education and planning are decreasing.  Almost one-fif-th
                of R'%IP operational funds are now in wbulatory care acti-%rities.such
                as neighborhood healih.centers and out-patient departments of

                hospitals.
                Moreover, these professional staff and operational activities a-re
                leading to the cre ation of important institutional linkages among
                hospitals, practicing physicians, and medical centers which affect
                and improve the whole system of delivering medical care.

              lVithin these broad areas of program direction, program accomplishments
              and problem  can be looRed at in relation to specific areas of focus.

              Imo-xrations-and Im-D-rovements in Health Care Delivery Systems
              New techniques and innovative delivery patterns that lead to improved
              accessibility, efficiency and effectiveness of health care are being
              developed and tested under R@ auspices.  'nie need for improvements in
              health care delivery patterns is evidenced by the poor utilization of
              physicians and allied health manpower in most medical trade-areas;
              th e acute lack of such mai-ip(x,;er in rural and ghetto areas; the -rising
              cost of medical care, particularly for hospitalization and related
              services; the uneven availability and accessibility of health services,
              again most scarce in'rural and ghetto areas; and the development of
              over-Sp ecialization in medicine due, in part, to the rapidity of


                                              18

             medical scientific advances.

                                      out-Patient Care
             In an effort to.promote greater out-patient care, for example, five
             community hospitals in Massaci-iusetts have begun home care program
             through the efforts of the Tri-State Reuional @ledical Program and the
             Mas.sachusetts Hospital Association.  Such programs will provide
             continuity of care for hospitalized patients.after discharge, as well
                                          i the hospital.  To date, one hospital
             as reduce.the length of stay._ n
             has achieved a fully coordinated home care program with excellent
             multidisciplinary input.  Three hospitals are planning to hire full-
             time nurse coordinators and have opened a much improved information
             interchange with tho-local Visiting Nurse Association.  One hospital
             moved the Visiting ',\Iu-rse Association -richt into the hospital building
             and also appointeda full-time qualified nurse as coordinator.

                               Accessibi:Lity in-Inner-city Areas
             A variety of'activitids attempt to improve accessibility in inner-city
             areas where the problem are more concentrated.  The New York @l,-tro-
             politan Regional @,I,-dical Program  for example, has undertakena
             program, administered by Harlem Hospital, for stroke management of
             Blacks in the Harlem inner-city area of Neiv York.  The activi@, has
             three facets:  intensive and follow-tip care of the stroke victim;
             screening and surveillance of potential Victims; and training of inner
             city residents as-coitnunity health aides to assist in follo@v-up and
             surveillance activities.  In addition,Ithe @ffl funds help to support
             the ho5pital's hypertension clinic, which reports that all but one of


                                              19

             the patients referred there in the last year. have had their ailments
             brought under-control solely throii(Th reoular out-patient visits.
             Preliminary mortality-statistics reveal that the mortality  rate  of
             stroke patients admitted to Harlem Hospital has dropped from  48  to
             27.4 percent in the nine months Vince the project's inception.

                                ]Rural Health Delivery Sys-tems
             In rural areas and in concert with related Federal, state and local
             programs, specific efforts are being directed to encourage the providers
             of healthcare to male care available and accessible to-those areas
             where there is a distinct scarcity of resources.  In the State of
             Washington,,for example,.because of a physiciai-i-manpoiver shortage, the
             iso lated community of South Bend and surrounding areas were about to
                                                           C,
             lose their hospital until the IVashii-igton/Alaska Regional @ledical
             Program stepped in to organize community, State, and Federal interest
             ancl resources to save it. Not only are new physicians locating  in
             South Bend but additional services beyond those formerly offered are

             now available.

             Rural health care system cannot be developed immolation nor can
             there be a set pattern for their desion'. They must be based  first
             on the M'x of services available in each area with other services
             added where the need exists. The emphasis needs to be  on  bringing
             the available services together in a systematic approach to meeting
             health care needs.  The Tennessee @lid-So-uth @IP-)ia@ helped plan for a
             comprehensive health care program in an isolated community in eastern
             Tennessee and Kentucky in cooperation with the Ohio Valley @T and the


                                                20
             Appalachian Regional Co,='s-@ion,  'Fliroi-ic,,Ii @,IP -;upport it has been
             possible to linl-, three isolated rural clinics in a mountain  valley
             of eastern T@-uiessee for the first time by telephone
                                                                  ,so that the clinic

             nurses can co@mpunicate with one another and with the  physicians  on
             whom they depend for consultation and support.

                                 Emergency Health Care Systems
             Another area which will.be receiving increasing emphasis by Regional
             @ledical Programs is emergency health 'care systems.  Systems are needed
             which bring together better transportation services, communication which
             would tie hospitals, transportation facilities  and  other  emergency
             organizations into rapid response systems  and emergency medical centers
             with specially trained physicians and nurses.  Once again, care must
             be taken to assure that such systems ate integrate d with the total health
             care delivery system of a com=ity or region.

                              @T's and Technological Innovations
             Regional @ledical Programs are supporting activities which provide
             opportunities for increasing the rate of implementation   of  systems
             innovations, new technologies including automation, and   changes  in
             delivery patterns, particularly those developed through   the efforts of
             the National Center for Health--Services Research and Development.  As
             Health Maintenai-ice Organizations and Experimental Health Services
             Delivery Systems reach operating status, MT's will, where appropriate,
             link their demonstrations to those ongoing service.systems so as to
             effectively improve the quality of care provided by the latter.


                                                  21

                                 Health \Iai-nt&nanco Organizations
              In relation to Health Maintenance Organizations in particular, Regional
              @ledical Programs are becominc, in-koli7-ed in developmental activities  in
              a variety of ways. Because of their provider linl-,ages, the  RI,@Ulls  can
              act as catalytic agents to bring together  the  various  elements  of  tJie
              health care system, provide  an  envirornent  conducive  to  planning,  and
              give staff support and technical assistance as necessary.  In this way,
              Regional Medical Programs will support organizations which have the
              potential for  becoming  Health  Maintenance  Organizationsi  In  addition,
              subsequent to the establishment of 1-1\10's, Regional @ledical Programs will
              be actively engaged in the professional aspects of planning for manpower
              programs, mechanisms for monitoring the quality of care, ambulatory and
              emergency medical care services, centralization of.   laboratory facilities,

              data system , etc.

              Development activity by the Ohio Valley @T, for example, includes receipt
              of a HSNIHA planning grant at a level of $51,250 to assist comunity
              interests in planning an IDIO for the Louisville, Kentucky area.  After
              moving the proposal to the  stage-of  funding,  it  has  turned  over@major
              responsibility to the Falls R6'ion Health Council, the Areai-jide CHP.
                                              9
              agency for the area.  The MT continues to contribute about 2      man days
              per week to this Louisville effort.

                                          Quality Standards
              As new and more effective   comprehensive healt]-i.-systems are  developed,
              such as Health Maintenance   Organizations, rural health delivery systems,
              and emergency health syst  e@ , there is-a' need to ensute'tliat  the  care


                                                  22

             provided meets quality standards.  'flie need for. such assurance is,
             particularly pertinent in terms of the  new 1-@10's which are designed to
             bring toaether a comprehensive range of medical services in.a single

             organization.

             To provide guidance in this area, MIPS as the lead agency in l@ilia has
             taken the responsibility to develop guidelines for review  of  the  quality
             of medical care delivered by I-DD's, and to design procedures and criteria
             for both internal and external medical audits.  RI\TS has also developed
             under contract with the Inter-socie@ Commission for Heart- Disease

             Resources the Heart Guidelines.

             As.the @D program and other comprehensive  health  systems  are  developed,
             it is expected that the 56 Regional @ledical Program will  be  involved  in
             implementing the guidelines and evaluating their impact  on  the  processes
             of care of individual and institutional provi ers.

             Manpower Development and Utilization
             Regional Ethical Programs :Ls and will be promoting a broad array of
             manpower activities, designed around the  central concepts of enabling
             existing health manpower to provide more  and better care, and training
             and more effective utilizdtion--of new kinds of health manpower.  Among
             new areas of program priority are Area Health Education Centers.

             The basic concept of RNIPS efforts in this area wil I be that better use
             can be made of existing manpower assets. lqithi:n a.given  situation,  this
             requires an accounting of the types of manpoi%,er already there, a task  or
             labor analysis of the  kinds of services which each type of manpower


              performs, and an effort to determine hoij the total services rendered can
              be increased by reorganizing tlid ivorl%. structure of this same manpower
                      The concept of haviiic, tile least expensive unit provide as much
              group
              of a given health service as is consistent  with  quality  care  is  essential
              here.  If-certaii -i medical f-unctions currently being clone by  professionals
              are capable of being transferred to a  less  expensive  type  of  personnel,
              either existing manpower can be retrained to  acquire  this  skill,  or  new
              kinds of health-iiiajipower can be developed to take  over  these  functions.

                                    New Cat@gorios of @lanpoi,:er
              Many Regional @ledical.Progranis have conducted studies to determine the
              need for, willingness to accept and feasibility of training categories
              of manpower to extend the  services of physicians.  @lost of these are
              related to the physician's  assistant  concept.  Some  @IP's  are  designing
              such projects and have funded operational activities in this area.

              In North Carolina, the Physician's'Assistant Pro ram  at  Duke  an  Boi@,man
                                                                 9
              Cray is an effort to provide-a well-traii-ied and educated assistant at
              the intermediate professional level AIio, by working with the physicians,
              can complement physician services and  thereby  reduce  the  physician  man-
              power shortage.  @IP-is also  cooperating with other HS@ffiA programs  in  the
              preparation Of family nurse practitioners who will also augment the
              services of physicians.  The North Carolina R@T, for example, is utilizing
              its linkages with the Regioilis practitioners to interpret the program
              to them and to encourage the identification  of  nurses  for  training  from
              the co    iti'es where the need exists.  To provide a desirable legal
              structure for the utilization of the professional assistant, in terms of
              such problems as licensure and malpractice, the Region is supporting  i,;orl,-


                                                 24

             on the development of model medical manpower legislation.

                             Improved Utilization of Existing @lanpoi%Ter
             Virtually all Regional @led'ical Procram  have  projects  designed  to  augment
             the knoivledce and level of performance  of  health  professionals  and  para-
                         C)
             professionals. @,lany of these projects lead  to  improvements  in  the  utili-
             zation of personnel. Per]-laps the greatest R@iP thrust  in  this.area  is  the
             training  of  coronary  care unit nurses; over  7,000  registered  nurseIs and
             licensed  practical   nurses have.been trained to date.

             The Nei-i Jersey @IP, i.n an' effort to improve manpower utilization, is
             supporting a program  to  standardize  coronary  care  unit  training  program
             for licensed practical nurses, so that  they  can  function  with  the  same
             protection and legal sanctions  as  registered  nurses.  Given  a  high  turn-
             over rate among coronary care unit trained registered nurses, their use
             as supervisors and.teacliers of  licensed  practical  nurses  may  represent
             better utilization of professional   nursing personnel.

             Other manpower and reclining activi.ties,,althougli  basically  designed  to
             provide continuing education for professional    and allied health personnel,
             have important spin-off benefits.  A recently    completed program to upgrade
             the quality of continuing education at a community medical center in Colu-ous,
             Georgia  for  example,   has contributed to substantial groivth  in  the  city's
             physician population and   the establishment of the  medical  center  as  an
             aremvide continuing  education  resource  for  smaller  neighboring  hospitals.

             As the basis for the program, the medical center in Col@us established a
             regular-univerit-.y-affiliated'teachin- program i..,ith the  Emory  University

             School of @ledicine.  Local physicians ive-re sent to the University for a


             newly organized clinical training program, and then, on return to the
             medical center in Colupblis  set up similar clinical and didactic trainina
                                                                                        C,

             for their associates. As part,of its  upgrading,  the  medical  center  at
             Columbus was selected by the Georgia R\IP as one of five community hospitals
             across the State  which would become areaivide continuing education
             facilities.  In  addition, approximately 28 new physicians have been attracted
             to the town during two years of the project, while there had been no.

             increase in the previous eight years.

                                 -Area Health Education Centers
             As part of this effort to iTnprove manpower utilization   and  development
             Area Health Education' Centers will be a  major  new  initiative.  Grant  funds
             at a level of approximately $7.5 million will be  available  in  1972  for
             initial organizational and development efforts and operational programs
             aimed at providing the necessary  structural  linkages  among  cooperating
             institutions.  These Centers will provide a means to improve the distri-L
             bution, supply,,utilization and efficiency of  health  manpower  in  an  effort
             to enhance the delivery of health care   in remote or  urban areas currently

             underserved.'

             Linkages between healtJi service   organizations and educational   institutions
             will be established to provide students both   academic education and clinical
             practice appropriate  to.theit discipline.  Students will have the
             opportunity to learn  their skills  in  settings which promote.the team
             concept of  comprehensive  health  service.  The network of institutions
             linked together to carry out  the  functions  of the center will provide means
             of extending advancements in  health  to  communities.  By  utilizing  existing
             health care facilities i.n.combination with  educational  institutions  to
             educate needed heal-L'ji@porsonnel, both the quality, ajid quantity of liealtj-l


                                              26

             care can be increased in undersoj@,od areas.

             A current effort in the l@atts-Willoi@brook project in Los Angeles generally
             reflects the type of program which could be developed.  'n-iis is an effort
               develop a nonacademic community which would function within an acute
             to
             general hospital, the Martin Luther King, Jr. General Hospital, in the
             deprived central area of Los Angeles County.. The primary aim is to
             improve the quality and quantity of health care in the connunity. Traininc,
             and educational components w.ill revolve around patient services and as a
             spin-off will provide outpatient and'inpatient health services to the area.
             The program includes undergraduate training and continuing education of
             community health practitioners.  It is anticipated that the project will
             in.the near future include a community mental health center, a school of
             allied health professions, and a clinical research building with residence
             for house staff.  The project also calls for the provision of technical
             assistance and resources to other educational and health care institutions
             in the llatts area for the purpose 'of developing additional training
             programs for' health care personnel.

             Regionalization and Institutional Linkages
             Regionalization and new organizational arrangements  a.re major themes of
             Regional Medical Programs, 'llorking -relationships and linkaaes among com-
             munity hospitals and between such hospitals and medical centers are among
             the.prima-ry coffce@ -of the program.- The linking of less specialized
             health resources and facilities such as small community hospitals with
             more specialized ones is an important way of overcoming the maldistribution
             of certain resources,.and thereby increasing their availability and

             enhancing their accessibility.


                                                    27

                                                              1 and institutional  Iiiil-a(yes
               The develop,-iicnt of regionalized professions                             C>
               aids in linking patient care with health research and education within
               an entire  region  to  provide  a  mutually  beneficial  interaction.  It  also
               helps to emphasize the delivery  of  primary  care  at  the  local  or  community
               level, while promoting specialty care as the province of the medical
               center and larger community hospitals.

               In North Carolina, co@nit-), developmei   -it of comprehensive'   stroke   program
               has been initiated,  with a central coordinating  unit  at  the  Boi@,man  Gray
               School of 1,@dicine.  A broad ranae of   activities is being undertaken,
               including  publication  of  guidelines  for  community  stroke  programs,  edu-
               cational activities  such  as  traininc,  program  for  nurses,  annual  stroke
               workshops,  stroke  consultation  service  for  physicians  through  the  cooper-
               ation of the neurological staffs of the three medical centers, and a
               family-patient education unit, designed to help patients and their
               families learn to  cope  with  the  long-term  effects  of  stroke  disability.

               Iklorki-ng relationships between  community  hospitals  and  the  medical  tenter
               or  among  community  hospitals  themselves  can  upgrade  local  capabilities,
               thus moving the delivery of semispecialized care closer.to the local leiel.'
               In  Oklahoma,  for  example,  continual  electronic  heart  monitoring   services
               comparable  to  those  available  in  large  urban  hospitals  are  beingintro-
                                              I
               duced into small community and rural hospitals as a result of a State-ilide
               coronary care program initiated by the Oklahoma RNIP.  Some 43 monitor-
               equipped beds for heart attack victims, or attack-threatened patients, in
               25 -small community  hospitals  have  been  linked  by  special  telephone  lines
               to 10 c--nti--I,monitori-,qg hospitals.  Q.--cially trained nurses in the


                                                    28

               central monitoring unit  help- monitor reiiiota,pi.tionts   and i@lion an
               abnormality is detected confer with local     staffs  by  telephone   "hot   lines."

               Kidney disease is  one area in wli-icli  the development   of   integrated   regional
               systems can prevent the duplication which has diaracteri      zed   certain   otjier
               specialized resources.  It provides the opportunity for a planned and
               organized model of how such scarce resources      can be linked together

               efficiently.

               In Wisconsin, the Regional @ledical Program and the Kidney Foundation of
               Wisconsin  are  supporting  the  development  of  a  comprehensive   renal   disease
               pro  ram.  Each  yea r  in  Wisconsin  about  140  persons  enter  the  final   stages
                 9
               of  renal  disease  who  are  judged  good  candidates  for  kidney  transplants  or
               artificial kidney machine dialysis.  Unti:L recently  the I-atest-advances
               in the care of such patients were high in cost and not uniformly availa) e
               Statewide.  The Wisconsin project is designed to develop a Statewide
               cooperative  kidney  transplant  pro   ram to  -reduce  expensive  'long  delays  in
                                                   .9
               transplantation  and  to  prevent   tissue mismatches.  This comprehensive
               effort  also'includes   establishment   of a program. of dialysis located within
               patients' homes and in strategic community hospital satellite units.  A
               prevention  and  early   detection   program is tindeiiiay as well, providing
               local  physicians  with  information   and inexpensive  testing kits   for

               detecting kidney disease.

                   e'rative Relationships   with other Ile@ith Pro    ms
               'n-le,passage of P. L.. 91-SIS, the legislative extension    of  Regional   @ledical
               Pro rams, Coff?i)rehensive Health Planning, the National @Cei-iter for Health
                  @g,


                                                   29

              Services Research and Develol);,,icpt, and othet-licaltli components,   resulted
              in an increased emphasis on the need for improved coordination cmcl co-
              operation iiitli-ot)-ier health programs. Ex
                                                          ,perieiace to date certainly
              suggests that tlae Regional @ledical Programs  can  best  help  to  improve  the
              overall effectiveness -of the' health care delivery system  by  worl-,iiig  with
              and contributing to related Federal and other efforts at the local, State

              and regional levels.

                                   -C
                                     OiTpreliensive Health Planning
              One of the most important of these iii-iks is with the Comprehensive Health
              Planning agencies.  Cooperation between Regional @ledical Programs and
              Comprehensive Health Planning agencies in particular is being fostered
              through emphasis on their complementary roles.

              Increasingly, the Re ional @,ledical- Programs, with their strong provi e-r
                                    g
              links, a-re being viewed  and  used  as  an  important  technical,  professional
              and-data resource by State and A-reaiqide Comprehensive Health Planning
              agencies in their planning    for personal health services.  In turn,.Regional
              @ledical Programs are looking to Comprehensive Health Planning agencies to
              express the health needs of the total     community from the consumer's point
              of view and  in effect to help set priorities for the Regional @ledical

              Progr     efforts.

              The legislative   extension  of both @,IP and GiP included   changes designed to
              promote closer   coordination between these programs.  One     change   requires
              that the Regional Advisory Groups which     .'advise the R%T s include rep-re-
              sentatives from health planning agencies.  Similarly,       the CfT agencies are
              required to httvc representation of R gional @ledical Programs on both State


                                                 30

             and Arcaiqide CoiTI)rehensi@ro Health Planning Advisory Councils. To  date,
             more than 800 individuals have beeii appointed to  fulfill  these  require-

             ments of cross-re resentation.
                              .p

             Another legislative change requires that Areaiqi.de Comprehensive Health
             Planning agencies have the opportunity for review and comment of Regional
             Medical Program applications before they are.al)proved by the Regional
             Advisory Group.  Although this requirement applies only to the Are    aiqide
             CliP agencies, there has been extensive cooperation in terms of review
             by the State CIIP agencies  as  well.

             Other areas  of  cooperation  include joint data collection,  processing  or
             analysis, staff  sharing  or  regular joint meetings, and sharing  of  equip-
             ment and facilities. In Kansas, for example, the RNIP  and  the  State  CHP
             agency have jointly funded botli a State data bank and   a State Health Man-
             power Information Program.  Currently they are also cooperating on the
             systems design for a Health Information System and on a Consumer Inventory
             Study in I\TorthA%,est Kansas.  The @IP Core Research and Evaluation staff also
             provide consultation to CHP.

                            Experimental Health Services Delivery Systems

                                                         e         p
             Another health program which involves clos    P.   coo eration is the ExTeri-
             mental Health Services Delivery System effort, funded by HS@,ff-l,%.  The
             EH$DS program aim to test xvhether a coi      ity management  structure  can
             improve the organization of tJie delivery system, and to determine i%,hether
             such an approach can achieve greater integration and coordination of
             Federal funds.. Regional @ledical Programs are  closely  involved  in  these
             @effort's in such places as Arkansas, Boise, Idaho, East  Los  Angeles,  and


                                               31.

             In Vermont  the Northern New F-oicland @IP and the State CIIP agency jointly
             produced the successful application for an Expe@eiita-I Health Services
             Delivery System.  Funded by the iNational Center for I-lealth Services Research
             and Deiclopment'at a level of $932,000 for a period of two years, the
             program involves the implementation and evaluation of a series of e'xteri-
             mental, regionally integrated co    ity health systems in the geographic
             area of Vermont, and possibly contiguous are@s of New limiipshire and Nei%,

             York states.

             A variety of different tasks are being assumed by the agencies involved in
             Vermont.  The State CHP agency, for example, is involved in defining the
             nature of public accountability in E-xpe@ental Systems, and defining the
             requirements of a regional plaiu-iing-manauenient system.  The Regional @,ledical
             Program is determining hu,,i'various components of the community health system
             can be integrated into an experimental model.  The RNffl will also provide a
             data base and health systems analysis capability.  @,iP has established a
             data base which can describe health and Health care  delivery in terms of
             demographic and socioeconomic characteristics of the communities being
             served; manpower, facility and dollar -resources available; utilization,
             supply and distribution aspects of the existing health care delivery
             process; and outcome, as measured by morbidity, mortality and patient

             satisfaction.

                                    Veterans Administration
             some 83 Veterans Admi.nistration hospitals are Currently involved in
             activities with  Regional @-ledical Programs. This.includes 'participation on
             RV Regional Advisory Groups 'as well as operational activities.  The


                                                 32

              California Medical Television NetA@ork operating out of UCLA,, for example,
              is funded in part by the R\R3 and includes a packaae of 36 videotape
              programs distributed annually to 30 participating V.,@ installations in the

              western United States.

                                           Model Cities
              Regional Medical ProcTram also have working relationships with some of the
              @iodel Cities programs, includiiia technical and  planning  assistance  and
                                              r>
              operational programs A Model  Cities'Health  and  I\Iutrition  Program  has
              been developed by the Alabama R\-IP to--meet the nutritional needs  of  the
              chronically ill, dependent preschool children, and pregnant adolescents
              in the Tusl-,eg-ee-@lacon County Area.  Tiventy nutrition al assistants, after
              completing a six months training course at the Tusk.egee Institute, will
              work with the -rural poor to implement the program objectives.  These
              individuals will be trained to observe family nutrition practices, instruct
              and counsel in sound nutrition  practices,  assist  in  preparing  teaching
              materials and make follow-up home visits to assist with menu      planning,
              food buying and cooking skills.   They will also assist with   dietary
              surveys and work with community groups.

              In concert with the broad range of public and private health organizations
              and institutions, and other Federal, State and local health program ,
              Regional Medical Programs ca@ work to provide an effective organizational
              framework for identifying and utilizing community    health resources,   so
              that continued innovations in health care planning.and delivery systems

              can be made.


                                                                                                                                                                                                     -@ibit I

                                                                                                       Budget  and   Grant   History
                                                                                                          (Dollars in thousands)

                                                                             FY   1966               FY   1967               FY 1968                 FY   1969               FY 1970                 FY 1971.                FY 1972

                                                                                    -000                      000                                                             .$120,000
            Puthorization               . . . . . . . . . .                  $50                     $90                       $200,000                $65,000                                       $125,000                 $15.9,000
            kppropriation:  grants                                               24,000                43,000                    53   900              56,200                      73,500                991500                    90,500
                                                                                                                                     .1
            A,Pount  available  for   obligation*.   24,000                                            431934                      48,900              72,365                      78,500                70,298                  135,000
                                             -   grants
            A,nount obligated,                                                    2,066                27,052                      43@635              72.9    365                 78,202                70,29S.:

             - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

            --- - - - - - - - - - - --- - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

            Recrion-, in:

               Planning Status                 . . . . . . . .                            7                     44                        41                     14                          1                     1                        1

               Operational Status                  . . . . . . .                                                  4                       13                     41                        54                    55                       55

                           Total RMP's                                                    7                     48                        54                     55                        55                    56                       56

               Includes carryover amounts
                                                                                                                                                                                                                        db


                                                                      LISTII\TG OF REGIONAL. MEDICAL PROGPAVS
                                                                                                                                                        Exhibit II

                                                                                                                                                                             'A
                                                  ALABAMA                                                  ALBANY                                                  ARI ZON
     @SIGN.@%TION

     "")G       CAL          Al ab an, a                                            Northeastern New York and con-                            Arizona
        L@D@TI
                                                                                    tiguous portions of Southern
                                                                                    Vermont and Western Massachusetts
     )PUL@Tioi,4             3,444,000                                              1,900,000                                                 1,773;000
     ;I i,%IATE @1971)

     !XDS
     ,.@IL@LE      IN        1  052@@                                               1,136                                                     865
     SC-U   YEAR
     @/'l .(in 000's)
     ,@OGRk%l@               S.  Richardson Hill,          Jr., M.D.                Frank M.      Woolsey,         Jr., M.D.                  Dermont W.      Melick,      M.D.
     C.RDIK-A,T0,RS          Coordinator-                                           Coordinator                                               'Coordinator
                             Uabama Regional Medi'Cal'Program                       Albany Regional Medical Program                           Arizona Regional Medical Progr@
                             P.O.  Box     3256                                     Albany       Medical       College' of                    University       of       Arizona
                             1108 South 20th-Street                                    Union University                                          College      of       Medicine
                                                           -35205
                             Birmincham,-Alabama                                    47     Xciv     Scotland     Avenue                       4402 East Broach,;,ay, Suite 606
                                                                                    Albany,     I\Tcw    York     12208                       Tucson,       Arizona       8S711
                             John M.  Packard, M.D.
                             Director
                             Alabama Regional Medical Program
                             P.O.  Box 3256
                             1108 South 20th Street
                             Birmingham, Alabama 35205


      P,EGIO'\,.AL                     ARKANSAS                                   BI-STATE                                  CALIFORNIA
   DESIG.\'.@tTION'
   EOGIZ@P@IIC-@kL     Arkansas                                   Southern Illinois and Eastern               California plus Reno-Sparks
                                                                  Missouri                                    and Clark County (Las Ifecas),
                                                                                                              Nevada

   OPUT-@,TIOIN        1,923,000                                  4,700,000                                   19,953,000
   STI@IATE (1971)

   @i.@,ILABLE  IN     1,363                                      1,147                                       8,357
   I,SC,%L YEAR
   971@ (in 000,S)
   R iD G i@kN I       Charles W. Silverblatt, M.D.               William Stoneman III, M.D.                  Paul D. @Tard
   D-DRDIINATORS       Coordinator                                Coordinator                                 @Executive Director
                       Nrkansas Regional Medical Program          Bi-State Regional Medical Program           California Committee on
                       500 University Tower Building              607 North Grand Boulevard                     Regional Medical P-Locrams
                       12th at University                         St. Louis, Missouri 63103                   7700 Edgei@,ater Drive
                       Little Rock, Arkansas 72204                                                            Oakland  California     94621


     RE C I O,\TAL              CENTRAL NBI YORK                        COLORADO-WYOiMING-"                        CO, L@CFICLJIT
   DESIG\!.@TION
                     Syracuse, New York   and 15 sur-
   ECC-IZI-',-PHIC-AL -rounding counties and Bradford         Colorado and Wyoming                    Connecticut
                     and Susquehanna counties in
                     -Pennsylvania
   '."PUI.ATIO,\,    1,700,000                                2,150,000                               3,032,000
   SI-I',I!kTE (1971)

   @,@IL;@I,E  IN    896                                      1,123                                   1,514
   ISC,@L Y'-PAR
   @'7'- (@@n 000's)
                                                              Howard W. Doan,   M.D.                  Henry  T. Clark,  Jr.', M.D.
                     John J. Murray
   DORDI.NATORS      Acting Coordinator, Central New          Director  Colorado-Wyoming              Coordinator
                       York Rouional Medical Program            Regional Medical Prouram              Connecticut Regional Medical
                     Upstate Medical Center                         ranklin Medical Building
                                                              410 F                                     Proaram
                     State University of New York             2045-Frank-lin Street.                  272 George Street
                     7SO East Ad@ Street                      Denver  Colorado 80205                  New Haven, Connecticut',06510
                     Syracuse, New York 13210


       REGIO@"%L                                   FLORIDA                                                 GEORGIA                                    GREATER DELAIIARE VALLEY
    D -@'z I (, N,@T I ON
    EOC,IVIII@%L             Florida                                                  Georgia.                                               Eastern Pennsylvania,  the
                                                                                                                                             southern.part.of @Neil Jersey an
                                                                                                                                             the entire State          of Del@iiiare

         LI@F I ON           6,789,000                                                4,590,000                                              6,200,000
    S-rI,@IA'fE  (1971)

    i.@DS
        I L@P L E   IN       1,448                                                    1,983                                                  2.1433
    ISCAL YF-AZ
    971  (in 000's)
    P,OGP-,@.4               Granville W.        La@ore,- M.D.                        M.     Charles     Adair,     M.D.                     Martin lvollmann,         M.D.
    Do-.RDI,\,ATORS          State    Director                                        Coordinator                                            @'F-xecutive Director
                             Florida     Reaional Medical Program                     Georgia Regional Medical Program                       Greater Delaivare         Valley
                             1      Davis BoulQvard, Suite 309                        Medical       Association       of Georgia                Regional Medical Prooram
                             Tampa,     Florida     33606                             938 Peachtree Street, N.E.                             551 last Lancaster Avenue
                                                                                      Atlanta,       Georgia       30309                     Haverford, Pemsylvania 19041

                                                                                      J.     Gordon     Barrow,     M.D.
                                                                                      Director
                                                                                      Georgia Regional Medical Program
                                                                                      Medical Association of Georgia
                                                                                      938 Peachtree Street, N.E.
                                                                                      Atlanta,       Georgia       30309


       RE-GION.,@                                                                                  ILLINOIS                                             INDIAI\TA
    DESIG.\7.,-kTIO\l
                           Entire State of Hawaii, plus.
    Er.'(@11,VHJTC-,kL     Arerica-.q Samoa, Guam, and the                      Illinois                                            Indiana
    o@,E-,VIGE             Trust Territory of the Pacific
                           -Islands  (Micronesia)

          @T
    "'PUL-  @CN            970,000                                              9,100,000                                           4,200,000
    @STT%',@
             E  (1971)

    UNDS
       1 Lt@ L E   I N     938                                                  1,794                                               1,275
    'r SC@1,L YEAR
          (4n OOOIS)
    97.1-
    ROG,@ZA.M              @lasato M. Hasegawa, M.D.                            Morton C.  Creditor, M.D.                           Robert B.  Stonehill'i M.D.
    C,ORDI@TKTORS          Director                                             Coordinator                                         Coordinator
                           Regional Medical Program            of Hawaii        Illinois Rcaional Medical Program                   Indiana Regional Medical Progi
                           1301 Punchbowl Street-                               122 South Michigan Avenue                           Indiana University
                           Harkness Pavilion-                                   Suite 939                                              School of ',,"iedicine
                           Honolulu, Hawaii 96813                               Chicago, Illinois 60603                             1300 West Michigan Street
                                                                                                                                    Indianapolis,  Indiana 46202


      RF-@G I O@, -U                   II\7FERYiOU.,NTAIN                                 IOWA'
    D,--SIC\!.L%TIO.,N

                                                                                                                     Kansas.
    EOC,R,ATi'IIIQ%L    Entire State of Utah, and portions             Iowa
    D'@TL-W@GE          of Wyoming, Montana, Idaho,
                        -Colorado and Nevada

    ")PUL,@Tio.,N       2,073,000                                      2)825,000                                     2)249,000
    -TI@
       @,LA.TE (1971)

    i'@DS
    @,.,'kILA3LE  IN    3,383                                          754                                           1,869
    I CkT
    ,D7.1 (in 000,S)
                        Robert    M. Satovick,   M.D.                  Harry B. Weinberg, M.D.                       Robert W. Bro@-n, M.D.
                                                                                                                                 r
     @RDI,\T @ATOT
               .ZS      Coordinator -                                  Coordiqator                                   Coordinato
                        Intermountain Regional                         IO-AA Regional Medical      Program           Kansas Reaional Medical Proora
                             Medical Program                           308 Melrose Avenue                            3909 Eaton Street
                        50 North Medical Drive                         Iowa City, Iowa 52240                         Kansas City, Kansas      66103
                        Salt    Lake City, Utah 84112


                                                                                          MAINE                                       @IARYIAND
     PI G I O.,\, tu                     LOUIS@
    ,ESIC,N.,kTIO.N
                                                                                                                      Entire State    o-L \Iaryland and
    OGP,AP.-iICAL      Louisiana                                       Maine                                          York- County iiy Pennsylvania,
    i@,I-RikGE                                                                                                        less enirlrons of Wash  ,ton, D.
                                                                                                                      and @,lontp-omeiv_ Col-m@,   i%@i, _vlan@

                                                                       994 000                                        3 222
    @PUL[k'lpioiN      3
    1                    %643 000
    ,TI,@l,kTE (1971)

                                                                       871                                            1,998
    AILABLE  IN        776
    S C-AU YEAR
    @7". (in 000's)
    ,OGIQ-@ll          Joseph A.    Sabatier,    Jr., M.D.             Manu Chatterjee, M.D.                          Edward Davens, NI.D.
    @ORDI@14LTORS      Director                                        Coordinator                                    Coordinator
                       Louisiana Regional Medical Program              Maine's Regional Medical Program               Maryland Regional Medical Prog-I
                       2714 Canal Street,       Suite 401              295 Water Street                               550 North Broadivay
                       New Orleans, Louisiana 70119                    Augusta, Maine 04330'                          @Baltimore, Maryland 2120S


       REGIONIAL                                    Nialpi-a s                             MROPOLITAN IVASHINGTON, D.C.                                           @CMGAN
     DLTI:@IGN'.@TIO,N
                              IVestern Tennessee, Northern
     ,@-OC.@,\J-:,IIC-AL      Mississippi Eastern A@.ansas                  and        District of ColLn@bia and contiguous                    Michigan
     0 @,L- Pv@ G E                                                                                            land  (2)  and
                              portions of       Kentucky and                           Counties     in      Mary
                              mi5souri                                                 Virainia  (2)
     C)PUL.,%TIO,N            2,399,000                                                1,800,000                                               8,875,000
     S-T.
         \,.-vrE C1971)

     IJ4\DS
     l@-,k I LAB L EIN        .1@, 907                                                 1,217                                                   2.1292
     IsIrl-i%T- 'YE6LIZ
     971@  (in 000's)
                                                                                                                 M.D.                          Gaetane M.  Larocque, Ph.D.
                              James   W,.-Cijlbertson, M.D.                            Arthur     E.      Wentz,
     X,U I MTOTZS             Coordinator -                                            Coordinator                                           'Acting Coordinator
                              Meirphis    Regional Medical Program                     Metro-politan Washington,             D.C.              Michigan Association for
                              1300 iMedical,Center Towers                                 Reaional Medical Program                                Recrional Medical Proar@
                              969 Madison Avenue                                       2007     Eye      Street, N.1l..                        1111 Michigan Averue, Suite 2(
                              Verrphis,    Tennessee.38104                             Washington,          D.C. 20006                         East Lansing, Nlichigan,48823


                                                                               MISSOURI                             MOUNLKIN STATFS
      REGIO:\'AL                   MISSISSIPPI
    i)ESICIN.@%TIO@N
                                                                Missouri, exclusive of most of           States of Id@o, Montana,
            IC-AL     %Iississippi
                                                                Metropolitan St. Louis                   Nevada and.'Alyoming

   'OPUL,,%TTO.N      23,217,000                                3,200,000                                21228.1000
             (1971)

   :LJNDS
                      1,168                                     2.9 282                                  1,764
   @T,IILABLE  IN
   :ISC-,@L YF--ATZ
   1,971 (iq 000,S)
                                                                                                         Alfred M. Popma, M.D.
                      Theodore D. L@ton, M.D.                   Arthur E. Rikli, M.D.                    Co rdinator and Regional Dire
   ,DOIU!NATORS       Coordinator                               Coordinator                                 0
                      Mississippi   Regional Medical Prograii   Missouri Regional Medical Program        Mountain States
                      University of Mississippi                 406 Turner Avenue      L  is Hall          Regional Medical Proara-Tn
                                                                                        ew
                        Medical Center                          Columbia, Missouri 65201                 305 Federal Way - P.O. Box.S7'
                      "2500 North State Street                                                           Boise, Idaho 837OS-
                      Jackson, Mississippi 39216


                            NASSAU-SUFFOLK                       NEBRASKA                          NEW JEPSFY'
    RE- G I OI\!AL

                                                                                           Jersey
   :Or-7 nT'i-iIC-@kL Counties ol Nassau and Suffolk Nebraska                           New
   )@IEII.'kGE    (Loncy Island) of the Stat  of
                  iNcw York
   )TI'llil@'ItTIO'N 2.1540 000                      1,484,000                          7,168,000
          (1971)

   JNDS
   TikIb@LE  IN   794                                626                                1,351
   'SC,@L YF-,'LR
   )7.1 (in 000,S)
                                                     Deane S. Marcy, M.D.               Alvin A. Florin,,M.D.
   'CG'
   ,  ilA,\'      Glen E. Hastings, M.D.
   )@IINATORS     Coordinator                        Coordinator                        Coordinator
                  Nassau-Suffolk Regional            Nebraska Regional Medical Program  Neii Jersey Regional Medical Pri
                   Medical Program, Inc.             700 CFU Building                   7 Gleiwood Avenue
                  1919 Middle Country Road           1221 N Street                      East Orange, New Jersey 07017
                  Centereach, Nlew York 11720        Lincoln, Nebraska 68508


       RE-GIO.@l,kL                       NEVV @ico                            NEW YORK MROPOLITAN                                    NORTH   CAROLIi@,k
    I)ESICIN.-@TIOIN
    iEOG,R-,'kt7ilIC:AL  New Mexico                                       New York City and Westchester,                 North Carolina
    'O%,'E-R,kGE
                                                                          Rockland, Oranc,,e, and Putnam
                                                                          Counties, New York

                                                                          9 266 000                                      5,082,000
       Ul@'kTION         1,016,000
     Ti'@,LA,TF-, (1971)

    .u.\DS
    ,@,.t4t!LABLE  IN    1 337                                            2,706                                          2JI337
    'ISCAL.YF--ATZ
    07'
          (in 000's)
    ;ROG.3.k\l           Jwnes   R.-Gay      M.D.                         I. Jay Brightman, M.D.                         F. M. S=ons Patterson,          M.D.
    ,C)ORDIKNTORS        Coordinator                                      Director                                       Executivb Director
                         New M@exico'Regional Medical Program             New York Metropolitan                          Association for the North Car(
                         University of New Mexico                           Regional @iodical Prograin                     Reaional Medical Program
                            Medical School                                The Associated Medical School@'                4019 North Roxboro Road
                         920 Stanford Drive, N.E.                           of Greater Now York                          Durham, North Carolina,27704
                         Building 3-A                                     2 East 103rd Street
                         Albuquerque,     New Mexico     87106            New York  New York 10029


                                                                                                                 NoRrFMRiN i\'D- F-NGIAO
                                    NORTH DAKOTA                            NORTHEAST OHIO
      REGIOK-@L
    DE'zi I @i %T ION
                                                                 12 counties in Northeast    Ohio         Ditire,State @f Vemont and
    ')EOGIZ-@IIC-,\L  North Dakota
                                                                                                          three contiguous counties in
    'O%,'ERAGE
                                                                                                          Northeastern in-cw York

                      618,000                                    4,llspooo
    'OPUL,,XTION
    -STINL,%TE- (1971)

    u @l' @ljs
                                                                 368                                      800
    @@,T.'kILABLE IN  309
    'I SC,,%L YEAR
    .971 (in 000's)
                                                                                                          John E. l@ennberg,  M.D.
                      Theodore  H. Harwood    M.D.               David Fishman,  M.D.
    ,@,,,Dj,\,ATORS   Coordinator -                              Acting Coordinator                       Coordinator
                      North Dakota Regional-                     I\Tortheast Ohio                         I\Torthern New England
                                                                                                            Rouional %Iedical Program
                        Medical Program                            Regional  Medical   P'rogram               C,
                      1512 Continental Drive                     10525 Carnegie Avenue                    University of Vermont
                      Grand Forks, North,Dakota 58201            Cleveland, Ohio 44106,  -                  Colleae of Medicine
                                                                                                          25 Colchester Avenue
                      Dillard A. IVric,,ht, M.D.                                                          Burlington, Vermont 05401
                      Director
                      North Dakota Regional
                        Medical Program
                      1512 Continental Drive
                      Grand Forks, North Dakota 58201


      RE- G 1 0.@U                     NOR        S                             NORTIBVESTERN OHIO                              OHIO
   DESI  -@l,@tTTON
                                                                                                                  Central and southern tiio-thiTc
   -r,OGIZk?IIICAL     Minnesota                                     20 counties in No@western Ohio               of the State of Ohio (61 count
   @OV'EIIAGE                                                                                                     excluding Metropolitan
                                                                                                                  Cincinnati area)

   ,-,PUI,A,Tjo\
                       3,805,000                                     1,381,000                                    42660 31    000
   STI,@.L@TE (1971)

                                                                     431                                          360
   @,%ILA3T,E  IN      1,251
   TSC,-
              TZ
   971   (in    000Ts)

   "OG@
   rx  ANl             IVinston R. Miller,     M.D.                  C. Robert Tittle, Jr., M.D.                  William G.   -Pace III,  M.D.
   DORD I.- T@i  OPXS  Proarair Director                             Coordinator                                 'Coordinator
                       Northlands Regional                           Nort@,,.vestern Ohio                         Ohio-State Recional Nledical
                          Medical Program, Inc.                        Regional Medical Program.                       Program
                       375 Jackson Street                            1600 Madison Avenue                          1480  ',lest Lane Avenue
                       St. Paul, Minnesota 55101                     Toledo, Ohio 43624                           Columbus,   Ohio 43221


                                                                                                            o@o@                                                     OREGON
        REGIOi@tkL                                OHIO VALLEY
     DE'z,ICNP,TIO',\'
     @-.OC;%%DJIICAL          Greater part        of Kentuckyp.South-                   Oklahoma                                                Oregon
     io@,'E-RACE              west Ohio,  and contiguous parts
                              of Indiana and West Virginia
     'O P ULA T I O.\T        s                                                         2  559,000                                              2,019,000
                                .$300,000
     S- TT
        ,NLiVfE (1971)

     U,\' L) s
     ,@,'.i%IL,NBLE   IN      1, 1-7@                                                   963                                                     930
     'I SCAL YF-ATZ
           CiT
              -I 0001-s)
                              William.H. McBeath             M.D.                       Dale Groom, M.D.                                        J.  S.  Reinsdmidt,          M.D.
     11',OGR,44M
     :OORDI,@                                                                                                                                   Coordinator
              T,KTORS         Director                                                  Director
                              Ohio Valley Regional@                                     Oklahoma Regional Medical               Program         Oregon Regional- Medical Progn
                                 Medical Program                                        University of Oklahoma                                  University of Orecon
                              P.O.@ Box     4025                                           Medical Center                                          Medical School
                              'Lexington,      Kentucky-40504                           800      N.E. 15th StreQt'                              3181 S.W.  Sam Jackson Park'Ro@
                                                                                        Ok@oma        City., Oklahoma 73104                     Portland, Oreao,.i 97201'


    REGIO@U                      PUERTO RI CO                           ROCHESTER                           SOURH CAROLINA
   ,ESI @'.,%TIO.,N

       PJIT
   ,OGIZ,A  I.C,@L Puerto Rico                             Rochester, New York.and 10            South Carolina
                                                           surrounding'counties

   @PULtkTIO,N     2JI690,000                              1,234,000                             2IS91,000
   ,I'I,@',,A,TE (1971)

   AILABLR-  IN    938                                     611                                   1,478
   SC,U YEAR
   71- (in 000's)
                   Ctistino R. Colon,  M.D.                Ralph C; Parker, Jr., M.D.-           Vince @loseley, M.D.
   OGP,k'4
   iC)F<DIIXATORS  Coordinator                             Coordinator                           Coordinator
                   Puerto Rico  Regional                   Rochester Regional Medical  Program   South-Carolina Regional
                     Medical Program                       University of Rochester                          Program
                   P.O. Box M.R.                             Medical Center                      'Medical University of South
                   @aparra Heiahts Station                 260 Crittenden Boulevard                Carolina
                   San.Juan, Puerto Rico 00922             Rochester  Nei%, York 14620           80 Barre Street
                                                                                                 Charleston  South Carolina 294(


                                     SOUIH DAKOTA                            SUS(T         'VALLEY                      TE-,@,ESSEE MID-SOUTH
      REG IO@@',@
       IC-'.\" kT I ON
    :EOGRAr-HIC.,%L    South Dakota                                27 counties in Central                      Tennessee and Southwestern
           E
    ,O@'E-R-kG                                                     Pennsylvania                                Kentuck
                                                                                                                       .y -

    @OPUL,@TION        666 000                                     2
                                                                      140,000                                  2 816,000
    zTI'@%LA7FE- '(1971)

    U.\. D s
    @,",%ID\BT-E IN    472-.                                       626                                         2)130
    T
    .LSC@L YF-,%R
    971 (in 000's)
                       John A..Lowe,   M.D.                        David H.. Small,         9
                                                                                      Actin' Coordinator       Paul E. Tescha,-i,  @l. D.
    :00,UI,KATORS      Coordinator                                 Susquehanna Valley                         'Director
                       South Dakota                                   Regional Medical Proaram                 Tennessee Mid-South
                         Reaional Yedical     Program              1104 Ferniiood Avenue, Box 541                Reaional Medical Program
                       University of South Dakota.                 Camp Hill, Pennsylvania 17011               1110 Baker Building
                         Medical School                                                                        110 21st Avenue, South.
                                                                                                               Nashville  Tennessee 37203
                       216,East Clark Street
                       Vermillion, South Dakota 57069


     RT; G I O,\A L                   TEXAS                                TRI-STATE                              VIRGINIA
   D'E-,S I (,N:kT I ON
   EC)G@T)IT-IIC-AL  Texas                                   Massachusetts, New Hampshire and       Virginia (less. parts of
                                                             Rhode Island                           Metropolitan IVashington, D.C.)

   OPUL.'@TIO.,\,    11,197,000                              71377,000                              4,300,000
   STTNW,-E (1971)

     Ds
              IN     2 094                                   2,022                                  737
   I.SCPIL @ll iz
   97" -(iii 000's)
   ,RCGP\A,\l        Charles B. McCall, M.D.                 Leona Baumgartner, M.D.                Eugene R. Perez, M.D.
   DORDIMATORS       CoordinatQr                             Coordinator                            @Coordinator
                     Regional Medical Program of Texas       Tri-State Regional Medical Program     Vi-rcyinia Regional Medical Proa
                                                                                                    700 East Main Street, Suite 10
                     4200 Lairar Boulevard, North            Nledical Care and Education
                     Suite 200                                 Foundation., Inc.                    Richmond, Virginia 23219
                     Austin, Texas 78756                     1 Boston Plate, Suite   2248
                                                             Boston, Massachusetts   02108


    RE-GIO.N,@L                WASHINGTOI\I/ALASKA                         WEST VIR8INIA                         WESTERN iNBV YOTU' ,
      @'j%TION
   @ia4p@IICAIL     Washington and Alaska                     West Virginia                            8 Western Kei4 York counties
   @T-.RAGE                                                                                            and Erie Co@ty in Pennsylvania

   PI @Jl@@l'ION    3 711,000                                 1,744,000                                1,985,000
   rI:@L,%TE (1971)

   .\'DS
   NILABLE  IN      1,644                                     721                                      1,363
   SC:@L YF-AJZ
   7.1 (in 000's)
   DG,Rk\l          Donal  R. Sparlman, M.D.                  Charle   D.  Holland                     John R. F. Inaall, M.D.
                                                                     s
   )p,DINATORS      Director      -                           Coordinator                              Program Director
                    IVashinatoyi/Alaska                       West Virainia Regional Medical           RegioRal Medical Program for
                      Reaicnal Medical Program                  Program,                                 Western New York
                    500 ."U' District -Building               West Virginia University                 State University of New    York
                    1107 N.E. 45th Street                       Medical Center                            at Buffalo
                    Seattle, Washington 98105                 Room 21@37  University Hospital          2929 Main Street
                                                              Morgantown, West Virginia 26506          Buffalo, i\Teii York 14214


     R17GIO,@',\L           WE-STERN PENNSYLVAINIA                      WISCONSIN
   DinSIC,NJ%TIOI\l

         III C-;kL  Pittsburgh and 28 surrounding         Wisconsin
   C.'@'L- G E          ties in Pennsylvania
                    coun

   'OPUL,.\TIO.N    4,284,000                             41418,000
   STI@,'IATE -(1971)

   'k,]NDS
   ,@AILABLE  IN    1,312                                 1,SS5
   I SC!KL @'EAR
   971 (!.n 000's)
                                                          John S. Hi-rschboeck,'M.D.
                    F.-ancis.S...Cheever, M.
    ,)RDT.,\,ATO.RS Coordinator                           Coordinator
                    Western Pennsylvania                  Wisconsin.Reaional Medical Program
                                                                       C>
                      Regional Medical Program            110 East Wisconsin Avenue
                    University of Pittsburgh              Nlilwaukee  Wisconsin 53202
                    1217 Scai-fe flall
                    Pittsburgh, Pennsylvania  15213

                    Robert R. Carpenter, M.D.
                    Director
                    Western Pennsylvania
                      Reuional Medical Program
                    3530 Forbes Avenue
                    501 Flannery Building
                    Pittsburgh, Pennsylvania 15213


                                                                        EXHIBI'F III

               CL-@CTERISTICS OF RE-GIC.@-V@ iIE-I)ICI-@ PROC-@ilt,-'@'IS

                                          D@i Y3G@kPHIC 17.,,\CTS

               There are 56 P,\.Ts i@b,icl-i coirer the entire United States and its trust
               territories.  The Programs include the eiiti@e population of the United
               Stat@ (204 million) and vai-y considerable in their size and characteristics.

                   LARGEST REGIO'.\T

                   .  In population:  California (@O million)
                   . In size:  Vv'ashingtop./Alaska (638,000 square miles)

                   S.\IALLEST RFGION
                   .  In population.:  NTorth.ern Nei@ E-n,aleo-id (445,000)
                   .  In size:  Metropolitan IVashington, D.C. (1,500 square miles)

               *   SOIIE PEGIO'\S APX- YAII\TLY URB.AIN (]\T-D,T YORY, MY@'ROPOLITh\T), SO@E- RURAL
                   (AIZKA,.@kS
               *   GEOGRAPHIC BOUI\'D.ARIES:  I\km,,ber of P,,egions ikThich
                   * L-ncon.Tass single states . . . . . . . . . .  . 33
                   *  Encompass tivo or more states  ... . . . . .  .  4
                   *  Are parts of sincle states   . . ... . . . .  . 11
                   *  Are parts of two or more states  . . . . . .  .

                   POPULATIO,'\: N@ber of Regions  iv]-iic)-i ha,,@e
                   . Less   than I million persons . . . . . . .  ...  5
                   . I   million to  2  million . . . . . . . . . . .  .
                   . 2   million to  3  million . . . . . . . . . . .  .14
                   . 3   million to  4  million . . . . . . . . . . .  .8
                   . 4   million to  S  million . . . . . . . . . .    7
                   . Over 5 million . . . . . . . . . . . . . . ..  . 11


                                         RF@GTO,@.AJ, AIIVISop
                                                            ,)r GPOUPS

                  SIZE:
                      *  1967                           1849@Pei-sons    (Total)
                                                           8     (Average   p
                                                          3             Groti
                         1969                           2324   Persons   (Total)
                      *
                                                          42  (Airerage   Group)
                      *  1970                           2481  Persons   (Total)
                                                          45  (Average  Group)
                      *  1971                           2696  Persons   (Total)
                             -                            48  (Pvera-ge   Group)

                                 COM-MSITION  OF  P%F-,GIOXAL  ADVISORY   GROUPS

                                                               FY  171   (10/71)            FY t7O (4/70)
                                                    NLutber          Perc
                                                                        ent       I\kml)er    Percent
                 Total                                2696              00          481           100
                   Practicing Physicians              726               27          656           26
                   Hospital Acbpinistrators           376               14          327           13
                   @ledical Center Officials          217               8           259           10
                   Voluntary Auencies                 200               7           212            9
                   Public Ilealtli Officials          iso               6           134            @6
                   Other Health IVorl,-ers            298               11          216            9
                   Members of Public                  SS6               21          468           19
                   Other                              173               6           209            8


                                               TASK FORCES Aj\l) CO-@D4lT7EES

                    ]\FIBER kND SIZE:
                             1969:   492 Committees in 54 Regions:   5,320 Total membership
                             1971:   410 Committees in 55 Regions:   6,379 Total. membership

                    CO@NLPOSITION:

                                                          Number                       Percent
                    By Profession                 (1-969)   (1971)
                    Physicians                       3273     3523                61         55
                    Nu-rses                           486      S80                  9         9
                    Allied Health                     672      802                .13        13
                    Other*                            889   -   1456              1.7        23
                         Total                    3@2   0     3@7  9              10-0       10-0
                        Includes i-nen,@bers of the     public,    hospital    administrators, and ot]-iers)

                    TYPE OF TASK FORCE/CO',\I,\IITTEE:

                                                           No.    of     Committees           Percent
                    Categ9l'y                              (1@69Y            (1971)       (1969)        (1971
                    Heart                                      65             41              13         11
                    cancer                                     60             42              12         10
                    Stroke                                     54             36              11          9
                    Other Disease
                     (includin,,,, Kicbiey)                    39             30                8         7
                    Plaiminc, & Evaluation                     30             27                6         8
                    Continuing Education &
                      Training                                 4S             47                9        12
                    Health @lanpoijer                          11             27                2         4
                    Other,                                    188               160           39         39
                         Total                                492               410          100          IOU


                                             RE.Gjo,\IAL liE@"UA@FE-RS

                                                         Coordinating Heacl'quarters          Grantees

                                                                      31                         34
               Universities
                                                                     (25)                         (27)
                  Public
                                                                         6)                         7)
                  Private
               Other                                                  25                         22
                  @ledical  Societies                                ('4)                           4)
                  Nei-ily Organized Agencies/
                    Corporations                                     (18)                         (15)
                  Existing Corporations                                  3)                         3)

                                                                     'CORE     STAFF
                                      REGIO,\IAL '\IEDICAL  PROGia%,IS
               Core staff in the 56 Regional @ledical Progran'is are involved in project
               development' revleiq and management, professional consultation and com
               munity liaiso          ba am dir ction and administration; planning studies
                                n; Pr or         0                                       1
               and inventories; feasibility studies; and central reuional services.

                    DISTRIBUTION OF CORE STAFF BFFORT BY RIN(7FION
                    .  Project Development      . . . . .  .  .  .  .  .  .  ... 20%
                    .  Professional Consultation        . . . . .  .  ..  .  ... 29%
                    .  Program.Direction      . . . . . . .  .  .  .  .  .  .  . 22%
                    .  Planning Studies       . . . . . . . .  .  ..  .  .  .  . 14%
                    .  Feasibility Studies      . . . . .  .  .  .  .  .  .        7%
                    .  Central Regional Services        . . . . .  .  .  .  .  .   6%
                    .  Other   . . . . . . . . . . .  .  .  .  .  .  .  ..  .  .   2%

                    COI\TOSITION
                                                                           Core  -Ml

                    TOTAL                                                      1,SS4
                       Physicians                                                184
                       Registered Nurses                                         63
                       Allied Ilealth                                            37
                       Other Professional/Technical                              677
                       Secretaries                                               623


                                          OPEPATIONI@ PROGPVIS

               The LEVEL OF FUINDING as of 1Ll-31-71 reflects        the foll(xvij'lg  program
               emphases:

                                      Operational Activity     r-.ntpfi as i s
               Organization and Delivery.for
                 Patient Services    . . . . . . . . . .. . . . . . .  .  .  .  .  .  .  .  .  37%
               Training   Existing   Health
                 Personnel in  I\Teiv  Skills . . . . . . . . . . . . . .                      31
               Training new Health Personnel       . . . . . . . . . . . .                       3%
               General   Continui.-ig   Education . . . . . . . . .     . . . . .  .  .  .  .  20%
               Other activities, such as com=ications
                 networks, improved patient record
                 system', and coordination of services         . . . .. . . . . .  .  .  .  .    9%

                                            Cate@orical        asis
               An  analysis of all'the operational grants m%,arded to date along cate-
               gorical lines  indicates  the  folloiNrii'ICJ  breakdown:

                                      Single Disease
                                        Heart  .. . . . . . .  .  .  . 22%
                                        Cancer    . . . . . .  .  .  . 12%
                                        Stroke    . . . . . .. .  .  . 11%
                                        Kidney    . . . . . .  .  .  .  5%
                                        Related  Diseases  ...   .   .  7%
                                      Mu-lticategorical     . . . .  . 43%

                         HOSPITAL PARTICIPATION IN REGIONAL @IE-DICAL PROGRK%IS
                                       Total # of               Number               Ni6)er
                                       shor-L-t--M,         participating     participating
                                       non-Federal      in planning and       in     operational
                                        hospitals           operational,       activities
                                                -            -activities           only
               FY   1968                  5   850                  851                  301
                                            p
               FY' 1969                   5,820                1,638                  11246
               FY  1970                   5$8S3                2@084                  1,471
               FY  1971  (est.)           s   880              .2,693                 2,079