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                           R E G I 0 N A L    M E D I C A L   P R 0 B R A M
                                                 F 0 R

                                    W E S T E R N   N E W  Y 0 R

                           STATE UNIVERSITY OF NEW YORK AT BUFFALO - SCHOOL

                                 2929 MAIN STREET  BUFFAW, NEW YORK

                                        T@hone (Area Code 716): 835-0728


      JOHN R. F. rNGM4 MJ[).
             Director











                                  COUNTY COMMITTEES REPORT



                     Over the past year our program has exemplified greater in-
                 volvement on the part of all our 9 counties. This  direction  has
                 been deliberate, in keeping with the concept of regionalization
                 and its particular applicability in this geographical  area.  Our
                 December federal site visit team recognized this capability,  and
                 urged its fuller implementation through expansion of liaison  staff,
                 and development of a County ChairmenIs conuiittee.

                     The expansion of our liaison staff and capabilities is in  pro-
                 c6ss. Miss Jean Hanna, recruited in March, serves Erie  and  McKean
                 Counties in Pennsylvania, and Chautauqua County, New  York.  Several
                 other applications are now being interviewed and assessed for tLle
                 liaison staff, which will, after development , be recognized as a de-
                 partment of our program charged with the maintainance of communi-
                 cations and visibility in each of our counties.

                     During the past year our program has developed an increased
                 concern for the health care needs related to the minority  segments
                 of our region   In demonstration of this, various conferences  of
                 inner city needs have taken place at staff and executive levels  be-
                 tween RMP and various inner city organizations and  representatives.
                 In the interests of studying, implementing, and maintaining  some
                 program structure for relating more effectively to the inner  city,
                 Mr. Michael Miller, formally of Model Cities, will join our  liaison
                 department on May lst.

                     A third and significant direction reflected by our program  over
                 the past year is a closer alliance with Comprehensive Health Planning,
                 RMP's "sister agency".  While certain interlocking aspects have pre-
                 viously been featured by CHP and PIV in this region, greater local de-
                 definition of this direction has in recent months been  demonstrated
                 by closely related CHP and RNP county committees, usually under  the
                 model of an umbrella County Health Organization.  Two of our counties








                  COUNTY COMMITTEE REPORT                       PAGE 2


                  are already into an RNP-CHP conjoined arrangement within which dis-
                  tinct roles will be enacted and coordinated.  Five county committees
                  are intently developing such a coordinated base.  Such conjoined
                  efforts appear to have a particular appeal in our less populous or
                  rural  counties.  While  some  apprehensions  have  been  expressed  re-
                  garding the dangers of diminishing individual program identity,
                  the involved counties do themselves feel that a close coordination
                  of RMP and CHP is essential  for  the  well  being  and  functioning  of
                  both at the local level.

                      In the context of these directions and developments, we feel
                  the past year has been realistically productive, and we anticipate
                  even more productive  articulation  of  RNP  throughout  our  region  in
                  the coming year.








                                                                Clifford  L.M.   Carpenter
                                                                Chairman, RAG    Committee
                                                                  for  County   Committees
                                                                          Z)f
                                                                        T. Sur#eti;
                                                                Associate ft County Committees
                                                                             .m
                                                                Lakes Area      P.


                  rjp



























                    Our theme is New Directions for RMP/WNY-our emphasis is Involvement.
                          In transmitting the 1972-1975 Triennial Grant Application of the Regional Medical Program for Western New
                    York (RMP/WNY) to the Director of the Regional Medical Programs Service, the President of the Health Organization
                    of Western New York, Inc. commented:


                                    Dear Dr. Margulies:

                                          ... It is my personal view that the Regional  Advisory  Group  (RAG)  for  the  Regional
                                    Medical Program  for  Western  New  York,  namely  the  Board  of  Directors  of  the  Health
                                    Organization of Western New York, Inc., has discharged its advisory role to Dr.  lngall  with
                                    the utmost industry and enthusiasm.  The  members  of  this  group  are  fully  cognizant  of
                                    their increased authority in the conduct of the program. They are, likewise,  very  sensitive
                                    to the need for continuous and unflagging involvement.

                                          I am proud, as Chairman, to report that we have met  on  a  monthly  basis  during  the
                                    last year and that this alone has been an educational exercise for all of  us.  You  must  be
                                    aware that the transition from a  categorical  program  to  one  which  embraces  an  attempt
                                    to facilitate the health care delivery system is difficult. I believe this has been achieved.
                                    Furthermore, at a recent workshop in which we clarified our goals and  objectives,  the  role
                                    of the program in the future  was  well  clarified  for-the  participants.  The  priority  of
                                    projects approved but unfunded was much easier to  decide  upon  in  the  frame  of  our  new
                                    approach and our statement of goals and objectives.  It  is  quite  obvious  that  there  are
                                    areas of program deficit. Action in these areas  will  be  formulated  and  encouraged  as  a
                                    most important feature of  the  Regional  Medical  Program  for  Western  New  York  in  t  e
                                    coming year ...







                                                                            Irwin Felsen, M.D.
                                                                            President
                                                                            Health Organization of Western New York, Inc.













                                                       A--













                                        The Annual Report of the Regional Medical Program for Western
                                     New York is not a document to support a piano leg or balance a
                                     bookcase. It is designed as a record to be read, to provoke comment,
                                     and above all to indicate the direction in which we hope to move.
                                        An organization that can be considered viable and lively is one
                                     that has the capacity for change, that can respond to constructive
                                     suggestions and inf luences in a positive fashion. Those familiar with
                                     the old heart, cancer, and stroke program, heavily categorical and
                                     often interpreted as yet another funding agency, now should see the
                                     Regional Medical Program as an enabling organization, inviting the
                                     involvement of all intelligent participants irrespective of the label
                                     "consumer" or "provider."
                                       I decry the perpetuation of these two labels in any legislation.
                                     We should be involving all those who can provide comment and support
                                     to the fundamental principle of improving the health and treating the
                                     illnesses of our region.
                                                                                     ro






                                                                               e Director
                                                                                Medical Program
                                                                       for Western New York





                          Table Contents

                          CHAPTER                                                                                                         PAGE
                                 Workshop Telegram from Dr. Margulies        ................................             inside  front  cover
                                 Letter of Transmittal                         ..........................................................    i

                           1.    WHAT    IS     THE     REGIONAL     MEDICAL     PROGRAM              ...................................    1
                                        Nationally                        ...............................................................    2
                                              Purpose of Regional Medical Programs     .....................................                 2
                                              Legislation                      ..........................................................    2
                                              The RMP Mission       .....................................................                    4
                                        Locally                         .................................................................    4
                                              The Western New York Region         ......i             ...................................    3
                                              The Workshop - New Directions for Western New York                 ........................    4
                                              Triennial Grant Application                    ............................................    4
                                              Health Activities Goals and Objectives   .....................................                 5
                           2.    WHO MAKES UP THE REGIONAL MEDICAL PROGRAM                                  .............................    7
                                        Regional    Advisory    Group ...................................................                    8
                                        Core Structure   ...........................................................                      10
                                        The    Volunteer    Component                   .................................................. 14
                           3.    HOW      DOES      RMP/WNY      WORK ...................................................                 15
                                        Staff Functions  ...........................................................
                                              Planning                       ............................................................ 16
                                              Proposal Review and Development                    ........................................ 16
                                              Evaluation                       .......................................................... 16
                                              Financial Management                      ................................................. 18
                                              Communications        ......................................................                19
                                              The    Enabling    Role ....................................................                19
                                        Projects and Proposals                     ...................................................... 19
                                              Operational    Projects ...................................................                 19
                                              Financial     Statement ....................................................                22
                                              Status   of   Proposals ...................................................                 23
                                        How RMP/WNY Works With Other Health-Related Organizations           ....................          25
                           4.    SPECIAL CONCERNS OF RMP/WNY                               .............................................. 27
                                        Manpower          Development ....................................................                28
                                        Area Health Education Centers                     ............................................... 28
                                        Rural Health Problems                      ...................................................... 30
                                        Inner City Problems                       ....................................................... 31
                                        Health Maintenance Organizations                     ............................................ 31





                       List o                                  igures




                                                                                                                               PAGE
                         FIGURE

                                                                                                                                   2
                           1   Current Legislation: P.L. 91-515                 ................................................   3
                           2   Map - The Western New York Region    ............               .................................
                           3   Health Activities Goals and Objectives              .............................................   5
                           4   Organization of RMP for WNY    .........    ................     I       ........................   9
                           5   Composition of the Board of Directors
                               of the Health Organization of Western New York, Inc  .  ........  I       .......................  1 1
                           6   Board of Directors of the Health Organization of Western New York, Inc  .       .................  12
                           7   Employees of RMP for WNY                    .....................................................  14
                           8   Volunteers' Contribution                  .......................................................  14
                           9   Proposal Review Process                  ........................................................  17
                         10    Financial Statement: March 1, 1971 - February 29, 1972             ..............................  22
                         11    Status of Proposals                  ............................................................  23
                         12    Proposals Submitted to Washington                 ...............................................  24
                         13    RMP for WNY Relationship to Other Health Related Organizations             ......................  25
                         14    Programs in Continuing Education - 1971               ...........................................  29

















                                                                              iv






                      VV t'pu the Regional
                                           Aft"



                       NATIONALLY
                            Purpose of Regional Medical Pr@,rams
                            Legislation
                            The RMP Mission
                       LOCALLY
                            The Western New York region
                            The Workshop - New directions for
                               Western New York
                            Health Activities Goals and Objectives
                            Triennial Grant Application








                                                                                      NATIONALLY

                    PURPOSE OF                                                           LEGISLATION
                    REGIONAL MEDICAL PROGRAMS  .
                                                                                               Regional   Medical   Programs   were   initiated   in
                           The    Regional    Medical    Programs    seek     to         October  1965  under  Public  Law   89-239.   The   concern
                    strengthen  and  improve  the   Nation's   personal   health         was  for  attacking  heart  disease,  cancer,  stroke,  and
                    care   system   in   order   to   bring   more   accessible,         related  diseases  with  emphasis   on   making   available
                    efficient,   and   high   quality   health   care   to   the         the   latest   advances   in   diagnosis   and   treatment.
                    American   public.   To   accomplish   these    ends,    the         Cooperative  arrangements  for  research,   training,   and
                    RMP'S    promote    and    demonstrate    among    providers         related  demonstrations   of   patient   care   were   also
                    new    techniques    and    delivery    patterns;    support         stressed.
                    training which results  in  more  effective  utilization  of
                    health   manpower;   and   encourage   the   regionalization
                    of health facilities, manpower, and other resources.


                          The   RMP's   develop   their   programs   through   a
                    consortium  of  providers  who   come   together   to   plan
                    and  implement  activities  to  meet  health   needs   which
                    cannot  be   met   by   individual   practitioners,   health
                    professionals,  hospitals,  and  other  institutions  acting
                    alone.   The   RMP   provides   a   framework   deliberately
                    designed   to   take   into   account    local    resources,
                    patterns of practice  and  referrals,  and  needs.  As  such
                    it is a  potentially  important  force  for  bringing  about      FIGURE    1.    CURRENT    LEGISLATION:     P.L.     91-515
                    and assisting with changes  in  the  provision  of  personal
                    health services and care.                                               In  October  1970,  P.L.  91-515  was   signed   into
                          The    initial    concept    of    Regional    Medical      law.  he new legislation:
                    Programs was  to  provide  a  vehicle  by  which  scientific            (1)    adds kidney disease.
                    knowledge  could  be  more  readily   transferred   to   the
                    providers of health services  and,  by  so  doIing,    improve          (2)    adds prevention and rehabilitation.
                    the  quality  of  care  provided  with  a  strong   emphasis            (3)    e m p h a s i z e sprimary       care      and
                    on heart disease,  cancer,  stroke,  and  related  diseases.                   regionalization  of  health  care   resources.
                                                                                            (4)    emphasizes   health   service   delivery   and
                    The  implementation  and  experience   of   RMP   over   the                   manpower       utilizatio.n. Directs       RMP
                    past  five  years,  coupled  with  the  broadening  of   the                   attention  specifically  to   improvement   of
                    initial  concept-especially  as  reflected   in   the   most
                                                                                                   services  in   areas   with   limited   health
                    recent  legislative  extension-has  clarified   the   nature                   services.
                    and  character  of   Regional   Medical   Programs.   Though            (5)    provides  additional   authority    for    new
                    RMP  continues  to  have  a  categorical  emphasis,  to   be                   construction.
                    effective  that  emphasis  frequently   must   be   subsumed            (6)    requires  that  public  members  of   advisory
                    Within   or   made   subservient   to   broader   and   more
                    comprehensive   approaches.   RMP   must   relate    primary                   groups  include  persons  familiar  with   the
                                                                                                   financing  of,  as  well  as  the  need   for,
                    care  to  specialized  care,  affect  manpower  distribution                   services  and  that  such  public  members  be
                    and  utilization,  and  generally  improve  the  system  for                   sufficient  in  number  to   insure   adequate
                    delivering comprehensive care.                                                 community   orientation.   Also   includes   a
                                                                                                   re p resentative     of   the         Veterans
                          Even in its  more  specific  mission  and  objectives,                   Administration  as  an  ex   officio   member,
                    RMP  cannot  function  in   isolation.   Only   by   working                   if there is a VA institution  in  the  region.
                    with  and  contributing  to  related   federal   and   other            (7)    requires  review  of   RMP   applications   by
                    efforts  at  the  local,   state,   and   regional   levels,                   areawide   Comprehensive    Health    Planning
                    particularly  state  and   areawide   Comprehensive   Health                   Agencies.
                    Planning activities, can  the  RMP's  achieve  their  goals.








                                                                                  2















































































                                                                                                THE WESTERN NEW YORK REGION


                                                                                                   The RMP/VVNY is one of 56 federally      funded,  locally
                                                                                                controlled programs in the United States.     The   Regional
                                                                                                Medical Program for Western New York        is  made  up  of
                                                                                                nine counties: Niagara, Genesee, Erie, Wyoming,  Chautauqua,
                                                                                                Cattaraugus, and Allegany in  Western  New  York,  and  Erie
                                                                                                and McKean counties in Northwestern Pennsylvania. It  covers
                                                                                                an area of 7100 square miles with a population  of  approxi-
                                                                                                mately 2,020,000 according to the 1970 census.
                                                         FIGURE 2. THE WESTERN NEW YORK REGION




                                                                                        3








                                                                            LOCALLY
                       THE RMP MISSION                                                        THE         WORKSHOP         -         NEW          DIRECTIONS,
                                                                                              FOR WESTERN NEW YORK
                              A    recent    document    of    the    RMP    National
                       Advisory   Council   provides   goals   and   guidelines   for               The    RMP/WNY    Workshop,    held     on     September
                       Regional Medical Programs.                                             23-24,  1971,  was  a  great  step  forward   in   region-wide
                                                                                              involvement   in   program   planning.   About    50    health
                              What  the   RMP   mission   has   become:   The   broad         professionals   from   throughout   the   region,    including
                       goals are  to  increase  the  availability  of  care,  enhance         Regional    Advisory    Group    (RAG)    members,     project
                       the  quality,  and  moderate  the  costs.  Specific   missions         directors,  proposal  authors,   and   others   met   at   the
                       are:                                                                   Holiday    Inn    in    Fredonia,    New    York.    At    the
                              E3  to   promote   and   demonstrate   new   techniques         Workshop,  the  mission   of   the   RMP   was   reviewed   in
                                and delivery patterns                                         its  new  context,  the   framework   for   future   decisions
                              0  to  expand  the  capacity  of   existing   and   new         was  established,  and  priorities  were   set.   Participants
                                personnel  to  fill  needs   of   underserved   areas         worked  with   the   new   concepts   of   the   RMP   mission
                              0 to stimulate regionalization                                  and discussed the  needs  of  our  own  region  in  the  light
                              @   to   improve   standards   and   quality   control.         of this understanding. As  a  result,  in  the  final  session
                                                                                              of  the  Workshop,  a  RAG  executive  group   was   able   to
                              How   RMPs   are   judged:   RMP's   will   be   judged         select  from   the   previously   approved   proposals   those
                       on (1) program, (2) performance, and (3) process.                      most  pertinent  to  the  goals  and   objectives   that   had
                                                                                              been developed.
                              (1) Criteria for judging program related to         the
                       RMP's provider action-plan with emphasis on                                  The    RMP/WNY    Health    Activities     Goals     and
                                                                                              Objectives   1972-1975   were   accepted   by    the    Health
                              (a)   increased   and   more   effective    utilization         Organization        of   Western       New     York,      Inc.
                                    of health facilities and manpower                         (H.O.W.N.Y.,  Inc.)  Board  of  Directors   on   October   14,
                              lb)   health    maintenance,    disease     prevention,         1971.
                                    early     detection,       and           expanded
                                    ambulatory and out-patient care
                              (c)   an    improved        relationship        between
                                    primary and secondary care.                               WE NEED YOUR IDEAS

                              Other   considerations   include    the    extent    to               Ideas   for   projects   and   activities   which   meet
                       which  activities   will   link   multiple   institutions   or         needs  within  the  region  and   which   help   fulfill   the
                       professions  and   will   tap   outside   funds   or   support         health activities goals  and  objectives  are  being  actively
                       other federal efforts.                                                 sought.   RMP/WNY     invites     the     participation     of
                              (2)   Performance   is   judged   by   whether   goals,         everyone  in  the  region   who   is   interested   in   t   e
                       objectives,   and   priorities    have    been    established,         delivery of health care.
                       productivity  of  program  activities,  and  the   degree   to
                       which   RMP-supported   activities   have   been   assimilated
                       by the health care financing system.
                                                                                              TRIENNIAL GRANT APPLICATION
                              (3)   Process  criteria     include      organizational
                       effectiveness,  active  participation  of   those   interested                On   November   1,   1971,    the    Regional    Medical
                       in   health   problems   in   the   region,   translation   of         Program  for   Western   New   York   submitted   a   triennial
                       assessed    needs    and    resources    into     continuously         grant  application  for  March   1,   1972   -   February   28,
                       evolving  plans  and  priorities,  and   the   self-evaluation         1975,   to   Dr.   Harold   Margulies,    Director    of    the
                       process.                                                               Regional    Medical    Programs    Service    in    Washington.
                                                                                              Accomplishments   and    problems    of    the    last    three

      i
                              There  are  few  organizations   with   challenges   of         years  were   reviewed   and   plans   for   the   next   three
                       this magnitude.                                                        years presented.




                                                                                        4








                     FIGURE 3. HEALTH ACTIVITIES, GOALS AND OBJECTIVES

                     Goal No. 1. To stimulate and promote preventive services in health maintenance.


                           OBJECTIVES

                           1 .    To continue defining the need for additional or new preventive services in each sub-regional area, based  on  a
                                  data profile  of  resources  and  services,  an  assessment  of  the  community's  characteristics  and  health
                                  problems, and on the acceptability of the service to the community.

                           2.     To encourage delivery of preventive services through sources of primary care  with  emphasis  on  the  role  of
                                  allied health personnel.

                           3.     To encourage coordination among government,  voluntary,  and  private  agencies  to  (a)  maximize  the  impact
                                  of preventive services and (b) assist public health agencies in responding to community needs.

                           4.     To encourage expanded programs in health education.

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


                           OBJECTIVES

                           1 .    To continue defining the need for additional altered or new primary care services in  each  sub-regional  area,
                                  based on a data profile of resources and services,  an  assessment  of  community  characteristics  and  health
                                  problems, and on the receptability of the pattern of services to the community.
                           2.     To maximize the role of  existing  health  personnel  in  delivering  primary  health  care  by  (a)  improving
                                  distribution of health personnel, (b) encouraging  the  expansion  of  ambulatory  care  within  or  associated
                                  with community hospitals,  (c)  using  inter-disciplinary  approach  to  the  delivery  of  primary  care,  (d)
                                  encouraging  the  development  and  evaluation  of  innovative  methods  of  health  care  delivery,  and   (e)
                                  promoting improved referral patterns to assure continuity of care.

                           3.     To encourage general and family practice and other forms of primary  ea t  care.

                           4.     To stimulate development of already defined new roles of health personnel.

                           5.     To seek feasible solutions to the problems of distance and lack of transportation as barriers to utilization of
                                  primary care, preventive and rehabilitation services.
                           6.     To promote consumer education regarding availability and utilization of existing health services.
                     Goal No. 3. To encourage the development, expansion and  integration  of  rehabilitation  services  into  the  continuum  of
                     medical services.


                           OBJECTIVES

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






                                                                                 5








                             For    the   f irst budget    period      (1972-73),               (c)   the  opportunity  to   use   staff   competence
                      RMP/WNY   requested    $1,821,626    from    the    federal                     in the enabling role.
                      government  for  the  program.  In  accordance   with   the
                      federal  mandate,  several  of   RMP/WNY's   projects   are              The     Lake    Area    Health    Education     Center
                      moving  into  self-support.  Income  thus   received   plus        (LAHEC)  was  the  first  center  to  be   funded   by   the
                      local contributions  to  the  program  in  dollars  and  in        Veterans    Administration.    The    monetary    investment
                      kind  will  bring  the   total   resources   available   to        by   RMP/WNY   has   been   $10,000-the   return,    $50,000
                      RMP/WNY  during  1972-73  to   a   value   of   $2,419,600.        invested   in   LAHEC   by   the   Veterans   Administration
                                                                                         and    the    local     E rie,  Pennsylvania      hospitals.
                      DEVELOPMENTAL COMPONENT                                            RMP/WNY's   investment   of   approximately    $12,000    in
                            The   triennial   grant   application   includes    a        the  Rural   Externship   Program   released   contributions
                      request  for  a  developmental  component.  A   sum   equal        of   $9,100    from    participating    rural    physicians,
                      to  1  0%  of  RMP/WNY's  appropriation  for  direct  costs        hospitals,  and   local   governments   and   $20,000   from
                      during  1971-72  can  be  awarded  to   the   program   for        the   Appalachian   Regional   Commission.   The    industry
                      the  coming  year.  This  same  sum  can  also  be  granted        and  time  of   the   Rural   Health   Manpower   Committee,
                      in each of  the  remaining  two  years  of  the  triennium.        the  preceptors,   and   the   enormous   TV,   press,   and
                      The    developmental         component     provides      an        journal   coverage   of   this   venture    show    how    a
                      opportunity   to   support   needed   activities    without        developmental     commitment     can     catalyze     active
                      delay.  Modest   funds   from   this   component   can   be        public interest.
                      assigned directly by the Regional Advisory Group.
                                                                                               RMP/WNY     looks     forward     to     accomplishing
                            During   the   year   1971-72,   core   and   project        even   more   with   funds   specifically   earmarked    for
                      funds  have   been   used   in   a   developmental   manner        development.   Uses   planned    for    the    developmental
                      which has achieved:                                                component include:


                            (a)   the   ability   to   respond   quickly,   while              (1)   capitalizing   on    the    positive    approach
                                  community         interest     is  high,     in                    being taken by inner city groups
                                  cooperative    ventures    to    develop    new              (2)   promoting    greater    involvement    by    the
                                  approaches to health care problems                                 county committees.
                            (b)   a   major  financial     return    for    funds
                                  invested









































                                                                                 6






                                                           2
                                       o #-intakes up the
                                         a
                            regional Afedt'cal
                        Prog

                        Regional Advisory Group
                        Core Structure
                        The Volunteer Component

















































                                                                        7








                                                                                   REGIONAL ADVISORY GROUP

                                                                                         The  Health  Organization  of  Western   New   York,
                                                                                   Inc. (H.O.W.N.Y., Inc) is a  group  of  over  220  persons
                                                                                   who     by-and-large    meet     monthly     in     county
                                                                                   committees.    The    H.O.W.N.Y.,    Inc.,    Board     of
                                                                                   Directors,  which  serves  as  Regional   Advisory   Group
                                                                                   to  the  RMP/WNY,  meets   monthly   to   direct   program
                                                                                   development.   The   Telephone    Lecture    Network    is
                                                                                   used  to  insure  maximum  participation  at   Board   and
                                                                                   committee  meetings.  Those  who  are  unable   to   leave
                                                                                   their  part  of  the  region  can  still  participate   in
                                                                                   important deliberations and decisions.

                                                                                          A continuing effort     is  made  to  involve   the
                                                                                   counties in a greater role in  defining  their  own  needs
                                                                                   and priorities. Complacency    must be  eradicated  and  a
                                                                                   high   level   of   interest   maintained    within    the
                                                                                   constituency.  A  staff  member  is  following  a  regular
                                                                                   schedule   of   liaison   with   the   county    committee
                                                                                   members and     their  chairmen   to   promote   committee
                                                                                   identification  with  the  goals  and  objectives  of  the
                                                                                   program   and    develop    more    active    involvement.
                                                                                   Concomitantly,  staff  working  in  the  counties  can  be
                                                                                   appraised of local efforts and  problems.  The  visibility
                                                                                   of  staff  in  each  county   affirms   the   reality   of
                                                                                   RMP/WNY's thrust towards regionalization.

                                                                                          This  summer,   staff   members   have   met   with
                                                                                   each  member  of  the  Board   of   Directors   and   with
                                                                                   numerous  members   of   the   Regional   Advisory   Group
                                                                                   at-large in the  various  counties.  These  meetings  have
                                                                                   brought  to  the  attention  of  RAG   members   the   new
                                                                                   purposes  and  directions  of  RMP  and  the   opportunity
                                                                                   for  developing  new  approaches  to  problems  in  health
                                                                                   care.  Important  insights  of  practicing   professionals
                                                                                   and  health  administrators  in  all  the  counties   have
                                                                                   involved  the  RMP/WNY  more  closely   with   the   needs
                                                                                   of each county.











                                   ,,;;-E 4. ORGANIZATION OF RMP FOR WNY




                                      ),W.N.Y. BOARD OF DIRECTORS








                                         Constitution and By-Laws
                                         Executive
                                         Search
                                         Proposals





                                                                      COUNTY
                   WNY-RMI                                           COMMITTEES
                                         Standing Committees         OFHOWNY
                                         Coronary Care
                                         Cancer
                                         Stroke
                                         Kidney and Dialysis
              Lak                        Pulmonary Planning
              Hea                        Cardio-Pulmonary
              Edu                        Allied Health
              Ceni                       Rural Health Manpower     Allegany
                                         TLN Advisory Group        Cattaraugus
                                         Evaluation                Chautauqua
                                                                   Erie, Pa.
                                                                   Erie, N. Y.
                                                                   Genesee
                                         Ad Hoc Committees         McKean,   Pa.
                                         Health Careers            Niagara
                                         Family Management of      Wyoming
                                         the Chronically III
                                         Programs for the Aged










                                                                                    CORESTRUCTURE


                                                                                          Each staff member has  a  well  defined  role  in
                                                                                    the organization and a  voice  in  the  development  of
                                                                                    t e tota program.  To  promote  the  greatest  possible
                                                                                    community   involvement,   RMP/WNY's   philosophy    is
                                                                                    to use the  small  core  to  staff  expert  committees.
                                                                                    Thus,  grants   management   staff   works   with   the
                                                                                    proposals  committee,   evaluation   staff   with   the
                                                                                    evaluation committee, county liaison  with  the  county
                                                                                    committees, and the Director  for  Nursing  and  Allied
                                                                                    Health Affairs staffs our  categorical  committees  and
                                                                                    implements their programs  throughout  the  region.  In
                                                                                    addition, staff  members  work  with  other  committees
                                                                                    in the community.


                                                                                         The Executive Director  has  worked  very  closely
                                                                                    with his staff, establishing the program and increasing
                                                                                    our involvement in and  usefulness  to  the  community.
                                                                                    He has been able to bring leaders  together  to  define
                                                                                    health problems and set policy for  their  solution.  A
                                                                                    measure   of   the   status   of   RMP/WNY    in    the
                                                                                    community is  that  the  Executive  Director  holds  an
                                                                                    associate deanship in the School  of  Medicine  of  the
                                                                                    University  and  serves   on   the   medical   school's
                                                                                    executive  committee.  In  the  last  year,  a  growing
                                                                                    percentage of the Executive Director's  time  has  been
                                                                                    spent  working  with  other  RMP   directors.   He   is
                                                                                    chairman of the Northeastern  group  of  directors  and
                                                                                    their  elected  two-year  delegate  to   the   National
                                                                                    Steering   Committee.   From   these    contacts    the
                                                                                    Executive Director has brought to  the  Board  and  his
                                                                                    staff  a  much  more  sophisticated  understanding   of
                                                                                    health  events  of  national    importance,      direct
                                                                                    communication with other  regional  programs,  and  the
                                                                                    possibility of learning from their experiences.























                                                                            10










                                                 FIGURE5. COMPOSITIONOFTHEBOARDOFDIRECTORSOFTHE
                                                               HEALTH ORGANIZATION OF WESTERN NEW YORK, INC.




                    100  -

                         oe
                         00 00,
                         40


                    30   -






                    25   -


                ui


                ui
                    20



                0
                I-
                LL
                0
                I-  15   -
                z
                ui


                ui

                    10  -






                    5    -






                    0
                                A            B        c           D          E          F          G          H           I          i


                                                                      COMPOSITION OF THE BOARD


                         A    9M.D.'s representing the 9 county medical societies
                         8    9members representing the 9 county committees                        G   1 member representing the Regional Health Director,
                         C    2members representing the School of Medicine at the                        Department of Health, State of New York
                              State University of New York at Buffalo                              H   1 member representing the Commissioner of Health,
                         D    2members representing Roswell Park Memorial Institute                      Erie County, New York
                         E    1member representing the Western New York Hospital Association       I   1 member representing the Veterans Administration
                         F:   2-embers representing the Comprehensive Health Painning Council      J   5 members at large, including 1 legal counsel
                              of Western New York, Inc.                                              33 total membership



                   FIGURE    6.    BOARD    OF    DIRECTORS    OF    THE    HEALTH    ORGANIZATION    OF    WESTERN    NEW     YORK,     INC.

                                                                 INSTITUTION AND/OR                            CATEGORIES OF
                               NAME                                   OCCUPATION                              REPRESENTATION

                   EXECUTIVE COMMITTEE


                   President:
                   1. Irwin Felsen, MD                      Physician                                  Allegany   County   Medical    Society

                   Vice President:
                   2. Father Cosmas Girard, OFM             St. Bonaventure University                 Cattaraugus County Committee

                   Secretary:
                   3. H. Gregory Thorsell, MD               Surgeon                                    Chautauqua  County   Medical   Society

                   Treasurer:
                   4. John C. Patterson, MD                 Roswell Park Memorial Institute            Roswell Park Memorial Institute

                   Chairman, Proposals Committee:
                   5. Harry Sultz, DDS, MPH                 School of Medicine, State  University      Erie County (N.Y.) Committee
                                                            of New York at Buffalo


                   Member-at-large:
                   6. Theodore T. Bronk, MD                 Physician                                  Niagara County Medical Society

                   Member-at-farge:
                   7. Edward E. Kemble, MD                  Physician                                  Erie  County  (Pa.)  Medical   Society

                   OTHER BOARD MEMBERS

                   8. Lester H. Block                       Attorney at Law                            Legal Counsel: Member-at-large
                   9. LaVerne E. Campbell, MD               New   York   State   Department    of      New York State Department of
                                                            Health  -  Regional  Health  Director      Health

                   10. Lloyd Cannedy, PhD                   Bradford  Hospital  -   Administrator      McKean County Committee
                   11. Clifford L.M. Carpenter              Co m p reh e  nsive  Health  Planning      Co m p r e h e n sive Health  Planning
                                                            Council of Western  New  York,  Inc.,      Council  of  Western  New  York,  Inc.
                                                            Executive Director

                   12. Max Cheplove, MD                     Physician                                  Erie  County  (N.Y.)  Medical  Society
                   13. Kenneth H. Eckhert, MD               Surgeon; Co m  p  re  hensive  Health      Co m p r e h e nsive  Health  Planning
                                                            Planning Council   of   Western    New     Council  of  Western  New  York,  Inc.
                                                            York, Inc. - Chairman

                   14. William H. Ennis*                    Hamot Hospital - Administrator             Erie County (Pa.) Committee
                   15. Ivan Harrah                          Western  New  York  Hospital  Associ-      Western  New   York   Hospital   Asso-
                                                            ation - Executive Director                 ciation






                                                                           12








                         16.    Herbert E. .Joyce,     MD              Nysician                                      Member-at-large

                         17.    Bert S. Klein, PodD                    Podiatrist                                    Chautauqua County Committee

                         18.    Edward   F.   Marra,   MD              &-hoof  of  Medicine,  State  University      School  of  Medicine,  State   University
                                                                       of  New  York  at   Buffalo   -   Chair-      of New York at Buffalo
                                                                       man,   Department    of    Social    and
                                                                       Preventive Medicine


                         19.    Elizabeth Moore                        Executive   Director,    American    Red      Member-at-large
                                                                       Cross of Genesee County

                         20.  William   E.   Mosher,   MD              Physician, C o  u  n  t  y  Health  Com-      Commissioner    of    Health    -    Erie
                                                                       missioner                                     County, New York.
                         21.    Gerald  P.   Murphy,   MD              Roswell  Park   Memorial   Institute   -      Roswell Park Memorial Institute
                                                                       Director

                         22.    William  C.  Niesen,   MD              Physician                                     Niagara County Committee

                         23.    Mary S. Northington                    C o m p r e h e  nsive  Health  Planning      Member-at-large
                                                                       Council  of  Western  New   York,   Inc.

                         24.    LeRoy Pesch, MD**                      State  University   of   New   York   at      School  of  Medicine,  State   University
                                                                       Buffalo  -  Dean,  School  of   Medicine      of New York at Buffalo

                         25.    John R. Rowan                          Buffalo           VeteransAdministration      Veterans Administration
                                                                       Hospital - Director

                         26.    Fred 0. Rush                           B a y f r  o  n  t  Development  Program      Member-at-large
                                                                       Gannon   College   -   Director,   Erie,
                                                                       Pennsylvania

                         27.    Patricia Stopen, RN                    Registered Nurse -                            Wyoming County Committee
                                                                       Wyoming  County       Health     Depart-
                                                                       ment

                         28.    George E. Taylor, Jr., MD              Physician                                     Allegany County Committee

                         29.    Donald  R.  Watkins,   MD              Physician                                     McKean     County     Medical     Society

                         30.    Paul Welsh, MD                         Physician                                     Genesee County Committee

                         31.    R.T. Williams, MD                      Surgeon                                       Wyoming    County     Medical     Society

                         32.    Duncan  C.   Wormer,   MD              Physician                                     Cattaraugus   County   Medical    Society

                         33.    George S. Young, MD                    Physician                                     Genesee    County     Medical     Society

                                Resigned September 1, 1971
                                Resigned January 1, 1972

                         The Buffalo and Batavia, New York and Erie, Pennsylvania Veterans Administration Hospitals will shortly all be represented on the
                         HOWNY Board.





                                                                                         13










                                         FIGURE 7. EMPLOYEES OF RMP/WNY


                                         Professional Staff Employees
                                         John R.F. Ingall, M.D., F.A.C.S., F.R.C.S. - Executive Director
                                         Sandra K. Berlowitz, B.A. - Administrative Associate, Writer
                                         Gene A. Bunnell, A.B., M.C.P., M.P.H. - Administrative Associate for Planning
                                         Floyd Cogley, Jr., B.S., M.P.H. - Administrative Associate for Grant Development
                                         Patricia Shine Hoff, R.N., B.S., M.A. - Director of Nursing and Allied Health Affairs
                                         Elsa R. Kellberg, B.A., M.A. - Research Associate for Evaluation
                                         Gary L. Reynolds, B.S., M.B.A. - Administrative Associate for Business and Personnel
                                         Marion R. Sumner, B.A., M.B.A. - Administrative Associate for Business and Personnel
                                         Gerald J. Surette, B.A., M.A. - Administrative Associate for County Committees
                                         Anthony Zerbo, Jr., B.A. - Director of Communications


                                         Staff Employees
                                         Jean L. Andrianoff, B.S.Ed. - Secretary
                                         Alice J. Bragg - Secretary
                                         Maria M. Dick, A.A.S. - Secretary
                                         Elizabeth M. Eberl - Statistical Clerk
                                         Barbara C. Lamberg - Secretary
                                         Kathleen C. McCron B.S. - Receptionist and Secretary
                                         Rosetta J. Parker - Secretary
                                         Joan L. Philipps, B.S. - Secretary
                                         Urban Batt - Clerk (part time)



                                                                   FIGURE 8. VOLUNTEERS'CONTRIBUTION

                                             in  1968  the  RMP/WNY  engaged  in  a  study  to  find  out
                                         what  was  being  contributed  to  the  RMP/WNY   operation   in
                                         terms of money by the many  volunteers  who  take  part  in  its
                                         activities.  This  included  the  use  of  such   resources   as
                                704    - meeting  rooms,  services,  time  spent  in  meetings   on   RMP
                                         business and other !-much factors.
                                            The  1968  study  of  the  volunteer  time  contribution   to
                                601  -   RMP/WNY  was  updated  in  1971  and  the  expected   level   of
                                         volunteer  time  contribution  was   projected   through   1974.
                             <           In  1968,  community  time  volunteered  to   RMP/WNY   equalled
                             -i
                             -i 50e  -   231 for every federal dollar spent.  By  1971  this  figure  had
                          w              risen to 40@ for every federal dollar. By 1974, it is  projected
                          CL             that local participation will increase to 67.54/federal  dollar.
                          F-
                             <  401    -
                          z  fr
                          :) w
                          0  0
                          :->w  30e  -
                          <  LL


                                20e    -



                                               1968                             1970                           1972                            1974

                          COOPERATIVE CONTRIBUTIONS TO RMP/WNY                            YEAR
                                                                                                                               PROJECTED
                          PER FEDERAL DOLLAR EXPENDITURE 1968-1974








                                                                                            14





                      Chapter3
                                        Aou,ne
                      lffotv W,,v RAfPoVVIVY
                      im


                      STAFF FUNCTIONS
                           Planning
                           Proposal Review and Development
                           Evaluation
                           Financial Management
                           Communications
                           The Enabling Theme
                      PROJECTS AND PROPOSALS
                           Operational Projects
                           Financial Statement
                           Status of Proposals
                      HOW RMP/WNY WORKS WITH OTHER
                      HEALTH RELATED ORGANIZATION






















                                                                                                            o



















                                                                  15








                                                                     STAFF FUNCTIONS
                     PLANNING                                                           RMP/WNY   programs.   The    detailed    proposal    review
                                                                                        protocol and criteria  for  RMP  review  are  part  of  the
                           RMP/WNY   is   an   operational   program   with    a        RMP/WNY  Kit  and  are  available  to   everyone   in   the
                     planning   component.   It   has   been   moving   in   new        region. This process of  involving  the  entire  region  in
                     directions, identifying deficits  in  health  care  in  the        proposal review reveals  possible  duplication  of  efforts
                     region and developing priorities  for  dealing  with  these        and    encourages    cooperation    of    those    actively
                     problems  and   needs.   Stronger   working   relationships        interested in a  concept  from  every  part  of  the  area.
                     with    the    Comprehensive    Health    Planning    (CHP)        The  proposal  author  is  in  personal  contact  with  the
                     Council  of  Western  New   York   have   been   developed.        series   of   groups   who   review   his   proposal.    In
                     Their  overall  plan  for  the  region   was   taken   into        particular,  he  must  be  prepared  to  explain   to   the
                     consideration   in   establishing   RMP/WNY's   goals   and        grassroots  organizations,  the  county   committees,   his
                     objectives.                                                        concept  and  its   applicability   to   their   particular
                                                                                        situation.  The  H.O.W.N.Y.,  Inc.   Board   of   Directors
                           The  Western  New  York   program   participated   in        (Regional  Advisory  Group  to   the   RMP/WNY)   has   the
                     the   Information     Support  System       of      Harvard        final authority.  Proposal  review  serves  an  educational
                     University,  a  system  designed  to  help  RMP's   develop        function. The review mechanism promotes:
                     program  activities  which  more  clearly  meet  objectives
                     specified in  the  legislation.  Data  generated  from  the               (a)   involvement of the sub-regional groups
                     interviews  conducted  in   Western   New   York   by   the               lb)   education of author and reviewers
                     Information  Support  System  have  been   used   to   help               (c)   equity of review.
                     identify   problem   areas    and    incorporate    program
                     activities to solve those problems.                                       The   Proposals   Committee   will   seek   projects
                                                                                        that   address themselves to  the  greatest  needs  of  the
                           The  research  and  data  acquisition  capability  of        region  as  documented  in  the   RMP/WNY   priorities   of
                     the  RMP/WNY  has   been   both   significantly   increased        goals and objectives.
                     and  established  as  a  regional  resource   through   the
                     employment   of    the    Community    Services    Research               A major objective is to involve  the  entire  region
                     and   Development   Program   of    the    Department    of        in one  unified  system  of  grant  proposal  review.  This
                     Social   and    Preventive   Medicine    of    the    State        would   emphasize    the    community's    need    for    a
                     University   of   New   York    at    Buffalo.    Community        common  data   base   and   a   coordinated   consideration
                     Health   Information   Profiles   (CHIP)   of   county-wide        of health care  goals  and  objectives.  Proper  investment
                     geographic  areas  for  long-range   planning   of   health        of resources available to  the  region  would  be  insured;
                     services    and     facilities  have  been       instituted        projects  receiving  funding  would  have  the  benefit  of
                     collaboratively    with    the     Comprehensive     Health        area-wide involvement and support.
                     Planning   Council   of   Western   New   York   and    the
                     Mid-State   Committee   on   Area-Wide   Health   Planning,
                     Inc.  In  each  case   supplemental   funds   either   from
                     county   government   or   one   of    the    comprehensive        EVALUATION
                     health   planning   agencies   have   been   committed   to
                     support  the  additional  field  staff  required  for  data               RMP/WNY   has   developed   evaluation   tools    to
                     collection at the local level. The  first  efforts  of  the        assure that (1)  health  activities  goals  and  objectives
                     CHIP program are  being  directed  to  the  rural  counties        remain  flexible  and  respond  to  the  documented   needs
                     of  Cattaraugus,   Genesee,   and   Allegany.   Plans   are        of the region, (2) the contribution of  activities  to  the
                     underway  to  develop  health  information   profiles   for        program's  goals  and  objectives  are  measured  and   (3)
                     most of the communities in the RMP/WNY region.                     the   activities   themselves   are   well-conceived    and
                                                                                        well-executed.  At  the  end  of  each  operational   year,
                                                                                        goals and objectives will be revised.
                     PROPOSAL          REVIEW          AND           DEVELOPMENT
                                                                                               County  committees  will  report  their   activities
                           The  proposal  review  process  has   been   a   most        in  defining  and  meeting  their  health  needs,   helping
                     effective mechanism for  involving  the  entire  region  in        the  Regional  Advisory  Group   base   health   activities





                                                                                   16












                                       FIGURE 9. PROPOSAL REVIEW PROCESS






                                             AUTHOR









                                        RMP-WNY
                                        HEADQUARTERS
                                        Staff Review and Comment
                                        Technical Review








                                              AUTHOR








                                        COUNTY COMMITTEES




                                        PROPOSALSCOMMITTEE           EVALUATION COMMITTEI
                                        OFHOWNY                      OFRMP





                                        BOARD OF DIRECTC
                                        OFHOWNY






                                  WASHINGTON
                                  (as part of the RMP-WNY total program)








                                                        17







                         objectives    upon    real    county    needs.    Using     the         EVALUATION WORKSHOPS
                         reporting   form   which   has   been   developed   will   help                On    February    11,    1971,    Donald    A.     Schon,
                         each  county  subunit  measure   the   effectiveness   of   its         Ph.D.,    Organization      for   Social    and        Technical
                         activities  and  define  its  own  priorities  for   investment         Innovation,   presented   a   discussion   on   the   evaluation
                         of   RMP   resources.   The   form   should   also   facilitate         of   the   effectiveness   of   regional    medical    programs.
                         communication    among     the     county     committees     by         Board  and  staff  members  as  well   as   representatives   of
                         giving them a clearer picture of each other's needs.                    various   community   organizations    participated    in    the
                                                                                                 day-long  program  at  the   Buffalo   Statler   Hilton   Hotel.
                                Project  reporting  forms   have   been   developed   to
                         aid    the    project    directors    in    reporting    needed                A   proposal    evaluation    workshop    designed    for
                         information.   This   will   allow   close    supervision    of         members   of   the   proposals   and    evaluation    committees
                         project efforts  as  well  as  provide  data  for  the  project         and   members   of   the   RMP/WNY   staff   was   held    April
                         site  visit  teams.  The  teams,  which  consist  of  at  least         23,   1971,   at    RMP    headquarters    in    Buffalo.    Key
                         two    consultants,    two    Board    members,     and     one         speakers   were   Dr.   Frank   Husted,   Dean,    College    of
                         RMP/WNY   staff   member,   have    provided    the    Regional         Allied   Health   Professions,   Temple   University   and   Dr.
                         Advisory   Group   an    independent    assessment    of    our         Harry   Sultz,   D.D.S.,   Associate   Professor,   Social   and
                         active  and  funded  projects.  These  visits  are  devoid   of         Preventive  Medicine,  State   University   of   New   York   at
                         punitive   or   federal   overtones   and   have   been    very         Buffalo School of Medicine.
                         informative.  Yearly  site   visit   reports   will   therefore
                         continue   to   be   used   as   one   source   for   measuring
                         project ef f activeness.                                                FINANCIAL MANAGEMENT
                                                                                                        In   its   fiscal    policy    the    Regional    Medical
                                The  measure   of   core   staff   activities   can   be
                         derived    from    a    summary     of     members'     monthly         Program   for   Western   New   York    has    been    operating
                         reports.  This  provides  an  easy  summation   of   activities         under  a  programmatic   approach   for   several   years.   The
                         for  the  anniversary   review   document,   reveals   excesses         fiscal  management  of  all  funds  has   been   in   the   Core
                         or  deficiencies  in  staff  activities  in  light  of  overall         office  with  no  direct  assignment  of  monies  to   affiliate
                         program   objectives,   and    serves    as    a    means    of         institutions. It is the policy at  the  end  of  the  first  six
                         communication    among     core     staff     personnel     and         months   of    a    fiscal    year    to    formally    consider
                         between  the   staff   and   the   Regional   Advisory   Group.         redistribution  of  funds  to  strengthen  the  program   as   a
                                                                                                 whole   and   to   seek   seed   money   for   projects    which
                                                                                                 have been approved but not funded.
                                A  cost  analysis  of  the  entire   program   will   be
                         undertaken   yearly,   taking   into   account   projects   and                When  the  budget   was   prepared   for   1971-72,   the
                         core staff activities.                                                  on-going   components   were   reviewed   in   the    light    o
                                                                                                 their    effectiveness    and     the     recommendations     of
                                Appropriate   evaluation   techniques   for    potential         project  site  visitors.  In   1971-72   funds   were   diverted
                         and    operational activities are assured by  the                       (1) to support a summer student extern  program
                         Evaluation Committee and RMP/WNY staff.                                 designed  to  acquaint  students  in  the  health  fields   with
                                                                                                 rural   practice   and      (2)    to    the    planning     and
                                Evaluation  efforts  will  be  used   to   (1)   measure         implementation   of   the    Lake    Area    Health    Education
                         the  dimension   of   achievements   in   meeting   goals   and         Center.    Projects    which    were    deemed     ready     for
                         objectives  in   a   specified   period   of   time   and   (2)         self-support    were    moved    more    quickly    into    that
                         provide   the   information   needed   to   effectively   guide         support,  and  funds  so  released  were   assigned   to   other
                         RMP/WNY   program   development.                    Information         facets of the program.
                         derived   from   measures   of   program   effectiveness   will                The   grantee   institution    for    Regional    Medical
                         be  used  to  periodically  reassess  goals   and   objectives,         Program   for    Western    New    York    is    the    Research
                         determine  the  level  of  support  for   ongoing   activities,         Foundation  of   the   State   University   of   New   York,   a
                         and  actively  seek   out   projects   and   activities   which         private   non-profit    corporation    established    for    the
                         address themselves to as yet unmet objectives.                          express   purpose   of   handling   federal   funds   for    all
                                                                                                 branches of the State University of New York.







                                                                                            1 8







                       COMMUNICATIONS                                                   been  excursively  RMP  operations.  (2)  County  medical
                                                                                        societies  and  hospitals   contribute   funds   to   the
                            RMP/WNY    activities    are    brought    to    the        RMP/WNY   advisory   group   (Health   Organization    of
                       attention of the public  via  the  news  media,  exhibits        Western New York,  Inc.)  to  meet  expenses  that  could
                       displayed at  conferences  and  meetings,  brochures  for        not  be  paid  for  by  the  Federal  dollar.  (3)  RMP'S
                       our  special   programs,  and      published    articles.        investment in  the  Lake  Area  Health  Education  Center
                       Television and radio have  been  used  to  cover  program        led  to  investment  in  the  Center  by  the  Boards  of
                       activities.  A  newsletter  brings  news   of   important        Trustees of  two  Erie,  Pennsylvania  hospitals  and  by
                       events in the health field, both regional  and  national,        the    Veterans  Administration       (4)  The    Rural
                       to  the  13,300  people  on  the  RMP/WNY  mailing  list.        Externship  project   was   able   to   attract   private
                       The  Western   New   York   RMP   brochure   and   annual        contributions  from  hospitals,  physicians,  and   local
                       report  have  been  widely   circulated.   Currently   in        governments of $9,1 00.
                       preparation  are  (1)   proceedings   of   the   Workshop
                       together  with  the  goals  and  objectives  of   RMP/WNY               The  acquisition  of  two   excellent   conference
                       for the  next  triennium  and  (2)  the  RMP/WNY  Kit,  a        rooms has defined the RMP  as  a  facility  used  by  the
                       compilation  of  material  describing  the  RMP  mission,        community.     The     communications     devices     and
                       guidelines  for  development  and  submission  of   grant        audio-visual requirements are available. In  addition  to
                       proposals,  and  the   proposal   review   protocol   and        use by those directly related to  the  program,  meetings
                       criteria.                                                        have been held  in  the  rooms  by  such  groups  as  the
                                                                                        Urban   League,   Buffalo's   Blue    Ribbon    Ambulance
                                                                                        Committee, CHP, the local  podiatrists,  and  Parents  of
                                                                                        Diabetic Children.
                       THE ENABLING ROLE
                                                                                               Participants at the RMP/WNY Workshop,  e
                            The  core  staff  has  emphasized   RMP's   enabling
                       role in  all  program  activities  RMP/WNY  serves  as   a       on  September  23  and   24,   reaffirmed   the   crucial
                                                                                        importance  of  RMP's  enabling  function.   They   asked
                       broker  for  the   community.   Help   is   given   where        that,  in  pursuing  specific  health  care   goals   and
                       required.  If  RMP   cannot   help,   other   appropriate
                                                                                        objectives,  RMP/WNY  not  forget  that  it  provides   a
                       organizations are contacted.  The  staff  is  seeking  to
                                                                                        territory  in  which  individuals  and  institutions  can
                       increase  its  effectiveness   in   counseling   proposal
                                                                                        come  together,   avoiding   wasteful   duplication   and
                       authors by  learning  more  about  funding  agencies  and
                                                                                        encouraging  a  large,  regional   approach   to   health
                       their areas  of  concern  and  becoming  more  expert  in
                                                                                        problems.
                       the development of excellent grant proposals.
                                                                                                PROJECTS AND PROPOSALS
                             Another  aspect  of  the  enabling  role  has  been
                       insistence  that  projects  have   a   viable   marketing        OPERATIONAL PROJECTS
                       strategy. RMP  resources  are  invested  as  seed  monies
                       for  activities  that  can   be   integrated   into   the               During   the   year   March   1,   1971,   through
                       health-care pattern of  our  region.  Centralized  fiscal        February  28,  1972,  five  operational   projects   were
                       control  has  allowed  easy  shifting   of   funds   from        supported by RMP/WNY.
                       activities  that  are   developed   enough   to   receive
                       community  support  to  new  areas  of  investment.   The        Project No. 1 Telephone Lecture Network (TLN)
                       requirement  for  a   marketing   strategy   is   clearly
                       defined  in  the  guidelines  for  proposal   development               Primary    Purpose:    General    continuing
                       which are distributed to all prospective authors  and  in               education
                       the  reporting  form  that   has   been   developed   for               Health  Care  Focus:  All  types  of  health
                       project directors.
                                                                                               care

                             RMP/WNY   has   been   successful   in   attracting               Target Group(s):  All  health  professionals
                       additional  monies  to  RMP-supported   activities:   (1)               and  special   primary   target   population
                       Voluntary  agencies  and  other  groups  have   committed               groups, i.e., parents of diabetic  children,
                       monetary  investment  to  what   otherwise   would   have               and the chronically ill




                                                                                  19







                                Geographic   Scope:    Seven    counties    in               Project No. 2 Coronary Care Training Program
                                Western  New  York  and  three  counties   in
                                Pennsylvania                                                        Disease Category: Heart Disease
                                Objectives: To  meet  the  growing  need  for                       Health Care Focus: Treatment
                                training and education  in  health  care  for
                                providers   and   consumers   by   increasing                       Target   Group(s):   Registered   Nurses    and
                                the  knowledge  and  skill  of  health   care                       Physicians
                                personnel  and   to   be   a   resource   for
                                community health education.                                         Primary  Purpose:  Training   existing   health
                                                                                                    personnel in new skills
                                During  the  three   year   funded   period,the   TLN
                       increased  in  size  from  a  network  of  15   hospitals   to               Geographic       Scope:      National       and
                       one  of  56  hospitals  (as  of  June  1970).   In   September               Canadian
                       1968   the   network   offered   two   hourly   programs   per
                                                                                                    Objectives:   To   improve   care   of    heart
                       week  -  one  lecture  series  for  physicians   and   another
                                                                                                    patients  by  training  nurses  and  physicians
                       for    nurses.    The    current     educational     component
                       consists   of   244   hourly   programs   scheduled   in    20               in operating intensive care units.
                       separate    lectures   series   and    provides     for     15
                       identifiable      career  fields.     Nineteen       agencies,               This   program   for   nurses   and   physicians   has
                       institutions    and    organizations     provide     voluntary        been   operational   since   March   1968.    Through    June
                       support  to  the  educational  component  of   this   project.        1971,   302   registered   nurses    have    completed    the
                       A  Spoken  English  course  for  foreign  born   health   care        course of  instruction  in  the  intensive  care  aspects  of
                       personnel       was    developed        to   alleviate     the        patients   with   acute   cardiac   problems.    The    basic
                       communication    problem    that    exists     between     the        format   of   the   teaching   programs   encompasses   three
                       patient  and  those   attending   him.   TLN   programs   meet        weeks  of  didactic  instruction  and  two  or  three   weeks
                       the   Continuing   Education   requirements    of    6    pro-        of clinical  experience  for  the  practical  application  of
                                                                                             nursing principles and skills which have be
                       fessional associations and one state agency.                                                                          en    taught.
                                                                                             Nine   metropolitan   Buffalo    hospitals    provided    the
                                The  results  of  the  1970  TLN   Survey   were   in        clinical    facilities  utilized   for   nurse      practical
                       general  positive  with  regard  to   content,   format,   and        experience   in    Coronary      Care    Units.       Two-day
                       acceptability    of    TLN    presentations.    The     survey        programs  for  physicians  were  conducted  each   year,   in
                       accurately   predicted   hospital   participation    on    the        cooperation   with   the   Office   of   Continuing   Medical
                       network for 1971-72.                                                  Education    of    the    School    of    Medicine,     State
                                                                                             University of New York at Buffalo.
                                Thirty  six   hospitals   registered   in   September
                       1971  under  the   new   fee   structure.   The   yearly   fee        MAJOR PROGRAM CHANGES
                       ranges  from  $1400  for  a  hospital   with   125   certified        IMPLEMENTED - September 1971:
                       beds  or  less  to  $1900  for   hospitals   with   over   400
                       beds.  The   educational   component   of   the   network   is        (1)    Tuition  fee  charged:  $350  per  session  per  nurse
                       now supported by the member hospitals.                                registrant.
                                                                                             (2)    Discontinued   reimbursements   paid   to   hospitals.
                                The  TLN  also  serves  health   and   administrative        Commitments   to   participate,   without    pay    in    the
                       groups  by  providing  a   means   of   information   exchange        program,   have   been   received   from    many    of    the
                       at  regular  meetings  and  conferences,  via   the   network.        cooperating agencies.
                       Additional  evening   programs   are   directed   to   certain        (3)    No lecturer reimbursement fees being paid,
                       groups  concerned  with  the   education   of   relatives   of        (4)    School  of   Nursing,   SUNY   at   Buffalo,   assumed
                       persons with chronic health problems.                                 the Director's salary.

                                                                                                    As  of  March  1,   1972,   this   project   will   be
                                                                                             supported     by  the     Department  of           Continuing
                                                                                             Education,   School   of   Nursing,    SUNY    at    Buffalo.





                                                                                      20







                       Tuition  fees  will  be  continued.  A   pilot   study   is          established  which  includes  one  active  and   responsible
                       underway   which   will   allow    combination    of    the          representative   from    each    of    the    participating,
                       Coronary  and  Respiratory  Care  Training   Program   into          affiliated  hospitals   and   which   also   includes   wide
                       a Cardio-Pulmonary Care Training Course.                             representation   from   the   outlying   communities.   This
                                                                                            advisory   committee   has   determined   that   the    Home
                       Project No. 3 Chronic Respiratory Disease Program                    Care   and   Rehabilitation   Programs,    established    as
                                                                                            models, should  now  be  extended  into  the  region.

                              Disease   Category:    Pulmonary

                              Target    Group(s):       Allied     health
                              professionals,  physicians,    nurses,    and
                              patients                                                      Project No. 10 Tumor Service Registry
                              Primary     Purpose:      Education       and                       Disease Category: Cancer
                              development of health care facilities
                                                                                                  Health     Care   Focus:     Diagnosis      and
                              Geographic   Scope:    Western    New    York                       Treatment
                              and Northwestern Pennsylvania
                                                                                                  Target  Group(s):   Physicians,   medical   re-
                              Objectives:   Provide    home    care     and                       cords personnel and cancer patients
                              rehabilitation   programs      for   patients
                              throughout       the    region;       provide                       Primary  Purpose:  Part   training   and   part
                              educational    programs     about     chronic                       patient services
                              respiratory disease for  nurses,  physicians,
                              allied health personnel, and patients.                              Geographic    Scope:    Western    New     York
                                                                                                  and Northwestern Pennsylvania
                              The  following  components  of  the   program   have
                       been   instituted:                                                         Objectives:   To   provide   better   care   to
                                    The   Screening    Program                                    cancer  patients  by  improving  (1  )  quality
                                    The  School  of   Respiratory   Therapy                       of care  by  hospital  and  physician  and  (2)
                                    Pulmonary    Physical    Therapy                              access     to   care  through         follow-up
                                    Continuing Education for Nurses                               procedures.
                                    Continuing Education for Physicians
                                    Model Pulmonary Care Facility                                 A tumor  registry  has  been  established  as  a  tool
                                    Respiratory Intensive Care Unit                         for improving the  quality  of  care  for  cancer  patients.
                                    Pulmonary Function Laboratory                           Tumor  Registry  activity  has  been  initiated  in   eleven
                                    Respiratory   Therapy    Service                        hospitals  where  none  had  existed.  The  efforts  of  all
                                    Home Care Program                                       member    hospitals    have    been    coordinated,     with
                                    Rehabilitation     Program                              continuous  training  of  hospital  tumor  registrars.  This
                                                                                            assures   improved   uniformity   and   quality   of    data
                              The first three years have  been  but  a  beginning.          abstracted,   since   each   registrar   follows    mutually
                       Development  of  staff,  a  team  approach,  and  lines  of          agreed  upon   procedures.   A   follow-up   procedure   has
                       communication   has   been   the   major   achievement   so          been   established    through    letters    to    physicians
                       far. The bulk  of  this  program  will  be  self-supporting          requesting   follow-up   information   on    their    cancer
                       by  March  1972,  in  the  estimated  amount  of   $345,000          patients.    This     encourages     continuing     periodic
                       annually.                                                            monitoring   of   the   patient's   condition.   Statistical
                                                                                            reports  which  reflect  regional  experience  and  that  of
                              Based  on  the  recommendations  resulting  from   a          the   individual   hospitals   have   been   prepared    and
                       project site visit, the regional  aspects  of  the  program          distributed.  An  advisory   committee   has   been   formed
                       are being  stressed.  At  the  further  suggestion  of  the          to  provide   the   professional   guidance   required   for
                       site   visitors,   an   advisory   committee    has    been          routine Registry operations.




                                                                                     21







                    Project No. 14 Information Dissemination Service                               Four basic services are available:

                           Target  Group(s):      Health      institutions,                        1.     Photocopy  and  mailing  of   journal   articles
                           health professionals                                                           and loan of books
                                                                                                   2.     Preparation of subject bibliographies
                           Primary   Purpose:   Provide   library   service                        3.     Reference service
                           to   health    professionals   and        health                        4.     Library    management    consultation    service
                           institutions                                                                   to hospital libraries.
                           Geographic    Scope:    Western     New     York                        During  the  first  year  of  operation  (June  1970  -
                           and Northwestern Pennsylvania
                                                                                             July  1971)  a  total  of  12,393  requests   were   received
                           Objectives:   Provide   library   services    to                  and processed. These included:
                           health   professionals;    encourage    hospital
                           libraries  to  develop   their   own   services;                        Photocopy of journal articles - 10,812
                           provide   consultation   service   to   hospital                        Journals loaned - 285
                           library personnel.                                                      Books  loaned   -   854
                                                                                                   Bibliographies prepared - 359
                           I m plementation          of  the           Information                 Reference requests - 83
                    Dissemination    Service    began    in    June    1970.    An
                    advisory  group  was   selected   and   a   policy   statement                 A   questionnaire   was   used    to    evaluate    the
                    formulated.   Between   June   and    September    1970    the           project in April 1971. As  a  result  of  interest  indicated
                    project  director   met   with   the   personnel   responsible           through    the    questionnaire,    two    workshops     were
                    for  library  service  in  the  hospitals   in   the   region.           conducted  for  members  of  the  hospital   library   staffs
                    Publicity   was   prepared   and   mailed   to   all    health           in   August   1971.   Subjects   presented   for   discussion
                    professionals in the region.                                             included  reference  tools   used   in   medical   libraries,
                                                                                             biomedical    communication    networks,    and    principles
                                                                                             of  library  management.  Fifty  percent  of   the   requests
                                                                                             have   come   from   health   professionals   in    hospitals
                                                                                             serving the inner city population.

                    FIGURE 10. FINANCIAL STATEMENT - March 1, 1971                      February 29, 1972
                    For the year March 1, 1971 - February 29, 1972, the Regional Medical Program for Western New York was awarded
                    $1,363,440, including a re-award of $197,108 for the development of an intensive care unit for the Respiratory
                    Program. From this total the following projects were budgeted:
                                                      Core Program                                          $      453,100
                                                      Telephone Lecture Network                                    122,678
                                                      Coronary Care Training Program                             50,795
                                                      Chronic Respiratory Disease Program                          423,771
                                                      Intensive Care Unit - Respiratory Program                    197,108
                                                      Tumor    Service    Registry                               65,050
                                                      Information    Dissemination     Service                   50,938
                                                                                                                $1,363,440

                                                   The following special activities were financed from Core Funds:

                                                      Rural Externship Program                              $    12,000
                                                      Migrant    Health    Program                               14,500
                                                                                                                 10,000
                                                      Lake Area Health Education Center
                                                      Continuing Education (Teaching Days)                           4,500






                                                                                      22







                                                                STATUS OF PROPOSALS

                       FIGURE 1 1. STATUS OF PROPOSALS
                       The following proposals went through the RMP/WNY review process during 1971-72:

                                                                                                                         Result of
                                           Title                                         Author                      HOWNY       review         Period
                       Postgraduate   Training   for   General   Practi-         Thomas Aceto, Jr., M.D.               Approved                 1 year
                       tioners and Pediatricians  in  a  Pediatric  Sub-
                       Specialty
                       Acquisition  of  Psychomotor  Skills  in  Surgery         Gavriel Saivendy, Ph.D.               Not     Approved         1year
                       Master  Plan  for   Planning   and   Articulation         Phyllis Higley, Ph.D. (1972)          Approved                 1year
                       of   Allied   Health   Education   in   the   WNY
                       Region
                       Allegany County Mobile Health Clinic                      Virginia Barker, Ph.D.                Approved                 3 years
                       Provision  of  Homemaker  Services   in   Niagara         Howard Patton, M.P.H.                 Not     Approved         1 year
                       County
                       Hospital  based  Continuing  Health   Care   Pro-         Norman Courey, M.D.                   Not     Approved         3 years
                       gram for Women
                       Continuation  of  Chronic   Respiratory   Disease         John Vance, M.D.                      Approved                 3 years
                       Program
                       Short-term Group T h  e  r  a  p  y  for  Cardiac         Lawrence Golden, M.D.                 Not     Approved         1 year
                       Patients




































                                                                                      23







                    FIGURE     12.     PROPOSALS     SUBMITTED     TO     WASHINGTON     AS      PART      OF      RMP/WNY'S      TRIENNIAL      GRANT
                    APPLICATION FOR MARCH 1, 1972 - FEBRUARY 28,1973.
                    Proposals  approved  in  1971-72;  proposals  approved  in  previous  years  but  as  yet  unfunded;  and  currently   operational
                    projects were  all  reviewed  by  the  Regional  Advisory  Group.  The  following  activities  were  judged  to  be  most  germane
                    to the  new  RMP/WNY  goals  and  objectives  and  were  included  in  the  triennial  grant  application  as  part  of  RMP/WNY's
                    program of activities for March 1, 1972 - February 28, 1973:
                                                                                                                                 Amount      requested
                                    Title                                                    Coordinator                         (for  72-73   period)
                    Telephone Lecture Network                                    Joseph Reynolds                                        108,117
                    Tumor Service Registry                                       John Patterson, M.D.                                    78,052
                    Information    Dissemination     Service                     Jean Miller, R.N., M.S., M.L.S.                         54,947
                    Chronic Respiratory Disease                                  John Vance, M.D.                                       151,853
                    Program
                    A   Model   for   Comprehensive   Family                     Ernest Haynes, M.D.                                    217,689
                    Health
                    Comprehensive   Continuing   Care    for                     Earl Noble, M.D.                                       243,290
                    Chronic Illness                                              Evan Calkins, M.D.
                    Master  Plan  for   Planning   and   Ar-                     Phyllis Higley, Ph.D. (1972)                            18,542
                                                      Educa-
                    ticulation of Allied Health
                    tion in the WNY Region
                    Allegany County Mobile Health                                Virginia Barker, Ph.D.                                 151,853
                    Clinic



                                                                                               matters  in  the  counties,  are  serving   both   RMP   and
                        Those interested in health    care  problems  in  the                  CHP.  CHP  currently  provides  written   comment   on   all
                  region often wear multiple hats.    The  presence  on   the                  grant   proposals   that   are   processed    through    the
                  H.O.W.N.Y.,  Inc.,  Board  of  members   who   also   serve                  RMP/WNY    review    mechanism.     At     the     September
                  with  other  health-related  organizations  is   often   an                  Workshop,   RMP/WNY   profited    from    the    involvement
                  informal, but  highly  effective  arrangement.  It  permits                  of  CHP  staff  and  Board  members  in  the  definition  of
                  information  exchange  and   collaborative   planning   and                  RMP/WNY's goals and objectives.
                  discourages   inefficient   and   costly   duplication   of
                  effort.                                                                             A  number   of   consumer   groups   -   Parents   of
                                                                                               Diabetic    Children,    Hemophiliac     Foundation,     and
                        There  is  staff  cooperation  in   committees   that                  others  -  have  benefited  considerably  from   RMP   help.
                  serve    both    the    Comprehensive    Health    Planning                  RMP  has  supported   their   efforts   in   education   and
                  Council  of  Western   New   York   (CHP)   and   RMP,   as                  information    dissemination,    made     their     programs
                  well   as   a   strong   relationship   between   the   two                  known  to  the  community,  and   provided   them   with   a
                  directors.  The  sub-regional  county   committees,   since                  communication    mechanism     through     the     Telephone
                  they  involve   those   actively   interested   in   health                  Lecture Network.




                                                                                     24









                                                      FIGURE 13. RMP FOR WNY RELATIONSHIP TO
                                                                      OTHER HEALTH RELATED ORGANIZATIONS



                                                                                                                    VOLUNTARY HEALTH AGENCIES



                                                                           PROFESSIONAL SOCIETIES


                                                     COUNTY
                          APPALACHIAN                HEALTH
                            REGIONAL                                             H ORGANIZATION
                          COMMISSION                                            STERN NEWYORK, INC.
                                                                                                                                          UNITED
                                                                                              COMPREHENSIVE                               HEALTH
                                                          VETERANS                            HEALTHPLAN                                  FOUNDAriON
                                        MODEL               ADMINISTRA-
                                        CITIES
                                                                                                                                     MEDICAL SOCIETIES




                                         ER I E COUNTY                                    RI
                                                                                                                                  K MEMORIAL INSTITUTE
                                         HEALTH    DEPARTMENT    40
                                                                                                                                   COMMUNITY
                                                                                                                                   SERVICES
                                        AMERICAN                                                                                   RESEARCH AND
                                                                  HOSPI7                                                           DEVELOPMENT
                                        CANCER SOCIETY
                                                                  ASSOCI     I
                                                                                                                                             HEART
                                                                                                                                             ASSOCIAriON
                                                                         SUNY
                                                                         SCHOOL                 STATE HEAL                                   OF
                                                                                                DEPARTMENT                                   WESTERN
                                                                         OF MEDICINE                                                         NEW YORK, INC.




                                                                               RESPIRATORY AND
                                                                               TUBERCULOSIS ASSOCIATION
                                      FORMAL    RELATIONSHIP                                                                       LOCAL GROUPS
                               M.     WORKING RELATIONSHIP
                               r-I    INFORMAL


                                      The   relationship    between              Working   relationships   in-                  Those   organizations    with
                               various health-related     organiza-        volve a continuing  cooperation  in           which  RMP  has  informal  relation-
                               tions  and  the  RMP  for  WNY   may        areas such as  awarding  continuing           ships  are  a  rather  broad  group.
                               be divided  into  three  categories:        education credit for  participation           Concerned  agencies  tend  to   band
                               formal,   working,   and   informal.        in  TLN  programs,   co-sponsorship           together to deal with  a  particular
                               Formal  status  entails  representa-        of teaching days, or joint planning           program or problem.
                               tion  on  RMP's  Regional   Advisory        for community health.
                               Group, the  Board  of  Directors  of
                               the Health Organization  of  Western
                               New   York,   Inc.,   as    mandated
                               in  the  by-laws  of  the   Regional
                               Medical Program.












                                                                                           25






                                                    r4
                      Spec'soal Conce s
                      RAfPm'VVIVY

                      Manpower Development
                      Area Health Education Centers
                      Rural Health Problems
                      Inner City Problems
                      Health Maintenance Organizations














































                                                                       27





                            MANPOWER DEVELOPMENT                                                         Projects    funded     by     RMP/WNY     have     aimed     to
                                                                                                                 manpower   problems.          For              example,
                                                                                                  alleviate
                              Nursing   and   allied    health    professionals    have    a      inhalation    therapists,    coronary     and     respiratory     care
                            strong   voice   in   RMP/WNY.   The   needs   of   the   health      unit   nurses,   and    medica.I    record    librarians    have    been
                            professionals  of  the  region   are   regularly   assessed   in      trained   under   the    auspices    of    various    projects.    The
                            order  to  establish  objectives  that  will  assist   them   in      Telephone     Lecture     Network     offers     a     program      of
                            providing    better    health    care.    An    allied    health      continuing    education     for     the     entire     spectrum     of
                            committee,   recently   formed   under                   RMP/WNY      health professionals. (see figure 14)
                            auspices,  has  established  goals  for  the   proper   use   of
                            allied   health    manpower    and    presented    a    position         AREA HEALTH EDUCATION CENTERS
                            paper   on  allied    health    participation      in        the
                            development   of    the    area    health    education    center               Early   in   1971    discussions    were    initiated    with
                            concept   to   the   Lake   Area   Health   Education    Center.         representatives        of Erie,   Pennsylvania.           hospitals
                                                                                                     concerning    the    establishment    of     an     area     health
                               RMP/WNY    is    exploring    ways    to    alleviate     the         education    center.     RMP/WNY     acted     as     a     liaison
                            severe    shortage    of    health    manpower:    (1)     Staff         between   this   group   and   the   State   University   of    New
                            members   have   attended   conferences   held   to    stimulate         York   at   Buffalo.   Initial   understanding    and    subsequent
                            the   development   of   new   types   of    health    manpower,         commitment   to   the    center    concept    was    obtained    in
                            and  consultants  have  visited  the   program.   (2)   Existing         writing     from     participating     groups.     A      composite
                            manpower  could   be   better   utilized   if   health   workers         document    contains    a    record    of    progress    i6     the
                            received  basic  training   in   a   unified   core   curriculum         establishment    of    the    Lake    Area     Health     Education
                            which   would   allow   them   to   work   in   whichever   area         Center (LAHEC).
                            has   the   greatest   need,   and    advance    through    more
                            specialized   training   after   the    basic    program.    (3)                The center       concept   was   based   on    four    broad
                            Students   are   encouraged   to   consider   health    careers.         goals:
                            RMP/WNY   is   currently    cooperating    with    the    United                        1.       Conduct      basic      and      continuing
                            Health    Foundation    and    CHP    to    plan    a     summer                                 education      programs      under      the
                            experience   in   health    agencies    for    local    graduate                                 supervision  of  the   faculties   of   the
                            students  who  are  interested  in  pursuing  careers   in   the                                 c o I I e g e a n d     u         niversity
                            administration of health programs.                                                               health-science  centers   with   which   it
                                                                                                                             is  affiliated  and  in  cooperation   with
                                 Highly   trained   specialists   of   the    region    have                                 local professional associations
                            involved   themselves   with        RMP/WNY              through                        2.       Provide    guidance    to     comprehensive
                            categorical   committees.   Committees    have    defined    the                                 colleges   and   community   colleges    in
                            promotion    of    educational    programs    held    throughout                                 the   area   in    the    development    of
                            the  region  as  their  primary   role.   A   small   investment                                 training   programs   for   allied   health
                            of   RMP   funds   has   allowed    cooperation    with    other                                 professions
                            agencies  to  meet  the  needs  of   local   practitioners   for                         3.      Promote       the     existence           of
                            education  and   consultation   in   their   own   home   areas.                                 community-hospital        services       of
                            These    educational    activities    of     the     categorical                                 outstanding    quality    and     cooperate
                            committees  have  brought   RMP   visibility   in   the   region                                 with     health-care        f aci I  ities,
                            and  the  good     will    of    practitioners.    They     have                                 institutions,   and   agencies    in    the
                            contributed   to   better        utilization    of      existing                                 planning    and    development     of     a
                            manpower   in   that:   (1)   Specialists   are   brought   from                                 health-care   delivery-system    that    is
                            their  ivory   towers   and   through   lecturing,   consulting,                                 more      effective,             efficient,
                            and   answering    questions    they    have    been    provided                                 economical,   accessible,                 and
                            access    to    the     community.     (2)     Knowing     about                                 acceptable  to  all   levels   of   society
                            improved    modes    of    treatment     has     given     local                         4.      Conduct   research                 programs
                            physicians    the     opportunity     to     practice     better                                 concerned       primarily   with          the
                            medicine.  (3)  Problems  stated  and  help   given   not   only                                 evaluation          o f         health-care
                            inf I u ence   referral    patterns     but    the      personal                                 delivery-systems          as           well as
                            involvement   has   a    major    role    in    education    and                                 appropriate    surveys    of    health-care
                            ultimately in quality of care.                                                                   manpower     and     their     utilization.


                                                                                                 28





                          During 1971, programs in continuing education have been held throughout the region for physicians, nurses, and
                          allied health professionals. Several of the programs were aimed at multi-disciplinary audiences. "Family Management
                          of the Chronically 111" was also attended by interested individuals from the community at large.

                          FIGURE 14. PROGRAMS IN CONTINUING EDUCATION, 1971


                          DATE                           PROGRAM                        LOCATION               NO. REGISTRANTS                   CO-SPONSORS

                          2/25/71               "Family    Management    of    the      Statier Hilton Hotel                 350           Continuing    Medical    Education
                                                Chronically 111"                        Buffalo, New York                                  School  of   Medicine
                                                                                                                                           S.U.N.Y.A.B.
                          3/4/71                Cancer   Teaching   Day    "Cancer      Buffalo Mercy Hospital               300           Department   of   Surgery,    Buf-
                                                Chemotherapy - 1971 "                   Buffalo,  New  York                                falo  Mercy   Hospital,   Buffalo,
                                                                                                                                           New    York;    American    Cancer
                                                                                                                                           Society,   Erie    County    Unit,
                                                                                                                                           Buffalo,   New   York

                          4/20/71               "From    Study    Into     A6tion"      Sisters of Charity Hospital          200           - - - - -
                                                Jerome   P.    Lysaught,    Ed.D.,      Buffalo, New York
                                                Director,   National    Commission
                                                for  the  Study  of  Nursing   and
                                                Nursing Education
                          4/29/71               Pulmonary   Teaching   Day    "Re-      Holiday Inn                          150           Tuberculosis    and    Respiratory
                                                habit itation Care of the  Patient      Olean, New York                                    Disease  Association,  Olean  Unit
                                                with Pulmonary Disease"                                                                    Olean, New York
                          5/19/71               Pulmonary   Teaching   Day    "New      Ramadalnn                            130           Northwestern Pennsylvania
                                                Trends   in   Pulmonary   Disease"      Erie, Pennsylvania                                 Tuberculosis    and    Respiratory
                                                                                                                                           Disease Society
                          5/26 and              Stroke    Workshop    "A    Multi-      Veterans    Administration    Hos-   165           Veterans    Administration    Hos-
                          5/27/71               disciplinary   Approach   to   the      pital, Buffalo, New York                           pital, Buffalo, New York
                                                Rehabilitation  of-   the   Stroke
                                                Patient"
                          6/3/71                Cancer   Teaching   Day    "Modern      Castle Inn                           175           American  Cancer   Society,   Cat-
                                                Trends   in   the   Treatment   of      Olean, New York                                    taraugus   County   Unit,   Olean,
                                                Breast Cancer"                                                                             New York
                          8/27 and              "Therapeutic   Work   with   Older      Campus   School,   State   Univer-   150           School of Social Work
                          8/28/71               Persons and Their Families"             sity College at Buffalo                            Syracuse   University
                                                                                        Buffalo, New York                                  Syracuse, New York
                          9/20 and              Pulmonary   Workshop   "Care    of      Statier Hilton Hotel                   75          Tuberculosis    and    Respiratory
                          9/21/71               Patients   with   Pulmonary   Dys-      Buffalo                                            Disease Association of WNY
                                                function:  Nursing  Makes  a  Dif-                                                         Erie County Unit
                                                ference"                                                                                   Buffalo,   New   York
                          9/23/71               Cancer  Teaching   Day   "Progress      Holiday Inn                          150           American Cancer Society
                                                in Cancer Therapy"                      Batavia, New York                                  Genesee County Unit
                                                                                                                                           Batavia,   New   York
                          12/4/71               Cancer   Teaching    Day,    "Some      Showboat Restaurant                  100           Doctors    Hospital,    Tonawanda,
                                                Aspects of C u r r a  n  t  Cancer      Buffalo, New York                                  New    York;    American    Cancer
                                                Treatment"                                                                                 Society,   Erie    County    Unit,
                                                                                                                                           Buffalo,   New   York
                          9/27, 10/4,           Inservice    Pulmonary    Teaching      Veterans    Administration    Hos-     51          Veterans    Administration    Hos-
                          10/18, II/l/71        Sessions                                pital, Batavia, New York                           pitat, Batavia, New York
                          11/4, 11/11,          Inservice    Pulmonary    Teaching      W.C.A.    Hospital,     Jamestown,     62          W.C.A.    Hospital,     Janwstown,
                          11/18, 12/2/71        Sessions                                New York                                           New York


                                                                                                  29








                                In   its   role   as   an   enabling    agency    RMP/WNY         Manpower    Committee    expanded    the     program     during
                         brought    together    the    various     agencies     initially         the   summer   of   1971.   An   eight-week   interdisciplinary
                                                                                                                                m    involved     students     in
                         necessary    for    the    creation    of    LAHEC.    RMP    is         rural     externship     progra
                         facilitating  the  close  cooperation  of  these   agencies   in         medicine,       dentistry,      and    the       health-related
                         such  a  fashion  that  all   are   equal   partners   in   this         professions.  A  total  of  20  students   were   placed   with
                         enterprise.   The   Telephone   Lecture   Network   will    play         preceptors   in   12    communities    within    the    region.
                         an  integral  role  in  fulfilling  some  of   the   educational         Central  objectives  of  the  program  were  (1)             to
                         requirements of the Center.                                              encourage health science students to pursue careers          in
                                                                                                  rural   areas   and     (2)   to  contribute  to         better
                                RMP/WNY    staff    members    were    present     during         communication    between    the    University    center     and
                         the site-visit of LAHEC on July            an        y  a  joint         rura communi ies.
                         federal   team   from   the    Veterans    Administration    and
                         the   Department   of   Health,    Education,    and    Welfare.               Flexibility  in  arranging   schedules   for   individual
                         RMP   has   supported   the   concept    that    LAHEC    should         externs   allowed   the    maximum    orientation    to,    and
                                                                          n - p r o f i t         involvement   in,   the   unique   aspects   of    the    rural
                         o p e r a t e    a s   a    p u b I i c ,    n o
                         corporation-for-education-and-scientific-purposes;                       community.         A    I iaison    network     of      faculty
                         such   an   incorporation   seems   the   most   effective   and         representatives,   the   student   coordinator,   the   project
                         efficient  manner   both   for   reaching   the   goals   sought         directors,     and     RMP/WNY     staff     assured     smooth
                         by   the    LAHEC    committees    and    for    managing    the         administration   of   -    the    program.    The    externship
                         funds  it  will  receive  from  a  broad  category  of  sources,         program  is  currently  being  evaluated   from   the   student
                         both local and federal.                                                  diary,   preceptor    record,    personal    interviews,    and
                                                                                                  questionnaires  distributed   at   the   orientation   and   at
                         RURAL HEALTH              PROBLEMS                                       the de-briefing  sessions.  A  measure  of  local  interest  is
                                                                                                  the    $9100    contributed    to    the    Rural    Externship
                                                                                                  Program       by     hospitals,   physicians,    and      local
                                Since   the   9   counties   are   predominantly   rural,
                         RMP/WNY  has  always   had   a   special   interest   in   rural         governments.
                         health     problems.     The     Rural      Health      Manpower
                         Committee   is   comprised    of    a    broad    spectrum    of               Community    leaders    in    rural     Allegany,     the
                         acad em ic ians,     practitioners,     representatives       of         smallest   of   the   nine   counties,   have   established   a
                         community  groups,  and  health departments.                  Is         committee   which   surveyed   the   health   needs   of    the
                         committee  asked  to  meet  under  the  aegis                 of         county   and,   based   on   these    well-documented    needs,
                         RMP/WNY  to   consider   ways   in   which   the   training   of         developed  with  their  local   university   a   proposal   for
                                                                                                  improving   health   education   and   service   in    Allegany
                         health  professionals   can   be   more   pertinent   to   rural
                                                                                                  County.
                         health care needs.
                         RURAL EXTERNSHIP PROGRAM                                                       The salary of     a  director  of  clinics  for   migrant
                                During    the    summer    of    1970,    the     Student         workers   was   assumed   part    of    this    year    as    a
                         American    Medical    Association,    under    contract    with         developmental     enterprise.     RMP/WNY      proposes      to
                         the     Appalachian     Regional     Commission,     and      in         support   the   RMP    Rural    Health    Manpower    Committee
                         cooperation    with    the    Western    New    York    Regional         in  its   activities;   work   closely   with   county   health
                         Medical    Program,     developed     a     nine-week     summer         officers   and   county    public    health    committees    in
                         program   in   which   a   total   of   nine   students,    from         meeting   migrant   workers'   health    needs;    work    with
                         schools   of   medicine,   dentistry,    and    nursing,    were         other   groups   concerned   with   rural   health   such    as
                         placed   with   preceptors   in   various   rural    communities         Appalachian    Regional    Commission,    the     Office     of
                                                                                                  Planning  Services,   OEO,   and   SAMA;   and   assist   rural
                         in     three     western     New     York     counties-Allegany,
                         Cattaraugus,   and   Chautauqua.   The    students    had    the         'people   in   making   their   voice   heard   in   RMP    and
                         opportunity  to   participate   in   rural   medicine   and   to         developing   proposals    and    implementing    projects    to
                         experience,  firsthand,  the   pattern   of   health   care   in         meet their needs.
                         these    communities.    RMP/WNY    placed     students     with
                         their   individual   preceptors.   As   a    result    of    the
                         successful   1970   summer   experience,   the   Rural    Health





                                                                                           30









                     INNER CITY HEALTH PROBLEMS


                           Positive  action  has  been  taken  through  many        and   tested.   It   behooves   the   Regional   Medical
                     channels to assist  inner  city  residents.  Two  major        Program,  which  reflects  many  of  the  interests   of
                     proposals for next year  involve  two  hospitals  which        providers,  to  involve  itself  in  the  efforts  which
                     are located in and serve the inner city. One involves a        validate the concept.  RMP  will  participate  in  those
                     family practice training center and the  second  is  an        efforts supported  by  the  medical  societies  and  the
                     attempt  to  minimize  the  in-hospital   episodes   in        State University of New York at Buffalo.
                     long-term illness.
                                                                                          The current status of the concept in  this  region
                           The Cooperative College Center at  Buffalo  is  a        is as follows:
                     preparatory  institution  for  students   whose   prior
                     academic  experiences  do  not  meet  the  demands   of              1 .   The   RMP/WNY   Director,   together    with
                     college   admissions.    RMP/WNY's    Health    Careers                    CHP,  the  University,  and  others  in  the
                     Committee is helping the Center  in  developing  Health                    health field, are  exploring  means  whereby
                     Careers Days, serving as a liaison between  the  Center                    the  new  university  campus  can   be   the
                     and  the  health  community.  RMP   is   assuring   the                    basis for an HMO.
                     presence of faculty and  students  from  area  colleges              2.    The  Urban   Development   Corporation,   in
                     and  SUNYAB,  as  well  as  representatives  of  county                    consultation  with  one   of   the   RMP/WNY
                     and state health departments and local hospitals.                          Board members and  a  group  in  the  health
                                                                                                field, is devising  a  plan  to  provide  an
                           On June 23, 1971,  a  meeting  was  held  in  the                    HMO  for  a   new   population   development
                     RMP   conference    rooms    between    RMP/WNY    core                    area on the Buffalo waterfront.
                     staff and representatives of inner city  organizations.              3.    The  staff  of   RMP   have   been   closely
                     It was organized  at  the  request  of  the  inner-city                    involved  in  the  development,  submission,
                     groups  to  seek  specific  short-term  commitments  of                    and  rewrite  of   the   HMO   for   Wyoming
                     RMP. Specific proposals to  be  submitted  to  RMP  are                    County.  This   complicated   document   was
                     being constructed by inner city groups, in response  to                    proposed under  the  leadership  of  one  of
                     this  meeting.  A  staff  member   represents   RMP/WNY                    the   RMP/WNY    county    committees.    It
                     on Model Cities Health Committee.                                          provides  an  opportunity  for  the  current
                     HEALTH MAINTENANCE                                                         providers  to  participate,  but  does   not
                     ORGANIZATIONS                                                              eliminate  the  possibility  for  conducting
                                                                                                medical practice  in  the  long  established
                           The concept of  HMO's  has  raised  a  number  of                    pattern. This  document  was  not  subjected
                                                                                                to  the  RMP/WNY  regional  review  process.
                     questions and has  yet  to  be  empirically  documented
























                                                                              31
























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

                                       Executive Director for the Regional Medical Program for Western New York
                                                                John R.F. Ingall, M.D.




                                                  Regional Medical Program for Western New York
                                                 2929 Main Street
                                                  Buffalo, New York 14214
                                                       Telephone: (716) 835-0728



                              The Regional Medical Program for Western New York is affiliated with the School of Medicine
                                                    of the State University of New York at Buffalo.














                                              As of March 1, 1972 the name of the program
                                              was changed to Lakes Area Regional Medical
                                              Program, Inc.