*EO(D 1 431








                                   SPECIAL ACTION REQUEST
                          Colorado/Wyoming Regional Medical Program


              Purpose:  The purpose of this request is to raise the current recommended
                        National Advisory Council level for the Colorado/Wyoming  RMP
              from $1,102,346 to $1,252,346.effective July 1, 1972.  This  recommended
              increase of $150,000 is exclusive of any EMS or Community Based  Manpower
              Educational System applications (out-of-phase supplements) which  might
              be presented to this meeting of the Council membership.

              Rationale of Request:  The Colorado/Wyoming RMP was-approved for Triennial
                                     status and was awarded developmental component
              funds by the November, 1971 NAC. At the time the Region  submitted  its
              application, a tight-funding policy was in existence since all  Regions
              had suffered a 12% reduction some 4 months earlier.  Because of this reason,
              the Colorado/Wyoming RMP had submitted a three-year application which
              requested a most conservative budget proposal. All activities  which  had
              been approved by the RAG were rated utilizing a priority  system.  This
              process allowed only 9 of the 24 approved activities to be included in the
              application in order for the request to stay within the limited  funding
              forecasted for the Region. As a result, an additional  12-15  proposals
              could not be considered for funding during the first year of the Triennial
              which started January 1, 1972.

              Additionally, at the end of this calendar year, only 3 of the 9  project
              activities currently being funded are due to terminate.  These terminations
              will provide only $73,000 for new activities next year.  Also, of -
              paramount interest is the fact that several new activities have  already
              been stimulated'which have a direct bearing on the new mission of  this
              Region.  One such activity is entitled, "Student Health Program for Migrant
              Agricultural Workers and Rural Poor."  This proposal has come about
              through the leadership of a Chicano who now serves on the RAG.  This
              particular type of activity had been strongly recommended by the site
              visit team which had visited the Program in-September, 1971.

              Conclusion: RMPS staff are of the opinion that this Region  is  beginning
                           to move and needs additional funds in order to pursue
              those activities which have been stimulated with developmental  component
              funds. In view of the tight turn-around monies available next  year,  we
              feel that an increase of $150,000 (d.c.) for each of the next 2 1/2
              years, starting July 1, 1972, would be a good investment.  If  approved,
              this Region would be receiving an increase of approximately 15% over  the
              pre April 1971 level.

                                              Respectfully submitted,


                                              Mid-Continent Operations Branch
                                              May 25, 1972






                                              .2
                  Com.,nonent And Finnnclnt Stimrnnry   Anniversary Apollcation



                                                                                IE C I f D v D
                                F.@ i'T
               qEIIT       CURII                 YFA@_             YF/,R
                           YRIS AWARD        #COU.'@C'L                           FUIM I 'IC
                              OPER.           fECO,"G,2@'DED   'REQUEST           x SARP
                           YF,AR              T,FVFT,                                REV. coal


                                                              1,020,400
     CORP                    93Z,846
     Sub-(,oiitracts
                             415,757                            577,500
     OPER,   ACTIV.

                        DISAPPROVED
     'DF,VET, COIT.                                             134,860*')
                                                                                 Yes      or 1',


     F,ARMARKS.,
         V                                                                        125,000
        ,T,T),,-F                                              (125,000)
             ,y (@,40)       111,826(d(
        cities (i@T45)        5.2,810                          (.-15,550)
                                    (dci)

       @BES Y@51                                           See Below





     P,Iin DIRECT          1,348,603     1 800,boC,'-D'      1,732,760         1,425,000*@,
     R F, 2L@, F, S -, F D2,750,577

     COJNCIL
     APPROVF'N TEVEL      1,800,000

     NON-Rl4PS  nnd
     TIZCO,V,E


       Under 2/8/72 Nr@C Policy, the  approved
                                                                   RF
       N@C level for @Lhe first year of th6                                   KANSAS
       Tri erni um prevail s
                                                                     June       t972
       klithdra,,,in by KRo',P                                                       R'EVIEII CYCI
       PLUS kidney funds of $125,0'00
       This amount inc Iti4e s. $125 000. f or #4-0 and $3 9', @5-0. for #45
  @*'--**Pendl'.ng is the fiNIlowing requ6sts: CBES, $123,3.04:-(for one year)
         Current program  request  1,732,760
         CBES request                 123,304
                                  $1,856,064

                                                                             -Revi.sed 5/25/72




                                 KANSAS REGIONAL MEDICAL PROGRAM
                           Anniversary Application within a Triennium


               PART I
               Staff Briefing Document                                             Page
                 Face Page.                                                 .
                 Map of Kansas Subregions   . . . . . . . . . . . . . . . . . .       2
                 Kansas (State) Profile  . . . . . . . . . . . . . . . . . . .        3
                 Component and Financial Summary  . . . . . . . . . . . . . . .       4
                 MIS Breakout of Request (06-07 period)                   . . .    5- 6
                 Accomplishments, Problems, Issues. . .                   . . .       7
                 Staff Review Report.                 . -                 - - .     8-10
                 RMP Review Criteria . . . . . . . . . . . . . . . . .    0 . 0    11-13

               PART II

                 Kidney -- not applicable

               PART III
                 Funding History (01-07 period)
                 KDIP Funding Statement
                 Summary of Core Feasibility and Planning Studies
                 KRMP Core Breakdown and EEO Breakdown
                 KRV,P RAC and Committee Data

               PART IV
                 KRMP Trip Report:  Staff Visit
                 KRMP Trip Report:  Staff Evaluation
                 Report:  Meeting of Dr. Margulies, KRMP Staff

               PART V

                 Advice Letter


               PART VI
                 Management Assessm,ent Visit     not applicable
































                                                        PART I



                                                R4S
                                      STAFF BRIEF@a'G DOC




   FEGION     Kansas                               OPERATTONS          Eastern       Mid-Continenr,
                                                       BRANCH          South-Central Z7 Wester.-.

                                                   BRANCH
   rYPE, APPLICATION:        B     LAST RATING     Tel.   No.   443-1790   Room    10"15
   E7        IAL           Feb.  197 1  DATE       BRANCH CHIEF   Michael J. Posta
   C&7 lst ANNIV YEAR           SARP               BRANCH STAFF     Mary E. M@hy
   Z7 2nd ANNIV YEAR       Z7 REV.   COM.          RO.   REP.       Ray Maddox
   eL7 OTHER               ZV OTHER  Staff         Last @%t. Assin't Visit                        10/7

                                                   Chai,man

   LAST S. V. Mar 4-5    197 1 -; Chair,,im  Alexander M. Schnddt, M.D.,
   @l'..aff Visits, last 12 mos. (DaLes, Ch      Is Name and Type of Visit)
    /i6/71 - Technical Site Visit - Cc=rehensive Nephrolo@@ r@rain. Prog. MC             Francisco
              Oonzales, M.D4
       12  1  -
               -,,ET Eva]-T-aL@icn -iisit Harold  O'Flahe  1-Y
                                                             ai
                                                                        Z' zi.avs-@,7
                                                               icL L      L


   KAJOR EVENTS @l. CH OCC       IN THE R'PGIOIN @(,.II\TG alE RMP SINCE ITS LA.ST FEVIEW
   in         197 1

   Ki'disAS L@TS
                                 r)f, tl??
                                                                                              (7/1
   2.  366--'L,al and Rehabilitation SePvice Contract of $55,800 to Atchison, TO'Oeka and Santa
       l,b Memorial Hospitals  Inc. to exolore a possible FHO (r@y 172)

   IDIP EVE, NTS
   10      I@ m Anderson, forTrer @@ctor,of Planninc, Services  Kansas Blue Cross-Blue Shiel-@
       Topeka, and Regional Advisory Council @rrber, a-,opointed l@ Associate Director
   2 . Mr, Roy C. Hoi e nc)r,,iinalu-ed and app--oved as Chai-   Re@Lonal Advisory Counci .  i@irs.
       Tom Gordon approved as Vice-Chaii-r;an.
   30  SubreFaonal Office changes:  (1) Northwest (Colby) Coordinator resigied; (2) Flint H'--,'
       (E,.@6ria) Coordinator resigned and office closed 7/71; (3) Central (nureat.Bend)
       CoordinE,,tor resigied 2/l/72- (4) l@orthcentral (Salina) Coordinator resi@ed.  Coor-l-ina-
       mp acemnts appointed to Great Bend and Saliiia.


                                                KA@SAS RFGIONAL O,:DICAL  P,ROGRAM
                                            Subregional Areas anc: Office Locations

                                                          July 1, 1971



                          "CATOR    tiaotrag F;4iLLI   SMi7'ii            REPUBLIC             t4ARSHAt-L t4EMAIIA BRO"



                                                                                     CIL A  R
                                                          PA
               COLBY                                                                                               I  Sol







         Wi@47A  SCOTT    Lagci    I
                                                                                                 ASC
                                                          GFEAT   R@CE


   4 i Lroq vc@y  F1149LIf

                  GiL
                   ci
                    c
                                                                                                                      WED
                                                        ,Aar
                                                                                                                      ICHA

                                     CLARK                                   @VOR
                                                                     QRPER






      FUIONAL               CL@CTERISTTCS


            Kansas   @ encotrpases the State of Kansas.(82-OL18 sq. r@ules)
            Counties - 105
            Congressional Districts -           5

      POPUIATION      (1970       Census)
            Total Population:           2 249,loo
            Popu-lation        Density: 27 per sq. i-aile.
            % Urban:                    66
            % Non-White:                6 (Amri                        8
                                                   can Indians.        ,700)

      AGE DISMIBIEION
            % Under 1  yrs.:          33
            % 18 - 65 yrs.:           55
            % 65 yrs. & over:         12

      @INCOIC
            Tv-erage Incorne per Individual @1970)                $318011
            U.S.    Average    -    $3,910
      MORTPJJTY RATES          per   100    ooc    (1968)
                                                        Kans@                U.S.
            Heart Disease                               3bO.b                T7 2-.'6
            Cancer                                      157.2                159.4
                   " ar I-esi ons  -Afl',    NS)
            Vascu                                       115    4             105    8
   40       All   c   uses,   all    qqes               97Q.0                @065-i-
      FACILIT]FIS     AND      RESOTJRCES
      Tch-cxu
            Medical School - Univ. of Kansas School  )f Medicine
                  i,o69/70   -    Student    Erirol-i@lent:    497
                  1969/70 - Graduates:   -'L-'L9
            Pro   fessi.onal. Nursing.-, Scho6is
                  19   Sdnools   -   5   Colle,--e    Affiliates
            Accredited Schools for health Professionals
                  Cyto @chnology - 3 (Hospitals:   1 -- Medical Centers:   2)
                  Medical    Technolo,@    -    9
                  '9adiologLc Technology,- 22 (Hospital or Medical Center Based)
                  Physical   'Iherapy   @-   1
                  Inhalat-li  n   Therapy   -   3

      HOSPTTALS - Co             ty    General    and    V.A.    General
                                             No.        Beds
            Short Tem                        l@         11@,    13
            Long    Ten'n     (special)         1              154
            V4A.  (General                      2              947

            .POSTER
                      ans   -   Non-Fiedera.'l   II.D.s   and   D.O.s   (1967)          M.D. Grou-p Praci,!-ces  (1969)
                       ve:   2,388                                                           Single @l)--cia'lty:   24
                  @Inadtive:   292                                                           Genera 1 71"1,ac'ullce:   C'-l
                  Ratio:    106    actiie     per 100.,OOO population                        Multispecialty:             5
                  U.S.    Rate:    132    per    100,000    populeL,41on
            Graduate Nurses





                                                      4


                                                            IVERSARY     APPLICATION
                COMPONENT AND FINANCIAL SUMMARY         ANN

                                                                                                   D
                                                                  T
                                                                                         FUNDING
                                     YR'S AT,]ARD      COUNCIL
                                     05 OPER.          RECOMMENDED       REQUEST         E7 SARP
         COMPONENT                   @EAR              LEVEL                             L3 REV.   COM.
                                     1/l/70-6/30/71

         CORE and                     932,846                              1,020,400
                                                                             577,500
         OPER. ACTIV.                 415,757
         DEVEL4 COMP.                DISAPPROVED                             134@860

         EARMARKSI:
                                      111,826(dc)
           Kidn
            ode
             Cities (#45)              52,810(dc)


                                                                           1,732,760
         RMPS DIRECT                 1,348,603
          4PS INDIRECT                413,441                                414,387
                                     1,,762,044                                   47
         1

         NON-RMPS and
           INCOME

         loi@AL BUDGE-!'
         REQUESTED                   2,750,577
         COUNCIL                     1,900,000
            ROI


              @-Withdtawn by KRMP                                       REGION     Kansas
                                                                        June        972, REVjEiel CYCLE








                                                                                                                       REGION - KANSAS
                 MARCH 17,1972                                                                                           RM 00002 06/72
                                                                        BREAKOUT OF REQUEST                                                 RMPS-OSM-JTOGR2
                                                                         06 PROGRAM PERIOD

                                                                               (4)
                                                 t5)                                             NOT          CURRENT       CURRENT
              NTIFICATION      OF                                                     (  LI                                             I    TOTAL
          IDE                 COMF()NENT     CONT  WITHINI CONT. BEYON")L  APPR. NOT       NEW#
                                             APPR. PERIODI APPR. PERICOI    PREVIOUSL      PREVIOUSLY         DIRECT     I INDIRECT
                                             CF SUPPORT     Of SUilPORT     FUt4OLD        APPROVED           COSTS      I    COSTS

          COOO   P,40CPAM    CORE
          U-OTO-ZTV-EL-C-P@ll-EN-T
                             COt',PONEtiT  PRI

          001    GREAT BE    DUCATICNAT.    Pi                                                                                               -Ia2jL3Z()
                                                                                                                         ----- 122-,32Q-l
          021    KT:,SAS  MEDICAL   LIPR,%RY   Si
                       - - - -- - -  -  -  -  -                                                                     QQ a
          040    UEVEL  (IF  Co@;"tElIENSIVE   Ni

          041    C,%@'@CER I!,FGRMATEL;N  SERIVII
                 - ----------------- - --                                                 --- - -- - - - -
                 C,@'@CLP CARE  r-ONTl-'4UING  El

          044    NLi@(.@f- LLit4[CiAN flf@CGRA14

          04  5  PIt:r@@ L C II Y @tE ALT H
          -    a-, I:-?                    I  !
          046    14EAL I) I SERV I-@ES Tik AI Pi ING I                                                                                                                LTI
                                                                                         J..
                            ----------
          047    DIA@FIES DETECTION  AND  El                                                             II     Z@QCLQ   I
          048    Pf4C)BLEM CPIE%TEU MEOICALI                                                             I

          04q    S@TA@ED 8A,4AG:;tl@ENT ENGINEI           I

          050  HEALTH   OCCUPATIONS   PROMCI
              T[ZBUL PP@Ony@tMS-'                                                                                                           _$22.000    t
                                                                                               S262t860  1  $1*7329760   1    $4l4t367  1  $29147tl47
                          TOTAL



         *Wi@hdrawn by l'IRMP








                                  MAFTCH  17,f972
                                                                                                                                                                                                            REGION        -         KANSAS
                                                                                                                               BREAKCIJT  OF  REQVEST                                                       RM  00002  06/72
                                                                                                                                      PROGRAM  PERIOD                                                                                           AMPS-OSM-JTOGRZ

                                                                                                                                          (4)
                        IDE4TIFICAT ION OF COMPONEt4T                            CONT.           WITHINI  CC4T.            BEYONOI  APPR.  NOr             I  NEW,  NOT                   ACCOL  YEAR
                                                                                                                                                                                                                                                TOTAL
                                                                              I      APPR.       PERICCI  A;l@IR.         PE;ZICCI  PREVIOLFSLY            I  PREVIOUSLY                     DIRECT            I                         I  ALL  YEARS
                                                                              I  CF  SUPPORT           I  OF  SUPPORT            I  FUNDEv'                I  APPROVED                       COSTS             I                         JOIRECT  COSTS  I
                        COGD  PROGRAM  CORE
                        ODOO        DEVELOP-IIENT        COMPONEN-T         PRI
                                                                            --I                                                                                                                                                         -1       s
                        001     GP.LAT       BEt4D        EDUCATICNAL        PI
                        -   -20 cl.,:j M-                    -                I                                                  I
                        E23     K t, N S A @t4 E Ti C t.-L @ I -0 R-A-R  Y-5  I
                        340     C E V E T-  C-F U@M 1-t -E H E N S 1 V  E  N  I

                        041     CANCER            INTORMATION            SERVII                        I

                        042     CA!4CER      C4;(E      CCt.@Ti.@,Ul@4G      El

                        044     NTRSE        CLlf4lClAh        PRCGRAP        I
                                                                              I       s 1
                        045@       lOPFL       CITY       HEALTH        MANPOWI
                        --E?                                                ---
                        046     HCAL"@L           SEPVICES           TRAININ'@L
                                                                                                                                                                    1 4 4   D.Q.0@                   IA64JODD-1.
                        01. 7   C)lAtiETES       DETECTION        AND        El                                                                                                    I                           I
                                                                                                                                                                    S.IOXQQQ-I-                        $3QXQQO-l                         t  -@.E.LQCO             I
                        048     PPI;I)LE-4          ORIENTED           ME31CALI
                                          .   .....  .......                  I
                                                                                                                                                                                                                                                  s@QOO           I
                        049     i     SHAPED     H-'NAGEME.NT     ENGINE      I

                        050     HEALTH          CCCU;>ATIO.14S           PROMOI


                                               -TOTAL                            S    9@,7@2           1                                                          $313,276  1           $l,8O4wO                                               $3
                                                                                                                                                                                                                                                9536,'Iaa



                                    *Withdrawn                      -by.-K-RMP.




                                                                             FEVIEW CYCUI      Jme


         OUSTANDING ACC94PLISIEOZ@ITS BY H,'iP since    Fiat__ 197 1
         1.  Regional Advisory Council redirected ProFrai-a activity from a project oriented
             dire ction to on@ with major er,@has 1 s   on iiiiorovement  in  the  distribution  of  rredica.
             care services throug-i @gionalization.
         2.  @ had an active role in data co.@i-latiori on which were based the plans for.
             estab  shm,--nt of the Uni-v. of Kansas    School of Medicine at V,ich-2Lta State Univ.  (I,,7,'
             pending Kansas Le@lsl.aL@ion.  YailP,actively assisted WSU College of Health Rela@ue
             Professions in getL-ing undeniay and supports it in part.
         3.  Nogotl*lations are mdc-ntay to develop several cities, in addition to Wichi:u-a.1 as
             Area Health Educatio,-i or Area Health Service Centers, namly, Topel<a, Salina, an@@,
             Hays.
         4.  Bylaws of Regional Advisory Co'mcil to lavt amended Oct. 2                        clude the
                                                                                   197'1 to in
             category of Ex-officio @lerrbersl-ij-p; to represent Ve,-erans Administration  CIT 'lb
                                                                                                31
             agency, and Kansas Dental Association.
         5.  Dr. Brown has consulted freely With @a physicians involved in HMO, EMS, and IL@-
             activities.  His assistance has been commended.




         PRD4r-'TPAL PROB@40
         10  Dr. Bro@,in's mde of communication, especially to slibregional staff has presented
             problem.  He has also @ted 1,AG innu'L-1 into the establishment of regional goals
             and objectives.
         2.  RAC relies heavily on Dr. Broin-i for direction of the Pmgram  and  for  setting  FCa@@,
             objectives. and           4- 4-c-s.
         3.  Kansas has se,,iere n--dical ma-,npcivier -Droble @@ tluo@out the state.
                                  "'ice has closed ard coordinators have resigned in
        @4.  One subregions! o.+L.,L                                                         three  addition
             offices. Dr. Brown does not view the fact as a failure or subregiorial-iza.-tion  hg,-T,



          s@- Ul@ i-

         1.  Comn@cation to      the si)b-@gions, staff @d LAG req,@res improvement.
         2.  Relative to the setting of @licy, prior!-ties, goals a-nd objectives,.
             a.  RAC  should  assume  more   leade@hiD
             b.  Priorities should be based on the available data base
             c.  Core staff's expertise should be more readily utilized.
         3.  Me Develop@ntal- Conponentis entire emphasis is directed toward Area Health
             Education, Science, gnd Service Centers.  Should it b-- so restricted?





                 -@4Z LI 95  CL  ;D '- @ i A 1, @ A " 14


                             Mary E. Murphy, Chairman
      Participants:                                          Date: March 24, 1972
      Michael J. Posta (MCOB)              Calvin Sullivan,  (MCOB)
      Frank Zizlavsky (MCOB)               Margaret Hulbert  (DPTD)
      Harold O'Flaherty (AICOB)            Marlene  Hall  (DP&E)
      Joan Williams (MCOB)                 Annie Stubbs (G@1B)


      Recommendation:  Approval of the application which requests
      $1,732,760 (direct  costs)  was  unanimously  accepte'd  by  staff.  The
      amount requested is below  the  National  Advisory  Council  approved
      level of $1,800,000.  The request includes funding of the following:

                       I.  A Developmental Component for the
                           amount of $134,860
                       II. Continuation.of Core (includes 11
                           projects of 46 components)
                      III. Continuation of  7  ongoing  projects
                       IV. Implementation of 5 new projects
                       V.  Termination of 4 projects
                       Please refer to @IIS Breakout of Request.
      Concern was expressed by staff regarding the following points.
      There is much lack of CHP 'lb" Agency  planning  activity  in  Kansas.
      Therefore, RMP Core staff have assumed much responsibility for
      health planning. Kansas RNIP  should  perhaps  observe  and  evaluate
      how the Iowa RMP was successful in stimulating CHP 'lb" agency
      activity.  As CHP functions on a 5011@(@) shared cost basis, local
      jurisdictions should be encouraged  to  elicit  funds  and   stimulate
      CHP 'lb" agency development in the Kansas subregions.
      Each Kansas subregion has its own  Local.  Advisoi@y.Group (LAG).
      Questions were raised relative to the actual initiative of the LAG
      in stimul.atina health activity and in initiating projects.  The
                            It, 4 .11 l@ 4 4-          IT
      in which the Dean, Dr. Cramer RoOd, played    such an active role,
      was cited as an example.  Dr. Reed was a member of    the Wichita LAG.
                                              I
      In reviewing the Regional Advisory Council membership of 24
      members, of which 3 ard ex-officio, it  was  noted  that  the  members
      are thinly spread throughout the five, newly established committees,
      namely:  1) Finance;  2) Planning;  3) Evaluation-  4) Annual Report,
      and  5)  Technical  Review  Committee.  Consideration should  be  given
      to increasing Council membership which would alleviate over extension
      Of- members.  Staff also felt that there should be more consumer
      representation on the Council.
      The KILNIP has not Yet received ,i Management Assessment Visit.  Staff
      recommended that the visit be' made  as  soon  as  possible.  Special
      emphasis shoul.d be placed on how activel.y involved is the RAC?
      Committees, more representative of the program thrust an  new
      national emphasis,  should  be  instituted.  The  presently  standing




      ciLte orical coniiyii-i;tees siioii.La De aDolisiluu. NUW@VUL , Li..k LIU WC3..y
      should the experts on these committees, representative  of  the  heart,
      cancer, stroke, kidney, and related disease  fields  be  disregarded.
      These experts are valuable and could be used on Ad Hoc committees
      established to give technical support and to review related   activities
      and project proposals.
      -It was apparent that the RAC is maturing and apparently  assuming
      a bit more leadership.  A criticism of the RAC, to date,, has been its
      lack of leadership in policy and decision  making.  It  has  functioned
      in a more or less reactionary manner to what has  been  presented  for
      consideration.  With the establishment and involvement by RAC
      members on the new committees, staff hoped for more direct involvement.
      Dr. Robert Broivn's capability as a Coordinator  with  leadership
      ability was acknowledged. His staff was  considered  a  capable  one.
      it was felt that their input could be used to  even  greater  advantage
      than has already been demonstrated. The subregional sta       ave
      felt somewhat cut off from the core of activity   and information source.
      The communication system could stand improvement.
      An evaluation system to be applied to Core personnel is  in  need  of
      development. This evaluation process would  be  the  responsibility  of
      the RAC.
      Two areas of concern were expressed  regarding  ongoing  projects.  The
      Great Bend Educational Program,of which Dr. Brown was the former
     @Project Director, is requesting its 06 year  of  funding.  The  project
      was submitted in the Triennial Application and funded for an
      additional three years which will carry it through %n 07 Year. Council
       olicy was later enacted limiting projects to five years of fun  1110'
      p
      A recommendation  was  made that RMPS staff  consider  the  possibility
      of an  in-depth  evaluation of the Great Bend Project and determine
      what impact it has  had  on the area it has served.
      The question  of  licensure was raised regarding  the  training  of
      Physician'8  Assistants  by the Nurse  Clinician  Program.  The  present
      'no  present a licensure problem.            should  the  training
      be extended to a fton--licensed health professional,  problems  of
      licensure Nould arise. This is a  National  concern,  however,  and  is
      presently being pursued by interested factions4
      Interest was expressed in the number of projects continued with
      outside funds when RMPS funding.-ceases.
      The Developmental Component emphasis is on  the  development  of  Area
      Health Science and Education Centers.  The Education Center would
      be directed tow rd the development of faculty, consultative and
      technical.  The Science Center would be directed toward the necessary
                 , and science function to maximize Potential I-lo meet  the
      educational
      public demand for primary health and medical   care. The  concepts  of
      the AIIEC, Area Health Science Center And the  Area Health Service
      Center-seein to fit the Kansas Medical  Community.  The  Administrati@,re




       framework among these responsible meciicai communities wouiu -Liiui.uu@
       the establishment of a Vice Chancellor for Health Affairs "Office
       for ICU@IC Associated (Affiliated) Programs."
       concern was expressed that the entire Developmental Component
       addresses itself to the AHEC, etc. concept.  Staff did not feel
       that such set limitation should exist.
       Staff reviewed the KRMP according to the RAIP Review Criteria.
       Please refer to comments recorded on RMP Review Criteria Form.
       There was-activo participation by staff in the review of the
       KIUIP and the new application submitted.



       @IPS REVIDL CRIT-PRIA MlYi                                        f El GI o@4 Kansas
                                                                         REVIEW CYCLE@   June


        A.  PERMFUvIP14CE
            Is   Goals, Objectives and Priorities  (I)
                 Developed and broadly stated.  Not based on available hard data.  Health
                 problems not prioritized by utilizing C-L systematic approach to planning,
                 needs,  Objectives and priorities should be determined.


                                                                            - - - - -  -  -  -  -  -  -
            2.   Accormlishments and Irmle,-,-.entation  (2)
                 KMT no longer  dominated  by  KU  Medical  Center.,  Grantee.  Redirection  of  P,-o@z
                 activity from project orientation to major emphasis on improvement in
                 distribution of medical care  s6rv-Lces  through  regi-onnllzation.  KRMP  evalup-ti,@
                 section has built in-project review.  Instr@ntal in establishment of VISU
                 School of  Medicine,  through  Kansas  Legislation,.and  in  assisting  WSU  College
                 of Health Related Professions.
                                                   - - ---- - -- - - - - - - - - - - - -  -  -  -  -  -
            3.   Continued  u.@ort  (3)
                 Continuation of projects ,,,,,iich have exhibited merit and  productivity  is  Kg,!P
                 philosophy,  Continued source of funding outside of IWS is explored.
                 been acconplislied in sever--,J. instances.



            4.  Minorill Interests  (4)
                 In conformance.  Minority representation needs strengthening, however,            cost,
                 project staff., RAC and Cc@.--,uttees. @,linroity emphasis on Blaclcs and America,-i
                 Indians.  PtL"ention     -Li-.3-,,easin@ female representation.




       'B.  PROCESS

            1.   Coordinator  (5)
                 Excellent Leademhip. Respect of Staff RAC and Health  Associates  in  the  S-,a',
                 Kno,viledgeable regarding
                                           state resources and has productive health contacts.
                 Has a dondnative-type personality.  Could ie'late more effectively to staff,
                 especially subregional a_ssic-mees. Has de'mnstrated success in rQnoving  KR:il?
                 from dondnation of KU k,@,e@,cal Center, grantee institution. Deputy  Coordin@uc,
                 is effective.  On 83% t:L@ basis (Coordinator).

            2.   Core Staff  (6)
                 larger staff (57) oiith much professional expertise.  Excellent  Evaluation  Sec'
                                                4-
                 Most staff essentially L@




                Regional Advisory Grow  (7)

                Regional Advisory Council is   maturing.  Instituted 5 new   RAC staffed
                Committees within year. Needs  to  become  more  active  in  dec-iding.policy,
                setting priorities., goals and objectives.  CoiasLner, female, and minority
                representation  should  be  increased.


                                                          - - - - - - - - - - - - -
                Grantee Organization  (8)

                Provides services as required.  No longer dominates KF2e or RAC.



                                                                     - - - - - - - - - - - -
            5.  Participation
                Key  heart'h interests, institutions, health providers, etc. appear  to  actl-%@e-Iv
                participate in YOe.    No interference from any one major interest or  poli@--Lc--'
                force.



                                                   - - - - - - -- - - - - - - - -  -  -  -  -  -  -
            6.  Local Planning  (10)

                CHP has  been  Ineffective.  extepting in  Kansas  City  area.  Re  staff  have
                assumd  responsibility  for   majority of health planning.  Each subregion -@,as
                local advi--ory gro   (LAG) finctioning.  Interest and input var es
                considerably bcween subregions.  CHP review-, and submits written con.-@nts
                rc-lat-L%Te to each    aoplicat@icn.

            74  Assessmnt of Np-eds and 'Ic@sources  (11)
                Manpower needs@have been given top priority.  EW is continually assessi------
                needs and resources.  Data b@.se is available, whether it provides bases fl-,-,
                decisions  is   -,cr-ewhat@questionable.



            8.  Man@errent  (12)
                Core activities ap@ear to be  well  coordinated.  The  ongoing  n@er  of  ac@U-%Tf,@..,
                is higji (11 projects - 46  co,-monents).  Project  review  is  built  in.,  held
                peric ica-Ily, and seems a most effective control mechanism. Progress  rep--,--@ll+.4-z
                provided at each review session.


            9.  Evaluation  (13)
                Evaluation section with             dL:-ccto.- Prd staff  is  superb.  Proje-+-
                evaluation  provided  on  periodic  basis.  Program   evaluation   less   success@   as
                goals, objectives, etc. too broad.  Good feedback to project staff ar,@;


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




       C.  PRCCRAM PROPO@--Al,

           li  Action Plan  (14)
               Priorities established and congruent with National goals and objectives.
               Proposed activities in keepirZ with sai-,ie, are realist, c and feas@ le.  More
                                                                     .L         -b
               definitive program priorities receiving attention and work-up of RAC
               @,laru@ Co@ttee.

                                                       - - - - - - - - - - - - - - -
           2.  Dissemination of Knovzledge   15)
               KIM has been successful in this area.  Acti%re participation of health educa4,-,-,
               and research institutions of Kansas.  Better care , at a reduced 6c)s@ is being
               demnstrated.  Profi-le periodical,, published by laT has wide circulation.


           3i  Utilization MariDcy@,ier and Facilities  (16)
               Major emphasis and thrust of Program.  Expect.inc--ease in manpower will result
               with beneficial effect to entire state.



               Txprovement of Oare (17)
               Proposed activities will markedly inTprove the delivery of health care.



           5. Short-Te , Payoff (i8)
               Projects have demonstrated short-term T)ciyoffs.



           6.        P -,zat,-or, (19)
               KF4vlP has subregion-Aized with lirpited success. is the accepted philosophy
               and reco @'zable mde of a successful operation. ABEC philosophy e)Tected
               to further strengthen concept.


           7. Other F-uri@n    (20)
               YPYIP has been looking for outside fLu-id--,Lng mcl-ianisms in order to continue
               proje-.',-                ha,;c @n@. a du-,-@rztr-able a,-id beneficial
               Some success, to date.




     MEMORANDUM                                 DEPARTN,IENT OF HEALTH, EDUCATION, AND NVELFAI@E
                                                                  PUBLIC HEALTH SERVICE
                                                  HEALTH SERVICES AND MENTAI, HEALTH ADMINISTRATION


                Acting Director                                         DATE: April 18, 1972
                Division of Operations and Development@-@




     F'ROM      Director
                Regional Medical Programs Service
     SUBJEC'I': Action on April 10-11 Staff Anniversary Review Panel Recommendation
                Concerning the Kansas Regional Medical Program Application RM 00002
                6/72.


                Accepted

                Rejected
                                                         (date)

                Modi f i cati ons





                                                     @2
                     C mponent    And Finsnclat    Sunmary      AnniversarX Applicgtion



              ON  NT@          CURPElrr                  YEAR                   YFAR         RECOMITTMED
                               YRIS AWARD            CourlciL                                  FUNDING
                                   OPP.R.            RECO14MENDED           'REQUEST           X  SARP
                                  AR@                'LEVP.L                                      @EV. COM.

                                  932,846                                  15020,400
                                                    X/
     S4       ontrat
     OiE       ACTT.              415,157                                    577,500
                               DISAPPROVED,                               134i860*0
              c    .                                                                         Yes         or, ?;o


                                  Illi826(do                                                   125,000

                                           d



         77



                                                i '800,6006)            1 732    760           425
             let  T                  48,603                                                   1,    ooo**&

                                  750,577


                               @l Si   00000





            e                  0       t
                                                                               REGION     KANS S
                                      ye r      th6
               n
                                                                                 June          72.       Ell C CLE
                         t n(s of $125,000




                                                                  REGION     ransd@
                                                                         -@Y C L E June      97 2
                                                                  REVIEW
                                                                  Type of Application Anniversair
                            RECOMMENDATIONS FROM                                 withi
                                                      Review Committee   Rating  264,-
                   SARP
                  Site Visit                    =7  Council
                                                                  (SARP) recommended    that
     ,--UNDING'RECOMMENDATIIOONN:  The Staff Anniversary Review Panel
                              KRMP be funded in the amount of $1,550,000 to include     kidney
     funds (Project #40) which are not to exceed $125,000 for the 06 operational year.
                                                                 pplication  request@was   for
     This amount ($1,550,000) reflects a reduction in that the a
     the amount of $1,732,760.
     RATIONALE:  SARP felt that the recommended amount would provide the Program sufficient
                Tinancial latitude for the projected  expansion  of  activities  within-the.
     Region especially sinc; the KRMP now plans to  pursue  the  supplemental,fundinq  route
     for several commun
                       ity health manpower programs.  Since  the  prerogative  of  an  out-of-
     phase supplement was not available to the Coordinator at the time   that the present
        -cation,was   p
     apple            repared, a Developmental Component had been  requested  for  the  sole
           "of establishing activities dealing with expansion and augmentation of manpower
     purpose
     programs at the community level.   In view of the new option  now  available,@the  Region
     has chosen to withdraw the Developmental Component and  compete  for  supplemental  funds
     using both the May I and June 1, 1972, protocols.  Since  the  Region  plans  to  utilize
     available liquid assets in the Core budget for 46  planning  and  feasibility  studies,
     reviewers did not feel that additional developmental funds  were  needed  at  this  time.
     CRITIQUE:  SARP concurred with Staff regarding its assessment of the
                                                                             KRMP.  The
                Coordinator's "style" and his apparent dominance
                                                                   over his  RAC  and  staff
     suggest some problems and weaknesses.  Program staff is talented but    apparently
     underuti li zed. Turnover of subre'gional 'staff is significant. The reviewers believed
     that the Regional Advisory
                                 Council should address these problems.
     In the past, the RAC has been somewhat of a "rub
                                                       ber stamp" organization although    the
     Coordinator indicates that this body is becoming more mature.  More involvement by the
     Local Advisory Groups and the RAC is strongly recommended.    Committee 'Organization and.
     Program Staff participation are indicative of increased interest and involvement.
     SARP felt that since KRMP was one of the first Programs to
                                                                  become  operational-,  their
     track record was somewhat disappointing.  Although there has been a great deal of Core
     and Project activity, it is very difficult to obtain any real sense of explicit
     accomplishment.
     Because of the above mentioned problems, SARP  had  recommended  that  the  Develo'mental
     Component be disapproved.  Since this request has subsequently been withdrawn    pand the
     requested funding level is below the NAC approved level for the 02 year, it would not
     be necessary that this application be submitted to the Review Committee.
     Technical assistance was recommended, as follows:  (1) Plan a Management Assessment Visit
     to KRMP in the immediate future. (2) Invite  Mr.  Ray  House,  recently  appointed  RAC
     Chairman, to participate in a site visit to an "A" Region with a strong Advisory GOoup
     (3) Invite Dr. Brown, Coordinator, to participate in a site
     Give  Technical  A                                             visit to  an  "A"  Region. (4)
                      ssistance to the KRMP in regard to the pending 910 Kidney application
     (composite; Bi-State, Missouri, and K                  i
                                            ansas estimated at $1,000,000)..  (5)  Assist  and
     encourage KRMP how best to use the results of their intensive evaluation efforts.
                                                                             4/17/72



       IdENIORANDUIN/i                                    DEPAT@'F,@IEN'F Ol,' IJEALTIJ, EDUCA.'I'ION, AND
                                                                               PUBI,IC 111@"AL'I'll Sl-'@l@\IICE

                                                            Ill,'AL'I'll SIll@\71CI,"S AN])     lil@'@ALTII AD,\Ifi@ISTI-"ATION



                    Acting Director                                                           April 18, 1972
                    Division of Operations and Developi-nerit@@@




       FRON,F       Director
                    Regional f@edical Prograins Service

       SUIIJ Eci,:  Action on April 10-11 Staff Anniversary Review Panel Reconiniendation
                    Concerning the Kansas Regional lledical Prograiii Application RM 00002
                    6/72.


                    Accepted
                                                                    tdee@
                    Rejected
                                                                       ate


                    Modifications:




                      Cotnponent And Fl.nancinl Stimmia - Annivernnry Anli@icntion




                                                           I-FAR
                    4T          CURPENT                                          YFAit         RFCOM@i'F-?ID.ED
                                YR'S AWARD             C 0 U,,C; TL L                             FtnMING
                                                                           -1@EQUEST
                                05     OPER.           RECOi@i  IIDED                            X  SARP
                                YFAR                   LEVFL                                        REV. COM.


                                                                             1,020,400
      CORE                         932@,846
      Sub-Contracts
      OPER, ACTTV.                 415,757                                  577    500
                                 DISAPPROVED                                134,860*0                       r  No
      DEVEL. C".                                                                               Yes         o


      EAR14ARKS:
                   (@'40)          111,826(do                              (125,000)             125,000
         R@d-el
         Cities (#45)               52,810(dc)                             (35,550)






      RI.IPS I)IRFCT            1,348,603        1,800,boo(@             1,732,760            1
                                                                                                @425,000**O

                                2,750,577

      COUNCIL                   11800,000
      APPROVED   LEVEL


      NON-RI-FPS and



         Under  2/8/72   NAC   Policy,   the    approved
         NAC level for the first year of the'                                   RE(;ION    KANSAS
         Tri enn i um pre vai I s                                                 June       t972
                                                                                                     REVIEW CYCLE
         @lithdravin by  KRMP
         PLUS kidney funds,of      $1252000
         This amount inclu4es.     $125-OGO.for #4-0 and$39"@5.0..    for  #45



                                                                                      Revised   5/2/72




                                                                    REGION      Kansas
                                                                    REVIEW CYCLE       June     II)i 2
                                                                    Type of  Appl.ication  Annivprsa
                               RECOMMENDATIONS FROM                                within   trienniu
              I=    SARP                                 Review Committee   Rating  264
              =7  Site   Visit                           Council
      FUNDING RECOMMENDATION:   The Staff Anniversary Review Panel (SARP) recomniended that
                                KRMP be funded in the amount  of  $1,550,000  to  include  kidney
      funds (Project #40) which are not to exceed $125,000 for the 06 operational year.
      This amount ($1,550,000) reflects a reduction in that the application request was       for
      the amount of $1,732,760.
      RATIONALE:  SARP felt that the recommended amount would provide the Program sufficient
                  financial latitude for the projected expansion of activities within the
      Region especially since the KRMP now plans to pursue the supplemental funding route
      for several community health manpower programs   . Since  the  prerogative  of  an  out-of-
      phase supplement was not available to the Coordinator at the time that the present
      application was prepared, a Developmental Component had been requested for the sole
      purpose of establishing activities dealing with expansion and augmentation of manpower
      programs at the community level. In view of  the  new  option  now  available,  the  Region
      has chosen to withdraw the Develbpmental-Componp-nt  and  compete  for  supplemental  funds
      using both the May I and June 1,  1972,  protocols.  Since  the  Region  plans  to  utilize
      available liquid assets in the Core budget for 46 planning and feasibility studies,
      reviewers did not feel that additional  developmental  funds  were  needed  at  this  time.

     A&TTTniir:. SARP concurred with Staff  regarding  its  assessment  of  the  KRMP.  The
                  Coordinator's "style" and his apparent dominance over his RAC and staff
      suggest some problems and  weaknesses.  Program  staff  is  talented  but  apparently
      underutilized.  Turnover  of  subregional'staff  is  significant.  The  reviewers  believed
      that the Regional Advisory Council should address these problems.
      in the past, the RAC has been somewhat of a  "rubber  stai-np"  organization  although  the
      Coordinator indicates that this body is becoming more mature.  More involvement by the
                                                                     Committee organization and.
      Local Advisory Groups and the RAC is strongly recommended.
      Program Staff participation are indicative of increased interest and involvement.

      SARP felt that since KRMP was one of  the  first  Programs  to  become  operational,  their
      track record was somewhat disappointing.  Although there has been a great deal of Core
      and Project activity, it is very difficult to  obtain  any  real  sense  of  explicit
      accomplishment.

      Because of the above mentioned problems, SARP    had recommended that the  Developmenta
      Component be disapproved.  Since this request    has subsequently been  withdrawn  and  the
      requested funding level is below the NAC approved level for  the  02  year,  it  would  not
      be necessary that this application be submitted to the Review Committee.

      Technical assistance was recommended  as follow
                                                        S: (1) Plan  a  Management  Assessment  Visi
      to KRMP in the immediate future.  (2)   Invite Mr. Ray House, recently appointed RAC
      Chairman, to participate in a site visit to an "A" Region with a strong Advisory Group.
      (3) Invite Dr. Brown, Coordinator, to participate in a site visit to an "A"         I
                                                                                      Reg'bn.    (4)
        ve TeclinicalAssistance to the KRTIP  in.regard to the  pending  910  Kidney  application
     icomposite; Bi-State,  Missouri;  and  Kansas  estimated  at  $1,000,000).  (5)  Assist  and
      encourage KRMP how best to use the results of their intensive evaluation efforts.
                                                                               4/17/72




                                                                    Region       FF-f)l 1ri
                                                                                             1972
                                                                     Review Cycle  June
                                                                    Type of Application:
                                                                    A             ithin Trienniuni
                                           Recommendations From     R



                       SARP                                             Review Committee



                       Site Visit                                       Council

                  CRITIQUE:  Review Co@ttee considered            a-Q-olication for  their  o6
                  year which  presented  tw.o Plans  Plan A for the com-Ltted amount of
                  $1.8 ndllion and Plan.B for an  expanded  program  level  of  $4.4  million.
                  During its deliberation, the Co ='ttee  accepted  the  reoort  of  the  April
                  4-5 technical site visit to review the computer and bicengineering
                  activities  (Projects  #69,  72  and  75).  Co=ttee  concurred  with  SARF's
                  recommendations to  disapprove  the  developmental  component  and  further
                  funding for the ',hree technological  projects:  #69,  Autormted  EKG  in  a
                  Rural Area; #72, Automated Phvsj-cian's Assistant;  and  #75,  Bioi,-edical
                                rv
                  Infonmtion Se  i e.  As a further -reasure, Co,=,ttee withc-ew
                  @iemial sta i         reduced the funding level to $1.6 million.  The
                  $1.6 figure was coiTputed by  deducting  from  the  co@tted  level  of  $i.8
                  ndllion the amount of $200,-OOO (the request for the technological
                  projects). Comdttee  also  recommended  a  site  visit  be  scheduled  after
                  -Council to coinunicate reviewers' concern about the Program to the R6gion.
                  'Ihe two @IS projects in the application   (#73, Subregional Emergency
                  Services, and #85,.Connunity F-Tnergency Health Systerp.) were  deferred  'or
                  special-review.  A coni-,iunity-based manpower proposal  for    Springfield
                  Missouri, was subndtted on May 1 and was reviewed by     the special  ad  hoc
                  education  review  panel.
                  The discussion of the   Dresent application  beoan  within  the  context  of
                  earlier reviewers' concerns about this          Reviewers   mentioned   the
                  vagueness of the goals and noted that projects still seemed to fiave
                  developed around the  interest  of  local  physicians  or  hospitals  without
                  regard to regional planning.  'Ihe  overall  program  still  appeared  to  be
                  a collection of projects, many of which continue to cling to the
                  categorical erThasis.  The Coordinator is not a strong director and
                  the large staff have not been organized or utilized to provide assistance
                  in designing regionalized programs to groikos in the periphery.  Minority
                  representation is  low  on  Progr@  Staff  and  review  bodies.  Revi@i--rs
                  were concerned about possible University domination o@' the Progran
                  as a result'of the large number of part-   time  University  faculty  on  the
                      payroll, since they questioned the investment in underwriting faculty
                                                        41ity                sity  to  continue
                  salaries beyond the financial capab,        -of the Univer
                  to sustain them when RMP support is phased out.




                                                             Region Missouri
                                                             Review Cycle  June  1972
             Recommendations From Review Committee           Page 2


            ""@ssourils continuing insistence on developing  the technological
             projects in contradiction to the previous advice from Council also
             disturbed the reviewers.  From'the technical site visitors findings, it
             appeared that Missouri seemed to be pursuing expansion of past developments
             and responding to an essentially rural constituency with  urban  methods
             and lots of expensive hardware. With regard to  Project  #69,  Automated
             EKG in a Rural Area, C@ttee agreed @iith SARP that no funds be provided
             for the project.  The site visitors hac suggested that perhaps some
             funds could be provided ($60,000) to redirect the  activity  to  provide
             a telephone consultation service for the rural physician,  since  this
             seemed more valuable than further automation  of  certain  tests.  Since
             the primary service of the Biomedical Information Service  (#75)  will
             soon be offered nationally by the national Library of  Medicine,  NIH,
             and it did@nbt appear likely that MPMP could enroll  enough  subscribers
             to support their system in the near future without  substantial  Federal
             investment, reviewers recomended that the system be phased  out  and  no
             future support be provided from MRM.P.

             The Automated Physician's Assistant proposal was also disapproved.. While
             the basic concept has merit, the site visitors determined  that  at  its
             present level of achievement and project direction, it shows no potential
             for providing a very useful or marketable aid for the practicing
             phy8ician.  They pointed out that the course MRMP has taken -- expansion
             of past developments, rather than an innovative attempt to solve the actual
                                                                    guided.  In addition
             problems of rural health care delivery     has been mis
             to cost considerations, reviewers found that the system had serious
             design deficiencies which made it difficult for the  physician  and  his
             office staff to use in an optional fashion. Present  efforts  should  be
             discontinued, and planned expansion to the  Satellite  Cl@c  and  Family
             Practice and Surgery Clinics should be put aside.  If in the future, any
             work is contemplated, it should first take into consideration the
             following: 1) a reassessment of the goals  and  specific  approachable
             objectives of the project; 2) other advances in computer  assistance  to
             medical care around the country,' 3) a revision of hardware  choices  so
             as to provide a more flexible, lower cost and more  adaptable  service
             to the physician; 4) a redesign of the overall system in  order  to  aid
             the physician in delivering Comprehensive, efficient, high  quality  and
             reasonably priced health care.

             The Region has made progress in several areas as noted in the staff
             materials.  'Ihese include the addition of a new Planning Director,
             consolidation of Program Staff functions, formation of Goals and
             Evaluation Co @ ttees, and greater success in seeking  outside  sources-
             of support for MRMP activities.  =    has also increased  its  program
             activity in co     ties outside of Columbia) including Kansas City.
             Newer projects, such as the Green Hills, the Docent Nurse  Outreach  and
             Pediatric Nurse Associate appear more relevant to the Regionts needs and
             MTS I review cri teria.





                                                              Region   Missouri
                                                              Review Cycle June  1972
             Recomendations   From Review Committee           Page 3


             Reviewers still  thought, however, that the application showed  little
             evidence that       leadership had clearly thought out their mission  or
             had co@tted themselves to bring about substantial change in the Program.
             Co @ ttee believed that a drastic approach was necessary to  show  the
             leadership responsible for this RMP that they are not pleased  with  the
             way the Program has met its responsibilities.

             After discarding SARP's recomendations, C  o@ttee  proposed   measures
             to Council which they hoped would be a first step in reversing the
             Region's poor showing.  They reco@nded that Triennial status be with-
             drawn and that a site visit be held in the near future to  inform  the
             Region what steps they @t take to become a better RMP.  They further
             recomended a reduction in funding from the  bo@tted  level  of  $1.8  to
             a $1.6 m. (direct costs) level for the 06 year and a disapproval of the
             developmental component request and further FMP funding  for  projects
             #6911 72 and 75.






                           Component and Financial Summary      Anniversary Application



       COMPONENT                 CURRENT        to   06 YEAR           -o6  YEAR        REtOt4M8NDtD
                               YRIS AWARD                                                 FUNDING
                                nr, OPER.                                                      SARP
                                'YEAR              COUNCIL
                                                 RECOliMENDED            REQUEST         XX    REV*
                                                     LEVEL                                       COM.
                                                                    A    878,147
       CORE                  $   828,441                            B  1,,11.37,602
       Sub-C6ntracts                -0-                                       -0-
       OPER.   ACTIV.                                               A    930,920
                               1,118,976                            B    133,050
                                                                           162350
       DEVEL.   COMP.               -0-                             B    190,000      Yes(   or N6(X)

       EAR14ARKS:


               KIDNEY               -0-                                       -0-


                           See Belovi







                        1,947,417-12 mos.                          -A  $1,825,4
       RMPS DIRECT                               tp.rnn-nno              4     52

       REQUESTED
                        5.061.962

       COUNCIL
                          2
       APPROVED LEVEL         500,000
       NON-RMPS   and
       INCOME

                    Under  2/8/72  National   Advisory Council policy,     REGION   Missouri
                    the approved  NAC  level  for  the first  year  of  the
                    triennium prevails.                                       u n e 197 2 Review Cycl

                    The EMS .proposals  were  part   of the basic application and are pending
                    special review.  Funds for these projects axe not included in this figure.
                    Plan A requests the co @ tted amount of $1,825,417.
                    Plan B requests the optimum   amount  of  $4,460,852.
                   .Staff and SARP recommend Plan A.
                                                       Plan A
               Current Program request                 $1,825,417
               Supplemental CBE request                   385,817
               SW-plemental EMS request                   345,185



                                                                                  FWi

                                                  RIIPS
                                        STAFF BRIEFIlt'G  DOCU,4ENT




                                                        ORERATIONS-  r7 Eastcrn            /V Mid' Ccnt
  i.EGION        Missouri                                  BRANCH         South-Centrll         western

                                                         'BRANCH
  ly        APPLICATION                                    Tel. No.    443-1790           Room   10-21
    PE                            -Lkn PI.TIIIG'
          TRIEN141AL       '4  197 1 .  DATE               BRANCH-Cli'LIEF  Michael Posta
  gg  lot ANNIV YEAR               SARP                    BRANC It STAFF  Dona Houseal
      2 d AN14     YEAR      E7    REV.   COM.             RO  REP.    Ray Maddox
           ER                C7    OTHER                   Last Mgt-. Assm't Visit                 197
                                                           Chairmaft

  'AST   S@.V. 3   107  1   Chairman  Dr. G.   VI Brindley
  @taff visit&-.      Last 12 ukos.    (Datds, Chairman    sName and Typo   of   Vipit)@
             or,   171     Four day    staff visit by D.   Houseal.  April  4-5, 1972

                ital Site Visit scheduled to review-computer    and bioengtteering activities

      @4--6haitman-"-Dr-.  Odt6 Barnett.



       BACK(;RO   Mi

        ace MRMP became an operational     program in 1967,   it has undergone several program  and
         aniiati6tial thang6s*  These changes.have been a consequence of several occurandes;

            1.  Dr. Rikli succeeded Dr.    Wilsoii as Cdotdinator-in 1968.

            2.  A  new  medical  school  hag betn established in Kansas City.  The     MRMP's office
                     YAn6a$ City has linked'somp- of its activities to this now gdhool, whose
                   a Ce'pt is to develop a com6unity-qriented medical education       program.
            3.   Two program site vis@ts wete@eld     by'RMPS (in 1969   And 1971).    A copy of
                   the last visit's results  is    attached.

            @4-  Asa  result  of  those  tVo critical reviews  and the relative slowness of
                   KW in responding to the change     in the RMPS program direction, @'s
                   4get has decreased from a $5.0 million to a $2.0 million level during
                   the past two years.

            5.'   In    onte  to   reviewers recommendations, KW has,.Rradually:reduced the
                   reap
                  pr     on of their mnies all6cated to computer and bioe@eriniz
                   activities; and increased the amoont df'funds f6r,community-based proj6dtsi




     MISSOUR'I REGA'ONAL i-TEDICAL PROrRA,14                                                                             RM 00009

     State of Missouri, except for St.                             Louis Metropolitan area which
     established program later-- BI-State.
     State has 115 counties; 10 Congressional Districts
     Population             1970 Census)'               -4,677,400; RMP Estimates overlap of about
                                                          1.5    million with Bi-State ( city of St.Lduis)
                                                                                                                       and County
     State:         Land Area 69,138 square niles; density 68 per sq. mile.
                    Urban - 70% ; non-white                     10%( 500,000 of whon 480.1 are                           Negro)
                    Metropolitan areas; 3 excl. St'*Louis -(total of 147804)
                        St. Joseph, Springfield, Kansas City,Mo.-Kansas.






                    WORTH

                            HARRlSOt4

                    GENTITY





                                                                           SHELIDI




                                                                            MOIIR
                                        CARROL




                                       YETTE    SAI.thE      ov-
     KAMAS CIT
                                                       00
                                                             (.-LUMBIAG

                                     SON       PETTIS









                                                                                              RAWFORD


                    Vtftt#Oft
                                                                                                                  FRANCOil
                                 cr


                    BMTOM
                                  DADE




                                    El


                                 BARP      ST                                   @LL
                                                                   OZARK                                                              NEW







             County With two or more CongressionotD;Str;cts




                                                                                       RM 00009


                 MISSOURI

                 Selected    Death     Rates per      100,000)    1968           Age Distribution     -Percent
                                           MO*               U.S.              Ape aroup     Mo.      U.50
                 Heart Disease             424.6             372.9           Under    18     37         35
                 Malig. Nedpl.             17809             15964           18- 64          51         55
                 Vase. Lesioni(CNSI        136.8             kO5.5           65 and over     12         10
                 Accidents                 63;1              57.5
                                           22.0              19.2
                 Diabetes
                 Broncho-pneumone          19.4              16.6


                 RESOURCES AND FACILITIES              Outside of St*     Louis)

                 Medical'   School  -  Univ.  of Mo.    School of    Medicine,    Columbia
                       1069/70     -    Enrollment     367     Graduatess     77
                 Developing School -  Unive of       Mo.,   Kansas   City,   MO*

                   6fessionAl Nursing S,.hools -  20, of which 11 are college or Univbased.
                  ra t,ICAI Nurse Training  -,21       of which 5 are college based
                 Allied Health Carzets Program,        Uhiv.    of     Missouri,Cdlumbia
                 @ch ol@s of (,-ceopathy - 1967/oS
                                                                             1-nent.   Graduate&
                     asas   City   Coll.   of   Osteopathy              428             106
                     and $urger., Kansas City,'-to.
                   K$ikiville Coll. of Osteooathy                       396               93
                     and Surgery, Kirkivi:le, &,AO*
                  yi  e6h66lo,,Iy - 1      SnidgrAss   Lahoratory,   St.   Louis    City Hosp.)
                 hed@c@l Technology        12 ( outside of St* Louis)
                   d oloiic.Technology - 20
                  hyotcal Therapy - I at Uni--. of Mo., Columbia
                 @Med c:il'Record Librarian ( 2 In St. Louis)

                                                                                    Extendtd Cate FdcilitiO!
                                                                  Beds
                   General   short term          90          .129095           Skilled   Nursing   Rd-.nes   208
                         ncle some      osteopathic)                              g(18 138abedakit
                      9 term general             7               1,644         Lon     etm c re       s       23
                   VoA4 general                  2                 729                 1513 beds)

                 Man      er@                     Outside of St.     Louis          St. Louis and County
                     hysicians        Active             2,873                         2976
                       ctive %iDs                        113                            103
                     0teopaths                           797                            119

                      ofessional      Nurses   idj. 1966 data)
                      tively   empl*   in   hurtin       8,389                         2632
                                                 9
                      t em@p-le in nursing              2,3(;2                         1183

                            ct@@e@j99)      State   Tota'L-.'
                            172;  Single   specialty   -   101
                                  General practice           20








                                     MISSOURI REGIONAL MEDICAL PROGRAM
                               Anniversary Application with a Triennium


                                                                                   Page

                 PART    I:


                        Staff Briefing Document
                          Face Page         ........................................   1
                          Demographic Information    ...............  * .........      2
                          Component & Financial Simm-gry    ..... a..........   t...   4
                          MIS Breakout of Request (06 Year).i.i      .........   O..   5
                          Accomplishmegts, Problems & Issues sheet         .........   7
                          Completed Criteria Sheatt.o     ....... t   ..............   9

                 PART II:

                        Kidney - not applicable

                  PART III:
                        April 4-50 1972 Technical Site Visit Report

                  PART  IV:
                        Site Visit report of March, 1971

                  PART  V:

                        Advice letter of May, 1971


                  PART VI:
                        Management Assessment visit - not applicable




                *Will be available for Review Committee





                                                                                                                          Regioi-.    i@s s o  u  r  i
                                                                                                                      Review  Cycle                 5/6    197
                                                                                                2




                                                                                          '@'ebruarv                          197@
   OI)TSTANDING    ACCC,,fVLISII'!ZliTS    13Y                       A 4@ 11'  s ionic  e

                      Reduced'the  s-zze  of-"  and                c'o n s o 1. i- d a t e -'k the        functions        of         rrogram Staff
                      Dr.       Phillip        @ft7,rgau        has.repi@ioell        Dr. C,eorge      Wakeriln       as       Chief       of Planning.

               2.     Formed       @i       Goals                              iiie,@,ibers   of     each     of     the     three review  bodies
                                                                                                             Established                      -Luation
                      to  develop  a  ii(--iq  set  o'@'-'         goa,"@s  '@n"'  oblect4@ves,,                                   an  Eva'
                      Committee          tc  propose  evalui@l.o7.-i  i)roce,,-"tiires  for                  -eview.

               3.     Increased          the    progi:aiii ac@ilv4-,.,                            City      to      the       extent that     all  b-f
                      the       L'---ee  new    acti-.                                  c-
                                                                                 -"-)r          appLication  originate  in                    the
                      subregion,

               4.     Ileedect      Couiic.11.      advi@--?      to i-@,,icrLa<3e                              of      -Lts       total       program
                      committed          to f-'Olll!TiL@,11 ' @y--b:ir@ @l                         The  C;@-c-eri  @-lills  project             (#83)
                                                bettei--                           a  couiiiL,.iii:y..-base    activity  directed
                      is         one'of  the-
                      towdrd  the  or@aiiiz--Li.on                 t.) i    s(,Z-,rices,,         edLic,,-iti,@n.
                      R@dti@c-,l    tliL!     amount     of     T?Ylps                  f@,)r  Lli@  o@@pute-r- and bioenp-ineerl
                                                                                                                               unds - for
                      activities       and       sot.ight       olli@-       --soLiu,--es     st,,,)         (.,qCliSR&D                           the
                      '%',isso,ar                              -o-I.o,.,y-Service  a@id  th..  Auto                 ted  Physician's
                                      At,,t,,)!nated  It @-L                                         p          ina
                      Assistant  irojects).                   The      current.      leveL       of       IUPS support  for  these
                      activities          is          a-pprcxiinateJ.y          $422,I)OO,           including the  contract          with
                      Dr.         Bass.


     ISSUES       AND            PROBL@IS:

               1.     1MI@'       has reviewed         t@).e  stru(@tL@        e c)     t s   tripartite       RAG        and        made the
                      ,decision       t h a t-  t h(-@'        Adv@sory                 (one  o      -,he    former            three     par
                                                                                                                                          ts)-is
                                                                               -ti   the  twe-'                                  r
                      the       'RAG.    Sta@cf  'is     coricerried"t,  at                      ive-member  Adviso'y  Counc  1
                      -does       not       fulfill       the       .@lega@        requirements for  i'@G.membership;  particularly
                      VA-and         CIIP          represei).tatic)n,.


                                                                                              is         3       million       and the    Council
               2-     Funding  level  for @LRIAP,                  file      co,
                      approved       level.        is        $2,Oi2.                sLibi@qitLi           for  use  of  $]-.8           million
                      and        $4.6                    '-hL-.,      preE,@@(it                       le-ve@-11  of  fun-ding  is  $1-.9
                      million.


                                                                                                                                   Pt
               3 .    A    technical    site    v-Lsit    @,7ac,     iel(I     A,,,,i:il.     4 and    5    to     review     'L-R4     s
                                                                                    of  coilpu'ter  and  bioerigineering
                      activities  an(]  t,)                          assistance             -to r@f'-'S      in      monitoring       the
                      contract   w@i.Liai    Di:,.    things    -'In                T'Tle  findings  of  'the  visit will                    be
                      available  f'br-Rev@,.-@w  C,or@iLizi.-ee                         Co@iiicil-..

               4.     The     need      to  develcii  a                                 or     @:,oa's and              objectives and an
                      action  plan.             Sta-,';-  acrt-(..c,.  .,.Iiat  i,,ianv   of   t.,hk,- projects  in  the  application
                      addressed  file                                          @;O)     bar       they were       unable        to find  in  the
                      application       evidQiice       L@f       a        past, for    addressing         tiie'se          target areas  in
                      any  unified way.





                                                                                                                       l@   IC-  l@     ic- -IC   IC   ici




          Page 2                                    I)raft:
                                                           Region Missouri
                                                           Revie  cycl  5/6 1972


          5.   MRMP's approach to rural health.  MRMP's projects dealing with the
               rural health care problem still appear disease category-oriented to
               some extent, but the more recently funded projects reflect a shift
               toward a more comprehensive emphasis, particularly in the Green Hills
               project. It appears from the application that MRMP staff has ngt
               developed an overall organized attack on the problem, again reflecting
               the need for a regional plan.
                                  r'                                      staff (60 positions;
          6.   The use of Program, esources.  Despite the size of Program I
                                                                          zed or deployed
               48.5 F.T.E.). Program resources do not appear  to.be  organi
               in a manner which permits the mr to more rap idly respond to new program
               goals and special initiatives, or to requests for assistance at the
               subregional level.
           7.  MRMP's continuing education and training proposals include many health
               professions, and teaching methods and are conducted at  variou's institutions.
               Some of the more innovative activities involve the health care team
               approach (Docent Unit - #86) and the pediatric nurse associate  (#86)
               in Kansas City.  A problem for reviewers in this area is the fact that
               MRMP has submitted the Continuing Education--Coordination Project for
               the fourth time.  Reviewers will recall previous criticisms relate
               to the lack of coordination with the overall MRMP program, and the
               emphasis in determination of needs at the University rather than  the
               community level.  Since the proposal is several years old, staff believes
               that it should be reexamined in the light of possible development  of
               future community health education systems in Missouri.



                          kot4t4*       CONT.    WITMTN!    tONT.    BEYCNOI APPO            I NFW# NOT        T     CURRENT     I    LURUtN4       I
                                         APPR.   Pr-Rionj   APPQ.    PEOInCt POFV*R          I POEVIOUSLY            DIPFCT          INI)TOFCT@
                                         OF SUPOf)'tT      OF SUPPORT        FUNOEAP         I APPRovEn                COSTS           COSTS

        1:  c r fl'F Cf'O#DtNAtng      I
                                                                                                                                               t222-1             7  1
             tcs          TICN5


             FICF (IF  P
                                                                                                                                                          2 1



                             PIRT$

              r 10 it L-'         EDUI                                     I

                                       If
               D!t        -
                    T-A
                 r


                1 &I EN        CARF
                                                                                                                                  ------ tq3A!A
                      c
                             Ff)S
                                                                                                                                                          3b7
            El    S
                                                                                                                      13                  zz,
              TFI;  N           N    $(JO
                                                                                                    12ZA44              2   A,2
                                                                                                            a-i-      I   2A                -t A

              I cr)
                                                                                                                                                    t




                     c    I
              k OT  @ic     @EVI:NT C',tl



                A  Cu


                            ON
                                                                                                                        142,.
            I   fo I c 4  q  HNSPI

            a  cn  0 c    Open

                          SF  CTACNI
                                                   1132                                                                    -32--L   @A-
                 f L@P,   FT
                          ---                        --I--                -I-
                c         5r@IA   A
                                                                                                                                                           z II

                    p@    C   A




                                                                                                                                              n rti kui,4 - p I @ N.-Ur L -
                                                                                    BREAKCUT CF REQOEST                                        RM OnOO9 P6/72
                                                                                     n6 PRCGRAM PTRIOD                                                                  RMPS-osp-.

                                                       (5)                (2)               (41               (1)
       IR)FNTIFICATICN CF CF)MPONENT             CCNT.       WITHINI cnNT. REYONf)l     APOO. NOT        I NFW, NOT         I      CT)RRENT     I    CT)PDFNT      I
                                                 APPR.       PERInOl APPP.  PERIOCI     PPEVICUSLY       I PPEVICUSLY       I      DIRFCT       I   INCIPFCT       I      TRTAL
                                                 OF SUPPOOT          OF SUPPORT         FUNC-ED            APPPOVFC                COSTS              COSTS        I

       A73     @UR   RFGTCNAL    EMFRGENCY    SI
            FO V I 1:
       n74     PLATELET     PLASMAPPEDESIS     I
                    --     L--T-        ---    I       -         -.L                  ------
       t)7S    P 7F'7')IF,7   N@n@MATif-IN    SI

       1)76    M-IIITLE   QFHAf!ILITt%TICN   @El                   I
       - -@@r F-S  -----   -   --      ----- --I-124-435                                                                            S  4.L /,.a
                         CAPE     MISSrtJPI
         7  7  CAPOIAC
                                                                                                                                                                              7.L.63:.
                       'AE-NT  OF  PI-AOM   SEPI
            V I r P
       14A   CAWEQON HEALTH CAPE

       141     BOANC%ON  INTENSIVE CAPE
               rN,    -7-;,    - - ---         I       S           - - ------ - --
        8 -  TTU N
               C    N      7@r)tJCATtOt4    Cnol

       183  GQFEN HILLS
                                                                                      - ------                                                                     I_--           71-
       nR4   PF5-1,,-%T-Q-iz-KLPS-E-AS-SOC-14-Ti
       --   F
       MRS    COMPI)NITY     EMERGFNCY     HFALI                   I

       nR6     DOCENT    NURSE     OUTREACH    I
                                                                                                                Sft?.175    I --IBZ,12's        I      577-ion     I
                                                                                                                            I
                          TOTAL                   $29683,336            $406,964,           $308,947        $1,061,6n5      I   $4*46rv852      I     t8P2,94?     1  $5p3439795


















                                                                                                                                                                       I @




                                     9               MGION   Missouri
     RWS FEVTL;W CRI7FRIA MTN                        EL,'VIEW CYCIE      T9

        A. PE, RFORMAN

            1.  Goals, Objectives and Pricrit'-,Es
                A Goals Committee has been established to develop a new set of goals
                4nd objectives. The present set encompass the universe of possible
                needs. No specific short-term objectives exist.




           2. Ac     li.,-)-ffmnl-s d Irplen,,entation  (2)
                LICCO-ITT@l-
                Worthwhile activities h@ve eon 's-ti. @mul.ated iii@ various parts, -of -t'hR'
                Region, but their results have not been extended to other areas as well as
                they shot).ld, While heavily continuing education and technology
                oriented in the past, MRMP is devoting attention to quality 'of
                care standards, peer review mechanisms, better utilization of
                manpower etc.

              @Continucd SuT) ort (3)
                          p
                MMQ is attempting to 'find other sour@'es '?if support for terminating
                activities.





           4. -minor,,.tv interests (4)
                There are no minority members and one woman in the.Advisory Council.
                Minority representation on staff is low. MP-NIP should consider these
                interests in replacing s@a@f.



                                                             - - - - - - - - --

       B.' PROCESS

          .1. Coo@ator     (5)
                The Coordinator is a capable director and has developed a cohesive
                staff.  He has not implemented some of the new program ideas as
                recommended by Council..




          2,A 'Core Staff
                Core staff has a broad range of talent. However, its adherance to its
                traditional organizational structure seems to interfere with its
                ability to respond to new program goals and special initiatives and
                requests for assistance at the siibregional-.Ievel.




                                                          - - - - - - - - - -
          3. 'Regional Adiri





                    Grantee Organization  k'8)

                    University of Missouri --- adequa'te support provided.






                                                         - - - - - - - - - - - - - - -
                    Participation  (9)

                    Broad spectrum of participation.





               6. 'Local P         (10)
                    Effectiveness varies from area to area.  RMP should possibly
                    consider eventually replacing part-time elderly physician' subregional
                    directors with younger health planners-.



                    Assessm nt of Needs and Resources (11)
                    An adequate data base exists, but it's use is not always reflected
                    in regional plans or programs.





               8.  Managemnt   (12)

                    Adequate






                                                             - - - - - - - - - -
               9.  Evaluation  (13)
                    An Evaluation Committee has been formed.  MRMP appears good at project
                    evaluation, but needs better. goals'to evaluate on the program level.





           C.  PROGRAM PRO,@AL

               1.   Action Plan (14)

                    Target areas have been delineated, but decision-making on the
                    bases of these areas does not yef appear functional.  An action
                    plan does not seem to have-been'articulated.






                .2.  Dissm6natJ.on  of llnr*tle@e (15)
                     @-of-       's stronger  emphases  as   reflected in the telelecture
                     and  biomedical  information  service   projects, among others., The
                     Continuing  Education  --  Coordination   project would attempt further
                     dissemination of continuing education activities from the
                     University.


                3.   Utilization  Manpovier and Faci.li-ti.es  (16)
                     Rest  efforts at improved utilization of manpower &Rg facilities
                     pl  ned for in Gre6a Hills and Kanias@@tity.    Technological activities
                     may eventually  help  uuderserved  areas,




                4.        ven-ent bf care  (17)
                     inpro
                     Hi-Blood and the Mobile   Rehabilitation proposals are some of MRMP     s
                     -b tter contributions to  ambulatory care-$ primary care, and
                                                 Problems    of.access to and continuity
                     transportation problems.
                                   C-urther attention
                     bf care-need



                50   -Sho@--Term Paoff    (18)
                     Some of  the  newer  projects  address  this-more adequately  than the
                     group of original activities, particularly      in the technological
                     area, whose payoff   is still some    years  away*




                6.   -Regionali-zation
                                                        ty  of Missouri  services  and training
                     Some,regionalization   of Universi
                     expertise to the  -rest  of  the  Region. Also  6xchanie of  information
                     -and-results among projects occurs     at Project Directors"veetings.




                7.1 Aher              (20)
                     More  being attempted now (p. 46 and    47):
                           Missouri Automated Radiology Service
                           @utomated   Physician's   Assistant
                          'Telelecture Project



        ,,,%IEMORANDUM                                                           DEPARTMENT OF  HEALTH,  EDUCATION, A@i;D NVELFARE
                                                                                                               PUBLIC HEALTH SERVICE
                                                                                    HEALTH SERVICES AND MENTAL HEALTH ADNIINISTRATION


        ,J.,o          Acting Director                                                                                   DATE:      April 17, 1972
                       Division of  Operations  &  Development




                       Director,  Regional Medical  Programs  Service


        @@UB
                       Action  on April  10-11  Staff  Anniversary  Review  Panel
                       Recorffnp-ndation  Concerning  the  i@ssouri  Regional Medical
                       Program Application RM  00009  6/72.



                       Accepted
                                                                                                                              '(dateJ




                       Re'ected
                                                                                                                               (date)





                       Modifications.






                           Component and Financial Summary      Anniversary Application



        COMPONENT                  CURRENT           06 YEAR           -c)6 YEAR       RECO,'4MENDED
                                YRIS A'6'ARD
                                                                                         FUNDING
                                     OPER.                                             /= SARP
                                @YEAR              COUNCIL
                                                 RECOMMENDED           REQUEST         /X-X7 REV.
                                                    LEVEL                                       COM.
                                                                    A   878,147
        CORE                 $  823                                 B I,]-')7,602

        Sub-Contract                 -0-
                     s                                                       -0-
        6PER.   ACTIV.                                              A   930,920
                                1,118,976                           F3 3,133,050

        DEVEL.   COMP.               -0-                            B   igo,ooo      Yes     or ,@io

        EARMARKS:


                KIDNEY               -0-                                     -0-


                EMS         See Below







                         1,947,417-12 mos.                          A $1,825,417
        RMPS DIRECT
                                     4                              B  4 4@o                    17**

        REQUESTED
                         @.o6i,962
        COUNCIL
        APPROVED  LEVEL     2,500.1000
        NON-RMPS  and
        INCOME

                     Under  2/8/72  National   Advisory   Council   policy, REGION  lqissouri
                     the approved  NAC  level  for  the  first  year  of  the
                     triennium     prevails.                            May June    197 2 Review Cycle

                     The EKS proposals were part of the basic application and are pending
                     special review.  Funds for these projects are not included in this figure.

                     Plan A requests the cormdtted amount of $1,825,417.
                     Plan B requests the optimum amount of $4,460,852.
                     Staff and SARP recommend Plan A.
                                                       Plan A
                  Current  Program   request             $1,825,417
                  Supplemental CBF, request                  385,817
                  Slipplemental EVLS request             1,3145,185
                  Region's  total   request.
                                                         $3,556,419




                                             3
                                                              Region  Missouri   @MP
                                                              Review Cycle June     1972
                                                              Type of Application:  Annive @144
                                                                within Triennium
                                      Recommendations From    Rating:   219


                   SARP                                   L7  Review Committee



                   Site Visit                                    Council



          Critique:

          The review of MRMP's r6qpest was handled in two parts:  1) Computer    and
          bioe6gineering activities, and 2) the main MRMP Program.

          I.  The first dealt with the findings of the April 4-5 technical site visit
                of the computer and bioengineering,activi@ties, which were presented by@
                s-taff who accompanied the site visit team.  A draft copy of the report will
                be available. SARP accepted the site visit report and recommended  that
                the following activities be terminated for lack of technical  merit:
                @rojects #69, Automated EKG in a Rural Area; #72, Automated Physician's
                Assistant; and #75, Bio-medical Information Service.  I-lith regard to
                the Automated EKG project, SARP differed with the site visitors'
                recommendation that $60,000 be provided for the proposer to  develop
                an activity which would establish-a remote consultation service using
                less expensive equipment in the local hospital, based on the commercially
                available analog transmitters of the EKG provided by the telephone
                6ompany.  Such a service could provide the local physician with both
                an interpretation and a consultation when requested.  SARP recommended,
                no funds for the EKG service, but directed staff to advise the RMP to
                explore this more productive areas outlined by the site visitors.
                (There was one negative vote.)
         II.    SARP then dealt with staff's concerns and recommendations covering  the
                main part of the MP14P program.  SARP agreed with staff's recommendation
                to approve the committed amount of $1,825,417.  The developmental
                component request was disapproved.

                MRMP submitted two budget plans:  Plan A for $1,825,417 and Plan B
                f6r $4,460,852.  Although MRMP had made progress in several areas,
                SARP agreed with staff that their serious concerns about the  course
                followed with the computer and bioengineering activities, and the  lack
                of strong leadership,precluded the approval of funds above the"
                committed level or the developmental component. Decision on the
                EMS projects, ik73 and #80, was deferred pending the results of the
                special RMPS review. Funds for these projects were not included in the
                $i.8 million figure.





                                               4

                Page 2 - Missouri RMP--Recommendations From SARP


                Areas of progress and positive accomplishments which staff  identified
                for SARP include the following:

                1. Reduction  in the size of and consolidation of the functions
                   of Program Staff.  Tn addition, Dr. Morgan has replaced
                   Dr. Wakerlin as Chief of Planning;
                2  Formation of Goals Committee to develop a new set of goals  and
                   objectives, as well as an Evaluation Committee to propose
                   evaluation procedures for review;

                3. Creater program activity in Kansas City;
                4. Increase in the proportion of its total program request  committed
                   to community-based activities.  Staff also found an improvement in the
                   quality of the more recently submitted projects in this area.   The
                   Green Hills Project (#83), for example, has provided  coordination
                   and organization of services and education among twelve  community
                   hospitals in Northwest Missouri;
                5. Greater success in getting outside sources of support for  MRMP
                   activities; and
                6. Development of activities more relevant to the Region's  needs
                   and RMPS' review criteria. Examples include development  of  a
                   position paper oh the physician's assistant, a survey of
                   commuhity's perception of health needs, interest in consumer
                   education programs, greater emphasis on preventive and primary care
                   programs (Hi-Blood,Phonocardioscan and Diabetes projects),
                   assistance to c6pimunity hospitals in bioinstrumdntation support
                   and implementation of a standardized medical record.  In
                   the area of manpoVer, two innovative proposals are requested
                   (Docent Nurse Outl,-each and Pediatric Nurse Associate).
                Areas requiring reviewers' attention and staff assistance during the
                coming year include:


                l.. The need to develop a workable set of goals and objectives  and
                   an action plan. T4hile many of the projects in the  Application
                   addressed MRMP target areas (p. 50). staff was unable to find in
                   the application clear evidence of a plan for addressing  these
                   target areas in any unified way.  In overall program areas such
                   as rural health and continuing education$ MRMP needs assistance
                   in developing a regional plan;
                 2 . Despite the size of Program staff (60 positions, 48 F.T.E.),





                                            5

             Pa ge,3 -,Missouri RMP--Recommendations From SARP
                                                                         yed in
                                                    be organized or deplo
                 -Program,resources do not appear to
                   - nner which permits the RMP to more rapidly respond to new.program
                 a.ma                   ativess, or to requests for assi tance at the
                 goals and special initi                                s
                 subregional level.

                               stained4)
                 (One member ab

             Summary of Recommendations:
             Approval of the $11,825,417 amount recommended by staff.. Disapproval
             of the developmental component request.  Disapproval and no funds
             for Projects.-#69, #72 and #75 (see Section I above).  SARP also
             recommends the concerns delineated above@be communicated to the
             Region in the advice letter.






























                                                                       4/19/72







           COIII>ONE14T            CURPF'IT             09   YEAII       1   @5      YEAR         RECOMIL9@,DED
                                   YR'S AWARD            COUI"C'AIL                                  FM;DING
                                -04   OPER.              RECOi'@IIDED            'REQUEST              SARP
                                   YEAR                  TEVEL                                         REV. C014.


                                   788,286                                       947,034'
         CORE
         Sub-Contracts


         OPER, liCTIV.             6305066                                    708,345
                               approved but
         DEVEL. CO!@.           Linft-,rided                                                      yeg         or 110

         EAP14ARKS:

           KTr)lirEY                  -0-


                                                                                               Di-sanoroved
          Kidney @k?4-                                                         74,576
    4:    Ilealth Trng.
               @,23 (CBES)     See  bel.o.i,)
          EMS @'25
                               See below**





         R14ps  I)TRFCT         ]@,418,352           1,741,000*                11,829.955         1,725@000

         RPQUESTED              2,449,24n

         conlc I'L
         AI'PROVED LEVET,       1,741 000        l@

         NON-RI-TS and
         it@COME


          *11-nder 2/8/72 National Advisory Council
                                                                                   REGION      Mountqin States
            @policy  the approved NAC level for the first
            @year of  the triennium prevails.
                                                                                   Ma@/Jtine         2
                                                                                                 t97  .REVIEW C@
         **Also  pending are the following requests
                          01            02         03
           EMS        3755576        234,945
           CBES       219,575        182,000      100,000
     Current Prog.
         Request       1,829,955
          Total
        is Request       2,425,106                                                   5/23/72 VIOB/RMPS





                                                                                      Page 1
                                                  RMPS
                                        STAFF BRIEFING DOCUMENT





                                                         OPERATIONS         Eastern            Mid-Con
                                                                      /-7 South Centrll rx7 Western
   REGION  MOUNTAIN STATES REGIONAL MEDICAL PROGRAM        BRANCH     -

                                                           BRANCH
   ryPE   APPLICATION                LAST RATING           Tel. No. 443-28                Room    i. 2
         TRIENNIAL              197- DATE                  BRANCH CHIEF Richard..
                                                           BRANCH STAFF James A. Sm-ith
   Lxl   lst ANNIV YEAR        /x / SARP
                                                              pEp. Dan Webster
         2nd ANNIV YEAR        LI   REV. COM.              RO
         OTHER                 /-7  OTHER                  Last  Mgt.  Assm't  Visit  N/A           19i

                                                           Chairman
   LAST  S.V.Mardh  197 1    Chairman   Clar
                                              aix@.tn's Name and Type of Visit)
       aff Visits,  Last  12  mc   (Dates, Ch
           1971          Jessie Sa                            Staff visit to observe the ReRibnls
                                                              Droie t review anel.


   Major Events Which Occurred in the Region Affe,ting the MT Since Its Last Review
   in              197 1
         Alfred Popma, M.D., Coordinator, retired in December, 1971     after  five   years
         of service to the program.  His deputy, John Gerdes, Ph.D., was hamed interim
         coordinator until a new coordinator is appointed.  Dr. Gerdes is a candidate
         for the job.
         The other significant happening for MS/RMP during the past year has been the
         emergence of long suppressed  feelings  of  discontent  with  its  grantee,  WICHE
         MS/RMP complains that the grantee (WICHE) maintains undue restraint on the
         programmatic efforts which hinders  the  Region  from  being  responsive  to  many
         of the hew  national priorities.  The Region feels that its progression of
         development and maturity is at the level where it can consider the
         possibility of  becoming  a  nonprofit  corporation.  WICHE  is  resisting  that
         notion, maintaining that the success of  MS/RMP  to  a  large  degree  has  been
         through its affiliation with them.  Currently, it appears that the two
         parties art workiftg  toward  an  acceptable  compromise.  WICHE  will  probably
         remain as grantee, but extend more programmatic latitude to the MS/RMP.









                                                                                          Page
             /Aountain 5tates Re8lonol /AeJlccil Pro8rom





                IDAHO
              MONTANA
               NEVADA
              WYOMING



























                                                              REGIONAL OFFICE - Boise

                                                              SUBREGIONAL OFFICES
                                                              o Idaho - Boise
                                                              0 Montana - Great Falls
                                                              0 Nevada   Reno
                                                              9 Wyoming - Cheyenne




                                                                                                   Page     3

                                                                                               ADDITIONAL
                                            Mountain States P-'4P (Wiclie)                     INFORMATION 3/72


                Ge6graphv     and     Demograohy
                      4   State    area:    Idaho,    Montana,    Nevada,    Wyoming;    interface    with
                                          Colorado-Wyomihg and parts of Intermountain

                      Land    Area:    435i643    square     miles
                             ation (1970 Census compared with 1960)

                                                   Total    in    000's                            1970 Per Capita
                                                1970                1960               (1970)          Income
                           Idaho                 694                  667               8.7             $3206
                           Montana               713                  675               4.8            3381
                           Nevada                489                  285               4.2            4544
                           Wyoming               332                  330               3.3            3420
                                                                                                             (,U.S.
                               Total           2.,228            1,957                                3910  Average
                           Rounded to 2,230,000; average density 5.1 per sq. mile
                           increase   of   14%   compared    to    1960
                           Median age:  (1960) each State below U.S. average of 29.5
                           Perc.ent Urban:      Idaho      54%;      Montana     53%
                                                Nevada      81%; I-lyoming      61%

                           4    State    average - 59% urban4, 41% rural
                               Metropolitan     areas - 1970 preliminary population,
                                        compared with 1960
                                                                  -1970                 1960
                               Billings,         Montana              86.1                79.0
                               Boise,      Idaho                      109.4               93.15
                               Great Falls, Montana                   79.7                73.4
                               Las     Vegas      Nevada              2-70.1            127.0
                               Reno                                   120.0               84.7
                                                                      665.3             457.6
                           Non-white    -     95,100   (4.2% of 4     State total)
                               Bla('@    -    34,500
                               Other          60,600   (mainly Indian and Spanish-surname)
                 Vital       Statistics -   mortality   rates   (per    100,000    @(            1967
                                                   U.Sl          Idalio    Montana      Nevada              in
                 Heart disease                     364.5          305.9        326.5      239.6        31-2.4
                 Malignant       neopl-            157.2          131.3        142.9      122.7        130.2
                 Vasc. lesions                     102.2         95.1           96.7        68.9         91.4
                    (off. CNS)
                 Diabetes                          17.7          18'.7          20.1        11.3         16.5
                 Br neho Dneumonia                 14.8          18.8           17.0        20.7         27.3
                   O(excl.'infl.    &     pneum)
                 Accidents       (1968)            57.5          79.5          79.4         85.1         89.2








                                                                                                  Page  4


                   Mountain States (continued)

                   Facilities and Resources
                      Medical  School  -  1  developing   2   year   school   Univ. of-Nevada, Reno;
                                           first  class  (24)  to  enter  fall  of   1972
                      Allied Health Sch - Idaho State Univ. coil of Medical Arts, Pocatello
                   Professional    N                                Licensed Practical Nurses
                                                                    15 - each affil. with school
                   Idaho    -  4  (4 College   or   Univ.    affil..)      district or college
                   Montana  -  6  (4 College affil.)                5  -  4college or high s,ch affil.
                   Neva(la  -  2  (2 University based)              8  -  6hosp; 2 priv. schools
                   Wyoming.-7_L(3    College affil.)                2  -  1college     based
                     Total    1,5 fl3 college or                    30  (20 are high school or
                                   university based)                      college affiliated)
                                     cal Technology              Schools'of Radiologic    Tech o
                   Schools  of  Medical   Tec,,noio
                          Idaho      -   6                          Idaho        -   7
                          Montana    -   4                          Montana      -   6
                          Nevada     -   3                          Nevada       -   7(2 Univ. based)
                          Wyoming    -   1                          Wyoming      -   2
                                                             spitals)              22 (20 at hospitals)
                                         14 (each at ho
                     cytoteclinology training - no schools                                              Z.
                                  Community  General   and   V.A.   General
                                                              n  te@
                                                             s      gi
                                     Short-term                    ec        V.A.    General
                                   T     s     Beds                 Beds         #   Beds
                     Idaho            48     2,879          1       37           1   172
                                             3,841          1       228          2   256
                     Montana          56
                     Nevada           17     1,951                ---            1   224
                     Wyoming          27     1  825         2       698          1   174
                                                            4       963          5   826
                                     148     10,496
                        *1965   report   -142 short term, 8814 beds
                     5 V.A. General hospitals, having total of 826 beds
                     Special Hospital Facilities 1969         idaho-Mont@Aa nevada W@oming
                     Intensive     CCU                              17   19      9        13
                                                                    1     4      1         3
                     Cobalt    Therapy
                     Radium                                         5'.   8      5         2
                     Isotape      Facility                          6     7      5         4
                     Renal dialysis Impatient                       4     5      4         1
                     Rehabilitation Impatient                       3     0      2         2





                                                                                                        Page 5







                       ower

                         llhvslcians    Non-Federal                          Graduate Nurses            1966-
                                                                                                     Empl. in
                      Active     kDs and DOs
                                1967                                                 Not empl.        Nursing
                                -,MD    DO      Total   Inactive           Total     in nursin_&       (-adi.)
                   I.daho       610     37     647           29            3049          1090           l@34
                   Montana      656     40     696           30            3404           916           2483
                   %levada      423     28     451           26            1533           470           1060
                   Wyoming      293     13     306           16            1621           410           1209
                     Total    1982*     118      2100        101           9607          2886           6706


                   Ratios of active practicing physicians                        About 70% were actively
                   range from 89 per 100,000 population                          employed    in     nursing.
                   in Idalio to 102 in Nevada.   Average                         Average ratio for region
                   for region is 94/100,,OOO compared                            about   301    per    100,000
                   with national average of 132.                                 compared to 313 for UiS.
                                                                                 as a whole.






                   *Of the total active practicing MDs (1982) 802, about 40%, are in general
                   practice.   The majority of the remaining are specialists; a small number
                   are hospital based And a smaller number are in other professional activities.

                   Group Practices        1969
                                                                     Single         General.           multi-
                   By State                     Total             Specialty         Practice        Specialty

                   Id-aho                       28                    10                 7              11
                   Montana*                     36                     5                 9              22
                   Nevada                       27                    18                 2                 7
                   Wyoming                      10                     2                 4                 4





                    Component_and   Financial Summar@Annivernary Anplicatlon                 Page 6


                                                      YEAR                 YEAR        RECOI*IENDED
            COMPONENT        CURPE?IT
                                                      it                                  FMING
                             YR'S AWARD           COU'NCIL
                           v o4 OPEP,.            RECOi4MFNDED        'REQUEST              SARP
                                                                                            REV. com.
                             YEAR                 LEVEL


                                                                      947,034
      CORE                    788,286                                  u     --
                                u
      Sub-Contracts
                             630,o66                                  7o8,345
      OPER.    ACTIV.
                                0                                     100,000           Yes       or No
      DEVEL. COMP.--


      EARMARKS:


         KIDNEY
          Kidney  #24           0                                       74.5-76
          Health Train-
          ira #2@                                                     219,575
          Network               0




                                               li5ll'3000           2,049,@30
      R@TPS  Z;l  ECT       i@4180@92

      RELUESTED             449 0 q4o

      COUNCIL               1,741,000
      APPROVED LEVEL


      NON-RMPS and
                                                                      374@000
      INCOME


                                                                                    Mountain States RMP
                                                                           REGION

                                                                              June     t972i,REVIEW CYCLE

                                                                              eceive $354,588 for.
        i-llr-ie 04 Year is be@ extended to 9/1 and the      ivegion   will   r
                                                                          -rd-of $1,772,940 for 15 months.
         the three month extension resulting in a direct aost awa









                                                                                                                    REGION - MOUNTAIN
                  MARCH 17,1972                                        OREAKCUT OF REQUEST                          KM  00032     06/72
                                                                         05 PROGRAM PERIOD                                               R14ps-osm-JTOGRZ

                                                                (2)           t 4 1
            IDENTIFICATION OF COMPONENT      CONT.     W[THINI 'CONT.     BEYONDI APPR. NOTINEWV NOT   I    CURRENT       CURRENT    I
      cd                                     APFR.   PERICtl    APPR.    PERICDI PREVIOUSLY PREVIOUSLY      DIRECT    I  INDIRECT    I    TOTAL     I
     P4                                      OF SUPPORT   I OF SUPPORT   I FUNDED        APPROVED           COSTS          COSTS

            cooo CORE
                                                                                                       1    s94 7. il 34   12@6&7    I-Ilsist.6al   1
            0000 DEVELOPt4ENTAL COMPONENT                                                              I                             I              I
                 ---          -            I              I     -        I                                                                sleo.ODD-1
            002   PROGRAM   IO    PROVIDE    COACNI       I                                                                                         I
                                                                                                                           -ll5-dl2  I    S12S,200-
            003  YfjU.IITA[tj  STATES  TUMOR   l@ll       I                                                                          I
                                           I                                                                216SLQQO-l      143,566  1   -=@U-      I
            DDT    CO@4T[NUING    EDUCA71ON    FOR]                                                                   I              I.             I
                b LI-RSI N G @ E YA DA - ------    -.L                                                          164.lnl1
            oii   cciilpiuipig   ERUCATICN    FC$tl                                                                   I
                                    --       --L--152AI2(L]                                                                  .15.L2R6   I  S&A.356
            ;iZ-   CORONARY   CARE   TRAINING    Si                                                                   I              I
                U41UNESL'Lo&tlo-----  -                                                                I--ll2.Lfigm   I         Jkl"5jLt   11,3_a 6 61
            013   CUNTZ'iU[t.G    EDUCATION    FCRI                      I                             I              I            .  I             I
                                                                                                                                           181,276  1
                                                     127  1                                                                 s=Aii2-i
            ots    Cc,%TlhulKG    EDUCATION    FCRI       I                                                                        @ l@             I
                                                                                                                            IJAAia     -1  163,901  1
             21  NEW   MAt@PoWER   FOR   THE   MOUI       I                                                                          I              I
                                           I              I--            I              I                                                 S199,311  1
            023   P.EGTCNAL   AREA   )iEALTH   EDUI       I              I              I                                                           I
            --- LAII                  --   I  -       ----I              1              I--121@@           11219,575  1    -135,612  1      -1255,2471
            024   KtU4EY   DISEASE    CONTROL    PI       I              I              I              I              I              I              I
               p@'I til&!i --                                            I              I     SZ4 576  L        S74,576I    lil.769  1     186,345  1
            5-25  PFtE-DEVELOPM-%TL  PLANItINr.   I                                     I              I              I  '           I              I'
                              LUER Hmn     .I-                                                                                  Islas1     114,216  1
                           TOTAL                                              $1000000       $407#976  1  S2tC49*530  1    $412*401  1   S2v46Lo931 1









                                        MARCH l7tl972                                                                                                                  REGION - MOUNTAIN
                                                                                                             BREAKOUT OF REQUEST                                       AM  00032 06/72
                                                                                                                06 PROGRAM PERIOD                                                                 RMPS-OSM-JTOGR2

                                                                                                    (2)               (4)
                                IDENTIFICATION OF COMPONENT              I CCNT.    WITHINI     CONT.     BEYONDI APPR. NOT        I NEWI NOT         I  A DiTi@L "YE A R                         TOTAL         I
                                                                         I APPR.    PERIODI     APPR.     PERICOI PREVIOUSLY       I PREVIOUSLY       I     CIRECT                             ALL YEARS
                                                                           CF  SUPPORT        GF SUPPORT         FUNDED              APPROVED               COSTS                            IDIRECT  COSTS     I

                                cooo CORE
                                B;5-0-@7@iTC-PMENTA-L CO-MPONENT
                                O@P-ROGRAM     TO      PROVIDE      CORONI                                                         I
                                ZB3    MCUNIAIN   STATES    TU?I.UR    INI                  I                                                         I                                                         I

                                007  CCITINUING  EDUCATION   FORI
                                                                         I                                                                                                                   1       164,101-1
                                31-1-    CONTINUING    EDUCATICK,     FCRI                  I                                                                                                                   I
                                                                                                                                                                                                        152,370 1
                                       (;CFTONAPY   CARE    TRAINING    Si                                                                                                                                      I
                                                                                                                                                                                                        S12,808 1
                                013    CONTINUING      EUUCATION      FORI                                                                                                                                      I
                                                                                                                                                                 5.  406  1                           7 el - @'4
                                -  75  CONTIfli(Nr,    EI)UCATICN     FCRI
                                0
                                                                                                                                                                 157,701  1
                                -oi2- NEW MAIIPCWER FUR THE  MOUI                                                                                                         I
                                                      REGLL[Iti          I                  L                   I                  1  --112@21        ]--   112()-   091  1                 -1     S294.6il     I
                                023    PEGIOttAL    AREA    HEALTH    EDUI                                                         I                  I                   I                  I                  I
                                                                         I                                                         I     S234@945     I     123A.ARA5-    I                  I     1454,52t)    I
                                Zi4    KIDNEY    DISEASE    CONTROL     PI
                                                                                                                                   I     t 112                                                     slael2.576   I
                                025    PREDEVELDPMNTL PLANNING
                                -ANn IIAL=AUF.FICFR H-40                 I                                                                                                                   I     Sig
                                                    TOTAL                    $1,13L#433     I                         $2000000           S642,036             SIP9739469                             $490229999























                                         ..       .             - @ - I- .-I .        I                                                                                              .





                                                                                           r aL t:
                                                                       Re v i c@.; c I e      I





                                                                       197  72
                                       BY  )t,   since
         The reorgan ization of RAG from a unwieldy group of 156 members to one of 30
         is one of the Region's most significant achievements.  This refinement of
         RAG has resulted in a more effective working RAC, that has increased
         awareness of their responsibility for the direction of the program.
         Other significant achievements has been the success of the Region in gaining
         acceptance of new concepts of health care delivery such as the nurse family
         practioner and Ht4O development.  Also, the Region has led the way In sponsoring
         continuing medical education in nontraditional methods through participation
         and involvement in WAMI.
         1AS/RMP has recognized the need'to shift to a more balanced program which
         is not so heavily oriented to continuing education.  This is reflected by
         the new projec.ts: (1) Kidney Digeaie Control, and (2) Predevelopmental
         Planning and Liaison Officer.for HMO, which are directed to developing health
         services.




         PRItiCIPAL  PPOBIXIIIS
          the past., the grantee (WICHE) has maintained a close and careful scrutiny
          14S/R'MP. program activities.  On one occasion, it actually restrained the
         MS/RMP core from accepting an Experimental-Realth Ser44ice Delivery Contract.
                      nt in programmatic decisions by the grantee is seen as a problem
         This involveme
         by the region.
         The selection of a nev coordinator could have considerable implications in
         the future development of the MS/RMP.
                      no ities on core and project staffs has presented a problem.
         The lack of mi  r
         The acting-coordinator admits the region has not faced up to this issue.
         The ever continuing squabble between the (Kountain,-State RMP,  Colo'rado/Wyoming RMP
         and 'Intermountain) over territorial rights is causing problems'.

         XS5Ur:.S, REQUIRING  ATrElITION  O'Ll  REVIE.IIERS
         F             year of  its  triennium  (05  operatio.nal year) the region
         or the  second
         is requesting $2@049$530 for support of Core, Developmental Component,
         seven continuation projects and 4 nqy projects.  This figure ex6eeds
         the Regioo's Council Approved level ($I$511,000) by $538,530.
         The complete lack of minority staff, professional or,supportive, on
         core and project staffs needs attention.






                                                              James A. Smith             DATF@:
          Mountain States

      1.  COALS, OBJECTIVES, AND PRIORITIES (8) --The region's goals of Subregional Centers
      for Continuing Education, Health Services for Rural Residents, Stimulating  Health  Man-
      power Development and Specialized Centers Development have not been changed  or  altered
      from those originally proposed in the triennial application.
      Site visit report (3/71) states that the region seems to have very adequately assessed its
      needs, problems and resources; objectives and goals are congruent with National priorities.
      To some extent, funding of operational programs to date appear to have been developed with
      political considerations in mind to give each of the states a  share  in  activities.  Site
      visit report approved this concept.
      New program proposals of New Manpower for the Mountain States Region,  Health  Training'
      Network, Kidney Disease Control Program and Predevelopmental Planning and Liaison
      Officer for HMO's appear to be congruent with the region's stated goals and objectives.





      - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
      @.econ,i,-,ended Action:





         ACCO@f.DLISH@MENTS AND IMPLEMENTATION (15)--ES/RNP has provided the momentum for expansion
      of the role of the nurse in health care services in rural areas.  Two  nurses  training  at
      Stanford's Nurses Practitioner Program are now providing primary health  care in two
      remote mountain communities.
      @/RMP developed an outstanding coronary care training program in Montana which set the
      pattern for similar programs in Idaho, Nevada, and Wyoming. The RAG reports  that  as  a
      result of this program, the majority of small remote hospitals now  have  special  units
      with trained personnel.
      MS/RMP has been instrumental in the development and support of the  Mountain  States  Tumor
      Institute located in Boise, Idaho.  For the first time, patients in this region have close
      access to a highly specialized diagnostic,treatment, and educational program.
      'MS/RMP continuing education efforts for nurses have resulted into four  separate  state
      ..programs that have@ a common thrust, training for the nurse outside the campus setting.
                eloped and supported the Montana Medical Education and Research Foundation through
      MS/RMP dev
   .@@@which representatives of all health professions and the educational institutions have been
  @'@'.--.,:'brought together in-a common bond.  A total of 105 continuing education programs for
  @,.i.@22 health professions have reached 4,909 participants.
      The RAG report states, 'W/RNP program activities are now proliferating through cooperative
      arrangements and co-funding which not only extend limited RMP dollars, but reinforce   and
                                                         qnrl hpalth orizaniiations.  YSIRNP is now





                                                                                Page 11



          untain States                                       James A. Smith        I)AT

    3.  CONTINUED SUPPORT (10)
        The region's policy for technical review requires the reviewers to ascertain whether
        there is a reasonable plan for the continuation of the proposal after RNP funding
        has expired.
        M/RNP phased out Project #9, Cardiac Care Training/Nevada, after two years of
        operations because it did not meet stated objectives.  Four projects are stated to
        terminate at the end of this (04) grant period ending May 31.  Only one, Project #8,
        Inhalation Therapy, will not be continued to some extent.














   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  @mmnded Action:







    4.  @IINORITY INTERESTS (7)
        MSIRM has two minorities represented on a 30-member RAG.  One black and one
        Spanish surname.  There are no minorities working on core or project staffs in
        either professional or nonprofessional positions.  Minorities account for
        approximately 5% of the total population in the region,










        0

   - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - -  - - -
   RECONMNDED ACTION:








                                                                              Page 12




                                                               James A. Smith



       COORDINATOR (10)
       The coordinator, Alfred Popma, M.D., retired in December  19'71, after serving five
       y ears in that cap ac i ty .  H is d eputy , Tohn Gerd es , Ph . d. ,was appointed interim
       coordinator until the RAG makes a final selection out of  a field of 65 applicants.
       Dr. Gerdes is a candidate for the job.













   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  ..ecomrended Action:







   6.  CORE STAFF (3)
       The programmatic operation of core is decentralized into sub-regional offices
       located in each of th e f our s tates .  The @central core of f ice wh ich f unctions in an
       adminls trative and coordinating capacity, is located at Bosie, Idaho.  The site
       visitors to the region in 1971 reported  that the  @IRW core reflected a broad
       range of profess ional competence and had been highly effective.




                                                                              Page i3



                                                           James A. Smith           DATE!
          ountain States                             DI


   7.  REGIONAL ADVISORY GROIJP (5)
        The RAG was reorganized in 1970 from an original group of 160 members down to
        a more manageable and effective number of 26.  However, the site visitor in
        1971 found the smaller new RAG to be largely weighed  ith medical people
                                                            w
        and generally inadequate in minority, allied health and consumer interest.
        In response to advice from RMPS to broaden the representation of the RAG, the
        Region increased the membership from 26 to 30 members.  The four new members
        were selected from nominees chosen to represent minorities and non-health
        related consumers.














  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
           ded Action:








   8.   GRANTEE ORGANIZATION (2)
        The site Visit report of March, 1971, found no reason to question the Western
        Interstate Commission for Higher Education (WICHE) role as grantee agent for
        the MS/  P.  WICHE as the "backdrop" for MS/RMP seemed to the site visitors
        to be A reasonable and functional organization that providesstrong management
        expertise.  However, there are currents of discontent on the part of some
        members of the MS/RMP staff and RAG regarding what they consider WICHE's
        over zealous involvement in programmatic affairs.  They see WICHE's responsibility
        limited to fiscal management and accountability.  These differences have surfaced
        and the RAG has begun deliberations to determine whether MS/RMP should remain
        with WICHE as grantee or form a separate non-profit corporation.










   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  - -
   'RECOMMENDED ACTION:








                                                                           Page 14



                                                              JaMr.-q  Slgith        T)ATE
          Mountains. States                    PREEARRI)

    9.  PARTICIPATION (5)
       The site visitors-reported that practicing physicians and organized medicine
      .are significantly supporting and participating in the program.  Many community
       hospitals,.including their boards and staff are firmly committed and involved.
       The involvement of nursing professionals is extensive.  In general, there seems
       to be satisfactory political and economic interaction in the MS/RMP.











   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - -
    Recommended Action:







     10.  LOCAL PLANNING (3)
          The Regional AdvisoryGroup reports that the advisory boards and councils of
          CHP, Model Cities, Community Action, Division on Aging and others include
          RMP representation.  Also, RAG or staff members frequently serve as consultants
          on projects developed by these agencies.  The RAG recognizing the need for
          close dialogue and relationships with these local planning agencies has
          thought about the possibility of a general chairman of health for all four
          (Model Cities, CAP, CHP, and RMP) agencies.




                                                                                                                                                       Page  15



                         Mountains  States                                                                  Ryf       James  A.  Smith


       11.        ASSESSKP-,NT  Ol,'  NEEDS  AND  PESOLIRCI--,S  (3)


                  The  site  visit           ors  reported  that  the  Regionb  efforts  in  determining  its
                  needs,  problems  and  resources  have  been  adequate  in  most  respects.
                  However,  planning  efforts  appear  to  be  limited  to  the  immediate  future.




















       -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  --
       ,ecomme-.ided  Action-








       'I 2.      MANACE@ENT  (3)

                  a'he  retirement  of  Dr.  Popma  could  raise  the  (luestion  as  to whether
                  the  ex6ell6nt  management  of  core  activities  will  continue.    However,
                  Dr.  John  Gerdes    his  deputy,  is  well  qualified  and  has  Dr.  Popmals  endorsement
                  for  appointement  as  his  replacement.



















                                               -  -  -  -  -  -  -  -  -  -  -  -  -  -                    -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -    -  -  -  -
     ZEC  %NENDED ACTION-.








                                                                               Page 16



        Mountain States                       PTZF-R  P@T) RY! -Tamas A. Smi-th


    13.  EVALUATION (3)
         The site visit,report stated that MS/@IP evaluation methods are under ver\l
         capable direction, and evaluation for the program is of very high quality
         In response to advice from RMPS to develop better feedback fo program and
         project evaluation to the RAG, the RAG has formulated a four-member
         evaluation committee.  This committee will assist staff in the development
         and dissemination of evaluative information to assist RAG in decision-
         making.

















  - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
   @Recommen8ed Action:








    14.  ACTION' PLAN (5)
         MSRMP has established a rating system which is used by RAG to establish
         priorities for all operational and supplemental projects.  The priority
         rating procedures appear to carefully asses whether the programs are congruent
         with national and regional goals.





                                                                                  Page 12



                                                                   James A. Smith
   RMP-, Mountain States RMP                      EREPARED

   5.   COORDINATOR (10)
        The coordinator,  Alfred Popma, M.D.,  retired  in  December 1971, after serving five
        y ear,3 in that capacity . Ht deputy , Yohn Gerdes, Ph d.  ,was appointed interim
        coordinator until the RAG makes a  final  selection  out  of a field of 65 applicants.
        Dr. Gerdes is a candidate for the job.















    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
  R-ecommended Action:







   6 .  CORE STAFF (3)
        The programmatic operations of core is decentralized into sub-regional offices
        located in each of the four states.  The -central core office which functions in an
        admint trative and coordinating capacity, is located at Bosie, Iddio.  The site
        visitors to the region in 1971 reported that the M/RW core reflected abroad
        range of professional competence and had been highly effective.




  p





  b
  2


  I
  a- - - - - - - - - - - - - - - - - - - - - - - - -    - - - - - -    - - - - - - - - - -
  S RECO@NDED ACTION:
  a,








                                                                                      Page 18


   IMP;    Mountain States RMP                         PARF.T) RY    James A.  Smith               k,"

     17.   IMPROVEMENT OF CARE   (4)

           The complexity of this region is manifold.  This is-a four-state region that
           contains not only vast rural areas but also urban concentrations.  With the
           limited funding available, the region feels it can be the most effective
           through their programs to up-grade the skills and knowledge of the health
           care providers.



















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

   Recommended Action:









    18.    SHORT-TERM PAYOFF



           The /,'O/RIAP's operational programs to improve the availability and quality
         .of health care in the region is beginning to pay off.  The RAG reports
           that the.Coronary Care training project has'provided most of the small
           isolated rural hospitals with trained staff.  Also, through the support and
           development of the MS/Tumor Institutefor the first time, cancer patients
           in the region have access to a high quality treatment center.




                                                                                Page 19




               Mountain States
   dL                                            EIZEARED U..    aamgs A, 5.%ith

       19.  REGIONALIZATION (4)

             The RAG reports that MS/RMP efforts toward regionalization has done much to
             dissipate the historic sectionalism in each of the Mountain States.  There
             Ate few, if any, areas in the Region which have not felt the thrust of
             MS/RMP-supported continuing education@ich professionals now consider a
             tight as well as an obligation.  The patient in an isolated area, as well as
             the health practitioner is benefitting from this impact.


















     - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- -
    @comnended Action:








       20.  OTHER FUNDING (3)
             MS/RMP is formulating an increasing number of co-funded and con"jointly
             sponsored programs.  The MS/Tumor  In6titute.with 365,000 local funds and
             coronary care ttaining--Southwest Idaho with 9,000 dollars, illustrate
             this trend.
























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     'RECO@NDED ACTION:




        NTORANDUM                    DEPARTMENT OF HEALTH, EDUCATION, AND NVELFARE
                                                   PUBLIC HEALTH SERVICE
                                      HEALTH SERVICES AND NLENTAL HEALTH ADNFINISTRATION

   TO       Acting Director                             DATE: April 18, 1972
            Division of Operations & Development



   FROM     Director, Regional Medical Programs Servic

   SUBJECT: Action on April 10-11 Staff Anniversary Rev iew Panel Recommendation
            Concerning the Mountain States Regional Medical Program Application
            RM 00032  May/June 1972



            Accepted
                                                       (date)



            Rejected                                   (date)


            Modifications:





                  Comnone'nt AnL4 Financial Summary_- Anniveranry Applicati2n


        C014PONENT          CUPPEL;T                YEAR               YEAR          RECOMIE'.IIDED
                                                    'CJYL
                            YR'S AWARD          coul,,                                  FUTMING
                            04 OPER.            RECOIOENDED        'REQUEST               SARP
                            YEAR                'LEVEL                                    REV. COM.

     CORE                     788 286                                947,034
     Sub-Contracts             -@o                                     -0-
     OPER.   ACTIV.           630,066                                708,345
                         approved but
     1)EVET,. COMP.         unfunded                                 ioo,ooo                      r No

     EARMARKS-.

        xi DITEY                 -0-
                                                                       74,576        Disapproved
        Ki<lney #24
        Health  Trng.
                                                                      219-575
           #23                   -0-





     RHPS  DIRECT            1,418,352         1-741 000            2-042.5jQ.          1.725,000
     RE2UESTED               2,449,40

     COUNCIL
     APPROVED LEVEL         1,741 000


     NON-R?4PS and
     TNCO.ME


                 '2/8/72 National Advisory Cpuncil
           Under                                                         REGION    Mountain States RMP
           policy, the approved. NAC. level. f oi. the first-
           year of-the triennium prevail@.
                                                                       May/june      t972,.REVIEW CYCLE

           Action on,educa.tion-proposal pending special,.;-.
           review.  Funds kor   th'at,              include@
                                      project n6t
           in  this  figure.'







                                                              Region   Mountain    States RM
                                                                                        2
                                                              Review Cycle  June      t97
                                                              Application:     Anniversar  thin
                                                                           Triennium
                                      Recommendations From    Ratin    314
                                                                   9




                                                                 Review Committee
                    SARP




                                                                 council
                    Site Visit
             The Staff Anniversary Review Panel concurred with staff  recommendations  for
               the 02 year Anniversary Applicati'on from Mountain States Regional Medical
               Pr'ogram.  The Panel recommended a funding'level of $1,725,000 for
               support of the Core Program, Developmental Component and nine ooeratioiial
               projects.  This proposed funding level does not exceed the Nati ona1
               Advisory Council's recommended level of $1,741,000 for the second
               anniversary year.
               Two new projects presented by the Region in this  application,  Yt23-Health
               Training Network and ik24-Kidney Disease Control Program are not  included
               in the above funding recommendations. Project #23-Health  Training  Network
               is an AHEC proposal and will be reviewed separately by the Ad Hoc Rev
                                                                                     i.ew
               Panel at Sun Valley. Based on the recommendation received from  the  Kidney
               Mini SARP Review, the SARP disapproved Project l@24-Kidney Disease Control
               Program. The Region will be advised of the proposal's inadequacies  and  be
               provided, if requested, with staff assistance and counseling in  developing
               a new proposal.
               There was general agreement by SARP that MS/RMP has been effective and Droductive
               in the past.  Jith the recent selection of Dr. John Gerdes, Deputy Coordinator,
               to become Coordinator, there is no reason to believe that this positive trend
               will not continue.
               Since the February summit conference meeting between MS/RMP, '.IICIIE,and RMPS
               the tension between MS/RMP and WICHE appears to have diminished.  The re'La-
               tionship of MS/P,'AP to @qICHE and particularly the issue of programmatic
               latitude is under study by the RAG.  However, there are favorable indications
               that a compromise amicable to both parties is about to be reached.
               The reviewers thought that the goals as promulgated by MS/KIP are all
               inclusive which gives them wide parameters for programing .  However,
               the lack of any definable short-term objective hinders any real
               measurement of achievement either by the Region or RMPS.
               SARP was especially concerned about the new  proposal  #25-Predevelopmental
               Planning and Liaison Officer for HMO in Sweetwater and  Fremont  CountieE,
               Wyoming.  It was noted that the budget zooms upward from $19,275
               for the first year to $175,000 for the second with no explanation for
               tne increase.  They advised that the Region be cautioned against any
               tendencv to get involved in the acutal development or support- of an  HMO.







            Page 2 - Recommendations From SARP                      Mountain States RMP

            Most of the reviewers thought that while liaison activity was a legitimate
            function for the Region, it should be a part of Core and not a separate
            project.
            SARP was equally concerned about the lack of minority employees on either
            the Core program or project staff.  It was noted that the Region had
            added minorities to the RAG in the past year and the new coordinator has
            requested a situation report on minorities by May 1 from each of the
            four-state directors.  However, it was recommended that the region give full
            attention  to acquiring minority employees when vacancies become available.
































                                                              4/18/72  WOB/RMPS




                                    T                                             01' ITEAL,'J-11, 1, ])UCAI-IC)N, AND \N,@E1,FAI',Y-,
        YL,EI OR @DU-'il\/@i-
                                                                                      I'LJBI@IC'@ III-'A],'J'll SilIl@VICII"

                                                                            SI"IRVI(,'I"S ANl)          III-"ALTII A.F)NIINIS,rRA'f'IO.N

     sk)             Acting  Director                                                        I)ATE:   Apri'l  18,  '1972
                     Division  of Operations  and  Develop@Tient@,-A-@





       I'l@0,\f      Di r,ector
                     Regional  Iliedical  Programs  Service

       SUBJEC'J':    Action  on  /\pril  10-11  Staff A@t-iniversary  Review  Panel  Recommendation
                     Concernina  t,@le  Kans@)s  Regional  l,ied-ical  Program [Application  Rtl 00002
                     6/72.


                     Accepted

                     Rejected
                                                                             ate


                     Modifications:






                                           2
                                                                  Anokicntion
              CoriT)onen tAnd                        AnTiiver3n



                                                                                     17"DvD
                        CURPIF@;T                           i)-L YFI@R        RECO@i@i,.,t
     CO',il'O',IE14T
                        YRIS A@.IARD                                            FUIMING
                                                                                X SARP
                        05 OPL@R.          RECO'            -REQUEST
                                                                                  REV. COM.
                        YEAR
                           932',846                               400
  (,'OR F
 ,Sub-Coiitracts
                           415,757                                  0
  OPER. A(,TTV.
                                                                    o
  'DFVET,. COI@T.     DISAPPROVED

  EARI.FARKS:
                                                             (125)000)           125,000
       YTR,'ITFY (#40)     111,826(d@)
       TV,
       I0                   52,810(do                        (35,550)
       c ies  (#45)




             CT                  03     1 Soo 'booct),       1,732,760               ooo*@
                                577



                          1 800,(
   APPROVED LEVEL

                                                                                                     <
   IqO','I-RI,IPS and


      Q) Under 2/8/72 NAC Polic,y, the approved                     Rr@(;ION KANSAS
       NAC level for the first year of 'the
       Tri enni Um prevai 1 s                                         June     1972   REVIE@4 CYCLF.  I
       Withdrawn I)y KRI@IP
       PI S  kidney funds of $125,000
                                            "z@-0 arid $3 q, S,6 O.- for #45
       This  amount incluqes $125@OOO.for @f


                                                                         Revised  5/2/72




                                                                      REG I Ot'@  I'\ans as
                                                                                            e
                                                                                            --TT7-
                                                                      !@EVIEW            un.,.--.    -
                                                                      l'yl)e of Applicati-oii Aiiiiivei-,@@
                                RECOMI@ENI@ATIO@IS FROI@L                            within tri(@rin.ii
                     SARP                           /-7  Review Committee     Ratinc,  264

                                                           Cotinci I
                     Site V i s i t


                                                         Review Panel  (SARP)  recommended  that
       FU@ DING R'[--COil'i@/iE@IDATIOI'4: The Staff Ai,inivers@a@yI
                                          f urid                of $1 550,000 to include kidney
                                 I'\ Rl,'i P b e--d in ',-he amount
       funds (Project 440) which are not 'to exceed $125,000 foi- -the 06 operational year.
       This amount ($1,550,000) reflects a reduction in that the application request was for
       the amount of $1,732,760.
       RATIONALE:  SARP felt that the recommended amount would provide the Program sufficient
                   financial latitude for the projected  expansion  of  activities  within  tile
       Region especially since the VRf@iP riovi plans to pursue the supplemental  funding  route
       for several community health manpo@v,,er  programs. Since the prerogative of an OLIt-Of-
       phase supplement was not available to the  Coordinator  at  the  time  that  the  present
       application was prepared, a Developi[iental Component had been requested  for,  the  sole
       purpose of establishing activities dealing with expansion and augmentation of manpower
       programs at the community level.  In view of the new option now available, the Region
                  to @q'tiidra\i the Deve
       has chosen      1                lopinental,Con-iponent and compete for supplemental funds
       using both the t@ay I and June 1, '1972, protocols.  Since the Region plans to utilize
       available liquid assets in the Core budget for  4@6  planning  and  feasibility  studies,
       reviewers did not feel that additional developmental funds were needed at this time.

     @,RITIQUE:   SARP concurred with Staff regarding its assessment of the KRfviP.      The
                  Coordinator's "Stylelt and his apparent  dominance  over  his  RAC  and  staff
       suggest some problems and weaknesses.     Program staff  is  talented  but  apparently
       underutilized.  Turnover of subregional staff is significant.  The reviewers believed
       that the Regional Advisory Council should addr,ess these problems.
       III the past, the RAC has been somewhat of a "rubber stamp" organization although the
       Coordinator indicates that this body is becoming more ma    .Lure.  Store involvement by the
       Local Advisory Groups and the RAC is strongly recommended.      Committee 'organization and,
         0
       Pr gram Staff participation are indicative of increased interest and involvement.
       SARP felt that since KRI'IP was one of the first Programs to become operational, their
       track record was somewhat disappointing.  Although there has been a great deal of Core
       and Project activity, it is very difficult  to  obtain  any  real  sense  of  explicit
       accomplishment.
       Because of the above mentioned problems, SARP     had recommended that the  Developillenta
       Component be disapproved.  Since this request     has subsequently been Witildl@a@qn and the
       requested funding level is below the i'@IAC approved level -for the 02 yea?-, it would not
       be necessary that this application be submitted to the Review Committee.
       Technical assistance was recommended,  as  follows:  (1)  Plan  a  Management  Assessment  Vis!
       to KRIIP in the immediate future. (2) Invite !,Ir.  Ray  House,  recently  appointed  RAC
       Chairman, to participate in a site visit -tc) an "A" Region with a strong Advisory Group.
       (3) Invite Dr. Brown, Coordinator, to participate in a site visit  to  @).ti  "A"  Region.  (4)
         ve Technical                                                                              k
                      ,Assistance to the KR@,IP in-regard to -the pending 910 Kidney application
     li@omposite; Bi-State, Missouri,@ and Kansas estimated at @1,000,000).  (5) Assist and
       entourage KRVIP how best to use the results of their intensive eva
                                                                             luation efforts.
                                                                                   4/17/72









                        ni - S i-' t@ E-: @ C) r t
               iv,oui@itain States                     @)ro@yram
                        i)isc!,iF;c- Control Procra-@Tt Proposal



                      on  @i  lack  of  any  Kidney  Disease  Program,  it  is   proposed   that
               2  ceiters  each  in  Idaho,  @@ontana.  Nejada,  and   WyoTnin-   be   developed
               for LI-te -retrieval and transportation oL' caclaveric kidneys to 6 trans-
                             centers  outside  of  the  re,,,ion  in  Seattle,  Denver,   llort-
                      @@ilt Lakc City, San Francisco, and Los An@eles.            Furt,@,--,rinore,
               it is  proposed  Lo  establish  a  continuing   education   pro,-,ram   'Lor
                              health professional directed toward the manaRe.-neiit of
               patients with ct,,rc)tiic renal disease.  It is also proposed to devel-
               op a reoional public education program regarding kidney disease.
               1',nc, ,)rojectc-d. Fst year budget for the program is $76,000.



                                recommended   that   the   MSl@@   Kidney   Disease   Coitrol
               Pro-l@,;i@,i Ilroposal@ not: be approved for funding.    The   Panel   feels
               that       intent  of  the  Local   Technical   @@eview   Panel   reco,@nenda-
                      have -iot  been  em,,Dodied  in  tnis  -,)roposal,  and  the  Panel
                          that the proposal does not fit the guidelines of Noverii-
               ber  1970  and  the  more  recent  position  paper  of   January   1972   on
               K!cJt@iey  Disease.  ne  panel  felt  the   technical   aspects   of   the
               establishment of     the   retrieval   and   transportation   network   were
               sound  in  tery-,@  of  ,,eo,,ranhic   distribution,   professional   perso:i.
               nel availability, and population concentration, however,               more
               than  a  retrieval  and   transportation   network   is   necessary   to   es-
               tablish  a  Kidney   Disease   Control   Pro2ram.   Ihe   panel   fears   that
               the  proposal  does  not   assure   that   any   @lountain'States   Regioi
                         will   necessarily   benefit   or   receive   transplantation   as
               @i result  of  tne  pro@ram.  'f,'he  pro,,Yram  does  not  address  itself
               to ,)rovidin.,,), cliroiic  or  home  dialysis,  aid  it  does  not  address
                         tc;  the  delivery  of  services  to   the   non-weallhy   patient
                     chronic renal disease.


                                          C) 1 is
                                     d a t.L


                    ',Ilc,@,inLain States Re;,,ion should prepare and present a new
                        Disease  Control  program   after   the   following   steps   have
               be@@-@ Izaken
               1.  A  survey  to  deter,-nine  the  number   of   potential   harvestable
               kidn@---Ys  within  the  re,@ion  should  be  conducted  to   determine   whether
               or       kidney  retrieval  wil'L  be  cost  effective,  and  as   a   ouide
               i@,,              where   retrieval   centers   should   be    established.
               2@  A  ,urvey  of   t@ne   incidence,   prevalence,   morbidity,   potential
                        of-'  trans:)Iant  candidates.  and  inort-i)ity  of  chronic   renal
                isiase In the t@vo uzisurveyed states of Nevada and L,,?yomin@ should
               be conducted to aid the reaion in
                                                                     g the scope and size
               of  the  various  aspects  of   its   Kidney   Disease   Control   Program.






                                            2


           The proposal should contain:
           3. More substantiative arrangements and agreements with the partic-
              lpating transplant medical centers concerning kidney usage, shar-
              ing, and transplantation of Mountain States patients.
           4. A program for the development of a chronic dialysis pro-ram and
              3rd party & State support for chronic dialysis for the patient
              in the Mountain States.
           5. Provisions so that the patient without unlimited wealth can be a
              renal transplant recipient i; medically acceptable.
           6. Provision for continuing professional education in the areas enumer-
              ated in the present proposal and including professional education
              in home dialysis and its supervision to dovetail with currently
              developing home dialysis training programs*
           7. Explanation of the 2@ times increase in 2nd year equipment ex-
              penses when equipment purchased in year 02 is only 5/4 of that to,be
              purchased in year 01.
          8.  Acceloration of the public education program timetable so that it may
              have some impact in meeting its objectives in the program.






           Jinrny L. Roberts, M.D.
           R@S/DPTD


           JLR/jlr




                                                             Review Cycle: June 1972
                                                             Type of Application:
                                                              Annive-rsarv'tllithin Triennium
                                                             Rating:   1 .4  B


                                        Recommendations   From

                      SARP                                  X/  Review Committee


                      Site Visit                                Council

                                                                                     ending
              RECOMMENDATION:  The Committee agreed with the site visitors in recomm
              increasing the Council Approved level for the 02 and 03 year,  approval  of
              the developmental component request, continuation of program Staff and
              seven ongoing projects, the implementation of An approved and unfunded
                                tiation of three new projects.    The Committee, paralleling
              project and the ini
              the recommendation of the KidIney Staff Review panel and  the  site  visitors
              disapproved Project #15 - Home Dialysis Training Program with advice to
              seek consultation from existing and proficient home dialysis training
              programs.
              The total request and recommendations are as follows:

                                                             Direct Costs
              Year                                   Requested                Recommended
              02                                     $1,316,577                si,ogg@ooo
              03                                      1,211,672                 1,138,135
              *Includes $27;060 for Project@ #14  Kid            onor Program

                         The-N/SMQ continues to   exhibit the strength that led the
              Coumittee to recommend an approval of the triennium application last year.
              The problem areas identified during last year's Site  Visit  have  received
              attention, and'although not all have been solved, definite progress has
              been accomplished  The reorganization of the corporation, both at the
              policy-making level and at the operational-level will undoubtedly increase
              the effectiveness of the Program.  The policy-making level is still
              cumbersome.  However, the Committee recognized the problems encountered
              in restructuring the organization to meet RMPS guidelines and believed
              that the organization as now formulated will prove to be functional.
              The Committee believed that the administrative capabilities of the
              Coordinator ani his key-staff have increased and that the Program,
              although somewhat lacking in-formal community participation has
              developed valuable informal participation linkages.  Committee further
              noted that the goals and aims committee does not  include  any  minorities.
              A mechanism needs to be developed to enable minority groups to present
              their views to RAG.
              The Region was found to be developin coordinated  program  thrust  that  is
                            1%                     9
              realistic in terms of community needs and there are adequate review
              mechanisms to establish priorities,  formulateprojects  and  Program  staff
              actions into programs and monitor these programs after they are
              operationalized.






                                             -2-

             The Committee questioned specifically two projects; The Pediatric
             Nurse Practitioner Training - Project #12 and A Regional Approach  to
             Computer Assisted Electro Cardiograph and Spirometry - Project #7.
             Regarding the latter project reviewers felt the expenditures were
             justified on two levels namely creating linkages among hospitals  and
             early plans to make this project self sufficient.
             The Pediatric Nurse Practitioner Project was found to be designed  in
             line with the joint "Guidelines on Programs for Pediatric Nurse
             Associates" issued by the L-nerican Nurses' Associat-ion and the
             American Academy of Pediatrics.  In addition the project also complies
             with the laws and standards set forth by the State of New York.

                 ial Council Action
             Committee recommends to Council for their review and consideration
             that HSNHA joint fund the Nassau-Suffolk RMP-CHP Inc.  From an
             organizational and theoretical point of view committee feels this would
             be beneficial to the region.  It would mean in effect that HSMHA would
             be receiving a single application from a single agency and that a joint
             award would be issued either from CHP or RMPS,  In effect RNPS would be
             coordinating our central and regional office efforts with CHP in  the
             review of the application and the expenditures of the region.




                        component And Financint Stimmar@Annivervary nopticaLiuti



               coiipoNENT         C U RP, E','TT       L?- YFAR                     YFAR          RECOMITF-?IDED
                                  YR'S AWARD            COU,','C"LL                                   FUNDIN-G
                                                                                'REQUEST
                                      OPER.             RECOiViElqDED                                  $,ARP
                                  YEAR                  LEVEL                                         (REV. COI,4.)

        CORE                       331,234                                    446,179                $381';OOO
        Sub-Contricts
                                   463,260                                    729,569                  61li940
        OPRR.      ACTIV.
                                                                              79,449                  7
        DEVEL.      COMP.                                                                         Yes zy,o@'.-,   r,

        EARMARKS,.,
                                                                              61,360                    27,060
              RIDIMY











        R14PS DIRECT           *Z94.4@                 868-408-.          1.316   -5,77-          1   -009-000

        REOUESTED                1,467,221


        COUNCIL
        APPROVED LEVEL             829,755


        NON-Rl4PS     and
         ITCOME


                                                                                              Nassau-Suffo@k P,,-T
                                                                                   PEGION

                                                                                     Ma /June
                                                                                      y         @t972,   REVIEW Cv@l%"l
                @.*$794,494     wa4 awarded-for   the  12-montfi@b@g&t period 7/71-6/72.
                   Region has'L.'e@n   extend6d   two  months to 8t.7'2.to    accommodate the
                   three-cycld,reyiew system.. A pro-rated-dmoilnt            of $132,414 has
                   @@eft    awarded for.the     two7month O-xtens.ion.






                                                         RNPS

                                              STAFF BRIEFING DOCUMENT







                                                                     OPERATIONS  IXI  Eastern                  Mid-Co@
   EGION  Nassau/Suffolk Regional Med. Program                     BRANCH         7   South   Centr'l   /-7    Westeri


                                                                   BRANCH
   YPE    APPLICATION         Not ratedLAST RATING                 Tel. No. 301-443-1810               Room  10-35

         TRIENNIAL                  197       DATE                 BRANCH CHIEF Mr. Frank Nash
        lst   ANNIV    YEAR              SARP                      BRANCH  STAFF   Jerome   J.   Stolov/E.   I.   Faal

                                                                   Ro REP.     Mr. Robert Shaw
        2nd   ANNIV    YEAR              REV. COM.
        OTHER                            OTHER                     Last Mgt. Assm't Visit            Jllly         19"
              March                                                Chairman   Mr. Simonds, Mr. Haglund,             --
   AST   S.V.   25-26   1971    Chairman      Dr. John Kralewski              Mr..Bakgr
   taff Visits,      Last 12 mos.   (Dates, Chaiman's Name and Type of Visit)

      1.   Nov. 11, 1971  Mr. Simonds, Mr. Mercker, Ms. Faatz





   ajor   Events    Which Occurred in the Region Affecting the RMP Since Its Last Review
   n    April         197 1

          March      1972 14-15  CHP Site Visit
                          Revisi'on of grantee and RAG bylaws to form new corporation.
                          Revision of cost accounting practices to better account for RMP dollars.

          Feb.    1972    Sept. I was designated to be the new anniversary aate for the
                          NSRMP     grant.

          Jan.    1972@   Dr. MarguliP-s comments on the need for RMP fund accountability and
                          RAG responsibility for program matters.

          Dec.    1971    Dr. Hastings responds to Management Team Report.   States his
                          objections to forming new grantee organization.

          Nov.    1971    11 Management Survey Team Report

          May     1971    Advisory Council recommendation for Ol-$829,755  02-$868,408
                            03-$908,043.
    iwarch        1971    25-26  Last Site Visit.






                                      REGIONAL CHARACTERISTICS OF
                               NASSAU-SUFFOLK REGIONAL MEDICAL PROGRAM















              Nassau-Suffolk Congressional Districts 1-5

                   1. Otis  G.  Pike  (I))                 3.  Lester L. Wolff (D)
                   2.  James R. Grover, Jr. (R)            4.  John W. Wydler (R)
                                         5.  Norman F. Leut (R)

              Geography and Demography--Region encompasses two counties, with an increasing
              population and urbanization.
                   Nassau County--I,428,000; Suffolk County--I,011,000; Total--2,438,000
              Population (1970 Census)--2,539,700 compared with 1,967,000 in 1960

                   Land Area:  Nassau--300 sq. miles; Suffolk--922 sq. miles;
                                  Total 1,222 sq. miles; Density, 2,080 per sq. mile.

                   Urban:  Nassau--nearly 100%; Suffolk--about 90%

                        Non-White Population, Nassau and Suffolk, 1960-1970

                        Year             Number            Per Cent
                        1960             76,919              3.9
                        1970            143,027              5.5
                     Population  per  Square  Mile,   Nassau and Suffolk, 1950-1960
                                                        1950           1960
                            Nassau (300)a              2,243         4,334
                            Suffolk (922)                300            723

                            a Area in square miles

                                           Population Growth
                                                     1950             1960            1970 (EST.)
                            Nassau                   672,765      1,300,171        1,461,250
                            Suffolk                  276,129        666,784        1,133,845
                              Total                  948,894      1,966,955        2,595,095

                            U.S. Census;  Long Island Lighting    Co. Population   Survey






                                                            ,- 3 -


                        Population, Distribution by Age, Nassau-Suffolk, 1960-1975
                                                   % of                      % of                       % of
                                      1960        Total         1970        Total         1975        Total
                  Under  15           667,617        33.94      833,470      32.00        872,229       30.15
                  l@5-19              119,335       6.07        244,649        9.39       282,556        9.77
                  20-24                 75,61-4     3.84        184,666        7.09       222,41-1       7.69
                  25-29               105,637       5.37        145,005        5.57       206,255        7.13
                  30-39               331,777        16.87      318,754      12.24        348,037       L2.03
                  40-49               279,825        14.23      380,462      14.61        371,220       12.83
                  50-69               304,993        15.51      402,038      15.43        484,078       16.73
                  70  and   over         82,157     4.18           95,778      3.68       106,433        3.68

                  TOTAL               1,966,955     100.01      2,604,822     100.01      2,893,219     100.01

                  Health Manpower

                  Physicians--Nassau, one practicing physician for every 716 residents
                  (U.S.   1/653);   Suffolk,   one    M.D./I,014.
                       50% of physicians--some type of specialty
                       25%    of    physicians--general     practitioners
                       25%   of   physicians--in   both   Counties   registered   no   hospital    affiliation

                  Dentists--Nassau, 1,457; Suffolk, 649; Total--2,106.

                  Nurses--Nassau,    8,827;    Suffolk,    7,193;     Total--16,020.
                    Inactive: Nassau, 3,750; Suffolk, 2,345; Total--6,050

                  Allied   Health--The   present   market   for   budgeted   allied   health    positions
                  is 16,965.  The employment figures reported are 15,304 allied health positions.

                  Health   Facilities--38   hospitals   in   Bi-County   Region;    32,000    beds.
                  A.     25,698 for mental care
                        1,068  beds at V.A. hospitals
                            510 proprietary       hospitals
                             86 Nassau County Medical Center
                             44 in    voluntary    non-profit    hospitals
                       23,990  State mental institutions

                  t.   6,657 General care beds and TB and Rehab.
                       3,745 or 56.3% in voluntary hospitals
                       2,176   or   32.77%   in   proprietary   hospitals
                         736 or 11.0'/. local Government

                  Long Term Care--5,897 beds in six nursing homes
                                      4,581 or 77.7% proprietary
                                      1,087 or 18.4% Government
                                       229 or 3.9% non-profit

                  Developing Medical School--State University of New York, Stony Brook, L.I.
                                                  Health    Sciences    Centek--Medical    School    plans
                                                   include   establishment   of   600   bed    University
                                                   Hospital





                                                         (4



                                  Nissau/Stiffolk    Feptonal    Medical    Prog ram

                                       (component and T'inancfa.1 Summary

                                                              Next Year                    Recommended
                                                                02 year                      Funding
                            Current Award                Council                               SARP
         ;,Component            01 yr.              Recommended Level  Request             C3 Review Committee
         i
         @Core                $   331,23.4                                 $   446,170

         Operational
         'Activities              463,260                                      7@9,569

         !Developmental
         @Component                                                               79,449

         Earmarks:
         .Kidney                                          -0-                    61-,380



         Ri@S Direct              794,494*           8   868,408              $1,316,577

         TOTAL PMPS           $   794,494                                     $1,316,577


         @on-RMPS &
         -Income                   -0-                                         -0-

         TOTAL BUDGET             794,494                                      1,316,577


         IREQUESTED              $1,467,221


         Approved Level           829,755     ;i
                                              I





         *$7q4,494 was awarded for the 12-month budget period 7/71-6/72.   Pegion has been
           extended two months to 8/72 to accommodate the three-cycle review system.  A
           pro-rated amount of $132,414 has been awarded for the two-month extension.




                                                              Region: Nasqau/Stiffolk l'IMP

                                                              Review (,y(@l(@: Jiin(-


                 A(,'COMI'I,]SIIMI,"N'I'S SINCI,' 1,AS'I' Rf@',Vll,"W

                 .1.  The proposed reorganization of the l@(,/(;rantee structure to
                     eliminate confusion and clearly spell- out the roles  of  each.

                 2.  The development of new cost accounting  procedures  for  better
                     control of RMP and CHP dollars.


                 3.  Reorganization of core.

                 4.  Apparent continuation of good and productive relationships with
                     numerous other organizations.

                 5.  Revision and simplification of the review process.



                 PROBLEM AREAS

                 1.  There is some indication that the joint RMP/CITP direction and
                     st,iffing, with i.ts organizational and functional reflections,
                     is not on]-y confusing to the larger provi.der cotftmunity but may
                     be cc)unter-pro@luctive from an RMP vantage point in  achieving
                     the cooperation of providers.

                 2.  The N/SRMP has invested a considerable amount of effort in planning
                     studies,  How have the results of the planning affected the Region,
                     both the RMP and others?

                 3.  Does the application present an overall plan of action into which
                     the various activities logically fit?

                 4.  Is the membership of the Joint Aims and Goals C,nmmittee and the
                     Joint Program Committee such to raise question as to the main-
                     tenance of separate identities for the RMP and CHP?


                 OTHER ISSUES REQUIRING ATTENTION OF Rf,'Vll,"Wl,"RS

                 1.  The reasonableness of the new RAC/(,rant-(@e s t rij(@. t ure.
                 2.  Adequacy of core organization  and management, and the nee(] for
                     additional core staff.

                 3.  The functions of the 19 local  Clip planning (Committees.

                 4.  The mechanics of the project  evaluation strategy.
                 5.  Adequacy of review process, both  programmatic  and  technical.
                 6.  i,as the progress of the Region during the past year been sufficient
                     to warrant an increase in the Council-recommended level?







                                  MARCH  1791972                                                                                                                                               REGION  -  NASSAU-SFK
                                                                                                                       BREAKOUT  OF  REQUEST                                                     RM 00066  06/72
                                                                                                                          02  PRCGRAM  PERIOD                                                                                  RMPS-OSM-JTOGRZ

                                                                                    (5)                    (2)                   (4)                      1)
                        IDE,4TIFICATIO.N  OF  COMPONENT                      CCNT.          @ITHINI CGNT.           BEYCNOI APPR.  NOT           I  NEW,  NOT                     CURRENT         I    CURRENT           I
                                                                             APPR.          PERICOI APPR.           PEPIODI PREVIOUSLY           I  PPEVICUSLY                    CIPECT              INDIRECT                   TOTAL
                                                                                                                            FUNDED                                                                       COSTS
                                                                            OF  SUPPURT           I CF  SUPPORT                                     APPROVED                      COSTS

                        cooo  CrIlPE
                                                                                  $446@9          1                                                                      I   -.Si  4  6   11.1@   I                              i 44.6,1 79     1
                        0000  DEVELCPMENTAL  CO@PCTENT                                                                                                                   I                        I                                              1
                                                                                                                                                           1 79,  i6L2-  1 --lZ2j442-j_-                                           ST9,449       I
                        ZZI     CC  PrE7ENSIVT HC;E  CARE                                                                                                                                                                                        I
                                                                                                                                                                                                                         I        S9'5   260     1
                        002     NASSAU      SUFFOLK       STRCKE       EVI
                        - kt L@'ULCN                                               S 94 .1                                                                               I
                        003     DEVELCPP.ENT      CF      PAR       StEAFl

                        004     kEGICNAL         MEDICAL         LIOR4P.Yl

                        005        CC,@PuTEkIZEU        RADIATCN        TI
                                                                                     3 4. j5i9    1                                                                                               I                               s@.  6  I  9-  I
                        006     S?I.CK  E  RS  W  IT  HDRAW  AL  WORKS   I                        I                                                                                               I                                              I
                                                                                      2-a 5 C     I                                                                                 I       7.,U.Q@                      I         .1 7. 0 50    1
                        007     C Oy P U T Eck I Z E 0 C KG A tiD S P I  I                        I                                                                                               I                      I                       I
                            RC%ETIY                                                 0    516      1                       I                                                       S 9 2@.Z6       I
                        009     REGII@';AL        DRUG         INFCR@ATICI                        I                       I                                                                       I
                                           -    -    --------    -     ---                                                        s  7,9.   2r.0-1 -   -   -   -    -    -
                        OL2     PLL)I@'TPIC        f,URSE        pRArTIT11                        I                       I                      I
                                                                                                                                                                                                                                   7  S.&  i.U-  I
                        013     DEVELOPMENT      '@F      A       DEPARTMI                                                                                                                                                                       I
                                                         ZEDICI@E  I--
                        014     NASSAU  SLFFCLK  RECO-"'AL

                        015     HK)ME      DIALYSIS      TRAINING       PI
                                                                                                                                                 -.1@zo                  I        S31t.320-1                                      $3@zo          I
                                                                                                                                                                                                                      L  L
                                              ]TOTAL                                                                             @$T,9 ZOO I
                                                                        11       -.$922.r,98i)                          II                             -.$3LS.279        11          3-Slo3l6i.57711                    11           @SIP316#57711




















                                                                                                                                      I , II                                                                                     I
                                                                                                                                                                                                                                           - -  @4,


                                                                                                                                         0



                                                                                                                                                                                                   REGION        -         NASSAU-SFK
                                    MARCH  17,1972                                                                        BREAKOUY  OF  REQUEST                                                    ;kS  00066  06/72                RMPS-OSM-JTOGR2
                                                                                                                           03  PROGRAM  PERITID
                                                                                     (5)                      (2)                    14)                   11)                    ADD'L  YEAR                                       TCYAL
                         IDENTIFICATION  OF  COMPONENT                        CC,\T.  ilTHINl  CUNT.  6EYC)NDI                 APPR.  NOT           I  NEw,  NOT
                                                                               APPR.  PE    KICDI  APi'R.  PERICDI             PREVIOUSLY               PREVIOUSLY                   DIRECT                                      ALL  YEARS
                                                                              OF  SLPPORT            I  CF  SUPPORT            FUNDED                   APPROVED                     COSTS                                    IC)IRECT  COSTS

                         COOO  CORE

                         0000  t)@VELCf@,ENTAL  COt4PCNEt%T
                                                                                                                                                                                        $7 9. 4



                         -0 -0                SLFF,-LK       STRC@E        EVI
                         003      OEv@IZCP'ME',T      OF      PAP       S@E@RI
                         ----                            aIE4SI-El@t -----
                         004                     MEL)ICAL             LIBRARYI                                               I
                                                                                                                                                                                                                                         $9 5.A7@-J--

                                                      -k-A-C-FA-T-1 -0 N  T  I
                         Z-0  -@GZP7TE            LEO                                                                                                                                                                                                   I
                         -     H : JR -@ 1-1 IL ----          -          ------------      L                                                          - - - - - -- -           t
                         OC6        S'LKERS        wiTHCR@,WPL        -,'@RKSI                       I
                                    p  ----               ---               __I                      I
                         0 C-  7    CL, -iP U I E R I i E D E KG A NO S P I  I
                         039                      DRUG      INFOSM.%T       ICI
                                                                                                                                                                                                                              I --A@3    .     970-     1
                         012        PE@IA191C     NLik      SE      ;IRACTIT11                       I                                                                                                                         I                        I
                                        T 11                -D@G@-At       ___I
                                    a                  p@          -                                                                                                                      ti@C4')                                                       I
                         013   DEVELCF@EIT  CF                        CEPARTHI                       I                                               I                         I                       I                       I                        I
                                                                01C.LtL-     I                                                                                                 t
                         014        ,ASS.U  surfCLK  RZCIL;,',,'L                                                                                                                                                                                       I
                         015        ti@'mE     D!ALYSIS      TRAINI@'G      Pi                                               I                        I
                                                                                                                                                                                                                                         S34@-          I
                                                                                                                                                                                                                                                        I
                                                                                                                                        $64,770               $209,569             SloZI1,67Z          I                            $2s528,249
                                                _!OTAL,                              *,g@lt333











                                                I\IASSAIJ-SUProi-i@                               PROGRAIL



                    The                                                     Prc)@i-,iiii    or(:,ai-Li.zatioilal-    structure    at
                    both  the   Core   I-c,.vc@-I   and   the   Co-.-,,)orAtc,       17",@G level          tlic@ source of
                    concern  for  a Site Visit team on @l,-ircili  25-26,                   19 71.     The team  rc@c.0m,-.i,,c7!r..ded
                            the  rc-l.o.-i be i,l,@cle                      fc)i-           yo;ii-F, with tl-le, CC)II(litio:i
                    that  they  obtain  Lle- services  of  rn outqicic                                    consultant  to
                    examine      tie       c)rp,,i@izati@onal       structure                      procedures with sr)ccll:lc
                    attention                                                  i-c-,,].@aL:ioiisliips.  On                  2s,  1971,
                    Dr. Margulies  offered  tiic-  services  of                t.ric,                  Survey Team.         Oil
                                  11, 1971, a team co@ril)o--ed  of            Tom Simo-lids, IZDD                                 Faa@Lz,
                    and Spero                                               to              these. arE!,@inizit:!-oiial structures
                    and the relationship                         I'@",P and Clip.

                    By N,)ay of                   the                                are niicip-.      Eacl-i     is     discussed
                    more.  full-,, in  t@lie boly  of  this  report.              The    toF@ni    concluded    that-,    the
                    of PJ.fl) an@ Clip have been                            Little    at    the-    same    time    Affecting    @,i
                    unusually close working re-l-atiL-:i:                 There is                     a need for more
                    accurate  cost                            The   presence   of    corporate    DicTi;    ers    on    the    P@'G
                                                                                                           @b
                    is,   riot   a   great   concern   to   l@"PS,   but   they   should   not    I)C'-    in    a    position    of
                    do-i@iance.        The   RkG   r.7LiFt   develop   its   o%,7n    set    of'B-v-La,,,,s    establisliiiic,    it
                    as  an independent 't)c)d,,, responsible  for                      program decisions.             The       team
                    did not  find any cause  for concern regarding the administration  of                                   the
                    Core offices or the  spat of control of  the I,':,-.ecutive Director.

                                                            PliP-CIIP         PELATIO!@'SIIIP

                    The     Nassau-Suffolk     Pcgional     lledical     Program     is     u-iiquc,,     in      its      relationship
                    to    Clip    in    a    couple    of    significant-.     respects.     Although     the-     ad\,isorv     boards
                    of.tlie    two    organizations    are     separate     (the     RAG     ind     the     CHP     Counci)),     there
                    is    being     created     a     joint     committee     structure     for     both programmatic           and
                    administrative    aspects    of    both     or-,-inizat:Loia,,;     as     indicated     on     the     attac'-,--d
                    chart.       (See  page  5           The I'@Ill Coordinator shares his  time equall@, between
                    PD,IP and Clip "b"  acti,,,-Lti-c--s  and serves  also as Director of the  Clip                         it b"      area
                    wide agency.          He   directs   a    joint    l@,IPIC'r'@P    core    stiff,    all    the    members    of
                    which  are,  for                          purl)oQ-c-.@,  on one payroll.  or another in an
                    approximate ratio of 40% C'    and 60% PI,IP.   In actuality all employees
                    devotes    their    tijre    to    @7liall-ever    area    is    timely,    regardless    of    whether    it    is
                    classified as P-IIP or Clip.

                    Altl-iou-ii    the    1:1,70    advisory    -rotil)s    are    separate    bodies,    the    staff    team     fully
                    expected to find this division                  to    be    primarily    a    paper     creation,     with     a
                    phantom superstrucc,,jre                          of    the    ovcrlaT)piii,,     memberships     bciti@ccn     !the
                    tvio groups pro,jidiii,,,  for a                      program merger in  fact,  if not  offi-cial',v.
                    This supposition appears not  to be borne  out by  an anil-ysis of the
                    of the  two groups,  although                                records     might      ilter      the      analysis








             Page 2

             Our analysis reveals that there are 82 scats on the RAG and 93 on the- CIIP
             Council.   Twenty-c,.@o people hold membership on both groups.     Therefore,
             of the total representation of 153, approxiriatc@l.y ].It% of the iiic,,i-@,bers have joint
             interests in both groups; 27% of the )!AG and 24% of the CIIP Council.       In
             terms of activity, rising as an ind,'-catoi.- membership on a cci.@iriittee or
             election to an office,  it  appears  that  for  most  of  the  overlapping  members,
             their predominant interest lies with either one group or another.  For
             instance, of the 22 overlapping members  only  seven  I)el.on-  to  a  committee  or
             hold office for both the RAG and the CIIII Council.     'llie rest concentrate their
             membership on one group, with only tol-,cn membership on the other organization.

             To counterbalance p@,Ter exerted  by  the  22  joint  members,  each  organization
             -has a large         of active  members  who  are  interested  in  one  organization
             only.   There is a sizable  number of active members (activity, acain,
             measured by participation in  at  least  one  committee  or  election  to  office)
             on each body which has no overlap with the other L!,roup:      23 on  the  PAG.and
             19 on the CIIP Council.  It does seem then that the Region is maintaining
             separation at the Council level,  although  @@iPS  staff  should  keep!an  eye  on
             situations which may mitigate against this division.  Primary among these
             might be the future formation of joint committees and the membership on
             each.   For example, the Joi-nt Aims  and  Goals  Committee  presumably  has  been
             functioning since the Spring of 1971.  It has an "open" membership;.i.e.,
             the dtites of mcetinos  are  circularized  and  those  who  are  interested  attend.
             This is further complicated  by  the  fict  that  membership  lists  furnished  to
             the staff visitors in mid-in'ovember still contained listings for separate goals
             committees for  the  two  organizations.  There  remains  some  question  then  as
             to who participates in ti-le iii,@I)o-rt-aiit functions of this coni.,iiittee--primarily,
             the fashioning of generalized  goals,  priorities,  and  a  program  plaii,for-  the
             ti%lo-county region-.

             Similarily the joint Program  Committee  b8s  not  yet  been  formed,  but  when  it
             is, it will have the task of allocating resources between RNT and CHP and
             monitoring the joint program effort.  Clearly, the membership on these
             committees is important..

                                 REGIONAL IIEDICAL PROG=4 GRANT FUND ACCOUNTABILITY


             The unique relationship between the Regional Iledical Program and Comprehensive
             Health Planning  in  the  Nassau-Suffolk  Regional  @ledical  Program  has  resulted
             in  the  establishment  of  one  health  planning  and  administration  organization
             that  is  funded  from  two  Federal  Government  sources.  Accountability  for  the
             Regional liedical '-Program grant funds is based on the relative amounts awarded
             by the two sponsors.  Accountability is not based an the '@t'-IP-CHP identification
             of the activity for which  funds  are  actually  expended.  The  M,,T-CIIP  orga@ii-
             zation prepares separate applications which are sent to the M,,TS and CILID.
             Each staff member, with  the  exception  of  the  Coordinator  is  assigned  to  the
             budget of the most  appropriate  sporxso@.  These  assignments  are  made  on  the
            .basis of general criteria which provide that M.[P administers operational
             projects exclusively-and Compreheii.sive  Ilealtli  Planning  includes  such  things









              Page 3

              as Enviroiiniental licalth and air pollution.     All other activities    are
              considered P@@fP-CIIP activities.

              The Core staff has a system that is intended to account for their            e>:pendi-
              ture of grant funds to both the P-',IP  rnd  CIIP  as  their  ci'anting  agencies.
              Accountability for the expenditure of grFiiit funds throughout the-       year    is.
              based on  the  budget  requests  submitted  to  the  two  sponsors.  @At  the  beg.inning
              of  the  grant  year,  Core  staff  establishes  a  ratio  of  @@M-CHP  grant  support
              requested and awarded.  Then as grant funds are spent the costs are
              attributed to P@,T and Cl-iP grants on the basis of the 'ratio.       Thus   costs
              incurred  throughout  the  year  are  charge  to  the  two  sponsors  on  a   prorata
              basis.  The  demands  placed  upon  I,--IPS  dictate  that  more  accurate  accounta-
              bility should be based upon expenditures ii-id not budce-t estimates.  'A
              system  should  be  developed  and  implemented  throuoh  which  -ra,-it   expenditures
              are periodically identified and allocated between             and CHP grant support.
              The minimal requirements  for  suc,i  a-systei,.i  will  be  developed  jointly  bet-
              ween the P-IIPS and CHP.  The CIIP has been contacted to initiate joint
              development  of  minimal   acceptable   grant   fund   accountability   requirements.


                           RE@GIONAL ADVISO@RY GROUP Al\'D CORPORATION


              The duplication of responsibilities and membership between the NSR@T
              Regional Advisory Group and the Coi-poration.has been the source of
              considerable  confusion  and  some   concern.   The   difficulty   in   understanding
              the  organization  at  this  level  results  from  thinking  of  the  Corporation   and
              RAG as separate bodies, each with  its  own  identil--y,-i,,Iien  in  reality  there'
              is little difference.  Intervie@.7s  with  'NSL@IP  officials  and  a  review  of  the
              By-Lai4s bear  out  this  conclusion.  As  an  example,  there  is  only  one  set  of
              By-Lai.:s  which'incorporates  both  Corporation  and  RAG  rules.  Again,   it   must
              be kept  in  mind  that  except  for  the  semantics,  there  is  virtually  no  dif-
              ference in the two.

              Ori ginally it was  the  plan  of  NSKT  that  there  be  only  one  gr-oup  and  that
              the  incorporators  would  also  be  the  RAG.  The  Regional  lledical   Programs
              Service  would  not  permit  this  arrangement  and  required  that  there  be   both
              a corporate body and a Regional Advisory Group.  To satisfy this requirement,
              NS%'IP added more members and designated them as non-corporate members of the
              RAG.  The 67 Corporate members remained as voting members of the 82
              member  RAG.  Although  all  RAG  members  may  vote  only  Corporate   members   may
              hold off-ice in the RAG or be a committee chairman.

              The dual  nature  of  membership  in  the  Corporation  and  RAG  and  of  the  By-Laws
              is inconsistent  with  the  basic  need  for  the  RAG  to  be  separate  and  distinct
              from  the  gra'ntee.  To remove the appearance of dominance by the Corporation,
              the  Corporate  membership  should  be  reduced  to  the  minimum   number   necessary
              to meet the  legal  requirements  of  the  State  of  New  York  and  to  provide  the
              fiscal, personnel and other administrative affairs of NSI@'.IP.  This small









               Page 4
               group should be considered as the Board of Directors of the Corporation
               and should conduct its iffai-rs in periodic meetings ipart from the total
               R@i, C. There is no objection to the Board of  Directors  being  Ti,,C@,P.Ibers  of
               the RAG; however, they should not hold office.  The designations of
               corporate and jion-corporat(-@ members should be removed.
               The B),--La@qs should be re-i,7ritten  to  establish  the  regional  Advisioi-y  Group
               as aii independent, self-Fustainii-ig entity responsible for all program
               decisions.  It  should  not  coiicern  itself  with  the   administrative   deli-
               berations of the Board of Directors.

                                                    OF CONTROL

               The   Executive   Director shares his time equally between P-%D-l and CHP activities
               and  in  addition,  is  responsible  for  the  management  of  the  Core  offices
               a-,id supervision of the Core staff.     On the surface this would -appear t'o
               be a herculean'task.     In  reality,  the  Executive  Director  does  not   perform
               his managerial duties    without assistance.
               The combined r,,'T-CIIP staff is organized into three Divisions; namely,
               Administration, Program Development and Evaluation, and Sub-Area Planning.
               Eacli6Division is headed by an Associate Director'i,;ho is responsible for
               the management of his Division and who reports directly to the Executive
               Director.  Appro-,,)riate  delegations  of  authority  have  been  made  in  writing
               to  the  Associate  Directors  to  carry  out  their  day-to-day  duties  and  to
               service the appropriate committees of the RAG and CIIP Council.  The
               Associate  Directors  also  serve  as-Deputies  in  the  absence  of  the   Director
               and  in  the  performance  of'tlieir   assigned   responsibilities,   relieve'the
               Executive Director of a great amount of detail.
               The team  concludes  that  the  span  of  control  of  the  Executive  Director  and
               the supervisory staff is reasonable and that responsibilities and delegations
               of authority have been assigned in a manner to provide for a properly
               managed  program,.  The  team  did  not  review  the  management  practices   and
               actions of the supervisory staff and, therefore, draws no conclusions on
               how well the staff is directed below the Division level.







                 P@ge 5




                                                                   SUl,-FOLI,-













                                                        appro-,@. 13% overlap

                         Clip                             in  incifiberst-iip                        Pd-@ G
                      Council.
                                                                                                 (82 tri-,nbers')
                    (119 1.0,-ibc@rs)



                                                                                                    Bd
                                                                                                  Directors
                                                           Aiins  & Goals


                                                                                                     Exec.





                      DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE




               Director, Regional 1-fedical Programs Service             Marc-'q 27, 1972
    IIIROUG',I: Acting Director, Division of Operations &
               Development,  @@-TS


               Chief, Grants I-lanagement Branch
               Division of Operations &  DeveloDment
               Regional IL--dical Programs Service

               Visit to Nassau/SuffoL'r, Regional 't4edical Program to Resolve  the  Problem
               of Accouatability of iUTS Funds/


               Enclosed is a copy of 1-ir. Miller's  subject  report  indicating  alternatives
               for adininisterin- the subject pro-raL-s grant funds.  We have two decisions
                                 C>               C,
               to  make:  1)  flow to satisfy expenditure in the current budget period, and
               2)  llcw to simplify an existing complex situation.

               To facilitate  Accounting for cucrent budget expenditure, I feel that
               Mr. Miller has indicates that detailed re-cords   must be maintained to
               identify the efforts of the employees in the pursuits of the two grant
               @rograms to the ,xtent that tiiey are able to charge costs appropriately.
               'fhey have tried this on a weekly, one-time basis and  have  slia4n  that  to
               a great extent it can be a-co-,nplished.  This we must do in order to batsify
               requirements,based on two separate budgets and awards.  For those activities
               th-t c-rinot ;)e identified oi a spec,.-':ic percentage of efforts basis, I  concur
               in I,lr. 1-filler's reco.@ndations tki-t the percentage established in  the  budget
               as miarded be applied. '.Lhis @Tould be communicated to  the  grantee  so  that
               there will be a basis for future audit.

               With respect to future years, I stronoly urae that we pursue a joint award
               with CIIP. This is what Dr. Ilastinc.,s would like to do and has so  stated
               orally to me.   If you concur, we will pursue this matter with CHP and
               appropriate offices.   It is ironic that this program is viewed by both
               It-[P S an d CHP as b c in gso-@thing iess than we would hope tlie'-pro-ram  could
               be. This point might well be one for consideration  when  and  if  we  review
               a budE t jointly with  CIIP.

               In a jointly-funded grant, a percent of support is established by the programs
               and is fu.-ided on that basis unless during the year--the efforts vary,  In  that
               case, the grantee should advise us and request an  appropriate  revision  to  the
               budget. If the volume of business in the future remains  as  it  is,  in  all
               likelihood we would be the lead agency.







                        OFFICE   SURNAME,  DATE 11 OFFICE SURNAME    I     OFFICE    SUP-NA2,iE
             L E
     nn  rn) Mn \\ /7









             Page 2   Director, RMPS

             My alternate reconnendation for future years would be to require the
             organization to beco-,ic separate.  As Mr. Miller points out, total costs
             would then be increased and we would probably not end up with that clean
             a br@ in the total picture anyway.  We should be glad to discuss this
             matter with you.




                                             Gerald T. Gardell


             Enclosure


             cc:
             Official Grant File
             Nash/Stolov
             Mr. Chambliss
             Mr. Miller
             Board
             File


             CM/ GTGarde 1: rc' -,.3/27/72



     MEMOI,tANi)U2,                                 1)11.UIN L  @L I 'L@rl- @ ,1.@ - -1 . @ . -@ I I I .1 @ @- . . --- - -- --
                                                            PUBLIC HE,@t,Tli SERVICE
                                              HEALTH SERVICES AND @IENTAI, HEALTH ADI\IINISTRATION
   00         Chief, Grants Management Branch'                   DATE:  March 20    1972
              Division of Operations and Development



              Grants Management Officer
     FRONI    Grants Management Branch, DOD
     SUBJECT, Visit to Nassau/Suffolk Regional  Medical  Program  to  Resolve  the  Problem
              of Accountability for IOIPS Funds


              The individuals participating in   the discussion of this subject from
              both the Grantee, RMPS and the Regional Office were as follows:
              Mr. Glen Hastings, Coordinator, Nlassau/Suffolk RMP, Mr. Harrison Owen,
              Associate Coordinator, I\Iassau/Suffolk RMP, Mrs.  Elaine  Kaldor,  Accountant,
              Nassau/Suffolk RMP,  Mr.  Gerald  Hunt,  Grants  Management-Officer,  Region  I
              and Mr. Roger Miller, Grants Management Branch, @NIPS.
              The  Nassau/Suffolk  organization  c.urrently  allocates  expenditures  to  its
              two Federal Programs based on the relative  amount  awarded  by  each  Program.
              The basis for allocation, however, does  not  include  funds  set  aside  for
              direct PDIPS "project" activities. The  basis  for  distribution  is  RMPS
              funds provided for Core  activities  versus  CHP  Federal  and  matching  funds
              provided for the same type  activities.  As  the  grant  funds  are  spent  the
              cost attributed to FIIP and the CIIP grants are distributed  on  the  basis  of
              this ratio which at the present time  is  61.8%  RMP  and  38.2%  CHP.  Where
              contributory funds from either @IP,  CIIP  or  matching  varies  substantially,
              then the percentage ratio of each  programs'  contribution  to  the  total,  is
              revised And a retroactive adjustment for the  entire  budget  period  is  made,
              to reflect the current level of contribution by  each  program  to  the  total.
              The grantee's-method of recording its  expenditures,  is  to  enter  all  joint
              RMP and CHP expenditures  in  the  RMP  cash  disbursement  ledger.  once  this
              is accomplished, at the end of each monthly  period  the  CHP  portion  is
              allocated from each expense  nomenclature  account  in  the  cash  disbursement
              ledger at the  contributory  percentage  of  38.2%.  This  journal  entry  in
              effect, represents the transfer of  the  CHP  portion  of  its  total  expenses
              to the CHP program; the balance  naturally  represents  the  RMP's  share  of
              its expenditures.
              Since generally accepted  accounting  procedures  dictate  that  an  allocation
              of expenditures should be  based  on  actual  experience  rather  than  initial
              budget .estimates, I felt it was my assignment to  determine  a  means  of
              resolving the above situation.  During  the  week  immediately  prior  to  mv
              visit the  staff  of  the  Nassau/Suffolk  organization  prepared  individual
              time-sheets by employee, whereby  each  employee  accounted  for  their  time
              on 15 minute intervals for  an  entire  weekly  period:  A  careful  review  of
              these time-sheets by the members Participating in this group indicated that
              time fell into three major categories which were (1) directly attributable
              to @IP activities, (2) directly attributable to CHP activities, or (3) falling
              into a category that could not be specifically identified to either program.






             Chief, Grants Management Branch, DOD                                       2


             Based on the review of the records and the ensuing discussion,  it  was
             resolved that we would come up with'five alternatives solutions  to  this
             problem. These are as follows, and are discussed in greater  depth  in  a
             latter section of this memorandum:


             RECO'i4MENDATIONS:

                  1.  Combine the organizations by issuance of a joint  award  under
                      the joint funding concept.
                  2.  Completely separate the organizations by requaring  two  separate
                      staffs at two separate locations.

                  3.  Allocate costs as presently operating.

                  4.  Prepare a time study on qu arterly basis for all  employees  to
                      determine what portion of effort is devoted to  each  program.
                      If it is found that a larger portion of effort is  devoted  to
                      one p- gram than the au-ual funds provided then it would
                      be recommended that the operational program be adjusted
                      accordingly.

                  5.  Place a restriction on the RMPS grant award that  funds  could
                      not be used for tho Core activity that would result in more than
                      a 50-50 split of Core costs between those funds provided  by  the
                      RMP program and the CHP pro,-am inclusive of both Federal and
                      matching shares.
             Based on my study of the entire situation, the following are my  pros  and
             cons to the above recommendations which I am listing in priority order
             with one being my most favored recommendation:

                  1.  I feel the most efficient recommendation which  would  encompass
                      the least problems would be to joint fund this  entire  operation
                      with a combined grant of RMP and CHP funds.  Since  RMP  provides
                      -the major portion of funds for the operation of this organization,
                      this option would include RMPS admiristration of the  total  grant.
                      Since RMP is now extending the grant to this  organization  to
                      August 31, beginning 9/l/72, the CHP grant and the  RMP  grant
                      would be on the same fiscal period. Since there are  costs  of  the
                      combined operations that dannot be specifically  identified  with
                      either one program or the oth,r, I am of the opinion  that  this
                      option would be the most feasible. In addition,  since  Dr.  Wilson
                      has proposed this concept, "ir- would be a feather in the cap" of
                      RMPSto be one of the first programs to attempt to implement such
                      a concept, with the results of the implementation  being  made
                      available to the Administrat'or.

                  2.  My second recommendation would'be to require the grantee to prepare
                      a time study on a quarterly basis utilizing a period of  an  entire
                      week each quarter as the basis for the allocation  of  costs  to








                                                                                        3.
            Chief, Grants Management Branch, DOD


                  each program. In discussions with  the  Nassau/Suffolk  representatives
                  on this recommendation, they feel that if a  hypothetical  situation
                  resulted where 30% of time could be specifically allocated to  CHP  and
                  30% of time could be specially allocated to RMP, and 40%  of  total
                  time fell into the category of both, they were of the  opinion  that
                  they could make the managerial decision to allocate the  time  into
                  either category as they saw fit, to come back to the current allocation
                  ratio of the 61.8% and 31.2%. I did not agree  with  their  conclusion,
                  since I feel that the time that fell into both  categories  would  have
                  to be allocated 50-50, and if'this study indicated  a  disproportion
                  of effort based upon funds provided, they would  have  to  redistribute
                  their program activities accordingly.

             3.   l'y third recommendation would be to place a restriction on the  RMPS
                  award to this organization, that RMPS funds could not be used  for  the
                  Core activity, in a larger percentage than those funds  provided  by
                  either Federal or matching fundi by the CHP  program.  The  representa-
                  tives of the Napsau/Suffolk program were adamantly opposed  to  this
                  proposal since they said it @uld severely  restrict  their  operations.
                  'I felt, however, that since Mr. Hunt indicated that their is  little
                  or no community involvement in CHP, that such action would  force  them
                  to stimu-.atc r-)mmunity involvement in CHP to obtain increased local
                  support for tne CHP operation which in eff-ct, allow them to  put  more
                  RMP funds into the Core activity. I realize this  suggestion  is  harsh
                  in nature, but I feel we may have to take such action if  this  is  the
                  recommendation that is proposed.

             4.   My fourth recommendation would be to allocate costs based on the original
                  budget estimates as is the current practice. Although  I  am  completely
                  opposed to @his proposal, this is the procedure  the  Nassau/Suffolk
                  organization would like to continue following. CHP programs  are  de-
                  creasing while funds     available to the RMP program  are  increasing.
                  As a result of this situation, continuation of the  current  method  of
                  allocation could eventually evolve -'-n RMPS picking up 90% of the total
                  Core staff salaries ai,d related expenses while CHP would only be picking
                  up 10%.  It.is currently the practice of Suffolk County, who contributes
                  a pnrtion of the matching share to the CHP project to be  very  restric-
                  tive as far as the amount of funds that are actually provided  for  the
                  CHP operation. Suffolk County is trying their best to  cut  costs  in
                  view of a potential deficit, and as a result the  Nassau/Suffolk  CHP
                  operation is looking forward to less of a contribution from this
                  county. A lower contribution from Suffolk County by  $5.00,  in  effect,
                  results in a lower contribution from Nassau County of the  same  amount
                  and a lower contribution from the Federal Government of  twice  the
                  amount. So a loss of $5.00 from Suffolk County results  in  a  tota   oss
                  of $30.00 to the CHP program.
             5.   My last and.least favored recommendation would be to completely separate
                  the organizations. This in e.ffect,. would solve the problem, but  would
                  result in increased,administrative costs to both the RIIP and  CHP  for
                  duplicate staff in all administrative areas.  I  feel  that  taking
                  such a step would be an extreme measure since I do  feel  that  there







           Chief, Grants Management Branch, DOD


                 is some merit to having these organizations combined and within
                 close proximity to each other.

           I am willing to discuss all of the above recommendations at lenath and
           write a letter to the Nassau/Suffolk Regional Medical Program indicating
           the recommendation selected for adoption by the Nassau/Suffolk organization.
           I indicated upon leaving the Nassau/Suffolk organization that we would
           inform them of our decision within the next week, so that the site visit
           team visiting the Nassau/Suffolk organization during the last week of
           March would be aware that this area has been resolved.




                                                          Iler


           cc:
           Dr. Margulies
           Dr. Pahl
           Mr. Chambliss
           Mr. Nash/Stolov




  JVI   iV/1 kJ l@ @ i N @ U IVJL
                                                      PUBLIC IILAI,'Fll SI-"ItVICi-,
                                        IlrALTH SLIKVICLS AND MENTAL I-ILALTII AD,\41NIS'I']tATION


                                                           DATE:  March 21, 1972
  r          I@'or the Record






  FROi\f     Edward T. Blomquist, M.D.

  SUBJECT:   Post-Mini SARP Meeting, March 20, 1972, Nassau-Suffolk Regional Medical
             Program

             Renal Organ Donor P  ram
             Purpose of Program - To procure cadaver kidneys from 24 donors each year
             from seven named hospitals in which there is a physician  committed  to
             the program.
             Part time physician coordinator and a secretary will be employed to
             administer the program. Participating surgeons and  hospitals  will  be
             paid a standard fee for service   Cost for developing and training
             procurement teams for maintaining transplantation registries,  and  for
             payment of cadaver kidneys will be $27,060 for the first year.
             Jitient selection, histocompat,-.bility testing. and transplantation will
              2 performed at facilities located in New York City.
             Action - RecomT-erd approv-1 of application as submitted for the  first
             year of operation. Futur.2 funding will be determined after  review  of
             application from Metropolitan New -York Region requesting support for a
             Tri-Regional (New York City, few Jersey, Nassau-Suffolk) Transplantation
             Program is reccived.

             Home Dialysis Tra.          am
             Purpose of Program - To develop 50 validated, modular,  single  concept
             lessons and tes s@for homa dialysis patients after a period of studying
             dialysis units in New York City and after developing patient behavioral
             objectives.
             Costs are projected for the firs!: year only.  During the first year,
             6 validated lessons and tests will be completed at a cost  of  $31,200.
             Action - Disapproval with advice to s@ek consultation from mature home
             dialysis training programs, as previously recommended by staff.

             Information for Local Regional Medical Program
             The objective to train the majority of patients for home care is admirable
             but the time and expense of the proposed program is  excessive.  It  is






           page 2 - For the Record
           rccoi,,liiiciided that full idvaiitige be talcon of the experience and teach-
           iiig aids now available at nature home training dialysis centers.
           Specifically it is recommended that contact be made with such resources
           as the Northwest Kidney Center in Seattle, Washingtonand those listed
           by staff in earlier letters of advice.
           Furtlier,it is recommended that the anticipated caseload of patients
           needing dialysis and transplantation be reviewed.  The quoted rate of
           70 patients per million population needing dialysis requires validation.
           Purther,the need for expanding existing dialysis facilities as implied
           in General Objective 1 requires additional study.



           Edward T. Blomquist, M.D.





                                                                Region: Nebraska
                                                                Review Cycle: June    1972
                                                                Type of Application:
                                                                 Anniversary prior to
                                                                 Triennium
                                                                Rating:- 298  B


                                      Recommendations From

                                    SARP              /X-X7   Review Committee

                                                              Council
                           /-7      Site Visit


                                               02              03

      Recommended Level of Funding          $725,000        $700,000
      eview Committee concurred with the funding-recommendations of the  March  30-31,1972
      Site Visit Team and agreed that the Nebraska RMP has demonstrated substantial progress
      by adequately responding to the eight specific issues raised in the June 11, 1971 RMPS
      advice letter. The recommended $725,000 funding level included full support  of  the
      Program Staff in the amount of $4ol.641 which includes $25,000 for the initiation of
      small planning and feasibility studies.
   *he Review Committee accepted the Ad Hoe Renal Disease  Staff  Committee  and.the  site
      Vist,tor's recommendation to disapprove Project #6 entitled, Kidney ContinUina
      Education Program and Project #7 entitled, Renal Dialysis Trainin2 Proposal.  In this
      connection, th;-reviewers strongly suggested that the Program develop a comprehensive
      statewide plan before pursuing any specific operational activities in the kidney
      disease area.
      When comparing last yearts Program Staff Budget with the current  request  reviewers
      agreed the proposed increase was justified.  The Reviewers believed that the additional
      four Program Staff will greatly strengthen programmatic efforts needed to develop  a
      Triennial Application.  Members of the Review Committee were impressed with the
      progress achieved especially since it had been accomplished within a six-month period.
      Favorable comments included the increased involvement of the RAG membership, its
      vasti  improved review process, its committee structure and its monitoring of ongoing
         @ y
      activities.
      Reviewers recommended that the composition of the RAG and its supporting  committees
      should be strengthened through the addition of more minority group representation and
      allied health disciplines,






                                                                                                  CIO,


                                   nt and Financial Summary       Anniversary Application
                           Compone



       COMPONENT                  CURRENT            Of YEAR             02  YEAR         RECO14MENDED
                                YRIS AWARD                                                  FUNDING
                                 01 OPER.                                                       SARP
                                   YEAR             COUNCIL
                                                  RECOMMET]DED,          REQUEST                REV.
                                                     LEVEL                                         C M.
       CORE                    232,196                                   3.76 11641          4ol,641
                                                                            0
       Sub-Contracts              0
       OPER. ACTIV.            267,804                                   405,556             323,359
       DEVEL. COMP.                                                                     Yes      No(X)

       EARMARKS:

              KIDNEY #6                                                     4,640           Di sapprovecr
              KIDNEY #7                                                    44,198          Disapproved







       RMPS DIRECT              *500,000                                 782,197             725,000

       REQUESTED               850,120

       COUNCIL
       APPROVED LEVEL          790,070
       NON-RMOS and
       INCOME


                                                                             REGION    Nebraska
                                                                              @June    197 2 Review tyc

                                    for the 12-month budget p riod 7/71-6/72i  Reg
            $500,000 was awarded                                e                      ion has been
            extended two months to accommodate the three cycle review system.  A pro-rated
            amount of $88,834 has been awarded for the two month extension.



     MEMORANDUM                           DEPARTMENT OF I-TEAI-:FH, EDUCATION, AND N%'ELFARE
                                                         PUBLIC IIE.,%L-I'll SERVICI"
                                           -III-"ALTII Sl-"I@VICES AND ',NILN'FAL, IJEALT14 ADIvflNISTRATION


     TO        For the Record                                 DATE:  March 23, 1972





     FRONI     Edward T. Blomquist, M.D.


     ,SUBJECT. Post Mini-SARP Meeting, March 20, 1972, Nebraska Regional  Medical  Program

               Kidney Continuing Education and Renal Dialysis Training Programs

               Purpose of Program - To produce 6 unspecified one-half hour t6acbing
               tapes at the Good Samaritan Hospital in Kearney, Nebraska, for  use  in
               undescribed training courses to be given an unknown number of patients
               and public groups and

               To develop an inadequatelydcscribed multidisciplinary continuing  education
               program in r-tal care for hos-pital personnel.

                    cost - $48,838 over one year

               Action - Disapproval. During the scheduladsite v-Ls-Lt to Nebraska,  atten-
               tion should be drawn to t-ae instructions for the preparation of kidney
               grant application as punished in November 1970 and as contained in the
               p-sit@on paper dated January 1972.  Particular emphasis should be given
          r    to the need for a comprehensive regional plan on which specific projects
               can be related.

               Advice to ReRion - The reviewers found the  applications  incomplete.  They
               had difficulty understanding what contributions  the  propose  programs
               would make in the absence of better documented need and plans for a
               regional renal disease Drogram.

               Comment contributed by local consultants were noted.  In the opinion of
               the reviewers, the criticisms raised by local consultants, Drs. Touhave,
               Smitll and Holmes, had not been corrected. Specifically, the  plan  of
               action is still not adequately documented and quantitated to give  the
               reviewers confidence that the objectives can be met.















                                                  RIIPS
                                       STAFF BRIEFIliG DOCLNEN'T





                                                          E
                                                        Or PATIOI;S        Eastern         /x I mid-cc,,t.
                                                                                           -7 Western
   WION     Nebraska                                      BRANCII        South-Centr'l  f

                                                              'CH
                                                          BRA14
   VPE APPLICATION:       None      U.IOIT RT.TIIIG       Tel. No.    443-1790           Room  10-15
      -TRIEh'14IAL            197       DATE              BRANCII-CIIIEF  Michael J. Posta
   LU lat'AN14IV Y           0  SARP                                  FF Frank Zizlavsky
                   FAR                                    BRANCII   STA
      2nd. AN14IV YEAR       L7  REV.   COM.              RO REP.  Ray @ddox
      OTHER                  L7  OTHER                    Last 14gt,. Assm't Visit  Feb. 11-13  1970:
                                                          Chairman     Tom Simoods
   AST S.V. April 107  1    Chairman  Joseph W. Hess,    M.D.
   taff Visit&       Last  12 mos.   (Dates    Chairiran s Name and Type of Vigit).
             'November 21-24, 1971, Frank'Zizlavsky    & Ray  Maddox, Staff Visit
             JanuarZ 21,   1972, Frank Zizlavsky, Staff Visit


   lajor Events IThich Occurred in   the Region Affecting the      RMP Since Its Last Review
   n    may     1971
         1.  NewCoordinator'- Deane-S. Marcy, M.D', its of-July 1,      1971.
         2.  Subregional offices     Un!,versity of Nebraska andcreighton U-nivers@ty phased out
            -as of February 15  1972.
         3.  February 25, 1972    Community O'f'Creighton,'-Nebrarka,   received- E'xperimental,Health
             belivery Sub-System site visit-fiom Nitiofigl Center-for.liealfh Services Research
             and D&velopment.








            *Com2onent    and   Financial     Sut-.varv    AiTniverso@t,       21.i cition


                              01  Current           02   Year                02
                                                                          YE tTll
         COI-IFONr-.t\'T
                                                                                               FUI@DING
                              YR'S AWARD          -c                                             SARP
                                    OPER.           R E  0'4- L@- I-, D F,D     REQUEST
                                 Y EAR                   LEVTL                             L3 REV.      COli.


                                232,196                                      @76,641
        CORE     and
                                267'                                         405,556
        OPEP,. ACTIV.                804

        DEVEL. CO',',T.


        EARIIATU' S:


            @iDl\'EY

                                                                          4,640
               #6
                                                                        44 198
               #7



        Rtf-S DIRECT            500,000*             7SD,070                 782,197

        RMPS   ITIDIRECT


        TDTAL


        NON-R@UIS and
           I @c o.@


        T OT A L B V. 1)%t LT
                                                                 0 was aw                    the-I -month
                                                     .$500,00
        REQUT-STR,D              850,12                  budgetx@eriod                  d@72.      Region has'
                                                         been e   ended  t,*o m-)nths              asV-3mmodate
                                                         the    thre-e    -cycle   REGION'  @e@ra      a
        COUNCIL                                          rsvi      Sysit m         Apro-rated amount  of
                                   0,070                 8   3     hl       ttgn
                                                           I  ii      Sr           J,,ne'  197 2,  RFVIL-W CYCL-Z-
        itrpRovED                                        alwar   d    '3       e              -
                                                         two month estens-ion.


            0                                                                                                          'N                     0

                                                                                                                   REGION - NEBRASKA
       AP@@k IL 4, 1972                                           BREAKOUT OF REQUEST                               RM (JO068 1)6/72
                                                                                                                                          RMPS-OSK-JTCGR2-@
                                                                   (%2 PROGRAM PERIOD
                                          1 5)            (2)            (4)             (1) NOT          CURRENT         CURRENT
     :NTIFICATION  13F  COMPONENT    CONT. WITHINI    CONT. BEYONDI   APPR. NOT     I NEW*                                                 TOTAL
                                    IAPPR. PERIODI   APPR. PERIODI    PREVIOUSLY      PREVIOUSLY          DIRECT         INDIRECT.
                                     OF SUPPORT       OF SUPPORT      FUNDED           APPROVED           COSTS            COSTS

       CORE NEP@-.@ASKA  REGIONAL ?II
     ,@.UAJ.-2                                 641
     LA COPOtiARY  CAPE  TRAINING Si
     Lil CORCt4APY CARE  TRAINING Si
     IC COPCINARY  CARE  TRAINING Si
     L

     3 i'iCjBl LE CA
     lialL
     4 PUN- ICAT 10,'iS I  EREPROVASC
     JIL@lp alln- Rl--La@!)@.EA.5-@
     5  NF3RASKA  PPOJECT  FOR   RESI
     1, 1.21- r n                                                                                           S45sad
     6 KI'DNEY  CLtITINUItIG   EDUCAT

     7 PENAL   DIALYSIS    TRAINING
                  TOTAL                  $6739898                                          $108t299        $782tl97         $162,656













                                                                                                                                     REGION - NEBRASKA
          APR IL   4t 1972                                                                                                           RM 00068 06/72
                                                                             BREAKCJUT E)F REQUEST                                                             RMPS-OSM-JTOGR2A
                                                                              03 PROGRAM PERIOD
                                                 (5)               (2)                4)                (1)             AC)DIL    YEAR                         TOTAL'
     E@4TIFICATION     OF     COMPONENT-   CONT. WITHINI      CONT.      BEYONDI APPR. NOT        I NEW,     NOT                                            ALL YEARS
                                           APPR. PERIODJ      APPR.      PERIODI PREVIOUSLY       I PREVIOUSLY             DIRECT                          IDIRECT     COSTS
                                           OF SUPPORT         CF SUPPORT       I FUNDED                 APPROVED           COSTS

     0.3 CORE  @4EL)'ZASKA   REGICTJAL   Ml
     @ICAL     ERO-,-AM                                                                                             I      S398,439                        I     $775sO
     IA   CORONARY   CARE    TRAINING    St                                                                                                                I
                                                                                                                                        f                  1      156,656
     IB   CORONARY   CARE    TRAINING    Si
      UPPOPT P4'IOGRA$4                                                                                                                 I                  1      S222408
     IC   COPC?;ARY   CARE   TRAINING    Si
      UPPGF',T P"P     LI-----                                                                                                                             I             3 q
     I  CriLrl(@rjr'-,T TOTAL                                                                                                                              I(    511@6
     3    MOBILE    CANCER     DETECTION
      U.4 T T
     4      PUBLICATIONS      CEIZEBROVASCI
                                                                                                               778
                                                                                                          $12,                                             1      127.,156
     -ULAP-'@-2.EL@TFD       DIS-E'XSF';  1,
     5   NECIRASKA   Pt'IOJECT   FOR   RESI                                                                                                                I
                                          1.                                                      t-      !&42,145             142,14@                            187.229
     @6    KID-NEY    CCNTINUING    FDUCATI
      YON I!RC-GU-                                                                                                                                                    $4264r
     7    RENAL    DIALYSIS     TRAINING
                                                                                                          t!A.76tg             S33.748                            182   94f2 I
     -PRNPOSAL-
                     TOTAL                      $3989439                                                  $939672          $492*111                               $1,274,308




                                                                                                                                     @9                                                          12           13        1     14              is              is


                                                                                                                                  NRMP      AC       IVITY       SITES




                                                                                                                                     A K.
                 Sioux           DAWES                 SHERiDAt                                       *Codf                              KEYA PAHA

                                                                                                                                                     A
                                                                                                                                                                                                                                  CEDAR
                                                                                                                                            0
                                                                                                                            W@       L.A.,


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                                   Box                                                                                                                                                     roo.0                                      siph




                                                                                         W"                         THOIAAS              @INE                                         vmEELER
                                          RILL            CA                                                               A                                                                                       tiADI
                                                                                                                           r@04                                                            Aso,#$*"  BOONE
                                                                                        GRANT  HOOI(ER            .                                                                                         A                                   @E-
                                                                                                  McFt4ERS@-  -  LOGAN                   CUSTER                                       I    IREELEY     Ubi-V           PLATTE
                                                                                                                                                                                                                   St   fd-.d
                                                                                       AAthw                                                                                                                                                     mo,th fkmd
                                                                                                              rly-A                                                                                                                                              emenij
                                                                                                                     St
                                                                                                                                         o A,"Id                                                     A@.,E  C....
                                                                         0                                  LINCOLN                                                                                                                              SAUNDERS        m-o,,
                                                                                                                                                                                                                            POLK
                  a                                                         I                                                                                                                             MERRICK
                                         *O.JCT            ')EUEL                                                      A
                                                                               ossi                               4po North ?Iaffo                   00
                                                                                            to.h.0
                                                                                                           Lncol@n lilb.)y   &.4,                                                                                                   SEWASCO
                                                                                                                                         DAWSO".                                           IA@l I-                      YORK.
                                                                                -,K[Nti

                                                                                                                                                            flop                                                                                   L               OTOE
                                                                                                                                                                                     &.                t!-A.MILTI                                   in'
                                                                                                                                                                         -ifi      -1      "7@,5       -CLAY-        rtLLM014E                                   Sr  "mid
                                                                                                                                                               L         KEARNEY
                                                                             CIIAIIE                                  -d-  *C.
                                                                                                            A         rnONI iER                                                                                                                   GAGE
                                                                                                          c@                                                             v.:               AOAMS

                                                                             u@-
                                                                              UNOY                                            RF@ILLOW          0                              AN                                                  ;E F F CRIO       B;Ogtf;t*
                                                                                                                                         (?"A*                                             WEBSTER
                                                                                                                                   1-d-.1. FURNAS
                                                                                                                                                                                FIMIlin   A                                                                                             C,i A?
                                                                                                                                                                                           Red ?.,d
                                                                                                       r          t
                                                                                                                                                                                                          E,,ft A D.


                                                                                                                                                                                  LEGEND
                           NEBRASKA
                                   st.le of Miles                     0    Learning              Resource               Center                                   St.#* cop;fot             co..Iy Soots
                                              40           00                                                                                                       MADTSON      Couoty       N@41
                                                                           Drug  InEorinaLion  & Tape  Library                                                         POPUIATION              KEY
                                                                     =Coronary                   Cire  &  ROCO@L                                              o@     yoocoo           a )n,000#.20,000
                      AMERICAN I.IAII COF.4PANY. INC.                MMobile  Cancer  Detection  Unit
                                                                                                                                                              50,ODO 1. looooo             5.(Wto 10,000
                                                                                                                                                              25,Lw   Po    soovo          t,oool. 5,000

                                                                                                                                                              20.(IOOIO      25,@          U.d., 1.000




          R,4 00068                                 -6-

                                            PROF  ILE

                                     STATE OF NEBRASKA

               Geography:      93    Counties
                               76, 612.square miles
               Population:    Total  -  1,483,500  (   1970   Census)
                              Density - 19 per sq. .nile  ( 1/3 as high       as U.S. average
                                                                of 57.5)
                              Urban -  61.5 %  ( 912,800)
                              Non-White - approx. 1% ( 50.,800)
                                   Negro   -   40,000
                                   Other   -   10,000   about 6,600 are Amer. Indians)
                       Age  Group:  Under   18   yrs.   347.
                                    18 - 64 yrs.        54
                                    65 and over         12

                Metropolitan Areas;

                       Lincoln     166,000
                       Omaha,Nebr-538,700
                           Iowa
                       Sioux    City,lowa-    113,900
                        Nebr.*( Dakota Cty)
                                 13,200
                  Average Income per    Individual, 1969
                        Nebraska        $3642
                        UOS.             3680

                  Political      Information:
                        Governor   -    J.-I. Exon  (D)
                        Senators -  Carl T. Curtis, (R)
                                      Ronan L. !Iruska  (R)       Appropriations Conmittee
                        Representatives - Cong. District        I   Charles Thone (R)
                                                                2   John Y. McCollister (R)
                                                                3   David T. Martin  (R)


                                     - - - - - - -  -  -  -  -  -
                   Vital Statistics Rates*  - Leading Causes of Death, 1968
                                                Nebr.           uoso
                       Heart Disease        -   407.1           372.6
                       @lign. Neopi         -   176.3           159.4
                       Cerebro vasc.        -   125.4           105.8
                       Accidents            -  65.3             57.5

                   Related
                       Diabetes                20.1             19.2
                       Arteriosclerosis        22.3             16.8
                       Bronchitis,     emphy.  24.4             16.6





               -Uuubd

                                     State of Nebraska          -7-


             FACILITIES AND RESUURCES

              SCIIOOLS


              Medicine                                                     1969        69/70
                                                                      Enrollment     Graduates
                  Creighton  Univ.  School  of  Medicine,  Onaha        316             73
                  Univ.  of  Nebraska,Co.11.  of  14edicine,O@ha        397             94
              Dental -    2   Creighton and U. of Nebr.,Lincoln)        422
              Phar,mcy - 2                                              300

              Nursing
                   Professional      13 of which 4 are College or Univ. Based

                   Licensed  Practical  -   7
              Allied !iealth Schools                            2Yr. Community and/or
               Cytotechnology -      1 Univ. of-Nebraska              Junior Colleges
                                                                        7 - majority Jr. Colleges
               Medical Technology -     9
               Radiologic Technology- 9
               Physical Therapy -      None
               Medical Rec(,.ds  -    1 - College  of  St.  Mary

              FACILITIES

               Non-Federal  Short  and  Long-Term  General  qospital@,  1970
                                                                             Beds
                    Short Tern Gen. & Special                  101         9149
                    Hong rerm Gen.& 51-acial                     2           334

                                 - - - -- --  - - - -
                    Veterans Admin. Genera'                      3           850

               Number of Hospitals wit%_Special Facilities, 1969
                    iccil                 30
                    Cobalt Therapy         6
                    isotope Facility      11
                    Renal Dialysis         7
                     .   Inpatient
                    Rehab - Inpatient      9
               Long-Term  Care   Facilities( ExLendod Care)  1969
                    Skilled  Nursing   lomes        152        9174  Beds
                    Long-term  care   Units          --5       1482  Beds





                                                       -8-

                                   State of Nebraska


          i4ANPOWER
             Physicians
                Total Physiclans  ( tncl. inactive)               1711
                Total Active Practitioners, reporting             1439  (inc. interns and
                                                                            residents)
                                                                  1188
                      Office-Based
                                                                   251
                      Other

                Active Practitioners, by Specialty
                     General Practice                              506
                     Medical Specialties                           258
                     Surgical Specialties                          385
                     Other  Specialties,  Resear,ch,               290
                       admin. and other

                Group Practices:         Total    81
                          Single specialty        37
                          General prac,;ice       17
                          Multispecialty          27
                 Doctors of Ust,:opathy (  as  of  Dec.  31,  1967) 32

              Professional ..'urses.
                 Actively employed in nursing                       4,730
                 Not activel- employed in nursing                   2,547
              Licensed Practical Nurses!
                 Actively enpl. in nursing                          1,147
                 No,, actively e-npl.  i-.  nursing                    348
              Licensed  Pharmacists  (  in   active practice)  1969   -1,020
              X-ray Technologists                                      485
              Radiation therapists( technologists)                        3
              Physical Therapists, 1970      members in active           60 full-time
                   practice    APT Assoc.)                                9 part-time





                                       -9-







           BACKGROUND & HISTORY
           The November 1970 National Advisory Council approved the
           separation of South Dakota from the Nebraska-South Dakota
           RMP.  To provide interim support for the Nebraska-South
           Dakota RMP's core staff and three projects (beginning January
           1, 1970), the first year award was extended for six months
           until June 30, 1971 at the Region's current level of support.
           The February 1971 Council recommended approval of South
           Dakotals planning application for three years including
           support for their part of the coronary care activities for
           one year.
           Nebraska RMP was site visited on April  1-21  1971  because  an
           initial application for operational status as a separate
           Region was submitted to RMPS.  The site visitors assessed
           the program structure, achievements and capability.  The site
           visit report, which received National Advisory Council
           concurrence, recommended that  the  Nebraska  Regional  Medical
           Program must develop and accomplish, as soon as possible,
           solutions to the following:
           1.  There is the need for stronger and more effective central
           program direction.  The  operating  objectives  and  priorities
           need to be better defined and understood.
           2.  The role of the RAG should be strengthened.  For example,
           the RAG should have a strong role in the selection of the
           Program Coordinator. It  should  display,  also,  its  interest
           in his continuing education in program management.
           3.   The following documents should be developed and officially
           adapted by the RAG:
                a. Mechanism of appointment of Committees
                b. Objectives of each Committee
                C. Procedure for reallocation of funds within RMP
                d. Procedures for monitoring projects over programs
                e. Procedures for project development
                f. Procedures for project review
                g. Procedure for project termination
           4.   The role of grantee organization should be re-defined in
           a way which will delineate the manner in which its
           responsibilities and authorities are  separate  from  those  of
           the Regional Advisory Group.




                                      -lo-



          5. The capabilities of  already  available  resources  on  Core
          staff should be more effectively Utilized in program planning,
          monitoring and evaluation.
          6. Available resources  should  be  utilized  more  effectively
          in defining needs and carrying this through to project
          operation.
          7.  There should be organized plans for phasing worthwhile
          projects to funding mechanisms other than RMP.
          8.  There should be strong involvement of core staff and RAG
          in directing the course of the mobile cancer prO3ect.
          The May 1971 National  Advisory  Council  recommended  approval
          as a separate and new Region with  operational  status  for
          three years at the current level with  the  following  conditions:
               1.  The concerns of visitors be communicated back to the
                   Region,
               2.  The review of the  second  year  continuation  request
                   include a site visit to  assess  progress  during  the
                   next year, and
               3.  The level of funding be increased if significant
                   progress is achieved in the first year.
          Additional concerns are contained in April 1-2,   1971 site
          visit report.
          During June 1971, Harold S. Morgan, M.D. resigned as Coordinator.
          Deane S. Marcy, M.D. became the. n-ew: .@r-dimat@or, r-&s -bt -.July Il,"',1971.
          The Nebraska RMP is currently in  its  01  operational  year.  The
          direct cost award for the present budget period is $500,000 and
          indirect costs amount to  $125,639  (24.4%).  The  current  budget
          period has been extended two months until August 31, 1972.  The
          Region has submitted an Anniversary Application before the
          triennial requesting 02 year support of $782,197 direct costs
          for the following:
               I.  Continuation support for Core                    376,641
              II.  Continuation support for two ongoing projects    297,257
             III.  Support for four new projects                    108,299
                                                           Total    782,197




                                                                      Region Nebraslci
                                                                      Review Cycle  ulle 197'@'
     OANDING ACCOIAPLISHMEUS BY RMP SINCE April 1-2       197 1
     1. Region has defined RAG, Grantee, and Coordinator responsibilities.  RAG has been actively
       involved in the Regions review process.
     2. Developed "Procedural Manual", "Administrative Policy Manial". (pg 13, 15)
     3. Core Staff is developing outreach to community rather than strict confinement to  medical
       comunity.
     4. Good relationships with CHP exist.  CHP is actively involved in RMP review process.
     5. Assisted comunity of Creighton, Nebraska in developing an Experimental Health Delivery
     t Sub-systeim proposal.
     6. RAG is active in terms of overall developmental aspect of programs . Nine functioning
       committees are involved.
     T. Program Coordinator has made successful accomplishments in reorganizing the MW.
     8. Education projects seem to include a methodology for evaluation.
     9. Inter-regional cooperative arrangements have been excellent.
     LO. Central program direction has been strengthened.

     PRINCIPAL PROB@
     1. f@ has clearly articulated its goals, objectives and priorities, however,  they  are  not
       tim-framd and an overall plan for the Region  does  not  emerge.
     2i Program is still quite "project-oriented".
     3. NRMP is not focusing its attention on LTroving the total delivery of health care.
     4. Collection and use of data to determine funding priorities or delineation of program
     @direction.
         ere are no minority group m@ers on core staff or the various project staffs, nor on
     lWhe 9    G Committees. (One black on the RAG)  Special health problems of Indians and
       migrant farm workers have not been addressed.
     6.  Too much conceptual planning (CHP responsibility).
     7.  Emphasis of kidney programs.
     8.  Needs should be defined before action statements on goals, priorities and objectives.

     @ ISSUES REQUIRING ATMWION OF REV
       The emphasis of NFMP is still categorical, and continuing education and trai@- they
       should be encouraged to broaden their health "Horizons".
       RAG should be encouraged to become more involved in the evaluation  process.  SUGGESTION:
       A "Planning and Evaluation C@ttee" to assist in monitoring overall  program  as  well  as
       specific projects and core staff activities.  (Compare this to role of Planner-Evaluator,
       pg. 22.)
     3. The data accruing from the Westinghouse Corporation study should be used as a basis for
       carrying out an overall needs assessment of the Region for developing a related 3-year
       plan of action.
     4. Two part-time salaried positions of grantee being paid by Core funds.
     5'Clarification of CHP 'lb" representative on RAG.
     6. Future relationships with two medical schools.
     7. Core staff position descriptions.
     8. Position Of RAG chairmn and president of Nebraska State Medical Association (same)
     9. Although manpower is a stated objective, what activities are planned.
     i   e role of 2 "Kidney projects" in NRMP statewide Kidney  plans.













                                            TABLE OF CONTEYRS

                                NORTH CAROLINA REGIONAL MEDICAL PROGRAM

                                         ANNIVERSARY APPLICATION


                 Staff BriefiM Document                                              Pa-qe
                 Face Page                                                              1
                 Regional Maps                                                          2
                 (;eography and Demography                                              4
                 Component and Financial SummaTy                                        6
                 Breakout of Request                                                    7
                 Problems, Accomplishments, Issues                                     23

                 Review Criteria                                                       27

                 Addendum to Briefinst Document                                        37

                 Organizational Structure                                              38

                 Regional Office Comments                                              43

                 Supplement to Application                                             46












                                                  RMPS

                                        STAFF BRIEFING DOCUMENT






                                                         OPERATIONS          Eastern            Mid-Cont
  EGION North Carolina 00006                               BRANCH     /X7 South Centr'l         Western

                                                           BRANCH
                            N/A      LAST RATING           Tel. No.   31740               Room in - 22
  YPE    APPLICATION
          TRIENNIAL     April    1972   DATE               BRANCH CHIEF Lee E. Van W@Li
       lst AN.NIV YEAR              SAR.P                  BRANCH STAFF Bill Reist
       2nd ANNIV YEAR               REV. COM.              RO REP.       Ted Griffith

       OTHER                        OTHER
                                                                               is,*, Planned  for    197'
                                                           Last Mgt. ASSM,T V  1L.        Early
                                                           Chairman-
            Nov.   1970     ChairmanHenry'Lemon, M.D. (Comittee); Bland Camon, M.D.(Coiincil)o
  AS@V.                              Edward Coppola, M.D. (Consultant)  RMPS STAFF* Dan Spain     -,
  tallisits,       Last 12  mos.  (Dat6s, Chairman's Name and Type of Visit)            Buddy Says, &
                                                                                        Ted' Griffith
     November   15, 1972- Bill Reist- Met  Staff-  Attended  RAG  Meeting-  Consulted  on  Migrant  Projec

     March     7-9, 1972-  Bill  Reist-  Met  Staff-  Obtain  supplemental  Information  for   AMlication-

     A REVIEW PROCESS VERIFICATION VISIT is scheduled for April 27, 1972
  @jor Events Which Occurred in the Region Affectitg the RMP Since Its Last Review
  n    May        1971

     Eastern Carolina University in Greenville has been appropriated funds by the State legis-
      ature, for a 2 year Medical School and School of Allied Health.

     State Legislature has passed a bill which provides payment for dialysis        of Kidney
     patents
     Legislation Research Committee has been appointed to study and make recommendations on
     EMS  in  North  Carolina

     It will be announced on April 7, 1972 that University of North Carolina has been
     selected by NOiSRDas 'd-tegrantee for  a  University  Center  for  Health  Evaluation  award




                                                                                                          North Carolina RW
                                  Map of Congressional Districts, Counties, and Selected Cities
           Metropolitan Areas:                                (11 Districts)
   @heville    -135.4
   liarlotte   -406.0
   )urham      -188.8
   @reensboro-
   V. Salem     598.9
   Police       225.6







                                                           STOKES


                                               ILKES

                                                                                              y

                                                                                   .ME









                                                                                     ETTEVIL



















































                                                                                     coli@



                                                                  EGIONS
    )RTH CAROLINA MULTI-COUNTY PLANNING R
                        Establ.ished By Executive order
                               Robert W. Scott
                           overnor Of North Caroiina
                         G
                                 May 7, 1970





                                                    ,q
                                           NORTH  CAROLINA   RMP                    RM 00006
                                                                                    3/15/72

                                                Regional boundaries coincide with the State
                                             cts - 11
                      Counties                   - 100
                  Population (1970 Census) -- S,082,100
                      Land Area:  49,067 sq. miles
                      Urban         45%
                      Density       103 per square mile
                        litan  Areas:  (5)  -  Total  population  of  1,SSS,000
                      Asheville  -   135.4          Greensboro   - Winston
                      Charlotte    -406.0             .  Salem   -   S98.9
                      Durham       -188.8           Raleigh      -   225.6
                  Race:  White     -77%  - 3,891,SOO                e Distribution
                                                                 Un r  1  Y_rs  _
                                                                                   5,
                         Negro     -     - 1,137,700                e
                         Other           -     S2,900            18-64 yrs.     - 57%
                           (majority indians)                    65    Over     -  8%
                                          Home Based      17,307
                           Migration intoTState            9,OS3
                                             0  1
                                             ta            6,360
                  Per  Ca-oita  Income:  North  Carolina  $3,188 -   (Ranks  #39)
                   (197b)              United   States    $3,910 -
                  @-rta@:      @aths per 100,000 population, 1967
                                                      NORTH CAROLINA     U.S.
                  Heart Disease                              303.6       364.S
                  Malignant   neopl.                         115.4       lS7.2
                  Vascular   lesions (aff. CNS-Stroke)       105.2       102.2
                  Diabetes                                     1S.2        17.7
                  Broncho-pneumonic                            11.0        14.8
                  (other)
                  Accidents                                    67.2        S7.5
                                                                              1970-1971
                                                                     Enrollment   Graduates
                  Resources  and   Facilities:
                  (3) Medical Schools      Bowman Gray, Wake Forest           273     S8
                                             Winston  -  Salem
                                           Duke Univ. School of Med.          383     80
                                             Durham
                                           Univ.  of  N.  Carolina            337     76
                                             Chapel Hill
                  (1)  Allied  Health  School,  University   Based
                                           Bowman  Gray  School  of  Med.,Winston Salem
                                           Division  of  Allied  Health  Programs






                   RM 00006                                                        3/15/72


                   Professional Nursing Schools                   Practical Nursing Schools
                       40 - 17 are college or                            37 Schools
                               University-Based


                   Accredited Schools - Allied Health
                   Cytotechnology             -   7
                   @dical Technology          -  14
                   Radiologic Technology      -  28
                   Physical Therapy           -   2(University   Based)
                   Medical Record Librarian   -   1
                   Hospital-c                            eneral         Hospital Special Facilities
                   Short Te-nn      36                                iccu           Si
                   Long Tenn-                                         Cobalt         12
                     (special)       7            484                 Radium         34
                                                                      Isotope
                         (g.eneral)  3         i,sos                   Facility      37
                   V.A.                                               Renal Dial-    13
                                                                       ysis (in-patient)
                                                                      Rehabil.         6
                       ower:                                           (in-patient)


                   Active            4,484
                   Inactive             199
                   osteopaths            21


                   Graduate Nurses, 1966:
                   Actively  employed  in  -nursing  12,126
                   Not employed in nursing            3,475

                   Group Medical Practices, 1969:
                   Total              153
                   single Specialty     92
                   General Practice     18
                   multi-Specialty      43

                                                                           RMPS/SCOB/DOD






                component and Financial Summary - Anniversary Application



        COMPONENT        CURRENT              YEAR               YEAR        RECOMMNDED
                         YRIS AWARD        COUNCIL                             FUNDING
                       .04   OPER.         RECOMMENDED        REQUEST            SARP
                         YEAR*             LEVEL                                 REV. COM.


    CORE                   558,193                           643  9bi2
    Sub-Contracts          -0-        <, XI
                                                             (73

    OPER.  ACTIV.       t,152,129                           1-248@175
    ,I)EVEL. COMP.        168,605-                            IBZ.8ql        Yes      or No

         RKS*.

       KIIDNEY  #28                                         (145.400)

       AREC     #41                                         (200,000)







    RMPS DIRECT         1,878,927       2,194,400           2.080-008

                        3,875,178
    REQUESTED


    COUNCIL
    'APPROVED LEVEL     2,194.4


    NON-RNPS  and
    INCOME                                                     34,691


                                                                 REGION North Carolina

                                                                 J ne       1971
                                                                                  REVIEW CYCLE



       The 04 year is being extended to 9/1 and the  region will received
       $365, 733 for the two month extension resulting in a direct cost
       award of $2,244,660  for  14  months.









                                                                                                                     REGTON - N CAROLINA
          MARCH     l7*t972                                         BFTEAKCUT OF REQUEST                             RM 00006 06/7Z        RMPS-OSM-JTOGRZ'el
                                                                     05   pRorFtAM   PERIOD

                                                                           (4)            (1)
                                            15)             (2)                                             CURRENT        CURRENT
     II)E,'4TIFICATION OF COMPONENT     CONT. WITHINI   CONT. BEYONDI   APPR. NOT     I  NEW, NOT           DIRECT        INDIRECT          TOTAL
                                        APPR. PERICOI   APPR. PERIOCI   PREVIOUSLY       PREVIOUSLY                         COSTS
                                           SUPPORT      OF SUPPORT      FUNDED           A PPRE)VED         COSTS
                                        CF


     :000 COQE STAFF
     0-             PMEKTAL
     3        OFZE;7E'LC--- OMPCNENT
     Fr,i--El   B@EIIC   CONSULTATICN   ANI                                                                                    t 7@O
                     ..L  Fylc@r        ------     - ---  --
     015  CCYPREFEP-SIVE    STROKE     PROI
                                            .125.0
                         ---- @TE     TRAI
     @19               A
                       ----------- -
     026  N  C  EmPtiYSEIIA  A.%D  LUNG  DI
                         N-
     OZ8  CARE  c@  PATli   TS   WITH   CFl
     029  CF)@IJED  PHY  ALF)H  PERSON-%EL[
     o3o  CC@P'ZCIIE.'iSIVE RtiEU!'ATIC                                                                                         .1@gz?         ICUAZO  I
     03L                   CARC!AC     PA[
     032 CAPI@E,4 LAD',)ER P,UilStk.'G  EDI
     034   FA?IILY   N,,PSE    PRACTITICNEI
        -B--- ---      ---                                             I-                               ---- 112
           ACULT S -@4.lt,,G  ;7ROG@AR  I
     035
     036  CUM; ,RE@IE,SIVE   CANCER   PRCI
     ---CgLf-                                                                                                sl5z4zbA-l-      SZ?.736   I
     039 t;EI-G-H.Bt-@RH-OO-D-FG-MT-CTRS Cl                                                                                             I
     --O@
     040   EZ)UCATIO'QAL  Yt:ST114G   SERVI
     04t  'AREA  tiEALTti  ECUCATION  CEI
                                                                             $14594GO        $277,468      $29080PCOB        $46OR480   1  $2954Ov488
                      TOTAL             I $1,657tl4O    I




                      IO.ARCH II.L97Z                                                                                                                REGION    -    N    CAROLINA
                                                                                           BREAKCUT OF REQUEST                                       RM  00006 06/72
                                                                                              06 PROGRAM PERIOD                                                                 RMP S-0 SM-J TO GR 2@f

                                                              (5)                (2)               (4)
                IDENTIFICATION OF COMPONENT              CONT.    WITHINI     CONT.     BEYONOI APPK.  NOT       I  NEW, NOT           ADC'L    YEAR                       I    TOTAL
                                                         I   APPR.   PERICOI   APPR.    PERICEI PREVIOUSLY       I  PREVIOUSLY            olit[cy                            ALL YEAR$
                                                         CF SUPPORT         OF SUPPORT         FUNDED            I  APPROVED              C057S                            JOIRECT CCSRS      I

                COOO CGPE  STAFF
                --- - ---  5-P TF T, T-A F C-L) ; -P 0- @E N- -T
                C)COO  CEYLL


                03    C)
                          CTIC       RNSULTATIUN       ANI

                015   CC!IIIRLIFNSIVE    STPCJ@,E    FIRCI
                - -r.?@@ ------- --- --                                                                                              - ---------        -   -   --------   -I
                019   P)IYI@ICIAt@S     ASSOCIATE     TRAI
                                    -          -----------                                                                           - - - -- -
                026   t,  C  Emfllty@LMA   AND   LUNG   01
                                                                            -  -  -   -   -   -                  - - ---- - - -      I-    S13@U4      -L----              I
                023   C-Ikt:   (@f   PATIENTS   WITH   CHI                 I
                029   CUT@ED   P)iY   ALUii    PERSCTJNELI                 I                  I                  I                   I

                030   C        C @N S I V E R ii E Utl,.@T I C I
                  E L Y r-@.- P 0 Li. I': 1 1'3'1 P -' 0 C,,2 L
                                         CII.PUIAC     PAI                 I                  1
                                                                                                                                                                                   15 JUAa9.&                00
                0 3 2 C,'@:li'F.P L.@P)LP  t,",RSltiG  101                 I

                034   rt,@iLy   i.,ui@SE   Pil.ACTITICr,[l
                --?-- - ---- -  -----------  -  ---      I
                3 5   A(.ULI   ',CP.LENING   PP(JGRAM    I
                                -- - - --------          I-
                                         CANCER       PRCI
                                                                                                                                           &276.L2.12
                039   @.ElGliPCk@ICOD   P.GMT   CTRS    Cl                 I                  I
                                      n                                                                          I_      16 1 .6z9.-I-       16@6Z2-
                040   c@OUC.'@T.0@.AL    TESTING     SERVI

                041    AREA    HEALTH    EUUCATILN     CLI
                                     TOTAL                                                           S145,400    1       $74?719 1   $2*195*500         1                       $4,275,506
                                                         I__@it9.75, 381



                                                                                                                                                                                              RMPS-OSM-Jtotlm@ll
                  MAP Cift    t)72                                                RFGln'4AL mFr]ICAL        yPFt ()GP AM S            e
                                                                                  SUMMARY BUDGET  tl   TYP@  OF                       I                                      FEBRUARY  1,  1972  DEADLINE
       ,EGIn',    1)6w        APNL                                                                                                                              REQUEST
                                                                                                                                                                      DIRECT
                                                                                                                                                                         CF)ST
                                                                                                                     Rmps                             RMPS           PREVIOUS           RMPS             RMPS
       .OmPrl,14ENT  PERSONAL        PATIENT          EQUIP.          CONST.             OTHER    TRAINING           DIRECT           INDIRECT        TOTAL           YEAR              DIRECT           DIRECT
                                                                                                                     IST     YR       IST    YR       IST      YR      AWARD            ZND YR           39D YR
           NO.              Svc       CARE                                                       t  FELLOWS.


           NEW     NOT      PREVIOUSLY APPROVED
       ,39                                                                                                           39#325           14#25,S         53,sst                                61,629
                    31     681)                       1,500                              6,145
       4-1                                                                              219343                       38,143           7,5-)2          45,695                                13te9l)

                                                                                                                     2.)o,(,.on
       141

           NEW        SUB-TOTAL
                    47,980                            19500                             77,988                       277#468          2l,8L)A         2999276                               74,719

           APPROVED NOT       PPEVInLtSLY FUNDED
       )Zo          I I fl, 4'1')                   if) 7  000                          25,nOO                       145,4')O         47,240          1   87,64,1                           I  45,4f)O-.

       40T  PPEV SUB-TOTAL
                    1 1 1), 4)f)                       I'l,000                         25,:)Ol                       145,4,)O         42,240          IR7,640                               145,4'@)O

           C',lk4TINIIATID'i WITHIN APPRNVED PERIOD               OF  SUPPORT

                    r)4,330                           29000
                    5                                                                  137*610                       643994)            241,q39       685,879            558,193            839,765
                                                                                                                                                                         IqB,eoo            lR79$q3
       )n3          4',l , I L@'4                                                       r,.141                       45,   25()       12,506          -T,756               62,550
       )15          65v3l4                            2t750                             56,nO6                       124,070          29,392          153946Z            109*000
       -ilg         5(.)#794                                                           66,no-)       o,oon           124,7q9          27,090          ist,sag            169,662
       176                                                                                                           5793sq           11,246          63,635               53#295           135,n34
       ')29         2692rlT                           29000                             39,743                       67,450           7955)           75,000               52,233           112,743,
       13f)         1699';8                                                              9,54D                       76,498           3,922           30,42')              33,821           110,RT6
       031     '-   28p3ZO                                                               9,040                       37,360           7,611           449'971              26,861           219236
       f)32                                                                                                          359893                           35,893               32,0(18          84,237
                                                                                                                     11.1,704         24,?D?          127,915              r)8,493          107,641
       134          839659                            11850






                MARCH         11),1972                                              PFC.InN,\L mrf)JCAI. PPNG!)AMS ,rRVICE                                                                      ItMPS-OSM-JT(IrMB




                        MARCH  1)91972                                                                                  REGIONAL  MEDICAL  PROGOAMS  srRVICE                                                                                                                     RMPS-OSM-JTC(,MSV;,-
                                                                                                                        SUMMARY  BUI)GET   BY  TYPE   f)F  ST)OPOPT
            RECIQN  M6               Nn  CAROL                                                                                                                                                                                        REQUEST  FEBRUARY  ly   1972  DEADLINE

                                                                                                                                                                                                                                              DIRECT
                                                                                                                                                                                                                                                 COST
            Cr)MPONE,'4T  PERSONAL                     PATIENT                 EQUIP.                 CONST.                OTHER                                        FTMPS                                        RMPS                  PREVIOUS                     Rmps                   RMPS
                                                                                                                                                TRAINING                 DIRECT                         INDIRECT      TOTAL--                     YE
                                         SVC     -       C/.R E                                                                                                                                                             .     .  .             AR                    DIRECT                 DIRECT
                                                                                                                                            9   FELLOWS.                 IST  YR                1ST  YR               I s,.T' I yik            AWARD                     2"10  YR               3RD  YR
            035                       37,986                                                                            179640                                                51;t626                 8t233           63,859                       74,176                   9qvO24
            )36                       32t5l2                                         31750                              66*()OZ                                               152,264                229736                 175tOOO                9lt4l2                276t932-
            CNNT.  WITHIN   SUB-TQTAL

                                    93/)tl@8
                                                                           12,350                                     424,427                   8,,')nn         1,     657,      4t).      31)6,432            2,053tS72                    19520*504               1 99?5ir38l..
            PEQUEST  TOTALS

                                   lvO94,568
                                                                           23        t85,)                            477,415                   Ft, oon        2,   (tan,   of)    13      46n,480             2,540,488                    1,520,504               2*1959500
            tuirl'i  T@l S


                                   1.094,568                               23,350                                     477v4l5                   89'10()                    2,')BD,008      463v48O             2954Dt488                    1952OPS04                   29-195,509'
                 C.'IIPONFPJT
                                                                                                                                        COMPnqF-.NT
            1111).                     TITIF                                                                                                    YF Alt

            ),4     tjrlcp.@rikii,ir,r)                      CT;Z',        CO'JTRNL        HYPT        A4D        LIZAB                         01
            ')t,o   @QtJrATIr)@'AL  TFSTI@JG  SFRVICR:   TEST  AND  EVALUATION
                 I  t.5)FA  lir,@ALTH  E@IJ',ATIO-Y  CE.N-TERS
            ')2  A  CARE  I)F  PATIE,@ITS  WITH  C@4PONIC                                UREMIA
            C' Ir)  C'IPF              @TAFF
            ') " r)) ;;@VFI,(IPMENITAt.  CP@PFINENT
            l@3     riAOLrric  Cn@lSt3LTATn,l  AN)  Fr)IJCATInNAL  SFRVICES                                                                     1) 5
                                                    STNUKE                                                                                      (15
                                                                   cl:Z 0 rO A M
            I   1)                           tSS:)CIATE  T;ZAI!JIPJR   PRC;GRA.4                                                                03
            2    6  N  C   EI,4PHYS@tlti  AN[)  LUN(,  I)ISCASE  PROGRAM                                                                        02
            1)29    Crl,'@FO  PHY  ALOH  PfPS()Pl@JEL   [@j  E  N  C                                                                            (%2
            030     Cr)MPI)F@iF,%ISIVF  RtiFtlItATIC  FFVFR   PREVENTION  PROGRAM                                                               r)2
            .') 31  COMP;ic,'IiENSIVF  CAROJAC  PACEMAKER  EOI)CATION  PROGRAM                                                                  n2
            ')32    CARE-FP            LAN[)ER             NI)PSING             EDI)CATION                                                      02
            -)  34  FAMILY               NIJRSR                PRACTITIO'4ER                                                                    ') 2
            135     tf)ULT  SCPFE,'.'114G   PROGRAM                                                                                             117
            @)36    Cr))IPREHEtJStVE  CANCER  PR)GRAM                                                                                           12




















                                                                                                                                                                                                                                                                             RMPS-OSM-JTU'7,Mt
                      m
                                                                                                                      HE(;INNAL  MEL)tr.AL  -RnrOAMS,                                      CF
                                                                                                                              I  irri-jr.  nf:  An,iirriipjAi


                                                                           FTEGI(INAL MEDICAL PRORRAMS                                                                        RMPS-OS)4-JTOGMRII@-
                          ARcl*972
                                                                                 L[SRING OF Ant)ITI41PIAL                                          REQTJEST FEBRUARY 1,  11)72 DEANLINF,-
        ,G,b.m.6            APOL.,
                                                                                                                 OTHER              OTHFR              TOTAL
        D@PO@EN'T         9-ps       GRA4T RELATED        INCOME           STATE              LOCAL             FFNERAL         NON-FEDERAL           DIRFRT          TOTAL       FUNDS
        NU1414ER          TOTAL     INTEREST            OTHER              FUNDS              FUNDS              FUNDS              FUNR)S         ASSISTANCE         THIS       PERIOD


        NEW NOT PREVIOUSLY APPROVED
        03q               539581                                                                                                                                             53r58l
                                                                                                                                                                             451695
        14f)              45#695      - -- ---
                                                                                                                                                                             20f),  nOO
                          2nltnoo

        NEW       SUB-TOTAL
                                                                                                                                                                             299,     6
                          219#276

        APPROVED NnT PREVIOUSLY FUNORO
                                                                                                                                                                             187#640
        2.R               l87v640

        IOT PREV         SUB-TNTAL
                                                                                                                                                                             187,640
                          187,64n
        COIITINUATI(I@L WITHIN APPPNVED PERIOD OF SUPPORT
                                                                                                                                                                             885,879
        CI)OF)            885,879
        n,Nnn             187,893                                                                                                                                            187,893__
                          5T,756                                                                                                                                             57,756
        115               li.3.   462                                                                                                                                        153,462-

        1)19              1 51 i 88'3
                                                                                                                                                                             63,635
        026               6 3 ,',3 5

        n7q               7c, , r)O'l
                          3@3,421)                                                                                                                                           3n,420
        031               44,971                                                                                                                                             44,971
                                                                                                                                                                             70,584
        A3?               3-),893                                                                '449691
                                                                                                                                                                             127,915
        334               1279915
                                                                                                                                                                             63,859
        1
        .)35              639859

        n36               175vOln








                                                                                                                                                                                                                  t
               MARCII     l-).1972                                           REGIO14AL MENICAL PRORRAMS SFRVICE                                                                 ftmps-osm-jTOGMS



                                                                                            4 1 t- AI )I) I, iL  uliu                            REQUEST FEBRUARY  1,  19 72 DEAR)L I t42
               (%6    .140 CAROL
                                                                                                                ()THER            OTHER              TOTAL
     Cn4p,itiE,JT       kmps          r.RANT RELATED (NCIJME               STATE             LOCAL            FEDERAL         NNN-FFI)ERAL          DIRECT         TOTAL FUNDS
       NV.'413ER      TOTAL          114TEREST,         OTHER              FUNDS             FUNDS              FUNDS             FIJNn,.;       ASSISTANCE        THIS PERIOD


     CNNT. WITHIN SUB-TOTAL
                    29053#572                                                                  34#691                                                                2tO889263

     9EG1')N TOTALS
                                                                                               349691                                                                2,5759179--
                    2,541)#488








                                                                                                                                                                                           -   --- - ------


































                M,AP'    -919 72                                            PEGTnN4L mEnICAL PRnrTZAM$              'VICE                                                    Ftmps-nSM-JTOGMS
                                                                            SUMMARY BI)OGET  MY TYPE O',              @nftT
                                                                                                                                                  REQUEST FEBRUARY it  1972 DEADLINE
       PFr,ln,4   I),     ISSCIUPI













                          4Ai@CH               10,11)1?                                                                   P@FCI()%'AL  '4Fr)IC&t.  PPrl(;ftA.4S  FRRVICF
                                                                                                                         S(JMMARY  lti)DC.FT  iiy  TY@ll-  'IF   stjpp.,IRT
                                     N         CAft(',LINA      P.MP Sli!,P YR                                                                                                                                                        PEQIJFST  MAY/JUNE  1972   kf-VIPw  CYCLE
              [)cSK         S(!UTH               CFPIT'-AL                                                                                                                                                                                                                      R         -     M-i  C(;Ra

                                                                                                                                                            @IMPS                                                 HMPS                       RMPS               Rmps                      TNT.L
                   C  0  M     P   n   N    F    N    T                                          cnP4PnN;:NT                                        DIRECT                          INNIPECT             TOTAI.                     DIRFCT                    OFRECT                      OIRECT
               P4 L)                                 TITLE                                     SuppnRr  YFAR                                        IST       Yit           IST           YR             IST        YR              2ND        YR             3RD  YR               ALL              @%kS


                   NEW           NOT           PREVI()USLY             6PPROVEr)

              )30       14@@                        YGITT        CTPS         CG                                                                    10  ,   -42,;                     14,256             53,50'@                    61,6Zq                                                1  0!7,,  9  54
                        @:T@CL       HY,"T        Al.;)
                 4,"    F 0 1. :,' @, T I     L T c @ T I  '!  r,  S'z  P.  V  I                       ol                                           -4,1,143                          7,-;57                    5,6q-)              ill,091)                                              .51,    2    33
                        Ct@   TEST   Al@L)  EVALUATICj%l
              )41       %.4FA          HEALTH          EDUC?.TlrjN           CEN                       ot                                                                                                2')",    00')                                                                    200,0@o
                        TLRS

                   NEW  STJB-TOTAL                                                                                                                  277.4f,@i                         21,ROO             299,276                    74,719                                                357,187


                                     k@IOT  PRE.Vlr"JSLY  FUNI)@@D

              )?B       (t.I!E       (IF       P.@Tl@@ITS       WITH        CtiP                       nj                                           1 4 -,, 4 O-)                     4?1240             187i640                 145,41o                                                  29r",      s@')
                        r,'41C  URFVIA

              .'40T  P;ZEV  SUB-TOTAL                                                                                                               145,4)-)                         42,24(,             187,64n                 14';,      4,),)                                         290,90,0


                                                                                 PFRIOR)  OF  SI.JPPORT

              C') n I   CIRE  STAT-F                                                                   05                                           641,q4l                          241,939             RAI,,379                839,765                                                        1,483,7@5

              D') 0 .0  DFVF.Lf)P4FiNTAL  Cfl"P('@-11@@IT                                              112                                          IST,RQA                                              187,AI)3                187,89-4                                                 375,766

              ')')3     OIA,3FT[I              Ct,N@JL,TATlOt4              A14D                       Or)                                          49,2S')                                              57,756                                                                           45 ,
                                                           V I Cf.'
                                                      STPI;KF              PFZUG                       ;I Is                                        1 24                              29,392             151,4f,2                                                                         124.       (17"

              )lq                               AS@LICTAT@.'                TPAT                       t)3                                          124,791@                 27,       Jl)(%             I -,I 'I  B.)                                                                    124,799
                        N  I   Nf;   P     r It M
              ')76      N     C      FMP'IY'FkiA      A@%4,)      L(1'4G      ni                       02                                           -)@,399                           11,246             63,635                  135.034                                                  187,423
                        sr.@';F   Pi':;(.RA'4
              ,)2  n    C.Illlf,)      Pi@Y      Al      ')if       Pt'R@("@;JFL                       I;)                                          67,   4   5-)                     7,-,50             75,,IOO                 112.743                                                  180,1-@3
                        114  I-   ri  c
              i,i  o    cr,,,PRrHrtisivF                                       F                                                                    26.4qS                             3,922             30,420                  lll),876                                                 137,',174

              )31                                                           P.@c                       (12                                          11,361                      7       1,11             44,971                     21,236                                                58,596
                        FF4t.KFR                                       PQI@t,RA4
              )37       CA;tFFk          LAI)DFP          NI)PSINR.          rDU                       ()2                                          15,891                                               35,893                     84,237                                                1 Z,'),  I  3Z;
                        CATICIN
                                                                                                                                                    I  nlv   71)3                                                                I,)        7.641
              1)34      FAMILY               NT]RSF                PIIACTITIONER                        ..02                                                                          24,207             1 27.9  1  li                                                                    211,349
              li5       AUULT        SCREEP41ilG  Ppnrg,%m                                             !%2                                          55,626                             8,233             61,8'i')                   9).       OZ4                                         154,65n



                                                                                                                                                                                                                              -CNNTTNUED  ON  NEXT  PAGE-








                                                                                           REGIF)NAL  kiFnICAL  PRO@'RAMS  SERVICE
             @r(,.ION                            RMP S(JPP  YR  01;                        SKJ@IMARY  BU()GER  giY'TYPr  OF  SLJPPRJRT -Cf)NT.-
             f)E SK     SOUT@I CENTL?AL                                                                                                                                  PFOIJEST  MAY/JIJNF-  1972 RRVIFW CYRLE

                                                                                                                   Ps                                 RMPS               RMPS                R4ps            TRTAL
               CC'@'4PC.iENT                                             COMP@)NIFNT                             nlr(rCT       ltl.'r)IH@CT          TilTAL                I)TRECT         DIRECT            n[RECT
                                    TITL@                               SU,-'P')PT YEAR                       IST     Yx        IST  YR              IST     YR         2t:D    YR         3RD YR          ALL    3    YRS
             1)36   CO)JPqEHn,NSIVE CANCFR  PROC                              02                                 152,264             22,736             175,000            276,932
                    RAM                                                                                                                                                                                            429#196
             COIIT. WITHI@L  SUB-TR)TAL                                                                      1.657,14,')            396,432           ?,151,572         lol)75,381                               31632,521
                       T.)T 'tL5                                                                                                   46(',430    2 i 5 4) 4  R  q          29105,50i                         4 2  75,.5')  8









                     -M Ai'                                                                                                        mF 0 1 C A L   I'Rn                   f P V I r F
                          -C!i     I'll      11)7?                                                              PF.G(P,'@AL
                                                                                                                        LISTIN(;  OF  Au;)[Tlll-'i&L                                                                    REOUF.;R  MAY/Jt)NF   197?  RFVICW  CYCLE
                             N                           PI-P  SLJPP  YR  r5
                                                                                                                                                                         T @iF. k                 I)T@IF ti                   TOTAL
        COMPIINENT                 12mps                 t',RA@IT  RELATEL)  I%C:IME                            STATE                      LnCtl.                    FFI)ERAL               '4f)N-F! )FRAL                  r)IP.ECT               TOTAL             FIINOS
                 @ILIMIIER        TNTAL                lil.'TEREST                                              F U.\'I) S                                             r u,it) S                  -i)hlf)S              ASSISTA.NCE                THIS            PE@l,')D


                 @@Ew  qOT  PREVICTJSLY  APPROVED
                                                                                                                                                                                                                                                             53*581
                                            53,591
                                      5,  f,';   5                                                                                                                                                                                                           45,695

                 r'41             2 ')

                 NE,d  SuB-TOT.@L
                                                                                                                                                                                                                                                             299,276


                 APPROVE[)  NI)l   PRRVIOUSLY  FU'4DFr)
                 2                  4  7  t  f-4,)                                                                                                                                                                                                           187,640

         ',,,,3  TPS.EV  SUi;-T()TL
                                                                                                                                                                                                                                                             197,640


                 Cn@4TI14UATIott  WITHTN  APPRI.)VEN  PERIOD  OF  StJOPf)RT
                                                                                                                                                                                                                                                             865,871)


                                  I F;7 ,  fk-)  I
                                                                                                                                                                                                                                                             57,756
                                            57,7i6
                                                                                                                                                                                                                                                             153,462
                 5                l';I,462
                 olq                                                                                                                                                                                                                                         151,889
                                                                                                                                                                                                                                                             63,635
                 ,)26
                                                                                                                                                                                                                                                             7 5
                 2                   7i,     C)',-
                                                                                                                                                                                                                                                             30,42)
                                               2,j
                                                                                                                                                                                                                                                             44,971
                 '131
                 c                         44,-;71
                 032                                                                                                                          34,691                                                                                                         70   ,    5ki4
                 034              127,<)IS                                                                                                                                                                                                                   1   27,'41   5
                                                                                                                                                                                                                                                             63,859
                 035                        63,859
                 036              1 75       ()f)O                                                                                                                                                                                                           1   75    !)Oo





                                                                              REGIO@.IAL MEL)IRAL PporkAMS SFRVICC
                   MAKC@I ll,),.1972                                                LISTIN(; @IF Al)[)ITlr.INAL F()NDS                            REUur-ST MAY/       -,E          -VIEW
                                                                                                                                                                   Jij    11)72   RE      CYC.LE
           PEGION 06 N CARRILINA           RMP SUPP YR 05
                                                                                                                   OTHER             nTIJFR            TOTT.L
                                                                                                                                %'IN-FFOCRAL         DIRECT         TNTAL    FUNII)S
           ,'CqPnl,,ENT      RIAPS                 RFLATEI)                    STATF             LRICAL          @rr)FkAL                          ASSIST.NCE       THIS      PFRIon
                            TOTTL         ITITFPF.ST         OTiirR            FI)NN.S                             $:L'NnS           F U%'@)S


           CotiT. WIT.41N SIJP,-TOTAL
                                                                                                                                                                           2,08S,263
                         7,0539572                                                                34*691

           kEGI,)N TR)TALS
                                                                                                                                                                           2,575,179
                                                                                                   34, t,
























































                                                                                                                     "Rvvrr
                                                                                 RFClfl-;-%L mFr-ICAL PI:(,
                              11), 9 72









                                                                                                                                                                                                                                                     PAGE      5
                                                                                                           REGIONAL  MEDICAL  PROGRAMS  SERVICE                                                                                                 RMPS-OSM-LFKRFQJ
                 MARCH                                                                                         RAps           FUNDS           RFOIIESTED
                                                                                                                                                                                                  REQUEST        MAY/JUN        1972        REVIEW         CYCLE          r)
       El;t[)N      06       N       CAROLINA         Rmp.supp            YR 05                        (PERCENT  OF  TOTAL  FUNDS  REQUESTED)

                                                                                                                                                TNTAL
                                                                                                                                                PMPS  FUNF)S                OTHER  SOURCEN                    TOTAL       SUPPORT        ---.-,RMPS        't
                                                                                        TITLE                                                                                                                 ALL               SOURCES         OF         TOTAL
       ()MPONENT  NUMRER                                                                                                                        REQUESTED                   OF              SUPPORT
                                                                                                                                                                                                                          885,879                       too
                                                                                                                                                       es5,679                                    0
                 COOD                       CORE  STAFF                                                                                                187v8gl                                    0                       1979893                       Ino
                 ot)00                      DEVELOPMENTAL  COMPONENT                        -DUCATIONAL  SERVICES                                      57 9  7-56.                                0                       57,756                        lo@ - .-
                                            [)IASET$r@       CONSULTATION        AND        E                                                                                                                                                                             C)
                                                                                                                                                       1539462                                    0                       153t462                       1
                 015                        COMPREHENSIVE  STROKE  PROGRAM                                                                                                                                                151,889                       10?)
                 1)19                       PHYSICIANS  ASS(@)CIATF  TRAINING  PROGRAM                                                                                                            0
                                                                                                                                                                                                                          6.4.     6",i                 10
                                                                            LUNG  ',)ISFPkSF  PROGRAM                                                  63,645
                 ')26                       N  C  EmpIlYSF
                                                               M  fA  A4  1)                                                                                                                      n                       1879640                       I O')
                                                                                                                                                       187*64q
                 ')28                       CARE  OF  PATIENTS  WITH  CHRONIC  UREMIA
                                                                                                                                                                                                  0                       750000                        100
                 029                        CONF.D  PHY  ALOM PEPSr)4NEL  tN  F  N  C                                                                  75,000
                                                                                                                                                                                                                                                        I n,)
                                            Compq                      HR-UMATIC  FFVR-.R  PREVENTION  PROGRAM                                         -4                                         0                       3#),420
                                                                                                                                                       0,420
                                                  .FHF
                 030                                      NSIVF  R                                                                                                                                0                       44,971
                 i3i                        COMP'AEHENSIVE  CAQD[AC  PArEmAKER  FI)UCATION  pFtnCPAM                                                   44,q7l                                                                        84                 51
                                                                                                                                                       '45,89-t                              349691                       70,5
                                                                           SINR,  FOUCATin.4
                 032                        CAREER        LADDER         NUR                                                                           7,915                                      0                       127.qlS
                 034                        FAMILY  04URSE  PPACTTTTNNER                                                                               L2
                                                                                                                                                                                                  n                       63,8'i9                       Ion               ili@
                 (135                       ADULT  SCREENING  PRr),@RAM                                                                                639859
                                                                                                                                                       1 7 r, , ') t.) ',)                        (I                      17'i.00()                     ll,)O
                 036                        CDMPREHFNSIVE  CANCFct  PROGRAM                                                                                                                                               539581      '     - -.        101)
                                                                                                                           . a                         53*581
                                            NEIGHBORtIO00  MG'4T  CTRS  CONTROL  HYPT  AND  ()IA
                 040                        EDUCATIONAL  TESTING  SERVICE  TEST  &NO  EVALUATION                                                       45,695                                     n                       4 .5,695                      100
                                                                                                                                                       2,no,  DO')                                0                       2  DO,   00t)                 ji) 0
                 t)   41                    AREA  HEALTH  E-F)UCATION  CENTERS
                                                                                                                                                                                                                                                        qq
                                                                                                                                                2*54C,488                                    34,691                 2,         5715,179
                                                                                            REGION    6
                   TOTAL OF    t7 COMPONENTS






           MARCH       0891972                                   REGIONAL-MEDICAL PROGRAMS SERVICE                     DESK  SOUTH CENTRAL AREA                   RMP-OSM-PEM001
                                                         LIST OF-COMPONENTS REQUESTED Fz)R NEXT SUPPORT YEAR
            REGION C)6                   RMP-SUPP-YR 05                                          REQUEST MAY/JUN 1972 REVIEW C-CLE
                     COMPONENT                         COMPONENT                         NEXT             DIRECT COST            EST DATE OF
                      NUMBER                             TITLE                           SUPPORT YEAR  NEXT PERIOD               TERMINATION
                      COOO   CORE STAFF                                                          05            643,940
                      DODO   DEVELOPMENTAL COMPONENT                                             02            IS7,893
                      003                         TION AND EDUCATIONAL SERVICES                  05            45,250            06/73
                             DIABETIC CONSULTA
                      015    COMPREHENSIVE STROKE PROGRAM                                        C)5           1249070           n6/73
                      019    PHYSICIANS ASSOCIATE TRAINING PROGRAM                               1.) 3         124,799           06/73
                      026    N C EMPHYSEMA AND LUNG DISEASE PROGRAM                              02            52,309            06/74'
                      028    CARE OF PATIENTS WITH CHRONIC UREMIA                                01            145,4r)O          06/74
                      029    CONED PHY ALOH PERSONNEL IN E N C                                   02            67,450            06/74
                      030    COY.PREHE@ISIVE PHEIJMAIIC FEVFR PREVENTION PROGRAM                 (%2           26,498            06/74
                      031@   CC!IPPEIIENSIVE CARDIAC PACEMAKER EDUCATION PROGRAM                 02            37,360            06/7
                                                                                         -,-. .                                                 I     ... -"- -. - .         -  .. --   -
                      032    CAREER LADDER NURSING EDUCATION                                     02            35,893            06/71-
                      034    FAMILY NURSE PRACTITIONER                                           02            103   708         06/74
                      035    ADULT SCREENING PROGRAM                                             02            55v626            06/74
                      036    COMPREHENSIVE CANCER PROGRAM                                        02            152,264           06/74
                      039    NEIGHBORHOOD MGMT CTRS CONTROL HYPT AND DIAS                        01            3c),  325   -7    06/74
                      040    EDUCATIONAL   TESTING    SERVICE    TEST    AND    EVNLUATION       01            38,143            06/73
                      041'   AREA HEALTH EDUCATION CENTERS                                       01            200,OCO

                           TOTAL REGION  06         COMPONENTS          17                                     2,080*UO8







                    MARCH        23*1972                                            REGIONAL MEDICAL PROGRAMS SERVICE                                                                                     PAGE      I
                                                                                SUMMARY BUDGET CATEGORIES BY COMPONENT                                                                       RMPS-OSM-JTOrM2 "19
         PEGION    (116    N    CAROLINA                                                                                                                       REQUEST       MAY/JUNE        1972        REVIEW.CYCLE
                                                                                                                                               PONENT                COMPONENT            COMPONENT         COMPONENT
                                       COMPONENT                 COMPONENT           COMPONENT           COMPONENT           COMPONENT       com
                                          NO      COOO       NO       DODO       NO Or)3             NO 015              NO  019             NO 026              NO 028              NO 029              No      030@

              I        PERSONAL        SERVICES                                                                                                                      09364               22,748              l4t494
                                              4479780.                              35,830               58,884              45,150            43i243               10
           SALARIES,         WAGES                                                                                           5,644               2,344               100036              3,459               21464
           EMPLOYEE            sENEFI.TS      56,550                                4,279                69430                                                       10*400              26,207              16.950
                            ,TOTAL             504,330                              4OwlO9               659314              50,794            45958T

             It     PATIENT         CARE
                    IN-PATIENT
                    OUT   -PAT   I   ENT
                         TOTAL


                    ECUIPMENT
                    BUILT-IN                                                                                                                                         10,000              2,000
                    MOVABLE                   2,000                                                      29750
                         TOTAL                                                                           2t750                                                       101000              2*000

             IV             CONSTRUCTION
                    N EW
                    MAJ  ALT     &REN
                         TOTAL


              V     OTHER
                    C'@.'-.'S U L T ANTS      4*,IOO                                                     3r2l6                                   Ifooo               5*000               249000.             4,200
                    SUPPLIES                  10,000                                       Boo           11250               7,000               3,680               5*500               39743
                    [)MST         TRAVEL      27,110                                       750           4y8OO               29500               29000               6#500               2,     500          1,000 -
                    FRGN          TRAVEL
                    PENT           SPACE                                                                 3,240                                                                                               2tl4D---
                                                                                                                             2,100                                                       1,000
                    RETJT    OT   HE   R      7,000
                    MIN   ALT   &    PEN      1,500                                                      i,ooo               5,000                     12Z                               2,000
                    PU BL I CA I  19N  S      2tOOO                                                      38,200              4:0,000                                                     3,000
                    COTITRACTUAL              73,000           1879893                                                                                                                   3,000.              2slOO
                    C EJIAK UN I C A TI ON    12,000                                     1,191           3,000               2,000
                    COMPUTERS                                                                                                -51000
                                                                                                         1, 300------        2,405                                   .80000                                       10;
                    OTHER                     i,ooo
                         TOTAL                1379610          1-87,89,'                 5tl4l           5690')6             66*005              6,802               25wCOO              39t243              99540

              VI      TRAINEE      COSTS
                    STIPENDS                                                                                                 8,000
                    OTF.EP                                                                                                   BVOOC-
                         TOTAL
           TOTAL      DIRECT       COST-      6431940          187,893              45t250               1249070             124#799             529389              1459400             67t450.             26t498
                                                                                    l2v5O6               29t392              27,090              119246              429240              7*550               3,922
                    INDIRECT        COST      Z4lt939
              TOTAL      DIR     IND          8859879          187,893              57,756               153,462             151,889             639635              187,640             759000              30,4ZO










                        MARCH 23vl972                                                       REGIONAL  MEDICAL  PROGRAMS  SERVICE                                                                                   PAGE         2
                                                                                       SUMMARY  BUDGET  CATEGORIES  BY COMPONENT                                                                        RMPS-OSM-JTOGM2-01+
               REGION 06 N  CAROLINA                                                                                                                                      REQUEST      MAY/JL$NE      1972      REVIEW      CYCLE

                                                   COMPONENT           COMPONENT            COMPONENT            COMPONENT           COMPONENT            COMPONENT           COMPONENT            COMPONENT          REG104
                                              .NO 031               NO 032               NO 034               NO 035              NO 036               NO 039               NO 040              NO 041                TOTALS


                     I       PERSONAL       SERVICES
                SALARIES*  WAGES                   24,451             32,566               73,00'J              32,818              75,011               28,800              16t3OO                                    .1*0519439
                EMPLOYEE            BENEFITS       3,869                   lt723           109658                5,168                79501               2t880                                                      123POO5
                              TOTAL                28v320             34,289               839658               379986              829512               3lt680              169300                                     191749444

                  II    PATIENT         CARE
                          IN-P  AT  I  ENT
                        OUT-PATIENT
                              TOTAL


                   III  EQUIPMENT
                        BUILT-IN
                        MOV AOL E                                                           1,850                                     3,750               1,500                                                       23,850
                              TOTAL                                                         Ite5o                                     3,750               1 i  500.                                                   23r850

                  IV    CrNSTPUr-TION
                       @4 EW
                       MAJ   ALT    C    REN
                              TOTAL


                     V  OTHER
                        CONSULTANTS                                                         80300                                   10,000                                     6,800                                  62#316
                        SUPPLIES                   1,500                                    49200                6,800                8#414               2,000                1,175                                  60*262
                        OMST        TRAVEL         29500                   1,604            5,t)00               zvsoo                7,050                     300            29335.                                 @68,449
                        FRG'4       TRAVEL
                        RFP,T        SPACE         2,140                                                         2t98O                                                                                                12,   90-,%
                        P-E t4 I    OT!IER                                                                                                                                                                            io,too
                       MIN   ALT    &    REN                                                                                                                                                                            11   501)
                        PUBLICATIONS                     100                                      200                                 2,074                     200                                                   12,69b
                        CONTRACTUAL                                                                                                 22#983                21000                                 200#000              567#076.
                       COMMUNICATION               29700                                          500            3,660                4,567               19045                                                       35,763
                        COMPUTERS                                                                                                     9t3OO                     600               4  5)                               15    t3.50
                        OTHER                            100                                                     1,700                1,614                                  11,083                                   27,3f)Z
                              TOTAL                9tD4O                   1,604           l8t2OC               17,640.             66,002                6.145              Zlt843             200*000              873,714

                  VI    TRAINEE  COSTS
                        STIPENDS                                                                                                                                                                                            81000
                        OTHER
                              TOTAL                                                                                                                                                                                         stooo

                   TOTAL DIRECT        COST        37v360             359893                  lO3v7C8           559626                 1529264           39#325              389143             200,000                 29080*008

                     INDIRECT         COST         7v6ll                                   24,207                8,233              22,736               14#256                79552                                 460,480

                  TOTAL       DIR     IND          44,971             35,893                  127,915           63PB59                 175,DOO           53,581              45*695             2009000                 2954ot488












                                                                                              II IN At M i 1) It. Al
                                                                                               CtiPR f 1, I                                              AS  oF  1(1/31/71                                            PAGE:       I
              RUN DATE    ollit/T2               PROG  YR        04                                           LEVEL  F,JNOI@4G
                                                                                                                                                                     i)[1@ICT                                         T(Il AL
              RLG         iEGION           camp                                     CUMPL)NT- r4Y  II I t 1:                                                         @, I,.% k a            AI%AP   U                 AYII.R 0
              NO          NAME             NO                                                                                                                         558.2',O               22r,,800                 779tOCj
              06          @NO   CAROL      cooo        CORE     ADM     RES      kVAL                                                                                                                                 196,800
              06          NO CAROL         Dooo        DEVELOPMENTAL
                                                                                                                                                                     74,r,'OO               19t3Oo                    9393CO
              t)6         NO CAROL         001         EOUC     RES      Comm     MED CAPE  NEEDS                                                                    44,,400                T,BDO                     52*200
                                                       CCU     TRG     DEV      CONED MD     N
              06          NO CAROL         002
                                                                                                                                                                     62,600                 159200                    779800
              06          NO CAROL         003         OIAS     MGT     TO      PRACT     CONS CLINIC                                                                16,000                 4,230                     2Ct2OU
              ,6                                                         xEGISTRY  REGIONWID
                          NO CAROL         004         DEVELOP  CA                                                                                                   23,600                 6,800                     3C,,.60
              @6          NO CAROL         005         ME()     LIBR     XTN      SLR
                                                                                                                                                                     57,OGO                   -T2,300                 69#300
              06          NU CAROL         C;()$       ED        PHYS        DENTISTS UNIV NC
                                                                                                                                                                     42   S;)G              7,5DO                     50, C; ')O
                                                                           ST Cp    RESUS  UNIT
              06          NO CAROL         013         CLOSED CHE
                                                                           UL ED    t,,LM  MISS  ASHV                                                                7,100                        300                 7,4CO
                          NO CAROL         014         HEART  CGNS
                                           015         COP.PR  SIR  PRG  1306MAN  (,RAY.                                                                             lrg,ooc                24,slc                    133# 5,JO
                          NO CAROL                                                                                                                                   3C,000                 12'stoo                   42,8
                          NO CAROL         017         REG CTITR  GT:ST  TF(OPHOOL  NEOP                                                                                                                              4
              @16                                                                                                                                                    16q,7c)o               53,600                    2Z3#300
              06          -t4C CAROL       C19         TRG  MD  ASSYS DUKE  U kURL  MDS
              C6          NO CARGL.        023         PILOT  STI)Y  SCH  CHLD  PHNCASCAN                                                                            22,200                 3,30C,                    25,500
                                                       CONED  10@OS  ALE)H  AECRT  EAST  NC                                                                          5C-,Or@o               10,000                    6C,CCO
              06          NO CAROL         029
                                                                                                                                                                     2 8  4(10              4,230                     32,60r,
              06          NO CAROL         030         RHEUM  F  PRG(, CHLURN
              06          NO CAROL         031         CARDC  PACEMAKER  EDUC  INFO  PRG                                                                             "6;jO                  3,600                     14,200
                                                                                                                                                                     50 , G(7ic             20,000                    7C., c co
              06          NO CAROL         034         FAMILV         N          PPACTLTIONER                                                                        72,6%10                12  *3()O                 841900
              6           NC' CAROL                                      R  AtiE.IAIA RELATED          FU
                                           035         ADULT      H ST                                                                                               759')CO                250000                    loo,occ
              06          NU CAROL         036         CA     PRG     CUNED     PKUF      LAY
              06          NO CAROL         037         Coop  CONED PRG STWD                                                                                          2(i,ooo                1,6@o
                                                                                                                                                                     ic9coo                 1,503                     111,5cc,
              C6          NO CAPOL         038         CA  TLPH  CONF  MU$  U  REG CTRS
                                                                                                                      gErloN  TOIALS                                 1,73l,guu              466,603                   2,lq8,5GO
              NO       OF       CCMPON-E'ITS     22                                                                                                                                                                                                         out






                            P'AQCH         14,     197   2                                                                             REGI@INAL  k'EOICAL   POOL;RA'4S  SEPvicr                                                                   DESK         SOUT14  CENTRAL  AREA
                                                                                                                                                                                                                                                                                                  RMP-OS-4-Pr.m,)Il
                            REGIGN          06     NO  CAROL                                                                                      BkIOGr.,T           Pfklt)')            LIS.'ING                                                                                   AWARD  AS  OF  12/31/71
                            RMP       C04P         FY        ACT               TYP          TYP            RMP              COMP                                CompnN(,NT                   TITLE                                                                  PUDGET         PERIOD
                            pi f]     NO                     DATE              ACT          SUP      SUP  YP              SUP  YR                                                                                                                                          FROM             THPU
                            06        C')OO        71        11/71               4            2            n4                   04          C-IRE                                                                                                                   07/71          06/72
                            06        0000         71        11/71              "5            5            04                   ot          DEVELOP'I[NTAL                                                                                                          L)7/71         06/72
                            )6        DOI          71        11/71               4            2            04                   04          EOUCATINN  AND                 PCSIARCH              IN  C(IMIAUNITY  ?iEDICAL  CARE                                    07/71          06/72
                            CJ6       i)02         71        1 1 /  7'1          4            2            f)4                  04          CI)KONARY  CARF                TRAINING              AND  I)EVELnpMENT                                                  C@7/71         06/72.
                            6                      71        11/71                            2            04                   f)4         rIAI3[.TIC                                       AND  Cl)kICATIO.'4AL                SERVICES                           07/71          06/72
                                      003                                                                                                                       CONSULTATION
                            ')6              4     71        11/71               4            2            04                   11) 4       CANCER  PtrIS,rRy  UTILIZATION  Piii)GRAti                                                                              117/     71    06/72
                            06                     71        11/71               4            2            )4                   C4          MT.'OICAL   LI-IRARY  FXTI'NSILIN  srkvice                                                                              07/71          06/72
                            j6        008          71        11/71            --4-            2            fi4                  04          CONTINUING  EOLJCATION   IN  DENTISTRY                                                                                  07/71          06/72
                            (j6       013          71        11/71               4            2            04                   C4          CLCS[D  CHRST  CARD10PULMONARY  RFSUSCITATION                                                                           i,)7/71        06/72
                            )6        014          71        11/71               4            2            )4                   04          litA;JT   CA"C.LR   ST@,@KL  CO@;,LJLTt.Tlt)t*'  AND  ED:JCATION                                                        Li7/7l         06/72
                            )6        .11    5     -71       11/71               4            2            1)4                  04          COMPi@Flif',t@SI'JC-   ST;znKE   PF,('CRAM                                                                              07/71          C6/72
                            IJ6       017          71        11/71               4            2            04                   03          REGINNAL  CENTEK  FOR  TROPtiD3LASTIC  DISEASES                                                                         07171          06/72
                            36                     71        11/71               4            2            u4                   L)2         Pi4YSICIA'.'%  A,SISTAliT   TFAillINC.  PPTICRAM                                                                1       ',7/71         06/72
                                      ;)2    2     71        11/71               '4           2            t)4                  13          cocqi)i%,.@TrD  r)NCI)L(ICY  CIIEIJOTPCRAPY   PRCGRAM                                                                   ')T/71         t)6/7Z
                            )6        023          71        11/71               4            2            04                   03          lirAItT  Sl',I@,:)S   SC!tEF!4lNr.  PRllr.RAP-                                                                          07/71          06/72
                            36        ",26         71        11/71               -4           I            n4                   01          N  C  [14PHYSEMA  A4D  LUNG  DISEASE  PROGRAM                                                                           07/71          06/72
                            16        129          71        11/71               '4           1            04                   01          CONT  ED  roR   PHY  ALLIED  14,LTH  PERSONNEL  IN  ENC                                                                 OT/71          06/72
                                                                                                           04                   GI          CIIMPRE.IIF.4rIVE  R'IC()14ATIC   FEVEP.  PRFVENTINN  PROGRAM                                                           07/71          06/72
                            ,6        -13')        71        11/71               4            1
                            06        @)31         71        11/71               4'           1            04                   )I          COv.FIRFlir,4SIVC  CARDIAC  PACFt'.AKFR  EDLICAIION  PROGRAM                                                            07/71          06/72
                            ut,       032          71        11/71               4            1            04                   ut          CARFER   LADDER  NURSINC.  EDUCATION                                                                                    07/71          06/72
                            @3(,      034          71.       11/71               4            1            04                   01          FAMILY  NURSE   PRACTITIONER                                                                                            07/71          06172
                            16        035          71.       11/71               -4           1            04                   DI          ADULT                SCPFENING                 PROGRAM                                                                  07/71          06/72
                            .)6       036          71        11/71               4            1            n4                   LI I        CO','rEHrN%[Vr  CANC@R  PRr.C.PAM.                                                                                      07/71          06/7Z
                            '6        .11    7     71        11/71               4            1            Al  4                .11         C(;(ii,rt;ATIVr  r'RrrWAM  nF  Cn.'4TINI)I.NG  LI)UCATI(IN                                                              t)  7/   71    ')6/72
                            1  6      ')3    8     71        11/71               4            1            ',I 4                   I        rFGIOPif%L   TFLEPH(INF   CA.4C[R  CO@IFEKFNCE                                                                          07/71          06/72

                                        'TOTAL (:rtI.PONENTS              REGION              06                                           25








                                                                  Region  North Carolina
                                                                  Review  Cycle


                PRINCIPAL PROBLEMS: The November 1970  Site  Visit  Team  identified
                                     three chief weaknesses of  the  North  Carolina
                program.  These were subsequently reaffirmed by the April 1971 Review
                Committee and May 1971 Advisory Council.  They were:
                    1.  Gaps existing in the composition of the RAG -  it  was  felt
                        Blacks, Allied Health and Consumers were  not  properly
                        represented.
                    2.  Of the two governing bodies, the RAG and the  Board  of
                        Directors, it was the 17 member Board that had final authority
                        for program and operation  ec s ons.
                    3.  The Research and Evaluation Division of  Core  Staff  which
                        was centered in UNC was not  instituting  adequate  evaluation
                        practices.  The site visitors believed a stronger evaluation
                        section should be developed in the central core office.

                Other observations of the reviewers were:
                    Nearly all health agencies were involved in NCRNP planning and/or
                    operational activities with the exception of  the  Black  Medica
                    Association.

                    Little enthusiasm could be mustered for  support  of  the  arge
                    number of renewal projects. One exception  was  the  Stroke
                    Project. It was believed the Region must  come  to  grips  with
                    phasing out new projects.



                OUTSTANDING ACCOMPLISHMENTS: During the past  year  NC/RNP  has
                                               concentrated on strengthening the
                weakness identified (above) by the National Review  Bodies  at  the
                time of their triennium submission.
                    1.  They have improved the composition of the RAG by adding
                        a Nutritionist and an X-ray Technician to the existing
                        three Allied  Health  representatives.  Public  representation
                        has been increased from 4 to 12  and  Black  representation
                        has been increased to 9.  To accommodate t ese new
                        members the total RAG has been increased from 36 to 51.
                    2.  The Region has reorganized its advisory bodies, disbanding
                        the Board of Directors, and giving final authority for
                        all activities and policy matters to  the  RAG.  A  13  member
                        Executive Committee, consisting of members of 7 designated
                        institutions and associations and  5  other  representatives
                        elected by the RAG, manages affairs in  the  interims  between
                        quarterly meetings of the total RAG.







               3.   The Research and Evaluation Division of Core at UNC  has  been
                    disbanded. Replacing it is the Division  of  Planning  and
                    Evaluation within Core which will be directly  responsible  to
                    the Director. This Division will be staffed  by  a  Director
                    (newly hired) a biostatistician (TBA) and an evaluator (TBA).
                    This Division will also be supported by a  $30,000  budget
                    item to enable subcontracting for data services  with  appro-
                    riate agencies.
            Consideration has been given to involving the Black  Medical  Society
            "Old North State" which has approximately a membership of 200.
            However, the Black doctor currently on the RAG and other Black
            physicians informed the Director this is not really a viable
            organization and they feel its representation  would  not.be  that
            relevant.  This is believed to be particularly true since the
            State Medical Society now has integrated representation.
            Of twelve renewal project requests incorporated in  the  triennium
            submission the Region saw fit to support nine during  the  current
            year. The 05 Anniversary Application requests  continuation  of  only
            two renewals, one the Stroke Project  mentioned  as  an  exception
            by the national reviewers (see above) and the  second  a  Diabetic
            Education Project.  Each request one additional year support.
            A third renewal the Cancer Registry is being incorporated at  a  much
            reduced level into another  (non-renewal)  project,  Comprehensive
            Cancer Program.
            In summary, of the nine renewal projects, six  are  being  supported
            from other sources, two are being continued one more year and
            one is being incorporated into another project.
            In one general statement, it is Staff's opinion  that  the  Region
            should  be commended on the accomplishments resulting from its
            effort  to respond to weaknesses identified by the  national  review
            bodies  a year ago.


            ISSUES REQUIRING ATTENTION OF REVIEWERS: While  Staff  in  its  review
            of this application was highly complimentary of the Region's
            achievements over the past year in correcting  major  deficienc  es,
            it identified a number of issues which should be  brought  to  the
            attention of the anniversary review bodies.
                 1.  The goals and objectives, while  having  been  moderately
                     revised since the triennium review, like many Regions
                     remain extremely broad and  non-specific.  It  should  be
                     remembered,however,that they were developed by a subcommittee
                     appointed by the old Board of Directors, right at  the  time
                     the program was undergoing the stresses  of  organizational
                     change. It should also be noted that  RMPS  reviewers  have
                     never before been critical of NCRMPs goals  and  objectives.
                     Recently a Long-Range Planning  committee  was  appointed
                     by the RAG Chairman. One of its functions  is  to  re-examine







                        and refine the goals and objectives, relating them to
                        specific time-frames and measurable,indicies.  Staff
                        believes the Region should be praised for recognizing
                        the need to develop more sophisticated goals and
                        objectives as the Region matures, and would recommend
                        that encouragement be extended and RMPS assistance be
                        offered as part of the forthcoming advice letter.
                   2.   While the Region is making significant strides in its
                        attempt to seat more minority representatives on the
                        RAG and to hire more minorities to core staff positions,
                        there has not to date been any significant effort made
                        to include minority or underserved health interests as
                        a major consideration of the North Carolina Program.  In
                        the past year, less than $100,000, of program funds, have
                        been spent in underserved health related activities.  This
                        might be explained by the fact that NCRMP has concentrated
                        basically on quality of care in categorical disease areas
                        which consequently relates primarily to those consumers
                        who have some means of meeting medical expenses, with little
                        relationship to the health needs of the underserved.
                        While Staff recognizes NCRMP has commitments for future
                        years to certain ongoing program activities which emphasize
                        quality health care, the myriad of accessibility and avail-
                        ability problems faced by the underserved of N.C. combine  with
                        the priority RMPS places on these problem Areas would  indicate
                        a need for NCRMP to devote more attention to availability
                        and accessibility.  Consideration must be given to the fact
                        that the Region's program was accepted last year by Council,
                        without criticism of.the direction it was taking at that  time.
                   3.   Within Core is a Continuing Edutation Component which  supports
                        part-time Institutional Coordinators and their Staff at Duke,
                        Bowman Gray, UNC and UNC/SPH  at a total of $97,158 (d.c.).
                        At the December '72 RAG meeting these positions came under
                        close scrutiny and a sub-committee was assigned to make an
                        assessment of the value of supporting these positions.  It is
                        speculated by the Deputy Director that this support will
                        be cut 2/3 to 3/4 and the institutions have been notified
                        of the possible cutback. The Director feels a  need  to
                        institute Rradual phase-out in order to maintain  these
                        institutions cooperation.  As a result of supporting these
                        positions, the schools make available faculty consultants to
                        NCRNP and its affiliates, free of charge.  The subcommittee
                        is also evaluating the entire RMP organization outlined in the
                        application which was developed at the time the Board and
                        RAG were in a state of transition.  It has not as yet been
                        officially adopted by the new RAG, although NCRNP is functioning
                        basically along these lines.
                        There is a disagreement among Staff as to whether the insti-
                        tutional coordinator problem should influence the funding
                        recommendation.  One side argues that the Region has not




                                                  .2

                                                     hese positions  and  reduced
                   taken it upon itself to eliminate t           Grants Manage @ t
                   funding would help it make this decision (see            gnize
                                The other side argues the Region does reco
                   attachment). d has taken positive steps in the form of a
                   the problem an          it, and given the Region's  record  of
                   subcommittee to resolve
                                 MS directives we could expect N.C. with proper
                   responding to p                    ed changes (without punitive
                   advice from us would make the desir           his should be
                   funding action).  Besides the aregument that t
                   done on a phased basis is reasonable.  Also the funds supporting
                                           iewed by the Region as an incentive
                   these positions can be v
                   in that as support is reduced , these funds  become  available
                   for other activities. It should also be  remembered  that  the
                   national reviewers a year ago had no problem with this arrangement.
              4.   The fact that the four Institutional Coordinators  being  paid
                   out of core funds also serve on the RAG and Executive Committee,
                   and that one serves as Chairman raises a question of propriety.
                   Staff does not see this as a legal question as the by-laws
                   do not specifically provide for this type arrangement.  While
                   it is obvious the Region sees no problem with this arrangement,
                   Staff agrees it is not one which insures against suspicion
                   or criticism of conflict of interest, excessive medical school
                   influence, and an ackward relationship  between  the  Director
                   and the Coordinator/RAG members who must play  duel  roles  to
                   each other.  Staff would recommend the Region discontinue this
                   --arrangement, and perhaps provide against such future arrangements
                   by means of a provision in the by-laws.



          North Carolina RW         prepared @iwilliam Reist               Date: 4/3/72      a2
                                         The goals and objectives presented in the Anniversary
             C)bjectives and -Priorities: Application were developed by a subcommittee appointed
        the old Board of Directors.  They differ moderately from those of the triennium a
     year ago but remain like most regions, very broad and non-specific.  The RAG, recognizing
     the need to update and refire them, has appointed a subcommittee which is in the
     process of developing     new ones which will be measurable and relate to specific
     time-frames. The national reviewers, a year ago had found the goals and objectives
     to be satisfactory, however as the region matures, so should the entire program. Their
     simplicity would indicate they are well understood, here again the reviewers of a year
     ago saw no problem in this area. While short-term objectives and  priorities  have  not
     been identified, plans are to include them in the new ones  being  developed.  National
     priorities are to serve as the general guidelines. Related local needs  are  to  be
     identified taking into account data and resources.  While the current goals and objectives
     leave much to be desired, theregion should be comended for recognizing a weakness and
     taking remedial action prior to it being pointed out from an outside source.


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

              @d Ar-tim:    Staff would encourage and endorse NCRNP's action -and  offer
                            RMPS Staff assistance if the Region would so desire.








     Arcmplishmen-ts and Implementatiots. Core can be comended on the number  and  types  of
     activities it nas engaged in and stimulated. Nbst activities have been  unique  to  the
     particular problem and in most instances were not readily applicable to other problems
     or areas.  Unique activities which could have national implications are the Stroke
     Program and,the Test and Evaluation Strategy for Improving Quality of@Nursing Care.
     Practically every project is desi2ned to,or has some component  which,promotes  new
     knowledge and techniques. The effect on moderating costs can be  assumed,  in  that
     the more skilled health providers are,the more efficiently  they  operate.  Quality
     of care as it relates to categorical diseases is probably the most outstanding
     a@ievement area, however it relates mostly to those who can cover medical care
     expensps.  Certainly the major health provider groups and institutions in the
     state recognize NCRMP as a source of professional expertise assistance and information.











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

           ended-Ar-tion:
                              No Action Recomended




                                                William Reist              Date:    4/3/72
                            o@ 12 renewal project.requests incorporated in the triennia
       Continued Support,:
                                                                                  -he current
                            submission, the Region saw fit to support 9 during    t
       year.  The 05 Amiversary Application requests support of only two renewals, one
       the Stroke Project was mentioned as an exception by the national reviewers a year
       ago although tfiey were generally critical     the large number of renewals.
       The second is a Diabetic Education       ect.  Each request one additional  year of
                                            proi
       support.  The third.ren       Cancer Registryis being incorporated at a much
       reduced level into anotrear (non-renewal) .project, CQm-prehensive Cancer Program.
       It should be noted that an overwhelming success of the'Stroke Program in
                                 and mortality influenced the decision of the Region
       reducing hospitalization
       to continue it for one more  year.  NC@  is  now  pursuing  a  policy  of  insuring
       other sources of support for the  continuation  of  projects  it  funds.  With  few
       exceptions, outside sources have picked up continued support of projects.
       In those exceptions  the projects were not worthy of continuation.

         Recomenclec' Act'on:     The Region should be comended    for its actiOn in teminating
       -renewed  rojects.
               p




    4.  Wmority InteTests:NCWs _goals and      objectives do not  place  any  emphasis  on
        1w,rovijig iiea   care to the  underservea.  Project  activity  tends  to  reflect
        no particular comitnent to serving the disadvantaged.  O'L the total NCRMP budget
        less than  $.loo.o@ has been spent in this service, all in feasibility or
        developme@ta'!'(foinponent activities.  While some of the training programs might
        indirectly result in some atloyment benefits to the minorities, it is only
        a matter of coincidence.  The Director has made an outstanding effort to include
        minorities on the RAG and is presently try@ng to recruit three Black professionals
        and three Black secretaries to Core Staff.. NCRMP does work closely with
        CHP and in some instances Model Cities.  It might relate more closely with
        Indian Health, Appalachian Program and Migrant Health.







    ---------------------      ------------------------------
                                            e North Carolina to look more closely to
             Recomencled Action., Encourag
                                   the needs of the undersexed -.are these not infact some
        of the more important needs of the Region.  Encourage th6  Region to balance quality-
        of care with accessibility and availability, particularly as it relates to the
        i in(I P--r-, erved.






                                                                               lbte:   4/3/72
           North  Carolinil           PMaTed By,: William Reist
           bordinator: Dr. Patterson has served as  Director  since  April  1970  (2  yrs.).
         Before 7e-was a practiciiig.surgeon in east North Carolina and did some
         cancer pMming as a  member  of  Core  staff.  He  is  highly  dedic'ated   and.very
         conscientious. He works extremely hard on his job and is respected by ail
         members of Core staff. He can be  credited  for  the  new  RAG  organization  and
         other major accomplishments over the  last  year,  all  of  which  apparently  were
         very difficult tasks,(Particularly since Dr.  Patterson  is  not  an  aggressive  and
         bold individual, but rather a person who avoids confrontation and.respects individual
         opinion). He relys heavily on Mt. Ben Weaver,       his  Deputy.to@carry  out  many
         administrative and managerial details.  Ben is highly competent, but does not always
         take advantage of other Core members knowledge  and  e!Kpertisp,  to  the  extent
         that he might. Core  members  feel  they  are  frequently  excluded  from.activities
         to which they could make a contribution, and that  their  ideas  do  not  always  get
         proper consideration.


                   ded Action: Dr.  Patterson  feels  a  Management  Assessment  Visit  ould
                                be of great benefit and will be making a written request for
         one to be conducted early in the next calendar year.






     6. Core Staff: Administrative Core Staff consists  of  12  professional  Staff,  11  of  whom
                      are full time, and 9.5 secretaries. Not  included  in  this  is  a  new
         Director of Planning and Evaluation coming aboard on May 1 and two subordinates,-
         a Bi6statistician and an Evaluator wl)ich are being recruited.  Also a Nutritionist
         and three secretaries are being recruited.  Core  staff  at  uNc  which  has  served
         as Research and Evaluation Division has been  dissolved  and  is  being  replaced  by
         .the  e   lanning and Evaluation Division  which  will  be  responsible  directly
         to   tRewDirector-
         Within Core  is  acontinuing education component which supports part-time institutional
         coordinators at Duke, Bowman Grey,,TJNC, LJNC/SPH- totaling $97,158 (d.c.).  At the
         December 1971 RAG meeting, these positions came  under  close  scrutiny  and  a  sub-
         committee of the RAG was assigned to make an assessment of the value of continuing
         support for these positions.  It-is speculated by the            Director  that  this
         support will be cut by 2/3  to  3/4.  The  institutions  h=llb%en  notified  of  possible
         cutbacks and are'somewhat disturbed.  As a result of supporting the coordinators,
         the schools make available other faculty consultants to NCRMP and its affiliates,
         free of charge-. The evaluation of the contribution  of  these  people  is  done  subjec@
         tively.  Some members of Core Staff 'are skeptical that dollar value to NCRMP is
         received,    howev.er, most can see the overall  continuing  education  effort  of  the
         Lmiversiti6s in North Carolina is enhanced.  The Committee evaluating the
         Continuing Education c6mponent is also examining the current organization  including
                          t.],- rr.,@-litee.-qtnirtllrp ------------------ --------------------------

         Recomended Action:
                               Coimnend the RAG in its effort to examine the,continuing
         education component and 'internal organization. Point out that organizational planning
         should be'done in concert with establishing goals objectivesand priorities.



                                   epaTed By: Willinm Reist              Date: 4/3/72      .jo

               Aclv-isory (;Toup: Reviewers of the Triennium Application one year ago
   7. Regional
                              deficient in consumer, allied health, Jay and Black
   - e=l (
        representation. The RAG now has or will have in  the  near  future twelve members Of
     the public at large, five allied health representatives and nine Blacks.  The
        recommendation that the Board of Directors and the RAG be combined into one governing
                               t. An Executive Committee meets on a  monthly  basis  to  aqt
        body has been carried ou                               Itings generally have  a  6S-
        on business for the RAG which meets quarterly.  RAG mee            ecutive Committee,
        70% turn out.  out of -the five ele6t6d members to the 13 -member Ex  ,
                                                      at uNC-none are Blacks .'i The RAG has
        one.,represents the public and is a professor                                    orted
        only met twice in its new capacity as a @olicy-making body, however, it is TeP
        that it has demonstrated new st're@gth at- the last meeting by questioning the
        organization of Core staff. As a result it appointed a committee  which  is  currently
        reconsidering NCRMP organization.  lVhile Staff has offered the current organizational
        chart, there is some doubt that it will be accepted. Althouah the  committee  has  met
        once it has not made known what in fact it is considering.
                              --- - ------------------------------------ -              - -----
             ed Action: Comments relevant to the RAG and the related by-lawl are part of
                        the attached Grants Management Branch report.






                              Du               serves strictly a,.
         antee Organization:  the Core staff member who works closest to the grantee reports
    8. G-r
                              Duke has never tried to use its position as grantee to influence
        decisions being made by NCRMP. He reports that the only  problem  arises  out  of  the
        attempt on his part and personnel at Duke to maintain books and records which comply
        with both Duke and RMPS regulations .  He claims this at times strains personal
        relationships. He claims that Duke is not  enthusiastic  about  serving  as  grantee
        and tends to be quite in@ ependent.  It has recently dissolved, for no apparent
        reason, its relationships with another federal agency from which it was receiving
        indirect costs.








    -----------------                         ---------------------------- ----------------------
                                           ent Branch sees a problem in the relationship
     Recommended Action.    Grants Managem
                            between Duke University, the Grantee and the RAG.
                            This problem is outlined in detail iik the attached Grants
        Manaizement. Branch Report attached to the Prog@am Analysis GuicLe.





    @IP: North Carolina           Prepared By: William @eist             @]Date: 4/
                       Most key health interests are represented on the RAG.  Numerous other
         articipation-       health institutions are involved, in that-they are active
         participants in ongoing projects.. llhile NCM has recently worked-closely with
         Migrant Health, and in fact is supporting one of its projects, there  is.little
         evidence that rapport has been established, or cooperative efforts have-been  made,
         with Indian Health Services or the Appalachia Program. History  indicates  that
         the  program has been highly medical-school oriented and dominated.. The recent
         RAG related changes, appeared to be having a significant change in -the balance of
         power. This is exemplified by the RAG's new initiative in assessing  the  total
         program and in particular the institutional coordinator's role,.







  -------------------------------------------------------------------------------------------
    -R6c6men'ded Action: (,iven the new emphasis North Carolin is placing  on  deliv
                                                              a                    ery
         systems and the considerable number of migrants,Indians and rural poor in
         North Carolina, it may be beneficial for the Region to work more closely with
         the Appalachia Program, and Indian Health Services. Consideration might  be
         given to including these groups on the RAG and subcommittees of,the  RAG  to
         which they might relate.



    10.' Local Planning: North Carolina has not subregionalized and developed local planning
         groups as have many other regions.  Rather, it has assisted and is-continuing to
         assist both with Core personnel and financial support the.development of health.,
         Planning Councils in the seventeen multi-county planning regions designated by
         the governor.  With this assistance available, planning, councils are now organized
         in the eight western planning regions-A handicap faced'by these planning organizations
         is the extreme difficulty in recruiting program directors. The -Region is assisting
         the planning councils in this area.  Planning councils are developing in the other
         nine regions which are located in the east. The Region envisions its close  working
         relationship with these organizations through the chief staff members(Fishel
         and Young) who have respon'sibility.for the continuing coordination of activities.
         These two people have almost daily contact with the planning regions. NCRMP
         policy-is now to involve local planning group@ in the initial stages of program
         proposals.










   -----------------------------------------------------------------------------------------
    @mended Action:       No Action Indicated






                                                                             Date: 4/
    RW: North Carolina RMP          PrL-2ared B
                                                So long as the Board  of  Directors  existe
     11.  Assessment of Needs and Resources: needs were determined primarily-by this g
                                                and to some degree were based on institutional
         interests.  Most programs,however, include some analysis of data. There-is continuing
         collection and updating of relative data particularly  as  it  relates  to  heart,
         cancer and stroke, and attempts are being  made  to.relate@it-to  new  program  goals
         in an effort to develop more specific objectives. This effort should be greatly
         enhanced by the new Director of  Planning  and.Evaluation  scheduled  to,join,NCR\lP.
         in June.  The centralization of the Planning and Evaluation Division at Teer House,
         as opposed to previously being split with  UNC,  should  also  strengthen  plann.ing
         efforts, as should the reorganization of this Division directly under     Dr..Patterson.
         Hopefully, the new organization of the Planning and Evaluation Division and the new
         Staff will provide the needed back-up for the planning  bodies  in  their  effort  to
         change program direction, including the establishment  for  the  goals  and  objectives
         which are relevant to national priorities,  but  which  have  special  significance  to
         North Carolina. In addition it is hoped  this  division  will  provide  the  -expertise
         for defining measurable objectives related to specific time-frames.
   -------------------------------------------------------------------------------------------
     P,e'comended Action: No action indicated, with perhaps the exception that the
                          Region should  be  complimented'on  its-reorganizational  efforts
         related to the Planning and Evaluation Division and the  hope  on  the  part  of  RWS
         that this division will play a significant role in identifying the needs of the
        .Region based on valid data, and that the  decisionmaking  bodies  w@ll  use  this  data
         in the development of,their program.



     12. Management: Core Staff is a relatively  small  group  of  individuals  who  demonstrate
         a            e of team spirit.  They respect each other and consequently take advantage
         of e'ac  others knowledge and capabilities in the consideration of their own program
         interests. They have weekly staff meetings which are designed to coordinate.activities,
         however, much coordination is done on a one to one basis as need arises.  Each member
         is responsible for monitoring projects and  other  activities.  lqhile  most  have
         monthly contact with their related activities, formal evaluation reports are
         required-every six months. ..Final reports are required as are monthly fiscal reports.










          --------------------------------------------------------------------------------------
     ,Recommended. Action: - - - No action indicated at this time. It should be noted that  this
         aspect of the program will be covered  in  more  detail  in'the  upcoming  verification
         visit.




                                                                                   Date:               jj
              North Carolina: RUP       Prel3ared BY: w
                                                                                ation Visit-it is
                             Without the benefit of a Review Process VerifiC
                             difficult to make any-valid assessment'of the evaluation process
                             in North Carolina. In discussing the subject with @aff, they
                           e is a need for incorporating more thorough evaluation techniques
              in                             developed and more stringent demands should be put
                ,projects as they are being
              on pvogress,reporting wh@ich-takes place twice a year.  it is anticipated that     der
              the new Director of Evaluatioii will have a significantly stronger position un
              the hew organization than the previous one. site visits of Technical Review
              Comittee's does take place when indicated.  In one instance negative results
              in national program emphasis-has resulted in discontinuance of a project.





      ---------------------------------------------------------------------------------
          Fbdoimehcled'Action:  None indicated at this time. Evaluation process as presented
              in the application is vague and should be clarified at the@time  of  -the  April  27,  197:
              .Verifica:Clon visit.





         14.  Program Pro-Dosal: Goals and objectives are    vague and priorities have not been
              set in any meaningtu.L way.  The RNP claims-this will be incorporated as the
              new goals.and objectives are developed. Two    of these in.the past have related
              quite well to the goals and objectives, concentrating on Categorical Diseases,
              Continuing' Education,Manpower imd Rekionalization.  The intended results of
                                 able of being quantified, however, this does not appear to
              activities are cap
              be done with any consistency.  Progress  report-s  are-required  twice  annually  but  thei
              relevance is     unknown at this time. Staff--claims attempts to rank.p@ojects
              against a -standard set of criteria has been rejected by the RAG.  Each RAG member
                                             is individual criteria.
              ranks.projects according to h











                                                                                             ------------
    -----------------------------------------------------------------------------
          Recom6nded Action: Given the relatively l'ittle information we have with regard
                               --tcf this aspect of the North Carolina Program it is difficult
              to make  a valid ass  sment.. Clarification should be ma4e at the time of the
                                   es
              upcoming Verification Visit on April 27,     1972.




                                                                           Date:  4/3/72
                                               William S. Reist
        North Carolina  RMP,     prepared By
                       of Knowledge: Since a large number of NCM proj ects are 6ithef
        Dissem, inatiori             educational in nature.or have educational components,
        they o in fict,.do disseminate knowledge to larae numbers of individuals in a la@ge
        number of facilities throughout the state -many involving the three major
        technical schools. Recently attempts are being made to involve more community
        schools. We can only assume better care to more people will result in some
        upgrading of the skills and kriowledge-of medical personnel.  Most activities
        relate td more.serious problems of the categorical diseases, still others
        in health manpower relate more to the lack of allied health personnel.





    ---------------------------------------------------- -------- ------------------        7------
                        Should @ommend the Region on its eEfort to de-emphasize categorical
    Recommended- Action .
                        disease@. Encourage'the Region's awareness.of problems related
        to availability and accessibility of care in.the use of paramedical personnel
        -to make improvements in these problem areas




    16.  Utilization  of  Manpower and Facilities: The cancer,  Stroke, and CPR projects
                                                   all emphasize the need to-utilize or
        improve certain medical  facilities,. so that they may serve an expanded role.
        As stated  above,  wIe can only assuneproductivity,of physicians is increased through
        education  but it might  be increasecy-more rapidly by concentrating more on delivery
        systems.  Three projects are developing new allied health personnel.While
        manpow6r has been a goal of the region for some time, NCRMP is placing more
        emphasis on it.. 'Ihe Family Nurse Practitioner and the Nurse Associate projects
        should ha@e particular influence on the underserved..







    ------------------------------------------------------------------- --------------------
     Recommended Action:         No action indicated.





                                                                                          Date:
        pj,lp: North Carolina RMP           Prepared   By:   Wilriam    eist                          4/3/72-
                                        Programs  designed  for  the  improvement  of   health   care   relative]
     Aftl7.  Improvement of Care:       lacking  in  NCPM.  None  of   the   current   p-rojects.relate   to
              improved  primary  mbulatory  care  delivery  systems   and,   in   particular,   non'   relate
              specifically  to  the  poor,  black,.and   red   minorities.   Six   activities   related   to
              improvement of care are.supported by developmental component funds.  While
              the  Region  has  the  capability  to  make  studies  related  to   access   and   availability
              of care few, in fact, have been conducted. @st of those-which have              been
              undertaken  resulted  in  outside  support  for  operations.  One  of  the   new   goals   being
              considered  is  health  services  delivery  systems.  As  stated   before,   this   is   an
              area which staff would encourage greater emphasis.  It should be remembered
              when  considering  this  aspect  of  the  program,   that.NCRMP   is   somewhat   @6mmitted
              to  a  categorical  program  related-to  quality  of  care  by  the  fact  that  this   is-hoiv
              the  original  Triennium  Application  was  designed'two   years   ago   by   the
              Board of Directors.




       ---------------------------
                                                         --------------------------------------------------------
                        -Action:  Conveyed  to  the  Region,  RMPS'  endor  ement   and   encou  ement    of
          Reconn. ended                                                                       @ag-
                                                                           s
              greater  emphasis,on availability and accessibility of care,-           @ary    @o  the  under-7
                                                                                    p
              served.







          18.  Short-term  Payoff:  We  can   only,assme   activities   being   undertaken   by   NCRMP   will
              have    sitive-effects on accessibility, quality of care,          and   cost   moderation,
                  @  Po
              since the Region has not reached a s@age of sophistication by which it can evaluate
              progress  in  these  areas.  -The  p'rograih  is  still  highly  geared  to  quality  of  care
              particularly  in  categorical  diseases.  Support   in   most   instances   can   be   withdrawn
              in three years or less.
              It should be notbd that     th6,November 19-70.Site      Visit Team  did  s.ight   numerous'
             @p-roj.ect atcompli bments   of  the  Region,   although   they did   not   relate   specificall
                                                                                                           Y
              to criteria of accessibility, quality of care and cost moderation. Similar
              accomplishments, are sighted in'-the current application, most of which demonstrate
              significant achievements in training, expanding activities into other institutions,
              @development,.Publication,  and   distribution   of   -educational   materials,   mortality   rates
              hospital stay rates, screening and follow-upand expanded use of paramedical
              personnel.







                      -------------------------------------------------------------------------------------------
                 @ehded Action:      Convey tothe Region our.hope-.that the new Planning and
                 il-da-ri:cFn 'Divi7s@6n'will make an increased effort to access activities as they
                 Late  to  availability  of  and  access  to  services  quality  of  care   and   moderation
              of  costs.





                                                                             Date:    '4/3/72
                                                 William    Re


              ionalization,
        Re i?na-,,-zaT-loi                                         iple provider gT     s)
                        and  newly  lanned   activities   serv.e Mult
    While most ongoing             p                                             -rvices  are
    sharing  of  facilities  has  been  a  by-productstscarce  resources  and   se
                                  ilabl'e but on a  som&what  unpyoportionate  -rate  between
                                                                                 .6xamples of
    being  made  more  readily  ava                 d  S@roke  projectsa-re  prime
                                   .  The.Cancer-an
    the  affluent  and   underserved                                          Th re is no
                                   and.  '.lity of resources and services        e
                                       q.ua                            is involved have served
    improving  both  the  q'uantity          I-an and in which NCR4P
                                             -K-
    doubt that the many activities Lmderta             efforts@of the heaath organizations
    to strengthen linkages and coordinate planning                in many instances.
    within the Region.  NC@ has served as a major catalyst




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

    No  action   indicated.







    20.   Otlier Funding:
      NC@ staff have worked on a number of activities which,once developed into
                       al.$ have attracted OEO and MO funds for operational support.
      potential propos
      They  have attempted to  help  other-pro@osals  identify  sources  of  support.  -.Many.
                                   are co suPPOr
      of the  Regiorl's  activities              ted with other funding sources and,iii turn,
      tend to  c   lement each Others efforts.
               OMP













                                   -------------------------------------------------------------
    ---------------------------
      Recommended   Action:
                                               the role it   has  played  in  identifying  an
       The Region should be complemented on
                                   t of-activities which will serve to.improve the total
       soliciting   outside   suppor
       health care system in North.Carolina.













                           ADDL,NDIR@I Ti)      CAff)LF-iA r,7Ar-F-


                tAs an oversight ir, nr)r Staff Briefin@,              on lqortit Ciroli@-ia,
                I neglect@-, to iwlude ttic f,,ict t@4,it t'iic observations  !,,-adc,  ivcre
                collectively agree(. uf*n @v Sti'Lf at its re,,riew oi-i
                Staff attending include,-':

                      Gene Iiclson       PlaiL-iii-W -.2iid Pyalu.,,tiort Di@,.Lsior.
                           Teets         Grants Itmst          Bra,-.cii
                                                             t
                      T(Xl Griffith      Regional Office     Representative   -   Region   TV
                      Lee Van Winkle     Soutii Cc.--,tral  Operatiorz  Prar-cli
                      Bill Reist         Soutli  CentTal   Operations   'Br;mich
                      Joeme Parks        @th Cejitral                    ErancJ)
                      Gloria flicks      Souti Central  Operatio.,,is  @i@rancii
                      .5MTon Dt@         @th   Cmtral   Operatior-s   il-r-,an&.
                Staff could not unani;wezly apTee on a rcca,.,rvndation. I%.to recc4incmtatimis
                %4ere therefore ma@ for SAPP consi-,ie-ratioii.
                      1. The Rej,  m  be  anrove,li  for  the  05  operatioial  ye-,ir  ,it  the
                          r@tod level of $2,080,008, wILicli is I,:)wEr ti-ian tlic NAC
                                     level of $LI,194,400.
                            pmved
                      2.  The Region be app-roved at the rftluested level, but that fundin-
                          @orizatio,.i for the Instittitional @rdinators/Contiyriing
                          Education  @nent  of  ('@re   I)e   withheld   rLtil   StAff   'was
                          reviewer the RAG -r          n@ations for t'iis cm.Wnent       bi mUition
                          to receiv:big a justi Fication for t'ic ne@i of tl)ese representatives
                          to Core Staff.
                time c         ts woul(-' =ost appropriately apT)ea-r  on  page  -16  olr  ycKtr
                North Carolina Briefiitp,, liocuntent.








                                                       lllillian S. iZeist
                                                       Ptitilic Ilealtl--l Aclvisor
                                                       Soiith k',entr,-il @,eTations  Brancii
                                                            mii   @,.i-;@cai   rropr".   Service




         SR:cmg
             Board
             File                                                                              303B/ -DOD/@,



   IEMORANDUM                         DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
                                                      PUBLIC HEALTH SERVICE
                                        HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
             Acting Chief                                  DATE: March  31,  1972
             South Central Operations Branch



             Chief
   ,@OM      Grants Management Branch
   jBjECT:   Review of Continuation Application for North Carolina Regional
             Medical Program


             Grants Management Branch's concerns, as expressed in the Continuation
             review of the application submitted by the North Carolina RMP,  have
             been accommodated by an in-depth review of existing  documents.  The
             results of this review are reflected in the enclosed  material  which
             is provided for attachment to the documents prepared by your staff for
             review by SARP.
             The organizational structure of the North Carolina RMP appears  o
             be compatible with the advice given by the Operations Desk, as
             evidenced by the attached letter dated, March 13,  1971.  Therefore,
             any constructive recommendations for change ought to be carefully
             phrased in the Advice Letter, to the RMP subsequent to SARP-
             Council action.
             Your attention is invited to the recommendations contained in the
             last paragraph of the GMB review concerning the funding of the  Core
             component for Institutional Coordinators and Directors of Continuing
             Education.



                                                    d T. Gardell


             Enclosure



                                                                  Grants Management Branch
                                                                       March 31,  1972


                        North Carolina RMP organizational Structure

            The North Carolina RMP is organized in a manner which places Duke University,
            the grantee, in jeodardy of audit exceptions for situations over which it has
            no control.  The transfer of its responsibilities as grantee to the "Association"
            also Approaches sub-granting. .
            The By-laws of NCRMP recognize Duke University as the applicant organization
            and fiscal agent.  The same By-laws almost immediately dispose of Duke with
            that one sentence of reaognitidn a'tid proceed to the Association and RAG.  All
            duties and responsibilities for both the program and administrative management
            of NCRMP are assigned to the RAG.  The Association appears to function more as
            the Board of Directors in'an incorporated RMP, but it in fact has no such legal
            foundation.
            The RAG can be controlled by a very small number of people.  Provision is made
            in the By-laws for more than 60 members of the RAG and there is a good balance.
            However, aquorum is only 25 .,nd 2/3 of those present and voting where a
            quorum is present shall be an act of the total RAG.  This then means that 17,
            or fewer, can act for more than 60 peop'-e.
            A similar situation is even more diL irbing in the case of the RAG Executive
            Committee because ot the inherent power of an executive committee.  The NCRMP
            Executive Committee is composed of 13 members with 7 constituting a quorum.
            Again, 2/3 of th-se ?r-sent and voting act for the entire committee  which
            in ti-n speaks for the total RAG beLween meetings. Therefore, 4  or  fewer
            me@ :a of the powerful Executive Committee can act for the total RAG.
            Changes in the orgA--ii-;ational structure, 'Trantee involvement, and the
            By-laws are necessary.  Apparently Duke University is willing for the
            Association to assume Dukes responsibilities as grantee.  Since there
            is no indication of trauma.resUltilLg from a change, the Association should
            become legally incorporated and be made the grantee for NCRMP.  The By-laws
            should be rewritten to clearly assign program responsibilities to the  RAG
            and administrative responsibilities t  the grantee.
            The By-laws should also be changed to require a quorum of the RAG and
            Executive Committee to be one inor6 thnn 50% of the total membership.
            .Ala,,, the wording should, be changed to r-quire that a majority vote of
            those pre,sept at a quorum@be necessary for the vote to represent an act
            of the tota.L body. This would cause the words "and voting" t:o be removed
            from that ortion of the By-laws s eaking to the number of  votes  required
                     p                        p
            at RAG or Executive Committee meetings.







          Included in the budget  request  for  Core  is.$97,158  for  Institutional
          Coordinators and  Directors  of  Continuing  Education.  The  program  has
          supported this service thru the three  medical  centers  and  are  of  two
          types:
               (a)   a physician in each institution serves in a liaison role
                     to the program on a part-time basis of 25% time and effort.
               (b)   the program has supported approximately 10% of the salaries
                     of the Director of Continuing Education in each of the
                     three medical  centers.  These  physicians  work  closely  with
                     Core Staff Director of Continuing Education in planning
                     and conducting NCRMP supported educational activities
                     throughout the State.
                     Because of the decline in importance of continuing education,
                     the RAG has designated one of its committees to study the
                     situation and possibly  reduce  the  funding  requirements,  if
                     they determine that this activity should be reduced.  These
                     activities have been supported in the past.
          In reviewing financial data obtained from the region, a total of $132,328
          is being requested to support these activities ($97,158 D.C. and $35,170
          I.C.).                  Institutional Coordinator and Continuing Educatio
                  A copy of the                                                        n
          Component budget is attached.  It does not indicate in which capacity the
          individuals serve, clerical, Institutional Coordinator or Director of
          Continuing Education.  Although  one  individual  may  serve  in  two  capacities,
          the total time and effort should not exceed     35%.  However, the budget
          requests for Dr. Emery Miller  (Bowman  Gray)  and  Dean  Fred  Mayes  (University
          of North Carolina) exceed that figure.  There are 6 professionals listed
          which  average  36%  effort.  Since  there  are  four  Institutional  Coordinators
          at 25% and 4 Continuing Education Coordinators from the three medical centers,
          (according to the application) at 10%, the maximum % of effort would average
          17.5%, so the salaries claimed are somewhat out of line with that stated
          in the application of the individuals listed.  The followind individuals
          receive compensation from the Institutional Coordinator and Continuing
          Education Component and are also members o.f the RAG and the Executive
          Committee  of  RAG;
                1. Dr. E. Harvey  Estes,  Chairman,  Dept.  of  Community  Health  Sciences,
                            Duke Medical Center, also Chairman of RAG and Executive
                            Committee
                2.  Dr. Robert Smith, Professor and Chairman, Dept. of Family Medicine,
                            UNC., School of Medicine, also Vice Chairman of RAG and
                            member of Executive Committee
                3.  Dr. Emery.C. Miller, Associate Dean for Continuing Education,
                            Bowman Gray School of Medicine
                4.  Dr. W. Fred Mayes, Dean, Schoo'@ of Public H   ealth, UNC.








               There are thirteen members on the Exe cutive Committee of RAG and  four
               are paid from Core funds, including the Chairman and Vice-Chairman  of
               the RAG.  Because of their Core-related activities and their responsi-
               bilities as members of Core, it is indeed hard not to assume that some
               of-the activities for which the individuals are being compensated  are
               for RAG-related activities, particularly in light of the rather  large
               percentages of effort charged to the grant. Furthermore,  there  may
               be a conflict of loyalties resulting which would infringe upon  their
               abilities to perform in their capacities as members of RAG and  Core.
               It is recommended that staff withhold funding authorization for  the
               institutional Coordinators/Continuing Education component of Cote
               until they have reviewed the RAG recommen dations for the  Continuing
               Education component in addition to receiving a justification for  the
               need of these representatives to the Core staff.  We further re-
               commend that no member of RAG (excluding the Executive Director of
               the RKP) receive any compensation from the program other than for
               travel expenses for RAG meetings. The final recommendation  is  that
               the Chairman of RAG (currently an employee of the grantee  institution
               and a member of Core staff) should not be permitted to serve as a
               ,voting member of the RAG.  Efforts should be made to replace the present
               Chairman at the next election of RAG officers with an individual  not
               employed by the grantee (Duke University).



                                                                  or and Continuing Education Component
                                   Institutional          Coordinat
                                                                       FY 1973

                                         Approx.                             Fringe
       Name                                 of         Salary             Benefit             Duke              UNC             71,4c/SPR          BG
                                        -Effort



     Harvey   Estes, Jr&p     X*De          -36             $13,320          $1,065         $14t985
    .len'Bivins                             50                @@351            419               3,770
                                            27                5,600            .625
                                                                                                5,.625
    lliam DeMaria, MOD.

                                                                               668
    bert Sinith, M.D.                       15                4,575                                                59.243
    ncv Vernon                              20                1,400            204                               1,  604-
                                                             .7,950           11161
     Glenn Pickard, MOD.                    30                                                                     9,111,
      Glenn "Zilson                         15                4,725            690                                 '5$415
    @an Fred ',Mayes                        50               13,542           1,977
    ,dia Holley'                            10                1,818            265                                                  2,083.-
    terv I-lill.er, M.D.                    60               17,000           1,700                                                                 $181,700
    @llv Rae McCartney                      ioo                                500                                                                     5.500
                                                                                                                  $2lp373        $173,02           .$24,200
         Tota'u Salaries                                    $77,681          $9,874         $24;380
                                                                                                                      627              431               500
         Travel    & Other                                                                          45           8
                    Totals                                                                  $24,,425             $30,,OOO        $18,033             $24,700

                                            Total Direct     Costs                          $97,158
                                                 Indirect    costs,                         $32    677
                                                            Total                             $129,835







       FY 1977 --)st




       UNITED STATES GOVERNMENT              DEPARTMENT OF HEALTH, EDUCATION, AND WELFAR'
           emorandum                                            REGION IV - ATL..ANT.A

                 Mr. William Reist
       TO        South Central Desk                                   DATE- March 20, 1972
                 Regional Medical Programs, Rockville
                                                                      REFF,R TO:
       FROM      Regional Health Director,
                 Region IV, Atlanta
       SUBJECR:  North Carolina Regional Medical Program Continuation Application
                 I have reviewed the North Carolina RMP Continuation Application and have
                 requested reviews from other programs represented in the Atlanta Regional
                 Office. I want to give you a summary of the comments  that  were  made:
                 Grants Management stated that they do not have the  guidelines  against
                 liable costsj etc., and that it would be hard to come up with specific
                 suggestions since they are unfamiliar with Regional Medical Program
                 ServicesIpolicies. This has been discussed with  Mr.  Gardell  who  has
                 promised to send updated information regarding Grants Management policy
                 for Regional Medical Programs.
                 office of Comprehensive Health Planning stated that "this is a very
                 impressive, agressive and bold application.  It is well coordinated,
                 clear and concise.  The justification for additional funds seems realistic
                 in terms of program activities and there is an interlocking membership
                 between Rt4P and CHP.
                 Although the applicant states that this application has been reviewed by
                 all appropriate health planning agencies and without any adverse comments$
                 the application is void without these comments.  It would have been of
                 interest to this reviewer to have seen these comments in order to analyze
                 how CHP views the activities of RN]?.
                 It is the recommendation that this application be approved with the
                 additional funds requested."
                 Health Maintenance Organization program states "In addition to a somewhat
                 unique and abbreviated format, the writer was impressed with the attitude
                 of the North Carolina @ regarding new and current trends in health,
                 with particular emphasis on alternate health care  systems  and  Health
                 Maintenance Organizations.
                 Although one might readily say that their activities have been somewhat
                 limited in regard to HMO development to date, this  could  be  expanded
                 considerably through one of the following methods:  (1) utilization of
                 both a formal and informal reporting system through the Regional





                                                                DUCTION PROGRAM










             Mr. William Reist, RMP, 3/20/72
             Representative concerning HMO potentials as well as developing activities
             in North Carolina, (2) that a conscientious effort be made  to  involve
             North Carolina @ officials early in the planning sphere of any HMO
             activities, and (3) to further consider possible funding potentials for
             RMP and HMO development; this would also relate to programs that  would
             be concerned with future HMO potential, such as Family Health  Centers,
             Neighborhood Health Centers and indeed any type of prepaid or  fee-for-
             service delivery system with specific population groups in mind.
             Again, I would.reiterate that the North Carolina RMP proposal is  brief
             and concise yet covers the,realistic elements of a very diversified
             program in the health  field."
             Community Health Service program states "At the present time there  are
             four county migrant health projects receiving federal grant funds  from
             HSMRA to provide services to migrant and seasonal agricultural  workers
             in North Carolina. In addition to those four projects the  State  Board
             of Health receives some HSMHA funds to provide health services  to  the
             migrants located in areas of the State other than within the four project
             counties.
             The limited categorical  funds do not allow for providing  adequate  health
             care services to the  migrants and the added problems of lack  of  accessi-
             bility and residence requirements to participate in state programs
             further magnify the problem. Education and income levels  and  language
             barriers, in some cases,  tend to isolate the migrants from necessary
             health services.
             The developmental component of the North Carolina Regional Medical Program
             contains a category in the amount of $35,000 to provide health  care  ser-
             vices in conjunction with the State Board of Health to migrant farm workers
             in North Carolina.  When combined with the migrant health categorical funds
             of the North Carolina State Health Department project, this will allow an
             extension of health care services to migrants outside the  four  county
             project areas where the needs are probably the greatest.
             In addition to the migrant health categorical funds, the funding of
             projects involving emergency health care services and providing  health
             services to the rural underserved areas of North Carolina will  have  a
             significant impact on the migrants' health care needs.
             The North Carolina Regional Medical Program has  apparently  recognized
             and is responding to the health needs of this particular segment of the
             population which is in a difficult position in obtaining  health  care.
             Migrants in other states are in the same status in regard to  health  care
             needs, and the problem recognition and efforts of other  Regional  Medical
             Programs would influence the services made available and have  a  positive
             impact on the migrants' health status."







                                                    Y-S


                  Mr. William Reist, REP, 3/20/72
                  Division of Emergency Health Service states "In general, the references
                  made in this plan to emergency medical services are peripheral.  They
                  seem to overlook the total EMS system approach.  I am unable to find
                  reference to the State Comprehensive Emergency Medical Services Systems
                  Plan and how EMS activities of R4P are coordinated within the scope of
                  this plan."
                  In summary, I was impressed with the organization of the material, the
                  conciseness, and I was very happy with the application.  I have not
                  received comments from Health Manpower, and @ternal and Child Health
                  Service.  When they are available, I will forw         on to you.



                                                 Emil E. Palmquist, M.D.




                  BY:  Theoda H. Grif'fl'th
                       Public Health Advisor, RMP





                                                    -Y fo

                                           THE ASSOCIATION FOR THE
                                NORTH CAROLINA REGIONAL MEDICAL PROGRAM
                                                   Executive Office
                                 4019 North Roxboro Road, P.'O. Box 8248, Durham, N.-C. 27704
                                                    919 - 477-0461






     F. M. Simmons Patterson, M. D.
     Executive Director
                                                  March 29, 1972


         Mr. William Reist
         Operational Branch
         Regional Medical Programs Service
         ParklaNqn Bu4-lding
         5600 Fishers Lane
         Rockville, Maryland    20852

         Dear Bill:
                In  an effort to keep you and the Regional Medical Programs Service Staff
         abreast of new developments concerning the North Carolina Regional Medical Program,
            ,-he progress that is being made, I would like to emphasize the following:
         and
                 (1)  As you know, whereas in the past the North Carolina Regional ',,Iedical
                       th a Board of Directors and an Advisory Council, we now have       only
         Program had bo
         one goverpiii- body, the Re-i6nal Advisory Group.     At the last L.Leeting of the
                     ?               b
         Regional Advisory Group on March 15, 1972, the Membership of this body, on the
         recommendations of the Nominating Committee, was revised so that we now have an
         increased number of Allied Health representatives and Ifinority representatives.
         I am happy to state that at the present time that in rel.ation to the total Membership
         of 51, 18% are Nlinority members.  I am enclosing a copy of the Regional Advisory
         Group Membership on which the Minority members are specifically designated.
                 (2)  On November 18, 1971, we received a document from the Regional Medical
         Programs Service stating the specific requirements that should be covered by
         the Articles of Association or Bylaws of a Regional Advisory Group.  lqe have       met
         several times with our attorney, Mr. Charles Dameron, of Greensboro, North Carolinai
         and have amended the Articleb of Association with the unanimous approval of the
         Regional Advisory Group, so that at the present time we feel our Articles of
         Association satisfactorily encompass the requirements listed.  For your edification,
         I am enclosing a copy of the Articles of Association in its recently amended form.
                 (3)  At present there are three vacancies on our Professional Staff.  I have
         made a sincere effort to recruit Minority members for these positions.  Tomorrow, I
         am intervie@qing a Minority member for a position on our Planning and Evaluat4.on
         Division, and feel that this individual will sign an agreement to join our Staff
                    ,terview.                   -.i- 'I)osit
         at this  ir.          For the two atlic        ions we have c(-jnticLc-d Minority individt,-.@'s
         that I will interview in tli(! next wc,el( oi- so.  T fc!t-I          t-li;it I will I-,c.
                     In                  two               @lli 'I(Itlitioll!i I() ()tlr '; t ;i f 1'.




                                          q7



            Mr. William Reist
            Page Two
            If I am unsuccessful in this endeavor, I will further pursue my efforts
            in this direction.
                      (4)  In regard to the matter of the Institutional Coordinators
            and Directors of Continuing Education that you have discussed  with  me
            several times, an Ad Hoc Committee was appointed by Dr.  Harvey  Estes,
            Chairman of the Regional Advisory Group, to study this matter in depth.
            The first Meeting of this Committee was held yesterday and much progress
            was made.  Another Meeting will be held in several weeks, and hopefully,
            a wise and just decision can be made concerning this matter.
                      (5)  A Long Range Planning Committee of the Regional Advisory
            Group has been appointed and its recommendations concerning  the  goals
            and objectives in keeping with the new emphases and directions  of  the
            Regional Medical Program have been adopted unanimously by the Regional
            Advisory Group.
                      (6) Subconunittees of the Reg4-onal Advisory Group are  being
            appointed so that the Regional Advisory Group Members can be  more  int.imately
            involved in the operation of the North Carolina Regional Medical Program.
                      As developments arise concerning our Program, I will continue
            to keep you informed.
                      With kind personal regards, I  am

                                                Very truly yours.j,-,


                                                   @.f.       P2tterscn, @!.D.
                                                Executive Director



            FMSP:mh
            dc:  Dr. Harold Margulies
                 Mr. Lee R. VanWinkle


            Enclosures




                                    REGIONAL ADVISORY CROUP

                                             of the

                            NORTH CAROLINA REGIONAL MEDICAL PROGRAM

       CHAIRMAN:  E. Harvey Estes., Jr., M.D.       VICE-CRAIR!.IAN:  Robert Smith, M.D.
                              SECRETARY:  Joseph G. Gordon, II.D.


       Medical Society of the State of North Carolina

       Charles W. St yron, M.D.,  President
       Medical Society of the State of North Carolina
       615 St. Mary's Street
       Raleigh, North Carolina  27605
       Phone:  919-832-6307

       John Glasson, M.D., President-Elect
       Medical Society of the State of North Carolina
       306 Soi,th Gregson Street
       Durham, North Carolina 27701
       Phone:  919-688-1059
          resEtntatives-at-Large from the Medical Sncietv of the State of North Carolina
       Edgar T. Beddingfield, Jr., M.D.                  .*John R. Chambliss, M.D.
       Wilson Clinic                                       Boice-14illis Clinic
       1704 South Tarboro Street                           100 Nash Medical Arts @iall
       Wilson, North Carcilina 27893                       Rocky Mount, North Caroll.na 27801
       Phone:  919-237-2151                                Phone:  919-443-884".
       represents Eastern  North  Carolina                 represents Eastern ',worth Carolina
       'Joseph C. Gordon, M.D.                             George W. Paschal, Jr., M.D.
       Kate B. Reynolds Memorial Hospital                  1110 Wake Forest Road
       1101 East Seventh Street                            Raleiv-h, North Carr-'l.-'@-- '-)7(-04
       Winston-Salem, North Carolina 27101                 Phone:  919-832-3431
       Phone:  9i9-@24-26:3i                               represents Central ',\orth Carolina
       represents Central  North  Carolina
       *Julian S. Albergotti, Jr., M.D.                    Louis deS. Shaffner, M.D.
       4101 Central Avenue                                 Bowman Gray School of Medicine
       Charlotte, North Carolina 2820                      Wake Forest University
       Phone:  704-537-0020                                Winston-Salem, North Carolina 27103
       represents Western  North  Carolina                 Phone:  919-727-4502
                                                           represents Western North Carolina

       Chief E-.@ecutive Officer. Duke University School of Medicine
       William G. Anlyan, ii.D.                        Dr. Anylan's designee:
       Vice-1.1r@.s-.'der,t for Ilealth tLf- 'Lairs       *E. Harvey Estes, Jr., M.D., Chairman
       Duke University                                     Department of Community Health S,'-n(
       Durham, North  Carolina  27710                      Box 2914, Duke Medical Center
       Phone:  9101-684-3438                               Durhain, North Carolina 27710
                                                           P]IOII)C: 919--684-531+



                             Cc)rmlttee







                                                      School of Medicine
     @icf        @cutive officer, Bowman
               11(@tads, M.D.                                    Dr. Meads' designee:
              ,,.,,;ident for Medical Affairs                            *Emery C. Miller, II.D.
        Vice-)
        Bowm;lil ii-ay School  of Medicine                               Boiman Gray School-of Medicine
        Wake          University                                         Wake Forest University
        Winstt'l$ !;alem, North Carolina 27103                           Winston-Salem, North Carolina 27103
        Phone.   919-727-4301                                            Phone:   919-727-4683
        Chief-.I,@(?cutive Officer, Univ                                       hool of Medicine
        Christ4liolier C. Fordham, III, M.D.                      Dr. Fordham's designee:
        Dean                                                             *Robert Smith,  i@I.D.
        Univel-@.@lLy of North Carolina                                  School   of   Medicine
             I ,f Medicine                                               Department of Family Medicine
        Schoo
        Chapel         North Carolina      27514                         Wing  D  -  3rd  Floor
        Phone:   919-966-1116                                            Old   Nurses'   Dorm'itory
                                                                         Universit  of North Carolina
                                                                                   y
                                                                         Chapel Hill, North Carolina 27514
                                                                         Phone:   919-966-5152
        Chief l@,i, cutive Officer, University of North Carolina School of Public Health
        W. Frc,t Mayes, M.D., Dean                                Dr.    Mayes'     designee:
        School i,f Public Health                                         *Mr. Charles L. Harper
     A&ivcr,@ity of North Carolina                                       Associate Dean
           en,,,, liall                                                  School of Public Health
    lwapel 'lill, Nortli Carolina 27514                                  University of North Carolina
        Phone:   919-966-1113                                            Rosenau Hall
                                                                         Chapel Hill, North Carolina 27514
                                                                         Phone:   919-966-111
           reE,,,tiiatives of   the N rth Carolina Hospital Association
        Mr. Jo,,@,@tili James                                            *Mr. Robert R. Martin
        AdMini,,.I&aLor                                                  Administrator
                                                                                           !@,L :7,Dspital
                      y
        Goldsl,@@lt,, North Carolina 27530                               Laurinbtirg, North Carolina 28352
        Phone:   1)19-723-2211                                           Phone:   919-276-2121
                                                                         represents Eastern North Carolina
        14t. Eai-I Bullard                                               Mr.  Don   C.   Morgan
        Admini.,iirator                                                  Administrator
        P,owan @iitiorial Hospital                                       C. J. Harris Community Hospital
        Salisbti,V, North Carolina 28144                                 Sylva, North Carolina 28779
        Phone:   Y04-636-3311                                            Phone:   704-586-2151
             er           tial North Carolina                            represents Western North-Carolina
        repr ,oiil-s Cen
        Direct(", North Carolina State Boara of Health
     @.acob               M.D., Director                               Dr. Koomen's designee:
           rth  (',(rjl.ina State Board of Health                        W.  Burns Jones, M.D.
           5 Nolli, McDowell Street                                      Assistant State Health Director
        post            Box 2091                                         North (,arolina State Board of Health
               0
                    i$vrtil Carolina 2Y602                               Post Office Box 2091
                                                                         Raleigli, North Carolina 27602





                                                        Iortli Caroli.nii Scl,001 of Dciitistry
         Chief E%                -or, Universitv Of
               ,:cct,,t ive Of
         Jam@s I,. Ila%,iden, D.l@.   Dean                      Dr.   Baw(Ic@ii's designee:
         School of.Dentistry                                          Ben D. Barker, D.D.S.
                                                                      Associate Dean for Acad mic Affairs
         University of North      ro 1 ina                                                        e
         Chapel Hill, North C,---.-olina 27514                        School of Dentistry
         Phone:       919-966-1161                                    'University of North    Carolina
                                                                      Chapel Hill, North Carolina 27514
                                                                      Phone:   919-966-1161
         Chief Executive Offi@er, North Carolina Medical Care Commission

         Mr.  Ira   0.   Wilkerson
         North Carolina @ledic-,t'- Care Commission
         Post  office  Box   25459
         Raleigh, North Carolina 27611
         Phone:       919-829-7461

         Director, North Carolina State Boardo of        Social Services
         Mr. Clifton M. Craig, Commissioner                     Mr.   Craig's alternate:
         State of North Carolina                                      Mr. Emmett Sellers, Director
         Department of Social Services                                Medical Services Division
         Post  Office   Box   2599                                    State of North Carolina
         Raleigh, North Carolina 27602                                Dgpartment of Social Services
         Phone:       919-829-3055                                    Post Office Box 2599
                                                                      Raleigh, North Carolina 27602
                                                                      Phone:   919-829-4550
         Chi f Executive Officer, North Carolina State Nurses' Association
         *Eloise R. Lewis, Ph.D.        (designee)
         Professor and Dean
         School of Nursina
                            t,
             ,,I--,itv of North Carolina at Green@boro
         Univ
         Greciisb:)ro, North Carolina 27412
         Phono:       919-379-5177
         Chief Executive Officer. Office of Comprehensive Health Planning

         Mr. I.'ln,2r  M.  Johnson
         Post  Office   Box   1351
         Raleigh, North Carolina 27602
         Phone:       919-829-4139
            rc,r,o,itativ  of Comprehensive Health PlanninR "b" A5zenci.es
         Mr. Co-orge @t.  Stockbridge         1975
         ExceLitive      Secretary
                 "laiiLiitig Council for Central North Carolina
         Home St,.,.urity Building
         505        Chapel Hill Street
         Post  off-ice  Bo--<  61.
                   north C-qroli,,-t 2770'-)
         Plioiit@: 919- 682- 3640








                                                                                  lir,a
                             e Veterans Administration-    system of Nortli Caro


       Ilospitizl Director
       Veterans   Adm'nistration    Hospital
       508 Fulton Street
       Durham, North Carolina 27705
       Phone:  919-286-4934

       Representatives of Public-at-Large

       East:_
     *Mr. Charles James        1973                              *Mr. John Taylor        1973
                                                                   Director
       Darden Funeral Home                                         Cho noke Development Association
       Wilson, North Carolina 27893                                   a
       Phone:  919-237-2169                                        104 Third Street
                                                                   Murfreesboro, North Carolina 27855
                                                                   Phone:  919-398-4131
                                                                 'Mrs. Marjorie B. Debnam         1975
     *Mr. 0. T. Faison         1974                                                              -
       Post Office Box 728                                         1615 East Davie Street
       New Bern, North Carolina  28560                             Raleigh, North Carolina    27610
       Phone:  919-637-5632                                        Phone:  919-834-4602

            a
           J)avid G. Warren       1974                           'Mr. Walter T. Johnson, Jr.          1975
       institute of   Government                                   Attorney-at-Law
                                                                   Southeastern Building
       Knapp Dii'Ldiiig North Carolina                             102 North Elm Street
       University of
       Chapel Hill, North Carolina 27514                           Greensboro, North Carolina     27401
       Phone:  919-933-1304                                        Phone:  919-274-8463
       "Mrs. William J. Kennedy, III         1975                  Harvey L. Smith, Ph.D.         1975
       102 East MAsondale Avenue                                   Social Research Division
                                                                        r-- r i'L a I 'L
       Phone:  919-682-7645                                        University of North Carolina
                                                                   Chapel Hill, North Carolina 27514
                                                                   Phone:  919-933-2007


        estern,-
       Carl D. Killian, Ph.D.           1974                       Mr. John B. Rogers, Jr.        1973
       Box 2672                                                    Post Office Box 337
       Cullowbee,   North   Carolina   28723                       Davidson, North Carolina 28036
       Phone:  704-293-9611                                        Phone:  704-892-0564
       Mrs. Evalyn trdndeJ, M.P.H.-         1975                   Mr. Donnell VanNoppen         19
       160 Cotintrv Club Road                                      Box 337
     @heville,     .North   Carolina   28804                       Morganton, North Carolina     28655
     Wone:  704-253-8424                                           Phone:  704-437-5261

       *Members of Executive Co:nmittee






                                                     Ot:licr Thati l@',edi-ccil Scllo,)ls

                                      1974                        Mr. E. 11.              l@173
     *],?dwin 1-1. Monroe, M.D.
      Vice-Presi.,dent  for  Health   Affairs                     Vice-president
                                                                         Dept.   of Community Colleges
      School of Allied Health and Social Professions              N. C
      Post  Office  Box   2772                                    State  Board   of Education Building
      East Carolina University                                    Raleigh,    North Carolina 27602
      Greenville, North Carolina 27834                            Phone:      919-829-7051
      Phone:      919-758-6310
     ollr.  George  T.  Thorne     1973                          "llr.  Earl  Murphy     1975
      Controller                                                  Assistant    Dean
      North Carolina   Central   University                       Craven Technical Institute
      Durham, North Carolina     27707                            Post  Office   Box 885
      Phone:      919-682-2171                                    Nei4  Bern,  North Carolina 28560

      Representative of a Philanthropic Orpanization

     *Mr. James R. Felts, Jr.         1974
      The   Duke   Endowment
      1500 North Carolina National Bank Building
      Charlotte, North Carolina 28202
      Phone:      704-376-0291

                                                     ies

      Mr.  W.  James   Logan     1974                             William A. Robie, M.D.         197?-.I-
      Executive     Director                                      5437 Thayer Drive
      North Carolina Heart Association, Inc4                      Raleigh, North Carolina 27609
      No. 1  Ile-art  Circle                                      Phone:
      Chapel  Hill,  North   Carolina   27514                     represents N. C. Chapter of American
      Phone:      919-968-4453                                                 Cancer Society
      represents N. C. Heart Association
      Eloise   P.   Hathcock     1975                            *T. Reginald Harr-is, M.D.         1974
      615 St. Mary's Street                                       8OoO @lor@,'i D-@',@alb S,:r@eL
      Raleigh, North Carolina 27605                               Shell)v, ':North C.-ir-lira 2SIc)n
      Phone:      919-832-6307                                    Phone :     704-482-1482
      represents N. C. Diabetes Association                       represents T.B. and Respiratory Assoc

                                         Clark R. Cahow, Ph.D.         1975
                                         Duke University Registrar
                                         114 Allen Building
                                         Duke University
                                         Durham, North Carolina 27706
                                         Phone:  919-684-3146
                                         represents United Health Services
      Representatives of Other Health Providers Including 3rd Party Carriers & Government
      @encies
      Mr. W. J. Smith        1975                                 Miss Sally Far'riiid       1975
      Executive Secretary                                         Physical Therapy Section
      North Cl-:roli-na Pliarmicetiticil- Association             N. C. State Board of licaitli
      Ro>: 1 53                                                   Po s t -u f f ic c i@) x @z, o'-@, i
      Chapel I ill,- ',orLli  Carolina  27514                     Ralei.gli, North Cirolina 27602
      Phone:      919-967-2237                                    Phone:     919-829-@J131
                   --  -  -.                                                   @,l  r,  T)I,,,cionl I'l@,@rinv








                                                               rd Party Carriers


         Mr. George Hider      197'3                          Edwin S. Preston, Ph.D.     197-'
         Pilot Life Insurance Company                         2711 Anderson Dri-%,e
         Post Office Box 20727                                Raleigh, North Carolina 27608
         Greensboro, North Carolina 27420                     Phone:  919-782-1@478
         Phone:  919-299-4720                                 represents 1\1. C. Health Council
         represents N. C. Health Insurance Council

                                    Mr. Ken G. Beeston     1974
                                    N. C. Blue Cross and Blue Shield, Inc.
                                    Durham-Cliapel Hill Boulevard
                                    Durham, North Carolina 27707
                                    Phone:  919-688-5521
                                    represents N. C. Blue Cross & Blue Shield, Inc.

         Executive Director, North  Carolina Regional @ledical    ram
        *F. M. Simmons Patterson, M.D.       (non-voting)
         Executive-Director
         North Carolina Regional Medical Program
         4019 North Roxboro Road
         Durham, North Carolina 27704
         Phonei.  919@477-0461







        *Memb6rs of Executive Committee
        'Members of  Minority  Groups


   "-M-EMORANDUM                     DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
                                                   PTIBLIC HEALTH SERVICE
                                       HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION

             Acting Director                            DATE: April 18., 1972
             Division of Operations & Development




    FROM     Director
             Regional Medical Programs Service
    SUBJECT: Action on April 10-11 Staff Armiversary Review Panel Recomendation
             Concerning the North Carolina Regional Niedical Program Application.



             Accepted
                                                 @l. (Ddte)



             Rejected
                                                      @te)



             Modifications





                                                              Region: North Carolina RMP
                                                              Peview (,),cle:  une
                                                              T'ype of Application:Amiversary
                                                                          within  riennium
                                                              Ratiniz: 324

                           REC      ATIONS  FROM




                  SARP                             Review Comittee



                  Site Visit                       Council





             RECO    ATIONS:

             The Reizion be approved for the 05 operational year at the requested
             level of $2,080.,008, pending'additional information and@satisfactory
             review of the $200,000 request for conmmity-'based edumtio@ programs.
             The Region be advised.,Of n*,weakaesses identified by SARP (see below)
             and that Staff follow up with careful study, advice, and
             assistance.




                 I UE:
             SARP was presented with two divergent recomendations by Staff
             who conducted a preliminary review of the North Carolina
             a-D-Olication.  The recomeMations were:
               I'he Region be approved At the requested level"of  $2,080,008.
               The Region be approved at the requested level, but that funding
               authorization for Institutional  Coordinators/  Continuing
               Education Component of Core be withheld until Staff has
               reviewed the RAG recomendations for this component in addition
               to receiving a justification for the need of these representatives
               on Core Staff.

             The members of SARP, with minor exceptions, agreed NCRNP must
             be viewed with a high degree of credibility and reliability, and
             therefore, can be entnisted to strengthen its weaker areas (dee below)
             with encouragement and advice from FMS.  It was not felt
             restriction or reduced funding, which might@'be interpreted as
             punitive action, would serve any@meaningf-ul. -Durpose. This
             rationale was based on the fact that the Region  has done  a
             connendable job in responding to, and resolving all  of  the
             problems identified by the national review bodies a year ago.




          Pag6 2 - Critique                                          North Carolina RMP



             The composition of the RAG has improved by  increasing
             allied health, public and black representation.

             The advisory and decision-making bodies have been reorganized,
             disbanding the Board of Directors, giving final authority for
             all activities and policy matters to the RAG.

             The Resear   and Evaluation Division has been  centralized
             in Program Staff and is directly responsible to the Directors.

             With few exceptionsrenewal projects are  being  terminated
             at the end of the current year.

             Staffing plans include the hiring of minorities,  three
             professional and three secretarial.


        While the reviewers were compl  entary of the Region's progress,
        they did identify areas of needed strength, and/or  correction.
        it@was believed these weakness-es could be corrected with proper
        assistance from RWS Staff.


             The goals and objectives while having been  moderately
             revised, since the triennium review; like many  Regions
             remain broad and non-specific. The  Region  recognizes
             this weakness and is taking corrective measures.

             While the program is de-emphasizing categorical and
             continuing education activities, there is a need for
             it to accelerate change toward direct impact on improved
             care,, particularly to the underserved.

             The role of and need for the Institutional Coordinator/
             Continuing Bducation Component of Program Staff is  highly
             questionable, particularly in view of the apparent changing
             program direction. The Region shares this  skepticism  and
             has designated a comittee which is studying the matter.

             The fact that the four Institutional Coordinators  are
             paid as part-time program staff wh3,,
             of the RAG and Executive Committee
             both from the standpoint of conflict of interest anct
             dual relationships to the Director.

             The relationship of the grantee to the RAG as presented in
             the By-laws is inappropriate.  The By-laws should be rewritten
             to clearly assign program responsibilities to the RAG  and
             administrative responsibilities to the grantee.


                                                                   RNPS/SCOB
                                                                   Bill Reist
                                                                   4/18/72




                                                                                    -AM211cation
                     Component and Financial Summary                     Anniver3iry_


         COZIPONENT             CURREIIT                      YEAR                YEAP,           RECOMIIEM
                                YRTS AWARD              COU',,'CIL                                   @UND I N
                              .04       OPER.           RECOIOMNDED          'REQUEST                   SARP
                                YEAR                    LEVEL                                           REV.   COM.

                                      558,193                                   643,940
     CORE
                                                                                (73 O-
     Sub-Contracts                                                                    OoL
     OPER,      ACTIV.          1,152,129                                    1,248,175              1,248,175
     DEVET,.     COMP.                168,605                                   187,893           y

     EARMARKS:
         KIDITEY  #28                                                          (145,400)__             145,400
         AHEC      #41                                                         (200,000)               200,000





      R14PS   ii@.,FcT          I-8Z8,227                                     ft non Ana            2.080@008
                                                          94.
      RELUESTED                 3,875,118

      COUNCIL
      APPROVED LEVEL            2,194,400
      NON-P,14PS and                  1009000                                     34,691
      INCOME


                                                                                    REGION  North Carolina

                                                                                       June       197      REVIEW CYCLE


           The 04 year is b@ing        exte.nAi4   to  9./1. and the, region     will receive
           $365,733 for th@,,two-month extension resultih' ina                  direct-cost
                                                                      9
           award of $2-,244,660 -for 14           months.
                                                          s at i s f actery. 4T-Ia"
         **P iclin2,.additionAl-.-informat-ion an                                   Of-@tl* $ZOO-t@000   Tequest
           f6r      com=ity-based      educational      p@og-rams.



                                                                                    4 18/72.     SCOBIRMPS






                                                                Re2ion  NORTHEAST   OHIO   RMP
                                                                Review Cycle  June 1972
                                                                Type  of  Application   Anniv.
                                                                        Prior to Triennial
                                                                Rating  132.S

                                  Recommendations From




                    SARP                                         Review Committee


                    Site Visit                                   Council



           Recommendatio'ns:
           1.   The approval of a one year  period  of  support  (September  1,  1972  through
                August 31, 1973) of the Program at a funding level of $600,000 direct
                cost.

           2.   That the NEORNLP would, during the 02 year of support., develop and submit
                an application more consonant with the priorities of the Region justifying
                the continuation of this program or face the alternative of a merger
                with the other Ohio Program or termination of funding.
           3.  'That the present operational projects be phased out and that the
                funds be utilized  to  support  planning  and  feasibility  studies  indicated
                by the program's data base.
           @4.  That attention be given to the recruitment of a Deputy Coordinator
                and Program Directors in evaluation and communication.
           S.   That the NEORMP give considerable attention to the delineation of the
                relationship and responsibility between the Board of Trustees, Fxecutive
                Committee., and the RAG.
                That all technical assistance recommended by SARP be provided to the
                Program.

           Critique:
           Committee  members were very concerned  over  the  fact  that  NEORMP  had  decided
           to   remain separate from the merger of the Ohios and it was the feeling of some
           of the members that all funds should immediately be withdrawn from t         program.
           The Committee Agreed with SARP that there was little apparent relationship
           between regional goals and the operational activities presently supported by
           the Region and also, that Program staff needs additional development.







         ortheast Ohio IW                   -2-
         Th6"Comittee expressed concerns in basically the same areas as did staff
         and SARP reviewers.  Also, Comittee members considered the fact t at
         NEORNP hadbeen without a full-time Coordinator for 17 of the just 19
         months of operational status and were in agreement with the types of
         assistance recomended by SARP.
         Committee felt that the NEOW had been anything but satisfactory up
         to the present time and that a year of planning was needed.
         Comittee indicated that their action was not intended to be vindictive,
         punitive, or anything of that nature, but felt that a strong directive
         was in order.




                       uomponenu ana ti.nanciat bummaiy




                   ONENT         CURPEITT                  @'FAR               YFAR            RECOMI'tEliDED
                                 YRIS AWARD            COUTICYLL                                 FUNDING
                                     OPER.             RECO'LViElIDED      'REQUEST                 "W
                                 YF,AR                 LEVEL                                        REV. COM.


                                   481
       CORE                              424                               637 796
       8ub Contracts                  55,000


       OPER,      ACTIV.
                                   208,763                                 193,501

                   114P.                                                                       yes
       DEVELO     Cb                                                                                       or No

       EARMARKS.#











       Klirb viRECT                690,187            .803,696.            831,297                  600,000

                                          '75
       REQUESTED                 1.1232,0

       COUNCIL                     78
                                     6,187
       APPROVEB LEVEL


       NON-Rl4PS     and
       TL'COME

                Does not    include 24 month  extension for
              01- year of $2,376,158                                             REGION     Northeast Ohio

                                                                                 M@y/June     1972,.REVIEW CYC'
                     01  Al                                 01  A2
           Cor                 67i                Core.,          .865,918
               e                 @8-26.
           -Proiects          359,,284.         -Projects          -473,1-30
           Direct       Cost-1,037,110           -Direct 'Cost    1,339,204&



          SCOB/RMPS
           ay    24, 1-972.







                                         TABLE OF CONTENTS


                            NORTHEASTERN OHIO REGIONAL MEDICAL PROGRAixi


                                      ANNIVERSARY APPLICATION



               Staff Briefing Document

               Pace Page

               Regional Map                                                      2

               Geography and Demography                                          3
               Component and Financial Summary                                   4

               MIS Printouts                                                     5

               Problems, Accomplishments, Issues                                 14

               RN? Review Criteria                                               15






                                        STAFF BRIEFING DOCUMENT





                                                         OPERATIONS          Eastern             Mid7Cor
                            RM 00064                                       South  Centr'!  /-7   western
                 NEORMP                                    BRANCH                         -


                                                           BRANCH
  yp2    APPLICATION         NA      LAST RATING           Tel. No.    3-1740             Room     10 2"
                               197      DATE               BRANCH CHIEF       Lee t. Van  Win le
        TRIENNIAL
       ist     IV YEAR               SARP                  BRANCH STAFF       V@tnie D-Ashby
       2nd ANNIV YEAR                REV. COM.             RO REP.-               ice C
        THER                  LI    OTHER                  Last Mgt.  Assmlt Visit                    19"

                                                           Chairman
  AS'f S@@V4 2/5-6 1970     Chairman-             ilin T-  Whirp, M 'n
                                             haii@-.,%nls Name and T  e of Visit)
    a f %7isits,   Last 12 mc      (Dates, C                       yp

           Ashbv            3/30"31/72           Staff Assist-a-nep




                  i6h Occurred in the Region Affe,,-ing the RNP Since Its Last Review
                    97
         T"-,e employment of  Dr.  Donald Glover as Coordinator on January 1, 1972.




                                                       2                             Rj'.l 00064


                NORTiE;'6TERN 0310
                Enco,npasses 12 counties in northeast Ohio centered around Cleveland.
                Population ( 1970 Census)
                  Total;  4,115,000;  86% urban               o,ier 3.5 iiillion)
                  Land area;  5,784 square miles;             densit@ 710 per sq. nile
                  Major metropolitan areas:  Akron, Cleveland, Lorain and Youngstown-Warren
                  Cleveland - 38% Negro
                  Cleveland S,'ISA#.  Per Capita income - 3,705

                               .9 Congressional I)Istricts
                                   Part of i@ 18






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                                                                                   RM OU064
                                                   3
            Northeastern Ohio  R,',IP
           Facilities and Resources                                                 1969/70
                                                                               Enrollilent  Graduates
               Medical Schools  Case Western Reserve Univ. Cleveland              362          92
                                                                        :,try     287          60
               Dental :  Case Western Res* Univos School of Denti
               Prof* Nursing Schools:  21 - 6 at colleges and Universities
               Practical Nursing schools  - 6@
               Allied  Health   Schools,,
                 cytotechnold-      -   7
                 Medical   Technology   -  16
                 Radiologic     Technol.-  18
                 Ph   sital   Therapy   -   1  (Case West. Reserve)

                             Non   Federa1    No. of Beds
                 General            65          16,545
                 Osteopathic        10     reported in planning application)
                 Veterans Administration:- 1 -780 beds
                   -InclIudea for Cleveland SMSA      32 hogp.  9229 beds ( about        total
                                                      reported for all 12 counties.)

                             Personal Care Homes

                     levelaod   SMSA:                       Beds
                                    are   qomes
                          Nursing   C
                          Personal Care Homes        19     1345
                          'with  Nursing   care

                  p yst6ians - Cleveland SMSA ( 1970)
                     Total non-Federai ( practicing and not practiting)-        4,148
                     Total  Active  -      3626
                       Gen. Practice       375
                       Med. Spec.          621
                       Surg.    Spec.      724
                       Other
                     Inactive              150
                  m  rsos (  Prof.)-  Cleveland  ST.LSA    1966)
                     Active  -   6305
                     Inactive - 2838,




                                                                            P,,'IPS DOD
                                                                            March 1972






                                                   4
                 Co mponent and Financial Summary        Anniversa
                                                                   ry Application


       COMPONENT           CURPIENT               YEAR               YEAR         RECOMMENDED
                           YRIS AWARD          COUNCIL                               FUNDING
     first 12 months                                                                   SARP
                           01   OPER.          RECOMMENDED       'REQUEST
                           YEAR                LEVEL                                   REV. COM.

                              481,424                             637,796
     CORE
     Sub-Contracts            55,000
                              208,763                              193,501
     OPER.
      EVEL. C                                                                      Yes        or No

     EARMARKS:


        KIDNEY






     IR'MPS DIRECT            690.187                              831,297
     REQUESTED             1,232,075

     COUNCIL                  786,187
     APPRO


      NON-RNPS and
       NONE

        Does  not  include  24  Month
        extension for 01 yr. of $2,376,158-.                            REGION Northeast Ohio
          01 Al                         @--.-Ol A2  -                    y/June    1972,.REVIEW CYCLE
      Core              677,826   Core               865,918
                       54  -284
      Projects        3   I.:i"   Projects           473,130
      Direct  Cost  Jo  7,1   0      Direct.Cost   1,339,048






                      -,@,72                                                                                                                      PrGinN       N5 CHI(,
                                                                                    9RF-AKC@JT  CF  REQUFST                                       QY flmr'64 (,6/72
                                                                                       2  rpnGRAm PFQfnf)                                                                     OMPS-CSti-JTrGR2


                                                                            2)                (4
     )rNTtFTrATICN CF Cr'vFrNEN'T             I Cf!@NT. WlTfJTNI    CCNT.        REYNNOI ADOO .  N-T       I NFWV  NCT                CtJOQr%'T     I    CIJDP ENt
                                              I APPP. PFRICrl       APPP.       PEPIR)CI PQE\JfntjSLY      I EIDEVirL;SLY             rjlRP(-.T         INDIPFCT               TRTAL
                                                OF SUPPI)QT         CF  SUPPCOT          FUNCEP            I APPRCVFD                 COSTS               COSTS


          coc?F
                                                                                                                               ]__-@.37.        7q6         $ 21.L A 'I@       ibi    @p
     I I  HNSPITAL     LTPQ'APY     Cf'tN'SLLTI
     .-I N, @,E     r                                              - -   - - - - -     -------------
     l@  @rCU NU;ZSF  TOAft\T@G

                             -        ---------                                                                                                     - - - - - -
     13   STPEP CTLTURF PRCGRAM


      7   STQCKF OEHAPILITATICN             OEI
            IIZ A Ti                                  S76,11 7                         --------   -                                                                                     7 6

                       TCIAL                        $F?1#21;?                                                                         %831      2q7         $51, 1 I!i           98   41 5




                         MARCH        23,1972                                            REGIONAL  MEDICAL PROGRAMS SERVICE                                                                           PAGE         1
                                                                                   SUMMARY BLOGET CATEGORIES BY  COMPONENT                                                                          RMPS-OSK-JTOC.M2
                REGION     64     NE     CHID                                                                                                                   REQUEST     MAY/JUNE     1972      REVIEW      CYCLE
                                            COMPONENT                COMPONENT          COMPONENT          COMPONENT          COMPONENT                                                                   REGIO!i
                                                  NO  COOO        NO 001             NO 002             NO 003             NO 007                                                                         TOTALS

                     I   PERSONTL          SERVICES
                                WAGES             3359522               26@920           4 79 226             75,000             20,034                                                                   5O4w7O2-
                      SALARIES.
                 EMPLOYEE            OFNEFITS     52,876                 3,365           5,668                 39IZ5           1#042                                                                      66,076
                              TO   TAL            438,398               30,285           52,894               289125             2lwO76                                                                   570977B

                     11  PATIENT         CARE
                                   IN-PATIENT
                         OUT-PATIENT
                              TOTAL


                   III   EQUIPMEf4T
                         BT)ILT-IN
                         )O,OVABLE                                                       109000                                     Soo                                                                   169899
                              70TAL               6*399                                  109000                                     500                                                                   169 899.-

                     IV  CRINSTRUCTION
                         NEW
                         M AJ AL  I  C  R  EN
                              TOTAL


                     V   OTHER
                         COti@ULTANTS             16#628                                                                       29200                                                                      18,829
                         SUPPLIES                 l2v597                250              59750                24o371                550                                                                   43,513
                         DMST          TRAVEL                           850              3#500                                 lo,750                                                                     25,  94  5
                                                  191845
                         FPC.N         TRAVEL
                                        SPACE     30tooo                TOO                                                                                                                               -.309 70',)
                         RENT
                         PENT           OTHER     6,300                                                                                                                                                        6,300
                         MIN   AI.T   C   PEN
                                                                                                                                                                                                          28,772
                         Pt)[ILICArIONS           2Ov272                500              89000                                                                                                            .55,000.
                         CR)NTRICTUAL             55,-On
                         COM,-iUttICATION         199857                200              2tOOO                                                                                                            .22 G 5 I.,
                         COMPUTERS                129500                                                                                                                                         -,@12# 500-
                         OTHER
                                                                                         19t250              24ip3TI                                                                                      243 9  620
                              TOTAL               1929999                2t5OO                                                 40500

                     VI  TRAINEE        COSTS
                         STI  PT  tiDS
                         OTHER
                              TOTAL
                                                                                                                                                                                                          8319297
                TOTAL       DIRECT       COST     637,796               32,785           629144              52IP496             26PO76
                                                                                                                                                                                                          51,118
                      INDIRECT           COST     319890                 6PO57           69347                 61824
                                                   - -                                                                           269076                                                                   SSZ9415
                     TOTAL   DIR    F.    IND     6699686               389842           889491               59t320











             MARCH   08.1972                              REGIONAL MEDICAL PPOG$KAMS SFRVICE           DESK   S(IUTH CENTRAL AREA
                                                    LIST OF COMPONENTS REQUESTED Ft)R NEXT SUPP(IRT YEAR
                                                                                                                                            AMP-OSM-PEMot)l
             REGION 64 NE OHIO CL     RMP-SUPP-YR 02                                REQUEST MAY/JUN 1972 REVIFW CYCLE

                   COMPONENT                      COMPONENT                   NEXT           DIRECT COST       EST DATE  OF
                   NUMBER                           TITLE                     SUPPORT YFAR  NEXT PERIOD        TERMINATION

                     CODO  CORE                                                     02          637t796

                     001   HOSPITAL LIBRARY CONSULTING SERVFCE                      02          32t7B5         06/73

                     002   CCU NURSE TRAINING                                       02          829144         06/73

                     003   STFIEP CULTURE PROGRAM                                   02          521,496        06/73

                     007   STAOKE REHABILITATION   DEMONSTRATION                    02          26,076         06/73


                         TOTAL REGION  64     COMPONENTS        S.                              $3lr297








                       MARC@I l')91972                                       PFR.I(INAL MFNICAL PROGRAMS SFFTVTCF
                                                                             SU4MAPY RUDGET,F%Y TYPE nF SUPPORT                                                                               r
               PERTI)N 64 @'E I)Hlf)        RMP SUPP.  YR 02                                                                              REQVFST-MAY/JUNE.     @1972 REVIEW CYCLE
               ')ESK    SOUT14 CENTRAL                                                                                                                            RMPS-OSU-JTOGRB

                                                                                             RMPS                             Rmps        RMPS           RMPS         TR)TAL
                  C 0 M P 0 N E N T                            Co.MpnNENT                   DIRECT        INDIttFCT       TG;AL'         nIPECT         DIRECT        r)IRFCT
                No.               TITLE                       SUPPORT YEAR                  IST   YR      IST YR          l@i YR--       2ND YR         3RD YR       ALL  3   YRS


                  COIITINUATIO@4 WITtilN APPRNVEO PERIOD OF SUPPORT

               COAN  CORE                                         02                         6379796         31,890        669,686                                        637,796

               I') I HOSPITAL LIBRARY CONSULTI                    02                        32,785            6,057       38,842                                         32t785
                     Nrl SERVICE
               'DZ   CCU F.'URSE TRAINING                         02                        8ztl44            6,347       813,491                                        2,144
               nO3   SRPFP CULTURE PROGRAM                        02                        52,4q6@           6,824       599320                                         52,496

               ')t)7 STNOKE REHABILITATICN       DEM              02                        @6,n76,.                      26,n76
                                                                                                                                                                         Z6o376
                     ONSTFTATI ON

               CONT.  WITHIN SUB-TOTAL                                                       8310297         519118        8829415                                        8319297


               QFGT(Ilq TOTATS-.




                                                                                                                                                                                          00


















          .10





                              PC"  11,1147P                                                  PfCt(tf4AL  MEC)ICAL                 s @(PVICF.
                     0                                                                             tiSTING nF Af),Ivbt@t@  filNOS                                                                                         0
                                                                                                                                                                        PFOUR-ST  MAY/JUNE  1972 RR-VIFW CYCLE
                  RFGtnf@  64 NF Otllf)              Pmp SUPF@ VP  (%2
                                                                                                                                     nT)4f Ft            OTHFP               TOTAL
                    rim Pnt@E NT      RMPS           GRANT R@LATFD lf4Cn4f-.                 STATE               LOCAL              Ffn&RAL         NON-FEDERAL            DirFCT  .        TOTAL i:u.%")S
                    Nulor)ER         TOTAL          INTEPLSI             OTi4F. A            FUNDS               FUNN$               ft)NI)S             F t?Nn S       ASSISTANCE          THIS PERT(ID


                     COt4TlNUATION WITHIN           APPPOVED PEPIW OF SUPPORT
                    1                                                                                                                                                                                 669,606
                    crj,),)          661) t  616
                                                                                                                                                                                                   38 #842 .

                                                                                                                                                                                                       88,491
                    i)02              SA9491
                                      599320                                                                       ')Ogooo
                                                                                                                                                                                                       26*076
                                      26.076

                  CNNT*         WITHIN SUB-TOTAL-
                                                                                                                                                                                                      939p4ls
                                     8879@415                                                                      30, (I'@)O

                  ottion         toTALS
                                     SR2#415                                                   279n.10             30*"'%O                                                                            939,415                           f,






                                                                                                                                                                                                                                        04)






                                                                                                                                                                                                                                                     P MPS-OSM- JTOC,@'k
                                     11), 11)7z                                                               RFr.InNAL          MFOIC&L          r-PO.rP@"S           @rPVTCr-
                                                                                                              SummAR.Y  bkjf)GFT           LIY     TYPR      'IF      SkiPPO;,T                                RROLI@ST  FFARIJAPY   1,   1972  DEADLINF
                              64      rHID  CL
                                                                                                                                                                                                                       UIPECT
                                                                                                                                                                                                                         Cr'ST
                                                                                                                                                         RMPS                                     pmps                PRFVIOUS               AMPS                  RMPS
                                                                                                                                                         DIRFCT             INI)IRECT             TNTAL                YrAr@                 DIRECT                DIRECT
                                PcPl@n!IAL          PATIFNT               EQUIP.              CONST.              OTHFR           TRAINING                                                                                                   ZN")  YR              3.qO  Yr%@
                   p@71.               SI)C           CAP E                                                                    C  FELLRIWO,.              IST  YR             IST  YR             IST        YR.       AWA',Zf)


                   Cr',-@T l@,UtT         WITHIN'         APPROVED         PERIOD         OF          SUPPDPT
                                                                              6,3q9                         19zpqq9                                   637,796               31*890              669,686                  865,QIB
                                                                                                                                                        '%2,7it5              6,-$T               3R,84?                          48,2?4
                               10,285
                                                                                                                                                                                                  AR,4@l                 130,944
              I')  2           5?,934                                                                         1907
                                                                                                                        .5n                             82rl44                i%,347
                                                                                                                                                        gi7  ,   496          6,q'24              51)03zn                2.').),  1   55
                   3
                                                                                                                                                        76#07h                                    76,076                          84,907


              ,r,NT.  WIT14IN  Slig-TOTAL
                                                                                                                                                      811,297               51,IIA              .3s?,415              1,3.i9,048
                               521*577                                       16,3q9                         2l4t74q

              ;kFOUFST  TOTALS
                               571,577                                       l6p399                         714,74Q                                   8-11,2qT              51,118              R82,415'              lt339#048

              arr.,L"l  @YALI

                               521,577                                       16,399                         214,749                                   q3l,247               5191IR              8829415               1,33q,048
                   C n,, Pn    F                                                                                              CIIVPI)NRNT
                                      TITLF                                                                                       YFAR

                                                                                                                                    r2
              C )I)    Cf'  R  E
              I)   I   Pr.)S,)ITAL  LTRQAIZY  CONSULTING  SERVICE
              ')IZ     CCU  NUGZS@  TRAINING                                                                                        (2
              )()3     STFTFP  CIJLTURE  PP(i-.RAM                                                                                  (2
              '11)7    STRNKF  REHABILITATINN  DEMONSTRATInt4                                                                       07





                                                                                                          (I$  A t@@) I I
                  t                 i    CL                                                                                                                        R I' ()I i I s II t BR@UAQ  YI tIl)Y., t)rADIINF
                                                                                                                      lociT m r A                  n T14F it           TOTAL
                        T                      rPt.@;T RELATED INCtimE                  STATF              LN(AL              FEDI:PAL         NnN-Fr()F$tAL          DIRECT           TOTAL FU40S
                    F k       TOTTL           I,%TEREST            OTtirA               FU,4n,;              t jj n,;          F U 14 L) S         F I I N i) S    ASSISTANCF          THIS PERinC)



               C"rINUATICt4 WITHIN-APPKOVEO                 PERIOD OF  SUPPORT
             c) ),I                669thpb                                                                                                                                                 669,686
             or.1                    M9842                                                                                                                                                   lt8vR42
             ,)'2                   88,491                                                                                                                                                   08,491

             t)') 3
                                                                                                                                                                                           116,320
             1)  )7                 76#076                                                                                                                                                   26oO76

                    WITH,,14    Sul-T()TAL

                                  P-82,415                                              27,000              3r),O(40                                                                       939t4lS

           REGION TOTALS

                                                                                        270 O)OO            ln,olo                                                                         919*415






                            t'AP.CH 17,1972                                                                                                                        REGION - NE OHIO
                                                                                                      BREAKCUT  OF  REQUEST                                        RM 00064 06/72
                                                                                                        OZ PROGRAM PERIOD                                                                      RMPS-OSK-JTOGR2

                                                                       (5)                  (2)                (4)                (1)
                    IDE'4TIFICATIC)N OF COMPONENT                CO,-iT.     WITHINI CGNT.        BEYCtDl APPA.  NOT        I  NEw,  NOT                CURRENT      I    CURRENT
                                                               I APPR.       PERICOI APPR.        PERIGOI PREVifUSLY        I PREVIOUSLY                DIRECT           INDIRECT                TCTAL
                                                                 OF  S'@'PPORT     I CF  SUPPORT        I FUNOtt)             APPROVED                  COSTS        I      COSTS

                    COOD  CCKE

                                                                                                                                                                                                    @6@9.6P6.  I
                     c-I -I ;5i-P-ITAL      LIERARY      C014SULTI                                                                                                                                          -  I
                        t tL   r, v lap     ---                1      132,785      1                                                            I        1.32.TS5    1                                     4?  1
                    002   CCU T@UPSE  TRAINING                                                                                                                                                                 I
                                                 I                                                                                                                                                             I --
                                                                                                                                                         S9 Zal4@--@.LIAZ
                    OD3   STP.EP C.'--LTUPE  PkCGPAli                                                                                                                I                    I                    I
                                                                      5 1) 2.L.J.2 6 1                                                          I               552@2@         S6,1124    I         159.12e-)  I
                    E07F    TREKE@  -ADILITATION             DEJ

                                        TOTAL--,.               --.$831#297                                                                             S6319 297            $519  118L   I   -S882o4l5       1.








                        MARCH l79L9?2                                                                                                   SUMMARY OF ALL     REGIGNS
                                                                                     BAEAKOUT OF REQUEST                                           06/72

                                                                                      IST   BUDG(T   YEAR                                                      AMPS-OSM-JTC@;Z2

                                                           151              (21              14)            (1)
                                                    I CCNT.     WITHINI CUNT.   BEYONC)L APPR. NOT      I NCW.   NOT         IST YEAR        IST YEAR      I
                                                    I APPR.     PERIODI APPR.    PERICOI PREVIOUSLY     I PREVIOUSLY          DIRECT      I   INDIRECT     I    TOTAL
                                                      OF   SUPPORT    IOF SUPPORT     I FUNDED            APPROVED            COSTS       I    COSTS       I


                          GRAND-TOTAL               1 $14,062#690     1,    SI,893,8501   $lv467,376    1  $4,21lt693    1 $21,635.609    1  $4,108.768    1 $25,744,377    1



                                                                                      2NO   DUEGET   YEAR

                                                    I CCNT.     WITHINI CCNT.    BEYONDI APPR. NOT      I NEWE   NOT     1   2.40 YEAR    I
                                                    I APPR.     PERICDI APPR.    PERIODI PREVIOUSLY     I PREVIOUSLY     I    DIRECT
                                                    I OF SUPPORT      IOF SUPPORT     I FUNDED          I APPROVED       I    COSTS       I

                          -G;tAND-TOTA@----         1 SllF363,076     1       $704.148    91,038,745    I'- $4,002.273   1 $17 #128 t242 -1



                                                                                      3;tD  6UDGET   YEAR

                                                    I CUNT.     WITHINI CONT.    BEYONDI APPR  NOT---I    NEW.    NOT    --I-3r3     YEAR-1                -I---TOTAL
                                                    I APPR.     PERICOI APPR.    PERICOI PREV;OUSLY     I PREVIOUSLY     I    DIRECT      I                I ALL Y--@ARS    I
                                                    I OF SUPPORT       Ci; SUPPORT      FUNDED            APPROVED       I    COSTS       I                IDIRECT COSTS    I

                          GRAND-TOTAL                                         $4379719       $269966       $1916OPS44    1  $lv627,529    1                I $4C,391&380    I
                                                                                                        I                f                I





                                                                                 Region
                                              14                                 Rev. Cycle


     PRINCIPAL     ACCOTPLISliMENTS  BY  RNP  since                  197-

     The Region has excelled in the development of cooperative relationships throughout
     the area and has involved large numbers of providers in the  committee  and  overall
     organizational structure.   It has a good data base and has the cooperation  of  all
     of the resources necessary to establish a complete data system.    Strong  ties with
     CHP, state health planning agencies and other institutions and  agencies  have  been
     developed.
















     PRINCIPAL PROBLEMS


        1.  The absence of critical staff members.


        2.  Relationship between the Board of Trustees and the RAG and the question
            of where decision making authority rests.

        3.  Currently supported activities for the most part do not reflect program
            goals or priorities.








     ISSUES   REQUIRING    ATTENTION  OF  REVIEWVRS

     Same as problems.














                                                                                        LI




                                                    15- -
                                                                            I)ate:   3/7//
         N'ortlieast Ohio,.                  BN,,: Vernie 1). As'tib@-
                                    Prepared

    Afts.- 'Obj active ana -Priorities:

    la,(,, statement of goals and priorities submitted with the first operational grant cojitiTui@l,s
    t,lithout change.
    I',.,Ich problem i.$ classified on a scale of urgency (Urgent.- 4, Important    Significant-
    -nd  6rt'  nt  - 1) and this scale is used in the priority-rankiiig b@ the Board of Trustees
        p   ine
    of the  protects that go through the review cycle.
    .1. @@.i,m-mediate fiealth service needs of the poor of the cities of-,NE Ohio (priority 4 -.urgor
    2.  NFORMP organizational goals (priority 4 - urgent)
                                                     p
        Prevention and early detection of disease   ( riority 3 - important)
                                                                                   .) - important)
    4.  Increase in the potential for the delivery of health services (priority '                1
        Faudlitation of the distribution of health   services (priority 3 - important)
           rovement of the quality of medical services (priority 1 - pertinent)
         IMP
    ('Lirrently supported activities for the most part do not reflect program goals
                                                                                     - - - - - - - - - - - -
                                                                                emphasis.
    -Recomended Action:









                ents and implementation:
    ll'ne NEO/IW has done a good job in conceptual planning.  It has a good data base and has
       coop r4tion of all resources necessary to establish a complete data system.  A
    p   's6d computerized network should be a valuable tool in improving the distribution
    0   dical services in the Region.  All 56 hospitals, having 4004000 discharges per year,
    area coo  tat'na in submitting summaries of those respective discharged patients.
           p    1  -
    co e supported feasibility planning studies which-show promise are-. 1. The@Laser TV
    Tr   ission with Case Western Reserve University, a  prototype  one-way  laser  system  for
    TV transmission will be expanded into a two-way 'System for health.services-co      ications.
    @fh'  St  will examine the value and reliability of the  system  as  well  as  implications
    fo @ ide  aDi)lication.
    2.     corganization for university cooperation in health which was    formed to  encourage
    @i cob@i@at6    oint planning for health manpower education through    Greater Cleveland
    @f t iOi ons (Cuyahoga Community College,  Cleveland  State  LJniv6rsity and Case Ilest6rn
    I s re Univer ity with  the  Metropolitan  Health  planning  Corporation and NEO/R4P representi
        cons   r and provider interest in the c      ity.  This study will explore the
    feasibility of establishing a formal mechanism through which  the  resources-of  the  three
    i  ti  ions could be used in the preparations of personnel in existing health occupations
      @new catejzo ies of'health manpower as these develop., If such a mechanism is feasible,
    t is@@-could be the foundation for the establishment of a jointly sponsored School of Allied
    eal


           W Co      staff has always been very active and have excelled in providing
           c functions for the program.       stantial staff effort is spent in convening
           litatinR activities.  There is a Very. close working relationship among agencies,
    ,:t8soc ati6ns and institutions within the Reizion.





                                           16
             Northeast Ohio          prepared 2Z: Vernie D. Ashby           'Date:  3/7/72

       3.  Continued Support--
     The Hospital Library Consulting Service project #1 to insure continuity of services
     following the phase-out of NEORMP support now has a fee for service arrangement.
     At present fifty institutions are now providing support.for services instituted as
     a result of the project.  Income is expected to increase thus insuring continuity of
     services to member institutions.  Project #2 continuing education of nurses in Coronary
     Care will probably be university-based following termination of RMP support.  %leans
     to finance this activity are being explored.  There is no indication,that the other
     two operational projects will be continued after termination of I\TEO@1P support.






             'Recommended Action:










       4.  Minority Interests:
    There are eleven full-time professional and technical positions on Core staff.  Six of
    these positions are - filled with females and five with males.  However, none of these are
    filled with blacks.  The Coordinator of the NEO@ffl is actively recruiting a black
    physician to fill the position of Deputy Coordinator.  Minorities occupy three of
    the seven clerical positions on Core staff.
    @@o of the eightben professional and technical positions on project staff are filled by
    minorities and one of the five clerical positions.  Seven of the members of the 55 member
    RAG are minorities.  The Coordinator of the NEORMP will strive for a balance with regard
    -Lo employment of minority employees and minority representation on the RAG and committees.
    71he plannina study to develop a comprehensive health care program for the medically
               0
    indigent of Loiain County is a plan to bring high quality care to tliese'people in their
    own neighborhood.  This is an area with a large minority population.





   --------------------------- ------- - - ----------- - -- - -- ------------- - -------------
              Recommended Action:





                                               17
       'Alp  NEOhio                  !=aTed -B3r:  Vernie D. Ashby                 3/7/72

           Coordinator@-

        PMP was without a Coordinator or Deputy Coordinator for approximately eighteen
    months,  Dr. Donald M. Glover was appointed coordinator on January 1, 1972.
    Dr. Glover was not on board in time-to hav6 input into the present application.
    Although Dr. Glover is 76 years old, he seems to be in excellent health and also
    seems to be quite alert.












                                                                           - - - ------------
                  ended'Action:












       6. Core Staf
      e Cor  staff includes eleven full-time professional personnel.  The majority of the
       e St    it physically located in the central offices in Cleveland with regional Offices
    i       stown and Akron housing small contingents of Core.  The following critical staff
    Po$     s  ave never been f:'Llled
    1.  Director  Evaluation
    2.  Di   tor,@Communica'tions
    I., Dep    Coordinator














  -------------------------------- - ------- - ---- --- - - ---------- - -------
                                                                                 -------------
                   ed Action-



                                                      e D. Ashby         Date:  3/7/72
                     hio


         Regional Ad
      7.            visory Group'.
    f"iie RAG has been meeting quarterly for the past year with a membership changed-
    significantly from previous years.  There is now a broader.repte,sentation according to
    vocation of individual members.  There has been a marked improvement in attendance at
    i@G meetings during the past year.  After a study by an Ad Hoc Committee 6f RAG,
    RAG itself concluded that its functions were purely advisory.  This would'indicate
    a serious weakness in the entire organizational structure of the NEO@1P., There is
    a need to-involve the RAG more actively in both the planning and dec'lsionmaking
    process.







    -- ------------------- - - - - -
      Ikecomended Acti@.










      8. Grantee Organization:
    'Fhe grantee is a non-profit corporation which receives fiscal services from the
    Case Western Reserve University.  The members of the corporation are the Board
    of Trustees.  Decisiomaking responsibility for program policy and direction rest
    with an Executive Co@]@.ttee, whose members are drawn from the membership of the Board
    of Trustees.  This arrangement has raised serious concerns as to whe,ther.th6 decisionmaking
    responsibility in this Region rested with the Board of Trustees or with the Regional
    Advisory Group.















    ------------------------------------------------------------------------------------------
      RecomFnended Action:






                               - -----------
        @lp: )Iortficast oflio    19
                                       Prepared By: Vernie D.'Asliby          Date: 3/
            Participation:
                                                  cooperativeIarrangements and close working
             -has succeeded in the development Qf             tionS With4
       relationships among agencies, associations, and institu          in the Region.,
       i.e., Blue Cross, CHP 314(a) and (b), the Health Department, the IVelfare Federation,
       the Medical School faculties, the Academy of Medicine, volunteer organizations, and
       the Community Qolleges.






    ---------------------------------------------------------------------------------------------
        Recommended Action:








        io. Local Planning:
     The area planning committees meet on a quarterly basis.  These committees are responsible
     for assessing area needs and for advisin  the Coordinator, Bo
                                             g                    ard of Trustees, and the
                                                                   four approved feasibility
     ;,-AG on NTEORMP proposals.  Core assistance to proposers led to
     studies including developmental planning for an AHEC for the Youngstown-lVarren area
     involving major Universities, medical centers, physicians and health organizations.
     NF,O@FP has a field office adjacent to the Summit-Portage County CHP office.  Staff
     and office equipment a@e shared.  CHP circulates pertinent applications to     for
     comment and CHP reviews and comments upon NEORMP proposals.  Also a NEO@   Istaff person
     is located in the@'4ahoning Valley Health Plannin Association office and shares many
                                                     9
     ,.Iaily planning and coordinating activities with CFffl.





  ---------------------------------------------------------------------------------------------
       Recommended Action:



                                     Preparj By@ -Vei-nie D. Ashby           Date:   3/7/72
     PM:  Northeast Ohio

      11.  Assessment of Needs and Resources:,
                                                                                        Liai
     k method of total program evaluation has been.designed and is under development.
               in Akron resulted in a' discharge planning study.  Assistance to proposers led
     uo four approved feasibility studies including,developmental planning for an Area
     'Flealth Education Center for the Youn'gstown-Warren area involving major Universities,
     ,.iedical centers''physicians, and  health  organizations.  NEO@  in  conjunction  with
     Blue Cross 'of Northeast Ohio and four CHP "B" agencies are co-founders of Center for
     Health Data' of Northeast Ohio.  This. center has supplied the necessary,data for a
     series of studies concerning hospital utilization and discharges and  manpower  data
     analysis. Joint data collection has been carried out in the  areas  of  health  manpower,
     he'alth manpower training programs, emergency services, and other surveys.

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

      Recommended Action:










      12.  Management.
     The real meat of the iNEORNlP has been in the realm of its Core functions.  Core activities
     have been varied and imaginative.  'Fhree critical positions remain vacant, these and
     tlle positions of Deputy Coordinator, Evaluation Director and Communications Director..
     ';N'EORW has a written procedure for the review of project applications with  Core  staff
     input beginning with staff assistance in the development of  projects,  regular  and
     systematic monitoring and evaluation  with  quarterly  expenditureand  progress  reports.









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

      RecoiTnended,Action:.-.




                                                                                             377172
     %IP:  Northeast Ohio         21    Prepared py:  Ver'nie D.    Ashby            Da.-.



   I'he position of Evaluation Director on Core staff is vacant and considered to be           a
   critical.1y@needed     sition.  Howeve , specific Core staff are assigned to monitor and
                       PO                   .]:
   provide  supportive  services  to  individual   projetts.   Major   Core   staff   responsibilities
   are  evaluation  and  financial  administration.  Two   reports   are   required   quarterly   from
   oath vrbioct. These are expenditure reports and progress reports.  An Assistant Director
   for   E @tion was hired in      April 1971.  A system for appraising and strengthening funded
   pyojects  with   periodic   reports,   com.ittee review and consultation is under @'ay.  A method
   of total program evaluation has been designed and is under development.






   -----------------------------------------------------------------------------------------
         comeiided'Action,











            Program PTODOsal:
   ,r    rog    priorities against'which projects are       reviewed are:
         I  diate health service needs of@the     tJrban poor.
   1.     eve  ion of Disease: Prevention of     CoApli6ations of Chrbnic Disease: Early Detection
       of Chronic Disease.
   .1@l.@Incre sing the Potential for the Delivery of Health Services.
   ,v.   on       46 Eauilitation of the Distribution of Health Services.
           9
   V.    improving the Quality  of Medical Service

   ,;k.Li proposals.receive an evaluation rating which determines funding.  Present operational
   orojects   show little relationship to goals and priorities.  However, certain Core activities
   ani Core-     orted  feasibility  and  planning  studies  show   promise.   F6r,oxample:   1)   The
   de  clopnient  of indices of com=ity health through the Center for.Health'Data. 2) Develop-
   m lit of t   model  for  Youngstown-Warren  AHEC.   3)   Expand   discharge   planning   throughout
   th  Region and  4) dev(-,]@opment of an educational data system.






   -----------------------------------       ------------------
                                                                 ------------------------------------
          o  elided Action.




                                  Pre-pared                               VCL t.

    15.   Dissemination of Knowledge:  The NEORMP has developed cooperative arrangements
          and close relationships among agencies, i.e, Blue Cross, various hospital
          administrators, CHP 314(a) and 3i4(@)-, the Health Department, the Welfare
          Federation, the Medical School faculties, the Academy of Mediciiie, and
          the Communi ty Colleges.. Data.-collection needs have been identified  and
          publications on health-related data have been compiled  and  distributed.













    ----------------------------------------------------------------------------------------
    Recome,nded- Action:









     16.  Utilization of @lanpower and Facilities:  A structure has been  developed
          which can stimulate grass roots interest-and need major health factions
          in the region. Close relationship.$ prevail among  agencies,  i.e.,  Blue
          Cross, hospitals, CHP I'All & "B" ag@ncies, the Health-Department, the Welfare
          Federation, the Medical School faculties, the  Academy  of.Medicine,  and
          the Community Colleges.


















    ----------------------------------------------------------------------------------------
     Recommended Action:




                                                                            Date:
                                    PrcT)a-rel

      17.    Iiiil)rovernent o-f- Care: A planning study is in progress to medically indi'gent
             orain County.  Initially, it will serve 5,000 of 28,000 poo'r in the county..
             A discharge planning study for continuity of care will test the feasibility
             of a coordinated discharge planning system for the improvement of corit'inuity
             of care.  A study titled "Preventive and Rehabilitative Needs of the Under
             Sixty-five Homebound" is di@ected toward a typical inneir-tity with a population
             of approximately  40,000 to determine the magnitude of the needs of.homebbund
             persons.under 65 years of age.











 ---------------------------------------------------------------------------------------------
       Recom,ended Action:









       18.   Short-term Payoff:   The Hospital Library Consulting Service provides a
             network of informational services@to fifty institutions which are now
             providing support to the project.  This project will be expanded further
             and should be self-supporting upon Germination of NTORNP support.in June  1973.
             The Continuing Education of Nurses in Coronary Care project has developed
             the necessary components to structure an effective educational program.
             Means of support are being explored for this project'which if terminate-- on
             or before June SI, 1973. .Since the i@eption of the Stroke Rehabilitation
             project over sixty patients have benefited from treatment received in this
             program.  Improvement has been.noted in terms of shortening the length of
             hospital stay, the course of  re.habilitation, and the course of the disease.











  ---------------------------------------------------------------------------------------------
        Reconimeiideci ACtion:




                                                        24                Date:
                                  Prcpared By'

          Regionalization:   For the most par@, peratibn'al activities are aimed at
          nurses and.other hospital health professionals.  Fifty hospitals are
          participating in the Hospital Library Consulting Service project and-the
          network 'of informational services will be @anded further.















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










     20.  Otlier Funding:  The Strep Culture Program which is NEORMP operational
          project #3 has $27,000 State funds and $30,000 Local funds allocated for
          this budget period.  Blue Cross of Nor.theast;Ohio has jointly sponsored a
          computerized tumor registry, supplied basic data for Radiation Therapy
          Guidelines and helped develop average cost of kidney  transplants and'other
          procedures-,;





















   ------------------------------------------------------------------------------------------
      Recommended Action:








                                       DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
     .KEMORANDUM                                     PUBLIC HEALTH SERVICE
                                        HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


     TO      Acting Director                             DATE: April 18, 1972
             Division of Operations & DevelopTnent



             Directo
     FROM    Regionalqd@ical Programs Service

     SUBJECT: Action on April. 10-11, Staff Anniversary Revieil Panel Recommendation
             Concerning the Northeast Ohio Regional @ledical Program Application.




             Accepted
                                                   (Datd)



             Rejected
                                                   (Date)



             bbdif ications












                                    Financ
                    Componont__and         ial  Summary - Anigivetoary Application



           COIIPONENT        CURRENT                YEAR                 YEAR        RECOMMENDED
                             YRIS AWARD          COUNCIL                               FUNDING
                                OPER.            RECOMMENDED          REQUEST             SARP
                             YEAR----            LEVEL                                    REV. CO@.


      CORE                   *-481,424                                637,796
      Sub-Cootracts             55,000
                                                X/    X

      OPER.    ACTIV.        208,763                                  193,501

      DEVEL.    COMP.                                                                Yes        or No (X

      EARMARKS-.


           KIDNEY










      RMPS DIPECT            690,18  7           803,696                                   786,187
                                                                     831.297

                             1,232,075
      RE2MESTED

      COUNCIL
                             786   187
      APPROVI&D LEVEL


      WON-RMPS    and
      INCOME


        Does  not  include  24   Month                                  REGION     Northeast Ohio
        extension for 01 yr. of $2,,376,158
          01   Al                         01 A2                         May/June  1972,,REVIEW CYCLE
      Core             677,826     Core             865,918
      Projects        @359@284     Projects         473,130
      Direct  Cost   1,037,110     Direct Cost  1,339,048





                                                                               4/18/72  SCOB/RMPS







                                                         Region       NEORMP
                                                                               197Z
                                                         Review Cycle  June
                                                         Type of Application: Anniv.
                                                                  Prior to Triennial
                                                         Rating    45

                                   Recommendations From

                   SARP                                     Review Committee


                   Site Visit                               Council



            Recommendations:
                  1. The funding level and period recommended by the National
                     Advisory Council at its February 8-9, 1972 meeting  be
                     approved. Specifically that the Program  be  continued  for
                     1 year at the present level of funding.(786,187  D.C.)
                  2. That RMPS recommend to the Region that they take a good
                     look at Program staff to see if there are unneeded positions
                     and that they give consideration to phasing down or out
                     the present operational projects, utilizing any  funds
                     freed-up to mount new programs and initate  activities
                     indicted by their data base.
                  3. That RMPS take a good look at the organizational structure
                                                      I
                     of the Grantee and make specific recommendations.
                  4. That technical assistance be provided to the Region by
                     RMPS. This assistance to include  strong  RMP  Coordinators
                     in addition to @S staff.
                  5. That the new coordinator, Dr. Donald Glover and the RAG
                     Chairman be brought into Rockville for RMPS indoctrination.
                  6. That program progress be assessed by RMPS at the end of
                     6 months.




                  The Panel concured with staffs recommendations including the
                  continuation of the Regions funding for 1 year at the  current
                  level.
                  Decision making responsibility for NEORMP policy and direction.
                  rest with an Executive Committee, whose members are drawn
                  from the membership of the Board of Trustees.  Reviewers  were
                  very concerned about the relationship between the Board of
                  Trustees and the RAG and the question of where the decision making
                  authority rests.









              Page 2 -  Critique


                        The reviewers of the application were in agreement tiat
                        very little progress had been made by the Region since
                        it attained operational status July 1, 1970.
                        The panel agreed with staff that there was litt e apparep
                        relationship between Regional goals and the operational
                        activities which are presently supported by the Region
                        and fur+.-her that there was an absence of critical Program
                        staff members in the areas of evaluation and communications.
                        The panel was concerned about the lack of minority repre-
                        sentation on the Board of Trustees and the Executiv6
                        Committee and the inadequate representation on Program
                        staff, RAG and committee structure of the NEORMP.
                        Panel in their deliberations considered the facts ,',iat
                        NEORNP had been without a full-time coordinator for
                        17 of the first 19 months of operational status and that
                        Dr. Donald Glover was appointed full-time coordinator on
                        January 1, 1972 and was not on board in time to have
                        input into the present application.  It was the opinion
                        of panel that NEORMP was actually back to a planning
                        grant basis and that Dr. Glover, the new coordinator,
                        should be given all of the assistance possible to  give
                        him a chance to turn this program around and head it in
                        the right direction.
                        Panel felt that some of the following forms of assistance
                        could be helpful to the Region:

                             1.  Staff assistance visits.
                             2.  Strong RMP Coordinator going out to the Region
                                 as a part of the technical assistance process.
                             3.  Have the coordinator and RAG Chairran participate
                                 in site visits to other regions.
                             4.  Refer coordinator to Regions that have sol-,7ed
                                 programs.
                             5.  Have the coordinator and RAG Chairman visit
                                 Rockville for RMPS indoctrination.





                                                                  4/18/72  SCOB/RMPS




                                                                        Region         OHIO
                                                                        Review %'Iycle    June  1972
                                                                        Type   of   Application   Anniv.
                                             Recommendations     I?rom           -Prior-to     Triennium
                                                                        Rating             197.7



                        SARP                                               Review Committee




                        Site Visit                                         council



          Recommended  Level   of   Funding:
          The Region requests one year of support, 9/72          8/73.  However     the   Review Committee
          recommended  two  years  of  support  to-  (1)  'provide  the  Region  with  the  opportunity
          to,tAke  the  necessary  steps  Of  putting  the  two   prog.rams  together  and  (2)  to build
          a strong and effective Program Staff.

          The Committee recommended a total of $1,400,000 for the          (01) year as compared    to
          th6 Rekion's request of $2,082 820.  In arriving At this amount, members of the
          Review Committee:
               1.   Recommended     $900,000 for  Program  Staff.  This   amount   is   approximate
                    10%  over  the   current Ohio  State  and  Northwestern  Ohio  RMPs  one   year
                    expenditures   for   the Program   Staff   component'.

               2.   Recommended     $500,000 for  operational   activities.   Included   in   this
                    amount  was  the  proviso  that  this  include  $201,535  for  Project   #3,
                    Ohio Renal Disease, if the project was approved and that this amount
                    was to be deducted if it was not approved.   (The 3 part Ohio Renal Disease
                    -project was reviewed  on  May  8.  1972  by  a  staff  AD  HOC  panel.  The
                    recommendations  of  this  group  are  the  subject   of   separate   documents).
                    Also  included  was  $162,393  for  the  10  month  continuation  of  Project   #12
                    Ottawa Valley Council for Continuing Education, and #2, Computer Assisted
                    Instruction,  which  have  one  additional  year  of   Council   approved   support
                    through the merging RMPS.

               3.   Recommended  no  support  for  Project  #8,  Health  Careers  of  Ohio,  as   the
                    activity was believed to be outside the guidelines of RNPS.
            e Committee recommended a total of $1,515,000 for the (02)          year.   This   was
          built  on  a  10%  increase  for  Program  Staff,  $990,000  versus  (01)  year   $900,000,
          and  a  5%  increase  for  operational  activities,  $525,000   versus   (01)   yearl$500,000.


          CiiticLue:
          This  application@was  not  reviewed  by  SARP.  A  site  visit  was   not   performed.
          Members of the Review Committee had a great deal of difficulty in considering
          this application.






            Page 2 - Critique


            First, they commended the very poignant comments of the  two  members
            of Council who participated in a January 10, 1972  Factfinding  visit
            to the three Ohio RMPS.  They we're.then in the dilemma of attempting
            to consider total program rather than individual projects when in
            reality there was, as yet, no total program to consider.

            Two of the present three Ohio RMPs Ohio State  and  Northwestern  Ohio,
                                              .9
            have complied with Council's recommendation to  merge,  effective
            September 1, 1972, to become the Ohio RMP with the Ohio State University
            Research Foundation as Grantee agency.

            The Review Committee considered the following as concerns:

                 1.  The Acting Coordinator, Dr. William Pace, will resign, effective
                     June 30, 1972.  (He has elected to assume a full-time position
                     with the Medical School).

                 2.  The Region has no formalized review process.
                 3.  The goals and objectives are very general, non-specific
                     statements.

                 @4. The Regional Adviso   Group is temporary and is  in  the
                                        ry
                     process of expansion.
                 5.  Major staff changes will not occur until  the  Region  becomes
                     operational.

                 6.  Nine of the twelve proposals in the application are  from  the
                     existing Northwestern Ohio IM.  (Members  of  the  Committee
                     had a considerable amount of concern that previous activities
                     in the Northwestern Ohio Region were aimed  towards  the
                     support of the newly developed Medical School at  Toledo  with
                     emphasis on that rather than to a greater degree on the
                     PJW component).
            Conversely,, the Committee believed the Region had taken some  positive
            ste7p@sr to deal with the problems.  These are:
                 1.  A Search Committee has been active (and successful) in locating
                     several qualified candidates for the  Coordinator  position.
                     A final decision is expected by June 30, 1972.

                 2.  The local review process is being prepared and  will  be
                     completed before the Region becomes operational, 9/l/72.
                     The review process will be a part of a developing policy
                     and procedure statement. Also, the Region plans  to  have  all
                     projects proposals, feasibility/planning studies and  many  of
                     of the program activities in this application reviewed  by  an
                     external review group prior to June 1, 1972.  Time constraints








            Page  3  Critique


                     made this impossible prior to the submission of the application.
                     The application describes a detailed program management planning
                     process.

                 3.  The Region has established a committee to reconsider and monitor
                     the goals and objectives.

                 4.  After September 1 1972, membership of the RAG  may  be  expanded
                                      3
                     to include broader representatives as outlined in  the  By-laws.

                 5.  Because of the pending appointment of a new Coor inator,  t  e
                     Region has made little effort to recruit personnel.  In the
                     mei'ging Regions there are currently a total of 22  professional
                     positions - this is to be increased to 32 professions s in
                     the new organization.

                 6.  The Region has agreed on a grantee and fiscal agent,  the  Ohio
                     State University Research Foundation, which  has  demonstrated
                     competency in the fiscal area.

                 7.  The Region currently has a relatively strong Acting RAG Chairman,
                     Dr. Brian Bradford, (who, it is understood, will remain in
                     this position) and an Interim Regional Advisory Group that
                     apparently has participated fully.and actively in  the  merger
                     effort.

                 8.  The reviewers commented that the RAG  has established an innovative
                     task force arrangement to continually monitor the  progress  of
                     the new program.



            Conclusions:

                 -   That the Region has made progress in merging.

                 -   That they have attempted, as requested by Council, to merge
                     with the Northeast Ohio and Ohio Valley RMPS.  This has not
                     been effective.

                 -   That the Region be encouraged to devote themselves  to  planning
                     and development activities rather than to  immediately  launch
                     new project activities.

                 -   That the Region be encouraged to  attract additional  minorities
                     to its staff, RAG and Committees.

                 -   That the new Region has some unusually strong  support  through
                     the Director of the CHP "at' agency as well as the Director  of
                     health.







            Page 4 - Conclusions


                     That the new organization appears sound and indicates intent
                     to establish field offices.  Also, the.planned assignment
                     of field personnel to work in CHP "b" areas should add a
                     demension heretofore unknown to this area.





















            DOD/SCOB
             5/23/72



                          Component And Flnnncial Summarv                  Anniversary Applicntion



                                                                                     01
                COZ,WONEliT           cLjRPE.@rr                  %'FAR                  YFAR             RECOMI,!E?iDED
                                      YR'S AWARD             COU',,'CTLL                                         FM4DING
                                          OPER.              RECOI-IY4ENDED          'REQUEST
                                      YEAR                  #LEVEL                                              REV.  C014.
                                                                                                          01               02

        CORE                                                                         1,23Z,668           900.000.         990.OC
        Sub-Conttacts

        OPER.        ACTIV.                                                            643,617           500,QOO          52,5,00

                                                                                       -0@
        DEVP,L.       COMP.                                                                               Ye g         or   'No

        EARMARKS:

            YIDITEY      #3                                                            201,535

             CBE #15,     16,1-
                                                                                     See Below









        R14PS DIAEDT                                                                 2,082                       0        515,00
                                                                                                      is 00,00         1


        RE2UESTED

        COUNCIL
        APPROVED     LEVEL


        NON-P,14PS   and
        iizcom                                                                         -0-
             Also   pending    are    CBE requests    as   follows:
          it 15    01-       78%019       Total Costs                                     REGION             OHIO
          #16      Ol-'    87'0,169       @irec't   Costs.
                                                                                              June                REVIEW      CYCI
          #17      01-       49.,900-     Direct,Costs                                                  .19721.

          Corrent    Program       Recruest       .21082,820
                                    t   -e
          Supplemental       CBE Re4u,st      -     --998,088
                   's.Total     Reqxiesv-     -   3 080$908.
          RO-gion

                                               OHIO STATE       N.W..OHIO          TOTALS
          Total.Direct       Costs            702,467              69-2-,800      1,3959267
                                                                                     811 751
          Program     Support     -(CORE)     451,8@l                358,900
             @projects                        249,616               -333,900         583,516..

              Summary     of     actual      expenditures for-the one     yeat  period    ending      March 31,     1972





                                                                                                         2
                                                                             Revie;,l CYcle, Ma  'u   7
                                                                             Type of       3  c
                                                                                       Appi _a  i
                                                                             Anniversary   Continual-ion-(ly
                                                                             prior. to submission of a
                                           recon,.mDnd;itionG  Proll.
                                                                             triennial
                                                          ..   . . ...... .  Rat'ing:   Review    Co@ttee-lE
                                                                                                            (C
                        SARP.                                                  Review    Committee
                        Site  Visit                                            Cotincil


            @Olq         ION.--.-'Ihe-LRP-vi   @ttiie @enr-ur-@d.-with.-.
                                                    or  ne-year in the reduced                    205  (d.c.)
            that  the   application   be   approved,r ... 0                           amount  39
                                                   '.-.advice   to the Region as follows
            This   recommendation   also   inclL4&-s                                        1) recruitment
            of  a  strong  Coordinator,  including   consideration   'of   a.,qualified   non-physician;
            2) strengthen the 1Drogram by reorganization of RAG and Program Staff,' as well as
            continued   subre   'onalization;-and   3)   improve   relationships   and    responsiveness
                               91-
            to CHP "bl' agencies.
            This  action  does  not   include   Emergency Medical     Services (EMS)  p-roj ect #25 Pending
            a-special  review.  @As   reported-by.-staff,   it-vas   alio.-noted   that   a-supple@-ntal
            application  for   planning   several   local health.manpower   systene    was e@ct&d
                                  review    prior
            June,l@for;special,                   to  the June  '72    Council.
            RATIONALE FOR FUNDING RECOMMENDATION:       Recommended      funding is  at-the 03   yea.r
            level  prior  to   the   April-'7i   boardreductions;   and   sh6uld be   adequate   to
            increase  Program  Staff,   necessary-reorganization   activities,   and   to   fund   some
            projects   (particularly   continuation   of   those   wthin   the   previously-approved
            support   periods   and   activities developed     by the    Tulsa:NE Subregion    and
            approved  by   the   CHPagencies)'..
            C!IITIOUE:   The   recommendation    was reached after  long      discussion'and debate
            about the   status of this.RogiGn.and      an appropriate     level of'funding.-     StafP's
            narrative   comm@nts including ORMP'S.    strengths   and we@esses,'the      subject    of
            SARP's discussion were        noted.

            'The   Review Coffdttee     expressed concern about  some of  the   disparity    in.project
            ratings., and they questioned whether CHP comments were          considered  in  the   RAG
                                                            ecognized and    discussed    the need   for
            d6cisionmaking  process..     -The    reviewersr
            a -different   administrative    mechanism    to provide  the   needed'leadership   for   a
            meaningful reorganizational thrust in Program Staffing           and    continued education
            of  the  RAG   and'its,committee-s..-         r-@f   staff   added.to.  e   difficulty   in
            identifying  current  Pro'   am   Staffvacancies   and   new   positions.   Concern   waIs
                                       gr
            expressed   abotkt-the    number.of.proj-ects 'SubYpitted  f6r  support,   during a   time when
            major  efforts  should   be   in   reorganizing to-turn  the  Region  around   in-the   right
            direction.   Even   though   minimal   breakthroughs   were   recognized,   sorqe members
            of  the  Committee  questioned.-wheth6j?  OR6P  had  really.gotten   the   message   and
            favored sharp funding reduction.
            On.  the Positive side, staff reported that the        Coordinato@  has   'announced   his
            decision  to  resign  as  soon  as  the  active  Search  Committee  recruits   a   qualified
            successor, and the Committee is thinking about the kind of leadership and
            organization  that,is  needed  including  competence  which  does   not   require   a   M.D.




                                                                 Region Oklahoma
                                                                 Review Cycle June/July 1972
          Recommendations,From Review C@,ttee                    Page 2


          Another hopeful sign recognized by staff is that the Director of the University
          MedicAl Center and the people in Oklahoma more and more are defining  the
          University Health Science Center as an institution to serve the State, and
          the ORMP represents the necessary link for community service.  Other noted
          progress included the implementation of subrevionalization in the Tulsa Area,
          the Macer,Co@ttee Study, and efforts by some Program Staff to strengthen ORMP.



                 COMT10nent And Financial Stimmnry Anniveranry ApE@icntion



                                                              YEAR        RECOMl.ic-ItDED
        COI,al0liENT     CuRrE@IT
                         YRIS AWARD                                         FUNDING
                         o@ 'OPER.        RECOi@i NDED     REQ'JEST       @SARP
                                                                           @7,EV . C
                         YEAR             LEVRL-.

     CORE                $354,ooo                           $677,300
                                                              4'(,100
                              -0-
     Sub-Contr@icts
                                                             629 782
     OPER. ACTTV.            384,500
                              -0-                                -0-       yes      or No (X
     DEVEL. CO.@.


     EARMARKS:
                                               0-                -0-             -0-


                       See     Below
         E4S #25









                                                                                 --,9 2 0 5
                                                            1,35@,182
              FCT           7@8,  0
      RE2UESTED              224.%o64
      COUNCIL                 o62,564
      APPROVFD LEVEL


         -Rl4PS and
      NON                                   >
                               -o-
      I.NCOM



                                                                REGIOII  Oki,@o-Ta


                                                                                 REVIEW CYCLE
                                                                   /June   t972@.

                                                   ch""   t  6/71-8/72 (15 months)
              This Region'4 currqnt-period ia being  @pd  o
              and funds       be Increased to $923'
                                                  % 125 d-.
              The DIS-iDrooosal-was a part of the basic-application and is pendi'
                                                                             rIg
              special revie@i. Punds ($140,690 for 'one-y@ only) for that project
                    t included in this figixe.
              are no
           Current Program     request    $]:.1354,182
           Supplemental F-@    request        14o,69o
           Region's-Total       -request $1, 9    72











                                        O@HOMA, REGIONAL MEDICAL PROGRAM


                                               @versary Application,
                                 For Consideration by June 1972 Advisoi-y Council



                                                 TABLE   OF   CONTENTS


                PART I:  STAFF BRIEFING DOCUMENT
                                                                                             Page
                           Face Page  . . . . . . . . . .. . . . . . . . . . . . .  .             1
                           Map, Geogr-aphy & Demography      ......... ..........   6........ 2-  4
                           His tory . . . . . . . . . . . . . . . . . . . .0        .             5
                           Canponent and Financial S             .....      ..................    6
                           MIS Breakout of Request (04 year) ..      ....................         7
                           Accoirplishments, Principal Problems & Issues         ...........      8
                           Pre-Sai-p Staff Meet@ Carznents in Rating
                             crif-@ia Order    ..........................           ........    9-14



                PART II: KIDNEY ACTIVITIES         None


                      III:  APPENDIX
                           Site Visit Report - July 1971           ..................0   .......  A-1
                           Advice Letter-August 1971             .............................   A-P
                           Staff Visit Report -.January 1972           ....................... $,".A-3
                                Macer Report     December 1971    ........              ......  A-3a






                                                                             rx I,, It p s






                                                                                                                           Eastern                   Mid-ccl@
                                                                                      OPI?.RATI-01,'.S
           10.                                                                                              r7 S  uth-Cotitr 1                      Wi&G'teri
       R

                                          t I,,ttefj  LAST        Pt.rIlIC               Tel. Lo.           44-3-l')O@0-                Room         ]@o-15
                                                 197          DAT E                       BRta;cit -ci,.icr.      Michael Portl
             @ist   ililiv YEtiR               r7       SARP                              BRANCII STAFR-          Luther Says
                                                                                                   P-    Dale            Robertson
             2nd       '41V YV"R                        Ptil    COX.                      rlo RE.
                  liER  anniversary            r-7      OTHEP,                           Ne x t   I-Ig t    Asein'.t         Visit    June             @19 /1
                         4th                                                              Chairmdn
              s.v.    iuly@  1071            Chairr,-in       Leonard Sherl,is.            M.D.
                                   Last  12   mos.         (Dat6s,       Chairman's Natne @A;id             Type of      Vigit).
                                    J.                  vis3'@t)        14oni.tor ProErecis  and consultation prior                    to         submission.
                             0  t  ap  lication.
                             .S aff visited  P,@111S.                       Ftaff for   2,                    try(-)  staff  fc)-  2  d-N,@  3  7-@---@
                                                                        sidr--Ilt for   @IGdical  Affair,-,  and Dir.  of LIMC ra              et A;7iti,,
              ,3   a                             Director        10/71.        3) l.h(- R.OIR.  visited,ORMP several                   tim(--,,,;  inci@uc!s.
                                   h  (iccutt64  in  the          Region Affecting the RMP since Ito Last                               Review
                             @197 1
         T    e    site     vi                  ified        manv ORMP      problems      which      must       be       seriously addressed      if      th4.
                             $it   s       en
                     -is    to     move     forward.     Th6     visitors'     main     concerti.     was     lack     or     capa 10 Core
           e      e  li p@  @(retioit      And  advice  16t-ter  Are            included in  this  document).
             ollowin@        i    'Site    visit,  the ORMP  ap ointed  a  s               .pecial  p6tmnittee                   et commi  te
       2@                      e                                         p                                                ("Mac                    e
              i   ding    t     Coordinator from Colorado/Wyoning JIMP to assess the                                    Region.
       3          n  ih6l Retina of the OR@IP Co6rditiator, Director of khc@ Uiiiv. Med. Center with title
                  tor@of@alPS at-id other staff, there was a clear understanding of the site visit
       .I-  ti       d    ng      It'was  reported  that  the   Coordinator   intended   to   resign.
       4     u    n       D cbmb6i 171 rettdat.of@the RAC, and Core staff,@prdgram directions were
                  d     d        light of'the site vi6itors-.and Macer Cbmittee@fiiidings.
                            n       172 meeting, the RAG aoptbved some affirmative changes                                       in   the PAG and
                             0 ty
                   tee structure, iubregionalizdtton and strengthening the Cote staff ... in
                   9 wit  new goals And objectives.




                                                     Map of Con@ssional District                              @.inties, and Selected Cities
                                                                                               (6 D
                                                                                                            -S)















                                                                                                                                                                                            OTTAWA
                                                         BEAVER                                WOODS                   GRANT           KAY
                                                                                                         @ALFA'LFA                                     BARTLESVILLE4
                                                                                                                                                                                           7-


                                                                                                                       a ENID
                                                                                   wo
                                                                                                                      GARriELD      NOBLE
                                                                         ELLIS                         MAJ

                                                                                                                                           PAYNE

                                                                                                        BLAINE    KINGFISHER   LOGAN                     c                                            A


                                                                                          CUSTER
                                                                                                                         N                                                                            14
                                                                                                                         A C


                                                                                         WASHITA
                                                                                                          CADDO               @CL 01,E.L A.'4 0
                                                                                                                               110111,IAN
                                                                                                                     GRADY
                                                                                           KIOWA                              M.C CL",@,                                                           FLORE

                                                                                                                                  GARVIN        Pi

                                                                                                         T

                                                                                                                                                                               PUS"M
                                                                                                                                                                   KA



                     County with @o or more Congressionol Di5tricts





                                                                                    U.S. Dcpar-mcnt of Commcrcc
                                                                                           Berclu of t,@ C,





                                                       3


                                                                                       RDB  3117/71
                                               glil,-ilio@a liMP


                                   pr,,ipity   Region encompasses the State.
                     Counties'.  77                    Congres8ionAl Districts:      6

              Population   (1970   Census)   -   2i559,300
                     Land  Area:   68,887   square   miles      Density:  37 per square mile
                     Urban:  68%

                             areas:    (4)     1,356,600
                     Fort S-,nlthp Ark--Okla.      156.8       Oklahoma City        623.6
                     Lawton                        104.5       Tulsa                471.7

              Race      White     89%
                        'Negro     7%
                        Other      4%  (mdj6rity Indian)
                            deaths  per iOO$Ooo population, 1967

                                                  Oklahoma          U.S.
                                                                    364.5
              Heart    Disease                     368.8
              @Mali--nant neopl.                   157.6            157.2
                 s   ".ir i                        127.4            102.2
                a c II-
                 (a  f.- CiiS - stroke)
                                                    16.9               17.7
              Diab   tes                                               14.8
                ro      -      -ic                  16.6
                  n6ho pneumop
                 (o her)

              Lesour es an  FacilLties
                     M  dical Schools - univ  of Okla., S       ool of Medicine, Okl
                        e                                     ch                       a. City
                           @'1969/70 - Enrollment      442
                            1969/70 -  Graduates       94

                     Allied  Health   School,   Univ.
                            Univ. of Okla.  School of Health Related Professi6ns, Okla4 City
                                    NuTEin   Schools             Practical Nurse Training,
                     Lr-l
                            15 - 7 of them   college    or             16 Schools
                                  university    based

                     Accredited   Schools
                            Cytotechnol.ogy      I (Univ. of Okla. M.C:)
                            Medical  Technology   -   13
                            Radiolbgid  Technology   -   9
                            Pllyt;ir-@il Tiieriipy - 'L (ULI.iV. of Okla. @I.C.)
                           @medical-Recotd Librarian - 1
                            Inhalation Therapy Technician - 2





                                                 4




                                                                             RDB 3
                                                                                    17/ 7

              Oklahoina (continued)

                  3-tals  Community General  -,nd V.A. General.


                                                             Beds
                   Short tem                   127          10,438
                   Long term (Special)           3             153
                                             (130)         (10,591)
                  V.A. (general)                 2             739

             Manpower

                  Ph  icians - Non-Federal M.D.s and D.O.s (1967)
                    y_q
                        Active       2622
                        Inactive      382

                               Ratio of active (per 1.00,000 pop.5..  106
                                 providing patient care

             Graduate Nurses, 1966

                  Actively empl. in nursing      4650
                  Not empi. in nursing           1842

                               Rat-'Lo of Etnti'L. (per 100,000 pop.): 188







               l@, A LO, RE(@IONAI. I     G14AM

               L
               This Regi-on was approved and funded for 2 years and 8 months of
               planning) 8/i/66 - 4/30/69, $835,902, including $121,032 indirect
               costs.  Kelly@West, M.D., now Professor of Medicine and Continuing
               E,dudation, University of Oklahoma School of Medicine, served as
               Coordinator during the planning phase.  H6 currently serves on core
               staff (20%) as Coordinator for Related Disease,,.
               @ollowing a favorable site visit in November 1968, the ORMP was
               approved for three years of operations and funded At (d.ci) $1,074,145
               -010 $1,162,157 -02 and $738,500 -03.  The 02 year application was
                                   St of their concerns were answ  red  satisf
               reviewed by staff.  MO                             e          actorily
               by 0  P.  A 1-@PS staff team visited the Region in June, 1970.  Within
                                           d d4rectly to most of their questions
               s x months the Region responde I
                               S.  Conce  s not addressed  Iby ORMP, were defeiied
               and recommendation       rn
               until the n6xt application was received and reviewed.
               Ilpon review of the ORMP Triennium Application for the 03, 04 and 05
               ea]:  by the 'i@evic-w Committee and May 1971 National Advisory Committee,
               approval was recommended for one year only in a significantly reduced
               amd  t including disapproval of the Devolopmental C6mponenti  A sj.'te
               Visit WAS recommended to determine actual progress; to study activities'
               impact on health care delivery; and to offer guidance to the Region
               i  de-,,2,L6pin,-, a MCL-A meaningful Triennium Ap lication for submission tllc
                                                           p
               ollowing year.
               T e July 1971 site visitors were greatly concerned about the leadership.
               There was some question about the Coordinator's capability and commitment.
               The  isitors were also skeptical about the strengths of the incoming
               G chairman, January 1972.  The outgoing chairman appeared to be
               imm ginatl.ve and relatively liberal.  Other identified areas in need
               Of strengthening:  (1) development of more optimistic core attitudes,
               (2)  ttemp,t to adopt a program philosophy more consistent with the 'RMPS
               iis,-.00h and Oklahoma health care needs- (3) evaluate and strengthen
               the professional core staff; (4) involve more "real" consumers on the
               RAG"(5) involve IIAG in actual projcict monitoring; (6) reconsider goals
               and;'ob'pctives@relative to current trends (including time i-rames) and
               de tify priorities; (7) implement slibregionalization- (8) establish
               @dtter working relationships with appropriate groups including F@ed6r4l
               sup ortdd programs, i.e4i OEOO,Model Cities and CHI' "a & bl"; and (9)
               :stt  gth6n evaluation,




  q

    I









                        Componeiit -ird Fitiinciil





                    COI-il'Ol@l;'LNT                   PREVIOUS                                   04 Y ]AP,                   P, I.-
                                                                                                                                  C O,'.    i) E D
                                              Ylt'S. t.@.'Al',D                                                                   F U.r,, D I,'; G
                                               03        -OPER.           R L7 C,.     I D  D          rL,:QUI-;ST                 SA;@r
                                                                                                                                      'V.   coil.
                                                  YEAlt                                                                     LY r,'-


                CORE  and                         354,000                                             724,14-00

                                                  384,5-00                                             770,472
                OPER. ACTIV.

                                                  -0-                                                     -0-

                                                                                                          -0-
                P. AR @'LA RI%'. S
                                                  -0-

                     KIDNR,,Y












                IRIIPS DIRI@CT                    738,500                                                 94,872

                RI-,ri>S  !!IDIRECT               224,,064                                              255, 77 O--

                -TOTAT,   RI-,PS                  962,564                                               Z--5 O@

                NON- @S and
                                                   -0-
                        .01,

                                                  962       564
                TOTAL BU.'PCII.,7


                RP.QUESTR@D
                                                                                                               REG T 0,Nl         Oklihomlli
                COLIZ@CIL
                                                  913,500                                                                     2
                ArilRollET)  LEVFT,                                                                              June 197            REVILW  CYCL:--



                     This R(@gioiis current period -is I)ciiig cl)a@ged to 6/7-1-'8/72 (15 months)
                     and funds ai-e to be increased to $923,125 d.c.




                                                                                                                                                                                                   REGI'NN @  CKLXHI!VA
           F F $):Z                                                                                                                                                                                      @no23  06
                                                                                                                 BOFAKC                       UFST
                                                                                                                    @4  rrr(lwlon,
                                                                                                    (2)
                                             PCNENT             CCNT.  WITHIP-,'!           CF-NT.        (1-yr@@,')l  APIIO.  @@@T                                                 CUIZPFNT                 Cl@tcl ENT
       r) E- @k4T I F I C AT i r-@ N,  r;F  C Csl                                                                                                                                   C T                     iNctfzFCT                     TC" AL
                                                                                                                       o@ 1: V ', CI, SLY          @IPFVTI-USLY
                                                                 A r PI' -  PER I r)(i      A P         P@- 7 i (.@C I                                                              CfjSTS                     (CST S
                                                                 CF  SUPPORT                CF  SUPP@PT                FUNOC@                      APP?CVFO


       lop         CCPF

                 COOCNARY        CARF        PPCCOAM         FOI
                      - - - - - -                                                                           51.     I                                                                   7' 7
                                                -------        I                                                                                     ----------
                 Rrri@N@L  UZCLCGN'             Pqr-JECT
                                                                                                                                                                                                                           'c

                 cl-@T i %$." I  Nr,  cf7,!,rtT  I  ON  C  FN  I
                    ',I T                                                                                             ------------
                                           C.@'PF         STT'rl                                                                                                                                                                  t
                                                                                                                                                                                      $f,4_tl  4
                                                               - - -- - -    - -                                                     _tl44                                                             --------- - --
                        L  T  @-'c                  C A T I- E I
                                                                                                                      - - - - - - - -                                                                            @'t.3  a 7                    36-- 1 7:F-
                                  PRF!G       FCO       PT;'ZALI
                                                                                                                                                           t,'Al-t'4                                                             1                   14.6
            14rs2       I
                                        F'                                                                                                                                                                                                       0
       71        T@ITS@          FL         CITIF
                                                                                                                                                                                                          ---------             --------
                 CcrTr'%"L           'CrOF'ItTTVF           VFCI
                                                                                                                                                                                                                            4 q



                                                                                                                                                                                                                                   ----    -------


       -4
                                                                                                                      ----------





                                                                                           --        -        ------- - - - - - -
       i@2 -1    f    1          T F F N t      k  C  r@H  I   L
           _n_   w@,-l -:a ------------                                                                                                                                                                -------      34                                7--
           e     rcIlTill.,@,li,.",  F,-,jf:j5  CCNTFP
                                 T.R!TAL                                                           $876lpqgg                    164     744               $155 11 1 29           $1,4944872                      $255,7?C,              SlvT5t9642









                                                     '-"i @y                          I.,   1,,71




                                                                                                             in
                                                       to 1)(I
                                                                       i-@,c-w fL)Ilctir-)iaal






                                                    L.@icy iy--co&@ize the, nc-ed fo.- Rti!3 training,

                                             iri   e-,.alL'13ti.011.




           1.
           2.                                                  c@@        and tire                   t  c@
           3                      O")jc-cti-vt-,.@          t,,o  bc@                          and

                                                             i-iot
                                                                                             y   is
                 t r u   o. f         c   a n.,i
                 P                                                 c ,7", ii3I.i@,e Ptlt'uil-)Fr the  cai,'U- be.-Lorp-  thc2     oz-oc.

                                    iy pj,,


           P.ppt,o,jall. -'Ln                                Of'                c;.e.             dc),-@,; nc)'

                              "a


                                                                   ',T. 7T.



                              1.)oth
           2                                 E'              c.,,n







                                                                                                         T



                                                                                               A.@D


                                                                                                     D  A'f   r,,: ADril  3@  19'12
                      Tffi@, BE, coi@





                      C)pera,tioll,5 Officer
                                                    atioris Bi,),Jcll
                        ,Lci-Col,it.inc,,,nt, Op@,-r
                                                                                                           '/,'7/'-(2 R@,gardiribr the
                                     Ar,,i.,,eed I)poi-i tL the
                                                                                       Oll


                      P arti. c:l. p@,-,trit @@3

                                          J.  Pc)sta   Cl-ii@,f, 14CO13
                                                        .1
                                         J.  Sa\js.  (),oeration,-3 Officer, TACO.16
                            *Carol Lar,son,  U."U.,D
                                      A-
                            'Mary . dell,  D?fD                                                              Prepared written
                            *Joan @,i-iscr, OPIIF@                                                           coments.
                            -x-CL-ittieriiie Scurloc',,,, OPPE
                            "'Annie Stubbs, G,@.3
                            *H,u@old O'Flclierty, MCOB, w@,- unable to be present,

                                                             ayid, .Di--! o,.-') tics (1),@ir@c It'i @)i6)
                               T-ie ri@,w goals, and objectives lialie been. eyl)anded but are still too
                               gc@iieral.   According to r@,dent telephone  conversations with Dr.  Coc)nek-,
                               the                 in concert with trick new Cc)],n@litir)ity  and Consuirc-r Health
                               and, Iiivolv(-@rfp-nt (,,c)rrfAttee; he is in the process. of                                            goal_.s
                               and objectives  (.-Lorig and s@ioi.-t  tlc.@nn)  vil)!.cli                    be rfore specific arl(j
                               eq@it(--@d to                           ll:r:i@or:Ltic,,@,  vjill  @3.'i.Fo  be                     (curr(.@,nt
                               prioriti-e.,i    are    not    listed.,     t@)ul,       the  sw@,            listed in last y(@@ars
                               appl.icatJ.on).   Ol:i@IP ft@-s workiii-)v, wi@i CIIP ",,L"  '2afk Force on hcaltla
                               statistics  to                         a      data I)at,Lk  for Okl,,JioTric@.R(--,.I@ative to goals  ,md
                                                          is     ncnq     better, cooperal.-,.@i.on with o,(-)n.,.DL7LTrp-r a-
                               it@    @,l    'lb")    and    a    move     toward

                        2.     Acccfi,,P.I-I.sl,2i-ients  and
                               Ii-i addition to the site visit recr)trrri(-,,i-idat@Loris-,  O@IP appointed a
                               CCT@ffnittee                 to study its  orL@anjz,,t,tiori incltj.(Il-rig core staff' after
                               vihich attempts have been made  to                              r-L! @,e arid s-r-c;,nrthei-i it-  c
                               ks indicated in the Coor(I.I@riLttor's                            lc@ttc-.r, and IV@r., renort,  t-Irl@l-liticli-I
                               inclu(-I(@s broader rc@,presentit,-.'tori  fi-,oi-n                         an@l ii-d.Tioril;y                 iz,
                               i,jc--I,   as ne'vi fizictic),Il,,tl                  ,@ilriacti.ire   -I.n           f,tL@,-,i.dt't-,.I-on,,Ll
                               catcrorica'L ap                       'Ile  nc@.@w           Norti)    I,',ac3t                         @-,taff'
                                                     . proacli.         e
                               and                  Ci.,roup  is  evider,)cc-@  of   tli(-I.r   rn@)-v(@-   to
                                                   stu( -e,,,,  should be helpf)-il. iri                                            -1        al
                                                         li                                                          ri(:.,,4 outi:,c,.@ c-i lie   ti-

                               care







                                     d
                     3.   C,@nt@,Lriue  Suol)ort (page 89-90)

                          Projects are monitored by inoi,it-,I@ly c-xpeiidj-tLU@
                          pror@'le,@is reports, ceiTli-afLi-iua-1. monitoring arid (.,val.ij;-.,ti.cn t,,-y        JR.PG
                             d Cu-i@iLittec,, sit(, visit-,.,,.            li@.ivc, bc.,(.,@n irrirle to teriLin,,ttc-@ FIIP
                          stipl)c)rt aft-f@@T., rr@azc)i-iabl.e pc-r,i O(i,;.   C)f t,@le 11.
                          siric(@ l,ii(, R@f@ori b(-,cairie                            (.)f 3
                                  t,wo yE!,.i.r,,   w@,,                        P
                          (03 yc,,-jA,) a        1-ii@ee
                                         f't(,r t               ',@@lpl)OL't   W@'Lll
                          has             for   -,u@)port-, frc),,,i            C)rlc,@           an(I               for
                          three y(@ars will t)c.- extended, tt)t@-e iff)nth@-,, coi-it,Jtiu@d                f()r or,(,'
                          more yc!Lir is rcclii(,@,-ted f'c)r tlle CCU project furi@l(.@d for              years.
                          ('The  CO(J  p:r,olcct  vjill  coiitl.yii.ie  and  thin  uroIc)&y  project  is
                          supf)oi,,t from IIIII/1,TCI).   Contir-iued ,,,upport is requested for three
                          pro,j(:?cts  which  beL,-,an  in the 03 operational year (each approved
                          for tl-li,ee years).


                          Minority    Interc@sts

                          Al.thouL,4a some progress      had been made there is an obv:ious need fo'r
                          much more tir@eal't minority and consumer p@icipation at all levels of
                          or@zation.   Goals and objectives do not specifically nr-nti.on
                          minorities, bat speak to advancing the delivery of health services
                          so each individual mV I)avc- access to the system.   'The Coordinator',-,
                          letter and RAG report (page 38) address,,,) more J-nvolv6,rmnt of
                          RAG i-neiijl)ersl-iip    been eyp,-,jiiJed to incaude- more cc),ns@r inpi-I
                          includ!iT, CI-11) "all hn(i llblt :repi-(-sentative@-,.   r,,AG (60) includ(@.@3 11     (18%)
                          minority representatives  (I                                                     7 Anc,,i'j.car,
                                                         (I'Ilo) :serve on
                          (12) - only 1 minority                    no fema-l.es).   All Carrpitte@,s (192)
                          only  3   PLinoxity   ije-,-bers   (black)   and   42   (22%)   are   females.

                          Core professional staff (FTE@) 13-15 - 8.65 mal.e                 4.5 female - only
                          1 black.   Core clerical staff (PIE) 8 - all female  1 blaclc.

                          Project professional staff ( iME) 1.6.5 - 6.4 male, 10.1 female, no
                          rdnor,-'LL-,ies.   Project clerical staff (@i) 4.3- all female, no
                          minorities.


                    5.    Coordi.i,,,itor

                          Ifne Coordinator is extremely          lacking in Ic,,ader,-iliJ.p ability necessary
                          to mov(@ this RE-p-,,.'Loi-i foniard.   '.the furture of the Region, despite
                          the             efforts of a fevi      of the more cc)iTpeter-it and committed
                          core ,,,taff, racists in erq)loyrrr@i-it of' a new coordinator as ,3oon Ew
                                        A stticly by the Operations Of'ficc:r, -indicates:             (1) Of 16
                          professionals on board at the time, of tYir,, JillY 1971 site visit,                  8
                          have tf-,rTnl.r-iated.   Of' 9 employed since that v.!-c,.It, 2 have         t(,.Tlnj.riat('d.
                          (2) Of 9 clerical ,@,taff ern@)I.c),v(@(I at-, tlic-.@ times of the 1,11-ite, v-1:@.-I t, ).I
                          have since terTiii-iated and 2 have been hired.   It's INT'c")'
                          that the Coor(li.riator is to bc@ replaced.   llo,,ievei.,, as of           3/31/7@' there
                          has been no forflial annomcc@irent of his leaving or effective date.












                     6       Core St,@Lff'
                                                                            @).r id c                      ti
                             'The lack of
                                                                                     @,,
                             .@'ar                                       li,@iii:@licaln
                             particularly since tire ,:irrival. ol' I)r. C"Oof)c-@r, I'lami(:,xl          3 ill l@,ovc@rr@@r,@r
                                     Th(3 Pd@,ri-T-)S ooc.-!raticias Ofi'.Icr-@r@ has O,)-@ei,,vc-d his  clig,@r!Lsiia  with
                             MO,o-t of the staff, i.e. Director                          SI)bmgion, Evaluator, and
                             Cl-iief' of (iiants ltmage-ment.
                             ID-le I'@@er'@' Committee report contains some very worthwhile
                             recafnc@ndat'Loi-is fbr reorganizing core.   R@IIPS staff' a3.so @-.,rrees with
                             the    concery@    abottu    the     Communications     Media     Staff     fundtions     which
                                             c effective and less expensive on a contractual basis.
                               jet be mor
                             Ilbe RAG vepci,t (page 112) is also @t.on tarfet.

                             RAG
                             Conipo,,@,.-,I.tion of @G and                       they               C)                anrl
                             t-,h-is report;.   Of' tt)c@ 1-U@G (60) 6P% @3-@                      (22
                                                              '13';f        (@rit Vol.ur@itam lir-@al,th Af,('@ncies and
                             2                          and      /,
                             otlicr@.   FC)@,',y-tlir(@,c pe@.r,cc@nt  (,)6)  of' the l@(@ ,irE- f'rorOi O'@:lF,.'-iorna City,
                                  (F)) frc,,Yn Ti-ilFa, and 4)1%  (26)  arc-,  f-r@o,-a  1.9  other  c-,orfnun:'Lti-e,-:).
                             p@          ,@@d 3 co.-Is@'@ners)          5         Oklahomc'L    City,    2    from    @ilsa,
                             and 5 fro.-,,i other communities).   T@i(@ 1,P.G met 3 t@rm@s and the E,-ecutive
                             Cori-nittee   met   6   times.   ID-ie   Manpc)@!er   Corn-riittee   met   once    and    the
                             Continuing Edu,,-at'o@-i ConTrd.ttee @, d not meet                 ID-le c@itegbiical
                             comqattees have been replaced by six new, mom @ctional committees.
                             Hcfgever, these coifrdttees v;efe            not approved until Jan@ 1972 and
                             all    members    have    not    been    retruited    and    no    meetings     @     reported.
                             As indicated in the RACT report, there is a need for better
                             0   crita@t.!,on,      well   @   j-mprov(.-@d   ociTunurL!-catiori,,-@   with   the   staff.
                             Acc@!nV, to conversations with con@ -3taf'f                     l@G will be iT.,ore involvf,,,,'
                             in the futiia,@.. i.e., Site                     cc)rfvryiltt,ce vioi@k, and earlier
                             involvement in development of                               ari(I review.

                       8.    Grantee Trist.t@iition
                             ,lyle (xrant(,(-@@ 3(:,enr3 to prOVL(I(@ a(Icqu,,tte adininii3trotive support to
                             OIW and                 J-@G flexibility                       deol.,,ioia    -Mcl     policy
                             making.                '11)e tJnivcr,,3-,I.I;y Mod:Lc,,.,L.'L C(@,nter J..,,, applicant of 9 of
                             the  io r)ropo,@,e@(i projects, in -Gne pre ent application.
                      .9.   Participation and 10.  'Local              Plbnning

                             TLiere 1-ia,- been some imor@oveiri@,nt in cooperative




                        including the CHP a and  b           and the application Includes
                        comments.
                                                     not included in the applications       indicates
                        Analysis of data from ORMP)
                                                            ing  by RAG  Core and the Tulsa-iTi',
                        significant disparity between rare      s                         ovals
                        Subregion.  'Ehere are some divergencies in CHP a and b appr
                        and'di      als.
                             -sapprov
                              rit of Tweeds and  Resources
               11.  Assessrri@
                                    )rier serves .on a "task force on health statistics" to
                        The C)R@ll-'   Plar
                        establish a data bank for Okla@io@,,qa.  O@4P has some reciprocal data
                        shariii@,, arr@,eiiic-ritr,.  C)IUln) data f,,,ithey-ing includes h(-,altli status in
                        14E Okla. , rural health :3tudi(:,-s, @tyid cont-,.i-nuiri,,,P, E.@ciucatl.orl and
                        needs.  Prol)usccl fe,,-tsilDili'-Iy 'jji(l pl,-qwli@, ,3tudi-es child
                        health,cnil)@iy.,z@c-nia, rural he'alt@i delivery,@ problem;; of' the urban poor, and
                                                                        o two Indian Ilospitals.
                        hc-iiiotolo(,r,y/oiicology consultative services t
                        Proposed project activities relate to stated goals and objectives.,

                12.     MaWelnent
                        Fiscal management seems good.  Chief of Grants Management is
                                                                          recently visited
                        attc-rrpting to strengthen fiscal control and
                        Texas PSJ-T.
                                                 ifi(D,.Iitoririg of activities by core and R A,@,s

                        w-idei-viay.
                        An FMPS T@gement Assessment visit is tentatively scheduled for June '72

                      13. alu liOn
                        In addition to the infori@,).tion (form 14, pafrc 89-90) and the staff
                        Visit to ofq4p, the             Planner and P,valuator visited at length
                        with ReS' PlanrL!nf-,, revaluation -,taf'f since submission of the  -
                        application.  In C,(.@iier,al the tvio ,-eem to work well to@rether.  There
                        is reason to be optimistic in terms of ORMP developing a viable
                        planning proces
                        [2he Planner seem to understand the need to carry out an assessment
                        of needs, relate them to resources, establish objectives and priorities,
                        and building appropriate methodologies (including tine-p@ed
                        objectives and terminal points for evaluation).
                        ,Ihe Evaluator is 1  ess impressive than the Planner, but nevertheless
                        appea-es to possess the skills and experience to effectively carry-
                        out his task.  ft\ffs Review Criteria have been modified and are used
                        in OF,@\'Ulls evaluation.  Concerns:  1) does not seem to be a procedure
                                                                                    ; and 2) there
                        fo@,              and evaluation core staff activities
                        does riot        to I)c- @i @y3'Ll-crii to det-,(L-r-r@)e Jjiil)act of activities, Oi'l
                                           targe'U uoui-115, lical't-II-) deiiVE@i,,y (qualiLy@



           oil                                   77




            14.    Action Plan (one year application)
                                                     review, tti(4, current period h
                   conL"T,Lwnt with the now three Cycle                           as
                      ext(,.ri(ded to 15 month.,,,,  Aufr.  3.@L) "I-972 (new -,t,-vt date
                                                       pror@ill(.,(l nri the currc@nt 1(,,vel.
                       3, 172), with additional
                   This vlas not known to O@ when third 8Lt)plicatli.on was submitted.
                   MCQB staff is concerned about the ayftjitiou,.-, 011-Droposal - viore than
                       the amount of the current level.  WI)i",.e 01@ has made some
                   progress, begiminZ, about Nov. '71, the nuriber of new activities
                   proposed see= unreasonable. As the Region develops a  progTain  daring,
                   the reil(vilryder of the current year and the O)t and prepares for
                   Tric,nm'.;-Ll-sub,pi.ssion, potential projects iMy have more iirportance than
                   those currently proposed. . Ileyiee, the pre-sazT staff reviewers are
                   concerned about- their subndssion of 11 new projects. It  would  appear
                   that much of the effort should be accorrplisla6d throuFh core activities
                   until a irc-,,aiii@r ul three.' year spending plan is developed.  The
                   proposed core budget could be scaled down by one third or more.
            !5i    Disser,@-nation of Knowle -e
                   Alluded to elsewhere in the report, i.e., approx. 107 project
                   performance sites, core studies, and cooperative relationships.
             6.    Utilization of M-anT)ower and Facilities
                   C;@H,,a3 do  a better i.ob of tli'is tiirouf@i better tie in w'Ltl:-,
                   other agencies  including an attenTpt to establish a state data bank.

             17.   Imp ovement of Care
                   Of those adtivities supported and those to be continued, there are
                   no iTleasurei-nents of their @act on delivery.  The CCU project,
                   requesting one additional year, will attempt to do this type of
                   evaluation. It can be reasonably assumed  that  dare  improves  through
                   support of these activities, but tangible ovidende is needed.
                   Project #19 Preceptor Pr6@am for Rural Hosp. Ll.b. Training and
                   Consultation is coTrpatible with #6-Litirary Infornution.  Support
                   of the lat'6r is being, PI=-ed out and an application    been  made  to
                   NIIiAqT-M (parts not qualifying for NIM support will be supported
                   tiu-oufj-i Core).
                   Activities receiving highest RAG rankings (8 out of 16) care #25
                   Erric,-rgcncy Health Care Irraining, #2 CCU) #15 Continuing Education
                   Center at Ada. and #14 at Bartlesville, #26 Pediatric Ilurse  Trainir-g
                   #17 Stomal Theilap  and Catherter Care, #16 Continuing Stroke Care-
                                   'y
                   Ada, #28 Continuirc. Education C6nter-. t4ercy liosp. (Core staff rated
                   5 of these 8 hi-F est). I the 8 ranked hig@iest by Core, #211  Newboryi
                                  .,h       n
                   Care in 1,TE, #23 Rural Allied 1-iealth Manpower, and #20 Corrfruriity
                   Ir-L-8ervice @ucation for Health Personnel, took priority over #i4,
                   17 and 28.








                                                                      assisting in
                               near unfold areas for stirulatilig and
                    Core studies
                    the develop=-nt of new projects in future years.

             18.    Short Ten-n Pal Of'f
                    'Ihe bii@pet sheets reflect no shaxed project support. ORMP's history
                    of phase out support (see no, 3 Continuing Support) and continuation
                    of the activities is good.

              19.   e
                    In-iey m@e well on the wa,.V-havirf,, established the Tulsa NP@, Subregion
                                            (PaEr
                    with gn Advisory Group     c 65), headquarters at Illulsa with a
                    professional and secretary,  Four more are planned in the 04 year
                    at Ada (SE)) Enid,(NC),.Bartiesville (NE,) and McAlester (SE).  Perhaps
                    there would be more wisdom in -,taffing one in the SE at Ada or
                                                                .at Enid, and using two
                    McAlester and one in the north central area
                    other field representatives from the central office to service
                    other areas.

              20.   Other, FuncdliinE
                    Already discussed... see no. 3 "Continu@ Support" and no. 18
                    t'Short 'Cem Pay Off".



  MEMORANDUM                       DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
                                                 PUBLIC HEALTH SERVICE
                                     HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION

  TO     Acting Director                              DATE: April 13, 1972
         Division of Operations and Developmer,



  FROM   Director, Regional Medical. ProETams Service


  SUBJECT: Action on April 10-11., 1972
         Staff Anniversary Review Panel
         Recommendation Concerning Oklahoma Regional Medical Program
         Application RM 00023 dated 2/l/72.




         Accepted:






         Rejected:
                                                                Date





                       Com")on(-nt An(i l,'Ii-i,iiirinl




           COI-IPONEI%"C          CLIRI"FL@IT            -04   yi.-                   YF-,AR           [tECOIllif,@iDZD
                                  YR' S A14A PD            C(I'UICT41.                                    FUli-DING
                                       OPER.              RECO,,VjEliDED         'REQUEST                    SARP
                                  YFAR                       TFVET,                                          REJ. CO!4.


      CORF,                       $3@54.000                                          ?C)77,300
      Sub-Contracts
                                       -n-                                           47

      OPER.       ACTTV.             84o5   0                                          629,732

      DF,VET,.    CO!-T.                -O-.                                               -0-     Yes         or No (x

      EAR14ARKS:


                                                                  -0-                      -0-                 -0-

                                    1-4o,62o                      -0-                   14o,690







                                                                                                            8@g,,20-
                  'CT                7@8.900                                         49]i
      R14PS                                                                                @872

      RYQUESTED                      @'2LI,c)64

      C OIN'C I L
      APPI@OVFD LEVEL                962,56)i

      NON-'R]4PS     and





                                                                                        RECIOII
                                                                                                               a

                                                                                              Tu:,,,   t972 REVIEW CYCLE

                                                                         4 I;,.
                                                                                      -d      6/71-8/72      (15
                           and    Am@s    are-to'be     iti'crease6 I.-O

                       **.,Action   on.FX@    'oroposal. (project      #25)  pending special       review.
                                s  ($140,6ab)' L-or     that project     not D.n.c luded   In   this    fio.Lre.




                                                                            6kl ah
                                                                  REGI
                                                                  REVIEW:           One     197   Z
                                                                                -@ati on      AR
                                                                  Type, of.,-. APPI i
                                                                    D.ri or @,to tri enn i 61
                                                                              Z29
                                                                    RAti  ng,

                              RECOMMENDATIONS FROM
                                                                   Re v i ew. commi tt6e
                 SARP
                                                             L=     CoOncil:
                  Si te Visit

       RECO MENDATION:  SARP approved staff's comments       and recommends approva       n
                          the reduced amount of $839,205     (d.c.).    This does     not.include
                                    dical Services (EMS) project #25,     pending  special
       action on the Emergency Me
       review.  See Briefing Document page B.
       RATIONALE:  The recommended level of $839,205 is the am6unt'@re"c'ommended       for  the
                    uj year prior to the April '71 funding reductions'         Staff   anal
                                                                                          ysis
       of the request also reveals this amount is adequate.
       CRITIQUE:  As reported to the Staff Anniversary Review Panel (SARP)         by   the
                   Mid-Continent Operations Branch (MCOB) staff,. subsequent        to  the
       submission of the subject application, all Regional Advisory Group .(RAG)
       Committees have been recruited and have met once.  The re'viewers--were concerned
       about  significant  differences  of  project  ratings  by  RAG  and  Program  Staff.
       With regard to disparity in Comprehensive Health Planning (CHP)@a and b,agenc-ies
       response, MCOB reported that Oklahoma Regional Medical Program- (ORMP)         met" wi th
       CHP representatives March 15, 1972 in an effort to evolve@ a better, understanding
       in this area.    In response to questions by the reviewers, MCOB.staff Advised
       that the status of the current Coordinator remain unchanged.





                                                        Review Cycle  June 1972

                                                        Type of Application  Triennium

                                                        Rating     21.

                                        Reco@endations From


                     SARP                          /X        Review   Committee


                     Site   Visit                            Council-



            Critique:  Committee recommended that Oregon PM 's Triennial application be
                       approved and that additional funds be provided in support of t e
                       R@gion.

                                            Funding'Levels
            Operational Year.    Developmental     Growth    Program    Project      Total
                                   Component        Funds     Staff     Activity    -Award

                 05 year
            (9-1-72  to  8-31-73)     -0-           -0-      $519,718   $401,812 1/  $9211530

                 06 year
            (9'1-73  to  8-31-74)  $75,000         $250,000  $427,336   $285,773 2/ $1,0389109

                 07 year
            (9-1-74  to  8-31-75) .$75,000         $250,000  $437,719   $246,201 3/ $IiOO8,920
                               1/  Includes  $86,812  for project  26  (Kidney)
                               2/ Includes  $62  954  for project  26  (Kidney)
                               3/  Includes  $47,963  for project  26  (Kidney)

            Committee agreed withthe site visitors' recommendation to fund the ORNP
            at the above levels.  It was noted that ORMP was moving further away  rom
            a primary emphasis on heart.disease and continuing education programs and
            has redirected its program toward new health care delivery systems.  The
            ORMP coordinator and program staff are extremely qualified and the site
            visitors had no question that ORMP had a cleat understanding of their goals
            and how to obtain them.





           Oregon RMP                          -2-                   RM 00012
           Committee questioned growth fund activities but were satisfied  that  there
           was a difference between the developmental component (D.C.)  funds  and
           growth funds.  ORMP sees the growth funds being utilized for specific major
           --program activities (projects) and D.C. funds as flexible funds to be used
           with program staff direction.  ORMP asked assurance that should ongoing
           planning, feasibility, and staff directed activities be fully developed,
           that their levels for 06 and 07 years be adequate to support  new  projects
           as they develop.

           Areas of progress and positive accomplishments include  the  following:

           1.  Due to the vigorous efforts of the coordinator and his  staff,  ORMP
               has been turned Around from a physician oriented program to  one  o
               broad acceptance by many groups.

           2.  ORMP program staff plays an active-role in stimulating needed activities
               whereas before the role was a project clearinghouse operation.

           3.  Project guidelines have been strengthened to include  budget  take-ovOr
               and evaluation mechanisms early in proposal development.

           4.  Progress of activities can be continually monitored by a budget control
               system which plots monthly expenditures versus units of accomplishments.

           5.  Most of the continuing education programs and heart disease activities
               have ended And new priorities focus on health delivery systems to meet
               local and national goals and objectives.

           6.  The Region is encouraged to continue their positive efforts in
               developing and maintaining Peer Review Systems.

           Areas of concern requiring attention during the coming year include:

           1.  RAB should be broadened to include more  consumer  representatives.
               These should be real consumers without direct or indirect  ties  wit
               other organized health agencies or interests.  More  allied  health
               professions and minorities should be included on RAB And other
               decisionmaking committees.

           2.  A deputy coordinator should be hired to assist with the overall program
               administration.  With the new ORMP ventures, the new director of the
               Needs Assessment Unit might serve in a dual role as deputy coordinator.

           3.  Additional program staff with adequate salary scales are  needed  to
               implement ORMP's new goals and objectives. Current  salary  scales  are
               inadequate to attract new personnel and to keep the current, highly
               qualified staff.  ORMP should investigate the possibility of higher job
               retlassifications with the Grantee and resolve the  salary  problem.





           Oregon RMP                         -3-                   RM OOOi2

           4.  A health information data bank should be developed to prepare ORMP
               for new health delivery programs three years  ence.

           5.  Project evaluation studies are needed to show improved health care which
               has resulted from RMP sponsored activities. Studies  should  pinpoint
                                            I
               minority access to better health care services.

           6.  ORMP should carefully review some of the growth fund activities  with
               other areas of the country, and document successful ones which  could
               be adopted in Oregon.

           Summary of Recommendations

           Approval of the triennial application is recommended by Review  Committee
           which includes growth funds and developmental component funds for the
           sixth and seventh operational years.  Committee recommends that the above
           concerns be communicated to the Region in the advice letter.


































                                                                        WOB/RMPS
                                                                        5/22/72






                                                   -COMPONENT AND FINANCIAL SUMMARY         TRIENNIAL         Regionb    Oregon RMP
                                                                                                                 Review gycle:  June     1972
                                                                                                                1

                              'Previous Yr's Award                       Requested                            Committee Recommended   Funding    LeN
                              From Apr. 1971 to Junel/                                                     From Sept. 1972 to August 1975
    Component                 1972 Operational Year               05              06              07            05            06              07

    ?rogram Staff                 $    275,407              $   519,718   $    427,336       437,719      $  519,718       $  427,336    $    437i?

    )per.   Activities                 470,979                   409,940     311   494       289,810         401,812          285,773         246,2

    Developmental Comp.                  -0-                     -0-            75,000       100,000            -0-              75,000        75,0
    ;rowth Funds                         -0-                     -0-         775,000         80010000    11     -0-           250@000         250,d

    )ubtotal                           746,386                   929,658     1,588,830       1,627,529       921,530          1,038,109     1,008,9

    @pecial Funding

     Kidney                              -0-                    (94,940)     (88,615)         (91,572)         (86,812)  2/  (62$954)   2/   (47919
     EMS  Proj. #027

    UPS  Direct   Cost                     86                 929,658                                        921,530          1,038,109      1,0081

           dir.                        183,402                 151
    MS In                                                           ?654

    'otal RMPS                        $929,788               $1,081,312
                                                                           1/  Two  months  extention   (July-August   72)   approved   for   $161,

                                                                           2/  Recommended by Technical site visit team on May 4, 1972

    16N-RMPS  &  Other                                                       Pending is the following:
      Income                            26,143                   91,009      EMS Project 027         532,950
    .Udget Total                    $955   931            M,172,     321
                                                                             Current Program
                                                                                Request              929,658
                                  $1,01;7,323(Revised) @)
    requested                                                                   Total
                                                                                  Requested.   $1,   462:0608
    ouncil  Ap   loved
              P,
       Level
                                  $1,064,291






                                   REGIONAL MEDICAL PROGRAMS SERVICE
                                SUMMARY OF A TRIENNIAL GRANT APPLICATION
                                       (A Privileged Communication)
                OREGON  REGIONAL  MEDICAL   PROGRAM                       RM 00012  6/72
                3181 S.W.  Sam  Jackson  Park  Road                       May 1972 Review Committee
                Portland, Oregon  97201

                Program Coordinator:  J. S. Reinschmidt, M.D.
                The Oregon  Regional  Medical  Program  is  in  its  fourth  operational  year.
                The direct cost for the present grant period (April 1, 1971 to June 30,
                1972) is $746,386  and  indirect  cost  is  $183,402  which  represents  a  48.32%
                rate for an campus and authorized off campus rates.
                The Region is ranked 28 in overall funding with a per capita rate of $.44.
                The ORMP has submitted a triennial application for the period July 1, 1972,
                to June 30, 1975, which requests direct costs of $929,658 for the first
                year, $1,588,830 and $1,627,529 for the second and third years.  The
                triennial  application    proposes:
                        1.   Continuation of core staff beyond approved period of support.
                       II.   Continuation of  one  project  beyond  approved  period  of  support.
                       III.  Continuation of  one  project  within  approved  period  of  support.
                       IV.   One approved project, not previously initiated.
                        V.   Five new projects, not previously approved.
                A breakout chart identifying the components for each of the three years
                is included as part  of  this  summary  on  pages  '@-4.  It  should  be  noted
                that ORNP is requesting increased funding in the second and third years
                of the  triennial  program  for  the  development  of  the  following  activities:
                                                                Second Year         Third Year
                        I.  Developmental Component             $   75,000             $100,000
                       II.   Patient Transportation                 75,000               50,000
                               System
                       III.  Peer Review System                     50,000               50,000
                               Development
                       IV.   Television Communication             125,000             175,000
                               System
                        V.   Demonstration of a Primary           150,000             150,000
                               Entrance Clinic
                       VI.   Demonstration Family Practice        150,000             150,000
                               Clinic
                       VII.  Feasibility Study and Develop-       100,000             150,000
                               ment of Area Health
                               Education    Centers
                      VIII.  Patient Origin Study                 125,000                75,000
   Jo















                         FEtiQuAQY 22,1972                                                                                                                          REGION     -      OREGON
                                                                                                       tiPFAKLIUT OF  PLQUFST                                       Rm   00012 06/72
                                                                                                         05 PR(,GRAM PERIOD                                                                     RMPS-OSM-JTOGRZ                 09
                                                                                                                                                                                                                                 0
                                                                                                                (4)                (1)
                     IDE'4T IFIC AT[ D@4 OF C OM PC@N E.% I      ICO'4T.     WITT$INI CUNT.     !IFYfiNril APPP.  NOT         I -NEW,  NUT        I    IST YEAR        I  IST YEAR         I
                                                                  APP9.     i'ERILIDI  APPR.     PERI()Ill PREVIOUSLY         I PREVIOUSLY        I      DIP EC T      I  INDIRECT         I      TOTAL
                                                                  OF SUPPORT        I  UF SUPPORT        I FUNDED             I APPROVED          I      COSTS         I     COSTS         I

                     COOO CURE  SUPPORT
                                                                                                                                                  I      $51q.71R      I     &I  I   3.L5.1"          1633,292  1
                                          --  --------
                     '70     i)PLJ  A   Y   EARE   TRAI'41'IG   PI                  I                    I                    I                   I
                         E211.CL  -        -        --------------I-     -      -------                                       -  -   --   -   -   -I-           $ZI.Ll@-                            S32.9iO
                            TLiAl.@l-@iG  P-Z:),-,QAM  F,-!D  PELI                  I                    I                    I                   I
                                                                 ------                                                       t --   -   -    -----                                                 S24,372
                     ois    optp   SERV   fit    RL.,40T.E    Cnpl                  I                    I                    I                   I
                                                                                                                              -------------                                                         &99.RSI     I
                     322    F-MFRC,   FE[)   TECH   TRAI@4ING    I
                                                                                                                                                                                19,212     1        S67.A64     I
                                                                                                         ---     -     -------- ------
                     123    MOBILE CANCER  NFTECTI@)N            I                  I                    I                                        I                    I                   I                    I
                     --- :.Lit[IC ----------------             ---i-------------                                                                  I                    I                            &63.4'4  A  I
                     n24     CC,,MMUNITY     CAPICER      SEPVICEI                  I                    I                    I                   I                    I                                        I
                       --A!IU-LL AL@UG                                                                                                       12   1       S 2 !I @.1 2 I                            $24,617     t
                     .IiS   C 0 '@ li U-4 I T Y S I; r K E R E @l A A I L I                                                                       I                    I                                        I
                                                       -----------                                                                                                                                  $29,679     1
                     ')26   CAUAVF.Q      KID%EY       PO,),@PFME]                                                                                                                                              I
                                                                                                                                                                                                      Stlt.444  I
                            ESTIMATEF)    GRnwTH     F-UNR)S     I

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

                                         TOTAL                          $24,373            $546,887              $99.85L            S256o547      1      $9291658      1     Sl5lv654      1        $LvO8lo3lZ












                                                                                                                                                                                                                                  C)


                                                                                                                                                                                                                                 ta















                                                                                                                                                             REGION - OREGON
                      FEBRUARY 22,1972
                                                                                                 flQFAK@Ut  (IF  kF4jULST                                    pH   03012 06/72                                          m
                                                                                                    06 PKOGPAM P[kit)D                                                                  RNPS-OSM-JTOGlt2              00

                                                                    (5)                 (21               (4)                41)
                  IDENTIFICATION       OF       C014PONENT   ICONT.    tilTHI,%l    CONT.    REYON')L APPA.  NOT          NEw.  NOT         I    2ND YEAR
                                                              APPA.    PERIODI     APPR.     PEO[I)DI PREVIOUSLY          PREVIOUSLY              DIRECT
                                                              OF  SUPPORT         Of  SUPPORT         FUNDED              APPROVED                COSTS

                  COOO COPE StiPPIOT
                                                             .. . .......


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


                                                             --- - ------
                  -018    IIPFR   S@"V   FOP   @Fmi!Tf    CURI
                                                                                                                    ILL -    -    -----------
                  -12 Z   F ME 0 G ME D T EC H T R A I N I NG
                                                                                 -    -    ---------- -------------
                  72  3   40f,[Ll    CAIICFP    DETECTION    I                  I                      '                I                   I
                  --.LLINiC    ---------      -      ---------
                  @-24    r.,j),'4U'4lTY   CAr4CER    SERVICE[
                    --- AILI-IEAIN N@,
                  ;25   C(:-":)IiITY    ST,(O',E    RE:HA131LI
                                               --            I                                       --- - --------
                  526     CAC),\VEP    KIL)'4FY     PRCCURimEl
                                            --------------   --- - - - -----     -------- -                                                                      ------                                   ---
                          E:STIMATED    GRCIWTH    FLIN,)S

                                          -----------
                                       TOTAL                                           $436,500             $53,508         SIP098#822      1   Slt58S983C      I








                                                                                                                                                                                            REG13N  -  OREGON
                  FEi3PU4,QY  22,1972                                                                            eREAK(IUT  (IF  PEQ@IEST                                                   RM    00012  0    6/72             RMPS-G$M-JTOGR2
                                                                                                                   07  ppoGRtm  PERIOO

                                                                                                                            (4)                                                                                                TOTAL
                                                                                              LUNT                     Allil;j .                                             3ki)  YEAR                                                                              m
              lt)Ft4TIFICATI,),4  nF  C014PO,'.FNT                  IC(i,4r.       i.ITHI.@ll                          ;)ZTVIJUSLY                      P@c-V[uUSLY           DIRECT                                       ALL YEARS                                OQ
                                                                    IAnP@.          PEPIIIL)I AVP'                                                                             COSTS                                    JOIRECT  COSTS           I
                                                                    OF  ST)PPDKI                   ',Li'POiT        I  FUNr)E3

              C)03  r(;E  SuPP,iiT                                                                                                                                             S4i
                                                                                                                     --- - --------           -------
                          p             ARE      TFZAltll'4G       Pi
              11) (i                                                             ----------- ----------
              --- iai@E-T    --------------           -           --- i--
              t) 1 6   Ti-Al,'41N-,      PRO-,PAM      F,IR      PERI

                                                kC-i',TL        C('RI
              r,ld     qpep  SFRV  FIJR
                                                                                                                                                                                 S46,675

                                   CA!4CEP       E--TTZTI    [)N    I
              o23      4tia I LE
                   r   "IL
              -                                                                                                                                                   7,   I                                                                           ti
              024      Col@m,,JNITY         CA@@CFP          SFRVICFI
                                                                    ---    -    ------     -
              C,2 5    r.(,,-mLr@ITY        STRt'KE         RE@IABILI
                                  Ezj.12L 1              ------------ ---- - --
                              V @ Q  K I       y  p  qoc  U4  E  M  F
                       C A,;                                                                                                                    ------   1.L4iz?.-         --iq                  t

                       ESTIMATED  Gk.)mTH  RUNL)S
                                                                                                                                                                  44         $1,627,529                                        $4,146.017
                                        TOTAL                                                        $437,719                   $28,966                   -$1,16098









                                                                                                                                                                                                                                                                         01%










                                                                                                                                        .i -



                                                                                                                                       .   .                                                             I
                                                                                                                                                                                                                                     I






            Oregon RN?                                             RM 00012  6/72

            Funding History
            A complete funding history to date is included on page 6.
         I. Description of the Oregon Region:  Oregon is a roughly rectangular coastal
                                               state situated in  Northwestern  United
            States and bounded by Washington, Idaho, California, and Nevada.  With an
            east-west length of almost 400 miles and a north-south width  of  nearly
            300 miles, Oregon's 97,000 square miles of area makes it the tenth largest
            state in land area.
            Oregon is divided into three topographical areas by two longitudinal
            mountain ranges, the Cascade Mountains, and the coastal  range.  East  of
            the Cascades is a high, semi-arid plateau comprising  approximately  two-
            thirds of the state's area. On the Pacific side of the  western  ridge  is
            a narrow coastal strip.  Between the two ranges lies the more heavily
            populated Willamette Valley, which averages 50 miles in width.
            Eastern and Cascade portions of the state have great seasonal  shifts  in
            temperature.  The Willamette Valley and coastal areas are much more
            moderate in climate except for heavy winter rains and  considerable  low-
            lying fog.  Oregon's weather, together with the distances involved,
            imposes a great deal of isolation on remote areas during much of the year.
            Oregon has 2,145,000 people. Approximately 45 percent  of  the  population
            resides in the Portland Metropolitan area, situated in the Northwest
            section of the state. Including Portland, 69 percent  of  Oregonians  live
            in the Willamette Valley.  Several immense Eastern counties are populated
            with as few as 5,000 to 25,000 persons.  These counties are several
            hundred miles distant from Portland and other larger valley towns.
            Racial and ethnic minorities constitute less than three percent  of  the
            total population. (Negroes a little more than one  percent;  Indians  and
            Orientals each about 0.5 percent; and Spanish-Americans approximately
            0.2 percent.) Blacks and Orientals tend to reside in  urban  areas,  while
            Indians and Spanish-Americans are predominantly rural  in  distribution.
            Lumbering, metal industry and agriculture remain Oregon's major industries.
            The state presently has an unemployment rate of 5.6 percent.  The Portland
            area contains the only medical school; of the state's  2,700  physicians,
            2,300 reside in Metropolitan Portland and the Willamette Valley.  A
            similar distribution pattern applies to other  health  personnel.  There
            are 83 general hospitals in Oregon with 8,738 beds.  Of  these  hospitals,
            39 have less than 50 beds.





                             Oregon RMP
                                                                                    -6-                                  RM 00012 6/72.




                                                                             OREGM    REGIONAL    MEDICAL    PROCRAM
                                                                             FUNDING  HISTORY   OPERATIONAL   GRANTS
                                                                                  (Direct   Costs   Only)
                             No. Project                    Awarded 01       Awarded   02     Awarded 03           Awarded 04        Awarded    Requested 05
                                                                          4/i/69-3/31170  4/l/70-3/31/71  4/i/71-@@6172              Total      7/l/72 6
                                                                                                                                                       2- /30173
                   CO       00 Core    I/                                    $198,521            $244,073          $275,407          $718.001   $519,718
                             1Heart, Cancer, Stroke         $1@,242          150,035             174,204           163,578           669,059
                             Circuit
                             2Early Diog. & Therapy         152.436          144,012             27,825                              324,273
                             3Surgical Treatment
                             of Vascular Lesions            9,375            10,281
                             4Comprehensive Stroke                                                                                   19,656
                             Care with Regional Ed.         44,800           51,396              56,859            .61,001           214,056
                             3Project Evaluation            22,578           27,621              31,567                              81.766
                             6CC Trng - Salem Hem Hosp      54,084           46,225              32,164            45,210            197,683      27,169
                             7CC Trng Sacred Heart Hosp     59,772           69,345              73,848            52,891            255,856
                             9Central ore& Heart, Cancer
                             and Stroke Pilot                                26,367              24,233            23.070            73,670
                             19 Coronary Care Teaching
                             Aids                                            12,774              4/ .5,572               713         19,059
                             11 Guiding Adult Patients
                             With Asphasts                                   27,120              27,019            21,980            76,,llg
                             12 SO.'Oregon Diabetic last-
                             -Evaluatt                                       18,064              22,091                              40,155
                                      0"
                             li Mobile Emerg. Cardiac
                             Project                                         39,499              6,249                               43.748
                             14 Trng. Pro&. Care of
                             Diabetic Patient                                32,886              39,285            28,815            100,986
                             15 Phys. In Res. Course
                             ITech. Cardiology                                                   28,920            32ii99            61,519
                             16 A Training Program for
                             Personnel of Oregon Hosp.                                           23,4X9            39,122            62,541     24,373
                             27 Diabetic Patient
                             Project                                                                               (9,762)2/
                             18 Coronary Care
                             Monitoring
                                                                                                                                                99,851
                             20 Corn. Coorde/Cont. Med.
                             Education     -                                                                       (9,945) 3/
                             22 Emerg. Med. Tech. Tr&. for
                             rural areas
                                                                                                                                                53.452
                   23        Mobile Cancer Det. Clinic
                                                                                                                                                63,438
                   24        Comm. Cancer Ser. & Its.
                             Program                                                                                                            24,632
                   25        Comm. Stroke Reb.
                             Program                                                                                                            22,085
                   26        Cadaver Organ Procure-
                             men t & Tissue Typing Pro.                                                                                         94,940
                                  TOTAL                     522,287               854.146        837,328           746,386          2,960.147  7i2-9,655



                             NOTES:  1. Core   Budget    (first year);  merged  with   operational,in   the   second   operational   year.
                                  2.  Project   117    funded from   Core   Budget   8/5/71
                                  3.  Project   #20    funded from   Core   Budget   8/5/71
                                  4.  Project   PIO    funded 5,572  +  3,200   from   care    8,772 3/25/71





               Oregon RMP                                               RH t)WI2  6/-12

         II.   History of ORHP Development
               ORNP was funded for planning in April 1967 and became operational exactly
               one year later, following an enthusiastic endorsement from a site visit
               in February 1968.
               In early 1968, OMe was concentrating on recruiting needed staff, assessing
               the medical needs of the Region, setting  proper  priorities  for  action
               plans and setting up adequate evaluation mechanisms.  At that time, the
               National Review Commi ttee had its doubts about  the  Region's  readiness
               to move into the operational stage, however,  the  site  visitors  seemed
               satisfied that a working list of.objectives and  a  scheme  for  setting
               priorities had been developed and that core was  capable  of  moving  the
               program into this phase. The Region  was  encouraged  to  arrange  for
               assistance from the College of Education of the  University  of  Oregon  for
               better evaluation of the program and some  of  its  projects.  In  October
               1968, Edward L. Goldblatt, M.D., replaced Myron R. Grover, Jr., M.D., who
               had served as the original program coordinator.
               The ORNP was site visited again in April 1969 and  the  team  was  greatly
               impressed with all aspects of the program, including core staff, Regional
               Advisory Group, and evaluation efforts.  The program appeared to be
               heavily provider and continuing education-oriented,.and there was evidence
               that-staff-was beginning to involve many  groups  throughout  the  Region.
               The report stated that the application  was  an  unusually  well-written-
               cleat "Model" application. The team concluded  that  ORMP  was  as  good
               as the words written About it. The ORMP  staff  had  a  sound  understanding
               of the purpose of RIIP and the abilities of Dr. Edward  L.  Goldblatt  and
               Dr. Delbert M. Kole, Coordinator for  Project  Development,  were  favorably
               noted. Relationships between ORMP and  Oregon  Medical  School  were  more
               than adequate.
               The Region's request for continuation of core and  ten  projects  for  the
               third year was well-received by RNPS staff.  It  appeared  that  the  Region
               had come a long way in establishing itself  as  a  broadly-based,  ongoing
               program as opposed to a series of isolated projects.  The RAG chairman,
               Dr. Herman Dickel, was proud that all projects  submitted  by  Oregon  had
               been approved for funding at the National level.  RAG had seemed to
               develop an awareness of local autonomy and  had  developed  a  mechanism
               for evaluating both incoming  proposals  and  ongoing  projects.  Some
               projects were terminated early as a  result  of  this  evaluation.  To
               further this internal evaluation effort, a contract  was  let  to  the
               Northwest Regional Education Laboratory to  evaluate  the  policies  and
               procedures of the core staff.







                                                                                 101  00012  6/72
               Oregon RMP                          -8-
               Two changes in leadership took place     in the third year.  Dr. Goldblatt
               was replaced by Dr. David Johnson, who served as Associate Professor of
               Public Health and Preventive Medicine     at the University of Oregon.
               Dr. Johnson resigned in November 1970     to  become  Regional  Health   Director
               for Region X, and was replaced by Dr.     J. S.  Reinschmidt,  who  had  been
               with the Student Health Service for the past seven years..
               During the four years  since  its  first  operational  award,  the  ORMP  has
               submitted  project  applications  regularly.  Eleven  projects   plus   core
               activities  constitute  the  current  program.  The  new  coordinator   has
               had a year of REP involvement.
               Some of the  more  notable  events  which  have  transpired  since  the  inception
                                           e'--'fi- t ' -
               of the Program  in  1967-ar  t  a  the  influence  upon  heart  disease  has  been
               unswerving and unmistakable.  From the start, the Board launched a
               concerted  attack  upon  acute  myocardial  infarction,  and  ORMP  efforts
               have undoubtedly shortened the interval required to implement improved
               techniques in the treatment of patients with this condition.  Two
               coronary care unit projects  have  schooled  scores  of  nurses  for  a  new
               life-saving  role  as  electrocardiographic  monitors  and  initiators   of
               urgent  cardiac  therapy.  Another  project  offered  analogous  courses   to
               physicians, with special emphasis upon the insertion of emergency
               pacemakers.  Exploration  of  radio-telemetric   monitoring   of   coronary
               patients while in transport to the hospital has continued.
               Continuing education grants-have been ORW forte from the        very    beginning.
               The Circuit Course Program, the first project funded, continues in its
               fourth year to provide courses to physicians, nurses, and allied health
               professionals  throughout  the  Region,  Idaho,  and  Montana.  other.   training
               projects have  been  instrumental  in  providing  a  network  of  volunteer
               directors of medical  education  on  a  statewide  basis.  With  one  or  two
               exceptions, the continuing  education  projects  will  come  to  an  end  on
                                             k of  a  constellation  of  projects  will  commence
               July 1, 1972, and a new loo
               on that date.


        III.   Performance
               In planning for the  next  three  years,  the  Oregon  RMP  has  reassessed  core
               and project activity in the light of changing national priorities.
               ORMP RAG has adopted three major goals and recognizes an increased Federal
               emphasis upon them:     (1) improving  access  to  health  care,  especially  for
               disadvantaged  urban  and  isolated  rural  populations;  (2)  enhancing  the
               quality of primary and other health services in Oregon; and (3) containing
               unit costs of  health  care  by  promoting  greater  efficiency  within  the
               delivery system.  The proposed projects, core endeavors, and other ORHP
               activities have  been  designed  as  a  move  toward  meeting  their  objectives.






              Oregon  RMP                      -9-                   RM 00012  6/72
              Core staff's most important consultative and planning contributions
              during the past year:
                        The newly  organized Gresham Clinic for the indigent.

                        The jos6phine-Jackson Counties Health Maintenance
                        organization planning application.

                        Physician assistant/nurse practitioner training program.

                        Family practice primary entrance clinics, and outreach
                        worker training program.

                        Concentrated employment program.

                        Metropolitan Portland Comprehensive Health Planning Association.

                        Multnomah County Public Health Division.

                        Model Cities, Tri-Metropolitan Bus System.

                        Multnomah-Clackamas Counties Association for retarded
                        children.


                        City County Council of Aging.

              Five feasibility and planning studies are now in progress and one
              additional study is proposed.  These include: patient origin study and
              health care utilization data system; a patient transportation system; a
              demonstration family practice clinic; a primary entry health care clinic;
              and a peer review system in collaboration with the State Medical Society.

              A.  Goals

                  The ORNP has elected to work toward the following:

                  1.  To improve the accessibility of primary health services in
              impoverished urban and isolated rural areas of Oregon through the
              stimulation and support of activities which:  (a) augment the supply of
              health care personnel and resources, or otherwise enhance the capacity
              of the health core systems; (b) encourage a more equitable geographic
              distribution of health dare personnel and resources; (c) facilitate the
              more effective emergency and routine transportation of patients or of
              health care personnel; (d) utilize new types of health personnel or






                                             -10-                 RM 00012  .6/72
             Oregon RMP                                                       -
             traditional health team members in innovative ways; (e) kTprove the
             continuity and comprehensiveness of health care delivery; and (f) facilitate
             the implementation of the Emergency Health Personnel Act which  is
             designed to place public health service physicians in areas with  other-
             wise unsolvable primary health service problems.
                2. To improve the quality of primary and  other  health  services  in
             Oregon with particular but not exclusive emphasis upon the  prevent  on,
             early detection, and rehabilitation of heart disease, cancer, stroke,
             kidney disease and other conditions deemed of major importance  by
             regional agencies by means of:  (a) encouraging the formation of peer
             review and ombudsman committees; (b) promulgating the  most  efficacious
             techniques of disease control in primary medical practice, and
             (c) facilitating the establishing of subregional education centers.
                 3. To contain or reduce unit costs of health care  delivery,  an  to
             promote greater efficiency with the health care delivery system by
             (a) promoting cooperative managerial arrangements which permit  quantity
             purchasing, nonduplication of services, sharing of  resources  and
             expanded use of ambulatory care units or outpatient facilities; (b)  en-
             couraging the development of utilization review committees  within
             appropriate medical agencies; (c) stimulating consideration of automated
             and/or computerized record keeping systems, data storage  and  retrieval
             methods, and multiphasic screening techniques; and (d)  encouraging  the
             use of those health care resources which provide the least costly method
             of service per unit without compromising the quality of those  services.

             B.  Methodological Objectives
                 The Region has enumerated six methodological objectives for  achieving
             the three major goals. These include the conduct  of  specific  projects
             with staff support and expertise in developing them in concert with
             ORNP goals, to provide educational experiences for providers  of  health
             services and the general public, to provide data and information on
             health care resources, to cooperate with CHP agencies, and to  continually
             assess the management and organization of ORNP staff, Board,and  Committee
             systems.


        IV.  Process
             A number of organizational reconstructions has taken place with the
             Committee structure and program staffing.  The former Grants Application
             Review Committee has been renamed the Program and Application Review
             Committee to signify an expansion of preview beyond  pre-Board  scrutiny
             of individual project applications. The committees  new  charges  include:
             (1) assessing compatibility of all proposals with ORMP programmatic goals;





               Oregon RMP                                             RM 00012  6/72
               (2) advising all proponents of unsolicited project ideas on relevance
               to the triennial plan prior to the furnishing of definitive developments
               assistance by staff; and (3) recommending to the Board priority rankings
               for all approval project activities. - Conversion of the  Regional
               Cooperation C,  ittee into the Health Resources Development Subcomittee
               brought about a cadre of knowledgeable Board members, assisted by a
               rotating panel of experts, to address each health care delivery proposal.
               Still another change in siibcomittee procedure is the rescinding of a
               former rule that all project applications be reviewed  by  the  Continuing
               Education Subcommittee, in view of the program shift,this no longer is
               a requirement.  At the present time, each project proposal is reviewed
               by the Program and Application Review Committeeby the Evaluation
               Committee (to ensure adequacy of design), by the new Comprehensive
               Health Planning Subcommittee, and by either the Health Resources Develop-
               ment Subcomittee or a single  technical  subcomittee  appropriate  to  the
               predominant thrust of the application. All proposals  are  given  a  final
               verdict by the Regional Advisory Board.
               Eleven committees or groups form the framework of the Region.  All are
               standing committees with the exception of the Ad  Hoc  Triennial  Applica-
               tim Review.

                                                                            Number of
                                                               Members      Meetings
                                                                            Last Year

                       Executive Committee                          9           11
                       Program Application and Review             10            3
                         Committee

                       Evaluation Committee                         7           5

                       Health Resources Development                 8           2
                         Subcomittee
                       Comprehensive Health Planning              11            1
                         Subcommittee (activated
                         November 4, 1971)
                       Kidney Subcommittee                        13            2
                       Ad Hoc Triennial Application Review        10            3






                                              -12-                    R14  00012  6/72
            Oregon RIIP                                                              -
                                                                           Number   of                ir
                                                              Members      Meetings
                                                                           Last   Year                L

                                                                  8             2
                     Heart subcommittee,
                     Cancer Subcommittee                          9

                                                                  8
                     Stroke Subcouwitttee
                     Continuing Education Subcommittee            9
              Organization changes in core staff reflect a markedly augmented    level
              of activities for core personnel. Core  is  now  divided  into  fIour distinct
              units: (1) Program  Administration;  (2)  Needs  Assessment  and  Continuing
              Education Programming; (3) Specific Disease, and (4) Health Resources
              Development. Each unit professes  its  own  set  of  operational  objectives
              although personnel fully interchange between units for purposes of economy
              pnd integration.  Some staff members assigned to the Needs Assessment
              Unit are derived from  individuals  presently  working  within  the  circuit
              course project.
              The Program Director is  immediately  accountable  to  the  Oregon  Regional
              Medical Program Chairman, Executive Committee, and Re ional Advisory
                                                                      9
                       effective overall  functioning  of  progiam.staff  And  project
              Board of
              personnel in meeting the goals and objectives set by the RAB.  In
              addition to assisting  the  Program  Director,  the  Program  Administration
              Unit provides consultation and  assistance  in  development  of  project
              activities.  This includes fiscal management of projects and activities,
              designing evaluation techniques, and designing informationa'l-communication
              techniques.  The Needs Assessment and Conti              tion      Progrann@
              Unit, as a major problem-solving and needs               omponent, will
              promote the quality of health services in Oregon.  The number one
              objective will be to establish a network of problem_   solving groups composed'
              of physicians and led by A trained coordinator.  Also, 13 local nursing
              groups will be established along the same lines.  The SDecific Disease Unit
              will have the primary  responsibility  for  activities  focused  on  improve
              health service  through  prevention,  early  detection,  and  rehabilitation
              of the major diseases.  Primary monitoring and liaison interface between
              OPM and projects will be a specialized objective of this Unit.  Health
              Resources Developmen@t UunnittL will focus on improved accessibility  of
              primary health services for impoverished urban and isolated rural areas.
              Identification of meritorious project activities which can be transferred
              to other communities and agencies and to offer consultation will be two major
              thrusts of this Unit.






              Oregon RIIP                         -13-                    RM 00012  6/72
              The core positions will be increased to ten with six of these full-
              time; two, 95%; one, 757.; and one, 507. time.  The positions of Healt
              Care Needs Assessment Unit and Project Liaison Officer are vacant.  This
              staff will continue the facilitator, convenor role in the Region;
              implement  the  Needs  Assessment  Program;  develop  programs  for  the
              medically indigent; assist in terminating projects; and explore area-
              wide health education activities.  Total funds requested for salary and
              wages of ten positions plus eight supportive personnel is $231,266.

         V.   Program Proposal

              The ORNP requests $1,081,312 (direct and indirect) for the first increment
              of a three year period, July 1, 1972, to June 30, 1973.  This amount
              includes core activities, feasibility studies, two continuation projects,
              and six new programs.  Developmental Component funds are not requested
              for the first year.  It should be noted that increased funds are requested
              in the second and third  years  of  the  triennial  and  these  will  be
              extensions of formal projects and potential subcontracts; a variety of
              other ideas for activities has been explored by program staff.  These
              activities have not been fully developed, however, they are included in
              the estimated funding  section  of  the  grant  and  will  be  addressed
              separately.
              Core Sgpport (COO)                                          Requested
                                                                          Fifth   Year
                                                                           $519,718

              The staff will be increased from six to ten professionals and from
              five to eight supportive personnel.  Six feasibility and planning
              studies will be conducted during the year.  The following broad estimates
              of time/effott allocation  have  been  made  for  core  staff  based  on
              requested funds:
                       Program Direction and Administration--267.
                       Project Development, Review, and Management--43%
                       Professional Consultation, Comittee Relations--22%
                       Planning Studies and Inventories--5%
                       Feasibility @tudi-es--47.

                  Sixth Year                                              Seventh Year
                    $427,336                                               $437,719








                                                                  RM 06012  6/72
             Oregon RMP                     -14-                              -
             project #006--Coronary Care Training PrograiA-       ReqiAested
                                                                  Fifth Year
                                                                   $27,169
             This project was initially funded beginning July 1, 1968, with April 1
             as the anniversary date.  on April 1, 1971, it began fulfillment of a
             15-month renewal application so that, in total, the project will have
             completed 48 months of operation on June 30, 1972.  To offset the cost
             of the program, a tuition charge has been implemented.  The activity is
             entirely compatible with the general goals of the ORNP and is germane to
             the State's comprehensive health plan.
             Future program activities will be financed by increased tuition, indirect
             subsidy by Salem Hospital and the development of an endowment fund
             derived from private individuals and corporations of sufficient size to
             provide adequate income for the project.
             Continuation support is requested for one year only to train an
             additional forty nurses in coronary care.
             Project #016--A Training Program for Personnel       Requested
                           of Oregon Hospitals                     Third Year
                                                                    $24,373
             The purpose of the project is to improve the care of patients in health
             care institutions in'the ORHP by providing one to-three day courses
             aimed at the entire spectrum of personnel who deal with patients in
             various ways.  Courses in emergency cardiopulmonary resuscitation,
             infection control, middle management, body mechanics and safety, and
             legal problems (a total of 42 courses) have been presented to 1,220
             students (nurses, nurses aides, orderlies, various technicians,
             emergency personnel firemen, law enforcement personnel, and others).
             The important goal is "to effect cost containment and efficiency in
             hospital management."
             This project was approved and subsequently funded beginning October 1,
             1970.  By June 30, 1972, the project will have completed 21 months of
             operation.  It contains a mechanism for take-over so that the affiliate
             institution is assuming one-third of the cost of the project.  At the
             end of the second year, two-thirds will be assumed by the association
             and, finally, after three years, the association will support the
             project totally.

                 Fourth Year
                  $9,164








               Oregon RIIP                      -15-                   Rm 00012  6/72

               NEW PROJECTS

               Project #018--Operational Service for Remote.            Requested
                             Coronary Care Monitoring                 First Year
                                                                        $99,851
               The objective of this new activity is to improve accessibility of care
               to patients with myocardial infarction in less populated areas  of  Oregon.
               The sponsoring institution, Emanuel Hospital, requests  three  years
               support to link five and communities to other consulting coronary care
               units.  Electrocardiographic monitoring will be transmitted on a 24 hour
               basis over telephone lines.  Critical EKG diagnoses and therapeutic
               suggestions may be made by highly experienced CCR nurses and physicians
               located at Emanuel Hospital. This project  was  previously  approved
               by the Oregon RAB, and by the National Advisory Council, but not instituted
               due to budgetary reductions.

                    Second Year                                         Third  Year
                                                                         $28,966
                     $53,508

                Project #026--Cadaver Organ Procurement Program         Requested
                               and Tissue Typing Laboratory             First  Year
                                                                         $94,940

                This is a three-year proposal to permit the University of Oregon Medical
                School to double the cadaveric transplant program to 40 kidneys per
                year and to increase tissue typing capabilities to  support  the  expanded
                transplant program.  It will serve the interests of the entire state and
                will cooperate fully with the Veterants Administration Hospital.  The
                public education component of the project will be subcontracted to the
                Kidney Association of Oregon. This project  addresses  a  special  Federal
                emphasis being Placed on kidney disease, as well as fulfilling general
                ORNP goals and objectives.

                    Second Year                                         Third  Year
                     $88,675                                             $91,572
                Project #022--,EmergencY Medical Technical              Requested
                               Training course for Rural Areas          First  Year
                                                                         $53,452

                The Oregon Division of Health requests three years support to expand their
                ongoing emergency programs to include the training  of  ambulance  drivers
                and to conduct the prescribed 72 hour course to volunteers.  Less than
                207. of the 2,000 ambulance personnel have received the recommended
                course.  Training for 500 attendants annually is proposed, utilizing
                video-taped physicians presentations developed by the University 0
                Kentucky Medical School.

                    Second Year                                         Third  Year
                      $45,277                                            $46,675







                                                                       RM 00012  6/72
                Oregon RMP                      -16-                             -
                Project #023--Mobile Cancer Detection Unit             Requested
                                                                       First Year
                                                                         $63,438
                This three year program will offer advantages of early cancer detection
                to female residents of Portland and  of  rural,low  income Areas  of  Oregon.
                A major;obstacle in reducing mortality  from  genital  and breast  cancer  is
                the failure of seemingly  healthy,individuals  to  undergo periodic
                examinations. Approximately  4,000  examinations  will  be conducted   during
                the first year, all in the Portland  metropolitan  area. The van will be
                manned by physicians, nurses, and  volunteers  organized through the
                Oregon Cancer Society, and all services will be provided free.
                Although the mobile unit will be used for cancer detection, it   is
                recognized that there are a number of organizations and agencies   who
                can utilize the mobile unit to carry out objectives if their programs,
                i.e.. classroom for education programs for nursing home personnel, a
                facility for individual genetic counseling, or general well-body care
                clinics.
                    Second Year                                          Third Year
                     $59,893                                             $66,325
                Project #024--Community Car             and              Requested
                              Training Program                           First Year
                                                                         $24,632
                The indigent population of southeast Oregon will  be the target  of this
                program.  Services to 3,000--residents include genital and breast screening
                for malignant tumors.  Diagnostic and therapeutic services are   pledged  by
                the Portland Adventist Hospital and medical staff at no cost to the
                indigent patient.
                The applicant, Portland Adventist Hospital, plans to test the feasibility
                of employing nurses specially trained in this project to conduct
                preliminary screening examinations under  the  supervision  of  physicians.
                    Second Year                                          Third Year.
                      33.932                                             $34,121
                Project #025--Community stroke Rehab litation            Requested
                               Projtr,am                                 First Year
                                                                         $22,085
                This project is sponsored by Good Samaritan  Hospital  and  its  affiliate,
                the Rehabilitation Institute of Oregon.  A multidisciplinary team approach
                will be employed to coordinate rehabilitation services for stroke patients.
                Local teams will be developed in six areas the first year and an additional





             Oregon R14P                     -17-                 RM 00012  6/7@
             eight c,  ittees will be chosen during the first and second years.  This
             proposal appears to be germane to the quality and accessibility of both
             primary and secondary care of stroke patients in Oregon.
                Second Year                                        Third Year
                  $21,651                                           $22,151

             GROWTH FUNDS
             Increased funding of ORIIP is requested in the second and third year
             of the triennial program.  Most of these activities are still being
             investigated and are scheduled for further staff development.
             Developmental Component--ORMP has not requested developmental funds the
             first year of its triennial plan because the Region needs more core
             support staff to implement such a program.  Additional staff will be
             employed the first year and the Region should assume the responsibility
             of a developmental program the second and third years of the triennial
             plan.

             Est @ ted    d requirements:
                 Second Year                                       Third Year
                  $75,000                                           $100,000
             Patient Transportation System--This activity is presently being
             pursued @y a planning study and will be developed further during the
             second and third years of the triennial.

             Egtimat6d fund requirements:
                 Second Year                                       Third Year
                  $75,000                                           $50,000
             Peer Review System Development--A peer review program is being devised
             in collaboration with the Oregon Medical Association for the establish-
             ment of a state-wide system.  During the second and third years, the
             system will be tested and refined before the operational phase of the
             system is implemented.
                 Second Y a@r                                       Third Year
                   $502000                                           $50,000






                                                                    RM 00012 6/72
                                              -18-
               Oregon RHP                                                       -
               Televisi' Communication System--This proposal would link large
               metropo.        al centers with remote rural health care facilities.
               Continual education$ consultation for physicians, health personnel and
               others will be fully utilized.  "Slow-scan" television techniques could
               be used at a much reduced cost.
                 Second   Year                                      Third Year
                  $125,000                                            $175,000
               Demonst ation of a Primary E          nic--The objective is to improve
               the acc                                   ons living in impoverished
               urban and remote rural areas of this State, the ORHP plans to assist in
               .developing primary entrance health care clinics.  There are several
               areas where these clinics may be initiated and, after careful study,
                     ent and coordination, at least one clinic will be established
               developm
               in an appropriate location.
                 Second   Year                                       Third Year
                   $150,000                                           $150,000
               Demonstration Familv Practice Clinic--A demonstration Family Practice
               Clinic is planned           provi e a model for a geographically or
               sociologically isolated community in Oregon.  It is designed to provide
               a professional environment capable of attracting, sustaining, and main-
               taining a family practice physician, and affiliated with a family
               practice residency program in order to provide consultation, training,
               continuing education, peer group contact, and innovative use of allied
               health personnel and preventive technologies.
               One of the more difficult health care delivery problems of the Region
               has been the recruitment and the retention of family practice physicians
               in some rural and impoverished urban areas of the state.  One or more
               demonstration clinics will be established to see how these problems
               might be overcome by use of paramedical personnel, improved consultation
               resources, relevant and convenient continuing education, etc.
                  Second Year                                         Third Year
                   $150,000                                            $150,000
               Feasibility  St   and Development of Area Health Educati n Centerss--ORMP
               @s  followed  w          rable interest the development of the concept
               of Area  Health Education Centers.  There are several areas where this
               concept could be applied beneficially in the State.  Funds will be used
               to develop Area Health Education Centers that could have considerable
               impact on the improvement of health care delivery in the Region.
                   Second Year                                        Third Year
                       100,000                                        @150,000





                                                             .1 LI 1,J ) L)kiL I I kJl\ , 1),I',  JJ  vy IJ:,
                      D u ivi

                                                 'RVICI-',S AND MLN'I'Al@ III,'ALTII AI),%41NIS'I'RA'I'ION
                                         III,'ALI'li SL



           I-or the I'\ecord                                      March  22,  1972





  I-'RO,\,f Edward T. Blomquist, M.D.


  3Ul3jECT:  Post Nlini-SAIU" Meeting, March 20, 1972 Oregon Re-ional Medical Program


           Cadaver Kidney Procurement, Tissue Typing Program, Public Education
             and Inforpiation Programs

           Purpose of the Pr   am - To double the number of cadaver kidney transplants
           from 20 to 40 each year.

           Under the direction of the Chief, Division of Noplirology, University  of
           Oregon, employs a full time coordinator and secretary to:

           1.  develop a 24-hour, seven days a week tissue typing service,

           2.  develop organrrocurement teams in 6 large cities,

           3.  develop a 24-hour communication and transplantation  program  between
               transplantation center and cooperating hospitals,

           4.  develop public support for a kidney donor card pro-ram adequate to
                                                                  0
               meet the Region's long term need for cadaver kidneys.

           Action - Approval in principle for a 3-year period with budget reductions
           to be negotiated by outside consultant and staff at early  site  visit.

           Advice to Region - The reviewers were very favorably impressed  with  the
           proposed proaram. They were particularly pleased with 1)  the  degree  of
           regionalization to be effected, 2) with the planned efficient use of
           resources available at the Veterans' hospital, and at the University
           hospital, and 3) with the planned integration of dialysis and transplan-
           tation services.  Several aspects of the budget were considered excessive.
           It was recommended that the site visitors review the total budget with
           special instructions to: 1) reduce the costs for  each  year's  operation
           by amounts that can be reasonable expected from third party  vendors  and
           from service charges, 2) to examine the need for major equipment  and  as
           many organ procurement teams as planned and to recommend any needed
           adjustments in the budget, 3) to evaluate the means by which the standard
           fees for hospitals and surgeons were established and to  recommend  any
           needed charzes.


           Edward T. Blomquist,@-@.D.




                                                               Region    Puerto  Rico
                                                               Review Cycle   June 1972
                                                               Type of  Application:
                                                                Anniversary prior  to
                                                                          Triennium


                                                               Rating - 325.5


                                Recominendati6ns From


                  SA@RP                                        Review Committee

                  Site Visit                             i=7  Council


            The Review Committee recommended that the Puerto Rico RMP be  supported  at
            a direct cost level of $l,loOiOOO for the requested -03  operational  year.
            While agreeing with the SARP that generous support should  be  provided,
            Committee questioned the Region's capability to effectively  utilize  too
            great an increase in support at this time in its  development.  It  was
            pointed out that the Region would be submitting a  triennial  application
            next year and th-ttthe initiation of new activities that do not  appear
            to be terribly exciting could limit the Region's funding  flexibility  at
            a time when 'it will be outlining a new three-year plan.

            Committee viewed the goals and objectives as being clearly stated  and  in
            the direction of RMPS planning with the main thrust in education and
            health manpower, health services delivery system, and collection  of  data
            and statistics. The goals emphasize increasing the  availability  of  care
            and enhancing the quality and the moderation of health care cost.  Ongoing
            activities were considered to be designed to have an  almost  immediate
            impact on the provision of health services even if the impact is not
            directly measurable. It was recognized that some  of  the  accomplishments
            ate quite dramatic and invblve  active participation from official
            agencies, governmental and nonprofit organizations  with  the  contribution
            of substantial funding support. The intensive  efforts  toward  regionali-
            zation, decentralization of treatment centers, the continuing e  ucat  on
            of health providers 'In isolated areas, and the comprehensiveness of  the
            educational aspects of ongoing activities in that they include the
            community, the patients, and their families were  favorably  recognized.
            The Administrative capabilities of the newly appointed  Coordinator  and
            the Region's activities directed toward the development  of  leadership
            roles for paramedical type personnel were also discussed.

            Committee concerns included the absence of minority interests  such  as
            allied health and nursing personnel on the Program Staff and  the  Regional
            Advisory Group. Regional Advisory Group criticisms  included  ina  equate
            representation geographically, from the Caucasians living in the community,
            and from consumer groups although the Coordinatot's effort in  the  latter
            was recognized. The reviewers sensed that the  hope  for  comprehensive
            accessible health services in Puerto Rico are going to be  dependent  on
            governmental sponsorship and expressed concern that very  little  contri-
            bution from the private physician and private hospital  sector  towar  a
            really enlightened kind of health care system was visible.




                                       ent  nild  Firinncial-  @;umrlarv




                     01@LNT                CUPI',P.IT                                                  YF--ATZ            REC@4@IEIMED
                                           YRIS AWARD                  ro, u ,IC IL i                                        FUI@DING
                                          02        OPER.              RECOti?ipj                  E     QUEST                x ku;@it7xx
                                                                                                                                REV.  COM.
                                           YEAR                        T,'@'VL



                                                  248,370                                    $     447     597
          '@'O R V'
                                               -  0 -                                              (22,C)OO)
          Sub-Contracts-

                                                  594,813                                            1,049,034
          OPER.  /@CTIV..-

                                                                                                      0
          DEVET,4  COI,,P.                                                                                                yes            or

          EARI,fARY,S'.*

                                                0                         0                           0
                YTI)@TFY












                                        $     843,183           $I,609,    386                     $]-,496,631                      00
                      @1,ECT

                                                1,136,564
            P      UE@'RED


          COU'NICIL
                                                  989,762
          APPIIO'IF,?,)  LEVEL


          tiON-Rl4PS     and
                                                 -                                               980,676_
          INCOME

          IN'DIRECT                                95,130                                              178,969
                                                                                                        REGION   Puerto Rico

                                                                                                              /june   1972, REVIEW CYCL


                                                                                             .1/   Excludes  $28,504,d.c.'re ue-st fo
                                                                                                                                         q
                                                                                                   Project #16--NucleAr Medicin6
                                                                                                   per  PR7@IP  telephone conversatio
                                                                                                   3/16/72.







                                                  RKP S
                                         STAFF 9RIEFING DOCUMENT
       0

                                                                                            Mid
                                                        OPERATIONS         Eastern
       GION    Pkiertb Rico                                BRANCH        South Centr        Wes
                                                           BRANCH                      Poom@-
     TY E   APPLICATION  'iO Numerica@t RATING             Tel. No.   X3-1810
                                                                         Mr. Frank '@@@ash
                                                           BRANCH CHIEF
           TRIENNIAL             197- DATE
                                                                H STAFF Mr. Ceorge Hint,.le
           St ANNIV YEAR             SARP                  BRANC
                                                                    Mr. Robert Shaw
                                     REV. COX.             RO REP.
          2nd ANNIV YEAR
                                     OTHER                 Last           t V s t   None
            OTHER                                               Mgt. Assm'   i

                                                           Chairman
                     @197 Cj  Chairman   r  I               7-i-pw rnynynittpp; mn
               its,   Last 12 mos.   (Dates, Chairmants Name and Type of Visit)
                       1971, 'C-r. @vill.iain S. Fields,   St.   Anthony    Center,    Houston,    Texas
               6w and evaluate progress on Proj6ct #10 -- @-,troke as per NAC direction

                   sLs@ance to new Coordinator and relative to continuation application Dr

                                                                    ince Its Last Review
                      ch occurred in the Region Affecting the RNP S
                      97@,@

       @16terats  iliai5tration-4@s negotiating the establishment of Area       T,,eiucation
         nte-      ifferent reizions in Puerto Rico.   The sub-regionalitation of their
         rvic s v    erable    amore efficient islandwide educational center a
                                                                              .Xrangent--nt
               is  @-l@nvolved  in current efforts within the,,,,.aii Juan area).
       ,,f s-pecial tote -1@s t.qe Jui-Le 21, 1969 enactment of Public Law 56 whit'@i permits
               Of   services    of private   patients   in   government   hospitals    and    Payment    for
       @i@ d4
           geftt p4tie,.its in private hospitals.





                                                   2 -                   Puerto Rico
                                                                         May/June 1972 Review Cycle
                                Commonwealth of Puerto Rico



                                                         Northeastern Region
                                                                         San Juan

                                        Arecibo
              Aguadil                                    Bayamon

                                                                                             Fajardo


                                                                           Caguas
             .@Mayaques

      Region



                                                                                              Culebra

                                           Ponce



                                                                                             Vieques
                                    Southern Region


        PROFILE  (Health  Related  Information)

        PoDillation:  1-970 census - 2,712,000; Approximately 58% urban; Median Age: 18.5
                      (US 29.5)
        @a-r.d Area:  3,435 square miles (Approximately 100 miles long and 35 miles wide)
        Density:      /50 per square mile
        Health Stat-Lstics:  Mortality rate per 100,000 for heart disease-136, cancer-90,
                             CNS vascu,lar,lesions-52, and diabetes-11.  First three are low
                             in comparison to U.S.,.diabetes comparison is not available

        Fdcilities Statistics:
           U-r,@-vers-'-ty oil Puerto Rico School of Medicine - 4 year school, enrollment of 301
           U,ni.vp.rsi-ty of Puerto Rico School of Public Health - Accredited, enrollment
                      '184
               prox.
           Ten          of nursing, 5 at University campuses and one junior college, others
             az hospitals
           Two schools of  medical technology (Department of Health, Institute of Health
             Labs and the  University of Puerto Rico School of Medicine) one school of
             cytotechnology
           Nursing and 2ersonal Care Homes: eleven skilled nursing homes and 7 long term
             care units are reported

        The L--,ierica-,i Hospital Association reports the following types of hospitals with a
        zota',@ bed caoacity of 9,999: 33 private (12 not for profit and  21  for  profit)'and
        ic, -,Dca- government hospitals for a total of 49 short term hospitals; three
        I  -I  L
        psychiatric and five tuberculosis non-Federal hospitals; plus two Federal
        hospitals - 59 total all types.





                                               3

        6file (Continued - Puerto Rico):
           er, the Commonwealth of Puerto Rico has seventy-five municipalities that have
           ain:res-ponsibility for  tovision of health care to the needy.  Statistical
                                    p
           provided by the PR-RMP   indicates that these municipalities have seventy-three
         iciDal and five district   hospitals to provide public health services.
        n'Dow r.@2,111 Active physicians  (80  inactive)  and  4200  professional  nurses
       n Puerto Ri o there are two systems whereby the population utilizes health care
       e  ic 9; the private and the public or governmental systems.  It is estimated
        at 32% of the population utilize private medical and hospital services and 68%
          iz  t 6 public services.  Betvdeen 30% and 40% of the population is covered by
           type Of health  insurance.  An  unknown  proportion  Of  the  population  uses
        ivat  serv ces at times and public services at other times, depending basically
      OA its econ  ic conditions at the time and on the nature of the illness involved.
            iv leis than 50% of the general hospital beds in the island are located in
      @p  at     sp ta!6, both private  non  profit  and  private  proprietary  hospitals.
           p   ate@Oroprietar,v  hospitals  are  owned  and  operated  b  physicians.  The
                                                                      y
           te  6sO tals for the most.part ate located in the main cities - San Juan,
                 ap-  z and'Humacao.  Private hos itals serve, not only the population in
                                                  p ,
                     ty   ere@they are located, but also receive patients from neighboring
          c
                    di6al and hospital  services are  administered  by  the  Puerto  Rit6
                  6 H6a!th, the  municipal  governments  and  other  state  agencies  such
                     omp6nsatipn.  As stated previously, basically, the municipalities
                         onsibility for the  provision  of  health  care  to  the  needy.
                         five municipalities ranging  in  size  from  7,000  to  500,000.
          Co            Gov rnments,  ow6ver, comp emen       e
          Du                and agreements with local governments, public health
                 p      a             ativ6) have been  organized  into  a  single  system
                 o   ly bv the DeDartment of Health and Municipal GovernTaents; the
       0
                     S  n  full responsibility for technical and professional service
             ti  a    all,municipalitie6, except San Juan.
         a ma o  it     t, e municipalities there are healt  centers either com let d or
          r co   tr@  ion. EAch health  center  includes  a  hospital  unit  (usually  one
          per    0   inhabitants), general out-patient facilities and a public welfare



                 Component  and Financial Summary      Anniversary Application


         COMPONENT        CURRENT               YEAR              YEAR          RECOMHTNDED
                          YR'S AWARD         COUNCIL                              FUNDING
                          02 OPER.           RECOIOMNDED      'REQUEST              SARP
                          YEAR               LEVEL                                  REV. COM.

    "ORE                  248,37.0                             447,597
                            -u-
    Sub-Contracts                                              (22, 000)
    OPER.   ACTIV.        594,813-                          1,049,034
    'DEVEL.  COMP.           -                                   -0-            Yes       or No

         RKS:
                            -0-               -0@                -0-
       KIDNEY









    ,@S     DIAECT         $8432183      $1,609,386,         $1,496,631

    REQUESTED            $1,136,564

    COU'tqCIL
    APPROVED LEVEL        989,762

    NOW-Ri,rPS and
    iwco,@                                                      980,676
     l@-DID,ECT              95,130                             178,969
                                                                    REGION    Puerto Rico

                                                                     May/June tgZ 2,.REVIEW CYCLE


                                                        1/ Excludes,$28,504 d.c..-request for
                                                           Elroject #16 - Nuclear Medicine
                                                           per PR-RMP telephone'conversation
                                                           3/16/72.




                                                 5                   Region  Puerto RICO
                                                                     Review Cycle,May/June 1972



        TSTANDING ACCO14PLISHIIENTS BY REP  since   May     -1970

        (1) involvement of governmental  and  private  non-profit  organizations  with  the
        @ope  iona projects. This involvement  demonstrates  the  impact  of  R14P  in  the
         ommrxity    d guarantees phasing out for ongoing projects.
        (2) Exoanston of the geographical scope of ongoing projects and the replication
       @6f su&6 sgful features on an island-wide basis.
        (i)  dtivo p4iti6ioation from the Department of HoAlth, Department of Labor, Labor
          ions,   4 community and Civic Organizations as well as health related organizations.
                 ou
         r;   t e        ealth, and local and FederAl sources.
              e@    ion's@continued active involvement and emphasis devoted to looki       for
         ther  sou   s of support with a view toward pha6ing-but PM 6uoport.
        (6)   e  c    6hdt6ivenegs of the educational aspects of ongoing Activities that
            ude  e    tion     t     ealth prov  ers,    e commun ty,
        t     ram     S.
             e4di Ohio role of the   RMP as d6oicted by the consultations provided to Saint
        Croix       aint@Thomas and  the Virkin !glands in establishing clinicg in their areas.
        ($) Th @@de_ree of outreach  of project activities  into  rural,  mountaineous  and
        9 etto  re s as@well as urban areas.
          ) @l   1     i in establishment of satellite clinics thus providing greater
          ai    iii   of  6alth s6rvide..



          c       PRABLEMS
                       ship idle of the Regional Advisory Group is a recognized problems
            n            tor has stated his recognition of this situation and is implementing

            Re       0       Of the current ongoing  projects  is  anticipated  beyond  the
          it@ia      e year support period before "full" support from,other sources can be
          ta
        (3)                ory     oup   re  e  a
            ,@ju           Only two from the South Region and only 6h6 from-t-he West    Region.
             o           t have dd64uate reoiesentdtion from the nursing profession (this
            a               of  past  reviewers).
                     ,SI procedures (pages  46-47 of the application) appear to subrbgate
            fi        roval authority of the Regional Advisory Group.



           S  R       G   TE

            Ou    an@e to be  rovided the Region with respect to anticipated renewal requii6-
                            p
           ts 0  6 going activities.




                                                              Review Cycle May/June 1972


      OUTSTANDING ACCOMPLIS@NTS BY RMP (HISTORICALLY)
         (1) Development of major interest and enthusiasm of lay and medical leadership
             in Guaynabo, Ponce, and to a lesser extent in Guayama.
         (2) Establishment of Regional offices in Ponce and Mayaquez.
         (3) Impressive progress in its sub-rogionalization development.
         (4) The establishment of a "master plan" for guidance of the Program.
         (5) Review and selectivity of the Regional. Advisory Group in that only eight
             of sixt7een projects initially reviewed were included in the application
             requesting operation status.  Six of these eight were approved by the
             National Advisory Council and subsequently funded.






       PRINCIPAL PROBLEMS (HISTORICALLY)
         (1) The NAC requested follow-up on the Guaynabo Community Stroke Project
             Community Family Prevention Program on Stroke (Project #10) with respect
             to previously reported organizational difficulties.
         (2) Regional Advisory Group criticisms:
             a. Insufficient members from the lay power structure, and model cities programs
             b. Only top echelon personnel with no representation from allied health
                professions
             c. Absence of representation from Western and Eastern Health Regions
             d. The Regional Advisory Group has not assumed the leadership ro e
         (3) The private medical sector in San Juan is quite inactive.
         (4) Nursing profession is being slighted as an ally in health planning and
             traineeships.
         (5) Core does not have adequate representation from the nursing and social
             services professions to enhance their outreach into the community.
         (6) Project-#15 - Education Program for the General Practitioner in the Western
             Region overlooks the private practitioner in the community.
         (7) Goals should include cooperative efforts between private and government
             medicine.







                     APRIL       4* 1972
                                                                                                                                                                               REGION        PRTO RICO
                                                                                                        BREAKOUT Or-  REQLIF--ST                                               RH 00065,O(,/72
                                                                                                         03  PROGRA@'4 PERIOD
                                                                                                                                                                                                             RMPS-OSM-@JTOGR2.@
                                                                       5)                     2)                  (4)
           IDENTIFICATION OF COMPONENT                        CONT.  WITfilNi-CONT   BEYONDI                 APPR.  NOT          I  NEW,  NOT                   CURRET@T              CURREN]
                                                              APPR.  PERIODI  APPR:  PERIC-DI                PREVIOUSLY          I  PREVIOUSLY                  DIRECT              INDIRECT                   TOTAL
                                                              OF  SUPPURT             OF  SUPPORT            FUNDED                 APPROVED                    COSTS                  COSTS
           C003  CENTRAL  OFFICE

                                                                                                                                                                                                               $51
           C)CI    @L' I TTTI C-C AiD-l 0                AR-1
                                                                                                                                                                                                   7   1
           002     HFMATOLD(;Y         CANCER         CHFMOTI                                                                                                                                          I
           -@F@  ANQ-DL-Q@ANKItir                           I        4. '7 -3
           -OC'3-  PEDIAT?IC PULMCNARY  0
                                                      is c- I--,
               AS F-
           O,-@ 4  ED(JCATIOP,  PACORAM  IN              CIAI
           -   BETFS  Mg:L                                          &41*                                                                                         I!k 1. 1 6H
           307   ED  TRAINING  PROG  FOR  MD
                                          I                                                                                                                                               12  .?.2a-   1       ..tgo.73
           -   p @ll  I IN-LE         @L 'D          T      I
           @G39-    CC)P,@yU@'ITY     APPPOACH     TO     COI                                                                                                                                                                 I
                                                                  -AFLLA@ L                                                                                      $El  1.  93  6-1         S  A.  li@-  t             190.496  1
           010     GUAYNABO         STROKE          PREVENTIJ ---  --  --         t                                                                     I                      t                       t
               ON                                                                                                                                      I..     11482916        1        171.66n        I           st7o.r.7h  I
           Oll        COMPUTERIZED        DOSE        DISTRIJ



                                                                                                                 s I C) 0. 00'0
           @015    EDUCATION  PRC'VRAM FOR  G
           __p  IN,  T                 LLpi4                                                                                                                      15-172       1        -SI.116                      116.?RR  I
           017--PUBLIC  EDUCATION 0

                                                                                                                                                                                          18.580       t        IS6.6Al       1
                                                                                       17
                                 TOTAL                                                                           $26Ov932                $78,101            $19496t631                $l78v969                    $lw675v6OO





      RMP:        PUERTO RICO                 PREPARED BY:  GEORGE HINKLE          DATE: 4-
      1.  GOALS, OBJECTIVES, AND PRIORITIES (8)
                  The Puerto Rico Regional Medical Program goals, objectives and priorities
                  are clearly and explicitly sta-@ed.'-'The PRRMP stated objectives in
                  Education and Manpower, Health Services Delivery Systems, and Collection
                  of Data and Statistical Projections are considered to be consonant with
                  the RNP mission of increasing availability of care, enhancing its
                  quality and moderating its costs -- thus making the organization  of
                  services and delivery of care more efficient.
                  PRRMP MASTER PLAN for obtaining the Program's objectives (Annual Report
                  1970-71) provided an analysis of program priorities with respect  to
                  geographical health regions.  The current application indicates that a
                  quantitative system is now being devised whereby relative weight  is
                  assigned to the technical quality of the proposed project, its
                  relationship to the goals and objectives of the Region, the reliability
                  of the sponsoring organization and the competency of the project
                  director. This system will yield a numerical score that  will  allow
                  objective classification on the basis of relative merit.
                  Consumer representation on the RAG represented this group in the
                  establishment of goals, objectives and priorities, and the present
                  proposed amendments to the RAG by-laws provided for increased consumer
                  representation from all socioeconomic groups.
    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  --  -
      Recommended Action:





     2.  ACCOMPLISHMENTS AND IMPLEMENTATION (15)
                  the Regional Advisory Group reports that there is no doubt that there
                  has been contributions to the present health delivery systems and to
                  the different governmental agencies involved.with the health care of
                  the Island.

                  All on-going activities are reported as being highly successful with
                  respect to established project objectives.  The geographic'scope of
                  the activities are either being expanded to an Island-wide endeavor
                  or plans provide for this expansion.
                  The Program has been successful in establishment of treatment centers,
                  teaching programs for health providers, patients, and families of patients.
                  The training of health personnel in new skills and the training of new
                  health assistants along with the establishment of new treatment centers
                  have greatly enhanced the availability and Accessibility of care.  Project
                  activities have been and are being conducted not only in the more affluent
                  areas but also in Model City areasi ghettos, and rural and mountaineous
                  regions of the Islandi







               Notable Program Staff planning studies include the establishment and
               utilization of a Program action plan which outlines procedukes.for
               the development and implementation of education activities by the
               o erational projects, and the Program staff 'maintained library.and
               Health Services Personnel Inventory that is made available@to all
               he lth professions and governmental institutions.
   -  - - - - -   - - - - - -    -- - --- - - - - - - - - - - - - - - - - - - - - - - -


               A  ION -







                  PUERTO RICO                                 GEORGE HINKLE
                                                PREPARED BY:                       DATE:


       3.  CONTINUED SB-PPORT (10)
                  The PR-RNP has a definitely established policy toward developing other
                  sources of support.

                      support for only one activity has been discontinued to date and it
                  is being continued with full support being provided by the Depa t@ment
                  of-Health.

                  It@ is reported that as RMP funds are phased-out (such as the recent 12%
                  reduction) other sources of funds have become available to continue
                  the activity.  All on-going activities make reference to possible future
                  sources of support as being either firm or highly probable.







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


       Recor@=,ended Action:







       4.  @/@-LNOR-iTY !NCTERESTS (7)

                  -,'oe goals and objectives are directed to all the people of Puerto Rico.

                  Throu 'n intensive efforts toward regionalization, decentralization of
                       .g
                  treatment Centers, continuation education  of health providers in
                  4-so'Lated areas and educational programs directed at both the patient
                  and th@ patients family, all interests are considered to be served.

                  1-r_ is noted that the Regional Advisory Group includes female
                  representation.











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



                   ACTYLON:





                                             PREP                                  DATE: 4-5-12
                      icico
                     10)
                 Dr, Jorge Fernandez is the newly appointed Coordinator (PRRM letter of
                 De ember 3  1971) although Dr. Cristino Colon, the previous Coordinator
                          31
                 still serves as a consultant to the Program.
                                                                             mb6r of the
                 Dr. Fernandez is described as a brilliant, young faculty me
                                                  de and inter6 t in the  field  of  education,
                 s  001 of Dentistry with experien             s
                 particularly dontinuing education in the health  professions-  He  hag  served
                 on ari6us committe6g of the Regional Medidal Program and  during  the  last
                                                                  uatioh   He now serves  on
                 year ds@Sp6dial Consultant in Education  and  Eval
                 th  Health Manpower Task Force at the National institutes of Health.
                 Dr,; Fernandez has initiated a reorganization of the Program Staff to  more
                 closely 4ily it to the new RIMP mission.  He has also directed efforts
                           amendment' of existing RAG by-laws in an effort to increase
                 to ard the
                 th  consumer representation at all socioeconomic levels.
                                                                  eview criticisms  directed
                 Th inadequate involvement of the RAG  and  past  t
                 t   d otol6tt interrelationships are also recognized areas of concern
                 i   ich Dr.@Pernandez is directing his efforts.,  He appears to.have
                 g nea the confid4nde of the Project directors  and  Program  Staff  personnel.
                     ntly, the PRRMP does not have a deputy director.
                    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -




                 p       tafi  is almost startin anew in that most  of  the  staff  resigned
                  ogram s                       9
                 s 86quent to  the.r6cent redudtions in Program funding.
                 T e Cbord nator has reorganized the Central Office in line with the
                 objectives of the program to optimize efficiency.  Staff is now organized
                 i to three sections*. HEALTH EDUCATION AND MANPOWER.'ADMINISTRATION AND
                        SERVICES SYSTEMS, and PLANNING AND EVALUATION.  Secretarial,
                 ci ticai,,and other t6n-piof6ssibnal and non-technical are@in a Central
                 0  ice to provide suOPortative services to each of the three sections.
                                                                  esou ces in  the  development
                    gram@Staff will utilize RAG Task  Forces  As  r   r
                   '@the  ians of action (RegionAl Planning  Health Education and Manpower,
                 P   posa a Review).
                    re is an absence of allied health personnel - no nurse discipline;
                 I SL anpl cation ieque6t6a 44 positions - current Application is for
                  2     h !I on-b r      11 fu                                     9
                                 oa d, a      11 time, (5-professional are vacant
                 57  leri al/secretaiiil.)
               - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -





                                                12

     RNP:        PUER!,:O RICO               PREPARED BY: GEORGE HINKLE            DATE:4-5-72@--@
     7.  REGIONAL ADVISO@RY GROUP (5)
                 'i.he RAG report states that the group realizes and has accepted its  new
                 role. and responsibilities as a result of the decentralization of procedures
                 wit'.-.,in RMP.

                 The new Coordinator reports that he believes the RAG  has  not  discharged
                 its duties, to date, but that he will encourage the RAG  to  exercise  its
                 prerogatives. He has already assigned a Program Staff member with liaison
                 responsibilities for greater involvement of Staff and the  RAG  in  daily
                 operations.
                 Representative of health interest groups and special task forces    and project
                 directors) provide an excellent representation of  the  most  outstanding
                 health professionals in the Region.
                 Currently 28'members - 4 vacancies,  four women; 20 are located in the
                 Northeast area, 2 in the South, and  one in the West.

                 Curre-,iz proposed amendments to the RAG by-laws.place numerical limits  to
                 the types of representation on the RAG and states that  "the  public  and
                 consumers category shall include at least ten  health  services  consumers
                 proportionally representative of all socioeconomic levels in Puerto Rico.
                 RAG has regular quarterly meeting; meeting will be held in sub-regions to
                 encourage attendance.
      - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - -

                  Action:





         GRA.LNTEE ORGLN7IZATION (2)
                 The University of Puerto Rico is the Grantee and Fiscal Agent for the
                 Program.
                 Cordial relationships exist between the Grantee and the  Puerto  Rico  RMP.

                 Adequate administrative assistance is provided and many  of  the  Grantee
                 facilities are made available to the RNP project staff in the  day  to  day
                 operational activities.
                 Dr. Adan Nigaglioni, Chancellor, University of Puerto Rico  was  the  first
                 Coordinator for the Program and is highly knowledgeable  with  respect  to
                 its aoals and objectives.
                     C>
                 There are no indications of Grantee.domination .and/or  interference  with
                 policy setting functions of the Regional Advisory Group.
  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

     RECO@-@NTDEI) AC,-iON:





                                             13

                 UEPTO RICO                PREPARED BY: QgORGL@ IIINKU-        DA
        PARTICIPATION, (3)
                 Active participation of other health agencies is obtained through member-
                 ships on the PR RN? RAG.
                 Program Staff planning studies are planned in cooperation with the State
                 DeDartmenti prepaid health insurance organizations, the P. R. Hospitals
                  sociation, Department of Health, the San Juan Municipal Government and
                 o her Muni6ipal Governments.

                 V terans Administration has cooperated  in continuing education courses,
                 offered hospital facilities in joint efforts, and joined in negotiations
                 for the establishment of community based health education facilities.
                 i int activities have been conducted with the P. R. Medical Association
                  d the Coordinator is a member of the Committee for Medical Education.
                  cal Health Planning Board Director has offered to cooperate with the
                 Mode."L Cities Program of the City of San Juan Collobotative efforts are
                 being initiated.
                 T  amounts of funds provided the RMP activities from other sources
                   pt6ximat6ly matching funds)is highly indicative of participation
                 from State and local organizations.
                  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -






                           tings are held with members of the section of the Department
                           ormunication for better coordination and avoidance of


                    ers of the CHP are on the Regional Advisory Group-
                   IL.MP has been appointed to the Municipal Advisory Board of the planning
                 of ice !or the Area of San Juan.
                 C  and PR-RNP share the health professions human  rIesburdes inventory an
                 60 era @iv6 arrangements have been made in the publication of the updated
                     tory.
                    Ce-@itral Program Staff Planning and Evaluation section has served as
                 C, Isultant and t@aken ste a to provide requested consultation services
                                        p
                     e     ning Bo d and the Department  of  Health.
                   th   Plan      ar
                   sortium of RIIP and other health agencies is being formed to combine
                   6rts in the collection of health data relevant to all concerned.
                    - -  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
              DED--A TION:





                                              - L-9 -
                PUERTO RICO                  PREPARED BY:     GEORGE HINKLE        DAT  -  4- I-,-

   11.  ASSESSMENT OF NEEDS AND RESOURCES (3)
                Health professions human resources inventory  has been completed,
                transferred to the local CHP for sharing and  arrangements have been
                made for updating the inventory.
                Efforts are underway to establish a consortium of RNP and other health
                agencies to combine efforts in the collection of  health  data  relevant  to
                all concerned to improve-channels of  communication  and  avoid  duplication
                of efforts.
                Core staff has planned activities and studies  to  gather  additional  basic
                .Lnf.ormation for the development of the operational plan for the next
                triennium. Many of these studies are referred to  and  a  direct  result  of
                the Program Master Plan developed for  the  Region.  Listing  of  activities
                are provided on page 33 of the application.
                Prior activities associated with need and resource determinations are
                recorded in the Master Plan and involved collection and analysis of.    data
                relative to health regions, medical, nursing and other paramedical and
                auxiliary personnel, as well  as  financial,  physical,  and  organizational
                resources.
   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

    Recornended Action:





    12.              (3)
                Writte-,i records of the project review are maintained by staff, the
                i@egional Advisory Group, and other Review Groups.
                Specific core staff is assigned to monitor and/or provide supportive
                services to individual projects.
                'Yio-,izhly meetings are held with project directors to share with them  all
                @ plans and  activities  and  thus  encourage  more  constant  communication
                between the Coordinator and the project directors.
                'Progress and expenditure reports are required and these are reviewed
                ?e-j-@odically as follows:  Expenditure:  RAG - annually, staff - quarterly;
                Progress - staff bimonthly.



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

         @@'.)ED ACTION:






                                                t5
                PUERTO RICO                   PREPARED BY:  GEOBGE HTNKT.F.         DATE:4-5-71--

                ATION (3)
                Evaluation procedures are required for each project; all projects  are
                evaluated by Program Staff and consultants; evaluation is of both  a
              .qualitative and a quantitative nature.
                During the past year evaluation reports have been completed  on  six
                p    t    all that were in't'ally funded except  Project  #10,  this
                rojec s -                  1 i
                activity wa@s very slow in being initiated.
                Program Staff is actively working toward completion of  the  development
                and implementation of the total Program Evaluation Plan.  It is anti-
                cipated that it will be completed during the coming year.





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








         I.CTION P    (5)
                Priorities have been established that Are considered to be consonant
                wi t, national  ,als and the goals of the Region.
                Th Regior, plans o continue  currently  ongoing  categorical  Activities
                    'aab Vesta-Led its goals and objectives in terminology agreeable  to
                t   RIIP8 tublished mission;          it is noted that activities appear
                to'be in complete agreement with these  goals.  Ongoing  Activities  are
                   t comprehensive with respect to patient services; education of health
                p viders, patients, their  families  and  the  comunities;  manpower
                utilization and establishment of new skills and types of personnel,,
                etc.





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






                                             16


                                                                                 T E    7
                TERTO RICO                 PREPARED

    15.  DISSEMINATION OF KNOWLEDGE (2)
                Health professions human resources inventory has been turned over to the
                CHP agency for sharing and mutual updating arrangements have been made.
                Analysis of educational plans and activities sponsored by the Program
                has resulted in establishment of procedures for the development and
                implementation of educational activities by the Program's operational
                projects.  IT IS ANTICIPATED THAT THESE EDUCATIONAL MODELS and
                MATERIALS WILL BE MADE AVAILABLE TO ALL AGENCIES AND GROUPS CONCERNED
                WITH HEALTH EDUCATION to achieve their ample utilization.
                Data inventory of medical and paramedical personnel is kept and
                distributed to all health professions.
                Medical library services is maintained and services are provided to
                Governmental institutions and hospitals.  Three hospitals in different
                I
                areas have requested help in establishing their medical libraries.


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

    'Reco=- ended Act -Lon:




     --L6.  UTILIZATION @OWER AND FACILITIES (4)
                Efforts directed toward continuing education of health providers and the
                training of health personnel in new skills and training of health assistants
                and family health workers tend to increase productivity of physicians and
                other health manpower.
                The utilization of facilities of the Department of Health, Veterans
                Administration, and community medical centers as nuclei for the
                establishment of Prototypes prior to replication throughout the Island
                provide for more effective utilization of community facilities.



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

     ,-X-CO@YiYIE'.\,DED ACTION:






                                                17

                PUERTO RICO                    PREPARED ty: GEORGE HINKLE        DATE:4-5-72

         -I.MPROVF@,@-NT OF CARE (4)
                Activity progress toward established objectives depicts the practicality
                of the projects.
                Establishment of new and satellite treatment centers, the change in
                patient referral patterns as reported by one project, and the extreme
                degree of direct patient involvement are positive indications of
                improvement of care.
                Health maintenance, screening, diagnosis* treatment and rehabilitation
                are t                  t outstanding when one reviews this application.
                     erms that are mos
                These are most certainly directed toward improvement of care.







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

              ed  Action:







          SHO                (3)
                8 6it-term education courses for the development of professional and
                c, rmnity leaders in the areas are planned and conducted.
                0 erational activities appear to have visible payoff in the availability
                Of   cAte4
                Periodic  reports (bimonthly) are reviewed by Program staff and regular
                me tiiags of ProJect Dir6ctots and Program Staff are conducted.







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

                       ON.







                                           18



                                                                                    -5- 7
               PUERTO RICO
                                          PREPARED BY:  GEORGE HINKLE       DATE:

        REGIONALIZATION (4)
               The Program Staff is located in the San Juan area, Northeast,.
               Sub-regional offices-are located in Ponce, Southern Region and Mayaquez,
               Western Region.  However, these offices consist of only an associate
               coordinator and a clerical staff-member.
               Project activities are located in each of these areas, but the greater
               number are headquartered in the San Juan area.
               Project activities appear to be reaching out into the underserved areas
               throughout the Region, or at least this outreach is projected for the
               forthcoming program year.
               Although activities are initiated in a specific predefined area, they
               are considered to be prototypes with the expressed intention of
               duplication and/or expansion of the concept on an Island wide scope.


    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - --
    RecoTr,mer-,ded A-ction:






     20.  OTHER FUNDING (3)
                The only project to be terminated will be continued with support provided
                by the Department of Health.
                All ongoing projects and all except one to be initiated project reIports
                funding support from other sources.  Funding from other sources, as
                reported, approximates the direct cost support level provided by RNPS.
                Other funding sources for continuation of the activities after termination
                of RMPS support is a most active concern of the PRRNP.


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

     Rr,Col,v@,NDEEID) AA(CTII@N:









                                        TABLE OF CONTENTS

                            SOUTH CAROLINA REGIONAL MEDICAL PROGRAM

                                     ANNIVERSARY APPLICATION


               Staff Briefing Document                                        Page
               Face Page                                                        I
               Regional Map                                                     2
               Geography and Demography                                         3
               Component and Financial Sumary                                   5
               Breakout of Request (05 period)                                  6
               Probl6ms, Accomplishments,;Issues                                8
               Review Criteria                                                  15



                                                     / aw
                                                     Ms

                                          STAFF BRIEFING DOCUMENT






                                                           OPERATIONS           Eastern               Mia-con
                                                                              South Centr'l /-7     W6s  tern
   LEG  ON                                                    BRANCH                          -
                  South Carolina

                                                              BRANCH
                               not
                                                              Tel. No.         31740          Room  10-22
   ,ipE   APPLI  AT   ON   applicable LAST RATING
         TRIENN AL              .197- DATE                    BRANCH CHIEF      Mi. Lee Van   Winkle        -
         St     IV YEAR               SARP                    BRANCH STAFF      Mrs. Lorraine Kyttie

                IV YEAR              REV. COM.                RO REP.           Mr. Ted Griffith
                                /-7   OTHER                   Last Mgt. Assmlt   Visit      January       197

                                                              Chairman           Dr. Albert Heustig
   .A$@   V. Ma ch'  971     Chairman     Dr. Edmund Lew                      Dr. Rverfkt- Co=
    a    Visit$.     att  12 mc      (Dates, Chaii.,,n's  Name and Type of Visit)

             21.    72 -  Lorraine Kyttle - to discuss Pre                 ,Tn obiprtivt--,t and uprnming


              tr  t.



                        Occurred in the Region Affe,ting the PM Since its Last Review


                  i    n@State to establish second medical school at CdlumbiA gaining impet s.
                       is as having possibly favorable or negative impact -on relationships
                     ante @(medical University of South Carolina).  Favorable in that they
                     assist to their efforts to regionalize way beyond present concepts of
                     iati e in that efforts to counter establishment of second school may
                       ests@of grantee at a time when SCRMP proposes significant programmatic
                  z    onal changes.




















         SOUTH CAROLINA SUB-STATE             C Eo it GI
                 DISTRICTS

         1.  Appalachia Regional Planning and
             Development Commission
         2.  Upper Savannah Development District                                                                    09
         3.  Central Piedmont Regional Planning Commission
       *4.   Cenlrijl Midlands Regional Planning Council
         5.  Lo@-ver Sjvannah Regional Planning and Development
             Comniission
         6.  Satitt!e-@liateree Regional Planning Council
         7.  Pea Dee Economic and Development District
         8.  Waccaniiiw Regional Planning Commission
       *9,   Charleston-8erkeley-DorchLster Development District
       10,   Low Country Regional Planning Commission
         Districts with funded CHP "B" agencies

         1 f7l





                  COMpbneflt and FlnanClOt  SUMMAry    Anniversarl Apolication



                                                               V.)
                ENT        CU-PIP.ElltT          YFAR             YEAR         RECOI*!EttDED
                           'MI S AWAP.D      COUI,'CIL                           FMMING
                          04  OPER.          RECOOFENDED      'REQUEST              SARP
                           YEAR              LEVEL                                 REV. COX.


         E                 415,587                               499,818
         -Contracts

         R.   CTIV*        596,137                             2,032,541

          t#  COMP*        62,500                                1003000       Yes       or 'No

           RKS   #55       43,500                                323,920

         vir










         9 Dit  CT,      1,074,224        1.550.000,         2.632,35c,

                        2  991.048


           IL
            ED LE  L
                         1,550,000


               an




                                                                   RECION     South Carolina


                                                                     June     197 2 REVIEW CYCI.E

                e 04 year jis being-extended to 9/l.an@"ih'e region has been
              advised that the funaixig-level will be $1.,550,000 for-the 14  month
              per  d







                                   MARCH  17,1972                                                                                                                                                             REGION  -  S  CAROLINA
                                                                                                                                BREAKOUT  OF  REQUEST                                                         RM    00035           06/72             PS-OSM-JTOGR2
                                                                                                                                 05  PROGRAM  PERIOD
                                                                                          (5)                      (2)                                                                          CURRENT                CURRENT
                          IDENTIFICATION  OF  COMPONENT                           CC@T.  WITiiiNI  CCNT.  BEYONDI  APPR.  NOT                                I  NEW,  NOT                                                                  I          OTAL
                                                                                  APPR.            PERIODI  APPR.  PERICC)L           PREVIOUSLY                PREVICUSLY                      CIRECT                INDIRECT             I          T
                                                                                                                                                                APPROVED                        COSTS                    COSTS             I
                                                                                  OF  SUPPORT               CF  SUPPORT               FUNDED


                          COOO        CORE
                                                                                               S499.RIB                             -------       -       ----                                                8   I      s      l@bo_      1               -1681,427
                          --EEVE7CPM  NTA7
                          LI O,)

                          022      MEDICAL        UNIVERSITY        OF        Sol
                               uTH                                              I                                                 I._                RI6     I                                                              s           17,171-1_@R4            .987
                          039       STATEWIDE       HEART        CLINIC        El                                                                            I                                                .   I                        I
                               r                                                                                                                                                                 159.7LB          1         111,495        1          17t.713         I
                               )IJCAT                                                                                                        I  5'9-  218_   1
                          040       UNIVERSITY       OF        SOUTH        CARD)
                               1       1144       SL2.C&E        NUEU-I&AitiiN(il         561.2(,Z       I_
                          042    HEART  IMPLEMENTATION                          I                        I
                                                                                1                                                                                                               stllZDA           1         124,111-1                          .,A79
                          044    STATEWIDE  CANCER  CLINIC                      I                                                                                                                                 I                        I
                               rDtJCAT                                                                                                                                                                            1          ILL-  1   27  1          ssa@159-1
                          045      NUCLEAR           MEDICINE            TRAININI                                                                                                                                 I                        I                          I
                               G                                                1         $60,649                                                                                                 s 6 O.L.6A  9   I                        1          t6Q.649         1
                          048      GYT@ECOLOGIC                     PADLOTHEPAPYI                                                                                                                                 I                        I
                                                                                I                                                                                                                        .6.1 3             i6a,491, A-               62ZO-177
                          049      STATEWIDE            LABCPATORY            PERI
                                                                                          1 2 5. Q.9                                                                                                        094   1
                                                                     TP&Iti.LN5-L
                          050      CENTRAL          MICILAt4DS           MEDICAL]
                                                                                                                                                                                                liz@@   I                   !L;)3.77n      I          11,@AR
                          051         CONTINUING          EDUCATICN          HEAI
                                                                                                                                                                                                              ?             lis.772        1          2 ITLA -  SI;4

                          0   53   INFORM
                                                                                1         196,617                                                                                                                                                     1120,373        I
                          054      PLAN     ic@D     -01     SCFIARGE-ATO     PRI                                                                                                                                                                                     I
                                                                                                                                              s5L@o          I                                                                                        iso.ann         I
                          055.  'iEtODIALYSIS  CONTINUING
                                                                                                                                                                                                                                                      S7.1"
                                                          HOME            TRAINII                                                                                                                 $156,                           184
                          055B  EXPA,'ISIO'4  OF                                                                                                                         l@8.L480      I
                          C55C      PARTIAL      SUPPCRT      OF      2      BEDI

                          055D        DEVELCFt'Et4T        OF         TRAI%SPLANI
                               T                                                                                                                                         $96,440                      b@4    l@              $2  3.16   5             $11
                          @56              CO;PREHENSIVE              RESPIRATORI

                          057      SP  AR  TA@.B  UR  G  MCD  I  C   AL   ED   uc
                          05e      COMPREHENSIVE           COQCTARY            Cl                                                                                                                                                                     @6,997          1
                                                                                                                                                                ------------
                          059     GF<TLNWOOD     C     C     U     LltJKAGE     I

                                         L
                          76Z--  ZH-l  'FRFNTFATD  I  0  Ft@S   P   I   P   A   I
                                                                                                                                                                                                                                                              9 5  2


                          061      DIABETIC  TRAINING
                                                                                                                                                                                                                                                      i A 4  .4  S-L


                                                                                                                           11 [(,Iot4 -
                                                                                                                           it  ouo )5 06, II
                   MARCH 17,1972                                            BREAKOUT OF PEOUEST
                                                                             0 5 p ROG R Am P Ept to 0
                                                                                   (4)            ti)              CURRENT        CUPPENT          TOTAL
                                                                    (2)               NOT       NEW, NOT           DIRECT        INDIRECT
                                                CCNT.   WITHINI (;ONT.  BEYONDI APPR,   SLY     pFtEv IOUSLY       COSTS           COSTS
             IDENTIFICATION OF COMPONENT        APPP-   PERICOI APPR.   PERICCI PREV'CU         APPROVED
                                              I CF SUPPORT    I CF SUPPORT    I FUNDED
             Of,2  RURAL MOBILE @EALTH-----
                                            ECI
                          "D                                                                                          329359       -
             6;4                                                                                    $595,161    @2-06               $595
                                                                                    $408,302
                                                  $19628,896
                             T OT-A@









                                       South Carolina "W

           Geography-and Demostraphv
                Region encompasses state -- 46 counties; 10 medical districts
          Population -- (1970 census) - 2,590,500
                Increase of about 9% since 1960;  Land area - 30,272
                     Population per Square Mile bv               tricts

                            Population per          Numbers of
                              Square Mile         Medical Districts
                                 120-170                    3
                                 60-  90                    3
                                30-   60                    4
          Of the 46 counties only 6 have greater than 50% urban populations.       Of these
          6 counties, 3 (Greenville, Richland and Charleston counties) have 70% or
          greater metropolitian populations.  Within each of these 3 counties there
          are 3 metropolitian areas fith populations greater than 60,000 each.
          The state has a non-white population of 33%.      In the 6 counties with
          large urban populations the distribution of non-white population is
          comparable to that of the state.    In areas of the state that are isolated
          rural the percentage of non-white population is much higher (approx. 50%).
          @e distribution-             lanre for 10 districts
          19 years and under                 38 to 45%
          65 years and over                   5 to  9'/.
          Average life expectancy is 66.4 years for the state.
          Mortality --  Deaths  per  1,000  population,  1969

                                          South Carolina       United States
              All Causes                       8.8                    9.4
              Heart Disease                    3.2                    3.6
              Cancer                           1.2                    1.6
              Stroke                           1.1                    1.0
              Infant Mortality                 24.2                   21.7
        The five leading causes of death in South Carolina respectively are:
        Heart, Cancer, Stroke, Influenza and Pneumonia and Early Infant Mortality.
        45% of all deaths in the state occur before age 50.
        Resources and Facilities
             Medical Schools:  Medical College, University of
                                South  Carolina,   Charleston








           Resourc a and Facilities (con't)

                Mod, College of S.C. - School of Allied Health Sciences

           Professional Hursipg Schools - 9 of which I-,,-are college or uhivetsity based

           lggctic 1 Nursing Schools - 25 of which 5 ate hospital bated

                dited allied health scho*ls

           Cytote  nology - 1 - Greenville Gen. Hospital
                             1 - Ned  College   School of Allied Health Sciences
           @ked  at  Oh  loiy -
                                 6
           Red* 1 i@$c Technology - 13

            0  tal Facilities

              e@     97 comonity hospitals in South Caroling of which 80% have 150
           beas@or less.  Only 8 c     nity hospitals exteed 300 beds*  Four counties
           ha   no @ ospi SI @facility.

           $a     r

                ei a  per  iooooo  Population  (1967)
                v, lassiticition                So. Carolina         United States
                             1)                     84                      163
            t                                       103                    205
                                                    71                      153
              a           to Urban                  45                      96
            ol                                      35                      59

              I         ratio of Registered Nurses  per 100,000 population was
           2 7/        as compared to th national average of 313/100,000.







         PRINCIPAL PROBLEMS - based on current application
         SCRNP's attempt to embrace new initiatives must compete wi th this  appli-
         cation which does not leave much fiscal room for  innovation.  The  Region
         .could be reviewed as being pretty well locked into a 3 year project
         program approved and begun last year that might,be difficult to remold.
         Core tells us (not in this application) that many of on  going  activities
         can be expanded and/or redirected. This  application  reflects  minimal
         response to specifics of last year's advice letter.



         PRINCIPAL ACCOMPLISHMENTS

         Please see attached statement.



         ISSUES                     F REVIEWERS
         1. The Region's funding level for the current year was raised from
            $1,074,224 for a 12 month period to $1,550,000 for a 14  month  period.
            They responded quickly with new budgets (RAG approved) which sub-
            stantiates their intent to put their money where their  new  directions
            are.  The on going pro4ects generally were given only add on dollars
                                  i
            for time extension; the Developmental Component account was  more  than
            doubled (to accommodate the new look activities to be  presented  to
            RAG next month); a sub-contract account ($12,500) under Core was
            established for the first time in the Region's history  (to  provide
            Core flexible response capability) and upon learning that additional
            prorated funds could be applied for, the region requested that their
            supplemental application be deferred so that the April 29th and 30th
            RAG retreat could consider new activities in light of hoped for prior-
            ity changes.
        2.  The issue of what delayed the region's response to national, HEW, HSMHA
            and RMPS signals until this time probably has no single answer.  Its
            geographic  traditions, the reception of the original legislation,
            the conservatism of the grantee and the professional societies  cer-
            tainly were influences.  Possibly also contributing was South Carolina's
            fairly successful track record of submitting applications that allo-
            cated 61% of the requested funds to activities beamed at general con-
            tinuing education of existing health professionals, 38% at coordinating
            existing health services and less than 1% at patient care  delivery.
            This was the descriptor profile of their triennial application.  The
            descriptors for this application are not yet available but the  content
            of it indicates probably there would be some shifting of the  former
            percentages but not to a substantial degree.



                                             9




                          SOUTH CAROLINA IS AT THE CROSSROADS


             South Q iolina's Executive Committee has finally heard the word and
             h re   ea it to the RAG.
             ori in Ily; this program was built upon a premise absolutely  on ined
             to he  atsldtive mandate to improve the care of patients suffering
             fro @h  rt disease, canter, and stroke.  Through cooperative arrange-
                                                                         ade the
               s gii6jaing specialized training, SCRMP proposed to upgr
               Ca  rare spoken to in the oiikin4l legislation.  Given this con-
             i        Sou   Carolina made substantial progress during its first
             th e@ ars of operation.
             r it  fourth Year of operation, the region submitted a triennial
                c  ion    ich, while still concentrating on the upgrading of
                           inR health manpower, was reaching some major health
                            state -- the rural physician and the improvement of
                           services in communities, most of which are far below
             th              ing for health services.
                      6p  e work was underway for the development of this aopli-
                          continues the bulk of the progr        6v6d for Adtiva-
                       ear)@SCRMP core and the Chairman of the RAG were making
                        the traditional mold of the program attempting to move it
                         iei6ticdl constraints.  The terms "expanddd mission
                           gesti     int o  d    as
             Co             was given delegated authority from a Decemb r 1971
                      g   r,the Executive Committee to make some final funding and
             rg      iong  iestiuctuting'decisi6ns which were deferred pending the
             u@t      f    Januarv meetin  in  St.  Louis.
                                          9
                            cerpt from a January 28th special meet  g of the
             El,           ttee of RAG *a interesting --- "The expanded'RMP
             M3            a fact.  Even though existing legislation has not
                             es Of activities, new legislation will and the RNPS
                                                    oubled to f  'lita
                            tion has already been d             aci    te the final
                       Of  t6grams fro  the strict categorital focus to the
                        7
                        Cl   with health services at a   community level."
                       has'developed a RAG retreat for   April 29-30 at which the
                                           enges (their words) will be explored.
                        si6n and new chall
                       as boot developed for the purpose of generating several
                          Core believes@ to be the pivots for redirecting the entire


                           Expanded' Mission  Study  Group  from which new goals
                             be sought.  The areas of inquiry will be:

                                 A.  Health ManPow6r Development







          Page 2   South Carolina


                               B.  Primary Health Care DeliveryPatterns
                               C.  Regionalization of Specialized Care & Support
                                     Services

                      A Reorganization Study Group - from which new RAG  &  Core
                      structures will be sought.

                      A meeting of the entire RAG from which  programming  of
                      Developmental Component monies in new  directions  will
                      be sought; a charge to Core to  develop  the  reorganized
                      structure; and a reassessment of program priorities.

          At this juncture, all of this is a promissory note.  Core  feels  it
          can come away from the retreat with enough to move the  program  way
          beyond where this application shows it to be. Dr.  Moseley  is  very
          realistic about making RAG restructure moves first  and  membership
          moves next. The region tells us that for a while they  will  have  to
          operate both programs in tandem, gradually phasing out  those  activ-
          ities not able or not willing to expand or  redirect  themselves.  For
          openers, staff says it has many new look developmental  activities  it
          will present to RAG at the retreat.

          All of this is presented by way of alerting SARP that  South  Carolina
          is indeed at the crossroads ... albeit rather tardy. These  exciting,
          hoped for changes are not reflected in the application you are
          reviewing.
          When RMPS staff met on March 22nd to preliminarily  review  SCRMP's
          anniversary application, they agreed that the events Core had
          generated since the application was prepared put the region in a
          different light. We were faced with a timing problem  --  our  pro-
          cedures call for a review of the region on April 10-11 and the
          success of the first stages of SCRMP's expanded  directions  cannot
          be assessed until April 29-30. Most of the staff  reviewers  felt  a
          postponement of review was justified. Mindful of  the  procedural  and
          administrative complications such a d@cision may entail, the reviewers
          also agreed to prepare this document and request that it be given the
          weight of an addendum to the application should a  postponement  of
          review not be feasible.  In that event, we agreed upon a recommendation
          that the region be continued at its newly approved funding  level  of
          $1,550,000 (the Council approved level) for its upcoming  12  month
          05 year. This figure is exclusive of the  expanded  kidney  proposal
          which is the subject of a technical site visit on April 10 by
          Drs. Gonzales and Gross. By pruning the requested  budgets  for  the
          continuation activities, the region could develop some  fiscal  room
          for activation of new initiatives.

          Attending-the March 22nd staff review were:








           Page 3   South Carolina


                                Frank Nash           EOB
                                Bill Reist           SCOB
                                Larry Pullen         GRB
                                Lee Teets            GRB
                                Ted Gkiffith         ROR
                                tbrtanie Kyttl6      SCOB

           Ge          P&E had  to cancel just otior to the meeti    and h   sub-
             ne@N  son                                            n       as
           mitt6a  is t6cb@ndations which are in agteeement with the above.
           H,S@     is  attached.





                                        2



                                        Lorraine M. Kyttle
                                        Publit Health Advisor
                                        South Central Operations Branch











                                                                              4/3/72



    MEMORANDUM                          DEP,-ILRT.\IENrOF HEALTH,
                                                        PL'BLIC   HE:\I,T@i   @ERN'lt'E
                                          HE:%I,Tli SFR@'ICES .\ND %IENT.\I,


             Lorraine Kyttle                                 I)AI'l,":  March 31, 1972
             fltiblic Health Advisor
             South Central Operation-, Branch, I)OI)
      II-f[ZU: Acting Chief
             South Central Operations Branch., DOD
   ]-'RO,Nl  Program Analyst
             Plaming Branch
   ,SUBJEC'F: Pending SARP Review of SCRMP Application   P&E Input

             For background information it should be stated that I have  only
             recently been assigned responsibilities relative to SCRNP.  I  have
             neither visited the Region nor otherwise been personally exposed to
             its program.  My input, therefore, is based on review of the appli-
             cation per se, review of past records, your report of findings  and
             impressions, and informal discussions with house staff.
             In keeping with the P&E function and joint  appointment  philosophy
             (at least so far as I view them) I have directed my attention  more
             to the general planning context than to content of the  application
             per se, viciving the latter as fittine more properly into the schema
             of reviewing groups other than P&E.  This approach is not unique to
             this application but is consistent with the approach I have  always
             taken.

             As to application content, suffice it to say I find it leaves  much
             to be desired. In t at @pect I concur with majority  mini-  SARP
             opinion. It strikes me as speaking more to the past than to  the
             future.  As to context, I submit the following:
                The evidence as I perceive it points up a problem  common  to
                planning-oriented efforts, i.e., the conflict  between  critical
                factors. Such factors generally include  (but  are  not  limited
                to) lack of planning expertise, internal  and  external  circum-
                stances over which participating interests have little or no
                control, differing goals, objectives, etc., among mutually con-
                cerned organizations, the myraid problems  associated  with  in-
                iiovation, comunication, administration and funding  at  various
                levels, changing signals and processes, timing,  and  the  like.
                In my opinion, successful planning efforts are  generally  those
                which view such critical factors in proper perspective, draw them
                into desired relationships to one another, and adapt well as those
                relationships shift, always keeping an eye on the ultimate goal.
                In a nutshell, it seem to me that South Carolina  has  not  been
                able to do these things well, and thus has not been able to stay
                on top of its planning process. The Region's  need  for  bending







              Page  2  Lorraine Kyttle

                                              one of the c itical factors in this
                    the rules reflects that.              r
                    case seems to be (an apparent) lac@- of planning expertise.  This
                    has resulted in lack o@ planning foresight which in turn con
                                            Itt' ,  It
                    tributed to the present   ming  problem relative to its application.
                    The region has also been heavily affected, however  by internal
                    circumstances (Dr. 14oseley's illness with its attendant influences)
                    changing national signals (including timing, scheduling, and
                    processing) and comm:'Lcations gap problems at  various  levels.  I
                    will not expand on the first two of these as you have already ably
                    done so.
                    MY input speaks primarily to the co     ication gap, one of the
                    more difficult problems facing the program at both headquarters
                    and field levels.  As I see it an intimate knowledge of an ap-
                    licdtion is not worth a tinker's dam  without  an  appreciation  of
                    p
                    the context within which that application subsists.  Your report
                    of findings and recommendations indicates an attempt to -reach  the
                    proper balance between content and context; and I think a very
                    valid and successful one.
                    Mini-SARP's decision to supplement this application with additional
                    information for SARP's perusal was a sound one, in which I concur.
                    in fact, I consider it essential to a proper review of this ap-
                    plication.
                    in totality, it seems to me certain basic issues arise-
                    1. @:ln view of the 'vm'nence of the South Carolina RAG retreat - at
                        which significant changes apparently will be made - is it
                        Tealisti& to make decisions now which might dilute effectiveness
                        of those changes?  Would that be consistent with our efforts to
                        promote planning?
                    2.  Is the SARP T)rocess one to which applications and planning must
                        of necessity respond with little flexibility, Or can the process
                        lend itself to mutual acconwdation?  If so, should it in this
                        instance?
                    3.  Dr. Margulies' directive of 2-22 states  that  certain  regions
                        should receive extra field assistance for upgrading their
                        programs.  Does the same-underlying philosophy carry over into
                        the MU (and mini-SW) Process?  As a cor llar,v, haw do you
                                                             twe          assi tance staff
                        establish effective c      ication be    en field     s
                        and SARP -reviewers in order to get the most milea-ae from  the
                        process'?









             Page 3   Lorraine Kyttle


                  4.  In the final test does the evidence warrant reviewing this
                      application in its larger context rather than reviewing it
                      on the merits of application content per se?

                  It seems to me the answers to-these questions hold the key to
                  effective review of this application and that those answers rather
                  obviously favor the total context approach.  What adjustments that
                  approach entails is another issue.  So is your problem of pre-
                  senting the extra information and insights required.



                                              Eugene J. Nelson






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                                                                                             rL ti0:3 :i 14 to rtn                                                    000
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                                                                                             :J ZI FJ- -0H-'d U) rt                                                   (D rt :4                   "rt
                                                                                             rt :3 Eg CD00H.M                                                         rt (D                      m
                                                                                             GQ (D"0:ix                                                               0pi                        m0
                                                                                             FJ :J0q:3 @ GQ Fl-                                                       tJ :3 (D                   m
                                                                                             r@6oC'Y rt F4 rt 0) Iri)                                                 mOD
                                                                                             H000rt rt                                                                (D Fl 11
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                                                                                             :i rt Z,0w:i                                                             En -0                      rQ
                                                                                             F40FJ-nU)ML-J- (YQ                                                       Pi
                                                                                             mmm0:iz"(D                                                               rt0                        CL
                                                                                             rt ri) aq 10 (Dnzr                                                                                  rr CD
                                                                                             Fl- 410 rt (D                                                                                       o;
                                                                                             lb o 0Id0En0Fl- 03                                                       rt ri)                     r?,
                                                                                             rt CL :i pi C-) .4 F,                                                    Fl- (D                     (D PI
                                                                                             Fl-Mo(D rt                                                               0CL                        (D            >
                                                                                             o:3 Li' (D                                                               (D :i                      m             -i
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                                                                                             rt                                                                                                                LI)

                                                                                                                                                                                                               0








                                                            L. Kyttle
   4p: South CaLolina

      CONTINUED SUPPORT (10)
      19 of original projects self supporting*RAG Manual (updated January 1972) speaks
      specifically to concept of SCRMP support to establish needed activity or. service
      and then shift to other sources if continued beyond general 3 year period.  At this
      time, SCP14P is rather locked in to supporting 3 year projects, most of which were
      linewlt at the time triennal application was approved and have 2 years to run.













   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
   Bcommended Action:







      NIINORITY INTERESTS (7)

      While funded activities specify target groups to be all inclusive regardless of race
      or economic status, most activities primarily concern specialized training programs
      for health professionals.  Wording of present goals and objectives does not lend
      them to an evlauation on this point.  Minority providers and consumers not adequately
      represented on RAG.  In response to specific recommendation last year, member from
      Palmetto Medical Society added to RAG.  At present time Care professional staff all
      white and all male (form 7 notwithstanding)












    - - - - - - - - - - - - - - - - - - - - - - - - - - - -  - - - - - - - - - - - - -  - - - -
   ECOMMENDED ACTION:






            th     oli@a                                         Uttle                    3/30/',

  50        NATO   (10)

       04rdihito   generally acknowledge4 as person with stature in the state who can meld
                   dii   ofessionalg and coinmunit  interests.  He just returned to office
                                                 y
                   illness.  Apparently 46vel6ped competent staff as program generated
                   @f6t hoped,fdr sweeping changes in his absence from office but which he
                   am hospital and convalescence at home.  Summetall, a 50% deputy, stepped
                   100%;during that time.

















         - - - -   -   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
          de








   64

                    goo  range of competence for existing Care structure, but. not neces"
                   str  tuieO mission they describe.  Very categorical.  Housed in increa-
           I        e quarters.  Entire staff literally cannot all sit At desks at same time.




















                    - - - - - - - - - - - - - - - -  - - - - - - - - - - - - - - - -
                   ON-.








     RMP    South Carolina
                                               PREEABEA EX-.    L. Kyttlg

    7.' REGIONAL ADVISORY GROIIP (5)

        RAG has 72 members.  Care realizes too large.  Very elite Executive Committee.
        Meetings usually attended by slightly more than half of membership.  Last full
        meeting, RAG adopted an attend or be dropped provision.  Mosely hopes to prune
        by this mechanism and make consumer additions as well.  RAG plays very active role
        in all program decisions.

















   Recommended Action:








   8.  cRANTEE ORCANIZATION (2)


       MUSC grantee.  Several bones of contention.  Most important:  Is new and expanded
       mission which SCRMP sees as its legitimate mandate also viewed as a legitimate
       mission by grantee?  Myrtle Beach retreat at end of April may open this up.




















   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  - - - -
   @COMKENDED ACTION:






          South Carolina                      EgEEAREn BXI    L. Uttle             T)az @/10/

   @9. PARTICIPATION (3)

        Reg on's medical political complek deeply involved it program.  RAG membership s;o
        attests.  Coordinator represents astute link between MUSC and SCRMP.  CHPA viewed
        as  o fective by SCRMP.  Two funded  B agencies out of 10 medical districts.




















  - - - -   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
           de 4 A i on:







        IOCAL P    TNG (3)

        ro a on in review procedure for CHP review and comment.  SCRN? structure in medical
                          anized Annual Conference of Health Planning Council whereby
       d  tr   s $CP" org .1
            i#  planning councils of CHP meet to review all programs and plans.  Overlapping
       s       d     membership on local district committees.

















           - - -   - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - -  - - -
              'A  I






                                                            L. Uttle.                          2
   fp - South Carolina                                BY;

   .1.  ASSESSMFNT OF NFED.9 AND RESOURCES (3)
        SCRNP developed South Carolina Health Data Profile which represents most'in depth
        attempt to accumulate interrelated health data in State's history. Medical
        Districts update.















   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -
   !commended Action:








   12. @MANAGE-.14ENT (3)
        Region received one of the first management assessment visits in January 1970.
        Very well rated at that time. Recent visits continue,to comfirin original
        assessment.

















     - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -   - - - - - - - - - -  - - -
   ECOMKENDED, ACTION:








            South Carolina                                       L. EXttle
                                                                                        DATE,. 3 30/-4


         EV  UATION (3)

         There is no full time evaluation director.  There is a    full time program analysis
         coordinator.  Region proposes evaluation (both individual project and program impatt)
      i  as an area to be specifically spoken to under A reorganization.




















        - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
          nded Action-







         ACT    p     (5)

         t is   n this area that region proposes sweeping changes to be aired at Myrtle
                    at.  As program now stands, goals and obj6c     es  o no  em race nat ona
                        mission entirely.  The activities proposed by Region are for most
                     @second Year request for continuation of specialized education activ-
                     kidney propsal expands beyond this concept and some of the flavor of
                      ities is to train patients, link hospitals and expand services.  In
        4eve     n   ew  u  ets uni r  ew      ing  eve , reg on  opt6    o Act vate t e new
         @r  e   d ling with expanded services and fund a previously approved activity that
                    OP a team approach to preventive and comprehensive medicine out of
        SP           General Hospital.












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






                                             PRRPARE       L. Uttle
   fp:    South Carolina

   15.  DISSEMINATION OF KNOWLEDGE (2)
        On the basis of information in this application and free standing documents, tlie.
        region appears to be meeting the requirements under this category.
















   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
   @commended Action:





   16.  UTILIZATION MANPOWER AND FACILITIES (4/)
        The region's currently identified priority of improving patient care through con-
        tinuing education is certainly proportionally reflected in the overall program.
        Existing community health faculities are utilized in the educational programs
        and it is more than likely that productivity of existing health manpower will be
        increased.  Each of the 10 medical districts in South Carolina is below the U.S.
        in health resources, the Central Piedmont district showing the largest discrepancy.












    - - - - - - - - - - - - -   - - - - - - - - - - - - - - - -    - - - - - - - - - -  - - -
   ZCOMMENDED ACTION:







                                                      RY                                 @30/7:
         South Carolina


   II.  IMPROVEMENT OF CARE (4)

        Studies pursued under the Developmental Component are beginning to focus this prbgra
        on the e@tent to which ambulatory dare might be expAnded.  Continuity of care is the
        6ubj66t of further activity pmpo-sed under the Developmental Component bat not spedi-
        @fied as an activity in this application. Most of the activities in this  proposal
        eal with improving specialized care. The step of strengthening  primary  care  and
        the elationshil) between primary care and specialized care is one of the  subjects
        of the upcoming retreat.
















              - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
         ded Act on-.







   18.   HORT-TERM PAYOFF (1)

          a proposed adtivities will increase the quality of specialized care and to A
         esse  ex'ent increase services available in,a short,term time frame.




















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

              cr






                                                    n        L. KVttle
         -South Carolina                     PRPPARR-

   L9.  REGIONALIZATION (4)

        SCRMP is building linkages and in this concept has regionalized well.  Its
        district structure has contributed to this and a strengthening of the medical
        districts is a priority of the upcoming year.















                               - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
   - - - - - - - - - - - - - -
   --co=wnded Action:







   20.  OTHER FMDING (3)

        SCRMP, like many other regions.has not done a.good job of telling this part of their
        story.  Without exception, the 16's show no other sources of support and the 15's
        do not speak to other contributions whereas when the staff described the activities
        in more depth on a recent staff visit, I found that many of the hospitals had con-
        tributed financially and otherwise to the training projects and the MUSC had made
        substantial contributions as well.  Conversely, SCRMP has co-authored several grant
        applications ultimately submitted to Appalachian organizations (federal and state)
        as well as NCR&D and BHM.















                                                                          - - - - - - -  - --
   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
   TECOMMNDED-ACTION;




        E-M-ORANDUM                   DEPARTNIENT OF HEALTH, EDUCATION, AND NVELFARE
                                                    PUBLIC HEALTH SERVICE
                                        HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


    TO      Acting Director                              DATEApril 18, 1972
            Division of Operations & Development




     FROM   Director
            Regional Mpi@l Programs Service
    SUBJECT: Action on April 10-11 Staff Anniversary Review Panel Recommendation
            concerning the South Carolina Regional @,ledical Program Application.


            Accepted        V/
                                                   (Dat@)-



            Rejected
                                                   (15ate)



            lbdifications






                        onent and Financial Summary - Anniversary Application



            COMPONENT        CURRENT            U -5 YEAR          b@ YEAR             RECOMMENDEI)
                             YR I S AWARD         COUNCIL                                 FUNDING
                            @ OPER.               RECOMMNDED         REQUEST                SARP
                             YEAR                 LEVEL                                     REV. COM.


                           41S    587                                  499JI818
     CORE
     Sub-Contractg
     OPER,     ACTIV.         S96)137                                 2,0321541      1,550,000.
     DEVEL.   COI,4P.        62,500                                     100@000        Yes (X     or NO

     EARMARKS:
                             43,500                                     323)920         150,363
         KIDNEY  #5r









                                              1 sso 000                              1
                            1,074,224                               2 632   359        )700,368
         3 DIRECT

                         2    991,048
     RE2UESTED

     COUNCIL
     APPROVED LEVEL         1,550,000

     NON-RMPS     and
     INCO',ME


                                                                                    South Carolina
                                                                          REGION
                                                                           June        1972 . REVIEW tYCTE

              *The 04 year is being extended to 9/1 and the region has been
               advised that-the-funding level Hill be $1,808,324 for the 14 month period.
               This represents a pro-ration of the $1,SSO,000 Council approved level.



                                                                                   4118/72  SCOB/RMPS





                                                           Region South Caro 'na
                                                           Review %'Iycle Tiinp -1972
                                                           Type of Application: Anniv.
                                                           within a Trieiuiial-
                                    Recommendations 'From
                                                            Rating - 240

                 SARP                                         Review Committee


                  Site Visit                                  council



       Recommendations:
       1.  That the Region's funding level be continued at $1,550,000 for  its
           OS operational year.  This level is exclusive of the kidney proposal.
       2.  That the kidney proposal be approved as recommended by the site
           visitors at a level of $150,368 for the first year and $104,691
           for the second year.
       3.  That disbursement of funds for the second year of the transplantation
           portion of the kidney proposal be contingent upon an appraisal of the
           first year's performance.
       4.  That the advice letter cover the specific points discussed by the
           Panel and delineated under the Critique portion of this document.


       Cri
       The Panel first considered the staff reviewers' proposal for postponement
       of the review of this application until an assessment could be made  of
       critical programmatic issues to be acted on by South Carolinals RAG  at
       a 2-day retreat to be held at the end of this month. SARP  agreed  that
       although the retreat issues were central to moving this Region in expanded
       and new initiatives, the real program impact of decisions made there could
       not be assessed in the immediate future.  Therefore, Panel decided to proceed
       with a review of the application as-presented with consideration also being
       given to the documents presented by staff covering developments in  the
       Region since the application was prepared.
       The reviewers agreed that the application reflected a failure to respond
       to specific recommendations included in the advice letter last June.
       The heavy categorical emphasis of the program; the traditional continuing
       education activities through which it is implemented; the Region's goals,
       objectives and priorities; the composition 'of the Regional Advisory Group;
       all were cited as continuing weaknesses.  With what Panel sees as superb
       lack of timing, the Region did not address these issues in its anniversary
       application but stands ready to do so at the RAG meeting which takes place
       while this application is under review.







         Page 2 -Critique                                      South Carolina PAT
         Panel agreed that the classical academic approaches characterizing most
         of South Carolina's activity to date reflect the confinement of the
         very conservative and influential medical/political structure.  To
         have moved this program in this State to the point of addressing the
         basic program issue of a mandate beyond that confinement and to have
         cultivated a preliminary endorsement of the proposal by key members
         of the RAG's Executive Committee, is, in the Panells view, encouraging
         evidence of Dr. Moseley's leadership. What South Carolina  has  undertaken
         through its operational project activity has been done well, and the
         reviewers felt the program could be expected to embark on new  initiatives
         with characteristic efficiency.
         The reviewers voted to accept staff's alternative recommendation that
         the Region's funding level be continued at $1,550,000 for its OS operational
         year. In arriving at this recommendation, the reviewers agreed  to  accept
         the Region's promissory note and,therefore, felt the funding should be  so
         established as tDallow South Carolina to implement its promised new
         initiatives. The recommended level would also require the Region  to
         prune the requested budgets for the continuation activities.  The $1,SSO,000
         level is exclusive of the kidney proposal which will be reported on  later
         in this document.
         Panel recommends that the advice letter to this Region specifically  cover
         the points that previously identified weaknesses continue in this application;
         that the recommended funding level represents a reliance on the Region's
         ability and intent to implement significant programmatic and organizational
         improvements in the very near future; and that any issues remaining unanswered
         following the RAG retreat be explicitly identified.
         The kidney proposal was considered and the recommendations of the site
         visitors were accepted.  The report of the site visit is attached which
         recommends $lSO,368 for the first year and $104,691 for the second.  A
         qualification was added to the site visitors' second year funding recommendation,
         that being that funds for the second year for the transplantation  portion
         are contingent upon an appraisal of the first year's performance.









         0


                                                           RMPS/SCOB/Kvttle/4/18/72




                      Component and Financini Summary           Anniver3nEL i%npticRLiutt



        P'-coiipoNr.NT          CURPE,@IT                @rFAlt             Y-FAR          RECOMIE-ITDED
                                YR'S AWARD           COU',,'CYLL                              FUNDING
                                                                        'REQUEST
                                      PER.           RECOIIMENDED                               SARP
                               jA 0
                                YEAR                 LEVEL                                      REV. C014.
                            (14'mo.                                  (12 mo                        eriod)
                                     period)                                  period)    (12 mo. p

        CORE                       620,627                                499,819
        Sub-Contracts
        OPER,    ACTTV.            981,947                              -.1,708,621          1,550,000
        DEVEL.    COMP.            155,000                                ioo,ooo          Yes (x     or  no

        EARMARKS:
           KIDITEY  #55             50,750                                323,920               150.368**

           CBE #63              See below*







        R14PS     ECT                             1,.550.,ooo           2 632   359          1,700,368

        REQUESTED                2,991,048
        COUh'CIL               1,550,000-12 m
                               1,808,324-14 m
        APPROVED LEVEL


           -Rl4PS  and
        NON
        INCOME

         Al o pending is,a,request      as follows:
           !3
         CBE component #63  01        $722,140; 02 :$820,523;                REGION     SOUTH CAROLINA
                                     '03   $942. 186@'
                                                                                June     .197 2, REVIEW CYC
         The  level of   approval for   the  second  ypar  of the  kidney
         component   is  $lQ4,@,,l.                            N

         Current                uest,      2,632,359
                  ..program req           $
         ,Supplemefital.CBE request           722,140
         Re@ion's total    request        $3,354,499



                                                                                         5/23/72'



      .Nl E ivi U i@ Pi i\J L) L) ivi                  N I- @ I@ @ "I @ .1 @ @ I@ "@ @. I @ . @ . -@ , ,. I ---- - -. I . -
                                                            PU13LIC IIE.\L,rji SFRVICE

                                                     SIll@VlCl,'.S ,\ND i\ILNT.\[,



                For the Record                                   DATE:






      FRO.NI    Yedical Consultant
                Division of Professional and Technical Develop",nt, PIIPS

      SUBJECT:  Recommndations of the Mini-SARP regarding South Carolina
                  Kidney Disease Proposal (55-B, 55-C, and 55-D)


            1.  Ptir2aae of the Program
                To expand an already existing Hor,,e Dialysis Training Prograi@l (55-B), as
                xfell as to establish a satellite dialysis unit at Colu,-,bia, South  Carolina
                (55-C), and to initiate a  university-based  transplantation  program  (55-D).

          .TI.   Action

                A.  The recoTn,@.ndations of the Mini-SARP were for the general  approval  but
                    with the stipulation that a site visit be i-tiade with the use of an  out-
                    side consultant plus staff for the purpose of:

                    1.   Determining a more realistic, overallll-v-el of funding;

                    2.   Resolving the issue of a proposed satellite dialysis unit
                         at Baptist Hospital versus Richland 14errorial Hospital;  and

                    30   Dlecu.-cin,. in grcater detail the proposed transplantation  activity
                         in view of making specific recor@t-,endations regarding the level of
                         IIITS supports

                B.  It is advised that this consultative activity be carried out as soon as
                    posEiibiLe, prefera'oly in time for our recoT@-i.Tendation that can be t-@-de to
                    the SARP at ito next in(!eting on April 4, 1972.




                JAIZS B. GRO     M.D




                                                                  Reg i on: South Dakota
                                                                  Review'Cycle:J6ne  1972
                                                                  Type of  Application-02
                                                                   continuation  plannin2
                                                                  Ratin @ 90.3


                                       Recomqiendations From


                               /-7      SARP           /X-X7   Review Committee


                              /-7       Site Visit     /-7     Council



    RECOMMENDATION.4  The Review Committee concurred with staff re viewers and SARP that  the
    a placation should be approved in the time and for the amount requested ($424,662).
     p
    This figure is exclusive of EMS and CBES supplemental requests which are presently
    under review.

    CRITIQUE: The Committee reiterated many of the points raised by SARP during  the  course
    of their review of this application therefore, they will not be repeated in the blue
    sheet. As mentioned previously, the Committee strongly endorsed  SARP's  recommendation.
    However,, mention was made of the fact that even though the Regional Advisory Group it
    comprised of 51% consumers, there appears to be a dearth of consumer representation  from
    such interest groups as the poor, farmers and organized labor. Of interest is  the  fact
    that the primary reviewer lauded the Region for its efforts in terms of establishing what
    @arS to be a very viable working relationship with the Nebraska Regional Medical
         am from whom it was divorced,

    In summary, the Review Committee agreed with other reviewers that the Region has
    demonstrated considerable progress during its first year of development.  Further,  the
    Committee reinforced the recommendation made by those who had previously  scrutinized
    this application that the Region's planning status should in no way deter it from  being
    considered for out-of-ph6se supplements in the areas of Emergency Medical Services  and
    tommunity-Based Education Systems. In conclusion, Committee noted that  they  concurred
    with SARP and were recommending an additional years support for the Coronary Care  Unit
    Nurse Training Project.






                            Component   and   Financial   Summary  Anniversary       Application



               ENT                 CURRENT             01 YEAR              02  YEAR        RECOMMENDED
                                 YR#S AWARD                                                    FUNDING
                                  01 OPER.                                                  L= SARP
                                    YEAR              COUNCIL
                                                      RECOMMENDED           REQUEST         /x-x7 REV.
                                                       LEVEL                                         COM.

                                  2590500                                   3201000
        CORE
        Sub-Contracts                 NA                                    (30,000)
        OPER.   ACTIV.            120,000                                   1041662            424t662
        DEVEL.   COMP4                NA                                      NA             Yes    No (X)

        EARMARKS-.
                                      NA                                      NA
               KIDNEY



               EMS   2                                                      see below
               CBES #3                                                      see below



        RMPS DIRECT                                                         --
                                   *379,500               313,000           424,662            42496@.2

                                  786t5OO
        REQUESTED

        COUNCIL
                                  379,500
        APPROVED LEVEL
        NON-RMPS   and
        INCOME
               Region  6xtended  for  2  months  at  $63,250  for a total
               of $442 750.                                                    REGION     South Dakota
                       I
               In  considering  an   in.creased  NAC  funding  level  for  t  e ',June   197 2 Review Cyc
               02 year, it should be noted that out-of-phase supplements in the          areas of EMS and
               CommObity-Based Educational Systems have been submitted.
               Pending are the following requests:  EMS, $470,1000 (for one year);'
               CBES, $165,000 .(for one year).
               Current program request          $424,662
               EMS request                      $470,000
               CBES request                     $i65,ooo
               keaions total request           1-OSq.662









                             SOUTH DAKOTA REGIONAL MEDICAL PROGRAM

                                  02 Planning Grant Application


                                        TABLE OF CONTENTS


                                                                            Paqe
       Part  I

       Staff Briefing Document

             Face Page                                                          I
             Geography and Demography                                       2-3
             Fiscal   Summary                                               4-5
             MIS Printouts                                                  6-7
             A6comblishments, Problems, Issues                                  8
             Staff   Comments                                                9-11


       Part  If

       Kidney - not applicable

       Part III

          k-uO  Material

             S ato-ment of Need for Coronary Care Training
               Program
             T ip Report    Harold O'Flaherty and Luther Says, Jr.

       P rt  I

       Site  visit Report

             Trip Report    Bruce Everist and Clark Millikan

       Part  V

       Advice Letter - not applicable

       P rt VI

       Management Assessment visit report - not applicable






                                                  @s
                                       STAFF     BRIEFING     DOC@


              South Dakota                              OPERATIONS        08ASTFFN ZO-7L,@, ,
                                                            BRANCH     OSOLnH-CENTRAL  4-@@tSWM

                                                        BRANC$I
              CATION:          NCNE   LAST RATING       @l. No.  443-1790           Room    10-15
    Z7     ENNIAL                 -197- DATE            BRANCH Cl=  Michael J. Posta
         St ANNIV YEAR             s                    BRANCH STAFF  Harold F. O'Flaherty
    L7    nd    IV YEAR        L7 FEV. COM.             RO.   REP.     Daniel Po    bs  r
               02-nlgnniniz    L7 MER                      t mgt. Assmlt Visit      NA          197-
                                                            airman
       t Sv. Oct.27197-L;     Chairman  Bruce Everist and Clark Milli@ National Advisory C
    3     Visits, Last 12 mos. (Dates, Chaiman's Narfie and @pe of Visit)
    October 5 6, 1971 - Richard Clanton 7 to meet with new Director
              6-27, 1972 - Harold O'Flaherty - to assess the overall program progress

                  WHICH  OCCU=  IN  THE  IEGION  ANECTING  THE  IM  SINCE  ITS   LAST
                  19T 1
     I @As o  9-1-71  the  W  recruited  a  full-time  Director,  Dr.  Jdm  A.  Lowe.
           e Dean of the Medical School has been removed from his position.
     3.  A decision regarding the establishment of a 4-year medical school has been put off
        @till the next session of the legislature.
     40    e State legislat@ has fmded a project entitled 11@mm @fom Health Services"
                which will make it possible for persons to have access to the health care syste
         in a@4-c6mtv area where there are no doctors, nurses., dentists or hospitals. ($186.00






        G'@"'OGFAP
          67 couPties                        Districts
            2


                                                                                                                                                         C P14CRSO"
                                                                                                                                 CAMPOELL
                                                                                               co;fsof.
                                                                                                                                                                             t        b;kow;i


                                                                                                                                                                                                             DAY
                                                         PERKINS                                                                                           EDMUM
                                                                                                                                 WALWOR H





                                                                                                          ocwcy

                                                                                                                                                                                       SPINK
                                                                                                                                                                                                         CI.AitK'

                                                                                  ZICOACH
                          AtJTfc





                                                   MEADE

                                                                                                            STA


                                                                                     MAAKON


                                     OPAPID CITY                                                                 JONES                    LYMAN
                                      PENNING'OM





                         CUSTCR




                                                       SMANNON@                                                                                                                    CHARLES Ml
                       rALL RIVER                                                                                 TODD
                                                                                                                                                                                                      @f-004 14(
                                                                                                                                                 Pop@TI@-1

       OLI'21CA
                                                                        4                                                                                                          on           666,300
                                                                                                                                                   Total POPulat'  : '                                                 A I,=
                           @ckard           F.    Fneip            (D)                                                              tion            population   Llensity:                      9 per sq-.
       overnor:                                                                               -o@ttee on,Nutri                                                                        M:        45
       senators:  George s  :11@Gove@-n                            (D)         Seleo-t                                                                                     %   Urb                                        85,ooo-@nly Indian)
                           Karl F.           ,undt                                                       Congress)-Jan@                        19'(1-                                                  'appro
                                            (congressional -c@istrict (92n                                                                                         % @-.on-white:                 5
       Representatives by
                            @ank E. De@ioL
                      2. Jaraes G. Abourezd-




                                                        3
                                                                                     F,EGION  South Dakota
                PROFTLE                                                              REVIEW               Turiee 197 2

                    FESO'URCES     --     SCHOOLS
                                                         --.       Enrollmnt   Uraduates
   @ools                                   Nurber              (1969/?O)       (1969/70)-          Location
   Ddici
    St  e@    IV  of S. Dakota                                 95                                  Vermillion
    s   ool  of Medicine - 2 yr.
           c    d.
                    .-Pcience


   ti        (19b7/bb)
          State       v. College              (1)             171                   49
       Q          Cy  .                                                  ,   -.t                   Brookings
            8         ursing                  9  (5  of  which   are   college   or   Univ.   Based)
    P  ct   ca3- @Nursing                     5  (Technica.1-Vocational Schools)
                      ty C61le e@             1 Jr. College
            vexisi     ased S      ol
       e     z4th  chools @approved       program)'
            c  010                            0
             i    Therapy                     2
              Te@,iology                      6
             ,V,i  Technology                 7
                  e apy                       0
                 co    L-Lbrarian             0

                AND   RESOURCES   --    HOSPITALS

   @on                   and Long-tem
    G.                als, 1969                                 Nursina & Personal Care Homs. 1967
                                             N@er                                                         Nuaber
       !a                     Nunber    of Beds-                @e                           NuTher       of Beds
         te                                3!0572                   116-& Nursing Hornes         134      3.,5
   ,Ong te                        1            76               Personal Care Homes
   [A Ge     1 IOST)itals         2           560                with Nursing Care                4o      1,704
   )HS      an                    5           194               Long-tem Care Units               9          249
                         Number   of   Hospitals   with    Special    Facilities
                                   of o Faci  ties                 'iype va      ty                of Facilities
                                        14                                    Ilberapy                    b
   ,ob(,                                --                         Renal Dialys s (in-pt.)                3
   [so             lity                   5                        Rehab-in patient                       7

                AND   IWOTJRCES    --    MANPOWER
                                                                   7
                              Nu&er    %  Total  Per 100,000           Prof                               100,000
                  actite-   485                                        Professional nurses
                      ce                  40                                actJ              .1089       308
                  cialties                13                                ina(                8o4
                   cialties               25                           LC.     I             s
        ir                                                               activ(
                                  31                                      in nursing            615       92
                                    1                                    not errpl.
                                                                          in nursing            159
                                                           77




                                                             4
                                                                                                  coMliEtfl)ZD
                             CURPF.QT                      AR                 YE               RE
       collwoNrIlIT                                 C 0 U 't,CL                                   FUNDING
                             YRIS AWARD                                                             @R@P
                             ol                     RECO',4MNDED             'REQUEST
                                 OPER.                                                             -REV.    C014.
                                                    LEVE
                             Y-LA


                                                                              320,000
                            259,50Q
    ,ORII.                     14A
    ;ub-Contrllctg
                                                                            io4,662
    )PE'R.  ACTI'V.          120,000
                                                                             NA                             or  '00  (XX
                               NA
    )EVET,. CO','P-


    ,'?AR14ARKS:
                                                                              NA
                                NA
       Y,TDI@Y










                                                                                                  4@4,662
                                                                            424,662
    R14PS    DIRFCT           379.,500              .313,000
               D              786,237
    R


    COUI,,CIL
                              379,500
    APPROVED    LEVET,

    ,NON-Rl4pS  and              flA


                                                                                  REGION        South Dakota

                                                                                     June       t972   REVIEW CYCLE
          Re ion cxt,-ndpd    .ifor 2.months    at  $ 63' '2 5 0 '.r  -fit a Iof  $442,750.
                                                               .0
             9
                                                      'ndinq   lev@l'f.r,the       02 year,  it  should   be
           In cQpsidering     an  increased    NAC.fu                   0
             ted tilat-out-of-phase supplcments'in            the  areas of    ETAS and  C orr-mun i't b a s c d
            no
        .:educational systems        have been submitted.';



                                                                                     South Dakota  Rm 00067




                                                   OUT OF REQUEST
                                               01 PROGRAM PERIOD
    ID   IFIIW'            ONENT      AMOUNT AWARDED         AWARDED DDWT COSTS        AWARDED INDBKT COSTS          TOTAL
    Core                                 259.500                                              80.3                   339 8 9
              Care                       120,000                   120.000                    12@3                   132
            -IOTAL,S                     79  50C                   379 500                    92.16!                 472.198





       FFBRUA@Y  2.1,lq72                                                                                           PEGION     S DAKOTA
                                                                    BREAKCUT CF PEOUEST                             RM r)0067 C6/72       RMPS-OSM-JTO
                                                                     n2 PPCNRAM PERIOD

                                            (5)             (2)            (4)                             CURRENT        CLI@IZPENT
    IDENTIFICATIO'4 OF COMPONEI%'T     CCNT. WITHINI CONT. BEYCNOI APPR. NR.IT          NEW, NOT
                                       APPP. PERIODI APPR. PERICCI PPEVTCUSLY           PREVTOUSLY    I    niPECT        INCIP@ECT          TCTAL
                                       CF suppnRT      CP SUPPOQT      FUNCFC           APC)POVFD          COSTS            COSTS

    CO@n COPE STAFF PLANNING
                                                      -- - - - - - - --L                                    3
    n- @'FA -C 5 P7. N A P Y-4 -P @ -T P A I I,, I N G U
                                                                                                             S A 5.L P 4     i.1 it s 4      t 9 P -t 2 q.2
    ONIA Cr)RnNAPY CARE TRAINING Ui
    __ NIJT_5T_.Jr!INS 'IrkAutRA                                                                                                              1 3-t P ?.I-
    INIC COPON4PY fAcF T-RAINING Ul
                       FV
                                           $1(24@@ A 7 II
                    TOTAL                  $4249662                                                        $4249667         $1269472        $551*134






                                                                                                         REGION    S DAXOTA.
    FEPRUARY 28,1972                                        BPFAKEUT CF AEOIIFST                         Rm ono67 06/72
                                                              03 PPCGRAM PERino                                               RMPS-OSM-JTVCP

                                      (5)            (2)           (4)
   FNTTFI@ATICN CF COMPONENT      CCNT. WITHTNI  CONT.  SEYCNOI APPR- NrT    I NEW, NOT     I  ACOIL  YEAR                    TOTAL
                                  AOPR. PERIOni  APPA.  PERIODI PREVICUSLY   I PRFVTOOSLY   I    nIRECT                     ALL YRAPS
                                  OF SUPPORT  I  OF  SUPPORT  I FUNDED       I APPROVED     I    COSTS     I              IDIQFCT CNSTS

   nt) CF)RE STAFF PLANNING
   -- ----------------                                                                                      --------
   JA CflqrN'ICY irjAPE TPAINING Ut
   -NIT
   18 COOOMAQY CARE TQATNING Ul

   IC COOONAPY CAPE TRAINING Ul
      CD ,-rbiEN                                            --i -------                       - - - - - - - -
                TOTAL                $376*t)00                                                    $376,cc@                     $Erc,662





                                              8
                                                                  REGION   South Dakota
                                                                  REVIEW 7CIE              j-q7 2


    )uTSTANDING ACCOPTLISHMENTS BY    since       1      197  1
    1.  The relationship between    and CHP has been clearly delineated.
    2.  The RAG plays a very active role in the development of the overall,program.
    3.  A process-problem-oriented approach has been utilized for planning.
    4.  Goals, objectives and priorities have been clearly articulated.
    5.  A talented core staff has been asserted.
    6.  The core curriculum project funded by BHME to the State DepartTwnt of Health has
        brought together representatives from all 60 manpower training progranB in the State
        to determine similarities, gaps and duplications in health curricula now being offered
        in South Dakota.
    7.  The Medical School component of core staff was phased out.
    -- - - -- - - - - - - - - - - - - - - -        - - - - - - - - - - - - - - - - - - - - -

    PRINCIPAL PROBLEMS
    1.  SDIW is requesting a 3rd year of support for the CCU Nurse Training project in  line
        with the c@trwnt made to the project sponsors when  there,existed  a  Nebraska/South
        Dakota HvT.  Review C@ttee and Council when they acted to establish SDRMP felt that
        only a 1-year c@tment should be made in order that the Region   might determine if the
        project was gerume to their goals, objectives and priorities. SDRE  feels  that  the
        project is both relevant and ijTportant and should be funded for only one more year;
        staff concurred.
    2.  'Ihere are no minority group representatives on core staff.
    3.  Goals, objectives and priorities are somewhat global
    4.  The mechanism to be used by RAG to monitor the progr@ is unclear.

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

    ISSUES REQUIRING A=@ T'ION OF FE@RS
    1.  South Dakota became a free standing @ separate from Nebraska on July i, 1971, it
        was awarded planning status.
    2.  The review criteria that will be used to rate the 02 planning grant application
        are geared primarily to be used in rating an operational grant application; therefore,
        some adjustment in the system is warranted.
    3.  Ihe question was raised as to whether or not a need exists to fmd the CCU Nurse
        T'raining project for an additional year.
    4.  The staff reviewers agreed that the $313,000 dco for the 02-year was too low; all those
        attending the p@-SARP meting recomended approval in the amount requested $424,662 dco




                                                9               REGION South Dakota
                                                                REVIEW CYCLE   u@ne    197 2
               STAFF DOC
  41A.  PERFORMANCE

           1.  Goals, Ob@ectives and P@ties  (i)

               a.  goals, objectives and priorities have been determined
               b.  lack time-frame but represent areas of program emphasis for their
                   three-year plan

           2.  Accomplishments and Implementation  (2)

               a.  as a planning Region they have been Lmderwav six-months when
                   application was subrdtted
               b.  have delineated staffing patterns and organizational structure
               c.  only one operational project underwav - has more than mt its
                   objectives
               d.  staff felt Region accomplished a great deal in only a few months
           3.  Continued S22port (3)

               a.  reduced funding requested for CCU project
               b.  plans made to continue it with local dollars once its initial three-
                   year cmdtment terminates
           11.  Minori@ Interests (4)

               a.  izdnority interests are at parity in terrm of minority interests
                   on RAG
               b.  Emil Redfish, Indian leader, member of RAG has been appo  ed
                   to Governors cabinet to head up Indian affairs
               c.  should encourage Region to follow through on condiment to hire
                   ndnority group representative for core staff

       B.  PROCESS

           1.  Coordi  tor (5)

               a.  excellent Coordinator
               b.  been on board since 9/l/71
               c.  has established himself as leader of the Prograin
                        --- - ----                       - - - - -
           2.  Core Staff (6)

               a.  small but talented core staff
               b.  know the Region well
               c.  are very competent
               d.  need to establish senior level position for evaluation and planning
                   purposes

           3.  Regional Advisory Group (7)

               a.  geographically, organizationally balanced
               b.  very actively involved in the Program
               C.  should be encouraged to establish a co@ttee for monitoring an(
                   evaluation purposes





                                                  I 0




                                                                          Review
                d.  RAG Chairman being nominated for membership on National
                   Comittee
                e.  RAG serves both CHP and RE  role of both agencies clearly
                   articulated
                Grantee Organization (8)
                a. grantee is medical school
                b. role to be trustee
                c. does not have veto power over RAG
                d. reviewers felt - does not provide enough services for funds
                   received in the indirect costs category
                                       - - - - - - - - - - - - -- - - - - - - - - - --
                P             (9)
                a.  key health interests'participating
                b.  program is not captured by any particular group
                Local Planning  (10)
                a.  RMP has field staff assigned in major areas to do local planning
                b.  no "b" agencies have been formally established
                C.  ?la" agency not interested in establishing "b" agencies
                                                        - - - - - - - - - - - - - - - - - - -
                A                                 (11)
                a.  RAG and core staff have systematically attempted to assess needs
                    and resources
                b.  these were translated into priority areas
                c.  feasibility studies are and will be carried out in each of these
                    areas

                     ement  (12)
                a.  core staff activities well coordinated
                b.  Region needs to formalize its monitoring procedures
                c.  time-framed reports gathered from project sponsor and other
                    recipients of core staff funds
                Evaluation   (13)
                a.  full-time Evaluation Director not hired
                b.  highly trained person on core staff provides this function as well
                    as establishing an EMS plan
                c.  Region still in planning - therefore little to evaluate
                d.  application indicates that evaluation to be built into each phase
                    of the three-year plan
                e.  Region should be encouraged to move more rapidly in this area




  0 PROGRAM PROPOSAL

            Action Plan  (14)

            a.  Region still in planning stage
            b.  have set priorities and objectives to be addressed in three-year
               plan
            c.  these relate to National mission
                                           -------------------
        2.  Dissemination of Know      (15)
            a.  only one operational project - CCU Nurse Training widely accepted
               has done well in this area of dissemination of knowledge
            b.  reviewers hoped that this would be a microcosm of what @t
               happen regarding the dissemination of knowledge
                                                        -  - - - - - -- - - - - -
        3.  Utilization Manpower and Facilities (16)
            a. most of the major medical care facilities represented on IA(
            b. too early to tell about utilization
            c. manpower high priority
            d. health manpower education systems viewed as common denominator
               to all other priorities
            e. out-of-phase supplements in this area will soon be received in
               Rockville
                                                      - - - - -  --       - - - - - - - - -
        4.     overrient of Care (17)

            a. improvement of chronic care high program priority
            b. EMS number one priority
            C. out-of-bha6e @ supplement to be submitted by April 15
               -----  -----                              ------------
        5.  Short-Term Payoff  (18)
            a. reviewers felt too early to te7
            b.  experience with CCU Nurse project indicates progress in this area
        6.  Regionalization (19)
            a.  regionalizatior; conceptually speakinF, used as a frame of reference
               for planning
            b.  considerable interchange of resources and information takes place
               among various health related groups
        7.  Other D@ding (2C))
            a.  concept of decremntal funding is a part of Regions philosophy
            b.  plans have been made to phase out support for CCU nurse training
               project
            C.  ,eviewers felt this was a positive siEp




               EMORANDUM                                                       DEPARTMENT OF  HEAL]-H, EDUCATION, ANI-) WELFARE
                                                                                                            PUBI-.IC HEAI,Tli SERVICE
                                                                                  HF,,ALTH SERVICES AND ML-"NTAL IILALTI-I ADMINISTRATION


         .110            Acting  Director                                                                             DATE:   April   17,   1972
                         Division  of  Operations  and  Development




         l@'R(-)M        Dirc;ctor,  Regional  Medical  Programs  Service


         @;(jBJEC,'T:  Action  on  April   10-11,   1972
                         Staff  Anniversary  Review  Panel
                         Recommendation  Concerning  South  Dakota  Regional  Medical  Program
                         Application  RM00067  dated  2/14/72.






                         Accepted:
                                                                                                                                    Da  e





                         Rejected:
                                                                                                                                    Date





                                                 2
                  Component and Financial Summar_v       Annlversanj Application



            oRr,NT         CURPIV.IT              YEAR                 YEAR        RECOK@iElfl)ED
                           YR'S AWARD          C 0 U,'l C 'A. L                       FTRMING
                         - Ol  OPER.           RECO14MEt;DED       'REQUEST             (S A
                           YEAR                LEVEL                                    REV. COM.


    CORE                   259.500                                  3201000
                            14A                      X..              0,000
    OPER.    ACTTV*        120,000                                  104,662
                            NA                                      NA
    DtvtL.    COMPO                                                                 Yes       or No _(XX'

    EARMARKS-,

                             NA                                     NA








                                                                    424,62          li@4 662
        > DIRECT           379-,500           .313,000
    RE2UESTED              7869231

    CottNCIL
    AP  O"IED LEVEL        379,500


    NON-P,?4PS   nd
    LI?CO-ME                 NA

                                                                       REGION      South Dakota

                                                                          June     t97 .REVIEW CYCLE


             ion extend
         Reg           pd'for 2 months    at $63 250 fo,re     tal of $442,750
         in considering 'an increased   NAC.funding   level' f6r-the 02   year, it should  be
         noted that-out-of-phAse supplements'in the areas of EMS and Communi'ty-based
       -!educational systems have    bd@n submitted.




                                              3 -              REGION      South Dakota

                                                               REVIEW  CYCLE  June   197   2


                                   RECOMMENDATIONS    FROM
            7@7 SARP                             Review  Committee
           /7  Site  Visit                  /7     council
   :ECOMMENDATION:  The Staff Anniversary Review Panel   concurred  with   the   staff-reviewers
      that the second year planning grant application submitted fromthe South Dakota
      Regional '.t4edical Program should be approved in the amount requested for direct costsi
      $424,662.
   1,ATIONALE: The justification for recommending  an  increase  in  the  funding  level  from
      $313,000 dco to the above mentioned figure was predicated uoon the fact that the
      Coronary Care Unit Nurse Training Project has requested  support  for  an  additional  year.
      An initial three year commitment was made to the project  sponsors  when  it  was  under
      the purvue of the Nebraska-South Dakota Regional Medical Program.    The present request
      in actuality represents the last year of that initial three year commitment.     The
      panel also was aware of the fact that when the South  Dakota  Regional  Medical  Program
      was initially established, it would be given the  prerogative  of  determining  whether,
      or not the Coronary Care Unit Nurse Training Project  was  consonant  with  its  overall
      goals, objectives and priorities.  Based upon the material presented in the application
      as well as the data appended to the briefing document, the  reviewers  agreed  that  the
      Coronary Care Unit Nurse Training Project was relevant  to  the  overall  goals  of  the
      Region and should@receive an additional year of support.
   -,RiTIQUE:  In view of the fact that the RMPS review  criteria  were  desioned  to  rate  a
      Regional Medical Program that has achieved operational  status,  the  panel  agreed  not
      to rate the Region, as South Dakota is still  in  the  planning  phase  of  development.
      However, the panel did indicate that the Region's  planning  status  should  in  no  way
      deter it from being considered for out of phase supplements in the areas of Emergency
      Medical Services and Community Based Educational Systems;  proposals  in  these  two
      areas will be submitted on or before the appropriate deadlines.
      In assessing the region, the reviewers were pleased with  the  progress  that  has  been
      made to date.  The panel felt the new director, Dr. John A. La%-je, hired affective
      September 1, 1971, has established himself as the leader of the program and is
      supported by a talented though small staff.  It  was  the  concensus  of  the  reviewers
      that the goals, objectives and priorities that have  been  delineated  are  somewhat
      global and lack a time frame, but it was felt that they represent areas to be addressed
      in the triennial grant application to  be  subrlitte'd one year hence.  From all the data
      that were available to the panel it seemed that the Regional Advisory rroup was very
      much involved in the affairs of the program; therefore, the  RAG  was  viewed  as  being
      a major strength of this Region. Also, the reviewers  were  pleased  to  learn  that
      the relationship between RMP and CHP had been  delineated  and  the  two  agencies  seem
      to be working together in a positive fashion.
      The reviewers did note that no one on program staff is assigned the responsibility for
      planning and evaluation perse.   Therefore, It was felt that  a  senior  level  position
      in this area should be established.  In this connection, the reviewers further
      suggested that the Region consider the feasibility  of  establishing  an  evaluation





                                                    4
       Page 2 @ Recommendations From SARP                             Region    South   Dakota
                                                                      Review Cycle  June 197 2

         mmittee to monitor not only projects; but also,  the  activities  of  program  staff.
       A major area of concern to the reviewers was the act  that  t  ere  are  no  minority
       group representatives oh the program  staff.  While  the  application  makes  reference
       to ameliorating this situation, the panel felt strongly that the Region should be
       encouraged to actively recruit for such individuals.
       The reviewers felt that at least two types of technical assistance should be
       provided the Region during the insuing year:  1) As the Region continues to
       implement its planning processi outside consultation should be provided to insure
       that:  a) needs have been adequately assessed  I b) the identified  needs  have  been
       translated into time-framed  action-oriented  goals,  objectives  and  priorities,  and
       C) the programs that are proposed include a  viable  strategy  for  evaluation  which
       should be carried out at specifically planned intervals.  2) l,t was suggested
       t at the central headquarters staff from both RMPS and C@IP  visit  South  Dakota  to
       evaluate the unique relationship between the Regional Medical Program and the
       314a,icomorehensive health planning agenc , I.e., the RAG, which is comprised of
                                                 y
       51% consumers is the advisory board to both agencies.
       16 addition, the panel agreed that It would be most helpful to Dr. Lowe if he
       were to b6 invited to take part in a site visit to  a  Regional  Medical  Program  in
       the neat future.  The panel felt that this experience would greatly enhance Dr.
      @Lowe's orientation to Regional Medical Programs.









                                           TABLE OF CONTENTS

              WESTERN PENNSYLVANIA REGIONAL MEDICAL PROGRAM -.ANNIVERSARY APPLICATION

              Staff Briefing Document                                    Page

              Face Page                                                   1

              Regional Profile                                            2
              Regional Map                                                3
              Component and Financial Summary                             4

              Breakout of Request (04 period)                             5

              Breakout of Request (05 period)                             6

              Ac6omplishment, Probl6ms, Issues                            7

              RMP@Review Criteria Form                                    8

              Additional Printouts





                                                   RMPS

                                         STAFF BRIEFING DOCUMENT






                                                         OPERATIONS           Eastern            Mid-Con
  EGION      Westert Pennsylvania                           BRANCH         South Centr'l /-7  Westerr

                                                            BRANCH
  YPt     APPLICATION      N.A.      LAST RATING            Tel. No. -3ol-44@-181o         Room 10-'35

          TRIENNIAL            197      DATE                BRANCH CHIEF Frank Nash

       ist ANNIV YEAR               SARP                    BRANCH STAFF Norman Anderson

                                    REV. COM.               RO REP .  C y
       2nd ANNIV YEAR                                                   de Couchman

       OTHER                        OTHER
                                                            Last Mgt.  Assmlt Visit III.A.           197
              March                                         Chairman-
  AST S.V.  l@0-11. 197 1   Chairman  Leonard Scherl.is.-.i-D.
  taff Visits,     Last 12 mos.  (Datesi Chairman's Name and Type of Visit)
           Verification of Review Process Visit, Sei)tembe             71   (Roland-.,.Petprson)




  ajor Events     ich Occurred in the Region Affecting the RNP Since Its Last Review
  n     Niav      197

     i.   The  Development  of an Experimental Health Care Delivery System in the Region with
          I.ittle relationship to other plans for the health care system.

     2.   HMO's  of both pre aid group practices and Medical Foundatioii types have begun to
                             p
          develop with little relationship to Region-wide planning.

          1
     3.   in 1970, house till  1311 was enacted.  It established a program for the care and
          treatment of persons suffering from renal disease.  The legislation calls  or an
          appropriation of $1,000-,OOO for fiscal,year 1971.

     4.   Dr. Carpenter, Coordinator of WPRMP is resigning June 30, 1972.

                                                          i(3nal Advisory Committee.
          'L@iarry K. Wilcox, elected Chairman of the Reg




                                                2




          D            nd  Resources   Data:


          (.;eography and Demography:

          l'opulation--1970 Census
             4,138,000:  no  real  increase  since   1960.
             Race:  no updated data from 1970 census available:  1960 census: State of
                     Pa. non-white--7.5%.  For 28 counties, non-white ranged from 0.1%
                     to high of 8.3% in Allegheny County (Pittsburgh).

          Re@;ources and Facilities:

          Medical School--University of Pittsburgh, School of Medicine
          School of Allied Health Professions, University of Pittsburgh
          Inhalation Therapy  - Community College of Allegheny
          Physical Therapy - Dept. of P.T., D.T. Watson School
          Medical Technilogy, university affiliated

          Schools of Nursing - 32 (16 in Pittsburgh, of which 4 are college or university
                                 affiliated).

          Practical Nurse Training - 14 (3 in Pittsburgh and arrangement with public schools)

          Accredited Schools: Cytotechnology (2 in Pittsburgh); Medical Technology-,-8 (4 in
                                Pittsburgh; plus 1 at School of Allied Health Professions)

          Certified Laboratory  assistants  -  7  (2  in  Pittsburgh);  Radiologic  te chnicians-23
                                                (6 in Pittsburgh); Medical Record librarian 1

          "ios2itals - Non-Federal*  short-term and V.A. General

                                          Community             V.A.   Gen.
                                              itals               Hospitals


                                              Beds                     Beds
          Pittsburgh                       20  6,919              1     945
          Other                            60 10,555              1     170
               Total                       80 17,474              2  1,115

               *These counts are s6bject to revision; they were      determined on the basis
                of county location, from A.H.A. Guide Issue, 1970 Edition.

          ,,'.a.@power --Physicians and Osteopaths

                Practicing MDs                    Osteopaths                     Total

          Active        4,593 (as of 12/31/67)           182                      4775
          Inactive        172                       (not updated)
                 Ratio:  115  per 100,000 population,    compared with 132 for U.S.

                 Professional nurses  (no data available by county)
                 1962:  Total    27,569;  active  16,574  ratio  of  395/100,000  pop.










                                                                   B
                                                                    UFFALO


                                                                               K,@IESTERN PENNSYLVANIA
                                                        REGIONAL tv',ED,IC.AL PROGRAM

                                                                                                   IVEW  YORK


                                                        7
                                                        a i                  Western Pa. RMP
                                                                             Tg  counties
                                                                              Lupulation-"-1970 Census
                                                         OFZEST                4,138,000
                     CLEVELAND                              6 rJi
                                        MERCES                                     Metropolitan Areas     declining pop    sir
                                        127,17                                                     1970       1960       1960
                         YOUNGSTOWN                      ON JEFFER                   toona        134.1      137.3
                                        LAWRENC             43k9.
                                                                                         town     260.7      280.7
                                                                  CLEARFIE
                                        IOI,Q74    @LER                                 burg     2383.8     2405.5
                                             12; q4l WRV) 0       74,610
             /0   T'@stern Pao          2 0 A8@41F@  STRONG,
         OH      ,,                     BE  ER
               Comprehensive Health          p
              T'l                                                                          PENNSYLVANIA
                -annj-ng tpencv
                                                   Hi                           NGDON
                   STEUBENVILLE                                                                     HERSHEY
                                                    sI  ELA                                                 (,reater 'Pela@       lley
                                                                                                                PHILADEL            RMP

                           WHEELING
                                  11    364         166 7
                                                    ETTE


     C.'OLUMBUS.
                                        MO;?ANTOWN
                                                                                         MARYLAND
                                  West  Virginia PMP  I
                              wEsr VIRGINIA




                                               4
                  Cory.nonent and Financial Summary    Anniversary Anpkication




                                                                               RECOMliENDED
                                                YEAR          04 YEAR
          COMPONENT       CURPElrr                              -                FUNDING
                          YRIS AWARD         COIP,'CIL                              SARP
                          03 OPER.           RECOliMENDED     'REQUEST
                          YEAR               LEVEL         9/l/72-8/31/72      Cy REV. COM.


                                                                  887,900
     CORE                          79
                                            X/
     Sub-Contracts

                                                                  388,169
     OPER.   ACTIV.         378, 359

                                                                   99,633      Yes       or No
     DEVEL.   COMP.           13,500


     EARMARKS:













     RMPS DIRECT             996,338     $1.450,000,            1,375,702

     REQUESTED            1, 7 5 7, 5 50


     COUNCIL
     ,APPROVED LEVEL      $1)450,000

     .N'ON-Rl4PS and
                              ?
     IIZCOME
     *7/l/71-6/30/72
     2 mo.  extension 7/l/71-8/31/72    $166,056
                                                                   REGION   lqestern Pennsvlvania
     extended (2 mb,)--new grant period 9/l/72-8/31/72

                                                                     June      1972,,REVIEW CYCLE

















                              MT,;ZCH 17,1972                                                                                                                       REGION - WESTERN PA
                                                                                                       BREAKCUT CF REQUEST                                          RM  00041 06/72
                                                                                                         04 PROGRAM PERIOD                                                                      RMPS-t]SM-JTOGR2

                                                                         (5)                 (2)                (4)
                      II)E14T IFICA T 10@4 OF C I; PI PON F.@'4T  CO'4T.  WI THI NJ    CONT.       BEYONol APPR.  NOT          NEW#  NOT                CURRENT            CURR EN T
                                                                  APPP.  PERICOI       APPR.       PERICCI PRCV:(IUSLY         PREVIOUSLY               DIRECT            INDIRECT        I      TOTAL
                                                                I OF SUPPORT   I       OF    SUPPORT     I FUNDED              APPROVED                 costs                COSTS



                      CC,OL   (J   E   PIZ,'IfCSS[Ot,AL   TRAINII


                      ,)OC@O [)EVELr:Pilt@,TAL COMPCN@CtsT      I

                      --..      -------------
                      0 r a i@Ai'k r L   k,'@T 4 It.,  ii Elm C

                      0 @ 9


                                  7, f,     r ,, R  r, Y I f r 4 T SI
                      -.-ji I I tJ 1 L       L L- P,!l @ t I A
                      rJI2  RCG              FOR  ;lt.T  IE114TS1

                      013   L",YC .Yt@IL A@t-A  Pijt--,C.NAPY


                                         @,T CF  t  @,LIPSE P
                                                                                                                                                                  4


                                      CCt)@4TY    LIPID     SCREI

                      017ii           f [i ')',TY    LIPIC    SCaEl


                                                                                                                                                                      I

                                         TCTAL                     $1#127#938  1            $63,000                                $1849764  1      $1#375#702  1           $414t$79  1   $1,790,581  1




                db                                                                                            db                                                                                            db







                                                                                                                                                                                                                 RERION  -  WESTERN  PA
                                   t P, Cii I 1, I'? 7 2                                                                         (IREAKOUT  or  REQUEST                                                           RM   00041  06/72                   R@MPS-OSM-JTDGR2
                                                                                                                                   05  PRCGRAM  PERIOD

                                                                                                                    (2)                      (4)
                                                                                         (5)                            flEYONDI   tPf'R.  NOT                I   NEW,  NOT                   ADO'L  YEAR           I                            I     TCTTL                I
                      IDE.@@TIFICATION  OF  COMPO?,CNT                         I CC14T.            WITHlf4i CCNT .                                                                                 DIRECT           I                            I   ALL  YEARS             I
                                                                               I Af'PR.             PERIODI APPR.       PF.RICDI   PREVIOUSLY                 I  PREVIOUSLY
                                                                                 OF        SUPPORT        I CF  SUPPORT             I  rutiDED                    APPROVED                         COSTS                                         ]DIRECT  COSTS             I


                                                                                              @u Q
                      -CEC      C    E   P    CF,--  S I 0 t4 A L  T P A  t,   I



                       C                             I  I -'I t I C M E I i E  I                                                                                                           - - -------
                                             T  @'A


                                                     fn@',      P@Tt@'4TS      I
                                      @LTLI_L@C.Y.LL-"
                                @FG       PPC-@P.@m       FOP,       P-@TiEt@TSI
                      612                                                                                                       0- I                                                                                                             I   -ii5 7. f,@i-
                      013                         AHLA       PUL,'G-@ARY       I                                                    I                                                                                                            I                          I
                                                                                                          I
                      Ti 5      CC-V[L')P@E.4T  Or  A  NUZSE                   Pi                         I
                                                                                  I -  @                                                                                                                                                                   III

                      -0 -1     l@ t r,      L 1  1      @'A  0  C  k,%M   I   N
                      0                   R '@ Li k2.,; T Y L I P I D SC R  C  I
                                                     --    ---------
                      @l7@       @l-A'4E4       Ctl@.NTY       LIPID       SCREI
                            11-111,,L p@u       I:IT                                                                                                                                                   Z4,-O,)o
                                                  TOTAL                             S I   10 7    5 7 0            $122#000                                              $191*000               $1#4209570                                            $2v796t272





                                           7                                          Region W. Pa
                                                                                      Rev. Cycle
   0OUTSTANDING  ACCOMPLISHMENTS  BY  RNP  since          May/June       197 2
           I..  Subregionalization seems to be well-designed and functioning adequately.
                Loca.] leadership appears to be en thusiastic and well qualified through
                stibregionalization.  Core staff has strengthened it's efforts to assist
                in project development.
           2.   Projects and studies are for the most part well coordinated with overall
                goals and priorities of the program.
                The Region has begun to move beyond the categorical disea     into the areas
           3                                                               se
                of primary care. Two new standing committees have been developed, "New
                Health Care Systems" and "Evaluation of the Health Care System."
           4.   The acceptance of standing orders for coronary care  units  and  stroke
                patients by a large number of community hospitals.
           5.   The Developmental Component will be used largely to  develop  a  system
                of primary care.
           6.   They are actively recruiting to fill the requested position of an
                assistant director for evaluation.






       PRINCIPAL PROBLEMS
           1.   Although it was agreed At the time of the triennial site visit that the
                RAG would expand to include more consumer interests  and  provide  more
                balanced geographical representation, not a great deal has been done in
                this area:

                a. Of the 8 new nembers, 6 are representative of medical interests, while
                  only 2 are consumers, and only  one  of  these  reprIesents a social welfare
                  organization; total consumer  representation  is  approximately  14%.

                b. Geographical balance has not bedn achieved.  A full 70% of the RAG
                  membership are from Pittsburgh.

                C. Minority group, female and allied health representation remain low, with
                  pprrentngas of 8- 12- and 2 respectively,
       18SUES   REQUIRING    ATTENTION  OF  REVIEWERS  (Same as reported in "Principal Problems)
                d. The RAG's Executive  Committee  breaks  o,tit as follows: (1) 2/3 are physicians;
                  (2  73% are from Pittsburgh-, (3) no minorities; (4) no women; and (5)
                  only one (of eleven total) consumer.

                6. The review of RMP applications by CHP "b" agencies seems to have been
                  worked out.  The executive director'for. 'th'e "b" agency has agreed to
                  provide a programmatic review, and not a  technical  review,  of  RMP
                  application.

         David E. Reed, M.Di has been appointed the Acting Director of W. Pa. RMP
         effective March 15, 1972.  Dr. Carpenter will  be available on a consultant
         basis through June.




                                                              REGION Western 1'entisylvizi, l@Mi'
      RMPS REVIEW CRITERIA FORM                               REVIE@CY L@E          1 9 7

          A.  PEPFORMAINCE

               1.   Goals, Objectives and Priorities (1)
                    The goals and objectives are clearly stated and well aligned to
                    the Regions operational approaches. Overall plan is to  coordinate
                    all resources of Health Care Providers through technical
                    assistance to improve the delivery and quality of Health Services.
                    Identify deficiencies and use RMP funds to bridge the gap to
                    improve the Health Care System.
               2.   Accomplishments and Implementation (2)
                    T  The region has begun to move beyond the categorical diseases
                    into the areas of primary care - 2. Evaluate the health care
                    system through assessment of the problem - 3. Recruiting a full
                    time evaluator.


                3.  Continued Support (3)
                    our of the original six funded projects will largely be  funded
                    from private sources beginning July 72.  Component elements of
                    four projects will be partially supported through core regional
                    service.



                4.  Minority Interests (4)
                    The program takes into account the medical need of the  poor,
                    which includes a wide variety of medical services, and attempts
                    to make these services available in terms of social and physical
                    distance, costs in money, and time in services, to all  persons
                    living in the Region.




           B.  PROCESS

               1.  Coordinator  (5)
                    avid Reed, M.D., Acting Director  effective March 15, 1972.
                    Dr. Reed has functioned as the unofficial deputy to Dr.  Carpenter
                    all along.  Excellent leadership has been demonstrated.
                    A energetic core staff - very competent, esprit de corps.


                    -re Staff  (6)
                    Approximately 19 full time professional positions.  Core  staff
                    seems to be very competent and well movitated.  Almost all have
                    Masters Degrees working toward Ph.D.

               3.   ReRional Advisory GrouD (7)
                                           al authority in deciding policy, setting
                    priorities, goals and objectives. Allied  Health,  consumer,
                    female and minority representation should be increased.  A  better
                    geographical distribution of representation should be attained.








                 4.  Grantee Organization (8)
                     The site visitors felt the grantee seems to have delegated almost
                     all the general responsibilities to the @ to the extett that
                     the grantee may be a paper corporation.  Apparently the grantee
                     had delegated to the RMP a free hand.

                 5.  Participation (9)
                     W. Pa. RNP is provider-oriented and ask providers already workino.
                     in the delivery system or vo untary efforts to  change  and
                     increase the system, establish a well balanced program through
                     coordinates of providers, medical societies, community hospitals,
                     and other health planning agencies.



                 6.  Local Planning (10)
                     RMP in conjunction with CHP have developed effective  local
                     planning groups.  There is early involvement in the p anning
                     process review by CHP agencies of RMP projects have been worked
                     out.  Core staff serves as a liaison to the nine area Advisory
                     Groups in their planning efforts.

                 7.  Assessment of Needs and Resources (11)
                     1.  Pre-study plans for project development
                     2.  Develop projects on 6xisting data from the Hospital.
                        Utilization Plan System
                     3.  Manpower needs is a high priority.



                 8.  Management (12)
                     core staff provides considerable assistance in project development
                     and staff surveillance for the (financial, management,  and
                     progress) of funded projects.




                 9.  Evaluation (13)
                     Dr. Reed devoted a great deal of time upon evaluation.
                     They are currently recruiting for a full time  coordinator.
                     They have an adequate review process, priority system,  and
                     provide feed back to unsuccessful applicants.



            C.  PROGRAM PROPOSAL


                 1.  Action Plan (14)
                     W. Pa. MD is in the process of updating its overall p an an
                     reviewing its priorities.  A greater emphasis will be directed
                     toward primary care and evaluation of the Health Care System.






             2 . Dissemination of Knowledge (15)
                 1. The acceptance of standing orders for coronary care units-
                 and stroke patients by a large number of community hospitals.
                 Active participation of community hospitals in continuing
                 education.



             3.  Utilization @lanpower and Facilities (16)
                 Nurse practitioner project is expected to increase allied
                 health manpower which should benefit the entire region.
                 Continue to concentrate health resources of community hospitals.



             4.                      (17)
                 Efforts are being directed to develop a system of primary care.
                 This will include development of nurse practitioner programs,
                 and rural and urban primary care demonstrations.



             5.  Short-Term Payoff (18)
                 Pro4ects such as the coronary nursing training program is a
                 example of short-term payoffs.  Continuation of activity is self
                 supporting through charging for services without appreciable
                 change in participation.



             6.  Regionali2ation (19)
                 W. Pa. @ has established nine sub-regional advisory committees.
                 Through these committees they involve all the health planning
                 agencies and consumers in the total planning efforts to improve
                 the health care system.



             7.  Other Funding (20)
                 W. Pa. RMP has been somewhat successful in  obtaining outside
                 support to continue activity supported by RMP funds.





                                                                                                                                              AL  -4r                norlIA!IS  srpvlcf                                                                                    P   A   Cr
                        P. ri            L  WEStEf@K PA                    PTXP  SUPP  YA  D4                                 fPE$tCENT  OF  T@                    JNDS  REQUESTFR))                                      REQUEST  MAY/JUN  11;72  REVIEW  CYt.

                                                                                                                                                                       TNTAL
                       CD?'.Pr,'@4c  Pi  T N@PER-                                                       TITLI:                                                         R4cs  FulqDs                 nT@iElk  S"UPCES.-                  TOTAL  SUPP,)RT.                   Rx:,S  %
                                                                                                                                                                      RFQT)[STFO                    OF           SUPD(',;tT            ALL           SOLIRCES              OF  TI)TAL
                                                             CORE                                                                                                          7 7 9 ,  169                                   0                      T7FJ,169                        lf)l
                                 C@ol                        Cnpe  PROFESSIONAL  TRAtNItir,  AND  EDUCATtn,4                                                               41R,696                                   110750                      452,4/.6                        97
                                                             DEVELOPME14TAL  COMPONENT                                                                                     990633                                         a                      99#633                          1 O?)
                                 r)nR                        LAUP.FL  MOU@,ITAIN  H)MF  HEALTH  AlnE  TRAINING  PONJFCT                                                    ;S,615                                    5.0n,)                      6(l.6  1   5                    02
                                 1) @) 14                    TRAINING  OF  CATJCCR  CHEYfIT14FItAPISTS                                                                     '42,9c)6                                                              32,956
                                                             A  REG  PROG  FOR  PATIE14TS  WITH                      SICXLE  CELL  ANEMIA                                  83t7ol                                    3m,nnn                                                      74
                                 D12                         REG  PRnrPA'4  F9R  PATIENTS  WITH  DIADERC$  MFLLirt)s                                                       /,I,31-                                        n                      41*313                          lo@
                                                                                                     rty  niSFASF  PQrrPAM                                                 31%.759                           2   4   'Ol)-i                      54,259                          56
                                                             BU(KTAI(-   AREI,  PULMO-4.%
                                 nl7A                        GE-AVER  COUNTY'LIPID  SCREF14114G  PROJECT                                                                   26rf86                                         n                      26,486                          illo
                                 017a                        BEAVER  C)U@.TY  LIPID  SCRFFNING  PROJFCT                                                                    299544                                         e)                     ?q,     54,4                    1
                                 nis                         I)FVFLOPYENT  OF  A  NURSE  PRACrITIONrk  Ppnr.RA4                                                                                                                                       116,042                    10@1)
                                 016                         AFGTNNALIZED  P;tr,,GRAM  IN  RA')IATION  THERokPY                                                            58,168                                                                59,168                          103

                                 TOTAL.flF   IZ    CCMPC)NE.I;TS                                            REGION  41                                                       1179,)VSsl                              7?t?Sl                         1*8&3vl3l                    96


                                                                                                                                                                                                                                                                                                   ki






                                                                                                                              CtL
                                                                                                     p f G f nN AL  @'@ :    I
                                                                                                                    @u,,;rVt      l@Y       tyllf               @IORT                              FtEoUrlt  FFFIRUARY  1,  lq7Z.DrA@)t.TNE,

                                                                                                                                                                                                           DTRRCT
                                                                                                                                                                                                             C(I ST
                                                                                                                                                                                       It M PIS           PREVIOUS               AMPS                 Ftmps
                                                                                                                                                                               T       TOTAL               YEAR                  DIRECT               DIRECT
               C?@; P,T  P F @ SnN AL        P AT ' C I,,T         EQUI P.            CONST.                  CTHER      TR 4 1 Ni Nr           DIFECT              INDIREC                                                      2NO  YR              3RO  Y;k
                                   Svc                                                                                &  FELLNWS.               IST      YR         IST       YR       1ST        YR        AWAGD
                                                                                                                                                                                                                                                                                    r\


               @@rW  Nr)T  P@,=')IOUSLY         AP@@CV@C)
                                                                                                                                                eS,734              3-4,808            116,042
        @15              67,659                                    3,000                                     14,575
                                                                                                                                                                                                                                      51,501
                                                                                                                                                f,9,.j3-            8,638              58,168
        116              24vplar)                                  7,80(.)                           16   ,    85')
                                                                   1,400                                      9,178                             26,4R6                                 26,486                                         26,000
        .)I   7A         15191)5
                                                                                                             6,FII4                             23v5l4              6,030              29#544                                         24,()@)O
        117B

               @IEW         SUB-TCT,@L                                                                                                                                                                                                                                              t
                                                                                                                                                                                                                                    191,000
                       125,147                                       lz,$200                                 47,4%7                             184,764             45,476             230,240


                                     Bay@40  AP@P.OVED  PERIOD  OF  SUPPORT
        Oil              45,0@O                                         90')                          1   51   50t,                             1, 3     e)         Zn,703             n397(3                                         60,0')O

        CONT.  PEYr@".r)  SIJLI-TOTAL
                                                                                                                                                6310flO             2OP70'S.           83,703....                                     60,000


               CONTI  NL,?,T  I   @')N W ITH l@'4  IPPROVEO  PEP10r)  OF  SI)PPNRT
        cno-)          4  5  7,  6')'i                             4,5nO                                   107,6')5                             5 6 Q , F;'))       2nA,16q            778,169                612,50n               6f)5
        r     ri       251,47!)                                    3,500                                     63,130                             318 , I,')O         120,596            438,696                                      365,000
                                                                                                                                                99,633                                 99,633                                       137,570
        1) @)  a         4 7  ,  7  90                                   300                                  7,525                             55,615                                 55,615                   76,600
               1)          1;     4'41                                                                 22, 'i'@                                                     4.Q56              -.42,056
               2         21,6?5                                                                               6,075                                 6    10         I 0 , 7  I'l       41,-Ilo                                        3 7  ,  Ol-)
               3                                                                                            17,50t)                             76,190              4  ,  ()6  9       3n*21)9                                        25     t@100

        CC,'4T.  ',?.ITHIN  SUB-TOTAL
                       794,67n                                     8,300                                    2Z5t335                               19127,93A         348,700                1,476v638          6A9@,100  lv,169,570.

                                     7                                14'1'1                                                                                        414,q7)       I    /')I,    '@Hl           hiq.l@o           1*42L),li7l)




                           '@t i 'I 14                                     Mt I, it@,4A@  @ IIII k At,  I'll    I."Vlk   11
          fl: rjy          w PrNN4                                         @UMMAIIY I%lll@rf T IIY t                   I                     AROUFIT    i-f BRUA%TY 1,  19TZ DrA9LI';E

                                                                                                                                                    C(IST
                                                                                                                                    PMPS         PREVIOUS        AMPS           FTMPS
                                                                                         TPA[ NIN@.      DIPFR.T     11,401PECT     TOTAL         YF.AR          OTRECT         DIRECT
          cn.Ap,@!:E'4T PE@Sl@4AL   P,%Tl ENT      Eaut P.       CIINST.      OTHFR
                          Svc         CAPE                                             C fELLOWS.        IST YR        IST Y$t      %ST YR         AWAFTO        2NO YR_        3;kD YR


                                                                                                                          ?9  l,79,)o58l            6809103     lo420*570
                    045,417                     22,400                    2881,252                  1,37S,?f%2


                       T I T L F                                                         YEAR

                O@V-LnP"rliT OF: t,            P;7ACTIrICI,.R P;,nr.RAM
                                  P,)rGOA!j Itl Czo',Ol.Titkl TH@;tli?Y                   Al
          ,il ?A          Cn@,,@jry LI DIn SCPEF@ I,,;C, P4CJ[rT
          II  7k          C"@)'JTY LIPti)                PR@JCCT                          nt
          III      P@r, PtG FnP@ PATIF'ITS @ITH SICKLE CCLL             ANEMIA            A?
          c If I,) Crop                                                                   M4
                CNRE POnFFSS"n%,At TRAI@liNr A@iD EDt)C4TIO-4                             n4

                                      H)@F HEALTH '.IDE TRATNI,%G PRRIJECT                n3
             9               I-F Ct.@,ICFP. CHFIAOTHRP.@DISTS                             (% I
          -it ? RFr, PpnrRA-4 Frrp ;14T[FNTS WiTm nIAIETF-S ME.LLITIJS                    112
          al3   BUCKTAIL AREA PULM,').'iA;tY DISEASE PRIlrKA#4                            A2




                                     II 11, I11) I?                                                       ArGintl,%L  HEOIC.AT.  ('kOC.;AAmS  @('ItVICE
                  wrr,@                  W  PF':14A                                                              Ll'ITINC.  Or  AOi)ITI.ot-14L  FUNOS                                             RFQUE@T  FE@RU,%r4y  It
                                                                                                                                                                                                                                           1972  DEADLI.N;
                              PIT                                                                                                                                               nTii'R                  T(ITI-L
                                         P     -r-S        GRA@IT  RELATED  I'l,r.)4E                     STATF                      LI)CAL            Fr-I)rP 6.L         NO','-FFI)FRAL             0 lkf-C T           TOTAL  FUNI)S
                                         TOT     tL      lt4TEREST                OTHCR                   FUNI)S                     rt)NDS              Ft)Nt)S                F u,,4 1) s       ASSISTANCE              TtilS  PERIOD

                      '4EW  NOT  PREVIOUSLY            APPROVE()

                                         116,,)42
                                                                                                                                                                                                                               116,042
                  'I' 6                  58,168
                  017A                                                                                                                                                                                                                58,168
                  0175                   29,544                                                                                                                                                                                       26,486                                e-.
                                                                                                                                                                                                                                      29,544
                   ':FW    SUB-TOTAL

                                         2 3) , 740
                                                                                                                                                                                                                               230,240
                   Cn@!TINUATIn@,  PEYOND  APPROVED  PERIOD  OF  SUPPORT
                    nil                  83,7r)3
                                                                                                                                                                                                                               113,iO'3
        Li     ro@,4r.          BEYOND   S'JQ-TOTAL
                                         83,703                                                                                  3f)tODO
                                                                                                                                                                                                                               113,703
                   CONTINUATION  WITHIN                APPROVED  PERIOD  OF  SUPPORT
                                     778,169                                                                                                                                                                                   778pl6o                                     (F)
                conj                 438,696                                      13#750
                                                                                                                                                                                                                               :452    .446_
                                         q9,6i3
                                                                                                                                                                                                                               99,63]k

                                                                                                                                                                                                                               6Ov6l5
                    O@9                  32,956
                                                                                                                                                                                                                               32,956
                    012                  41*310
                                                                                                                                                                                                                               41.310
                F) 1  3                  3,) , 2 59                                                                             24    ')f)O
                                                                                                                                                                                                                               54p259
              CO.'iT.  WITHIN            SUF@-TOTAL

                                          19476i638                             18#751)

             REGIO@4            TOTALS

                                          IV790,581                             18,750                                               54,000
                                                                                                                                                                                                                                   IY8639331











                                                                                                                                                                                                                                                                @ .11                  I
                                                                                                                                                                                                                         I                                      'II - @


                                                                                                                                                                                                                                                                                                                             O'


                                     MARCH   l)ol972                                                                                REGIO14AL             MFI.)ICAL              PROu,.kMS              SERVICE
                                                                                                                                    SU-414ARY        BLJUGET         BY         TYPE         OF         SUPPORT
                          REGION  41   WESTERN  PA-     RMP  SUPP  YR  04                                                                                                                                                                        REQUEST  MAY/JIJNE  1972  PEVIEW  CYCLE
                          DESK         EASTERN                                                                                                                                                                                                                                             RMPS.-OSM-JTGGRB
                                                                                                                                                                 RMPS                                                 Rmps                       Rmps                      RMPS                   TT)TAL
                            c   0  m  p  0  14  E  t4  T                                                    C04Pr)NE4T                                         DIRECT                         INDIRE-CT             TOTAL                      DIRECT                    Dl;tFCT                  DIRECT
                          N).                            TITLE                                           SUPPORT  YEAR                                         IST         YR          IST  YR                      IST         YR             2NO         YR            390  YR                ALL      I       YRS


                            NEW  NOT  PREVIOUSLY  APPROVED
                          1)15     DEVElopmr-NT        nF-        A        NURSE         PR                        .11                                         Ar),234                    30PROB                  116,q42                      eg,-,O,)                                             174,734
                                   ACTtttnPirD,  PRSGRAM
                          016      PFCT(l'IALIIEI)          PROGRAM          IN           A                                                                    49,530                       0,638                   54,164                     51,-)Ol                                              101,030
                                   A@')I.%TltlN  THERAPY
                          1)17A    F@fi%VFP         C,-d)'4TY         LIPID          SCFTEE                        -n 1                                        26,486                                               26,466                     2      61'3011                                         S2,4B&
                                              PR@I.IRCT
                          ')I?B    REAVRR        CfIU14TY        Lt        PTO        SCREE                        01                                          23,514                       6,030                   20,544                     2 4                                                    479514
                                   NING  PROJECT
                            NEW                  SUB-TOTAL                                                                                                           IR4io?64             45#4'r6                 2   30   2    4)           1 91      (),I.,                                       375,T64


                            CONTINUATION                 BEYOND                    APPROVED PERIOD  OF             SUPPORT
                          ')I I    A       REG       PPR)G       Fnp       PATIENTS       W                        t" 2                                        6'4,     I)f)o             2119703                   81   p    7i)l             6.1,   -in   1
                                   ITH              SICKLE CELL   ANEMIA
                          CDNT.  BEYOND  SUB-TOTAL                                                                                                             63,t)or)                   2%19?03                   839703                     611,000                                              1232100
                                                                                                                                                                                                                                                                                                                                                  VW


                            CnNTI-41JATtn'l  WITHIN  APPRnvEn  PERT(ID  OF                                         SUPPORT
                          Cfllln   C)PF                                                                            '14                                                56q,Rn)          20S,369                    ?Tatl6q                    6 t) 5  ,  D')')                                   ltl74#RO'3
                          CO')  I  CI)RE               PROFFSSIO'4AL                TRAININ                        1)4                                       31 n I  I  0  1)          1209596                    430,,696                   365,()f)O                                                      -683*101
                                   G  AND  EDUCATION
                          0101)    DEVELOP14ENTAL  COMPR)NENT                                                      oz                                          99,634                                               99,613                   l,4T.57p)                                              2371,2',13
                          I)IIB    LAUPFL          Mr',IJ14TAIN          HNMF          HF&L                        1) 3                                        55,61,                                               55,615                                                                            S5t6t5
                                   TH  ALIF   TRAIPIIP:R,   PPr)JeCT
                          I') 0    TIZAI'41@@G        -'IF         CA'4r.FP         C!IEMOT                           1                                        7i3,,lol                     4,956                   32        9-56                                                                    28,001
                                   lirRAPIST';
                          it?      pcrl  PprlrlptPA  FOP   PATI@t4TS                                               r, 2                                                   -1)             In,71o                    41 ,  'k  I,,)             37,)e)O*                                               6   7,   6!),)
                                   WITII  DIABETES  OFLLITUS
                          '113     RUCKTAIL           AREA           PULMONARY            D                        C%2                                         26,19)                       4,069                   31),   2    59             25#01)")*                                              5 I  I  I  q,)
                                   !SEASE  PROGRAM
               t-,        CONT.      WITHIN  SUB-TOTAL                                                                                                              lolZI9938          340*700                1.476,616                             1,169#570                                   2#29T*508

                                                                                                                                                                    1937itTO2          414,glq                1,T90,1591                            1,421,57n                                   2p796*2TZ







                             RCH  10, 1972
                                                                                       RRGI(IAIAL  MFni@AL
                                                                                            LIST %'G OF                4S SFRVICE
                  R;:Gft.)N  41  WESTERN PA       RMP                                             I                   iAL  FUNDS
                                                        SIJDP YP' 04                                                                                       REQUEST MAY/JUNE  1972 REVIEW CYCLE
                                                                                                                           OTIICR            OTHER             TOTAL
                  CnHPn,NF?4T       P    t,.Ps    GRANT ;ZELATFD INCOME               STATE              LOCAL           FEDERAL         NNN-FEDERAL          DIRECT         TOTAL FUNC)S
                                    TNTAL        INTEREST           OTHER             FI)NDS             FUNDS             FUNDS             FUNDS         ASSISTANCE        THRS PERIOD

                       NF 'ri NOT PREVIOUSLY APPROVEO
                      015           11-5pC42

                                                                                                                                                                                 ll6rD42
                      016           539168

                                                                                                                                                                                       5SPI68
                     017A           ?6t486

                                                                                                                                                                                      26r4B6
                   nl7fi            29t544

                                                                                                                                                                                 .29,544
                     NEW SUB-TOTAL

                                    23@'),240

                                                                                                                                                                                 2309240
                   CONTINUATIO'4 BEYOr4r) APPROVet) PER10r) OF            SIJPPOR T
                                    83,703                                                                   -lo,
                                                                                                         30,                                                                     ..I 13, 703
                 CONT.          BEYOND SI)B-Tr)TAL
                                    83,703                                                               30,04)0                                                                 113t7O3
                  CONTI@4UATIO,4 WITHIN APPPOVEO PERIOD r)F  SI)PPORT
                 C f),-) r)         773,169                                                                                                                                      778tl69
                 co,)l              43-1,696
                                                                                                                                                                                 452,446
                                    99,633

                                                                                                                                                                                 99,6.33
                 of)8               55,615
                                                                                                                                                                                 60jr6l5
                                    32,91;6                                                                                                                                      32,956
                 012                41,31,')                                                                                                                                     41*310
                 013                3f)g 259                                                           24,r)00                                                                   54,259
              COt4T. WITHIN         SUB-TOTAL
                                  1,476,6.39                      18,75P                               24,')OO                                                                     19519,388
              REGION           TOTALS
                            I  7 Q.-), 5  81                                                                                                                                       19863*331






                                       DEPARTMENT OF HEALTII, EDUCATION, AND WELFARE
    I&EMORANDUM                                      PUBLIC HEALTH SERVICE
                                        HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


     TO      Acting Director                               ATE: APR 2 0 197Z
             Division of Operations & Development, RMPS




     FROM    Director, Regional Medical Programs Servic


     SUBJECT: Action on April 10-11 Staff Anniversary Review Panel Recommendation
             Concerning the Western Pennsylvania Regional Medical Program
             Application RM 00046 6/72.



             Accepted
                                                         (datle)



             Rejected
                                                         (date)




             Modifications:








                                                             Region Western Pennsylvania
                                                             Review Cycle June   1972
                                                             Type of Application: Anniversary
                                                              Within a Triennium

                                 Recommendations From        Rating - 330


                  SARP                                        Review Committee



                  Site Visit                            L7    Council


           The Staff Anniversary Review Panel accepted staff's recommendation  that
           WPRNP be approved At the requested amount of $1,375,702.
           This is a well organized application designed to coordinate all resources of
           Health Care to improve the delivery and quality of Health  Services.  The
           Region has begun to move beyond the categorical diseases into the  areas
           of primary dare. Two new standing committees have been  developed,  "New
           Health Care Systems" and "Education of the Health Care System."  They  are
           actively recruiting to obtain the services of a full-tim6  evaluator.  His
           immediate task will be in the development of a system to evaluate  primary

           care.
           They have been somewhat successful in obtaining other funding to  continue
           project activity initiated by RMPS funds.  Four of the original six funded
           projects will largely be funded from private sources beginning July  '72.
           They are requesting continuation of five operational projects and the
           initiation of three new projects all consistent with the Region's  stated
           priorities. Support for project #11--A Regional Program for  Patients  wit
           Sickle Cell Anemia and Related Hemoglobinopathies is requested beyond  the
           approved period of supporti SARP recommends that advice be  provided  to
           the Region and make them aware that a sickle cell anemia program has  been
           established within HSMHA and continued support should be directed to  that
           program.
           The Regional Advisory Group is physician dominated and a full 70% of  the
           RAG membership are from Pittsburgh. Minority, female, and  Allied  Health
           representation remain low, with a percentage of 8, 12, and 2 respectively.
           SARP recommends that appropriate advice concerning the issues  identified
           be provided to the Region.







                    component and Financial Summary         Anniversary Application-



            COMPONENT        CURREIIT                YEAR                YEAR         RECOMTENDED
                             YRIS AWARD          COUII,C'A.L                            FUNDING
                             03 OPER.            RECOIOENDED         'REQUEST              SARP
                             YEAR                LEVEL          9-1-72/8-31-72


      eProgram                   604.479                              887,900
      Sub-Contr
                acts

      OPER.    ACTIV.            378,359                              388,169

      DEVEL.    COTT.             13,500                               99,633         Yes    x   or No

      EARMARKS:


          KIDITEY











      RMPS DIRECT           $    996,338      $1.,450,000         $1,375,,702        $1,375,702

      REQUESTED              1,757,550

      COUNCIL
      APPROVED LEVEL         1,450,000


      NON-RMPS    and
      INCOME


      7/l/71-6/jO/72
      2 m6nth extension 7/l/71-8/31/72        $166,056                   REGIO,R   Western Pennsylvania:'
      Extended (2 m6.)--New grant period 9/l/72-8/31/72.
                                                                           June      19@2,. REVIEW CYCLE