16



      arml*



                                            ALABAMA


             CONTINUING EDUCATION IN BLINDNESS PREVENTION

             In the State of Alabama, optometrists provide services to 51
             counties while ophthalmic services are offered        lin 12
             counties.   It is, therefore, imperative that             sts  be
             trained to detect  potentially  blinding  conditions.  With  this
             in mind, the Alabama Regional Medical Program gave partial
             funding to a project at the University  of  Alabama  in  Birmingham's
             School of Optometry.  This is            the  first  optometric
             ok6iect ever supported,by a regional medical program,
                   the firstf@ @@.-.k-ind in the nation.

             The objective of this project, to  upgrade  the  knowledge  and
             skills of the optometrist in  the  detection  and  identification
             of potentially blinding conditions,  is  being  obtained  through
             40-hour residencies.  These residencies entail training in the
             following causes of  blindness  and  related  diseases:  epidemiology,
             social consequences, specific clinical entities leading to
             blindness and the relation  to  hypertension,  glaucoma,  diabetes,
             stroke, cancer, arteriosclerosis, cataract, neurological
             diseases, and other related problems.

                              two seminars held thus far, involving 40 Alabama
             Optometrists. In an evaluation of the  first  seminar  held,  it  was
             reported that for five weeks prior to the  courset  nine  of  the
             twelve optometrists reported a total  of  63  potentially  blinding
             conditions.  During the five weeks following the course, all
             twelve optometrists detected and  referred  235  potentially  blinding
             conditions. These were examined  and  verified  by  ophthalmologists,,
             internists or other specialists.     his       of optometrists was
             compar   t @,@@8  tome ists whe during  rive  weexs  prior  to  the
             course, report:@-7-a"'@6tal of 98 potentially blinding  conditions.
             During the five weeks following the course, 26  of  the  28  reported
             a total of only 94 potentially blinding conditions.
             2'a-@          'owed           %AT! 5@

             The program utilizes the most  sophisticated  methods  and  machinery
             known for detection of such  blinding  conditions  as  vascular
             disease, cancer, diabetes, myopia, affections  of  the  cornea  and
             sdlera, and optic nerve atrophy.  It  is  projected  that  seminars
             of this type will be held for small groups of optometrists until
             all Alabama optometrists have had an  opportunity  to  take  advantage
             of this unique project.

             Status:  Partial funding beginning July 1971 of $7,488.
                      Funding as Project #38 - 4/l/72 -- 4/30/73 - $18,600.



               AlabamaRegionatMedicalProgram * P.O.Box3256 o 1108South2OthSt. o Birmingham,Alabama35205 * (205)934-5394







                    NSAS YTEGIONAIL MEDICAIL PROGRAM


                        ["NIVIIII@Sili'l' ll'ON@'l@j@ BLI)G. 1,N]VI@RSITY  IZO('II -,2201 110 4-52,):@@


         AFF)I@f,@k'I'ED 'flfl@        Ol,'                 ('EN'FER


                                      September 18, 1972




            Dorothy M. Bailey
            Writer
            Office of Communications
            and Public Information
            Regional Medical Programs Service
            Rockville, Maryland 20852


            Dear Dorothy:

            I do hope that the enclosed sheets will provide the information you need
            for the cardiovascular project. Dr. Douglas just happened to be in my
            office when the mail arrived with your request for specifics.

            About the discrepancy in the first paragraph on Regional Laboratory
            Quality Control, the correct figure is 13. Participating hospitals
            include:


            St. Bernard's, Jonesboro; Cross County, Wynn; Cleburne County,
            Heber Springs; Newport Hospital, Newport; North Arkansas Hospital and
            Clinic, Batesville; Medical Center, Calico Rock; Fulton County, Sa em;
            Randolph County, Pocohontas; Lawrence Memorial Hospital, Walnut Ridge;
            Piggott Hospital, Piggott; Van Buren County Hospital, Clinton;
            England Hospital, England; and Rison Hospital, Rison.

            Should you need further information, please let me know; but before
            closing let me thank you for the nice comments in your letter.


            Sincepely,



            Director of Information
            Arkansas Regional Medical Program








                                                                    ARKANSAS


                 Cardiovascular Rehabilitation Facility and work Evaluation Unit


                 The need for combating heart disease is apparent from this

            statistic:  between 1964 and 1968 persons died of heart disease in

            Arkansas. The Arkansas Regional Medical Program is meeting  the  need.
            They have supported numerous coronary care units designed to provide
            training for physicians and nurses in modern concepts of care for  the
            acute coronary patient. Another heart disease statistic  has  prompted
            further ARMP involvement:  the 21,613 persons in Arkansas whose activi-

            ties are limited because of heart disease. No state  facilities  exist

            for cardiac rehabilitation or work evaluation.  Thus, the "Cardio-

            vascular Rehabilitation Facility and Work Evaluation Unit" project,

            initiated by the University of Arkansas Medical Center, and  supported

            by ARMP, is meeting an important health need.
                 John Douglas, M.D., assistant professor of medicine at the Univer-
            sity of Arkansas and director of heart disease at ARMP, is director of
            the new project.  The project supports the staffing of a central cardiac
            rehabilitation facility, located at the Arkansas State  Hospital.  The

            center provides training in the concepts and techniques of cardiac re-
            habilitation for medical and paramedical personnel from the larger sub-

            regional hospitals in the State and to any others who might be  inter"
            ested.  Incorporated in this training are concepts of cardiovascular
            conditioning, exercise tolerance testing, cardiovascular monitoring
            during simulation of the patient's particular employment activity
            and adapting these results to a prescription of his cardiovascular

            potential.

                 The cardiology divisions of the UAMC and the Little Rock Veterans
            Administration Hospitals are contributing to the effort.  Three  staff







             members from these hospitals are concerned primarily with training.

                 Teams of personnel from the sub-regional hospitals are invited
             to the center to observe testing and training sessions. These personnel

             undergo on-the-job training until they have acquired the proficiency
             necessary to operate on their own.  Consultation is provided to assist
             these personnel to establish work evaluation and rehabilitation units

             in their own hospitals.
                  Through support of the work evaluation unit, ARMP will further
             assist in development and continuation of coronary care through

             evaluation of results of such programs.




                                                                                   ARKANSAS



                     Cardiovascular Reliabilitati,on l,acil-ity and l@ork- Evaluation  Unit

                   The need for combating heart disease is apparent from this statistic:

              between 1964 and 1968, 6,884  persons  died  of  heart  disease  in  Arkansas.
              The Arkansas Regional Medical Program is meeting the need.  They have
              supported numerous coronary  care  units  designed  to  provide  training  for
              physicians and nurses in modern  concepts  of  care  for  the  acute  coronary
              patient.  Another heart disease statistic has prompted further ARMP involvement:
              the 21,613 persons in  Arkansas  whose  activities  are  limited  because  of

              heart disease.  No  State  facilities  exist  for  cardiac  rehabilitation  or
              work  evaluation.  Thus,  the  "Cardiovascular  Rehabilitation  Facility   and

              Work Evaluation Unit"  project,  initiated  by  the  University  of  Arkansas
              Medical Center, and supported by A%MP, is meeting an important health need.
                   @@ouglas, M.D., assistant professor of medicine at the University

              of Arkansas and director of heart disease at ARMP, is director of the new

              project.  The project supports the staffing of a central cardiac rehabilitation
              facility,__Iocated at the MM.  The center provides training in the
              concepts and techniques of cardiac rehabilitation for medical and paramedical,
              personnel from the larger sub-r@ional. hospitals in the SI        e @,.,to any

              others who might be interested.
                 LThe          cardiology a-@iv@is"lo@n@s 'of th@'@e UAM nd Vhe Li,ttl
                                                                        v
              Admini          Hospitals are contributing to the effor@       Thre
              members from these hospitals are concerned primarily with training.
                   Teams of personnel from the sub-regional hospitals are invited        to the

              center to observe testing and training sessions.  These personnel undergo

              on-the-job training until they have acquired the proficiency necessary to
              operate on their own.  Consultation is provided to assist these personnel to
              establish work e@a         .,--and rehabilitation '@inits in their own I-lospital-s'





                                                                            @tion 'Unit
             page 2'- Cardiovapcul-           tation Faci@@,,.-

                    rough support of the work  evaluation unit, AR'I\T will further assist
                    lopment and continuation of coronary care through evaluation of

             results of such programs.




                                                                                      Alli@@SAS
     Ile,


                             Car(lio-,Tic-cular                  FacilitY
                                      l@iid Work


                                                -re are 21,613 I)e                        -tei-r
                          itc@ of .6x', ap@as the                  rsoris Iiiiiitcd in tl
                   LI](! St                                                          4    per-
           li,Zijor                      clisei,-c-. Bet@.7een 1.964 a-lid 1968, 6,88
           sotis d.'Lcd of heart disease in i@rkansas.   In recent years, numerous coro-
           ll"!ry care units have I)c@(--n activated and -nir)dc@rn concepts of care for the
           acute coronary patient have been propoaated through A.@MP-siipportcd train-
           ini@ courses for physicians and v.,arsc,.s.    Hc)-,.7cver, there have been no
           facilities  in  the  state  for  worl,   evaluation   or   cardiac   rehabilitation.
           John Dc)ti(,,las, @I.D.,  -assistant  professor  of-  Medicine  at  the  University
           of I,.rl<aiisas and director of  heart  disease  at  Z@P@IP,  is  director  of  the
           new Cardiovasc,,ilar Rehabilitation a-Lid Work Evaluation projects            This
                 project  supports  the  staj'fin-  of   a   central   ctrdiac   rehabilitation
           facility.    The  center  pra-,Tides  tra4-ninc,  in  the  concepts  and  techniques
           of  cardiac  rehabilitation  for   medical   and   paramedical   personnel   froin
           the larcc-,er svlb-regiolial hospitals in  the  state  and  to  any  others  @,7ho
           ni,,it be interested.
           The  entire  cardiology  divisions  of  the  U  of  A  @ledical  Center  and   the
           Little  rock  Veterans  Adniiiistration  Ilospitals   are   contributing   to   the
           effort, but three T@ic,--,bers are concerned primarily with training.
           Te---,.s of personnel fro-i.,i the sub-re-io-,i-,l hospitals are invi.t ed  to   the
           center  to  coserve  testin-  and  trair-@in-  sessions  and  to  undergo  a   pro-
           gra,-a of on-the-job  training   until   they   have   acquired   the   proficiency
           necessary  to  operate  on  their  oi-Tn.  Consultation  is   provided   to   assist
           these  personnel  to   establish   work   evaluation   and   rehabilitation   units
           in their ox,7ii hospitals.










                                        'T
                                          acl--ut-) Slieet



          Re@io-,I-  Arkansas Pe@i.onal Iledi&al Procraiii

                      tivitv:   Operational     Project

           -oiect Title     Cardiovascular Rehabilitition

          Status:   @Oing
                                      State B.ospital and IJi-ii,,T(,rsity of Arkansas lle(lica
            Center
          Project Di .rector, Title, and   Address:   John DooFIas, I-'.D.
                                                      Assistant I)):Ofessor of Medicine
                                                      Uiii-versity of Arkansas  ijedical Center
                                                      Little Rock, Arkansas     72204
                                                      501-664-5000

                         ary,, 1972   December,    1974
          Dates:  Febru

          Fund in g        64
                     $25,2

          Other Ftinds:  none
                                                 o'

          Area SerN7ed:  Ist year     'Pulaski   County
          T            latio@n:  lst year - approxiinatcly 2 to 300 persons
          Congre ssional  Districts:  Ist  year  -  ililliim  B.  Alexander  (D), District #1
          Continuation After PIT Su-p ort I,!itlidr@iwn    The  program  will  be sel.f-sus tainin-.
            through fees, organizational and institutional, support, insurance, etc.
          Core Staff Contact:  John Douglas, @I.D., APIIP director of heart        disease

          Date Prepared:  2/10/72
          Drafted a:  Kathleen Dozier, AIU4P director of information





                                  Re@,ional Laboratory (ki,,,I.itv CoriLrc),l


             This I-,roject, involvin- the clinical                          of '@e coi-,@-T-  !!Llllity
             hospitals in Northeast Arl@ansas, is cc@i-ill--ered at St. Perna@d's  I-los-
                    j.,@, Jonesboro.   ljnder the direction of Glen                  @i.D.,
                               of li,-'-)o-@--atory performance have been established in        l(i3
         @sub-regional co7,i,,iLiniLy hospitals.
             Visits have been made to all participating hospitals to su                 rvc! y   the.
             laboratories and to classify laboratory personnel on the basis of
             tr,iiiiiii,-, and experience.    All equi.pTiient used in pcrfori@,iir,.c, tests has
             been calibrated and procedures analyzed for the type of tests performed,
             the methodology and accuracy.
             Indivi(3ual technician competence has been continuously checked to deter-
             mine  need  for   additional   training,,   and   laboratories   l@iL,%Ie   been   supplied
             x-7ith   basic   texts   and   other   materials   pertinent   to   quality   control.

             P,--fresher training has been given in Jonesboro to local laboratory per-
             soiinel,   and   local   laboratories   are   regularly   inspected   and   reco@Lr:,-enda-
             tions iqade as to space, orientation of                 areas, @,dequacy of equip-
             ment and safety.

                                                                                      of   the    accep-
             This I)iE,,iily successful project is an oulcL,
             tancc of responsibility by a larger sub-ro@ional               hospital for assisting
             the- sinallcr               hospitals j@ii @.ts ar   ea.   All   efforts   are   bei.n-
             made  to   provide   establis)@,enL   of   quality   control   pro--.&dures   in   each
             hospital  I-a@)orator'.@,y  as  i  regular  element:  of  its  operations   and   to   con-
             ti.iiue after the tc-@ry.,,iinitioi-i of the project.

             Under quality controlled standards, physicians of the area find that
             all   reports   from   the   participatiii,, laboratories are acceptable.   They
             find   it   unnecessary   to   question   or cross-clieck.   Since the patient is
             charged   for   all    medical    laboratory reports, he obviously benefits under
             the   quality   control    program's    cost containment.  -@e established, these
             standards will continue to be maintained.









            Reql.on:  Arl@'a).isis Regional Medical

            LOctis O'c             Oj.:)erational ..Proj(,ct

                              Regi.o-,-ial @-boratory Q-,ial.ity   Control

            St@ttu,@  Ongoing

            ,Sponsoti.ri,@ Institution:  St* Bernard's   I'Lospital at Jonesboro
            .Project Director,  Title,  Address:    Glen  F. Baker,  II.D.
                                                    Pathologist
                                                    St. Br@rnLrd's I'@os ital
                                                                       p
                                                                I,,i-Ic@insas 724-01
                                                    Jonesboro,
                                                    501-9-0)2--7430

            Dates:  July, 1970      Dec@,.ber, 1972

            EuiicJ in
                 @:  1972, 03 year, $40,786

            Other Funds :  @lone

                              --i.es @rid irstit7Litioiis: State I-licaltli Dc-Tarti-.)eTIt and Co;-,@iiunit@y'
             hospitals in the area-Y

            Area Served: -1@,lortlieas+.- Arkansas

            Tar@,,c!t Populatiozi:  244,977

            Conc-,ressi.onal Districts   @rl   Bill Alexander   (D)

            Cop.ti.nuation A.f ter 1,@@P Sli-pport ",-,Iithdra@,,n:    Standirds will be maintained now
             that they are established.

            Core Staff Contact:  Ed Renscii, associate coordinator, @IP

            Date PreDared:  2/10/72

            D            Kathleen Dozier, Director of Information, ARMP




              zw



                                                                                    ARKANSAS



                                  Coronary Care Trainin& for Physicians



                In 1966 there were no  coronary  care  units  in  Arkansas; now,   more than
                50 CCUs are operational or in an advanced              planning.  This
                growth is due largely to the success of    CC  Training  for  Physicians,and
                         the Nurses Coronary Care Training Project.
                -The physicians' project, terminated Dec., 1971,    was proposed   to)estab-
                1J.'sif@a coronary care unit, with  supportive  equi@ent,at  the  University
                of Arkansas Medical Center and to utilize@this to of er,an intensive
                course in  the  diagnosis  and  treatment  of  coronary.disease.  Originally
                the project proposed to train nurses and physicians, but it was decided
                to train physicians only at ULMC and rely on the Mu@-siipported co-,n-
                panion course at Baptist Medical Center in Little Rock to train nurses.
                Actually the two shared faculty and clinical facilities.

                A six-bed CCU was opened Feb.  10,  1970,  in  University  Hospital  to
                serve the dual purpose of treatment and @@ost-graduqte learning
                        f                                                 "@Jack    Da
                center - or--            physicians.    roj@i  director   w          vis,
                Y-.D.,VFrom t@@--6p'e' iiig d@@e to July 1, 1971, 508 patients with  various
                forms of  acute  cardiovascular  disease  were  admitted.  Upon  completion
                of the third year, the project had trained 217/@p@t'hrysicians a@

                Dr. Davis confirmed the mortality rate -iedu             30 to  40  per cent
                ixL,@th"    @@-h@                 n,      ed to 10 to 15 per  cent  in  the
                CCU.' Dr. Davis  also  reported  th@project  had  over-achieved  its  stated
                objectives and that the program  would  be  dontinued.on  a  tuition  basis
                at intervals determined by the demand.

                On-site consultation  programs  in  the  community  hospitals,  further assis-
                ting in the development and continuation of coronary care and evaluating
                results of such programs, is to  be  continued  through  support  of  other
                @UAMC projects.

                As a direct outgrowth   of this project a Cardiac Rehabilitation and
                Work Evalu.ation Program has been initiated at.UAMC, funded by ARNII.








                                                Back-up Sheet



                 Reaion:  Arkansas   Regional   Medical   Program

                 Locus of P@tivity:  Operational Project
                 Project Title:  Coronary Care Training for Physicians
                 Status:  Q3 year terminated December,       1971
                 Sponsoring Institution:  University of      Arkansas  Medical  Center

                 Project Director:  Jack L. Davis,     M.D.
                                      Asst. Prof. of     Medicine
                                      Director of Coronary Care,
                                     'University of   Arkansas  Medical  Center
                                      Little    Rock, Arkansas 72201
                                        -501-664-5000

                 Dates:  August,   1969    December, 1971

                 FundiE&:  $376,640
                 Other Funds:  $127,311        (U@IC, $116,226;  Attending physicians,     $11.%. 085)

                        @t Li    e n i.@e  None

                 Area  Served:   State  of Arkansas
                 Target Population:     1,697 full time   non-federal  physicians
                 Congressional Districts:  #1 - 14m.    B. Alexander       #2 - Wilbur  D. Mills
                                              #3 - John P. Hamerschmidt        #4 - David   Pryor

                 Continuation After PJIP Support Withdrawn:  On-site       consultation  programs
                 in the con=nity hospitals, further assisting in the development and con-
                 tinuation of coronary care and evaluating results of such programs, is to
                 be continued through support of other UAMC projects.  Training will con-
                 tinue on a tuition basis at intervals determined by the demand.

                 Core Staff Contact:  C. W. Silverblatt, M.D.i ARMP coordinator

                 Date   Prepared:    1/20/72
                 Drafted By:  Ka  thleen Dozier, ARMP director of infomation





                                                                         ARKANSAS




                            Continued Education for Nursing Home Personnel
                                 In Heart Disease, Cancer, Stroke
                                       And Related Diseases



           The need for additional training for personnel serving the 12,000 nursing home
           beds (93% occupancy) in Arkansas is indicated by the fact that the patients are
           cared for by 4,000 aides, 265 LPNs and only 125 full-time registered nurses.
           Nurses' interest in a program of education has been amply demonstrated by attendance
           at workshops held in central locations by the Arkansas League for Nursing, sponsor
           of this project. The workshops, however, did not reach aides and LPNS. This project
           -tresses on-site workshops tIhat are designed for the LPNs and aides.

           The ultimate goal is to improve the care and facilitate the rehabilitation of heart,
           cancer and stcoke patients in the state's nursing homes through one and two-day annual
           workshops in each of the sub-regional communities throughout the state.
           These workshops are devoted to separate programs on the care of patients with heart
           disease, cancer and stroke.

           The League for Nursing, having just completed a three-year project, Continuing
           Education for Nursing Personnel and Citizens in Heart Disease, Cancer, Stroke and
           Related Diseases, is qualified to achieve the goal set forth. There has been
           invaluable experience gained and competence demonstrated in the League's previous
           project which i-s continuing  under the co-sponsorship of the League, Arkansas Heart
           Association, Arkansas Chapter of the American Cancer Society and individual agencies.









                                       Back-up Sheet



            ion: Arkansas Regional Medical Prorram

          Locus of Activity: Operational Project
          Project Title: Continued Education for Nursing Home Personnel in Heart Disease,
                        Cancer, Stro'ke and Related Diseases

          Status: In 01 year operation

          Sponsoring Institution: Arkansas League for Nursing
          Project Director, Title, Address: (Mrs.) Nell T. Balkman
                                            Director of Continuing Education
                                            Arkansas League for Nursing
                                            1815 West 12th St.
                                            Little Rock, Arkansas   72202
                                            501-375-5305
          Dates: January, 1972-December, 1974

          Funding: $79,407

          Other Funds: None

          .Cooperating Agencies and Institutions: Nursing Home Association, State Health Dept.,
                                                  Arkansas Medical Society, and various other
          Area Served: State of Arkansas                                  organizations.
          ,Target Population: Approx. 4,400 aides, LPNs and RNs  and those having heart
                             disease, cancer, stroke ard related diseases who are counted
                             among the 11,160 nursing home patients in the state.
          Congressional Districts: #1 - William B. Alexander (D); #2   Wilbur Mills (D)4,
                                   #3 - John P  Hammerschmidt (R); #4   David Pryor (D)
          .Continuation After RMP Support Withdrawn: There is a plan for continuation through
              fees and agency support after AKIP funding is terminated.
          ,Core Staff Contact: Jacquelyn Walter, RN, a member of ARMP's Project and Evaluation
              Section.

          Date Prepared:  2/10/72
          .Drafted By: Kathleen Dozier, Director of Information, ARMP





                                                                               ARKANSAS

                          Comprehensive Program for Kidney Disease Control


               In July, 1971, Arkansas received a $1,400,000,grant to combat,end-stage
               kidney disease.  This grant provided for the expansion of kidney trans-
               plant facilities at the University..of Arkansas Medical Center and  the
               provision of facilities at Arkansas Baptist Medical Center for the
               training of patients to perform their own d@@alysis in their  homes.  Wil-
               liam J. Flanigan, M.D., UA14C associate professor of medicine and  dir-
               ector of clinical research, is the project director.

               Since July, 1971, 15 patients have received transplants,  and  26.patients
               have trained or are being trained for home dialysis. All but  one  of  the
               sub-regional nephrology centers in the larger  community  hospitals.around
               the state are no@q in operation, providing backup dialysis and  programs
               of prevention.

               A tissue typing laboratory, with trained staff, and an  Organ  Procure-
               ment and Distribution Section has been established at U@1C. A Belser per-
               fusor makes it possible, for the first time, to retrieve  kidneys  from
               anywhere in the state.  The OPD Section participates in an inter-
               regional organ-sharing program whereby kidneys, which cannot be used
               at the point where they are received., are shipped from city to city
               and/or state to state, wherever they might be utilized.

               Mortality statistics for 1967 in Arkansas revealed 673  deaths  attribu-
               table to renal disease, indicating an incidence for  Arkansas  consider-
               ably higher than in the nation as a whole.  Of this number, it is esti-
               mated that from 150 to 200 persons are suitable@for  treatment  annually
               by chronic intermittent dialysis or by kidney transplantation.

               Although patient training in home dialysis is based at the  Arkansas  Bap-
               tist Medical Center, personnel and facilities of this  center  and  the
               Little Rock Veterans Administration Hospital are being utilized.





                                                                               ARKANSAS


                          Comprehensive Program for Kidney Disease Control


               In July, 1971, Arkansas received a $1,400,000.grant to combat,end-stage
               kidney disease.  This grant provided for the expansion of kidney trans-
               plant facilities at the University of Arkansas Medical Center  and  the
               provision of facilities at Arkansas Baptist Medical Center for the"
               trainina of patients to perform their own d-'@alysis in their homes.  Wil-
               liam J. Flanigan, M.D., UAMC associate professor of medicine  and  dir-
               ector of clinical research, is the project director.

               Since July, 1971, 15 patients have received transplants, and  26  patients
               have trained or are being trained for home dialysis. All but  one  of  the
               sub-regional nephrology centers in the larger community  hospitals  around
               the state are now in operation, providing backup dialysis  and  programs
               of prevention.

               A tissue typing laboratory, with trained staff, and an  Organ  Procure-
               ment and Distribution Section has been established at U@1C. A Belser per-
               fusor makes it possible, for the first time, to retrieve  kidneys  from
               anywhere in the state.  The OPD Section participates in an inter-
               regional organ-sliaring program whereby kidneys, which cannot be used
               at the point where they are received, are shipped from city to city
               and/or state to state, wherever they might be utilized.

               Mortality statistics for 1967  in Arkansas revealed 673 deaths  attribu-
               table to renal disease, indicating an incidence for  Arkansas  consider-
               ably higher than in the nation as a whole.  Of this number, it is esti-
               mated that from 150 to 200 persons are suitable for  treatment  annua  y
               by chronic intermittent dialysis or by kidney transplantation.

               Although patient training in home dialysis is based at the  Arkansas  Bap-
               tist Medical Center, personnel and facilities of this  center  and  the
               Little Rock Veterans Administration Hospital are being utilized.





                                                                                   ARKANSAS



                                  Continuing Education for Lhy i-cians

                 Quality of health care has spread throughout the state of Arkansas
                 as a result of Continuing  Education  for  Physicians.  Family  practi-
                 tioners in the rural areas now  may offer patients the benefit of'up-
                 dated medical methods and procedures just as efficiently and as know-
                 ledgablq,as the urban physician.  This project was based on three
                 basic elements

                 (1) A consultation-visit program for smaller community hospitals    inclu-
                 ding hospital rounds and examination of patients and records in clinical
                 areas selected by the local physicians themselves;  (2)  a  program  of
                 seminars for councillor districts as a whole;  and  (3)  a  self-education
                 program including,,,a dial access teleplone tape system and  other  audio-
                 visual self-teaching units in one hospital in each councillor district.

                 The program, especially the  consultation-visit-rounds  aspect,  has  been
                 enthusiastically received by doctors of the state.  The director, Lee
                 Parker., M.D., personally has conferred with local  practitioners  of  the
                 munity before and after consultation sessions.  Five seminars have been
                 held in two councillor districts, Southeast  and  Northi4est  Arkansas.

                 The dial access tape facility has a library of hiore than 475 tapes
                 and averages about  7 calls wee  y.

                 The project, terminated in December, has been in most   part very   grat-,
                 ifying.  The most effective parts of the program are being incorpor-
                 ated in a new project, University Medical  Extension  Services  for  Rural
                 Arkansas,, in coordination with the  Arkansas  Medical  Society.  Asso-
                 ciation with the A14S has been close and continuous throughout the
                 term of Continuing Education for Physicians.



















                                      t I:









                                            Back-iip Sheet


                Region:  Arkansas Regional Medical Program

                Locus of Activity.,  Operational Project

                Project Title:  Continuing Education for Physicians

                Status:  Terminated
                Sponsoring Institution:  University of Arkansas School of  Medicine
                Project Director, Title, Address:   Lee Parker, M.D.
                                                    General Practitioner
                                                    University of Arkansas Medical Center
                                                    4301 West Markham
                                                    Little Rock, Arkansas  72201
                                                    501-664-5000

                Dates:  July, 1970   December,   1971

                Funding:  $128,207.76

                Other Funds:  None
                Cooperating Agencies and Institutions:  Arkansas  Medical Society

                Area Served:  State of Arkansas

                Target Population:  1,923,295
                Congressional Districts:  Yrl - William B. Alexander (D); #2   Wilbur Mills (D);
                                           #3 - John P. Haumerschmidt (R); #4   David Pryor (D)

                Continuation after PkT Support WithdraN,7n:  Physicians' support of this
                  project and the University of Arkansas School of Medicine's extension
                  efforts assure continuance of,this-project.  Consultative services are
                  self-sustaining through a fee system.
                Core Staff Contact:  Walter Robbins, ARMP director of education

                Date Prepared:  2/10/72
                Drafted By:  Kathleen Dozier, ARMP director of information








                                              CANCER EDUCATION SYMPOSIUM



           over 300 persons             y involved in  the  care  of  cancer  patients  attended  an

           educational symposium "Caring for Cancer - 1972 Stylell sponsored by Area I RMP
           Regional Cancer  Program,@,  February  1,  1972.  This  was  the  first  program  of  its

           kind to be held  in  northern  California,and  served  as  the  prototype  for  future  cancer

           education programs.



           This symposium was initiated at the request of the Napa-S61ano District Advisory
           committee of Area I   @\which represents a      tot4l@population  of  249,081  persons   in

           A combined two-county rural district.  Of      this population,  it  is  estimated   that

           1,430 new cases will be diagnosed and that 310      persons will  die  of  cancer  each  year.

           The health professionals in  this  rural  Area  who  are  not  closely  affiliated  with  a

           large city hospital or cancer institute find it difficult to care for their cancer

                                                                                 is rare'          nd
           patients and manage 'their problems.  The tumor board mechanism(                  '60-6 a
                  '@lviitually non-existent.


           The cancer  education  symposium  was  designed  to  present  the  latest  developments  in

           comprehensive cancer care.  It was intended primarily for nurses, nursing students,

           social workers, social work assistants, volunteers, staff members of cancer societies

           And physicians and dentists who  are  faced  with  the  problems  of  caring  for  the  cancer

           patient.



           Both the medical management and the meeting of nonmedical needs of cancer patients

           were presented in a psychodramatization of an ideal tumor board by a team of specialists

           consisting  of  radiotherapists,  chemotherapists,  surgical  oncologists,  a   nurse   and

           a cancer social worker.  Social, emotional, nursing, And non-medical facets of each

           pa  ient's  case  were  discussed  along  with  medical  aspects.  Seven  patients,  currently

             California Health Data Corporation Studies (197u).






          undergoing treatment for cancer, held a round-table discussion openly  relating  to

          the audience all they knew about their disease, including the prognosis  and  their

          ability to cope with cancer and death.  The health professionals gained great insight

          into the personality of the cancer patient.



          it is difficult to evaluate the impact of this program on the target area  of  Napa

         .@,and Solano counties at this time.; Material presented at the symposium  will be

          incorporated into the instruction  at the Napa College School of Nursing, Solano

          College School of Nursing and the  inservice nurse training at the Veterans Administration
          Hospital in Yountville. (Area I hopes that the tumor board models would be considered

          for implementation in these two counties.  This would represent a significant advance

          in dander care stimulated by the Regional Cancer Progtam's  educational  symposium.



          Other counties in Area I have already expressed an interest in co-sponsoring similar

          presentations for their districts.



                     1 Cancer                              all reques
          The Regiona         Program hopes to accomodate            ts for programs of  this

          nature.








                                                     Back-up Sheet




           REGION:        California
                        (California Committee on Regional Medical Programs)



           LOCUS OF ACTIVITY:       California Area I Regional Cancer Program
           PROJECT  TITLE:      Cancer Education Symposium ( Caring for Cancer- 1972 Style)

           STATUS:      Ongoing


           SPONSORING INSTITUTION:       Area I Regional Medical Programs

           PROJECT DIRECTOR:       Samuel R. Sherman, M.D.
                                   Cancer Coordinator, Area I
                                   Regional Medical Programs
                                   745 Parnassus Avenue
                                   San Francisco  California  94122

           DATE:     February   1, 1972



           FUNDING:       03  year Cancer Program

           OTHER FUNDS-.      None

           COOPERATING    AGENCIES AND INSTITUTIONS:  Napa County Medical Association, Solano
                   County Medical Association, American Cancer Sodiety--Napa Branch, and Napa
                   Collegoi

           AR    SERVED:     Napa and Solano counties

           TARGET POPULATION:  Napa --  79,140; Solano -- 169,941,

           CONTINUATION AFTER RMP SUPPORT WITHDRAWN:  Rmp  believes that the tumor board models

           will be considered for implementation in the two counties where this type of activity

           is almost non-existent.  The cancer education portion of the program will be incorp6rat-

           ed into the instruction at the schools of nursing At both Solano and Napa colleges,

           And into the individual practices and attitudes of professionals working with the

           cancer patient.
           CORE STAFF CONTACT:  Samuel R4 Sherman, M.D.         Cancer Coordinator; (415) 666-4221

           DATE PREPARED:  2-11-72

           DRAFTED BY:     Naheed R. Aly





                                           CORONARY/INTENSIVE CARE



          the C61usa Memorial Hospital was built in 1930 as A memorial to the war veterans of

          ColusA County.  Until the mid-50's, it provided special medical benefits to veterans

          and their dependents.  During the late 60's  deterioration of the facility became a

          matter of great concern to county residents.  The need for a new, well-equipped hospital

          was Generally recognized.  $645,000 of Hill-burton funds were ultimately allocated

          for a new facility with the stipulation that matching funds be provided.  Community
          resistance to higher taxes eventually led to the matching funds being provided by

          a private, non-profit corporation--Eskaton* which leases the land for the facility

          from the county And in return has a contract to provide care for county residents.



          In June of 1970, while th old community hospital building was still in use,  the

          hospital administrator and medical staff realized the need for new skills to operate

          the modern, sophisticated equipment being installed in the new facility - especially in

          the Coronaty/intengive Care Unit   The hospital administration contacted Area  I
                                                                  L)
                                                                                 '7
          Regional Medical Program  ancl-ne-gotlated -physl-c4-@.@d,@@'.               training
                                                              ommitments to an ICU-.CCU

          program#  Monthly pre-sessions at Colusa began in September 1970  to provide instruction

          in blood gas analysis and EKG recognition.  Arrangements were then made for i

        -,-]>h--   a to come to PAcific Medical Center (PMC) for-PrActical training and experience
          in the skills of intensive care.                                          ual-i-ied

             truction at PMC. A three-week, RMP-spons6red course for ICU/@CU  nursing  was

          conducted concurrently with the physician training sessions

          Special emphasis was placed on the assessment and evaluation of crucial problems

          encountered in intensive care.  In December 1971, after'@         ?a-r@

          phys.@n&4-had..,.,completed th@training program@I

                     e,@in-residence instruction was established At the Colusa facility for


          *EOkaton is a non-profit, charitable corporation related to the Christian Church
                     of Christ) of Northern California-Nevada. -It is comprised of three divisions:
          health care, housing, and education. The Eskaton Colus4 Healthcare Center  is  a
          satellite facility of the Eskdton American River Healthcare Center.






            appraise              k@.  @Tfiis  in-residence  training  was  conducted  by  cardiologists
                    @4ately-two.wee

            Robert Popper, William  Armstrong,  and  Rodger  Shepherd;  and  Mildred  Czar,  R.N.,  M.S.

              e purpose of follow-up in-residence training at the Colusa Healthcare Center wa

            to supervise the physicians and nurses as they applied their new skil           o   patients
            in their own intensive care uni      and to identify and remedy problems         ountered,-)
            with the new equipment and procedures.
            The Eskatbn Colusa Healthcare Center opened in October, 19@i as an 84-bed health care
            facility(designed to serve the 12,400 residents of Colusa Count      @). On October 28, 190,
            A modern  fully equipped,   six-bed intensive/coronary care unit in     the new facility was

            opened.  Physicians and nurses from the RMP 'training program went      out  to  Coluoa  and
                                                          i ity. (Acc
            provided follow-up training in the now fac 1             oHIng to the doctors and nurses

            at the hospital the follow-up instruction served to reinforce the previous training

            programs in San Francisco     All nurses, and two additional staff'physic'ians have

            subs quently been involved in the in-servide training that continues at the hospital.

            'Ead  level of nursing care receives instruction to facilitate continuity of care

            between general nursing, coronary care nursing, and intensive care.  Consultation is

            Conti nuousl  available  rom Dr. Rodger Shepherd, Dr. Robert Popper, and Mildred
                       y            If
            Czar, R.N., M.S. (Clinical Specialist in Cardiovascular Nursing)                @-so a

            24-  ur telephone consultation servi



            lth6dih  the Colusa Hospital training experience is too recent to afford statistical

            ev4      n in terms of morbidity and mortality, the staff is convinced that the increase

            i  the duality of care over the past few months has been "fantastic."
                                                                                         Physicians
          i@@and nurses  are  now  able  to  make  immodiatO  and  accurate  diagnosis.  Although  outside
           @c    t  tion from larger ho!t pitals continues, the physicians, because of increased

            on ide  e,in performing new skills and expanding medical awareness, are taking on more

            responsibilities in managing complex patient problems.  The use of the phbno-trace






           @ysteiR has diminished, indicating that'physicians are becoming more confident that
         .,,,,,their EKG interpretations are consistently correct. An interesting  development
           resulting from concurrent training in intensive/coronary  care  skills  for  physicians

           and nurses is that communication between these two specialties  has increased
           considerably.  Physicians now feel confident that nurses are well qualified to

           interpret accurately the patient's condition and  provide  relevant  and  necessary

           feedback.  Nursing standing orders have been re-written and ate far more comprehensive.

           The introduction of comprehensive routine standing coronary care orders., carried

           out skillfully by the n urses, combined with a cooperative  nurse-physician  team,  has

           resulted in more efficient and improved care.



          'Some direct results of the RMP iCU/CCO training course for  physicians  and  nurses  at

           the Eskaton Colusa Healthcare Center are as follows-.




           -A crash cart" was established for the first  time.  This  cart  contains  all  the
              necessary equipment for emergency treatment of cardiac arrest.

           -A "Code 9911 (Cardiac Arrest) procedure can be performed skillfully with complete
              cooperation, coordination and efficiency.  Each member of the team is sure of his
              function.


           -Ctitital care patients are placed on a heart monitor.

           -Nurses and physicians can immediately recognize critical changes in the heart
              monitor patterns.

           -All staff nurses are able to:  1)  assist in monitoring arterial gases     2)  maintain
              arterial and venous lines; 3)  assist in the insertion of these lines; and
              4)  measure and evaluate central venous pressure readings.

           -Nurses at this facility are now able to evaluate the general  status  of  the  patient
              And contact the physician only if he is actually needed.  Physicians Are confident
              that nurses can -perform these skills accurately.

           -continuing Education is "ongoing."  Joint  physician-nutse  conferences  Are  held
              weekly for EKG reviews, and monthly for review of IeU/CCu cases.

           -Other members of the health care team such as inhalation therapist , physical
              therapist'. occupational therapists, dietician,.etc. are now being involved in the
              total care of the patient on a regular basis.







          The best testimonial for this program's success can be summed up in a quote  r
          Cheryl Adams, R.N., Inservice Nursing Director, "The new system has been worki
          so well that it seems like it has always been this way."








                                                Back-Up Sheet



          REGION:    Area I Regional Medical Programs (California Committee on Regiona
                                                       Medical Programs

          LOCUS OF ACTIVITY:  Intensive/Coronary Care
          PROJECT TITLE:  Intensive Care Program:  An integrated and problem solving approach.
                                                                    I   iversity of California,
          SPONSORING INSTITUTION,  Area I Regional Medical Programs' Un
                                   San Francisco; pacific Medical Cdfiter, San Francisco.

          PROJECT DIRECTOR, TITLE ADDRESS:     Elliot Rapaport, M.D.
                                               Acting Coordinator and
                                               Associate Dean for Regional Medical Programs
                                               745 Parnassus Avenue
                                               San Francisco$ California  94122
                                               (415) 666-4221

          DATES: Colusa Project: June, 1970  through  December,  1971
          FUNDING:  Core Consultants And Travel Budgets--$6,000,
          OMR FUNDS:  Fees paid by physicians and the Eskaton Corporation
          COOPERAT NG-AGENCIES AND INSTITUTIONS:  Pacific Medical Center, San Francisco;
                      ChildrenO Hospital, San Francisco; University of California, San Francisco;
                      Eskaton Corporation, Medical Staff of ColusA Healthcare Center; San
                      Francisco General Hospital.

          AREA SERVED:  Colusa County

          TARGET  OPULATION:  12,400
          CONGRESSIONAL DISTRICT:  New districts not available yet.
          CONTINUATION AFTER RMP SUPPORT WITHDRAWN:  In-hospitAl program for continuing
                       education in intensive care will be sponsored by the medical staff and
                       hospital administration on a monthly basis.
          CORE STAFF CONTACT:  Rodger Shepherd, M.D., Pacific Medical Center,(415y 931-8000, E t. 334

          DATE PREPARED:  2-11-72

          DRAFTED BY:  Naheed R. Aly







                                                            California,  Area   IV

                  PERIIqATAli CRISIS CARE PROGRAM AND SERVICE DEVELOPMENT

           A three-year Area  IV  operational  project  is  making  available  to
                  I
           community hospitals in Southern Cali-fornia modern perinatal concepts
           and technology used primarily by major medical centers in diagnosing
           and treating critically-i.11 newborns.
           This effort, based  at  Harbor  General  Hospital,  Southern  campus  of
           the UCLA lledical School, will  prepare  physicians  and  nurses  in  the
           prerequisite  specialized  skills  and  provide  consultation  and  assis-
           tance to  their  hospitals  to  encourage  establishment  of  perinatal
           units. It is financed  the  first  year  by  a  $72,000  grant  awarded
           September, 19  .
           A major target  of  the  program  is  the  life-threatening  complications
           which occur during  the  perinatal  period--from  the  onset  of  labor
           through the  first  four  weeks  of  infant  life.  These  conditions
           which often affect the respiratory system, the heart and other vital
           functions of the newborn  accounted  for  4,522  infant  deaths  in  Cali-
           fornia last year.
           Training is being  conducted  in  the  intensive  perinatal  unit  at
           Harbor General, among  the  few  facilities  in  the  state  combining
           the care of the fetus  and  the  newborn.  It  is  fully  equipped  with
           bassinettes,  incubators,  isolettes  and   special   monitoring.eouipmoht
           to record breathing and heart beat patterns of the newborn.
           Dur-i-ri"this firs-L year, focusing exclusively  on  nurses,  three  weeks
                  9
           of   int         truction isbelp                  0
                  ensive ins                  g offered to f  ur  enroirees  at  a
           tirue, @ outreach services@     participating  hospitals   to   facilitate
           application  of  acquired  knowledge.  Fifty  percent  of  the  training
           time is  devoted  to  clinical  experience  emphasizing  nursing  assess-
           ment of the  infant's  clinical  condition  and  nursing  management  of
           the  silk  neonate.  Highlights  of  the  course  curriculum  include
           detection and management  of  high  risk  mothers  and  infants,  manage-
           ment  of  infants  with  respiratory  disease,  infant  resuscitation,
           use of  monitoring  equipment,  transportation  of  infants,  control  of
           nursery infections and oxygen therapy.
           Twenty-four physicians will be the focus of the second year's
           efforts with the final year spent in team training.
           The program was initiated by  Dr.  Joseph  St.  Geme,  Jr.,  UCLA  profes-
           sot of pediatrics and  chairman  of  the  Department  of  Pediatrics  at
           Harbor General in response to what he termed
           need" for community  hospitals  to  develop  these  @nits  because  tta-
           ditional academic  teaching  hospitals  can  not  assimilate  all  the
           infants  who  need  intensive  care.  Problems  of  transporting  the
           critically ill infant from  one  hospital  to  another  also  are  inten-
           sified.@
           Directing the program is Dr.  Williaii  oli,  associate  professor  of
           pediatrics and neonatology at  UCLA  and  head  of  the  Division  of
           Neonatology  at  Harbor  General.  Also  represented  on  the  program
           faculty are  the  other  specialties  concerned  with  perinatal  care,
           including  fetology,  gynecology,  obstetrics,   pediatric   neurology,







                                                       California, Area !V
                                         -2-

          microbiology, surgery and cardiology.
          The application of perinatal concepts makes it possible to deter-
          mine genetic defects, such as mongolism, in the fetus and certain
          congenital disorders which can be reversed if treated immediately
          after delivery.






                                                     California, Area IV


              ion:  California
           Locus of Activ@:  Operational Project
           Project Title:  Perinatal Crisis Care Program and Service
           Development

           Status:  Ongoing
           Sponsoring Institution:  Harbor General Hospital
           Project Director, Title,, Address:   Joseph W. St. Geme, Jr.p M.Do
                                                William Oh, M.D.
                                                Department of Pediatrics
                                                Harbor Gerieral Hospital
                                                1000 West Carson Street
                                                Torrance., California  90505
           Dates:  September 1, 1971 to August 31, 1974
           Funding:  $72,000

           Other Funds:  -0-
           Cooperating Agencies and Institutions:  None
           TapLet Population:  Nurses and physicians working in newborn units
           of community hospitals throughout Southern California.
           Congressional Districts:  Senators Alan Cranston and John Tunney
           Continuation after RMP Support Withdrawn:  Integration into
           inservice education programs and perinatal units in community
           hospitals.
           Core Staff Contact:  Lee Horovitz, Associate Area Coordinator,
           California Regional Medical Programs, Area IV (UCLA)

           Date Prepared:  February 12., 1972
           Drafte@b      Jackie Reinhardt


      6AI, (@v) -                                     California,  Area  IV  (UCLA)

                              Central Indian Health Project

           Home for approximately 1,000 Indians  in  rural  Central  California
           is four isolated rancherias located in@ rough, heavily-wooded
           terrain in Fresno and Madera counties.  Medical care is a low
           priority among this  population  who  lack  transportation,  telephones
           and other communications to link them  with  the  closest  urban  com-
           munity, 50 miles away.
           Most of the residents receive public assistance.  They live in
           makeshift dwellings with no plumbing.  Jobs  are  scarce  and  those
           that do exist are seasonal, primarily  associated  with  the  timber
           industry. Day-to-day  existence  is  frequently  a  struggle,  Preclud-
           ing any major concern with good health or nutrition.
           To improve access to and utilization  of  health  services  among  this
           minority group the Central Indian  Health  Project  was  initiated  in
    j4ll   September'      , with $12,290 in core  funds.  A  major  impetus  for
           this project@ as the findings of serious dental problems among
           200 Indians screened in  June,  1971.  Seve@@-@r6sno  dentists  recruited
           by the Central San Joaquin  RMP  District  Committee  volunteered  their
           time and facilities for this effort.
           over a six-month period four  indigenous  residents  have  been  recruited
           and trained as health advisors and as  advocates  for  their  peer  group.
           They'lea'rned adva@ced'fi;s-t aid, how to recognize  symptoms  for  common
           illnesses, nutrition  and  sanitation  information.  Returning  to  their
          'respective rancherias in February,  the  health  advisors,  all  women,
           are helping to identify unmet health problems  and  to  act  as  "medica
           ombudsmen."

           Mobile tw       s    -wave radios are installed in  cars  owned  and
         -opekated by  these Indian women, linking  them  to  the  project  head-
           quarters whom they alert in cases  of  injured  and  lost'hunters,  fire,
           civil disturbance and law  enforcement  problems.  A  base  station  at
           Valley Medical Center, expected to be  fully  operative  in  Marc@,  will
           enable them to contact  physicians  directly  for  consultation  regarding
           a medical problem and, when advised to  do  so,  transport  patients  to
           the hospital for treatment.
           In addition to the four weeks of  training  they  have  already  received
           .through the Fresno and Madera County  Health  Departments,  the  health
           advisors will complete another  four  weeks  of  instruction  beginning
           in March, 1972. This will enable  them  to  take  on  their  responsibil-
           ities with more confidence, although at  no  time  are  they  instructed
           to provide medical treatment as paramedics db4
           Medical and related resou@@s -ipthe  two  counties  have  been  high  y
           supportive of this effort,'w@i'e'@h can expect to be continued at  the
           conclusion of the initial funding  period  with  additional  RMP  money
           or with funds from other Federal sources.






                                                       California, Area IV

          Region:  California

          Locus of Activity:  Developmental Component
          Project Title:  Extending Health Care Services to Remote Indian
          C-om-munities


          Status:  Ongoing
             nsoring Institution:  Central Valley Indian Health Board
          Project Director, Title, Address:  Mr  Richard Johnson
                                             Fi;cal Officer
                                             Central Valley Indian Health Board
                                             541 Fifth Street
                                             Clovis, California

          Dates:  September 1, 1971 to August 31, 1972

                 :  $14,978

          Other Funds:  -0-
          Cooperating Agencies and Institutions:  Fresno County Comprehensive
          A-ealth Planning, the Fresno County Health Department, and the
          Valley Medical Center oubpatient department.
          Area Served:  Four rancherias in the eastern, mountainous parts of
          Madera and Fresno Counties.
          Target Population-.  Approximately 1,000 Indians
          Congressional Districts:  #16, B.F. Sisk (R)
          Continuation after RMP Support Withdrawn:  The Central Valley
           ndian Health Project will include the project in their subsequent
          funding applications, as well as examine other possible funding
          sources to maintain this service, if it proves successful.
          Core Staff Contact:  James Ricketts, District Coordinator,
          Central San Joaquin District of Area IV RMP

          Date Prepared:  February 12, 1972

          Drafted by:  Jackie Reinhardt







                                                        California,  Area  IV

                        SA14 FERNANDO VALLEY HEALTH CONSORTIUM

          The San Fernando Valley Health Consortium evolved out  of  an  Area
          IV operational activity concerned with improving health  care  to  a
          target population of 250,000 residents in  the  northeast  section
          of the Valley. Although part of Los  Angeles  County,  the  144-square
          mile area comprising the Valley has its own  character  deriving  in
          part from the mountains surrounding it and the  two  million  people
          of all economic levels who reside there.
          The RMP project surveyed existing health  resources  prerequisite  to
          the pre-paid comprehensive health system it is now  in  the  process
          of establishing with OBO funds. Findings  showed  that  health  care
          was not only poorly coordinated but a  serious  manpower  shortage
          exists, especially in the Northeast  Valley.  Few  opportunities  are
        ,,,'available for recruiting and training minorities in health  careers.
          From early grass roots discussions initiated by  San  Fernando  Valley
          State College in 1969, a consortium of health care providersk-
          hospital   private physicians, extended care  facilities  and  public
          agencies     educational institutions and  health  care  consumers
          was deveh'ped. Eight Task Forces were  formed  and  assigned  respon-
          sibility for the following areas  of  concern:  medical  legislation,
          legislative liaison and funding, review of  consortia  models  and
          determination of program priorities, survey  of  existing  educational
          institutions, programs, facilities and personnel,  survey  of  health
          manpower needs, survey of existing community health facilities, pro-
          grams and personnel and accreditation and certification.
         ...Included in the accomplished documents of these Task Forces  are
          a compilation of the many accreditation  certification  and  licon-
          sure bodies involved in the allied heal@h  professions;  a  compila-
          tion ofexisting curricula  in  the  consortium;educational  institu-
          tions,'@questionhaires to survey health manpower needs.
          The San Fernando Valley Health Consortium  achieved  corporate  status
          September 16, 1971 and a 25-member Board  of  Directors  representing
          all community elements was elected.  Its major activities are
          directed toward organization and coordination of  existing  and  new
          health manpower training programs within various member institutions.
          This work is be ng carried out with Area IV and V  core  and  develop-
          mental component funds, $50,000 from the  Northeast  Vallev  Project
          and $5,000 contributed by participating hospitals.     xpansion  of
          the effort as an Area Health Education Center is pro(posed  as  part
          of an Area IV operational proposal submitted February, 1972@







                                                        California,  Area  IV

          Region:  California
          Locus of Activity: Core,  Developmental  Component,  and  proposed


          Project Title:  San Fernando Valley Health Consortium

          Status:  Ongoing
          Sponsorinq Institution:  California  Regional  Medical  Programs,
          Area I'v        nd San Fernando Valley State College
          Project Director, Title, Address:  Addie  Klotz,  M.D.,  Director
                                              San Fernando Valley Health
                                                Consortium, Inc.
                                              10401 Balboa Avenue
                                              Granada Hills, California  91344

          Dates:  June, 1970 to August, 1972
          Lundi@: $22,500,  1970;  $3,000,  6/71;  $25,000,.9/71;  $50,000,
          approved 1/72.
          other Funds:  $22,500 from San Fernando Valley State College,
          T5,-Ooo from participating hospitals and other institutions.
          Cooperating Agencies and Institutions:  Five major hospitals, two
          valley colleges, the Welfare and  Planning  Council,  Comprehensive
          Health Planning and representatives from Areas IV and  V  of  RMP.
          Area Served: San Fernando Valley  Consortium  Area:  San  Fernan  o
          Valley, Ant elope Valley, Simi Valley, Santa Monica, West Los
          Angeles and Ventura County.
          Target  oLulation:  Entire Consortium area population--approxim.ately
             0 000 people.
          Congressional Districts:  #13, Charles M. Teague (R); #20, H. Allen
          Tmi-th (R); lt22, James C. corman (D); #26, Thomas M. Rees,  (D):
          427, Barry M. Goldwater, Jr. (R); #28, Alphonzo Bell (R).
          Continuation after RMP Support  Withdrawn:  Project  results  will
          be used in SFV Health Consortium 0 erational  Project  to  develop
          core curricula for allied health personnel,  which  is  presently
          seeking Pd4P funding.
          Core Staff Contact: Nat Feder,  ACSW,  Assistant  Coordinator,  San
          Fernando Valley District, California  Regional  Medical  Programs.

          Date Pr pared:  February 12, 1972

          Drafted By:  Jackie Reinhardt



        z-  v)
           f

                                                     California, Area IV
                CONTINUED EDUCATION AND SER'@,TIC',-, DEVELOPMENT PROJECT
                            FOR EXTENDED CARE D'ACILITIES


           California which leads the nation in the number  of  licensed  nursing
           homeb--an estimated 1,271--does nor-, now require  its  administrators
           to meet continuing education requirements  or  to  be  licensed.  That
           ,will change in July, 1972, the effective date of a  Federal  direc-
           tive requiring all states to give li.censure examinations  or  forfeit
           matching payments un,@-er Medicare and Medicaid (Medi-Cal).
           This requirement and the interest expressed  by  nursing  home  pro-
           fessionals in increasing their knowledge and their  skills  led  to
           a three-day planning conference convened by CRDIP Areas IV and V
           in July, 1969. Several priority concerns emerged.,  among  them  the
           need for better interprofessional understanding toward the goal
           of improved patient care.
           The Continuing Educati,-n and Service Development Project  for  Exten-
           ded Care Facilities is one outgrowth of the  planning  session..  It
           is financed by a $62,280 operational grant  awarded  in  September,
           1971, more than two-and-a-half years after  the  planning  conference.
           Despite the long time lag, the project has been  able  to  generate
           much support from the nursing home profession.
           Thirty-five professionals serve on an ECF  steering  committee  and
           three subcommittees Cun,@er the direction of Hoyt Crider, who  also
                                --.-s@e0
           chaired the  planning   s.%i n         v   evelbped  the  curricula
           for a series of patient odre'and management courses which  admiiii..s-
           trator    d          rectors.bf--riursing services participate in toge-
           ther,                sponsibilities for coordinator and faculty,
           orientation, public  relations and enrollment, reporting an
           evaluation procedures.
           More than.300 nursing home administrators  and  directors  of  nursing
           services, @:many---of-, th-em---from,.the         are expected  to
           have completed one of the six courses by  August,  1972.  Instruc-
           tion is being offered in four counties--Los Angeles, Orange.,  Santa
           Barbard and Fresno.
           The course is recognized as an important educational tool  not  only
           for meeting the lic@nsure requirements, but for  extending  continu-
           ing education Opportunities to the nursing  home  professions.  Its
           focus on the development of an administrative-management  team  is
           unique since most educational programs segregate administrators
           and nurses, preventing them from benefiting from each other's
           experience.  It is expected that the refined curricula will be
           incorporated into          extension-type courses          by
           various colleges and universities in the Californiq region.







                                                           California,  Area   IV

           Region:    California

           Locus of Activity:  Operational Project
           Project  Title:  Continuing  Education  and  Service  Development  Pro-
           ject for Extended Care Facilities

           Status:  Ongoing
           Sponsoring  Institution:  Western  Center  for  Continuing   Education
           for Health Care Facilities, UCLA Extension
           Project Director, Title, Address:    Kelly Swaryck
                                                Project Coordinator
                                                Western Center
                                                University  of   California,
                                                   Extension
                                                Statewide Programs
                                                Los  Angeles,   California   90024

           Dates:  September 1, 1971 to August 31, 1974

           Funding:  $62,280.

           Other Funds:  -0-
           Cooperating  Agencies  and  Institutions:  American  Cancer   Society,
           Los Angeles County  Branch;  California  Association  of  Nursing
           Homes,-, California Association of Nursing Homes  for  the  Aged;
           California Regional Medical Programs, Areas IV, V and VII;
           California State Board of Nursing Education and Nursing Regis-
           tration,i California State  Department  of  Public  Health;  Geriatric/
           Extended Care Conference  Group  of  the  California  Nurses'  Associa-
           tion, Los Angeles County Chapter; Hospital Council of Southern
           California; Los  Angeles  County  Health  Department;  Los  Angeles
           County Medical  Association;  Los  Angeles  County  Heart  Association;
           Tuberculosis and Respiratory Disease Association of Los Angeles
           County.
           Target  Population:  Nursing  Home  Administrators  and   Directors
           of  Nursing  Services
               ressional  Districts:  Senators  Alan  Cranston  and  John  Tunney
                               i
           Continuation after RMP Support  Withdrawn:  At  the  end  of  the
           @67nt period it is expected  that  the  refined  curricula  would be
           incorporated into regular  extension  type  course  offerings  by
         ,-various colleges and universities in the Region.
           Core  Staff  Contact:  Al  Torribio,  MSW,  Associate  Coordinator,
           CRMP Area IV  tU-L@A)

           Date Prepared:  February 12, 1972

           Drafted by:  Jackie Reinhardt




        L, I V,)                                  California,  Area  iv   kuu@)





                        ORGAN PROCUREMENT AND TRANSPLANTATION PROJECT




           Since Harbor General  Hospitalts  participation  in  the  California
           Regional Kidney Disease Program in  September.,  1971,  the  number
           of cadaver kidneys it  has  procured  has  tripled.  This  increase
           is attributed to both a $40,000 RMP  grant  and  the  formation  of
           the Greater Los Angeles Belzer Preservation Service, a cooperative
           community effort affiliated with four medical schools., including
           UCLA.
           Harbor's Department  of Renal Transplantation used to work in
           ttcrisis" atmosphere associated largely  with  the  maximum  six
           hours in which a kidney could be safely preserved by freezing
           methods,  With the acquisition of two Belzer Preservation units.*
           one of them financed by RMP., that time has  been  extended  to  48
           and sometimes as long as 72 hours.  It has also relieved much
           of the stress connected with harvesting  the  organ.,  finding'.
           a suitable recipient  and successfully transplanting the ki neY at
           Harbor.or one of the  other  nine  kidney  transplant  centersf@
           which@'    uppiies cadaver kidneys.

           The.RMP funds, subcontracted through  Area  IV,  also  have  enabled
           the Harbor effort to add a second technician, special monitoring
           equipment and purchase a mobile  unit  which  speeds  the  harvested
           organs to waiting redip4@ents.as far away as San Francisco.
           This support has resulted in real strides in meeting the
           needs of end-stage kidney patients, according to Project Director
           Thomas Moore, M.D. Monitoring  can  be  done  with  more  precision
           because of the newly-acquired equipment which measures the osmolity,
           Ph, electrolytes oxygen  and  carbon  dioxide  composition  of  the
           fluid used in perfuming the  organ.  There  also  is  more  time
           for tissue typing to match the,,donor and the recipient and
           for the first time more thah.@Onor  can  be  serviced  at  once.
          'Additionally., Harbor is getting more kidneys of better
           quality.
           Another $30.,OOO approved by CRMP in Dedemb@r@ 1971, wil   1
           provide for a nurse or technician coordinator, relieving
           Dr. Moore of the record keeping and data,accumulation
           duties, and a transplant burgeon trainee,3boosting Harborls
           transplantation capability from 12 organs a year to ab many@as'loo
           by the end of 1972.






                                                     California, Area IV

              o@n:  California
           Locus of Activity:  CCRMP Core Activity
           Project Title:  Organ Procurement and Transplantation, California
           Regional Kidney Disease Program

           Status:  Ongoing
           Sponsoring Institution:  Harbor General Hospital
           Project Director, Title, Address:  Thomas Moore, M.D., Chief
                                              Dept. of Renal Transplantation
                                              Harbor General Hospital
                                              1000 West Carson Street
                                              Torrance,  California   90509
           Dates:  September 1., 1971 to August 31, 1974
           Funding_: $40,000 CCRMP Core Support (Awarded  September,  1971)
                     $30,000 CCRMP Core Support (Awarded February, 1972)
           Other Funds:   In-kind contributions of the Greater Los Angeles
           Belzer Preservation Service and the Southern  California  Kidney
           Foundation
           Cooperating Agencies and Institutions:  The Greater Los Angeles
           IFelzer-preservation Service and the southern California  Kidney
           Foundation
           Congressional Districts:  #17, Glenn M. Anderson (D)

           Area Served:  Southern California
           TarGet Population:  End-stage kidney patients in Southern California
           Continiiation after RMP Support Withdrawn:  S61f-supporting
           Core.Staff Contact:  Wadie Elaimy., Dr.P.H., Director of Research
           and 15evelopment@alifornia Regional Medical Programs, Area IV (UCLA)

           Date Prepared:  February 12,, 1972
           Drafted by:  Jackie Reinhardt




              t V)




                                                       California,  Area  IV



                            NURSING CAREER LADDER SERIES

              In May, 1971, a special task force of the San Luis  Obispo
              District Committee, California Regional Medical  Programs,
              was appointed to delineate the health problems in the District.
              One of the problems noted was the lack of opportunity  for
              upward mobility in the nursing field, especially  from  nursing
              or hospital attendant to licensed vocational nurse  to  R.N.--
              A.A. degree to R.N.--B.S. degree.
              In August, 1971, the San Luis Obispo District Committee
              received a core grant of $937.00 to carry out a feasibility
              study of such a ladder series system centered around Cuesta
              Community College, San Luis Obispo, a  junior  college.  The
              study was to determine interest in building a nurses ladder
              series including junior colleges, state colleges,  and  various
              nursing licensing agencies.
              The feasibility of such a career ladder series has been estab-
              lished with Cuesta Community College and Fresno  State  College
              providing the major ingredients.  Cuesta  Community  College
              has agreed to offer courses in nurse aides, licensed vocational
              nurse and registered nursei A.A. degree. It  is  planned  that
              the student could then transfer to Fresno State College without
              loss of credit to completed R.N. degree program.
              The program will provide the student with opportunity  for
              gainful employment at each level with the right to  return  for
              upward career mobility at a later date with no loss of academic
              credit. The program will eliminate "dead-end"  jobs  for  those
              individuals with capabilities for advancement.

              Nursing career candidates from low income, disadvantaged
              minority groups will be provided with a program that  will
              afford them an opportunity to be gainfully employed and
              the opportunity to continue training for better careers it the
              nursing field.
              To date, there has been superb response from  the  educational
              institutions and the various licensing agencies.

              miss Juanita Booth, R.N., M.S., Director of  Nursing  Program,
              Cuesta College, San Luis Obispo, is the Project  Director.
              A Nursing Career Ladder Series Committee has  been  responsible
              for the study.
              This small core grant of $937.00 coupled with  a  determined
              volunteer Regional Medical Programs committee membership
              generates considerable optimism for a ladder series in  nursing
              that is unique in the nursing education field and  one  that
              may be a national model.








                                                       California, Area IV

          Region:  California

          Locus of Activi@y:  Core Activity
          Project_Title:  Feasibility Study of a Nursing Career Ladder Series

          Status:  Ongoing
          Sponsoring Institution:  Nursing Career Ladder Series Committee,
          @h Luis Obispo District Committee
          Project Director, Title, Address:   Miss Juanita Booth, Director
                                              Nursing Department
                                              Cuesta College
                                              P.O. Box J
                                              San Luis Obispo, California  93401
                                              (805) 544-2943

          Dates:  September 1, 1971 to March  1, 1972

          Funding:  $937

          Other Funds:  In-kind contribution of $2,780


          Cooperating Agencies and Institutions:  Cuesta College, Fresno State
          Co@i:&ge, 1 censin'g agencies, UCLA ffchool of Nursing  Mt. St. Mary's
          School of Nursing, Bakersfield State College
          Area Served:  San Luis Obispo and Fresno Counties, California

          Target Population:  400,000 population
          Congressional District:  #12, Burt Talcott (R)
          Continuation after RMP Support Withdrawn:  To implement the curric-
          ulum, a developmental component grant proposal is being written.
          Core Staff Contact:  Victor Farrell, Assistant Coordinator, San
          Luis Obispo Distxl@ct, California Regional Medical Programs.

          Date Prepared:  February 12, 1972

          Drafted By:  Jackie Reinhardt




              (I VI)



                              ANEMIA SCREENING PROJECT
          In November, 1971, Guadalupe, a small. migrant farming  community
          with no hospital facilities and only one physician,  screened  592
          children for anemia. This ambitious effort was  made  possible  by
          the pooling of health and other community resources with its
          neighbor, Santa Maria, also in northern Santa Barbara County.
          With the help of the Santa Maria @IP Community Committee  and  $940
          in Area IV core funds, a two-day clinic was set up  in  Guadalupe's
          two elementary schools. In-kind contributions  totalled  more  than
          $5iOOO, representing services from  the  Santa  Maria  Hospital  Out-
          patient Clinic and private physicians acting as  referrals;  Blood
          Bank Volunteers, Visiting Nurse Association of Northern Santa
          Barbara County and the Santa  Barbara  County  Welfare  and  Health
          Department.
          Extensive outreach services attributed to the response of Guadalupe
          residents. Families  of  preschoolers  were  contacted  personally  by
          outreach workers from the Guadalupe Center  who  went  from  door  to
          door in this Spanish-speaking area.  Local school children channeled
          information to school children  and  obtained  consent  forms  from
          their parents.
          Although only preliminary results of  the  tests  are  available,  they
          support the concern of Santa Maria pediatricians who stimulated the
          Project. Using the copper sulfate  method,  63  percent  of  the  pro-
          schoolers' and 33 percent of  the  school  children's  tests  indicated
          an anemi6 condition (less than 12mg. hemoglobin).
          More than 125 of these youngsters  have  been  referred  to  physicians
          and.the Santa Maria clinic  for  follow-up  testing  and  treatment,
          with ut charger" 'as of  January,  1972.  Outreach  workers  currently
          are contacting parents of another  70  children  whom  records  show
          have not seen a physician.  Many  families  indicated  lack  of  trans-
          portation, financing and inability to  leave  their  work  as  reasons
          why they had not responded.  It  is  anticipated  that  these  efforts
         'Will be continued as part of  the  Nutrition  and  Health  Project  of
          the Guadalupe Community Council.
          RMP sponsors also sought  to  accomplish  several  other  objectives.
          One of them--the establishment  of  new  links  between  physicians
          in Santa Maria and Guadalupe children--is already measurable.
          Physicians report many of the  children  referred  from  the  Anemia
          Screening Project are new  atient8 or patients who       not   made
                                     p
          a visit for an extended period.
          Other objectives still  being  evaluated  include  determining  the
          motivational patterns of rural  farm  workers,  their  responses  to
          free cas6-finding services and  the  potential  for  anemia  screen-
          ing in other areas.







                                                      California, Area IV

          egi In@.  California
         Locus of ActiviLZ:  Core Activity
         Project Title:  Guadalupe Anemia Screening Project

         status:  Ongoing
         Sponsoring Institution:  Santa Maria Community Committee
         Project Director, Title, Address: James Handley, M.D.
                                           P.O. Box 1232
                                           Santa Maria, California  93454

         Dates:  September 1, 1971 to August 31, 1972

         Funding:  $940
         Other Funds:  $5,000 ih-kind contributions from the Santa Maria
         @s-pital Outpatient Pediatrics Clinic and private physicians.
         Cooperatinq Aqehcies and Institutions:  Santa Maria Hospital Out-
         @at-i-e-nt Pedial      id, Guadalupe Community Council, loca
         physicians.

         'Area Served:  Guadalupe

         Target Population:  592 children
         Cohgressional Districts:  #13, Charles M. Teague (R)
         Continuation after RMP Support Withdrawn:  Will be continued as
          art of the Nutrition and Health ProjecT of the Guadalupe Connun-
         ity Council.
         Core Staff Contact:  Victor Farrell, Assistant Coordinator,
         CaIifornid Regional Medical Programs, Area IV (UCLA)

         Date Prepared:  February 12, 1972
         Drafted@:  Jackie Reinhardt





                                                      Californias Area IV (UCLA)

                           MOBILE DENTAL CLINIC PROGRAM


           When school nurses in Ventura County were asked by the RMP  District
           Committee what they saw as the most pressing health problem  among
           school children, their response came back loud and  clear:  Bad
           Teeth!  It also triggered in June,$,@@1971,, a mobile dental clinic
           program spea@neaded by a"Joint RMP-CIIP Task Force in cooperation
           with UCLA and USC Dental Schools.
           More than 300 low-income elementary school children were screened and
           follow-up services provided by the student dental team as of Februaiyj
           1972,  The program, which expects to reach between 700 and 1,000
           youngsters the first year, has been financed totally by in-kind con-
           tributions from the RIIP
                      i-          , CI-IP., UCLA and USC Dental Schools., local
           school districts, Ventura County Health Department, Ventura County
           Community Council., Ventura Dental School and other civic organiza-
           tions.
           Santa Paula, t@ first of five communities to be visited, demonstrates
           the cooperation which has characterized this effort.  Arrangements
           for the five visits during June and July, 1971, were handled  by-a
           local community planning committee under the direction of Joe Bravo,
           Santa Paula School Superintendent. This group provided  the  follow-
           Ing:
                --Lodging for the student dental team at Fillmore  nursery
           school and St. Sebastian Church in Santa Paula
                --Preparation of meals for children and workers by the  Mexican
           American Civic Organization and several other local  organizations
                --Transportation for parents and children by policemen who
           volunteered to man school buses during off-duty hours
                --Follow-up services offered without charge by several  local
           dentists.
           In return 196 children from Santa Paula and neighboring  commun  es
           of Fillmore, Piru, Ojai and Saticoy received dental services  valued
           at more than $8,000, although it cost the communities  involved
           $2..750 or $13 a child.
           Several significant spin-offs also have occurred as a result of
           the mobile dental clinic program. Sixteen Ojai  dentists  screened
           47 children and treated some of them. They offered the  use  of
           their offices to the USC-UCLA team to treat 27 others.  Similar
           efforts are just beginning among Ventura dentists and school
           children.
           Although only midway through the first year, the mobile  dental
           clinic program anticipates continuing support. Already  16  dentists
           have committed their services for another 12 months.







                                                    Calif ornia, Area IV


             ion:  California

           Locus of ActivJ.ty:  Core
           Project Title:  Mobile Dental Clinic Program

           Status:  Ongoing
           Sponsoring Institution:  Joint Pd-4P-CIIP Task Force, Ventura
           District
           Project Director:  Norman H. Fortier, D.M.D.,
                             Ventura

           Dates:  June, 1971 to June, 1972
           Funding:  Core RMP staff, in-kind contributions

           Other Funds: -0-
           Cooperating Agencies and Institutions:  UCLA and USC Dental Schools,
           local school districts, Ventura Uounty Health Department, Ventura
           County Community Council, Ventura Dental Society and other civic
           organizations.
           Area Served:  Ventura County, including communities of Ventura,
           anta Paula, Oxnard., Simi Valley.
           Target Population:  1,000 low income elementary school children.
           Congressional Districts:  #13, Charles M. Teague (R)
           Continuation after RMP Support Withdraiin:  Although stimulated
           and coordinated by an RMP-CHP Joint Ta@k Force., this project is
           not dependent on financing from RMP.  UCLA and USC Dental Schools
           and Ventura County dentists have pledged their support for continued
           operation during a second year.
           Core Staff Contact: Dan Sullivan, District Coordinator, Ventura
           District of Area IV, CILNIP.

           Date Prepared: February 12, 1972

           Drafted by-. Jackie Reinhardt








                                                         California,  Area  IV



                       SANTA MARIA CONTINUITY OF CARE.PROGRAM


              A comprehensive Continuity of Care Program  for  a  rural-urban
              community with a population of 58,000 was initiated in September@
              1971, at Santa Maria, California.  This  prograiefunded  by  a
                                                  .,,from Cal
              $9,476 Developmental Component.Gra@            ifornia  Committee
              Regional Medical Programs  Services,provides  a  coordinating
              body in the community to furnish  consultative  services  to
              physicians or health institutions in order  to  foster  good
              discharge planning, continuity of care  and  referral  services.

              The program will help to reduce health care  costs  by  better
              utilization of health services in the community  and  at  the
              same time assur@@ the patient of continuous, adequate, approp-
              riate and efficient care. Quality of care  will  be  improved  by
              placement of the patient in a care plan  tailored  for  him
              as an individual.

              As a result of this grant all three  acute  general  hospitals
              now have full-time continuity  of  care  coordinators.  The
              project furnishes a community coordinator) and  secretarial  hel
                                                                             p
              to coordinate the entire program and to  work  directly  with
              patients in the physicians' offices and after  discharge,  from
              the acute units.

              The Santa Maria Community Committee  has'assurance  from  the
              Visiting Nu         ice o@,Vg
                         rse               Fthern Santa Barbara  County,  Inc.
              that                    support the program after  the  project
              funds are used.,
              ipecific need for                       among a large population
            i@ group of farmwbrkers' families with Spanish surnames)
              re          It@,l@ld@ren and the elderly,we.

              Most Continuity of Care  programs  h.ave been primarily  concerned
              with acute hospital discharge  planning.  Although  this  is
              a feature of this program, emphasis is  placed  on  continuity
              from the home situation, the physicians  office,  acute  hospital
              care, E.C.F. care, follow-up care and back  to  home  care.
              The referral for assistance may occur anywhere  in  the  chain.

              The project is officed with the Visiting  Nurse  Service  of
              Northern Santa Barbara County,  Inc.  Other  agencies  involved
              are Santa Barbara County Welfare  Department,  Community  Action
              Committee, O.E.O., in Guadalupe and Santa  Maria,  the  Santa
              Maria Academy of Medicine, a local  physicians  group,  throe
              acute general hospitals, a representative  from  the  local
              E.C.F.'s and the Santa Barbara  County  Health  Department.







                                                       California, Area  IV

          Region:  California

          Locus of Activity:  Developmental Component
          Project Title: Proposal to Develop a Continuity of  Care  System,
          Santa Maria-Gaudalupe Area

          Status:  Ongoing
          Sponsoring Institution: Visiting Nurse Service of  Northern  Santa
          Bar ara County, Inc.
          Project Director, Title, Address: Mrs. Catherine  Carey,  Director
                                             Visiting Nurse Service of Northern
                                               Santa Barbara County, Inc.
                                             1035 W. Main Street
                                             Santa Maria,  California  93454
                                              80 5) 9 22-1 4 4 8

          Dates:  October 1, 1971 to March 31, 1972

          Funding:  $9,476
          Other Funds:  IN-kind contributions of $13,800
          Cooperating Agencies and Institutions:  Marian Hospital; Santa
          War-ia Hospital; Valley Community Hospital; Visiting Nurse Service
          of Northern Santa Barbara County, Inc., Santa Maria office of  the
          Santa Barbara County Department of Welfare Services; Mr.  Charles
          Rivas, Director, Guadalupe Service Center, Community Action  Com-
          mission; Santa Maria Academy of Medicine; Santa Barbara County
          Health Department.
          Area Served:  Santa Maria-Guadalupe, California
          Target Population:  57,842 people, 15% with Spanish surnames
          Congressional District:  #13, Charles M. Teague (R)
          Continuation after RMP SuP2ort Withdrawn:  Visiting Nurse  Service
          of Northern Santa Barbara County, Inc.
          Cote Staff Contact:  Victor Farrell, Assistant Coord3nator,.San
          Luis Obispo District, California Regional Medical Programs.
          Date Prepared:  February 12, 1972
          Drafted@:  Jackie Reinhardt





    AL                                                 California, Area  IV



                             CANCER CHEMOTHEIRAPY FORUM

             Late in 1970 and early in 1971 the Continuing  Education  Sub-
             committee of the San Luis Obispo District finalized  plans  to
             present a series of educational sessions for physicians concerning
             cancer, diagnosis and treatment, especially in the  area  of
             chemotherapeutic agents.  A survey revealed that 75 - 100
             physicians would be interested in such  a  series.  Interest
             in physicians' on-going education in the local area is
             unusually high since the closest medical center is over 200
             miles distant.

             it was the intent of the Cancer Forum to reduce the morbidity and
             mortality of cancer in the area by providing the area physicians
             with additional education and training in the  cancer  area.
             The Regional Medical Programs committee felt that the cost and
             inconvenience to patients could be reduced if the  patient  was
             treated locally and not referred 100 to 200 miles away.

             A $1,000 core grant was received from Area IV@early in 1971
             to help finance the series.  A  close,cooperative  arrangement
             between the local American Cancer Society and  the  District
             Regional Medical Programs resulted in the California Division,
             American Cancer Society, granting an additional $1,250  to  the
             program.  These funds and a required registration fee for each
             physician has already funded four sessions, two-mo@e are
                     scheduled and                      funds available  for
             at least six more )sessions.

             Sessions are held on Saturdays and each session is led  by  an
             authority in a particular area of cancer.  Subjects have ranged
             from a general overview of cancer treatment to  a  scheduled
             session on the problems a physician encounters with  the  dying
             patient, their family and friends.  Each session enrolls
             25 to 30 physicians.          @-f irrer-
             The cancer p           @is district will receive direct
             benefits             acaltional expertise being acquired  by
             approximately 50 to  75 physicians in the diagnosis and  treat-
             ment of cancer.








                                                     California, Area IV

         Region:  California
         Locus of ActiviLy:  Core Activity

         Project Title:  Cancer Chemotherapy Forum

         Status:  Ongoing
         Sponsoring Institution:  Continuing Education Subcommittee, San
         @ui-s Obispo D-i-stiF!ct-, W.IP Area IV; local and California division,
         American Cancer Chemotherapy Forum.

             ect Director, Title, Address: Eugene Juel, M.D.
                                            148 Casa Street
                                            San Luis Obispo, California 93401
                                            (805) 543-8310

         Dates: May 1, 1971 to September 1, 1972

                   $ 1, 0 00
         Other Funds: $1,250 from the California Division, American Cancer
         @ociety.
                                            ns: Continuing Education Sub-
                                             alifornia Division, San Luis
         Obispo Branch, American Cancer So iety, Sierra Vista Hospital,
         San Luis Obispo, Consultant: Justin J. Stein, M.D., Professor of
         Radiology, UCLA Center for the Health Sciences, Department of
         Radiology, Los Angeles.
         Area Served: Northern Santa Barbara County and County of San Luis
         Obispo, California
        'Target Population: 300 physicians
             ressional District: #12, Burt Talcott (R)
         Continuation after RMP Support Withdrawn: Cancer Forums will not
          ontinue, however, this series has already created interest in
         other physician educational programs by Regional Medical Programs,
         San Luis Obispo County Medical Society and interested private
         physicians.
         Core Staff Contact: Victor Farrell, Assistant Coordinator, San
         Luis Obispo Distr@ict of California Regional Medical Programs.
         Date Prepared: February 12, 1972

         Drafted Bv: Jackie Reinhardt



          L                                                California,  Area   IV
                       PEBIATRIC NURSE PRACTI'PIONER PitOT PROGRAM

           Since 1953 @.7he-ri the first       child  health  conferences  were
           developed in California, interest  in  and  recognition  of  the  expan-
           ded role of the nurse in  pediatrics  has  continued  to  grow.  Today
           nurses from many different sett.ings--child health clinics, hospital
           outpatient departments and private i.)Iiysician's offices--are
                   ideal candidates for pediatric nurse practitioners.

           Opportunities for training in this extended role, however, have not
           kept up with the desire or ability  of  nurses  to  function  in  this
           capacity or with the need  for  their  services  in  pediatric  practices.
           Most preparation has  been  through  inservice  education  primarily
           associated with  public  agencies.  only  recently  have  academic  insti-
           tuti-ons begun to realize a continuing responsibility in nurse
           education.

           Three universities in California  currently  offer  or  will  soon  be
           initiating training for R.N.s wanting  to  expand  t  eir  ro  es.  To
           enroll in these courses, nurses must either take a leave of absence
           from their jobs or resign altogether.

           The need for other alternatives led in  October,  1970,  to  the  for-
           mation of the Southern California Pediatric Nurse Practitioner
           Advisory Committee  composed  of  representatives,  including  PNPS,  from
           35 agencies, hospitals and other institutions.  Through subcommittees
           and task forces, they investigated current course offerings, developed
           a curriculum for a short-term  course  and  methods  of  evaluation.
           Area IV provided staff  assistance,  classroom  space  and  core  funds,
           although the effo.rt was carried out largely  on  a  volunteer  basis.

           sixteen enrollees were accepted  for  the  seven  month  course  which
           started May@1971, in cooperation with UCLA Extension and the
           School of Ifursing. It included  one  month  of  intensive  training
           and a six"month  preceptorship  in  the  nurses'  own  agencies.  Each
           enrollee was,employed in  ambulatory  child  care  settings  and  recom-
           mended by      employer who @     agreed to allow  her  to  utilize  her
           new skills during and upon completion of the preceptorship.

           Some tentative conclusions have  been  drawn  from  the  testing,  oval-
           uation and observations to date:

           1.  The format of the curriculum,  one  month  of  intensive  training
               followed by a six  month  internship  is  workable.  However,  the
               first month should be extended  to  six  weeks  for  inclusion  of
               mote clinical and didactic instruction and              more  time
               for independent study.

           2.  Students found the  instruction  by  so  many  volunteer  teachers
               and proctors fragmented,  therefore  full  and  part-time  faculty
               are needed.

           3.  Even the student who  is  still  in  training
               worth for she is able to take  on  new  tasks  formerly  carried
               ou  b
                 t y physicians.
                  C;i
                                                     tp    -L-,o
                                      eing incorpora       c  @both  a  developmental
                 modifications":are b
           component  and  operational  grant   proposed)40P  tinuati'on of  this
           program.




                                                              ea IV (UCLA)
                                                California, Ar




           Region: California
           Locus of Activity: Area IV core funds
           Project Title:  Pediatric Nurse Practitioner Pilot Program

           Status: Ongoing
           Sponsoring Institution: Southern California  Pediatric  Nurse
           Practitioner Advisory Committee
           Project Director, Title, Address:    Joseph St. Geme., Jr.., M.D. chief
                                                Department of Pediatrics
                                                Harbor General  Hospital
                                                1000 West Carson St.
                                                Torrance, California
                                                Bonnie Bulloughp R.N., Ph.D.
                                                Assistant Professor
                                                UCLA School of Nursing
                                                Los Angeles,  California

           Dates: February, 1971 to December, 1971


           Fundin : $1.,OOO Area IV core funds
                 9  In-kind contributions of more than $ii,ooo

           Other Funding: none
           Cooperating Agencies and Institutions:  UCLA.Extension, UCLA
           School of Nursing, USC Medical Center,  California  Pediatric
           Center., Children and Youth Project, California State Department
           of Public Health, Southern California Permanente Medical Group,
           Read Start Program, Orthopaedic Hospitalo California Nurses,
           Association, Pediatrics Outpatient Department, UCLA Medical Center-,
           South Central Multipurpose Health Services Center, Children's
          'Hospital, Charles Drew Postgraduate Medical School, Martin Luther
           King Jr. General Hospital, Los Angeles City Schools, Los Angeles
           County Health Department, East Los Angeles Child and Youth Clinic,
           Harbor General Hospital, and Regional Medical Programs., Area IV.
           Congressional Districts:  Honorable Alan Cranston  D)
                                      Honorable John Tunney    @D)
           Continuation after RMP Support Withdrawn:    Incorporation into
           nursing curriculum offered by UCLA Fxtension or School of Nursing
           Core Staff Contact:  Sheila Cadman, R.N., assistant coordinator
           for nursing and allied health,, California Regional Medical Programs,,
           Area IV ('UdLA).
           Date Prepared: February 14, 1972

           Drafted by Jackie Reinhardt







                                  CALIFORNIA REGIONAL MEDICAL PROGRAMS                     AREA V
                                  1 WEST BAY STATE STREET 0 ALHAMBRA, CALIFORNIA 0 91801 (213) 576-1626
                                               P. 0. BOX 1390 o ALHAMBRA, CAUFORNIA gItM-
                                  UNIVERSITY OF SOUTHERN CALIFORNIA  9  SCHOOL OF MEDICINE
                       PI                                    September 6, 1972




                      Ms. Dorothy M4 Bailey
                      Writer
                      Office of Communications
                      and Public  Information
                      Department of Health, Education, and Welfare
                      Public Health Service
                      Health Services and Mental Health Administration
                      Rockville, Maryland      20852

                      Dear Ms. Bailey:

                      I am enclosing vignettes, as requested in your letter of
                      August 3, for the Pacemaker Registry and Information Center,
                      SEARCH:  A Link to Services, Comprehensive Stroke Care and
                      The American Indian Free Clinic in Compton, as we          as some
                      information on The Coordination of Free Clinics.

                      We think the publication of selected vignettes is a great idea
                      and hope that at least one of our programs might be represented
                      in the next revision.

                      Please contact me if any additional material is needed.

                      Si



                      (Mrs.) Elsie M.  McGuff
                      Communications Coordinator


                      McG:cc
                      Enclosures











                 HEALTH CARE FOR OLDER RESIDENTS OF A BMIO


                 Older citizens of an inner-city barrio are the particular target of

                 an exploratory one-year program funded by Area V of California

                 Regional Medical Programs.


                 The goal of the project is to investigate the feasibility of an

                 ambulatory,,total follow-up health care clinic for senior citizens.

                 Data is being collected and solutions sought to such needs as

                 specific health problems, transportation, special problems that

                 influence or affect the health of the aging, and the nee  an

                 utilization of different types of hme care services.


                 To qualify, the patient must be-over 50 years of age,  ambulatory,

                 a resident of East Los Angeles or Northeast Public Health Districts,

                 willing to return for specialty clinics for a period of one  year,

                 and cooperative about completing questionnaires.  A thousand cases,
                 selected randomly, have been screened and are being followed by  a

                 case-manager-total-follow-up approach. The citizens who  were  not

                 selected after screening are referred to appropriate agencies.


                 The test project is conducted from two trailers parked on a vacant

                 lot near the local public health department building.  Community

                 interest is such that the senior citizens volunteered to care  for

                 the grounds and landscaping on which the trailers are situated.


                 The project is carried on by contract with the Los Angeles  County

                 Health Department.






           Rii:(;I.ON:  CALIFORNIA REGIONAL MEDICAL           AREA V
            NAtff,,' OF PROJECT:  older Residents Integrated Health Care Program
           LOCUS OF ACTIVITY: (circle one) :.C-,o,re_AP-tiyity
                                               Operational Project
                                               Developinental Component Project
           STATUS:  (circle one)  Ongoing        @'t-ompleted'-')  Just beginning


           SPONSORING INSTITUTION;             Contract with Los Angeles County Health Department


           PROJECT DIRECTOR, TITLE,            Jane Shields, M.D.
           Al)ljlcESS:                         District  Health  Officer
                                               East Los  Angeles  Health District
                                               670 South  Ferris  Avenue
                                               Los  Angeles,  California 90022
           DATES: (indicate beginning date and date     of completion, if finished)
                   August, 1970 (did not actually get underway until June,1971-June, 1972)

           FUNDING  PERIODS  AND  AMOUNTS:   (01   $402000



           OTHER FUNDS, if any:


           COOPERATING AGENCIES AND INSTITUTIONS:        Los Angeles County Heart Association  and
                                                         East Los Angeles Health Task Force




           AREA SERVED:                        East Los Angeles Health District and
                                               Northeast Los Angeles Health District.


           'rARGET POPULATION:                 Residents of area over 50 years of age (ambulatory).



           CONGRESSIONAL DISTRICTS:          #19 (Chet Holifield (D) and #30 (Edward R. Roybal (D)
                                                         Covering part of Los Angeles County


           CONTINUATION AFTER RMP SUPPORT CONCLUDES:  Los Angeles County Health Department



           CORE STAFF CONTACT:    Miss Teresita Moreno, M.S.W.
                                  Assistant    Coordinator
           DATE PREPARED:         August 29, 1972




                                        Pro   ect   Information   Sheet


             l@ii@(.I()N:  (;A],[.FoIMIA REGIONAL MEDICAL PROGRAMS,   AREA V
              NAME OF PROJECT:Stroke Rehabilitation Liaison           Nurse Program
             LOCUS  OF   ACTIVITYI   (circle   one)(   Core   Activity)
                                                     Operational Project
                                                     Developmental Component Project

             STATUSO.   (circle  one)( ongoing)          Completed          Just beginning


             .@Po@i,<;ORIN('y INSTITUTION: California Regional Medical Programs, Area V


             PROJECT DIRECTOR, TITLE,      Robert   H.   Pudenz,   M.D.
             ADDRESS:                      Special Advisor, Stroke and Related Diseases
                                           1 West Bay State Street
                                           P. 0. Box 1390
                                           Alhambra, California 91802
             DATES: (indicate beginning date and date of completion$ if finished)

                                           January 1970

             FUNDING PERIODS AND AMOUNTS:   (01



             OTHER FUNDS, if 6ny:Short-term traineeship for two nurses for a Rehabilitation
                                     Workshop Services in kind from L. A. County - USC medical & nursing
                                     staff & Huntington Memorial Hospital medical & nursing staff
             ('O()TIERATING AGENCIES AND INSTITUTIONS: L. A. County - USC Medical Center, Huntington
              Memorial Hospital, Rancho Los Amigos Hospital., Casa Colina Rehabilitation Hospital,
              Community Hospital of San Gabriel, Midway Hospital, Intercormnunity Hospital iLli Covinl,
              Presbyterian Inter-Community Hospital, St. Joseph Hospital, St. Francis of Lynwood


             Alit@A: SERVI@D:

                                           Area V


             'i.@AR(ir,,i, POPULATION:     Stroke victims in acute care hospitals



             (,()NGR.I@'SSIONAL DISTRICTS: 13-17-19-20-21-22-23-24-25-26-27-2 -2 -30-3 -32-34



             (@ONI',INUATTON AFTER RNP SUPPORT CONCLUDES: Major support presently provided by
                                                                community.  Regional Medical Programs acts
                                                                primarily as organizer and conve er o
                                                                existing resources
                   STAFF CONTACT:  Kay D. Fuller, R.N.
             DATE PREPARED:          August 28, 1972












                             STROKE REHABILITATION LIAISON NURSE PROGRAM


                 Over three years ago, the Area V Stroke Committee identified  ear  y

            r,(@llabi'iitation and continuity of care following acute hospitalization as

            primary problems involving the management of stroke patients.  To improve

            direct patient care in these two problem areas, a  Stroke  Rehabilitation

            Liaison Nurse Program was developed by Area V staff, based on  a  similar

            and very successful program at Memorial Hospital,and Medical  Center  of

            Long Beach.

                 The concept involves training a Stroke Liaison Nurse to  initiate  a

            specific stroke management program in the acute  hospital,  This  nurse,
            after evaluating the newly admitted stroke patient, works  closely  with

            the Attending physician and nursing staff developing the overall patient
            care plan for that particular patient.  This patient care plan subsequently

            involves others on the multi-disciplinary "stroke team" such as physical

            and occupational therapy, social service, etc.
                 Another phase of the program has the Stroke Liaison  Nurse  working
            closely with the patient's family and agency-institutions outside the hospital,
            in anticipation of discharge from the acute  hospital.  Training,  consultation

            and coordination of services for extended care facilities and home health

            agencies fill out the role of the stroke nurse.
                 Totally.through an Area V core effort (no operational funding was involved),

            and working with and utilizing community resources, six Stroke Rehabi  itat  on
            Liaison Nurae,s(representing a total of 1700 acute beds) have now completed

            A comprehensive seven-week didactic and clinical course.  This  stroke  program
            has since been well established in each of the participating hospitals and


                                                                         Page I of 2  Pages







            the Area V.1'stroke team," composed of core staff members, is presently

            developing strategy for expanding the program into six more acute hospitals

            during the remaining months of 1972.

                 Qu@irterly "Stroke Seminars" have been initiated providing an oppor-
            tunity for the Liaison Nurses and Area V Stroke Team to meet for the

            purpose of information and program exchange.










































                                                                         Page 2 of 2 Pages




                                   Project Information Sheet

           REGION:  CALIFORNIA REGIONAL MEDICAL PROGRAMS, AREA V
            NAME OF PROJECT:  SEARCH:  A LINK TO SERVICES
           LOCUS-OF ACTIVITY: (circle one) (Core Activity
                                              Operational Project
                                              Developmental Component Project
           STATUS:  (circle one)(        ng)     Completed        Just beginning

           SPOINSORING INSTITUTION:    USC School of Medicine


           PROJECT DIRECTOR, TITLE,    joy G. Cauffman, Ph.D., Principal Investigator
           ADDRESS:
                     University of Southern California School of Medicine
                     2025 Zonal Avenue
                     Los Angeles, California 90033
           DATES: (indicate beginning date and date of completion, if finished)


           FUNDING PERIODS AND AMOUNTS:  (01 - $              Area V participated in the planning
                                                              and contributed a small amount of
                                                              funding in the 01 year and continues
           OTHER FUNDS, if any:                               to contribute staff expertise.
                     Department of Health, Education,and Welfare, Public Health S6rvice,
                     National Center for Health Services Research and Development
           COOPERATING AGENCIES AND INSTITUTIONS:


                                         See enclosed brochure




           AREA SERVED:


                                         Los Angeles County

           TARGET POPULATION:
                                         People seeking health and related services
                                         in Los Angeles County
           CONGRESSIONAL DISTRICTS:      13-17-19-20-21-22-23-24-25-26-27-28-29-30-31-32-34



           CONTINUATION AFTER RMP SUPPORT CONCLUDES:



           CORE STAFF CONTACT:           Mrs. Kay D. Fuller, R.N.'    (.213) 576-1626

           DATE PREPARED:                August 30, 1972









                                      SEARCH:  A LINK TO SERVICES



           As one of the largest metropolitan areas within the United States,  Los  Angeles

           County is in serious need of a comprehensive and efficient system  for  providing

           @heal,th information and referral services.  In an effort to alleviate this situation,

           SEARCH: A Link to Services, at the University of Southern  California  School  of

           Medicine, has been developing a computerized information and referral system.

           Assisted by Area V since its developmental phase, and funded by a  grant  from

           the US Public Health Service, the SEARCH system is designed to  match  persons

           seeking medical and/or social assistance with individuals or  agencies  providing

           such services.


           A study of referral patterns in the County was carried out with  several  objec-

           tives: To implement a system for classification of  consumer  health  problems

           and services; to develop an effective method for tracking  customers  referred

           for health care; to construct a feasible model for measuring the  outcome  for

           referral; to evaluate the significance of variables associated  with  the.outcome

           of referral.


           After surveying all health information and referral services within  Los  Angeles

           County, the project has specifically identified the characteristics  of  existing

           services, has determined their compatibility, and has explored  the  feasibility

           of linking these services into one computerized health services data system  for-

           the County.


           In the period from 1972 to 1975, the project will endeavor to  establish  health

           counselling and referral centers, sponsored by SEARCH, and located within

           existing facilities of cooperating organizations.  Within these centers,

           computer terminal devices will be provided as a tool for health workers to






          use in linking consumers with providers of care.  These terminal devices will
          be connected to a central time-sharing computer facility via telephone lines,.
          At the central computer facility, a data bank will be maintained which contains
          a comprehensive description of medical and social services within the County.
          When center personnel counsel consumers, they will query the bank for information
          to assist them in directing consumers to services tailored to meet their indi-
          vidual needs.  It is expected that such a system will enhance the referral
          process, thereby enabling more consumers who have health problems and need

          help to reach appropriate sources of health care.





                                                                                                                      L
                                           Project      Information      Sheet

              Rl,,(;ION:   (,ALIFORNIA REGIONAL MEDICAL PROGRAMS, AREA V
               NAME OF PROJECT:   PACEMAKER
              I,OCUS    OF    ACTIVITY:    (circle    one)    Core    Activity
                                                         (.Operational Project)
                                                           Developmental Component Project

              S'J'Al.'US:   (circle one)  (Ongoing)            Completed             Just beginning


                             INSTITUTION:   USC School of Medicine


              lll@O,fECT DIRECTOR, TITLE,  Michael Bilitch, M.D., Project Director
              ADDRESS:                            Los Angeles County - USC Medical Center
                                                  1200 North State Street, Room 6131
                                                  Los Angeles, Cal,@f.forn@i.n 90033

              I)A'I'I',S:  (indicate beginning date and date of completion, if finished)
                                                  May 1,  1970

              J,'tTNI)ING PERIODS AND AMOUNTS:   (01 - $ 48,530
                                                       (02  -   $   67,458   )
                                                       (03  -   $   88,676   )

              OTIIT;,',R FUNDS,  if any:  -0-


              ('O()Ill-i,RATING AGENCIES AND INSTITUTIONS: Hospitals in California Regional Medical Programs
                                                                   Arbas IV, V, VIII, Pacemaker Clinics,  ftiiieral.
                                                                   ltoiyie directors, County Coroner's off@i.c(,



              Alll,',A SERVED:                    Los Angeles County, San Bernardino County, Orange County,
                                                  Ventura County,  Kern County, Santa Barbara County


              'I'Ai?(;P','r POPULATION.,          Patients with Pacemakers


              ('t)N(;]@l;',.r)S@l'ONAL DISTRICTS: 13-17-19-20-21-22-23-24"25-26-28-29-30-31-32-34...24-33-
                                                  38... 25-32-34-35...  13...18-27... 13


              ('()],i'[']'NIJA'I'ION AFTER RMP SUPPORT CONCLUDES:       integration into the Los Angeles County
                                                                        automated data bank.         Available on a
                                                                        subscription basis to physicians and
                                                                        pacemaker manufacturers.
                             CONTACT:             Kay D. Fuller, R.N.
              I)A@l,'E PREPARED:                  August 28,  1972








                              THE PACEMAKER  RE@GISTRY AliD INFORMATIOli CEIITER


            This project, which became operational in May,  1970,  has  four  major  objectives.
            The first of these is to register patients with pacemakers, @ as of August 31,

            1972, 970 patients with pacemakers have been identified.  Of these, 280 are
            fully registered and are actively followed by the Registry.  The remainder ate
            patients who are actively followed by various  pacemaker  clinics  or  whose  physi-

            cians, for one reason or another, do not  wish  full  registry  services.  In

            preparation for an on-line computerized  pacemaker  status  and  clinical  data
            system linked with the Los Angeles County/University of Southern California

            Medical Center computer service, the Registry's  data  collection  forms  are
            now being used by an additional pacemaker clinic  serving  120  patients  in  the
            area. The Registry is  currently  exploring  alternatives  for  following  patients'

            progress, utilizing a remote  data  collection  device.  Several  devices  have
            been developed making it possible to  receive  and  record  pacemaker  interval
            data via telephone lines.  Follow-up  transmission  has  proven  effective  and

            demonstrates economy of time and money for the patient, physician, and medical

            facility.                                  evices and--by- t-@.-mean,&"         ntly
                                     t@ three such d                              are   curre

            follow@   96 patients.


            The recovery of pacemakers is  another ob ective of  the  project.  To  date,

            some 850 pacemakers have been  recovered, of which over  half  are  recovered
            on replacement, the remainder  being acquired  post  mortem.  The  recovery  program

            is proving a valuable asset in determination  of  the  reliability  and  validity

            of pacemaker function.


            The project also acts as an information center  concerning  the  use  and  functions
            of pacemakers.  This  aspect of the project became fully operational in February,



            Pacemaker - Area V California RMP                              Page I of  2 pages






           1971 and since then, more than 80 consultations have been provided.  The
           Registry format for patient follow-up is being used as a model by physicians
           And others in establishing pacemaker clinics both nationally and internationally.


           Professional education in the use and functions of pacemakers is a fourth 6bjec-
           tiv(i of the.projecto  A special exhibit displays the various kinds of pacemakers
           And describes their uses and parameters.  An easily read, quick reference chart,
           which can be displayed on the walls in emergency and critical care rooms, is
           distributed to health care facilities in Southern California to aid the
           clinician to correctly identify pacemaker function.and malfunction in light of

           pertinent clinical evidence.

           over-100 physicians responsible for the care of patients from whom pacemakers
           have been recovered have been interviewed to assist in correlating clinical
           information with that acquired from the recovered units.  Records are also
           maintained concerning how physicians feel about pacemakers, And about the care
           of those patients who have permanent pacemakers.  A survey of 315 hospitals
           disclosed 130 where permanent pacemakers ate implanted, and a record is kept

           on which physicians are involved.


           Other educational efforts have been the presentation of lectures and seminars
           throughout the country, and several papers presented at local and international
           meetings by the Project Director.  A one-day pacemaker course held in June,
           1971 is to be repeated in June, 1073.








           Pacemaker   Area V California RMP                           Page 2 of 2 pages





                                FKUJEUT iNFU @ TION SHEET

          REGION:  CALIFORNIA REGIONAL MEDICAL PROGRAMS, AREA V
           NAME OF PROJECT:    Coordination of Free Clinics
          LOCUS OF ACTIVITY: (circle one)  Core Activity
                                                  ional.-Px@t.,
                                                  pmental Component Projec
          STATUS:  (circle one)                Completed       Just beginning


          SPONSORING INSTITUTION:   Southern California Council of Free Clinics



          PROJECT DIRECTOR, TITLE,    Michael Wood, Director
          ADDRESS:                    3493 Cahuenga Boulevard, #3
                                      Los Angeles, California 90028


          DATES: (indicate beginning date and date of completion, if finished)
                         December 15, 1971


          FUNDING PERIODS AND AMOUNTS:  (01 - $27,400



          OTHER FUNDS, if any:


          COOPERATING AGENCIES AND INSTITUTIONS:   Los Angeles County Health Department,
                                                   Los Angeles Regional Family Council
                                                   Childrens Hospital of Los Angeles




          AREA.SERVED:     Southern California




          TARGET POPULATION:    Aliented youth and families who for geographic, ethnic,
                                or financial reasons have failed to connect with established
                                health  facilities.

          CONGRESSIONAL DISTRICTS: 11-19-20-21-22-23-24-25-26-27-28-29-30-31-32-34 ... 25-32-34-
                                  35...35-36-37... 24-33-38... 38...13



          CONTINUATION AFTER RMP SUPPORT CONCLUDES:




          CORE STAFF CONTACT:        Mrs. Jane Z. Cohen
                                     Assistant Coordinator
          DATE PREPARED:             August 23, 1972












                                 SOUTHERN CALIFORNIA COUNCIL OF FREE CLINICS


                 The  success of the free clinic movement in serving alienated youth,

            and families.who for geographic, ethnic or financial reasons have failed

            to connect with established health facilities  has  been  attributed  to  their
            approach -'Wlv@ combines an atmosphere which lends itself to treating
            the patient instead of the symptom, a lack of intensive screening       personal,

            financial or residentia     and as non-judgmental a climate As is humanly

            possible;  total community involvement on all levels of operation'. with
            both professional and paraprofessional staff composed entirely of volunteers.

                 Although initial programs dealt  largely  with  crisis  intervention,  the

            services of the clinics have been expanded to meet the health care needs of
            their   communitIies more comprehensively and now offer medical and 8ental

            treatment, family planning and prenatal  classes,  legal  and  draft  counseling,

            psychiatric counseling, and pregnancy and abortion counseling.

                 The Southern California Council of Free Clinics was established in

            August, 1970 with representation from each free clinic in Southern California.
            Ideas discussed by Council members Are directed back to each clinics' Board

            of Diredtors, composed of representatives from  the  community,  thus,  a  direct

            line is created between the users and the  providers  of  free  clinic  services.

            The Council meets regularly once a month; the Executive Committee once a

            week, and committees as necessary.  An Advisory Board has been formed and
            began meeting in October, 1971.  Bi-month     clinic   schedules   arepublished

            and a small central office  is  maintained.  A  developmental  component  grant

                         to the Southern California Council,i                  .  Its activities


                                                                              Page 1 of 2 Pages








            in defining, evaluating and improving the quality  of  care  delivered  by  free
            clinics have, thus far, proved very successful.  The Council now has a standing

            committee on Quality Standards as one result of progress on the developmental

            component.
                 A grant proposal submitted by Area V has been approved, but remains unfunded
            at the present time.  It proposes: To develop the ability of Southern California

            Council of Free Clinics to maintain itself;  to  protect  the  individuality  of

            each free clinic; to be sure the Southern California Council reflects the

            clinical needs; to help each free clinic maximize  its  range  of  services  and

            use of resources; to enhance the maintenance of free clinics financially and

            through support of volunteers  and voluntary health agencies.

                                                                                       --all
                 There are now over 50 Free Clinics throughout Southern California

            private, non-profit corporations directed and operated by the people who use
            them.  The free clinics in Los Angeles County alone recorded 450,006 patient

            visits in 1971.




























                                                                               Page 2 of 2 Pages.







                                                                            .  -,Barlow/
                                                                            joimson
                                                                              Advertising  and
                                                                              Public Re!-ations
                                                                              Syracuse   Albany




                          June 15, 1972



                          Ms. Patricia Q. Schoeni
                          Dept. of Health, Education and
                            Welfare
                          Health Services and Mental Health
                            Administration
                          Rockville, Maryland  20852

                          Dear Pat:

                          At long last -- some Central New York vignettes'.
                          And there's more to come.

                          As you know, this has been a chaotic time for
                          CNYRMP and it  has taken this long to get some
                          of the specifics from the projects for use in the
                          vignettes.

                          I look forward to seeing you in Boston.

                          Sincerely,


                                 'O
                          (Mrs .) S    ra M, Anglund
                          Vice Pre  den  t   or Public Relations

                          SMA/nam

                          Enclosures

                          P.S.:  Here's an advance of the Utica Sunday supplement
                          with a good RMP story.










  117 Highbridge Street, Fayetteville, N.Y. 13066  315/637-9895

















                        GENERALIST  NURSE  PRACTITIONER  TRAINING   PROGRAM



                            Twenty-seven  area  nurses  are  currently   being
                       trained as generalist nurse practitioners in a
                       program representing a new concept in health
                       delivery, sponsored by the Central New York Regional
                       Medical Program.  Of  the  nurses  in  the  programr
                       25 are from agencies  serving  the  rural  and  urban
                       medically disadvantaged.

                            Under  this  project,  nurses  from  hospitals,
                       health  agencies  and  doctors'offices   participate
                       in an intensive seven-month educational program,.,
                       learning  to  provide  primary  medical  care.  Nurse
                       practitioners work under a phy8ician's direction,
                       but on  their  own,  handling  common  health  services
                       and thereby  expanding  the  care  delivery  po  ent3al
                       of the physician.
                            It i6 estimated that if,        nurse   practit-
                       ioner can save a physician from seeing 16-20
                       patient.q,,,,,with common medical problems each week-
                       day,       physicia@ would have one,t,,,,r
                       al..half more weekdays available for-Palcou'@6le-anq@-0
                       lems,@%@continuinq education, etc.

                            Many of  the  people  currently  being  treated
                       by the  nurse  practitioners  are  elderly  individ-
                       uals and others  who  would  otherwise  not  receive
                       continuing medical care.







         REGION:  Central New York Regional Medical Program


         FOCUS OF ACTIVITY: Operational Project


         PROJECT TITLE:   Nurse-Clinician Training Program (Generalist Nurse
                                                                   P r a c t i t i o n e r s

         STATUS:  Ongoing


         SPONSORING INSTITUTION:   Community-General Hospital, Syracuse, N.Y.

         PROJECT DIRECTOR, TITLE, ADDRESS:    Miss Gertrude Chorescavich, R.N.
                                              Director of Nursing Services
                                              Community-General Hospital
                                              Broad Road
                                              Syracuse, New York  13215
                                              3 1 5 - 4 6 9 - 5

         DATES:  10/l/71-12/31/72


         FUNDING:   $42,850


         OTHER FUNDS:   Space



         COOPERATING AGENCIES AND INSTITUTIONS:
         Nurses from any agency in 17-county area are eligible to attend.



         AREA SERVED:  17-county Central New York RMP area.



         TARGET P            40 nurses per year.
                 OPULATION.




         CONGRESSIONAL DISTRICTS: NY #31, Robert McEwen; NY #32, Alexander
         Pirnie; NY #33, Howard Robison; NY #34, John Terry; NY #35, James
         Hanley; Pa #1@0, Joseph,,,McDa e.
         CONTINUATION AFTER RMP SUPPORT WITHDRAWN: Program will become self-
         supporting through tuition charges.














                          MEDICAL LIBRARY ASSISTANCE PROGRAM



                 The Medical Library Assistance Program,  including  a
             medical bookmobile sponsored by the Central New York
             Regional Medical Program, was designed to fulfill  the
             need in many area hospitals for a better developed library
             facility.

                 In one year, the bookmobile visited  43  hospitals
             and five subacute facilities in Central New York and
             Northern Pennsylvania, training the person who serves  as
             hospital librarian and stimulating interest in  develop-
             ment of a hospital library. A total of 1,201 health personnel
             visited the unit.

                 The renovated motor home carries a set  of  journals
             and medical books which form an integrated health  science
             core library for physicians, nurses and allied  health
             personnel. These 90 books and 74 journals  represent  what
             experts have selected as the minimal amount of  literature
             which even the smallest hospital should provide in  its
             staff library.

                 As a result of RMP assistance, a total of three hospitals
             have received National Library Medicine improvement  grants;
             two have received notice of approval and five are  currently
             submitting applications.

                 Through the bookmobile and RMP, health  people  through-
             out the region can borrow books or photocopies of  journal
             articles from the library at Upstate Medical Center  in
             Syracuse. The hospitals visited are encouraged  to  have
             the basic indices so that they may make full use of
             Upstate's lending facilities. Requests  for  inter-library
             loans to the Upstate Medical Center from area  hospitals
             increased to 5,127 or 56.5% over the previous  year.  The
             Biomedical Communications Network handled 343  computer
             searches or 64.9% more than last year on behalf of the area's
             health agencies.
                 Of special interest is the fact that  two  paraplegic
             patients in area hospitals became interested in serving as
             hospital librarians as a result of the mobile's visits.  One
             has been trained by the RMP staff librarian and is  now
             handling the job in a hospital which also recently  received
             a National Library of Medicine improvement grant as  a
             result of RMP assistance.  The second paraplegic is currently
             in training.








         REGION:  Central New York Regional Medical Program


         FOCUS OF ACTIVITY:  Core Activity  (Stated as Feasibility Study)


         PROJECT TITLE:   Medical Library Assistance Program


         STATUS:  Ongoing


         SPONSORING INSTITUTION:  CNY RMP Core Service


         PROJECT DIRECTOR, TITLE, ADDRESI.:  Miss Suzanne Murray
                                            Library Coordinator
                                            Central New York
                                            Regional Medical Program


         DATES:  711171 - 9/30/71 (officially), but activity has continued
                                                                 under Core

         FUNDING: Initially shared $19,437 with health mobile project.


         OTHER FUNDS:  Now - Core.




         COOPERATING AGENCIES AND INSTITUTIONS:

         Upstate Medical Center, all facilities in region.



         AREA SERVED: 17 counties served by CNYRMP.



         TARGET POPULATION: 55 hospitals, selected nursing homes.



         CONGRESSIONAL DISTRICTS: NY #3 1, Robert McEwen; NY #32, Alexander
         Pirnie; NY #33 Howard Robison; NY #34, John Terry; NY #35 James
         Hanley; Pa #10, Joseph McDade.

         CONTINUATION AFTER RMP SUPPORT WITHDRAWN:









                    STROKE REHABILITATION MOBILE CONSULTING SERVICE



                  The stroke mobile sponsored by  the  Central  New  York
             Regional Medical Program, 1969-1971, served both a patient
             service and health professional education role.  The unit,
             staffed by a team of rehabilitation specialists visited
             hospitals and nursing  homes;  conducted  extensive  patient
             evaluations and taught local people  how  to  carry  out  treat-
             ment.  Perhaps its greatest effect  was  in  showing  health
             people that there were things which could be done for
             stroke patients,:( that they should not,just  let  them,,lie  in
              @d
                  During its 2@-1/2 years of operation, the service
             conducted 136 programs ranging  from  one  to  six  days.  These
             included institutes, demonstrations, patient consultations,@,",@
             nursing inservice program development.
                  Personnel from 148 different facilities f       -ell 17
             counties participated  in  the  unit's  programs.  Following  is
             A list of  the types and number of facilities from which
             personnel  participated:

                        Hospitals--45
                        Extended care, nursing homes--62
                        Public health agencies--16
                        BOCES and manpower  development  and  training--6
                        Schools  (nursing,  health  education,.social  work,.
                          physical thekapy)--10
                        Heart associations--2
                        Nursing home district associatidns--2
                        Department of social sekviceg--l
                        RMP nursing subregional programs--4
                  Altogether, 4,896 contactswere made by the mobile unit.
             Of the 370 physicians who took part in unit programs in some
             way, 126 referred  patients.  Other  contacts  made  were  3,751
             nurses; 225 occupational,  physical  and  speech  therapists
             and social workers; 482 other personnel; 547 family and
             interested people from the community.  A total of 241 patients
             were evaluated.







          REGION:  Central New York Regional Medical Program


          FOCUS OF ACTIVITY:   Operational Project


          PROJECT TITLE:   Mobile Rehabilitation Service


          STATUS:  Term     31/71


          SPONSORING INSTITUTION:,,SUNY - Upstate Medical Center


          PROJECT DIRECTOR$, TITLE, ADDRESS:   Leo Jivoff, M.D., Prof. & Chm,
                                               Dept. of Rehab. Medicine
                                               SUNY Upstate Medical Center
                                               750 E. Adams Street
                                               Syracuse, N.Y.  13210
                                               315-473-5820

          DATES:  7/l/68 - 3/31/71


          FUNDING:    $308,724


          OTHER FUNDS:




          COOPERATING AGENCIES AND INSTITUTIONS:

          Personnel from 148 different facilities participated in strokemobile
          activities.


          AREA SERVED:  17 counties served by CNYRMP



          TARGET POPULATION:  stroke patients    health p6rs,onnel




          CONGRESSIONAL DISTRICTS. NY #31, Robert McEw6n; NY #32, Alexander
          Pirnio; NY #33, Howard R-bbisoh; NY #34, John Terry; NY #35, James
          Hanley; Pa #10, Joseph McDade.

          CONTINUATION AFTER RMP SUPPORT WITHDRAWN:
















                             HOME DIALYSIS TRAINING PROGRAM





                  The Home Dialysis Training Program funded by the Central
             New York Regional Medical Program annually trains 15-20 patients
             and their families to conduct he@"O'dialysis in a home setting.
             It also serves as a training center for  physicians,  nurses,
             allied health professionals and technicians from  hospitals  and
             public health agencies throughout a 17-county area.

                  8emodialysis is the treatment in which an artificial
             kidney "cleans" a patient's blood when his own  kidneys  have
             failed.

                  A major impact of the program is to moderate the cost of
             care and-'-iree hospital beds. While a hemodialysis machine  re-
             presents a substantial investment -- about $3,000 --  it  proves
             less costly to use at home than in the  hospital.  Figured  into
             the cost of in-hospital use must be the services  of  nurses,
             technicians, and other health personnel, plus  linens,  supplies,
             and normal overhead.  These costs may add up to over $15,000
             annually.  Home dialysis expenses are less than one-third
             this amount.  In addition, when dialysis can be done at home
             on a flexible time schedule, kidney disease victims may  be  able
             to hold down a job, go to school,.e-tc-.

                  Prior to the RMP-sponsored uniti several Central  New  York
             kidney patients had gone to New York City for  similar  training.

                  While the patient and his family ate being trained, health,
             care personnel from his area are train6d,also.  These people
             are then able to serve this particular patient in the home
             environment.  But, perhaps more important, by updating the
             knowledge of health people throughout the region, the  basis  for
             a coordinated regional dialysis program is  being  developed.

                  There are approximately 75 patients in the 17-county
             area on hemodialysis.







        REGION:  Central New York Regional Medical I-Irogram

        FOCUS OF ACTIVITY:       Operational Project

        PROJECT  TITLE:   Home Dialysis 'I'-t,aining Program

        STATUS:  Ongoing

        SPONSORING INSTITUTION:  SUNY, Upstate Medical Center

        PROJECT DIRECTOR.- TITLE, ADDRESS: E. T. Schroeder, M.D.,, Assoc Prof.'Med.
                                            SUNY, Upstate Medical Center
                                            750 E. Adams Street
                                            Syracuse, New York 132 10
                                            315-473-4456
        DATES:. 6/26/70  12/31/72

        FUNDING:      (1) $43, 219 allocated, $9, 786 spent
                      (2) $30, 028 allocated, $22., 010 spent (3) $18, 329 allocated
        OTHER FUNDS:  Hospital space and full time nurse by Onondaga County Health Dept.


        COOPERATING AGENCIES AND INSTITUTIONS: Upstate Medical Center
                                                Onon.. Co. Health Dept@.





        AREA SERVED:   17 counties served by CN-Y RMP



        TARGET POPULATION-       76 patients currently on hem odialysis, 80-100 new
        patients per year; health professionals serving them in their homes.


        CONGRESSIONAL DISTRICTS:  NY #31, llol)ert'McEwen; NY #32, Alexander Pirnie,-
        NY #33 Howard Robipfson; NY #34, John Terry; NY #35 James Hanley; Pa #10, Joseph
        McDade



        CONTINUATION AFTER RMP SUPPORT WITTIDR..,IIWN-










                           PULASKI MODEL RURAL AMBULATORY CENTER


                   Residents of a 21,000 population  rural  area  near  the
              eastern shore of Lake Ontario are receiving medical care
              from the Pulaski Model Rural Ambulatory Care Center, located
              40 miles north of Syracuse.  The center, which is funded by
              the Central New York Regional Medical Program, treats 150-200
              patients every week; (,4--.days.).
                   Prior to the opening of the  Pulaski  Center,  the  area
              was served by only two physicians in spite of the fact
              that community leaders had worked to attract doctors for
              five years.  Their efforts included offering facilities.
                   The problem was solved with the  help  of  St.  Joseph's
              Hospital Health Center of Syracuse  which  offered  to  staff
              the facility under its Family Practice program.
                   Liaison is maintained  presently  through  the  exchange
              of staff members. When a  proposed  new  clinic  building  is
              completed, communications will be  effected  through  the  use
              of closed circuit television, Xerox telecopier and data
              phone.
              The center provides a model which other areas with physician
              shortages might copy.  It is based on the idea that
              physicians may be more willing to pra-ctice  in  rural  areas
              if they have continuing education opportunities, modern
              facilities, a team of doctors  and  allied  personnel  to
              work with and a strong liaison  with  a  medical  center.
                   Residents from St. Joseph's  and  students  from  Upstate
              Medical Center rotate through  the  clinic  in  two-month
              intervals.  The goal of these rotations is to encourage
              young doctors to undertake rural practices.
                   The Pulaski facility is  owned  by  Northern  Oswego
              County Health Building,  Inc.  (NOCHBI),  which  was  created
              f i
               ive years ago to help attract  physicians  to  the  Pulaski-
              Sandy Creek area. It is  through  NOCHBI's  efforts  that  the
              center, presently located in a  ranch  house,  was  purchased,
              maintained and equipped.
                   Every week 5-10 patients are treated for previously
              undiagnosed conditions. Patients  in  whom  a  known  con4dition
              was not receiving adequate care prior to the project'n@mber
              5-10 per week.






          REGION:  Central New York Regional Medical Program


          FOCUS OF ACTIVITY:    Operational Froject


          PROJECT TITLE:     Model Rural Ar,,-@tlatory Care Center


          STATUS:   Ongoing


          SPONSORING INSTITUTION:  St. Joseph's Hospital, Syracuse, N.Y.


          PROJECT DIRECTOR, TITLE, ADDRESS:    Francis S. Caliva, M.D., Prof. & C,hm.
                                               Dept. of Family Practice
                                               Upstate Medical 'Center/and
                                               Director of Medical Education
                                               St. josep@h's Hospital
                                               Syracusei New York  13203

          DATES:  10/l/71-12/31/72


          PUNDING-  $53,433


          OTHER FUNDS:   St.  Joseph's  Hospital
                         NOCHB Inc.
                         Patient @eceipts

          COOPERATING AGENCIES AND INSTITUTIONS   Northern Oswego County Health

          'Bldg., Inc., Upstate Medical Center



          AR A SERVED:  Northern" Oswego  County



          TARGET POPULATION: 21 000 - patient service area in a rural setting; coht.
          education for Family Practice residents.



          CONGRESSIONAL DISTRICTS:   NY#31 Robert'MtEweo



          CONTINUATION AFTER RMP SUPPORT WITHDRAWN:











                           MEDICAL LIBRARY ASSISTANCE PROGRAM


                  The Medical Library Assistance Program, including a
              medical bookmobile sponsored by the Central New York
              Regional Medical Program, was designed to fulfill the
              need in many area hospitals for a better developed library
              facility.
                  In one year, @he bookmobile visited 43 hospitals
              and five subacute facilities in Central New York and
              Northern Pennsylvania, training the person who serves as
              hospital librarian and stimulating interest in develop-
              ment of a hospital library. A total of 1, 201 health personnel
              visited the unit.
                  The renovated motor home carries a set of journals
              and medical books which form an integrated health science
              core library for physicians, nurses and allied health
              personnel. These 90 books and 74 journals represent  what
              experts have selected as the minimal amount of literature
              which even the smallest hospital should provide in its
              staff library.
                  As a result of RMP assistance, a total of three hospitals
              have received National Library Medicine improvement grants;
              two have received notice of approval and five are currently
              submitting applications.
                  Through the bookmobile and RMP, health people through-
              out the region can borrow books or photocopies of journal
              articles from the library at Upstate Medical Center in
              Syracuse.  The hospitals visited are encouraged to have
              the basic indices so that they may make full use of
              Upstate's lending facilities. Requests for  inter-library
              loans to the Upstate Medical Center from area hospitals
              increased to 5,127 or 56.5% over the previous year.  The
              Biomedical Communications Network handled 343 computer
              searches or 64.9% more than last year on.behalf of the areals
              health agencies.
                   Of special interest is the fact that two paraplegic
              patients in area hospitals became interested in serving as
              hospital librarians as a result of the mobile's visits' One
              has been trained by the RMP staff librarian and is now
              handling the job in a hospital which also recently received
              a National Library of Medicine improvement grant as a
              result of RMP assistance.  The second paraplegic is curren@-ly
              in training.







          REGION: Central New York Regional Medical Program

          FOCUS, OF ACTIVITY:  Core Activity  (Stated as Feasibility Study)

          PROJECT TITLE:   Medical Library Assistance Program


          STATUS:  Ongoing


          SPONSORING INSTITUTION:  CNY RMP Core Service

          PROJECT DIRECTOR, TITLE, ADDRES-":  Miss Suzanne Murray
                                             Library Coordinator
                                             Central New York
                                                    1 Medical Program
                                             Regiotia


          DATES:  7/l/71 - 9/30/71 (officially), but activity has continued,
                                                                  under Core
          FUNDING: Initially shared $19,437 with health mobile project.


          OTHER FUNDS:  Now - Core.



          COOPERATING AGENCIES AND INSTITUTIONS:
          Upstate Medical Center, all facilities in region.


          AREA SERVED: 17 coun ties served by CNYRMP.


          TARGET POPULATION: 55 hospitals, selected nursing homes.


          CONGRESSIONAL DISTRICTS: NY #31 , Robert McEwen- NY 132, Alexander
          Pirnie; NY #33 Howard Robison; NY #34, John Terry;  NY #35 James
          Hanley; Pa #10, Joseph McDade.

          CONTINUATION AFTER RMP SUPPORT WITHDRAWN:

















                             HOME DIALYSIS TRAINING PROGRAM





                  The Home Dialysis Training Program funded by the  Central
             New York Regional Medical Program annually trains 15-20 patients
             and their families to conduct hemodialysis in a home  setting.
             It also serves as a,training center for physicians, nurses,  :
             allied health professionals and technicians from hospitals  an
             public health agencies throughout a 17-county area.

                  Hemodialysis is the treatment in which an artificial
             kidney "cleans" a patient's blood when his own kidneys have
             failed.                        k

                  A major impact of the program is to moderate the cost  of
             care and free hospital beds. While a hemodialysis  machine  re-
             presents a substantial investment -- about $3,000 -- it  proves
             less costly to use at home than in the hospital.  Figured  into
             the cost of in-hospital use must be the services of nurses,
             technicians, and other health personnel, plus linens,  supplies,
             and normal overhead.  These costs may add up to over $15,000
             annually.  Home dialysis expenses are less than one-third
             this amount.  In addition, when dialysis can be done at home
             on a flexible time schedule, kidney disease victims may be  able
             to hold down a job, go to school, etc.

                  Prior to the RMP-sponsored unit, several Central New  York
             kidney patients had gone to New York City for similar  training.

                  While the patient an d his family are being trained,  health
             care personnel from his area are trained also.  These people
             are then able to serve this particular patient in the home
             environment.  But, perhaps more important, by updating the
             knowledge of health people throughout the region, the basis  for
             a coordinated regional dialysis program is being developed.

                  There are approximately 75 patients in the 17-county
             area on hemodialysis.






        REGION:  Central. New York Regioiiil. I')-orfrani

        FOCUS OF ACTIVITY:       Operatioii,,i.1 Ilroiect

        PROJECT TIT.T.,E: Ilon-ic, Dialysis 'I't-.,itiing P,,-o-,t-,i.ni

        STATUS:  Or),goillg

        SPONSORING INSTITUTION:  SU@,-, 1)'I)statc, Medical Center
        PROJECT DIIIECTOR, TITLE, ADDRESS: E. T. Schro(-,-clcr,, M.D., Assoc Prof. 1\@led.
                                           SUNY, Upstate Medical Center
                                           750 E. Adams Street
                                           Syracuse, New York 13210
                                           315-473-4456
        DATES:  6/26/70 - 12/31/72

        FUNDING:      (1) $43,219 allocated, $9, 786 spent
                      (2) $30, 028 .illocate(l, $22, 010 spent (3) $18, 329 allocated
        OTHER FIJ-NDS: Hospital space and full nine nurse bv Onoii(,',,i.ga County Health Dept.

        COOPERATING AGENCIES AND INSTITUTIONS: LTp@,tit(-, Medical Center
                                                Oiioii.. Co. Ilealtli Dept.






        AIZEA SERVED:  17 counties served I)v CN-Y RAII'


        TAIIGET POPUI,@ATION:    76 patients currently on liemoclialysis, 80-100 new
        patient per v(@@tr; health-professionals serving them in tlic@ii@ homes.

                                   -Y #31, ltol)crt I\IcE@%7c@ii; NY #32, Alexancle Pirni
        CONGRESSIONAL DISTRICTS:  N                                  r    e
        NY #33 HoNvarci Robi)(son; NY #34, John Tr-@i-ry; NY #35 James Hanley; Pa #10, Joseph
        McDade



        CONTI@7\'-UATION Al,TL;'I->, R-AIP SUPI'301'LT





                                                                           YORK
                                                              CENTRAL   NEW






                           PULASKI !,IDDEL RURAL AMBULATORY CENTER

                  Residents of a 21,000 population    rural area  near  the
              eas-@-ern shore of Lake Ontario are receiving  medical  care-
              from the Pulaski- Model Rural Ambulatory Care Center, located
              40 miles north of Syracuse.. The center, which is funded by
              the Central New York Regional Medical Program, treats 150-200
              patients every week (4 days).
                  Prior to the opening of  the  Pulaski  Center,  the  area
              was served by only two physicians in spite of the fact
              that community leaders had worked to -attract doctors for
              five years.  Their efforts included offering facilities.
                   The problem was solved with the  help  of  St.  Joseph's
              Hospital Health Center of Syracuse  which  offered  to  staff
              the facility under its Family Practice program.
                   Liaison is maintained  presently  through  the  exchange
              of staff members. When a  proposed  new  clinic  building  is
              :completed, communications will be effected through the use
              of closed circuit television, Xerox telecopier and data
              phone.
              the center provides a model which other areas with physician
              shortages might copy.  It is based on the idea that
              physicians may be more willing to  practice  in  rural  areas
              if they have continuing education opportunities, modern
              facilities, a team of doctors and allied personnel to
              work with and a strong liaison with a medical center.
                   Residents from St. Joseph's and students from Upstate
              Medical Center rotate through the clinic in two-month
              intervals.  The goal of these rotations is to encourage
              young doctors to undertake rural practices.
                   The Pulaski facility is owned by Northern Oswego
              County Health Building, Inc.   (NOCHBI), which,was created
              five years ago  to  help  attract  physician's to the Pulaski-
              Sandy Creek area.  it is through NOCHBI's efforts that the
              center, presently located in a ranch house, was purchased,
              maintained and equipped.
                   Every week 5-10  patients  are  treated  for  previously
              undiagnosed conditions.  Patients in whom a known condition
              was not receiving adequate care prior to the project number
              5-10 per week.








                   Central New York Re,@o
                                                   a  illro gv, a ni
          REGION


          FOCUS OF ACTIVITY:    Operatio@ial ri-o,ject


          PROJECT TITLE:     t@'@,odel Rural Ai@,@@ Care Center


          STATUS:   0 n g o i n g


          SPO NSORING INSTITUTION:  St. Josepfi's Hosp.ital, Syracuse, N.Y.

          PROJECT DIRECTOR, TITCE, ADDRESS:   Fran-cis S. Caliva, M.D., Prof.   Chm.
                                              Dept. of Family Practice
                                              Upstate Medical Center/and
                                              Director of Medical Education
                                              St. Josenii's Hospital
                                              Syracuse, New York  13203

          DATES:  10/l/71-12/31/72


          FUNDING:  $53,433


          OTHER FUNDS:    St. Joseph's Hospital
                          NOCHB Inc.
                          Patient receipts
          COOPERATING AGENCIES AND INSTITUTIONS: Northern Oswego County Health

          B-Idg., I-nc., Upstate Medical  Center



                                  'Oswego County
          AREA SERVED:   NorthL'rn



          TARGET POPULATION:  21,000 - patient service area in a rural setting; cont
          education for Family Practice residents.



          CONGRESSIONAL DISTRICTS:   NY#31 Robert'McEwen



          CONTINUATION AFTER RMP SUPPORT WITHDRAWN:








                    STROKE REHABILITATION MOBILE CONSULTING SERVICE


                  The stroke mobile sponsored by the Central New York
              Reaional Medical Program, 1969-1971, served both a patient
              service and health professional education role.  The unit,
              staffed by a team of rehabilitation specialists visited
                                   homes'; conducted extensive patient
              hospitals and nursing
              evaluations and taught local people how to carry out  treat-
              ment.  Perhaps its greatest effect was in showing health
              people that there were things which could be done for
              stroke patients: that they should not just let them  lie  in
              bed.
                  During its 2 1/2 years of operation, the service
              conducted 136 programs ranging from one to six  days.  These
              included institutes, demonstrations, patient  consultations,
              nursing inservice program development.
                  Personnel from 148 different facilities from all 17
              counties participated in the unit's programs.  Following  is
              a list of the types and number of facilities from which
              personnel participated:
                        Hospitals--45
                        Extended care, nursing homes--62
                        Public health agencies--16
                        BOCES and manpower development and training--6
                        Schools (nursing, health education, social work,
                          physical therapy)--10
                        Heart associations--2
                        Nursing home district associations--2
                        Department of social services--l
                        RMP nursing subregional progtams--4
                   Altogether, 4,896 cbntactswere made by the mobile unit.
              Of the 37  physicians who took part in unit programs in some
              way, 126 referred patients.  Other contacts made were 3,751
              nurses; 225 occupational, physical and speech,therapists
              and social workers; 482 other personnel, 547 family and
              interested people from the community.  A total of 241 patients
              were evaluated.






            '@ll E G I                      I Medical Program
                    Central Believe York Regi ona

            FOCUS OF ACTIVITY  Operational Project
            PROJECT TITLE: Mobile Rehabilitation S e r v i c e

          .STATUS.  Term. 3/31/71

            SPONSORING INSTITUTION:-SUNY  Unstate Medical Center
            PROJECT DIRECTOR, TITLE, ADDRESS:   Leo Jivoff, M.D., Prof. & Chm.
                                                Dept. of Rehab. Medicine
                                                SUNY Upstate Medical Center
                                                750 E. Adams Street
                                                Syracuse, N.Y.  1 3 21 0
                                                3 1 5 - 4 7 3 - 5 8 2 0

            DATES:  7/l/68  3/31/71


            FUNDING:   $308,724


            OTHER FUNDS:


            COOPERATING AGENCIES AND INSTITUTIONS:.
            Personnel from 148 different facilities participatedin strokemobile
            activities.

            AREA SERVED:  17 counties served by CNYRMP

            TARGET POPULATION:  stroke patients -.health personnel


            CONGRESSIONAL DISTRICTS: NY #31, Robert McEwen; NY #32, Alexander
            Pirnie; NY #33, Howard Robison; NY #34, John Terry; NY #35, James
            Hanley; Pa #10, Joseph McDade.
            CONTINUATION AFTER RMP SUPPORT WIT@IDRAWN:













                       GENERALIST NURSE PRACTITIONER TRAINING  PRCIIJ'RAM


                           Twenty-seven area nurse.s are currently being.
                       trained as generalist nurse practitioners in a
                       program representing a new concept in health
                       delivery, sponsored by the Central New York Regional-.
                       Medical Program. of the nurses  in  the  program,,
                       25 are from agencies serving the  rural  and  urban
                       medically disadvantaged.
                           Under this  project,  nurses  from  hospitals,
                       health agencies  and  doctorsloffices  participate
                       in an intensive  seven-month  educational  program
                       learning to provide  primary  medical  care.  Nurse
                       practitioners work under  a  physician's  direction
                       but on their own, handling common health services
                       and thereby expanding the care delivery potential
                       of the physician.
                            it i6 estimated that if  each  nurse  practit-
                       ioner can save a physician from seeing 16-20
                       patients with common medical  problems  each  week-
                       day, that physicians would have  one  or  one  and
                       a half more weekdays available for acute prob-
                       lems, continuing education, etc.
                            Many of the people  currently  being  treated
                       by the nurse practitioners  are  elderly  individ-
                       uals and-others who would  otherwise  not  receive
                       continuing medical care.






           REGION:  Ciyntral New York Regional Medical Program


           FOCUS- OF ACTIVITY: Operational Project


           PROJECT TITLE:  t@urse-Clinician Training Program (Generalist Nurse
                                                                      Practitioners)

           STATUS:  Ongoing


                                     Community-Ceneral HOSDital, Syracuse, N.Y.
           SPONSORING INSTITUTION:


           PROJECT DIRECTOR, TITI:E, ADDRESS.   Miss Gertrude Cherescavich    R.N.
                                                Director of Nursing Services
                                                COMMLInity-General Hospital
                                                Broad Road
                                                Syracuse, New York   1 3 21 5
                                                31 5 - 4 6 9 - 5 5 1 1


           DATES: 10/l/71-12/31/72


           FUNDING:   $42,850


           OTHER FUNDS:  Space




           COOPERATING AGENCIES AND INSTITUTIONS:
           Nurses from any agency in 17-county area are eligible to attend.



           AREA SERVED: 17-county Central New York RMP area.



           TARGET POPULATION: 40 nurses per year.



           CONGRESSIONAL DISTRICTS: NY #31@, Robert McEwen; NY #32, Alexander
           Pirnie; NY #33, Howard Robison, NY #34, John Terry; NY #35, James
           Hanley; Pa #10, Joseph .,@IcDade.
                                                      Program will become self-
           CONTINUATION AFTER RMP SUPPORT WITHDRAWN:
           supporting through tuition charges.












                              0  c, ',Jay Rulo,  l@. il@f.
                         ID i @L --a! a-@ Arcadia,                               -@h,-, fir           @:ary
                                    nurse training cc),@--se                        by th@              and
                                                         a-,- 4 C) -4
                     the F-'Lor-Lda Heart Assoc-L  L-.L @l In -LI-i@ Summer of ic)(@j9.


                                                                    --      -                         -i @.h
                              ,ac     returned     home         Wi@@    L@ii@,  desire to

                                       r


                                    writir-,-T                           nor of one nurse           a
                                                                         n
                     @o    ano@.aer,    Miss    Rule    has prcpar@,-,d a practica.-i-          de O',   h,  -,,'i7
                     to                             re   uni-L--              1 hosr  L--.L
                         open    a    coronary     ca           In      SrLaa-

                                  will       requ-@rc                    @n@-@nt of wo--rl,-,   a.L-,Ll.
                     ,@over@-@@@ce,"    she     warns ncr

                            Then    she     proceeds     to                 t-at will enable
                              in    a    small     hospital --c avoid a           of   wasted    iro'--'-on
                     ai-d           accomplish   the   rL@@s-dlts    dc@s.-,L:ced.

                            ','he paper,  "Tips  for C,--:,@nin(-.r  --  Corona--y Care Ui-ii-@ fo--
                     the N,urse in a Small Hospi@a'-,"                   expected"   to   be    pub-'@-.shc;L,
                     "-his


                            L)aSoto's         fi-ve-bed        was  opened Deceimh,,..-,  I-,  1969.
                     i-r-,@--lU(Les thlzee beds that az@ mc----'-@--ored and               beds   -Lcor    re-
                     cover,,,7 @,@--nd ICU patients.           a s-lk-- @L -.L@ --F consists c-.@ @-  ful,L-ti:-:@@
                     1.@is,  4 part-time RNs,  2 full-@LircLe LPNs ,  1 par--@-time


                            '-he special Care Unit                her hospital,  Dc-Soto
                     served "LO9  cardiac patieni--E;  cLur'Lllg 1970  and 140 during 197'".
                     There were 29  cardiac death @- the first year and 24 the
                     L--@cond year.

                            @Lhc-:fe- was  a total of @           -")a-'k--ienL-s in the unit di:,--ring 1970
                      o-- a,-,i av@-,,,@--age stay of 3.7 days.   The Unit served 374 oat'@L.e-rts
                     @--.e reyt year for an average s't--a,7 of 2.5 days.

                                                                         ci
                                                                L           -a-tion CCKJ
                                                      da lfc, .1'..
                               (I -Lc) ct-@@:)le  nurses   -'Cc)           in   the   ii-12;1-:CUCLion   of
                     ot'.-.@'ier @'CU personnel,  particular-LV valuable to '@hose from
                     si.,,aller hospitals.   More than 300 nurses  co::Li-,olc@ted the course
                     cLurinq     the     Fr@viP     support     period.     Community     support     arragne-
                     ments will continue to provide -L"-his training.













               REGION:  Florida Regional      -@cal @lrogram

               LOCUS OF ACTIVITY:  Opcra-tio--ia-L I?ro-jec@L'

               PROJECT TITLE:  Florida Co@,,c)r@a::v Care Nurses Tra4 riinc@;

               STATUS:  Concluded


               SPONSORING ORGALNIZATION:        i d a T:lo--art Association


               PROJECT DIRECTOR:  LouLs             j%I.D.


                                    Mia@iii, :'Ic)ri.cli 3'-'@) 1 4 5

                ,"'@'ES:  llarch 1, '@969 - FcL-i-i-iar,/ '972

               FUNDING:  01 - $110,261; 02 - $-125,517; 03 - @,82,975

                      FUNDS:  None


                                                                      Hosp.-Ltals
               COOPERATING LGE'@,TCIES AND I'              Community
                and CoL@aun-' 'Zy Junior Co!'L@-c.,@s

               @,-@A SERVED:  State of Florida


               T@-RGET POPULATION:  Nurses from hospital staffs

               CO'@@TINUT-r
                        2TON AFTER Pd@P SU2@2O@-              ContinuF,,@-on of t-@@
               training activities will be provided by varying local coopera-
                                                                          -2. 1e
               tive arrangements.    In so--c- -,@r-s-L--E,.nces , tuition fees w-- -'-l b
               cnarged students with a portion of the cost being absc---bed "@-Y
               the sponsoring institution.     -L.,i other locales,, the local co-@--Ci-
               ..unity junior college will provide didactic instruction with      +-I-@
               training hospital providing necessary clinical experiences.

               CORE ST@--7F CONTACT:  Gordon R. Engebretson, Ph.D., Deputy
                Director


               DATE PREPARED:  February 1, 7L972

               DRAFTED BY:  Harold A. Tyler, Assistant Director for Coramunications







     Vignette:  GRMP Activity

                        A KIDNEY DISEASES PROGRAM FOR GEORGIA

          A plan to develop and integrate health care resources  for  kidney
     disease throughout the state of Georgia was instituted - with the support
     of GRMP- through the joint efforts of the Regional Nephrology  Centers  at
     the two medical schools of the region, Emory University School  of  Medicine
     and the Medical College of Georgia, and the two hospitals that have been
     designated as Kidney Area Facilities in Georgia.

          I                         strides being made in  kidney  research,
      e    aqspite of the tremendous
     G orgi  lags behind in its preparation to translate these research
     accomplishments into improved patient care for its  citizens.  In  Georgia
     approximately 100,000 cases of genitourinary tract disease occur each.year,
     200 of which enter the category of terminal renal failure  susceptible  to
     radical therapy by dialysis or transplantation.  Neither the facilities nor
     the trained personnel are available to provide new forms of  therap  to  all
   \\those who would benefit from them.                                 y
          Improvement in the quantity and the quality of care  for  patients
     with kidney disease is the main focus of. activity at this time., GRMP  is
     playing a major supportive role 4n the achievement of progress @n   the
     following projects:
         tThe support of,'-the Regional Nephrology Centers based at the two medical
          schools which will expand referral services to the entire region.
          Complete utilization of medical school resources will  permit  trans-
          plant surgery, organ retrieval, and tissue typing.  With  the  proposed
          expansion of atient care services in the region  and  area  facilities,
                       p
          development of new skills for physicians, nurses and  allied  pro"
          fessionals is essential. The educational facilities  available  at  the
          medical schools will make the logical sites for  specialized  training.

          In order to begin  o assure,@'thorough regionwide coverage, two area
          facilities have b@tn designated, one at Columbus and one at Augusta.
          Each area facility will be headed by a regional,,,centertr ane
          nephrologist.  Specialized diagnosis and treatment of patients
          with kidney disease will be offered.
          There are future plans for the establishment of limited-care low-
     cost dialysis facilities throughout the state.  This type of facility wil
     be designed to provide long-term dialysis for patients who, for  one  reason
     or another, are unable to g@ on home dialysis, but who require only limited
     assistance(to be carried out in an accessible center.











                                     BACK-UP SHEET

     Region:  Georgia Regional Medical Program

     Locus of Activity:  Operational Project
     Project Title:  A Kidney Disease Program for Georgia
                      (Regional Nephrology Centers and Kidney Area Facilities)

     Status:  Ongoing

     Sponsoring Institution:  GRMP
     Project Director, Title, Address:
     Regional Nephrology Centers           Kidney Area Facilities
     Elbert P. Tuttle, Jr., M.D.           George E. Van Giessen,, Jr., M.D.
     Advisory Director                     1021 15th Street
     Atlanta Artificial Kidney Center      Suite 11
     69 Butler Street, 8.E.                Augusta, Georgia
     Atlanta, Georgia  30303
                                           C. Daniel Cabanisst M.D.
     James B. Hudson, M.D.                 Chairman
     School of Medicine                    Department of Internal Medicine
     Medical College of Georgia            The Medical Center
     Augusta, Georgia  30902               Columbus, Georgia

     Dates:  2-1"72 through 8-31-74

     Funding:  $103,028  (Current Year)
     Other Funds6. Collection of fees, medical schools and hospitals, training
           grants from National Institutes of Healthi Georgia Heart Association,
           private foundations, facilities grants from Division of Vocational
           Rehabilitation of Georgia, contracts with the U.S. Department of
           Health Education and Welfare
     Cooperating-A4encies: Emory University School of Medicine, Medical College
           of Georgia, designated Area Facilities.- National Institutes of Health,,
           Georgia Division of Vocational Rehabilitation, National and Georgia
           Kidney Foundations, State of Georgia: Board of Regents of the
           University System

     Area Served: State of Georgia
     Target Population: Patients throughout the state stricken with renal disease











      BACK-UP SHEET
      Page  2



      Congressional Districts:

            (1) G. Elliot Hagan, Sylvania
            (2) Dawson Mathis, Albany
            (3) Jack Brinkley, Columbus
            (4) Ben B. Blackburn, Atlanta
            (5) Fletcher Thompson, East Point
            (6) John J. Flynt, Jr., Griffin
            (7) John W. Davis, Summerville
            (8) W.S. Stuckey, Jr., Eastman
            (9) Phil M. Landrum, Jasper
           (10) Robert G. Stephens, Jr., Athens
      Continuation After RMP Support Withdrawn:  Fee scale and continued grants

      Core Staff Contact:  Mr. William Wilkins

      Date Prepared:  February 15, 1972

      Drafted by:  Ms. Patricia Harris






            Vignette:  GRMP Activities
                          CARDIOPULMONARY RESUSCITATION PROGRAM


                  The Georgia Heart Association, with  financial  support  from
            GRMP for a three-year period, set up  and  achieved  the  following
            objectives in.the field of cardiopulmonary resuscitation, throughout
            the state.of Georgia:
                  A cardiopulmonary resuscitation training program  was  es-
                  tablished as of August 1971 in almost all  major  hospitals
                  throughout Georgia; 117 of the 220  licensed  hospitals  2
                  VA hospitals, 9 military hospitals.
                  DeVelop@,a cadre of trained instructors. Throughout the
                  --State and to-     a structure' @@r@bugn wnicfi an instructor
                  could function in his respective community#  yithin  the
                  period of time from June 1, 1968 through Au    t 31,  1971,
                  the 2520 instructors who were trained in CPR care indludedt-

                      215 Physicians
                     1028 Nurses
                     1277 Others (paramedical, personnel  in  high  risk  occu-
                                   pations, police, fire, utilities, industry)
                  The 2520 instructors who were trained,cover 120  of  the
                  Georgia counties, a total geographic'/area in which  93%
                  of the state's population lives.  In addition, 38 countywide
                  committees on CPR wore formed to enable  instructors  to
                  carry on activities within their own counties.
                  Courses are being conducted statewide for instructors
                  nd other persons who have the need for  a  continued  pro-
                  ficiency in CPR procedure. ;n  addition,  assistance  in  the
                  development of CPR in-servi   training programs             ls
                  I                                                      is
                  being offered and encouraged on a continuing basis  by  the
                  Georgia Heart Association.
                  The CPR program is remaining an ongoing program of the Georgia
            Heart Association. The skills of the four  CPR  Field  Reps  who
            have been with the program are continuing to  be  utilized  in
            their new assignments as GHA Field Reps.  A  recent  increase  in
            budget has allowed the,hiring of additional field staff (expansion
            from 6-10 members).I'-'@he geographic territory to be  covered
            by each rep has been reduced from 24 counties  to  18  counties.






                  BACK-UP SHEET:  CARDIOPULMONARY RESUSCITATION PROGRAM

            Region:  Georgia Regional Medical Program

            Locus of Activity:  Operational Project
            Project Title:  Cardiopulmonary Resuscitation Program
            Status:  Terminated; continuing on own funds
            Sponsoring Institution:  Georgia Heart Association, Inc.
            Project Director, Title, Address:  Joseph A. Wilber, M.      Chairman
                                                CPR Committee, Ga.        Assn.
                                                2581 Piedmont Road, N.E.
                                                Atlanta, Georgia  30324
            Dates:  July 1, 1968 - August 31, 1971

            Funding:  01,02,03:  $265,916

            Other Funds:  Georgia Heart Association
            Cooperating Agencies and Institutions:  Georgia Heart Association,
                 hospitals throughout tFie state, fire departments, police
                 departments, public utilities, business and industry,
                 ambulance and rescue personnel, military base.

            Area Served:  State of Georgia

            Target Population:  Entire Region

            Congressional Districts:

                 1.  G. Elliot Hagan, Sylvania
                 2.  Dawson Mathis, Albany
                 3.  Jack Brinkley, Columbus
                 4.  Ben B. Blackburn, Atlanta
                 5.  Fletcher Thompson, East Point
                 6.  John J. Flynt, Jr., Griffin
                 7.  John W.  Davis,  Summerville
                 8.  W.S. Stuckey,  Jr.,  Eastman
                 9.  Phil M. Landrum, Jasper
                 10. Robert G. Stephens, Jr., Athens

            Continuation After RMP-Support Withdrawn:  The CPR program
                 has remained an ongoing program ot the Georgia Heart
                 Association.

            Core Staff Contact:  Mr. William Wilkins

            Date PreDared:  February 10  1972
                                         .1

            Drafted by: Ms. Patricia Harris







       Vignette:   G,%@@',P Act-ivitY
             CO,@l@MUNITY HIGH BLOOD PRESSURE PROGRAM IN METROPOLITAN ATLANTA
             A concentrated effort  to  detect  and  control  hypertension  is  being
       conduc@ed in  a  predominantly  black,middle  class  urban  community  of  23,000
       a        9               e   residing  in  S.W.  Atlanta.  The  majority  of
         dults
       indivii a, 4 15      old  r
              uals  with  elevated  blood  pressure  are  either  undetected,  untreated
       or  inadequately  treated.  This  demonstration  program  will  identify   those
       existing conditions which deter indigent patients from medical care of
                                                               -@'@ncoura ge indigent
       hypertension and will discover procedures          wt
       patients to seek and @ accept care.  If the majority of hypertensives
       in the country could  be  adequately  controlled  through  the  use  o  proper
       medication, a maDor  reduction  in  morbidity  and  mortality,  especially  in
                    stroke among men, would be achieved.
             GRMP funding of the project began September 1, 1970.  Various methods
       of screening for elevated  blood  pressure  were  tried  and  evaluated  for
       effectiveness.  The most successful methods found were mobile van screening
       (shopping centers,  apartment  complexes,  etc.)  and  door  to  door  screening
       throughout neighborhoods.  Prime testing times were pinpointed:  week-days
       between the hours of 3:00 p.m. to 8:00 p.m.
             During the first year  of  operation)  6012  adults  were  screened;  1,713
                                             sive.  7i%  bf"@hese@(1224)   were   either
       (28.5%) were classified as hyperten
       undiagnosed,  untreated,  or  inadequately  treated.  Letters  referring   the
       identified hypertensive patient for diagnosis and treatment were more suc-
       cessful (59.3%) and efficient than phone calls made to individuals (50.9%).

             Presently  the  program  provides  services  including  screening,   refer-
       ral,  education  and  follow-up.  Without  availability  and  accessibility   of
       diagnostic and treatment  facilities,  results  from  the  use  of  the  services
       will not  be  recognizable.  During  the  first  operational  year,  a  follow-up
       system was established and 1000 patients were followe            ve@ipnly     25%
                                                                        r
       of these hypertensives  are  presently  under  treatments,  @@a@  e  @  t  under
       adequate controllfor a number of  reasons-,,  including  lack  of  knowledge
       about  hypertension,  limited  transportation  to  centers  administering   caret
       and the high cost of medical care,.,-                        v

             A target date of February           set for the  openincT  of  a,low  cost
       or f ree Community Resource Center Cin.. the target-,are4) whic@ @" of f er.
       care to 100 patients who  will  be  randomly  selected  from  the  75%  untreated
       follow-up cases.' Trained  volunteers  will  play  a  vital  role  in  operating
       this center After the initial two or three months of implementation.








                                   BACK-UP SHEET

    Region:  Georgia Regional Medical Program

    Locus of Activity:  Operational Project .
    Project Title:  Community High Blood Pressure Program in Metropolitan
                     Atlanta


    Status:  Ongoing
    Sponsoring Institttion:  Georgia State Department of Public Health
    Project Director, Title,'Addre,ss:   Joseph A. Wilber, M.D.
                                         Director, Cardiovascular Disease Control
                                         Georgia Department of Public Health
                                         47 Trinity Avenue, S.E.
                                         Atlanta, Georgia  30334

    Dates:  9-1-70 through 8-31-74
    FundLng:  $181POO '00 (for first two operational years with GRMP support)
                   A
    other Funds:  Georgia Department of Public Health, Health Services and
                  Mental Health Administration, Department of Health, Education
                   and Welfare

    Cooperating Agencies and Institutions:  Georgia Department of Public Healthi
               Georgia Heart Association, Atlanta Medical Society, Fulton
               County Medical Association, Fulton County Health Department,
               Community Council of Metropolitan Atlanta.
    Area Served:  Urban community in S.W. Atlanta; approximately 23,000 middle
                   class predominantly black adults
    Target Population:  Adults ages 15 years of age and older in this urban
                         indigent area of Atlanta
    Congressional Districts:  Fletcher Thompson, Ea'st Point
    Continuation After RMP Support Withdrawn:  Sources t  o help continue activi-
          ties are actively being sought.

    Core Staff Contact:  Mr. William B. Wilkins

    Date Prepared:  February 15, 1972

    Drafted by:  Ms. Patricia Harris






                          G,@,viP Activities


                                  HEALTH OCCUPATIONS COUNSELING


                   one hundred rural,,G          predominantly black,disadvantaged
              high school students are    -oarticiz)atinq in a unacrvle  e lth occupations
              counseling                                  project""@46A  '@6hstrate the
              feasibility of this approach @solving                   of the current
              health manpower problems. G@viP selected ten high.school counselors
              from rural middle Georgiap p4xet-ully in-@erview@-@Aem and-we-@@
                   their principals to assure'that, the counselors                have
              the                   capabilitv'cnebded  to  work  with  students  in this
              intensified health occupations Counseling approac
                   special  orientation  in  health  careers   and   educational
              opportunities  was  provided  the  -oarticinating  counselors   at  the
              beginning  of  the  program,  through  a  workshop  that  included
              sessions  with  experts  from  governmental  and  educational   intti-
              tutions in the  state,  as  well  as  practicing  members  of  the
              health professions.

                   Most students  pres,,en@@  Pursuing  a  health  career  are  from
                                 L.   'han  rural  areas.  In  turn,  these   indivi-
              urban           rather r_
                          p                                               r.,:thi s
              duals will  robably practice in the urban sett
              reason,                       e9 ia this proDect@)On the  rural   set-
              ting and @ schools with large numbers of disadvantaged students.

                   Tfihen high  school  students  think  of  health  professions
              thev  generally  think  of  physicians,  dentists,  nurses,  or  phat-
              macists.  Because  o-  their  background,  many  students  from   the
              lower  socioeconomic  sector  will  not  pursue  these  health  pro-
              Lessions because they seem unattainable.  Through this
              disadvantaged high  school  students  will  be  made  aware  of  behind
              the scene workers  in  the  health  field,  such  as  nurses  aides,
              orderlies, laboratory technicians,     medical   records   specialists,

                   Each counselor selected    tez'students,
                                                 ng,,ba@.-i.-s throughout the
                                 ual counseling  with qro     activities deki@
                                                                           e
              to                                        @erstanding of  th        @ed
              portuni-L.ies ava  1                       suit6d.
                              .---et.-h@-cally,ox,economicall-y dis dvantalged students
                                                                   someLthing,@.-in-@
                     -L-i there'Ore,, if goa.1s,,,are to be met, these per@son@s,@@
              tanq@
              i-ftust..have models,.-with,,.,,whom-.t-hey can identify.   T@
             --f@orl'students I         ht   to   the   Atlanta   metropolitan    area    on
              a group trip                  e-@f vi                               n
              each  of  the  health  fields   s@L.Udiedr?@o@t-   "O@ly   ptp@r@   eir
              or--ice, hbsoital, or laboratory R-                t   also   in the     in-
              zor,,nal  set-,.-ng  o-9 eir homes.
                                  th

                                 -proDect   plans   call   for   the   oftehd  -oarti-
              c  zL 4-nc.,   s-.uaents   to   maintain   active    involvement during the summer
              vacn-"@i-on months, wherever nossible,@hrough actual         employment
              as   aides,   clerks,   etc.   working   on   a   daily   basis    with    health pro-
              -essiol-als.








                   BACK-UP SHEET:  HEALTH OCCUPATIONS COUNSELING

          Region:  Georgia Regional Medical Program

          Locus of Activity:  Operational Project
          Project Title:  Health Occupations Counseling

          Status:  Ongoing
          Sponsoring Institution.-  Georgia Regional Medical Program
          Project Director,'Title, Address:    Mr. Algie Jordan, M.P.H.
                                               Associate Coordinator
                                               Facilities and  Services
                                               Georgia Regional Medical Program
                                               938 Peachtree Street, N.E.
                                               Atlanta,  Georgia  30309

          Dates:  September 1, 1971 through August 31, 1972

          Funding:  $13,810

          Other Funds:
          Cooperating Agencies:  N. E. High School (Macon), Peach County
               High Schooi (Ft. Valley), R.E. Lee Institute Guidance
               Center (Thomaston), Willingham B. (Macon), Lamar  County
               School (Barnesville), Baldwin High School (Milledgeville),
               Warner Robins Senior High (Warner Robins), McEvoy B. (Macon)
               Mary Persons High School (Forsyth), N.E. Complex (Macon).
          Area Served:  Six county area in Georgia:  Monroe, Jones  Baldwin,
               Putnam, Peach, Houston.
         'Target Population-.  Predominantly black disadvantaged ri;ral high
               school students with a potential interest in a health career.
          Congressional Districts-.  #3 Jack Brinkley, #6 John J. Flynt,
               Jr., 410 Robert G. Stephens,  Jr.
          Continuation After RMP support withdrawn:  Possibilities  for
               other sources ot continuing support-are actively being
               pursued.

          Core Staff,Contact: Mr.  Algie  Jordan

          Date Prepared:  February 10, 1972

          Drafted By:  Ms. Patricia Harris








                                                                                     Greater Delaware Valley


                                 COMMUNITY   AID   AND   REFERRAL   EXCHANGE    SYSTEM


                                                        "CARES'L



                               The need for a central information and referral service to simplify,
                  facilitate and fol               irect referral of individuals to appropriate health
                  agenc                              he  Health  and  lqelfare   Council   of   Chester   County,
                         ies @@reco' 'g'@Oi
                  Penns3                                           ta-t-i                       u@ - -8      e
                  @Va-s cc                                       that persons needing health services
                                                                 vices   and   that   available   services   are
                  used efficiently and fully.

                                           11 of Chester County and part of Delaware County, @s-
                               Cover@ a
                                       uccess of this project can establish a design for other Areas
                  in the region and iw the states a@,a@t-@a to develop simi ar serve ces.,
                               The pr                          ivi        0                         help him
                                      ogram   guides   the   ind   dua@
                  an  tries to provide @           other@a-s-s-ts6@tice -as
                  he receives-@ help,                               the  program   acts   as   a   communication
                  link between the agencies.

                               The.central   information    and    referral    service                  useful
                            --to   identif@hat   provider   services    currently    exist,    whether    they
                  are    @essibie,    available    and    accept                         verlap  and   what   new
                  provider   services   may   be   needed.    it
                  identify@   improved   ways   for   agencies   to   work   together   in   providing    health
                  care.

                               Adcli:t-i,ma-i--,st@e           @pplonma-l-                               @n-ed
                                    collect@-        pertinent  data   on   how   agen                 referrals,
                  an             computer"d@i..@ "retrieve                  ineormatio                  agencies
                                        their  servicesiv/as  well  as   to   reach   out   through   development
                  of  Community   Centers   and   by   utilization   of   trained   volunteers   supervised   by
                  professional staff to extend substantially the health services to people
                  otherwise unable to obtain such service.











                                             BACK-UP SHEET






               REGION:   Greater Delaware Valley Regional Medical Program
               LOCUS OF ACTIVITY:   Planning Project
               PROJECT TITLE:   CARES
               STATUS-   In second And final year
               SPONSORING INSTITUTION:   Health and Welfare Council of Chester County
               PROJECT DIRECTOR:   Mrs-Brent W. Roehrs, Director
                                   Chester County CARES
                                   14 East Biddle Street
                                   West Chester, Pennsylvania 19380

               DATES:   October, 1970 - October, 1972
               FUNDING:   1971 - $5,000;  1972 - $5,000
               OTHER FUNDS:   various for cooperating agencies
               COOPERATING -AGENCIES AND INSTITUTIONS:   Pennsylvania Department of Community
                     Affairs; Pennsylvania Department of Welfare; Mental Health/Mental
                     Retardation Board of Chester County; West Chester Rotary Club; Dolfinger
                     McMahon Foundation and interested individuals
               AREA SERVED:   Chester County and part of Delaware County, Pennsylvania
               TARGET POPULATION:   All individuals and families needing health services
               CONGRESSIONTAL DISTRICTS:   Various
               CONTINUATION AFTER RMP SUPPORT WITHDRAWN:    Governmental, state and local,
                     and participating agency, funding
               CORE STAFF CONTACT:    Stephen B. Langfeld, M.D.
                                      Associate Director, Program Development and Operations
               DATE PREPARED:   2/i4/72
               DRAFTED tY:   Ronald E. Miller




        IV





                                                                      Greater  Delaware   Valley



                                      FIGHTING RESPIRATORY DISEASES


                          Respiratory failure,  like heart or kidney failure, can often
                be reversed if the victim gets  proper treatment in time.  Establishing regional
                centers to provide advanced treatment for people with acute respiratory failure
                is one of GDVRMP's current objectives.
                                                 Dr. Robert F.lj"ntn, coordinator, Head, Chest
                Section, Hahnemann Medical College and Hospita , a    @ining program for physicians
                and allied health personnel in the treatment of respiratory failure,
                A total of 87 professionals have been trained.

                          Surgical problems, neurological diseases, poisoning
                                                                              ,)or   overwhelming
                pneumonias can cause respiratory failure. Most cases,  however)  are  caused  by
                chronic obstructive lung diseases such as chronic bronchitis, pulmonary emphysem@
                and bronchial astluna.,
                           n recent years, cases of emphysema and bronchitis have   increased
                sharply. In 1955, they caused 4,946  deaths.  In  1966,  the  figure  jumped  to
                22,686.  Some experts predict these deseases may cause an many as 6,000 deaths
                in the Greater Delaware Valley this year.
                          Diseases like emphysema can also cripple.  In 1963, 14,897 people with
                emphysema received disability allowances because they could not work. Only
                heart disease disables more people.

                        .@@Adding to the problem is the growing number of older cit zens.
                Respiratory illness is greatest and mortality  highest  among  people  over  40.
                As this segment of the population has increased, the  problem  has  grown  faster
                than treatment facilities. GDVRMP's respiratory  project  is  aimed  at  helping
                close the gap.
                          When trained personnel and proper facilities  are  available  to  treat
                respiratory patients, results are impressive.  In one instance, a special
                respiratory care unit treating over 400 patients a year achieved a survival
                rate three times'higher than the rate prior to the opening of the unit.  Another
                special unit boasts an 80% survival rate among  patients  suffering  from  acute
                respiratory failure.
                          Designed to give participants intensive experience in the latest
                methods of treating respiratory failure, GDVRMPis  training  program  is  divided
                between classroom work and bedside care of the critically ill.  The faculty is
                made up of staff from three hospitals.  Guest lecturers from Temple University
                Health Sciences Center, Children's Hospital, University of Pennsylvania Medical.
                School and Geisinger Medical Center have also participated.






               FIGHTING RESPIRATORY DISEASES                                     Page Two

                         The respiratory care unit athahnemann is under the direction of Dr.
               Leon A. Kauffman,  The five bed unit serving as the training and demonstration
               center for personnel from Philadelphia and nearby Ne w Jersey hospitals.
                         The four bed unit at Allentg  @ospital,'             the general
               intensive care unit, is under the    Dr. John P.' Galgon.  It serves Lehigh,
               Northampton, Berks, Schuylkill, Carbon and Monroe counties and parts of
               Warren County in New Jersey.
                         The Wilkes-Barre General unit, under the direction of Dr. Charles E4
               Myers, is also in the intensive care unit.  It servos as the training and
               demonstation center for the northern part of the region.
                           cated in Pennsylvania's coal mining region,,,Wilkes-Barre General has
               had parti@u@Olar interest in respiratory probl@,-i  Under Dr. Myers direction,
               a clinic to treat anthradosilicosis or miners disease has been established.
               Some 400 patients visit the clinic regularly.













                                            BACK-UP SHEET





               REGION:  Greater Delaware Valley
               LOCUS OF ACTIVITY:  Operational Project
               PROJECT TITLE:  Centers for Respiratory Care
               STATUS:  Ongoing
               SPONSORING INSTITUTI@N:  Combination of hospitals
               PROJECT DIRECTOR:  Robert F. Johnson, M.D.
                                  Coordinator, Head Chest Division
                                  Hahnemann Medical College and Hospital
                                  Philadelphia, Pennsylvania
               DATES:  Started October, 19 9.
               FUNDING:  $47,953 currently
               OTHER FUNDS:  None
               @OOPERATING AGENCIES AND INSTITUTIONS:  Hahnemann Hospital, Allentown Hospital,
                         and Wilkes-Barre General Hospital
               AREA SERVED:  Major part of Greater Delaware Valley Region,
               TARGET POPULATIO_IN:  Adults with respiratory diseases.
               CONGRESSIONAL DISTRICTS:  Several
               CONRINUATION AFTER @IP SUPPORT WITITDRA14N:  To be financed by participants
                         or by solicitation from other sources
               CORE STAFF COWACT:  Stephen B. Lan-feld, M.D.
                                    Associate Director for Program
                                    Development and Operations
               DATE PREPARED:  February 14, 1972
               DRAFTED ZY_:  Ronald E. Miller




         @v







                                                                      Greater  Delaware  Valley

                  HOSPITAL PROGRAM TO IMPROVE PATIENT CARE THROUGH    SELF-EVALUATION


                          Ten area hospitals are participating in a   program to improve
                patient tare through self-evaluation in the Greater   Delaware Valley   Region.
                The project is funded by a grant approved by the GDVRMP Regional Advisory
                Group in the amount of $59,963 for the first year of operation.
                          Co-directoisof the program are: Dr.Daniel S. Fleisher, Director,
                Center for Health Education Studies, Temple University Health Sciences Center,
                and Dr. Gerald Escovitz, RMP Unit Chief, Medical  College  of  Pennsylvania,  who
                replaced Dr. Clement R. Brown, Jr., formerly Director  of  Medical  Education  at
                Chestnut Hill Hospital.
                          The improvement via self evaluation program  is  divided  into  three
                phases.  Phase One, completed by the cooperating hospitals, involves a work-
                shop at which physicians, hospital administrators,  hospital  Board  members  and
                medical record librarians develop approaches for  drawing  up  explicit  criteria
                for patient care.  A form is designed so the medical record librarian can
                gather data concerning the hospital's performance.  the  kind  of  data  needed
                is determined by the hospital's own  physicians.  The  information  collected  by
                each hospital is then compared with the criteria for  patient  care  set  forth
                by the medical staff of the hospital.
                          Phase One of the program has proven completely successful and each
                of the cooperating hospitals is committed to the two-year program.
                          In Phase Two of the program, each of the hospitals will select
                three diseases, conditions, operations, or other problem areas in patient
                care. The selections may vAry from  hospital  to  hospital.  Once  the  choices
                are made, each hospital will set its own optimal and minimal criteria  or
                patient care in the chosen areas. Data on patients in  each  area  will  then  be
                collected.from hospital records.
                          Phase Three calls for careful study by each hospital of its own
                data and narrowing the selected problem areas from  three  or  two.  Which  two
                are selected will depend on the discovery of deficits in patient  care  -  some
                area of perfomancebelowthe hospital's own minimal criteria.  After analyzing
                P.0 ssible reasons for the deficits, the hospital, with the assistance of the
                project directors, will design   educational programs aimed at overcoming
                them. One year after  the  educational  programs  have  been  launched  patient
                records will be re-examined to measure changes in hospital performance.











                                             BACK-UP SHEET




               REGION:  Greater Delaware Valley Regional Medical Program
               LOCUS OF ACTIVITY:  Operational Project
               PROJECT TITLE:  Improving  Patient Care Through Self-Evaluation
                  T S-  In  second year of thirty-month program approval.
               SPONSORING INSTITUTION:  Combined community hospitals.
               PROJECT CO-DIRECTORS:  Daniel S. Fleisher, M.D.      and    Gerald Escovitz, M.D.
                                       Director, Center for Healtb         Chief, RNP Unit
                                         Education Studies                 Medical College of
                                       Temple University Health              Pennsylvania
                                         Sciences Center                   Philadelphia, PAi
                                       Philadelphia, Pa.

               DATES:  Operational - August, 1970
               FUNDING:  $59,963 first year; $57,276 second year.
               OTHER FUNDS:  None.
               COOPERATING AGENCIES AND INSTITUTIONS:  Ten community hospitals.
               AREA SERVED:    Major portion of Greater Delaware Valley including Philadelphia.
               TARGET POPULATI i@TS:  Hospital patients generally.
               CONGRESSIONAL DISTRICTS:  Not applicable.
               CONTINUATION AFTER RMP SUPPORT WITIIDRAI@N:  Individual hospitals to assume
                          continuation costs.
               CORE STAFF CONTACT:  Stephen B. Langfeld, M.D.
                                     Associate Director for Program
                                     Development and Operations
               DATE PREPARED:  February 14, 1972
               DRAFTED BY:  Ronald E. Miller











                                                                       Greater Delaware Valley


                                           KIDNEY PROGRAM


                         A grant to launch a regional program for patients with kidney
               disease has been approved by GDVRMP and funded by Regional Medical Programs
               Service.
                         The Regional Kidney Program is working for increased use of home
               dialysis and the expansion of existing dialysis units.  It will also estab is
               a central information service including a registry of kidney patients, dialysis
               capability, tissue typing, transplant candidates and the availability of kidney
               donors.
                         About 250 cases-of renal disease needing dialysis are diagnosed each
               year in the Greater Delaware Valley.  Some authorities feel that people between
               the ages of 15 and 54 are the most suitable candidates for diaylsis.
                         The cost of treatment is a major problem.  Dialysis in a' hospital
               costs about-$14,000 per year.  Home dialysis costs about the same the  irst
               year but is reduced to slightly over $3,000 in following years.
                         Estimates are that at the end of five years costs for  dialysis
               patients in the Greater Delaware Valley will total an average of $3.5 million
               per year.
                         Three states recently acted to help patients pay the high  cost
               of treat ent. Pennsylvania has enacted legislation providing  $1  million
               a year for patient support.  New Jersey has allocated $250,000 and Delaware,
               $581,000.
                         The Regional Kidney Program will encourage additional  projects
               to aid kidney patients.  One project now being drawn up calls for training
               nurses in dialysis.  Another is for training technologists.
                         The kidney program is sponsored by the University City  Science
               Center.  William C. Ellenbogen is project director.












                                           BACK-UP SHEET




               REGION:  Greater Delaware Valley
               LOCUS OF ACTIVITY:  Operational Project
               PROJECT TITLE:  Renal Disease Patient Support Program
               STATUS:  Ongoing
               SPONSORING INSTITUTION:  University City Science Center
               PROJECT DIRECTOR:  William C. Ellenbogen
                                 University City Science Center
                                  Philadelphia, Pennsylvania
               DATES:  Started April, 1971
               FUNDING:  Current year $23,360
               OTHER FUNDS:  None
               COOPERATING AGENCIES AND IN TITUTIONS: Medical schools, hospitals, health
                         departments, voluntary agencies, and practicing physicians in
                         Regioni
               AREA SERVED:  Entire area covered by GDVRMP
               TARGET POPNATION:  All persons in Region affected by renal disease
               CONGRESSIONAL DISTRICTS:  Various
               CONTINUATION AFTER RMP SUPPORT WITHDRAWN:  Participating hospitals, official
                         and voluntary agencies expected to be sources of funding together
                         with government.
               CORE STAFF CONTACT:  Stephen B. Langfeld, M.D.
                                    Associate Director for Program
                                    Development and Operations
               DATE PREPARED:  February 14, 1972
               DRAFTED BY:  Ronald E. Miller




        l@ v-





                                                                   Greater Delaware  Valley


                                CORONARY AND INTENSIVE CARE TRAINING


                         Three hundred sixty-one nurses from 44 hospitals in the Greater
               Delaware Valley have received training in coronary intensive care  in  programs
               sponsored by GDVRMP.
                         They were trained in 22 sessions at four hospitals.  Sixty-two
               of the.nurses received training in general intensive care, including respiratory
               failure, head trauma, kidney failure and other acute conditions inaidition
               to basic instruction in coronary care.
                         The coronary care courses were given at Wilkes-Barre General Hospital,
               Reading Hospital and Wilmington Medical Center. The general  intensive  care
               course was given at Allentown Hospital. All Pour programs  are  continuing  and
               will train additional nurses.
                         GDVRMPis program stresses cooperation among@S",N)'3.'tals
                      for high quality training.-@iaculty                 are  recruited  from
               several institutions and the trainees come from a number of  hospitals.  The
               44 hospitals that have sent nurses represent more than a quarter of the  165
               voluntary short-term general hospitals in the region.
                               most of the nurses who received training,      r came from
               nearby hospitals, one came from 170 miles and another came from Jerome, Idaho,
               a distance of 2,400 miles.

                         About 68 percent of the nurses taking the training courses are
               currently employed in CCU/ICU's, and an additional 10 percent have been
               so employed at some time since completion of their training.

                         While many of the nurses came from hospitals that already had CCU'S,
               some hospitals sent nurses with the idea of establishing units when t e trainees
               returned. Other hospitals had CCU's that were running  below  capacity  because
               of staff shortages.  The training the nurses rece     ?,n, "GDVRMP      'permitted
                                                                ived(         --,Programs)
               the hospitals to increase their service.
                         A survey conducted among all trainees at the end of the courses
               showed most nurses enthusiastic about the program.  Comments ranged from "an
               excellent learning experience" to "I feel more adequate to go back and work in
               the unit of my own hospital."












                                            BACK-UP SHEET




                   REGION:  Greater Delaware Valley
                   LOCUS OF ACTIVITY:  Operational Project
                   PROJECT TITLE:  Coronary Care Training; Intensive Care Training
                   STATUS:  Ongoing
                   SPONSORING INSTITUTIOR:  Various hospitals
                   7ROJECT DIRECTORS:  One for each of four programs
                   DATES:  Late T5-6-9 to present
                   FUNDING:  Current year - Coronary Care - $44,428; $43,461; $44,227, and
                          Intensive  Care - $48,887.
                   OT'HER FUNDS:  None
                   COOPERATING AGENCIES AND INSTITUTIONS:  Medical Schools, hospitals,
                          official and voluntary agencies, practicing physicians  and nurses
                   AR      VED:  Major part of area contained in GEVRMP
                   TARGET POPULATION:  All prospective patients in Region
                   CONORE8S!ONAt-I-BTRICTS:  Various
                   CONTINUATION AFTER PKIP'SUPPORT WITHDRAIQN_:  It is anticipated that
                          participating hospitals, schoo s and agencies will develop sources
                          of funding for continuation of programs
                   CORE STAFF CONTACT:  Stephen B. Langfeld, M.D.
                                        Associate Director for Program
                                        Development and Operations
                   DATE PREPARED:  February 14, 1972
                   DRAFTED BY:  Ronald E. Miller







                                                                   Greater Delaware Valley



                                 VNA-HOMEMKER CONSOLIDATION PROJECT





                         The Visiting Nurse Association, with three offices in Luzerne
               County, Pennsylvania, and the Homemaker Service Agency of Luzerne County,
               have 'Consolidated into a single organization which is working with the
               cooperation of other health planning and provider organizations to reduce
               duplication and pb improve home health service to residents of the county.
               The consolidated agency is known as Home Health Services of Luzerne County.

                         The consolidation developed from the recognition that a large
                  y@-of persons eligible for discharge from hospitals could not be discharged
               due to their inability to obtain adequate home health services             @ou7g6-
               @ho-l@ds while convalescing, and that there were many other persons who require
               more complete health care than they were obtaining.

                         Health services provided by this  consolidated  agency  include  nursing
               care, homemaker service, home health aide service,  medical  social  work,  speech
               therapy, physical therapy and occupational therapy.  In effect, the development
               of this consolidated agency has provided this community with a "hospital without
               walls".


                         Additional health services are being added as  the  new  agency  becomes
               more involved in the total health care problems of  the  area.  A  recent  service
               added is that of providing home care for respiratory disease patients.

                         Other health providers in the area have endorsed this concept of
               consolidated services, and third-party payment agencies have expresse
               interest.


                         The GDVIOIP participated in the consolidation in  the  planning  process
               and provided  partial financing.















                                               BACK-UP SHEET








               REGION     Greater Delaware Valley Regional Medical Program
               LOCUS OF ACTIVITY:     Planning Project
               PROJECT TITLE:     VNA-Homemaker Consolidation
               STATUS:    Completed
               SPONSORING INSTITUTION:     Homemaker Services of Luzerne County
               PROJECT DIRECTOR:     Robert V. Stevens
                                     United Penn Bank
                                     Wilkes-Barre, Pennsylvania 18701

               DATES:  Fall, 1971
               FUNDING-    $5,000
               OTHER FUNDS:      various
               COOPERATING AGENCIES AND INSTITUTIONS:      Wyoming Valley United Fund; Blue Cto6s
                          of Northeastern Pennsylvania; Welfare Planning Council, Wilkes-Barre,
                          Penna.; Model Cities Agency, Wilkes-Barre; Rural Health Corporation
                          of Luzerne County, Health & Hospital Planning Council of Northeastern
                          Pennsylvania
               AREA SERVED:    Luzerne County, Pennsylvania
               TARGET POPULATION:     Hospital Patients being discharged
               CONGRESSIONAL DISTRICT:     Honorable Daniel J. Flood #11
               CONTINUATION AFTER RMP SUPPORT WITHDRAWN:       Self-sustaining
               CORF, STAFF CONTACT:    Stephen B. tangfeld, M.D.
                                       Associate Director, Program Development and Operations
               DATE PREPARED:     2/14/72
               DRAFTED BY:    Ronald E. Miller






                           Program staff members are utilizing their talents in working with
                   physicians who a-re specialists in drug abuse to produce a Drug Abuse Manua'-,
                   titled "Guide to the Perplexed."  Individuals and organizations in the
                   community have shown interest in the project.  For example, the State
                   Department of Fducation has -requested 400 copies.
                           The target group for the manual is primarily physicians, but will
                   be of value to anyone working with those abusing drugs.  The booklet will
                   assist workers through the frustrating maze of fact and fantasy which so
                   often dominates the area of drug abuse and addiction.
                            Sections of the manual, separated into different colors, cover the
                   following subjects:  1) the current drug scene in Hawaii; 2) street names
                   of drugs; 3) diagnosis and treatment; 4) chemistry, physiology and
                   complications of drugs; 5) bibliography; 6) signs and symptoms; 7) comunity
                   services and programs; and, 8) legislation.  To combat obsolescence, a
                                                                           covering  current
                   newslettervin addendLn fonn will be mailed periodically"
                   drug information) to those requesting such material.  The manual will be
                   a quick aid to assist health workers to communicate easily and knowledgeably
                   with drug users, thereby enabling them to give timely aid and assistance.








                                              Back-up Sheet


            Region:  Regional medical Program of Hawaii
            Locus of Activity:  Core Activity
            Project Title:  Desk Reference on Drug Abuse
            Status:  Coinpleted
            Sponsoring Institution:  Regional Medical Program of Hawaii
            Project Director, Title, Address:  Masato Hasegawa, M.D.
                                               Executive Director
                                               Regional Medical Program of Hawaii
                                               1301 Punchbowl Street
                                               14onolulu, Hawaii 96813
                                               (808)-S31-6525

            Dates:  October 1971-March 1912
             unding:  Initial cost $3,595.for 1,000 copies.  Manual will be sold at an
                      appropriate cost to defray expenses of printing and binding.

            other Funds:  None
            Cooperat@ Agencies & Institutions:  State Department of Health, Division of
                                                  Mental Health, Alcohol and Drug Abuse Clinic;
                                                  University of Hawaii, Medical School, Department
                                                  of Pharmacology; and private physicians

            Area Served:  All of Hawaii
            Target Po7pulation:  500 Physicians, 400 Teachers and Counselors, and 100 Allied
                                Health Workers
            Continuation After RV mort withdrawn:  This is a one-time proj    ect.  Follow-UP
                                                       newsletter will be published by program
                                                        staff.

            Core Staff Contact:  Masato Hasegawa, M.D., Executive Director, REH
            Date Prga-red:  February 15, 1972





                                                                    AIR MAIL SPECIAL DELIVERY





                    Regional Medical ProgTam of Hawaii/ H@,k,@ss Pavilion, 1301 Punchbowl Street, Honolulu, Hawaii 96813 Phone 531-6525 Cable RMPHawaii





                                                              February 15, 1972





                 TO:      Patricia Q. Schoeni
                          Acting Director
                          office of Communications and Public Information-@

                 FROM:    Masato Hasegawa, Executive Director


                   SUBJECT:
                          Vignettes on RMP Activities                    j


                          In accordance with your memo of January 6, 1972 we are
                          enclosing a vignette from this Region.
                          I hope you are able to use this even though we have
                          missed the deadline.




                          fk
                          Encl. - "Desk Reference on Drug Abuse"





                                                             TT T IT,  OIC



                                     @',i(dne-; Di.sease P@og@am

               More thEii).350 I_]_-'I-104S ViCti@CIS of end-stage renal failure
           are waiting for         transplants. Their alternatives to
           transplanta@L-ion are a lifetime of hemodialysis(using  the
           artificial kil@l,ney riachi,-,,c) or death. Chronic kidney disease
           kills more AyiLericans yearly than automobile accidents. But
           enough kidneys are not being donated to  meet  the  present
           demand for transplants.
               The Illinois Kidney Disease Program(IKDP)  is  a  joint
           project of the Illinois  Regional Medical Program  and  the
           Illinois Department of Public Health. Since  it  began  in
           August, 1971, IKDP has worked to formalize the network of
           renal care providers to ensure quality  care  for  all
           chronic renal patients. IKDP is involved in educating
           the medical and lay populations about  the  needs  of
           the chronic kidney patient, and in providing the
           expertise to meet those needs.
             IKDP transplant surgeons are on call 24 hours  a  day  to
           perform nephrectomies and give advice  on  potential  donor
           suitability. One central number  connects  all  physicians
           in the state with Program personnel  and  the  various
           facets of transplant procedure can be begun from
           one location.
               When a physician obtains permission for an organ
           donation, he contacts the IKDP  surgeon  who  advises
           him on donor suitability. The IKDP man then calls
           a central tissue typing laboratory at the University
           of Illinois Hospital in Chicago. This lab identifies
           and locates the renal patients  most  closely  matched
           in blood and tissue type to the  potential  donor.  A
           strict best match policy is enforced.  If  no  appropriate
           match is found, the kidney is sent where  there  is  a
           good match. Organs have gone as far as Omaha, and
           have been received from Vancouver  and  New  Orleans.

               .Police and fire departments, the  Illinois  Emergency
           Services System, and private  citizens  all  cooperate
           with IKDP by providing cars, small planes  and helicopters
           for the Program's donor retrieval teams. IKDP surgical
           teams get to a potential donor as quickly as possible.
           Most nephrectomies are performed within  an  hour  of
           death. Last winter, Illinois and Wisconsin State troopers
           joined with City of Chicago police to form  a  relay  that
           delivered a kidney from Milwaukee to a Chicago transplant
           center in about two hours.





                                   more






           add one                                             ELLINOIS

                       Illinois Ki     Disease Progr_anl
               After removal, kidneys are brought to Ch.il@reii's
           Memorial Hospital in Chicago, where they are evaluated on a
           Belzer apparatus. The Belzer, funded by IKDP,  preserves
           kidneys for up to 72 hours, allowing ample time to
           observe the organs, and often preventing useless transplants.
               Training physicians, nurses and technicians in nephrology
           is another major concern of IKDP. Visits to participating
           medical centers are encouraged and geared to the expertise
           of individual groups. IKDP and'the Kidney-Foundation  of
           Illinois sponsor a symposia series for practicing internists
           and general practitioners to focus on specific  clinical
           and practical problems related to renal disease.  These
           one day conferences are periodically convened in different
           cities around the state.
               IKDP also has a traveling representative who meets with
           hospital administrators, nurses and medical personnel to
           discuss the Program and its needs. Physician awareness is
           a vital part of the kidney shortage solution, and  these
           talks emphasize the assistance physicians and  hospital
           personnel can provide to the renal victim. !KDP's central
           procedure number, posted in every hospital and
           emergency room in the state, serves as a continual
           reminder that kidney donations are desperately  needed.
               in only one year of operation, more than 100 cadaver
           kidneys have been donated through the IKDP. Seventy  of
           these have been transplanted in Illinois.. The public
           and professional awareness of the need for kidneys is
           increasing. Donor retrieval and transplant procedures
           have been sophisticated and streamlined.'Further
           refinement of the Illinois kidney i-,,etwork through the
           IKDP will continue to help transform unavoidable  death
           into the extension of life.for other peo@16-@











                             BACK UP SHEET

            egion: Illinois Regional Medical Program
            Locus of activ@: operational project
            Prolect Title: Illinois Kidney Disease Program

            Status: ongoing
                          itution: Northwestern University

            Project Director: Frank A. Krumlovsky,M.D.
                             Ass,ociate in Medicine
                             Northwestern University Med-ical--School
                             303 E. Chicago Avenue
                             Chicago, Illinois 60611
                              (312) 9 44-42 0 0

            Dates: April 1972- March 31, 1975

            Fundin : 01 year $364,000
            Other funds: Illinois Department of Public Health
                        in- kind contributions by participating institutions
            Cooperating agencies & institutions: Illinois Department of
              Public Health, Kidney Foundation of Illinois, University of.
              Illinois Medical School, Northwestern Memorial Hospital
              (Passavant Memorial Hospital and Wesley Memorial Hospital
              merger), University of Chicago-Pritzker School of Medicine,
              Veteran's Administration Research Hospital, Evanston Hospital
              (Evanston), Childrenis Memorial Hospital,  Memorial
              Hospital(Springfield), St. Francis Hospital(Peoria),
              City Colleges of Chicago, Chicago Heart Association,
              Illinois Academy of General Practice, Chicago Medical
              Society, Chicago -Pediatric Society, North Suburban
              Association for Health Resources, Illinois  Masonic
              Hospital Association, Southern Illinois Hospita
              Corporation(Carbondale),Christ Community Hospital(Oak Lawn),
              Rockford Clinic(Rockford), Christie Clinic(Champaign),
              Kishwaukee Valley Medical Group(Woodstock), Blessing
              Hospital (Quincy), Mercy Hospital(Urbana), Moline Public
              Hospital(Moline), Illinois Heart Association,  West
              Suburban Hospital(Oak Park)

            Area served: state of Illinois
            Tarqet population: all Illinois end-stage renal victims

            Congressional districts:entire state

                               more










            add one
                           BACI@, T,'..-, @"--)"@lh'ET

            Continuation auto,-,.    support                        for this
                                              withdrawn: planning
              through       anc'. oi--I,ior resoti.-i-ces is a part of the project's
              activity, since this relatively new     field is not currently
              a routinely supported part of the health care system.

            Date Prepared:  8/30/72

            Drafted by: Cynthia B. Brilliant






           add one                                             ILLINOIS

                      Illinois Kidney Disease Program
              After removal, kidneys are brought to Children's
           Memorial Hospital in Chicago, where they are evaluated on a
           Belzer apparatus. The Belzer, funded by IKDP,  preserves
           kidneys for up to 72 hours, allowing ample time to
           observe the organs, and often preventing useless transplants.
              Training physicians, nurses and technicians in nephrology
           is another major concern of IKDP. Visits to participating
           medical centers are encouraged and geared to the expertise
           of individual groups. IKDP and the Kidney Foundation  of
           Illinois sponsor a symposia series for practicing internists
           and general practitioners to focus on specific  clinical
           and practical problems related to renal disease.  These
           one day conferences are periodically convened in different
           cities around the state.
               IRDP also has a traveling representative who meets with
           hospital administrators, nurses and medical personnel to
           discuss the Program and its needs. Physician awareness is
           a vital part of the kidney shortage solution, and  these
           talks emphasize the assistance physicians and  hospital
           personnel can provide to the renal victim. IKDP's central
           procedure number, posted in every hospital and
           emergency room 'n the state, serves as a continual
           reminder that kidney donations are desperately  needed.
               In only one year of operation, more than 100 cadaver
           kidneys have been donated through the IKDP. Seventy  of
           these have been transplanted in Illinois. The public
           and professional awareness of the need for kidneys is
           increasing. Donor retrieval and transplant procedures
           have been sophisticated and streamlined. Further
           refinement of the Illinois kidney network through the
           IKDP will continue to help transform unavoidable  death
           into the extension of life.for other peo@ld-@











                             BACK UP SHEET

           Region: Illinois Regional Medical Program
           Locus of activ@: operational project
           Project Title: Illinois Kidney Disease Program

           Status: ongoing
           Sponsoringlinstitution: Northwestern University
           Project Director: Frank A. Krumlovsky,M.D.
                             Associate in Medicine
                             Northwestern University Medical-School
                             303 E. Chicago Avenue
                             Chicago, Illinois 60611
                             (312) 944-4200

           Dates: April 1972- March 31, 1975

           Fundihg: 01 year $364,000
           Other funds: Illinois Department of Public Health
                        in- kind contributions by participating institutions
           Cooperating agencies & institutions: Illinois Department of
             Public Health, Kidney Foundation of Illinois, University of
             Illinois Medical School, Northwestern Memorial Hospital
             (Passavant Memorial Hospital and Wesley Memorial Hospital
             merger), University of Chicago-Pritzker School of Medicine,
             Veteran's Administration Research Hospital, Evanston Hospital
             (Evanston), Children's Memorial Hospital,  Memorial
             H6spital(Springfield), St. Francis Hospital(Peoria),
             City Colleges of Chicago, Chicago Heart Association,
             Illinois Academy of Gendral Practice, Chicago Medical
             Society, Chicago Pediatric Society, North  Suburban
             Association for Health Resources, Illinois  Masonic
             Hospital Association, Southern Illinois Hospital
             Corporation(Carbondale),Christ Community Hospital(Oak Lawn),
             Rockford Clinic(Rockford), Christie Clinic(Champaigh),
             Kishwaukee Valley Medical Group(Woodstock), Blessing
             Hospital (Quincy), Mercy Hospital(Urbana), Moline Public
             Hospital(Moline), Illinois Heart Association,  West
             Suburban Hospital(Oak Park)

           Area served: state of Illinois
           Target population: all Illinois end-stage renal victims

           Congressional districts:entire state


                              more









          add one
                        BACK UP SHEET

          Continuation after RMP support withdrawn: planning for this
            through fees and other resources is a part of the project's
            activity, since this relatively new field is not currently
            a routinely supported part of the health care system.

          Date Prepared:  8/30/72

          Drafted by: Cynthia B. Brilliant







                                                                   ILLINOIS



                              IMPROVING THE MEDICAL RECORD


                 Physicians today are faced with  great  demands  on  their
                 time and energy.  It makes sense that improving the
                 traditional, often chaotic medical record would help
                 physicians provide  better  patient  care.  The  Illinois
                 Regional Medical Program (IRk4P),  recognizing  this  need,
                 has committed itself to  implementing  the  Problem  Oriented
                 Medical Information  System  (PPOMIS)  in  Illinois.  This
                 method, originated by Dr. Lawrence L.  Weed  of  the  Univer-
                 sity of Vermont Medical  Center,  establishes  a  logical
                 framework for keeping patient records.
                 Using the PROMIS concept, the  physician  sets  down  data
                 relating to specific patient  problems  in  a  structured
                 manner. Key  elements  of  PROMIS  are:  1)  establishing
                 a data base; 2) formulating all  patient  problems;  3)  set-
                 ting up treatment plans for each  problem  and  4)  follow-
                 ing up each problem with progress notes.  A problem-
                 oriented medical record  allows  a  physician  unfamiliar
                 with a patient to see at  a  glance  the  patient's  problems
                 and what steps have already been  taken  to  alleviate  them.
                 The IRMP is promoting PROMIS by several methods.  A problem-
                 oriented strategy group  of  interested  health  professionals
                 from all over the state has been  formed  and  has  adopted
                 a three-level plan for  PROMIS.  The  clinical  component  is
                 dealing with how to implement  the  concept;  the  technologi-
                 cal component is developing  manual  and  computerized  tech-
                 nology for those desiring it  and  the  pedagogical  component
                 is investigating teaching methods for PROMIS.  Subcommittees
                 are currently concentrating  on  developing  format,  data
                 base and educational guidelines and examples.
                 IRMP is also circulating copies  of  Dr.  Weed's  film,  "The
                 Problem-Oriented Medical Record," to interested individuals
                 and institutions around the state.  There  are  p  ans  to
                 develop a PROMIS training film.  A bibliography of articles.
                 relating to the PROMIS concept has been compiled.
                 Several institutions in Illinois  have  begun  using  the
                 Iproblem-oriented medical  record  in  Various  departments,
                 including Michael-Reese Hospital,   Chicago;  Hines,   Downey
                 and Westside Veterans  Administration  Hospitals,  and  Rush-
                 Presbyterian-St.  Luke's  Medical  Center,  Chicago.  Medical
                 students at the Peoria School  of  Medicine,  Abraham  Lincoln
                 School of Medicine  and  Northwestern  University  are  being
                 introduced to PROMIS.
                 By bringing together all  the  institutions  and  individuals
                 in Illinois working with the problem-.,.oriented  medical
                 record, IR-MP is hopeful that a  unified  system  of  medical
                 record keeping can be developed  for  the  entire  state.







                                              Back-    li e et

                ion:  Illinois Regional Medical Program, Inc.

             Locus-of            Core Activity
             Project Title: Problem Oriented Medical Information System (PROMIS)

             Status: Ongoing

             Sponsorinq Institution:  Illinois Ri4P
             Project Director:   Marvin A. Schilder
                                 Associate Executive Director
                                 Illinois Regional Medical Program
                                 122 South Michigan Avenue, Suite 939
                                 Chicag@, Illinois 60603

             Dates:  March 1972 - PROMIS Strategy Group met for the first time.

                       $90,000 for 01 year

             Other Funds: None
             Cooperating Agencies and Institutions: Michael Reese Hospital and Medical Cenfer,
                  Chicago;  [,It. Sinai Hospital and Medical Center, Chicago; Northwestern
                  University Medical School,  Chicago;  Rush-Presbyterian-St.  Luke's  Medical
                  Center, Chicago; University of Illinois, School of Basic Medical Sciences,
                  Champaign-Urbana;  University of Illinois, Abraham Lincoln School of
                  Medicine, Chicago; University of Illinois, Rockford School of Medicine,
                  Rockford; Chicago College of Osteopathic Medicine;  Educational Support
                  Resource, University of Illinois College  of  Medicine,  Chicago;  Hines  VA
                  Hospital;  Illinois Institute of Technology - Research Institute, Chicago;
                  Mercy Hospital, Urbana-, University of Chicago;  Southern  Illinois  Univer-
                  sity, Carbondale. Efforts are underway to involve as many hospitals and
                  medical schools in the PROMIS strategy as possible.

             Area Served: entire state of Illinois
             Target Population:  16,000 Illinois physicians, as well as other health
                  professionals

             Congressional Districts: entire state
             Continuation after RMP Support withdrawn: If the  PROMIS  effort  is  successful,
                  it will be carried On in the everday workings of the doctor's office,
                  the hospital and medical school. PROMIS  seeks  to  change  the  physician's
                  working behavior. IRMP funds are currently  being  used  to  facilitate  the
                  development of a uniform problem-oriented medical record system in
                  Illinois.
             Core Staff Contact:  Marvin A. Schilder, Associate Executive Director

             Date Pr    red: 8/30/72

             Drafted by: Ellen Soo Hoo






                                                             ILLINOIS



                           Illinois Kidney Disease Program
               More than 350 Illinois victims of end-stage renal failure
           are waiting for kidney transplants. Their alternatives to
           transplantation are a lifetime of  hemodialysis(using  the
           artificial kidney machine) or death. Chronic kidney disease
           kills more Americans yearly than automobile accidents. But
           enough kidneys are not being donated to meet  the  present
           demand for transplants.
               The Illinois Kidney Disease Program(IKDP) is  a  joint
           project of the Illinois Regional Medical Program  and  the
           Illinois Department of Public Health. Since  it  began  in
           August, 1971, IKDP has worked to formalize the network of
           renal care providers to ensure quality care  for  all
           chronic renal patients. IKDP is involved in educating
           the medical and lay populations about the  needs  of
           the chronic kidney patient, and in providing the
           expertise to meet those needs.
             IKDP transplant surgeons are on call 24--hours,a-day  to
           perform nephtectomies and give advice on  potential  donor
           suitability. One central number  connects  all  physicians
           in the state with Program personnel and  the  various
           facets of transplant procedure can be begun from
           one location.

               when a physician obtains permission for an organ
           donation, he contacts the IKDP surgeon  who  advises
           him on donor suitability. The IKDP man then calls
           a central tissue typing laboratory at the University
           of Illinois Hospital in Chicago. This lab identifies
           and locates the renal patients most  closely  matched
           in blood and tissue type to the potential  donor.  A
           strict best match policy is enforced.  If  no  appropriate
           match is found, the kidney is sent where there  is  a
           good match. organs have gone as far as Omaha, and
           have been received from Vancouver and  New  Orleans.

               Police and fire departments,  the  Illinois  Emergency
           Services System, and private citizens  all  cooperate
           with IKDP by providing cars, small planes  and helicopters
           for the Program's donor retrieval teams. IKDP surgical
           teams get to a potential donor as quickly as possible.
           Most nephrectomies are performed within an  hour  of
           death. Last winter, Illinois and Wisconsin State troopers
           joined with City of Chicago police to form  a  relay  that
           delivered a kidney from Milwaukee to a Chicago transplant
           center in about two hours.





                                   more







                                                                        ...........






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




      I N F 0        R   M A T           0 N         D A T A
     PROMOTING COOPERATIVE EFFORT IN THE ORGANIZATION AND DELIVERY OF QUALITY PATIENT CARE
            (Heart Disease, Cancer, Stroke, Kidney Disease, Chronic Pufn)onary Disease. Diabetes)



                 CLARK COUNRIY @rrH STUDY GROUI'



                   1300 WEST MICHIGAN STREET, INDIANAPOLIS, INDIANA 46202 317/264-8492

                                       .A                 -R@
                An Indiana comurity and eight neighboring townships    being  assisted
           in their determination of health needs by the Indiana Regional Medical ProSran.
           The effect may ultimately lead to constriction of a new health clinic and to a
           wide range of health services for resiiE!nl:s of thp- ccnmunity.
                The project was triggered when public announcement of highway  construc--
           tion plans signalled the displacement of a medical clinic owned and operated by
           a physician in Charlestown, F, southeastern Indiana comruniLy o-@' 5,726 residents.
           The physician requested I@ assistance in dete@-,ing the range  of  services
           that should be offered by the replacement clinic he planned to build.
                IRT's first act was to help fonn an ad hoc state advisory co@t-tee  to
           guide the project's initial stage.  NaTned to this cam-Littee were represe-Titati\7es
           from the Indiana State Board of Health, Indiana Heart Association, Indiana Tuber-
           culosis and Respiratory Disease Association, and IRT.  Ea&, c@ttee member
           shared a con=n talent: skill in L-ommunity development and organization.
                After a series of mee-@gs, the ad hoc c@ttee began the task of compil-
           ing necessary preliminary dat-a--demaraphic'@ormation, leadership profiles,
           and lists identifying interested health providers and citizens.  The c@ttee's
           work led to the @Lorrat2-or. ol' @,e @,Torth Clark County Fe,,@t@ Study C.-o,.ip,  -  rised
           of local leaders, interested citizens, and health providers  From the ranks of







           Page Two

           North Clark County Fealth Study Group
           A Vignette, Indiana P@


           the Heart Association &-id IRT, two resource people were named to  support  the

           study group Is v7orl,,.
                InitiAl target of the study group was to determine health needs in Charles-
           town and the eight northern townships of Clark County.  Twelve  pressing  needs
           were later identified via face-to-face surveying of 1,124  of  the  @als  5,617

           families.  The top priority              survey indicated, was that  of  estab-
           lishing a full-time e,-ner,-,ency medical service, transportation system for coirmun-
           itv residents. Even before the survey documented this need,  physicians  in  the
           c=nunity, as a result of the interest beirZ shown by  residents,  had  organized

           seven-day-a-w6e]-,, round-the-clock emergency coverage.
                Analysis of data from  the  Charlest@-Northern  Cl@  County  project  still
           co@,inues with IRIP playing an active, interested role.  Today, the study group
           operates on a broader, more comprehensive scale.  @other   organizations    have
           indicated a willingness in helping the study group meet its objectives    The
           project stands as a model of how IRMP and its many resources can bring improve-
           ments in medical care delivery to the people of Indiana.


           Prepared by:  Joe McCammon
                         Field Representative




           Al k@,


                        A significant effort has been made by the Intermountain Regional
             Medical Program to promote co.mmunity-based programs which stress continuing
             education concepts through Visiting Teaching Clinics in Heart Disease, Cancer,
             Stroke, Renal and Respiratory Disease and also through the subregional Cardio-
             vascular and Coronary Care Training Programs for Physicians and Nurses.  Several
             other seminar type training programs and "in house" traineeship programs are
             also offered at the University of Utah Medical Center.


                        Many of the above clinics have been conducted through the Subregional
             Learning Centers. and @@have proven to be beneficial in stimulating medical personnel
             to seek further training as well as to provide on-site training opportunities since
             it is often difficult for professionals to participate in training programs outside

             their own communities.


                        Regional networks are being established to provide coordinate  resources
             at graduated levels of care to form a linkage between the primary physician an
             resources of the subregional centers and the major medical centers of the region.
             When fully developed, these centers will make previously non-existent specialty
             training and care available at the local level.









                        The Carnegie Commission on Higher Education identified five
             cities encompassed by the Intermountain Regional Medical Program which
             should become Area Health Education Centers. These cities are: Grand
             junction, Colorado; Pocatello, Idaho; Billings and Butte, Montana; Cedar
             City, Utah. In three of these areas IRMP has  already  stimulated  significant
             activity through the establishment of Community Health Learning Centers.
             On-site medical education coordinators working with  local  advisory  groups
             assess educational needs and draw upon IRMP  and  other  resources  to  meet
             those needs. The health learning centers will also become quick reliable
             sources of medical information and gradually develop resource retrieval

             systems.


                        Hospitals in each learning center subregion will have access
             to a pool of AV equipment - "hardware" (projectors and recorders)  and  "soft-
             ware" (filmstrips,, slides and audio and video tapes). In addition,  centers
             will serve as a vehicle for planning educational programs and  assisting  with
             the over-all health planning activities of the area.  Funding for the Centers
             has been a cooperative effort of the IRMP, hospital  associations,  hospitals,
             and other local groups. Workshops and seminars in  such  fields  as  trustee
             orientations, infection control, emergency room service,  neonatal  care,  and
             burn therapy have been presented based upon identified needs.








                        The estimated 44, 000 diabetics in the Intermountain Region will
             receive assistance in understanding and dealing with their illness through
             the Diabetes Education Program of the Intermountain Regional Medical Program.
             The project is establishing a Diabetes Education Center at Holy Cross Hospital
             in Salt Lake City, Utah. The Center is designed to provide the diabetic patient
             and a selected family member with a "live-in" educational experience for five
             days.  During that period of time, patients are given self-care training skills
             for self-management and to recognize the warning signals related to complica-
             tions. Several hundred diabetics per year will participate in the educational
             programs.  The Center will also serve as a research and educational facility
             for physicians, nurses and dietitians.  Traveling programs to acquaint health
             care professionals with new developments in diabetes care will be arranged for

             the rural areas of the Intermountain Region.









                                                      KANSAS


                       model Cities Manpower Recruitment Program

                A grant of $20,415 to Model Cities Health  Manpower  and
           Recruitment by the Kansas Regional Medical Program provides  or
           a coordinator and training of nine neighborhood  health  aides
           in Kansas City, Kansas.
                After an initial orientation course lasti@g three weeks,
           each of the aides was a.ssigned, time in varying sequence to get
           first hand knowledge of the operations of six offices  of  the
           City-county Health Department and the five  other  community
           health care and social service agencies.  They  also  received
           a three week course in clinical counseling and  casework  at
           the local mental health clinic and were  separately  enrolled
           in six hours of course work at the Kansa.s City Kansas  Junior
           College.  In addition, the aides participate actively in
           preventive medicine educational programs conducted  at  public
           schools, day care centers and homes for the elderly in this area..

                The project director, Miss Francine Carter,  of  the
           City-County Health Department, consults with the  aides  on
           future vocational possibilities, supervises  their  training
           activities and counsels them in their performance.  Hopefully
           the aides will further their education or be hired  by  local
           agencies after one year with the program.

                A major function of the program is communication between
           the residents of the Model Cities area and the aides.  Concen-
           tration with the model neighborhood residents ha.s been  in
           home interviews.  From this contact stems most of the services
           rendered.

                From May 1, 1970 through December 31, 1971,  the  aides
           performed a total of 2,004 initial  household  interviews
           and 550 follow-up visits. Between July 1  and  September  30,
           1971, the aides made 708 home visits with  public  health
           nurses; made 25 referrals to clinics in  model  neighborhood
           areas; developed three educational seminars -  on  venereal
           disease, immunization and beginning case work -  and  distri-
           buted health literature.

                In December, with the coordinatot's  assistance,  each
           health aide chose a multi-problem family  for  concentrated
           visits. The purpose of the visits was to  change  the  family
           attitude to one of good health practices by  helping  the
           family understand their problems and guiding them to the proper








           Two Model Cities



           community agencies for assistance.  Follow-up was made to
           determine whether appointments were kept and whether other
           problem areas developed.

                Future plans include recruitment of health aides to
           enter into the program in August, 1972; a. continued search
           for educational resources and employment for the aides who
           have not entered into an educational program; finding means
           of transportation to Model neighborhood residents; and
           working closely with other community agencies in the area
           to coordinate services and hopefully provide better services
           to residents.







           Region:    Kansas Regional Medical Program

           Locus of Activity: Kansas City, Kansas

           Project Title:  Model Cities Manpower Recruitment Program

           Status:  Ongoing

           Sponsoring institution:  Model Cities, K. C. Wyandotte County
                             Health Department

           Project Director:  Francine Carter
                              Wyandotte County Health Department
                              Kansa,s City, Kansas

           Dates:  9/l/71 to 6/30/72

           Funding:  $20,415


           other Funds:

           Cooperating Agencies and Institutions: Ka.nsa.s City-County Hea. t
           Department, Kansas City Jr. College and Kansa.s City community
           health care and social service agencies.

           Area Served:  Model Neighborhood area

           Target Population:  18,000 households in Model Neighborhood
           Congressional Districts:      Larry Winn, Jr., Third District

           Continuation after RMP Support Withdrawn.

           Core Staff Contact:  Mary Ann Blakeney

           Date Prepared: 7/2/72     Dra.fted by:  Mary Ann Bla.keney











                                                     KANSAS


                            Nurse Clinician Program

                To determine the demand for  physicia,n's  assistants,
           the Ka.nsa.s Regional Medical Program mailed out a survey
           questionnaire to all members of the Kansa,s Medical Society.
           The 72% who responded indicated a wide variety of assistants
           would be hired. The "general''  physicians  assistants  seem-
           ed to be in most demand and the preference  to  hire  nurses
           retrained for expanded assistant roles rather than ex-
           corpsmen or newly trained personnel was apparent.

                As a result of the survey a. nurse  clinician  program
           began in January, 1972. The purpose of  the  program  is  to
           further develop nursing skills to a.ssist    e -Phvsicia.n.
           Under the supervision of the physician, the  nurses  will  be
           able to do many of the necessary things  required  in  pro-
           viding primary patient care.

                Approximately 40 nurse clinicians will  be  trained  in
           the program.  According to Jea.n Tomich, Ph.D., project
           director, "The eight week formalized courses wil  focus
           on medical biological, psychosocia.1 and health care services.
           When the nurse completes the formalized  course,  she  will
           study under the tutelage of the physician with whom she will
           be working. Each enrollee will be  sponsored  by  an  indivi-
           dual physician or an institution with  the  full  guarantee
           of employment at the completion of tra,ining.@'

                Candidates must be  licensed  professional  registered
           nurses educated in diploma, baccalaureate, or higher degree
           programs in nursing.  Through experience and job performance,
           the nurse should have demonstrated a. concern for people, above
           average learning abilities, independent thought and judgment,a.nd
           the ability to give or manage nursing care for a.  group  of
           patients. The major responsibility  of  selection  lies  with
           the sponsor of the candidate who evaluates  whether  or  no
           the candidate meets the criteria.

                In general, the physicians who answered the questionnaire
           felt that physician's assistants could both  qua,nta.tively
           and qualitatively increase their practice.







           Region:  Kansas Regional Medical Program
           Locus of Activity:  State of Kansas - Didactic training in Kansa.s City

           Project Title: Nurse Clinician Program

           Status:  Ongoing
           sponsoring Institution; KRMP and individual physicians or
                                  institutions.

           Project Cirector, Title, Address:  Jean Tomich, Ph.D.
                                              Nurse Clinician
                                              KRMP
                                              3909 Eaton
                                              Kansa@s City, Ka.nsa.s 66103

           Dates: 7/l/71 to 6/30/72

           Funding:  $80,000


           Other Funds:  None
           Cooperating Agencies and Institutions:  Individual physicians
                            and institutions in Kansas.





           Area Served: State of Ka.nsa.s
           Target Population:  Kansa@s patients of physicians and institutions.
           Congressional District:     Larry Winn, Jr., Third District

           Continuation after,RMP Support Withdrawn:
           Coro Staff Contact:       Project Director  or Mary Ann Blakeney
           D@)te Prepared:  2/2/72   Drafted by:









                                                  KANSAS



                            Model Rehabilitation Project

                In April, 1971 the St. Joseph Hospital and Rehabilitation
           Center,, a 450-bed facility located in Wichita, received  a.
           contract for $63,428 from the Kansas Regional Medical Program
           for a model rehabilitation pilot project.

                Collaborating in the project are St.  Luke's  Hospital  in
           Wellington and Kingman Community Hospital in Kingman.  Both
           hospitals are approximately 50 miles from Wichita.

                The program involves training  of  nurse  rehabilitation
           specialists from Kingman and Wellington at St. Joseph's
           in Wichita.  After training, the nurses return to their respec-
           tive hospitals to train others  in  rehabilitation  techniques.

                A "circuit" team, which includes both  a  physical  and
           occupational therapist, a clinical psychologist, speech
           therapist, home health supervisor, medical social worker,
           and nutritionist a.ssist in the complete range  of  rehabili-
           tation services provided to stroke patients  in  Kingman  and
           Wellington hospitals.

                The goal of the pilot project is to  duplicate  in  the
           local community, rehabilitation experience of a  ma.jor  re-
           habilitation center so that this program can be shared with
           other communities in Kansas.

                During the period from July 1 to December  1,  1971,  40
           inter-institutional patient referrals for rehabilitation resulted
           from the program.    so far 46 registered nurseso  10  licensed
           practical nurses and 182 aides have received training.

                Kingman County is currently seeking to  establish  a  con-
           tract with Kingman Community Hospital to  have  the  project-
           trained rehabilitation nurses provide home health care services
           to county residents.








           BACK-UP SHEET



         Region:                 Kansas Regional Medical Program

         Locus of  Activity:    Wichita, Wellington and Kingman (Kansas)

         Project Title:     Model Rehabilitation Program

         Status:     ongoing
         sponsoring institution:    St. Joseph Hospit'al and Rehabilitation
                                  Center, St. Luke Hospital and Kingman Cty Hosp.
         Project Director, Title, Address:       Alfred Hinshaw, M.D.
                                                 Garvey Laboratory
                                                 3241 Victor
                                                 Wichita, Kansas 67208


         Dates.-  5/l/71 to 4/30/72



         Funding:     $63,428



         Other   Funds   none


         cooperating Agencies and    Institutions:
                            The sponsoring three institutions.




         Area Served:   South Central Kansas area.
         Target  Population-.  Stroke victims or rehabilitation ca.ses in
                   two towns within a.radius of 50 miles from Wichita.
         Congressional Districts:     Garner E. Shriver, Fourth District

         Continua'[-ion a-fter RMP Support Withdrawn:  None known at this time


         Core Staff Contact:    Dr. Alfred Hinshaw
         Date Prepared    2/l/72                    Drafted by: Mary Ann Bla,keney





                                                        KANSAS



                               Ottawa, County Health Survey

                Recognition of the lack of public health nursing and environ-
           mental control services by        citizens of Ottawa. County, located
           in north central Kansas, resulted in a. cooperative  program by t e
           State Department of Health, the Ka.n-,as Regional  Medical  Program
           and the Ma,rymount College Department of Nursing.

                In June, 1971 with a. grant of $1,650 from Ka,nsa.s Regional
           Medical Program, an environmental survey  studied  health  con-
           ditions and the gathered information was  presented  at  public
           meetings of the concerned citizens.

                The second part of the  survey  involved  personal  interviews
           with 250 heads of households selected during the environmental
           survey.  Information was gathered from each respondent re-
           ga.rding the occupation of the head of the  household,  the  family
           size, their length of county residence, size of house, home
           sanitation facilities and family assessibility to health
           services.  The interviews also gathered data regarding the
           personal utilization of health services and the status of
           respondents.

                Conducting the interviews were 20  nursing  students  from
           Marymount College, dressed in uniform, carrying college identifi-
           cation cards.  The students were equipped with 1-hour long ques-
           tionna.ires plus the familiar instrument for taking blood pressure
           readings, "the cuff."

                By November, the  confidential  information  collected  from
           the questionnaires was coded for computer and re@lts were analyzed
           by the Kansas Regional Medical Program.

                Ottawa County has 6,1183 citizens of which  1,479  are  5-17
         @@'years o
                   f age and 1,263 are over 65 years of age.

                According to Sister Mary Savoie, R.N., the student's faculty
           advisor and director of the survey,  results  indicated  the  exis-
           tende of health problems which might be aided by a public health
           nurse.  Since Ottawa County has no such service, Sister Savoie
           and Mrs. Mary Wright, are      @,th nurse for the Kansas  State
           Health Department, have        @on"@a short term  basis,  nursing
           clinics and health information programs.

                The nursing clinic is a new type  of  health  service  which
           provides health screening checks of individuals  who  are  well
           in an effort to identify health problems before they become
           obvious.





                Page two Ottawa County

                If a problem is found in the clinic, the individual is
           referred to his physician for medical diagnosis  and  treatment.
           !@Early identification and treatment of health problems,"  said
           Sister Mary Savoie, "often saves the person huge  medical  bills
           and hospitalization for a condition which, if found earlier,
           could have been treated on an out-patient basis."

                Four county physicians are cooperating, with the two nurses
           and the senior nursing @t@ p
                                            from Marymount.  When i-t
                     ein the survey'that 34% of the county women between
           the ages of 18 and 60 had never had a pap smear, an  April  date
           wa.s set for a clinic. The physicians agreed to give  the  test
           to detect early cancer of the cervix.

                At the first three clinics, out of the 33 persons who
           attended, 8 were found to need additional evaluation  of  their
           blood pressure.  The survey showed that 90/c of the county  ouse-
           holds interviewed suffered from high blood pressure.  T e
           second series of clinics had double the number of participants.

                The nursing clinics are held in seven  locations,  Delphos,
           Wells, Bennington, Minneapolis, Ada, Tescott  and  Culver.  Two
           adjacent counties are exploring their possible participation
           in an expanded nursing clinics network.

                The Ottawa County Commissioners are  contemplating  putting
           the question of County Health Service on the ballot at the
           primary election in August, 1972, for a vote of county residents.







          BACI@UP SI-IEET  I,'OR VIGNETTE ON OTTAWA COUNTY SURVEY TO GO TO DRIMP
                          COMMUNICATIONS


        Region:      ',<ANSAS REGIONAL MEDICAL PROGRAM

        Locus of Activity:    OTTAWA COUNTY

        Project Title:  OTTAWA COUNTY SURVEY

        status:    SURVEY COMPLETED - NURSING   CLINICS IN PROGRESS

        Sponsoring Institution:      KANSAS STATE HEALTH DEPT., !AARYMOUNT COLLEGE
                                     DEPARTMENT OF NURSING
        Project Director, Title, Address:  SISTER MARY SAVOIE
                                             Professor-of Nursing
                                             Marymount College
                                             Salina, Kansas



        Dates:          Sinc6 June,-1971




        Funding:     Kansas Regional Medical Program


        Other Funds Home Demonstration Units from Ottawa County token donation of $8.00 each

       .Coo@rating Agencies and Institutions:
                     Kansas State Department of Health
                     Marymount College
                     Kansas Regional Medical Program
                     American Cancer Society


        Area Served:     Al] of Ottawa County

        Target Population:   Population of Ottawa County 6,789

        Congressiona.I:Districts:  X)% Keith G. Sebelius, First District ?

        Continual--ion after RMP Support Withdrawn:   That the program will be taken over
        by Ottawa County and supported with tax money

        Core Staff Contact:   Mary Ann Blakeney, Director of Public Information
        Date  Prepared   1/24/72                  Drafted by:  M. A. Blakeney





                                                                           LOUISIANA



                           A COORDINATED CONTINUING EDUCATION PROGRAM
                                   FOR NURSES IN LOUISIANA


            LRMP funded this project to develop a process to assess needs  for  con-
            tinuing education of nurse practitioners in each of Louisianals subregions.
            After the needs are identified, priorities are established and educational
            and training programs to meet these needs are  implemented.  State  and
            subregional Advisory Councils were formed and are responsible for assessing
            both the information on continuing education needs and  the  priorities
            for educational program implementation.  Ultimately, the activities will
            be coordinated to result in a comprehensive statewide program.
            Present, need-related information is being gathered in  all  subregions.
            This data includes an expression of felt needs from nurse practitioners,
            input from hospital administrators, nursing directors,  RMP,  voluntary
            health agencies, CHP 'lb" agencies, and various state health  agencies.
            Based on an analysis of need-related information from  each  subregion,
            individual educational programs are being prepared and conducted by
            appropriate local institutions such as nursing schools and  hospita  s.
            Nurses throughout the region will obtain much needed continuing education
            which they are not now receiving. The project also  seeks  to  stimulate
            nursing schools to assume a more active role in the continuing education
            of nurses. It is anticipated that the organization  and  processes  that
            have been initiated by the project will continue to be used by local
            groups and institutions in planning and evaluating their continuing
            education activities.








                                     BACK UP SHEET


            REGION:  Louisiana  Regional Medical Program



            LOCUS OF ACTIVITY:   Core Project


            PROJECT TITLE:  A coordinated Continuing Education Program for Nurses
                            in Louisiana




            STATUS:   Ongoing



            SPONSORING INSTITUTION: La. State Nursing Association


            PROJECTOR DIRECTOR, TITLE,_ ADDRESS:  Mr. Malcolm Martin



            DATES:   9/71- 2/72



            FUNDING:  RMP-$100,105


            COOPERATING AGENCIES & INSTITUTIONS:  Dept. of Health & Education-Heart
                                                  Association-Cancer Society-State
                                                  Medical Society-CHP 'lb" Agencies


            AREA SERVED:  State of Louisiana


            TARGET POPULATION:  RN's & LPN's


            CORE STAFF CONTACT:  Miss Jerianne Heimendinger


            DATE PREPARED    2/11/72


            DRAFTED BY:    MISS ROSEMARY STASKIEWICZ





                                                                            LOUISIANA



                              HEALTH CAREERS RECRUITMENT PROGRAM

             For the past three years, the LRMP has @ ded a Health  Careers  Recruit-
             ment Program.  Initiated in 1969, the program was established to acquaint
             high school students with educational arid training programs available in
             the health field.  It      t to inform"i'he educational institutions  of
             changes in the environment of the health care worker so that their
             graduates can m@e -5-cl@@tel@,y meet @ob needs in the health care
             system. Staff has also held conferences with  college  and  university
             administrators concerning their programs and plans for  training  health
             professionals in an attempt to acquaint health manpower  educators  with
             on-the-job needs of their graduates.
             Thirty-three counselor workshops were held throughout the state to
             orient school counselors to the opportunities in  health  careers.  Well
             over 500 health careers presentations were made by the project sta
             in 168 schools before 69,581 students. Student,$"requests  for  health
             careers literature total 4S,471. Nine high school  health  career  clubs
             have been formed.  An extensive public relations campaign was conducted
             on the radio, television, and through other advertising media, with
             little cost to the project.
             In addition, a Health Careers Newsletter was initiated in February 1971
             for school and college counselors, educators, hospitals,  health  pro-
             fessional8 and organizations.  A Financial Aid Sourcebook for Careers
             in Health was published in February 1971, providing a  detailed  listing
             of financial assistance programs available to students  entering  health
             careers.
             Since the onsiet of this program, a great impact has been realized  by
             the health affiliate schools. In the past three  years,  nursing  school
             enrollments has increased by 13-1/2%.
             Though funding support from the LRMP has terminated, the Health Careers
             Recruitment Program is being conducted through the Louisiana State
             Hospital Association.















             Feb. 1972








                                        BACK-UP SHEET




            REGION:  Louisiana Regional Medical Program



            LOCUS OF ACTIVITY:  Core Project




            PROJECT TITLE:  Health Careers Recruitment Program




            STATUS:  Terminated




            DATES:  3/69 - 2/72



            FUNDING:  $130,228



            COOPERATING AGENCIES & INSTITUTIONS:  State Medical Society, Department
                                                  of Health,, Education and Welfare,
                                                  State Department of Hospitals, CHP
                                                  'lb" Agencies, Various parish school
                                                  systems, state universities

            AREA SERVED:  Louisiana State



            TARGET POPULATION:  High school and college students



            CONTINUATION AFTER RMP SUPPORT WITHDRAWN:  Louisiana State Hospital Assn.



            CORE STAFF CONTACT:  Miss Jerianne Heimendinger




            DATE PREPARED:  2/11/72



            DRAFTED BY: Miss  Rosemary  Staskiewicz







                                                                 LOUISIANA

                     RURAL COMMUNITY HEALTH DELIVERY SERVICES PROPOSAL

            Louisiana's state-supported hospital  system  offers-the,indigent  population
            episodic acute care and a high level  of  in-patient  therapeutic  services.
            Unfortunately, this system of care is not linked with out-patient care
            resources to provide comprehensive, continuous, supportive medical
            management of chronic conditions.
            LRMP has approved and funded the Rural Community  Health  Delivery  Services
            Proposal to promote the effective linkage of  rural  health  care  resources
            and to develop a community health delivery service in  the  parish  Public
            Health Unit which will provide nursing home-bound  maintenance  and  follow-
            up services.   Through one rural parish in Louisiana,  this  proposal  seeks
            to determine whether or not improved hospital  discharge  planning  involving
            linkage of public and community funded hea t care  resources  can  mea  u  -
            bly improve the level of care utilized by  the  indigent  rural  population.
            The rural area selected is Richland parish,       Yhe poverty level is,,,so.
            great', 63.3% of the N@ro households  lack  plumbing.  The  Louisiana  State
            Department of Health, through the Richland Parish Health Officer, will
            coordinate a program with state-supported E.  A.  Conway  Memorial  Hospital
            to link resources in Richland Parish's Public Health  Unit  with  hospital
            resources, parish public welfare offices, and OEO supported health
            activities.
            Involved in the program will be a manager, a director,  a  community  health
            nurse, and a medical records clerk. The manager  (Director  of  the  Rich-
            land Parish Public Health Unit) will be responsible for the overall
            administration of the program.  The director (Associate Director of
            Nursing Services in the Northeastern Region) will be responsible for
            management and supervision of the project's  nursing  services  and  collec-
            tion and evaluation of data.
            The community health nurse will cooperate with E. A. Conway Memorial
            Hospital by providing necessary follow-up  nursirg  services  to  discharged
            patients. Upon receipt of patient referral data  from  the  Hospital,  she
            will contact the patient and/or his family in an effort  to  provide  con-
             in 't of care in accordance  with  medical  recommendations.  The  community
               ul
            hea th nurse will also be responsible  for  conducting  on-going  activities
            with community groups, physicians, public health  and  welfare  employees,,@
            rehabilitation therapists,        to stimulate functional linkage of
            health care resources for @ indigent rural patient5           ' n.
            A committee will be formed, composed of physicians and nurse practitioners,
            whose responsibility will be to assess whether or not the therapeutic
            home-bound nursing services.-rendered have significantly improved  the  level
            of health eare,for -thi-s-@--.papul--at-i-an@
            A statistical analysis will be made of the number of Richland Pbrish's
            residents who were discharged-patients-from E. A. Conway Memorial Hos-
            pital during the project term and the number of referrals made to the
            Richland Parish Health Unit.






            Rural Community Health Delivery Services (Cont'd.)
            Page 2



            If this model proves successful in Richland Parish, it will provide a
            feasible system for improving the availability and accessibility of
            continued health care for many indigent rural areas in the Louisiana
            region.











































            Feb. 1972








                                      BACK UP SHEET




            REGION:- Louisiana Regional Medical Program



            LOCUS OF ACTIVITY:   Core Activity



            PROJECT TITLE:    Rural Community Health Delivery Services Proposal



            STATUS:_  Newly Funded



            SPONSORING INSTITUTION:   State Department of Health through it's
                                      Richland Parish Public Health Unit


            PROJECTOR DIRECTOR, TITLE, ADDRESS: Miss Ruth Miller, R.N. Associate
                                                Director of Nursing Service in N.E.
                                                Region


            DATES:    March 1, 1972 through February 28, 1973



            FUNDING:   $21, 774



            OTHER FUNDS:  O.E.O. $1@200 , Public Health Unit $10,875



            COOPERATING AGENCIES & INSTITUTIONS:  State Department of Health, Dept.
                                                  of Welfare, St. Dept. of Hospitals
                                                  E.A. Conway Mem. Hosp., O.E.0,
                                                  314 CHP 'lb" Agency, local private
                                                  Medical practitoners, Richland
                                                  Health Facilities, Richland Police
                                                  Jury

            AREA SERVED: Richland Parish



            TARGET POPULATION:  Rural indigent population, Richland Parish





                                             - 2-
    I'@ .,@ v



            CORP STAF'P CNNTACT--  Mr. Jim Guillory



            DATE PREPARED:  2/11/72



            DRAFTED BY:  MISS ROSEMARY STASKIEWICZ









                                                                                                           NON-PROFIT ORGANIZATION
                                                                                                             U. S. POSTAGE PAID
                                                                                                              PERMIT NO. 175
                                                  Development, Inc.                                           AUGUST-A, MAINE

                                                                                                Address corrmtion requaW


                                                                        Rolarld
                                                                                                                   vice
                                                                        P      aign   Bldg.,   Fl.   11,   Room    39









        April 1974                                        NEWSLETTER                                   Volume 8, Number 3



                                                                                       an



                     if matters had gone according to the timetables  of  some  policymakers  in  the  Nixon  Admin-'
                istration, the week of February 7, 1974, would have been  a  week  of  farewells  throughout  Region-
                al Medical Program (RMP) offices. Ironically, however, the week of February 7 of this year brought
                news that Maine's Regional Medical Program - and RMP  facilities  across  the  nation  -  would  not
                only stay in business, but would be implementing health-care projects of pivotal importance to
                future national programs.

                     In one year, the Regional Medical Program concept was given the  official  coup  de  grace  from
                the White House, refused to die, worked to survive, and - 52 weeks  later  -  emerged  from  the  ex-
                perience stronger and wiser than before. In addition t6,-the dr--amatic events of the turn-around  -
                events in which the Maine office played a key role - the year brought  a  reanalysis  and  reevalua-
                tion of the health care programs sponsored by RMP. -That self'analysis has helped produce an
                organization that now looks forward to making  the  coming  years  even  more  productive  than  the
                busy ones of the past.


                     At no time since it was organized in the mid-Sixties had the Maine RMP office and its 55
                counterparts across the country received news as foreboding as  that  which  reached  them  on  Feb-
                ruary 1, 1973. On that date, Maine's RMP - and all the  others  -  were  notified  by  Western  Union
                Mailgram to ". . . phase out all RMP project support by June 30, 1973 . . .  ."  The  telegram  went
                on to explain that only limited federal funds would be made available  to  keep  some  staff  people
                and a few selected projects funded until February 15, 1974. By  that  date,  the  message  inferred,
                all further federal support for Regional Medical Programs would  be  stopped,  absolutely  and  with
                irrevocable finality. The President's Budget included no grant funds for any  RMP  offices  in  '74.
                     The message was generally meant to be interpreted as a notice of shut-down, the end of








                  RMP'S; and it may well have achieved those results if it had been taken without response. But
                  the staff people and program executives at Maine's RMP office believed too much in the work
                  they were doing to give up without a chance to have their  say.  They  acted  immediately  on
                  three different levels.
                    As a first action-step to make the case for  RMP'S,  program  executives  and  health  care
                  specialists turned to the U.S. Congress. In a series of special Congressional hearings called for
                  the purpose, RMP achievements across the  country  were  outlined,  projects  explained,  and
                  local representatives heard from.
                        When the hearings concluded, Congress indicated its judgments. The Senate voted 94 - 0
                  to extend RMP program funding for one more year; and the House of Representatives - a body
                  not known for its unity - voted 372 - 1 in favor of the same motion. By these votes, more than
                  any other single action, the members of Congress made it clear that they believe there is an im-
                  portant place for Regional Medical Programs in the national health care picture.

                        Next, they turned to the courts. Joining forces with the Lakes  Area  RMP  of  Buffalo,
                  New York, Maine Medical Care Development, Inc. (grantee for MRMP) participated in the ini-
                  tiation of a civil suit. On September 21 ('73), six months after the work began, the suit was
                  filed; it asked - on behalf of all 56 RMP national offices (who are now members of the Nation-
                  al Association of RMP'S) that RMP funds duly authorized and appropriated by Congress be
                  freed of the impoundments imposed by the Nixon Administration.

                     -IDEAS WANTED!

                            Limited funds and technical assistance are available for  developing  programs  in:
                               1. New Methods of Delivering Health Services
                               2. Health Manpower
                               3. Quality Assurance and Cost Assessment
                               4. Continuing Education
                             If you plan to submit proposals, however, we would appreciate receiving your
                        letter of intent at your earliest convenience.

                            Please call Manu Chatterjee, M.D. or  John  LaCasse  (622-7566)  if  you  have  any
                        questions.


                        On February 7 of this year, United States District Court Judge Thomas A. Flannery or-
                  dered Caspar Weinberger - U. S. Secretary of Health, Education, and Welfare - to distribute
                  more than $120 million in impounded funds. This will mean that all RMP offices will soon begin
                  receiving their shares of those funds. The support will come in the wake of the Federal Court
                  decision which states as a conclusion of law that RMP " . . . operational activities should be per-
                  mitted to proceed unhindered and this should be done until Congress indicates a contrary inten-
                  tion."
                        In addition to ordering the release of the impounded funds, Judge Flannery also lifted pro-
                  gram spending restrictions which had previously been imposed by Secretary Weinberger. Now,
                  every RMP will be allowed to allocate its funds to those programs and projects which most effec-
                  tively meet local and regional health care needs.

                        These two steps toward survival - one to the courts and the other to Congress - were taken
                  as united efforts in cooperation with other RMP units. A third step was taken here in Maine by





























                   the Maine RMP when it sought the help of the 106th Maine Legislature during its regular session.
                   Just as the courts and Congress had responded, so too did the men and women of the Legislature
                   when they voted a special $265,000 appropriation to help sustain Maine RMP programs which
                   had already proved their value to thousands of Maine citizens.
                         In combination, the three steps - to the Congress, courts, and the Maine Legislature -
                   took the Regional Medical Program from a position of preparing to be dismantled to one of pre-
                   paring for the future. When Judge Flannery's decision is implemented, the Maine RMP may re-
                   ceive more than $1 million. This money will permit this operation to remain effective for at



                       -GRANTBULLETI,        Af
                              A grant application in the amount of $61 1,000 for a 5-year program to expand
                         the Central Maine Family Practice Residency has been submitted to the Bureau of
                         Health Resources Development, Department of Health, Education, and Welfare.



                   least another 18 months;and this effectiveness includes the capability to operate and fund
                   worthy new projects, as well as help maintain several of those which have proven their
                   value.
                       Te dimensions of the turnaround are startling when the events of the past year are thus
                   encapsulated. From being told no funds would be forthcoming, the Maine RMP has now been


























                   informed that over a million dollars may be forthcoming. It is a heartening turn of events
                   which imposes new, and greater responsibilities.
                      Te sinew to assume those responsibilities has been reinforced by the year of past chal-
                   lenge. On the RMP side, every program was looked at and reviewed with a critical eye; and what
                   nonproductive elements there were have been weeded out. At the same time, the effort to sur-
                   vive led to the development of new and firm funding bases, including the Congress of the United
                   States, now more aware than ever of the need for a coordinated health-care mechanism which is
                   designed to help meet the growing ai-id complex medical problems of the Seventies - including
                   the approach of some form of national health insurance, and the critical need for the improve-
                   ment of health-care delivery system.-.     I
                       These are challenges which RMP offices anticipate with the confidence they have gained
                   in a turbulent year. Grateful for the help they received during that year - from such varied
                   sources as the Congress and the Maine Legislature - they scarcely paused to realize on this
                   February 15, 1974, that this was the day they were once supposed to be closing up shop.




                       -GRANTBULLETI
                              An application for $51/2million to implement eight interrelated projects in
                        education, training and utilization of health manpower in Maine has been submitted
                        to the Veterans Administration for consideration.



    /Vi
            ALT-IFD HEALTH I'll"
               A Fo            ove the education, training, and utilization    of allied health
                   I-LIM to impr
            manpower in the metropolitan Washington area was established May   1971 at-the
            14W/RMP.  Composed of health educators, practicing professionals,  and specialists
            in health needs and resources for the region,  the  idea of the Forum  grew  from
            Irecominendations presented in the Carnegie Conimission's report on "Higher Education
            and the Nation's Health". A major  theme  emerging  from the Commission's report
            was adapting health manpower educati6n to  the  changing needs of the health care
            system through responsible planning  by the a'cademic community.
                The Forum is a first step in translating concepts into acti.on programs.
            The structure provides members of the,Forum a framework for interaction and
            communication.  Interdisciplinary cooperation and exchange are prerequistes     to
            planning to meet manpower need for the Washington, D.C. metropolitan area.
            Since its creation in May, a Steering Committee of the Forum composed of
            representatives froro the National Institute of Mental Health, Comprehensive
            Health Planning Agency of  D.C., the National  Medical  Association   Foundation,
            and MW/RMP have focused efforts on  areas of deficiency and duplication in the
            education and training of allied health          el at  the'baccalaureate   level
                                                      personn
            and below.  The MVIIR14P is acting as an  information  clearinghouse  for  various
            on-going health career proarams  in the region.   The specific  purpose  of  this
            activity is to -improve communications between -academic institutions and
            clinical facilities offeri-ng education and training programs in   allied health.

            @'A study d
                     one at the direction of the Forum Committee concludes    that  while
            numbers of allied health programs are increasing in the region,     a lack of
            uniform curriculum and accreditation standards negates the value ofmany
            programs.   Information describing health career program  s at :academic institutions
            t[nd clinical facilities has @een compiled by MW/RMP   and will be published jointly
            with the National Medical Association Foundation in    Febrdary.




         ALLIED liEALTII FORUM
         Page 2


         The [iealth Careers guidebook will serve both-as a reference for prospective health
                                         as a tool for health educators in planning 'future
         professionals in the region and
         programs.  Other items to be'considered py the Forum this year include:
         curriculum innovation and reform, career ladder and lattice concepts,
         continuing education for manpower already in th'e-system', new health occupations,
         and education and training for the disadvantaged and.minority groups.






                                           Back-up Sheet


          Region:  Metropolitan Washington
          Focus of Ac         Core  Activity
          Project Title:  Allied Health Forum

          Status:  Ongoing
          Sponsoring I-nstitution:  Metropolitan Washington Regional Medical Program
          Project Director,  Title,,Address:   S. H. N. Zumbrun, Director
                                               Aliled Health Programs
                                               NWRMP
                                               2007 17,,e Street, N.V!.
                                                     .Y
                                               Washington, D.C.   20006
                                               202-223-6490

          Dates:  May 18, 1971 to present
          Funding:  Core Activity Additional Funding Not Required

          Other Funds: None
          .Cooperating Agencies and Institutions:  National Institute of Mental Health,
                                                   L;Omprehensive Health Planning Agency of D.C.
                                                   National Medical Association Foundation
                                                   Academic Institutions of the Region.
                                                   Clinical Facilities proving Training in the
                                                    Region
          Area Served:  Washington, D.C.; Arlington and Fairfax Counties and the City of
                        Alexandria in Virginia; Montgomery and Prince George   s Counties in
                        Maryland.
          Target Population:  Health Educators and Practicing Professionals at 77 academic
                               institutions and clinical facilities in the M.W. region

          Congressional District:
          .Continuation After RMP Support Withdrawn:  Funding of the Allied Health Forum is minimal.
                                                      Funds alloted to the MWRMP Allied Health Progra
                                                      Division are used for mailing costs, etc.
          ,Core Staff Contact:  Nina Woodside, M.D., Associate Coordinator, Community Health Programs
                                                     MWRMP
                                S.H.N.. Zumbrun, M.Ed., Director, Allied Health Programs
          Date Prepared:  January  31,  1972
          Drafted b@:  Judith McIntire



            -D6


                                           COUNCIL FOR NURSING


               A Council to improve the education, training and utilization of nursing personnel
          in the metropolitan Washington area was established August, 1971 at the MWRMP.
               Composed of nursing educators, practicing professionals, and specialists
          in nursing needs and resour'es, the aim of the Council is to provide members
                                      C
          the opportunity to cooperatively plan.to develop nursing service capability and

          quality for the region.

                                                                    A
                                                                      facilities inv-'ved in
               The. r^utn,-ii ,#-li @na e these                   a@-u i   I  I-     VI     I
          nursing to focus together on resource allocations for nursing education,    student

          demand, and manpower needs.
               MWRMP staff have compiled a.n index of nursi.ng educational and traini.ng
          programs going on in.the region which will  give Council members  an  informational
          framework to plan future educational programs with minimum duplication.  The
          listi.ng includes education and training programs for L.P.N.s and Nurse Aides as
          well as diploma, associate degree, and baccalaureate programs for R.N.t.  The
          information will be published as a section of the MWRMP  Health  Careers  Guidebook

          in February-
               The Council is organized as a technical advisory body to the MWRMP RAG and
          includes of the major nursing.organizations throughout the metropolitan Washington
          area including public and private health care facilities, comrnunity.agencies,
          professional organizations and consumer groups involved in nursing.






                                          -Back-Up Sheet

       Region:  Metropolitan Washington

       Focus of Activity;  Core Activity

       Pro ect Title: Council for Nursing

       Status: Ongoing

       Sponsoring Institution:  Metropolitan Washington Regional Medical Program
       Project Director, Title, Address:  Lucille P. Ashley,' Director
                                          Nursing Program
                                          MWRMP
                                          2007 Eye @itrec-+., 114'.W.
                                          Washington, D.C.   20006
                                          202-223-6490

       Dates:  August 11, 1971 to present

       .Funding:  Core Activity--Additional Funding not required

       Other Funds:  None

       Cooperating Agencies and Institutions:

                     3     American Nurses Associations in D.C., Maryland, and Va.
                     3     Leagues for Nursing in D.C., Maryland, and Va..
                     I     Hospital Nursing Service
                     3     Official Health Agencies in D.C., Maryland, and Va.
                     I     Comprehensive Health Planning
                     6     Nursing Educators (baccalaureate, associate, diploma, L.P.N.)
                     I     Nursing Representative on Regional.Advisory Group
                     3     Visiting Nurse Associations
                     1     Representative, Tri-State Association of Deans
                     I     Veterans Administration
                     I     Hospital Council of the National Capital Area
                     I     Director, Nursiiig Pr.ograiiis Division, MWRMP
                    25
       Area Served:  Washington, D.C.; Arlington and Fairfax Counties and the City of Alexandria,
                     Virginia; Montgomery and Prince George's Counties, Maryland
       Target Population- R.N.s, L.P.N.s  Nurse Aides and educators in the M.W. region
       Congressional District:

       Continuation after RMP Support Withdrawn: Funding of the Council for Nursing is minimal.  Fund
                                                 alloted to the MWRMP Nursing Program Division are
                                                 used for mailing costs, etc.
       Core Staff Contact:  Nina Woodside, M.D., Associate Coordinator for Community Health Programs
                           Lucille P. Ashley Director, Nursing Programs
       Date Prepared: Feb. 1, 1972
       Drafted By:  Judith McIntire






                                   ALLIED HEALTH PROGRAMS, MWRMP


           The new program for inhalation Therapists at Washi.ngton Technical Institute and
       programs for Physical Therapists and Medical Records Tech nologists at Northern Virginia
       Community College will soon begin producing the badly needed allied health manpower for
       the Metropolitan Washington area.  Shortages of paraprofessionals have reached the
       critical level in and around the nation's capital and health planners view these new
       programs as the first step (dow,n a long road @o improved health care.  A similar
       emphasis has been placed on continuing education with the result that numerous
       workshops anci seminars have been conducted for va@@r u@.- levels of in-service P,,,,,Ofessional
       and lay personnels, Working to bring together t4@te'resources and manpower
       improved patient care,'the Allied Health Programs Division of the MWRMP i@s,,at the core of
       meaningful progress in the field of  healt in  the Metropolitan Washington area.
           Charged with the  task of developing and  effectively utilizing new kinds of health
       manpower, the Regional Advisory Group of the Metropolitan Washington Regional Medical
       Program has assigned top priority to its programs for Allied Health Manpower.  In 1971,
       the core staff 'of the Allied Health Programs  Division assisted in the formation of an
       Allied Health ro@um. A program  of  Continuing  Educati on for Tumor Registrars was
       conducted.  A Health Careers Brochure which lists allied health training programs at
       clinical and academic facilities in-the metropolitan area was published.  T@,,,,o seminars
       in health education for teachers were held as  were  ma ny other similar activities.
            An Allied'Health conference was held on May 18, 1971 to' determine ways and means of
       coordinating training and education in,the allied health professions on a regional scale.
       The conference was attended by  educational  administra tors in higher education concerned.
       with programs of instruction in the allied health professions, administrators concerned
       with training in clinical situations, and employers of allied health person4-.el.
            Until recently, there had been@,no one document that iisted@@the allied health training
       programs be@g offered in the Washington area.    Realizi.ng the value of such a        tion
       in.t4e hands of counselors', education and health planners and administrators and especially






                                                 -2-


       those considering a career in all@ied health, MWRMP,solicited the cooperation and support
       of area training facilities @published@ th-e@t-s-t---@aft-of@@@a brochure entitled,
       "Hospital Careers", which was made avail-abIL- free of charge upon request.  The  brochure,
       included not only job descriptions for the various allied health occupations, but detailed
       area institutions offering program s of instruction and traini.ng, admission requirements
       and expenses, degree  or  certificat'e awarded upon completion and other essential
       information.  The brochure became so much in  demand that the second,  updated  edition  is
       expected to;be released in  early 1972 with an initial  rinting of nearly 3,000 copies.
                                                              p
            On February 15, 1972,  the Allied Health Programs Division of MWRMP sponsored
       a conference (a@-the D. C. Medical Society auditoriu  titled:  "Status Report on
       Current Education and Training Programs for  the  ATlied  Health Professions--Nationally
       and Locally".       offmnc@e---was - attended   by,representatives of the  Federal  government
       as-well as local health administrators and community organizations).  (More  than  anything
       .else) conferences and seminars of this sort bri,ng together all s.egments of the health
       community where meaningful dialogue can lead to positive action                     to
       improve patient care.  B            ing liaisons with the providers of  health care,
                               .y establish
       MWRMP has a direct effect on the health  picture  of  the'region it serves and @(n the
       Washington area@ the Allied Health Programs Division  of  MWRM'P mean positive action to
       improve pa+ient care.






                                               Back-up Sheet


           Region:.  Metropolitan Washi,ngton
           Focus of Ac          Core    Activity
           Project Title:  Allied Health Forum

           Status:  Ongoing
           Sponsoring Institution:  Metropolitan Washington Regional Medical Program
           Project  Director,  Title,   Address:  S'. H. N. Zumbrun, Director
                                                  Aliied Health Programs
                                                  MWRMP
                                                  2007 rye @;f,reet, N.II.
                                                  Washington, D.C.     20006
                                                  202-223-6490

           Dates:  Ma rch 1 , 1 970  to  present
           Fundin2_:  Core Activity Additional Funding Not Required

         .Other Funds: None
           Cooperating Agencies and Institutions:      National Institute of Mental Health,
                                                       Comprehensive Health Planning Agency of D.C.
                                                       National Medical Association Foundation
                                                       Academic Institutions of the Region.
                                                       Clinical Facilities proving Training in the
                                                        Region
           Area Served:  Washington, D.C.; Arlington and Fairfax Counties and the City of
                          Aiexandria in Virginia; Montgomery and Prince Geo.rge's Counties in
                          Maryland.
           Target Population:  Health Educators and Practicing Professionals at 77 academic
                                 -institutions and clinical facilities in the M.W. region

           Congressional District:
           ,Continuation After RMP Support Withdrawn:  Funding     of the Allied Health Forum is minimal.
                                                          Funds alloted to the MWRMP Allied Health Progran
                                                          Division are used for mailing costs, etc.
           Core Staff Contact:  Nina Woodside, M.D., Associate Coordinator, Community Health Programs
                                                         MWRMP
                                  S.H.N. Zumbrun, M.Ed., Director, Allied Health Programs
           Date  Prepared:  January   31,   1972
           Drafted by:    Tony Iasper





                                                                                        ivilCHIC-AN'





                  N i-  than   @ive tho-@;---id blac7-, cr-,4                                        -iigan
                     e                                      -id--a-i in 20 Grand Rapids, Ydc7i
                  schools have been screened in a r,,assi,,,e, free program of testing
                                                               S4
                  -_For the                fatal   disease,    -Lck!Le-cell    ana-nia,    an    hereditary
                  co@-  tio,-i         -or@-i   iv   attadKs   blac@-    T-@ple.    The    tests    uncovered
                  '@09 carr 4-ers o@-- the trait, a,-id 2 with po@   tial -c r developing the
                                                                         @en      10
                  condition itself.

                         late  in  ivav,   1971,   the   tests   are   parl- o J@- ademnstration          program,
                  funded  by   a   $10,000   grant   fro,,i   the   Michigan Association     for      Regional
                  i@@ca'L   PrograL@.   (MAR,2).   Tne    projects    a-,@so provides follow-up screening
                  for relatives of carriers, as well as genetic counseling for affected
                  fanLil-Les.   P:-oject    Director    Robert    N.    iva@ndian,    M.D.,    Associate-
                  Pathologist   at   Blodgett   Y=.,orial    Hospital    L-i    Grand    Rapids,    developed
                  both tire now rapid, low-cost "automated dit,@onite" screening test
                  and a @t@t:riod of treating crises of the disease using urea, a substance
                  prcd,aced by the body.
                  -i L-- has been estir.L--ted that one    out   of   every   500   blacks,   or   about   45,000
                  in the U.S." sl,.avs s@,.@-,s of         sic7@le-ce"@l ar.@a, with a irkuch larger.
                  nurbe-- w.,io are carriers of the        trait.   Tne condition involves a
                  reduction   in   n@ibers   of   red   blood   cells,   vjhich,   in   periodic    crises,
                  becam--   a-e@'o@   in   a   sick'Le   or    crescent    shape.    S@t=    of    the    disease
                        and go with increasing
                                                       frequency as r-he.body @t-ures.
                  Until recently, no al@ .  te         or effective treatment was available             for
                  sidkl-e-cell   an@a.   iNow,   there    is    growing    evidence    that    urea,    while
                  not   a'@l,-e,   is   helpful   in   overcoming   acute   s@tcros   of   the    disease    such
                  as   convulsions   and   crippling,   e-@ling    pat.-Lents    to    per.Lorm    normal
                  ac-Uvi-ties,   and,   preventing    pre-,natlire    death.
                  Co.,.@L,ini,@Z  pkvsici&ns  will   be   instructed   in   the   rationale--and   use   of   the
                  newly developed -tests.  L@ollow-up will be CC=-ipd--o-dt by the Neig@rhoc)d
                  14.ealth S.e--vicas Board with the assistance ol' theCounty Deoartment of
                      14
                       ,-c   Health   a:-id   the   County   Office   of   the   Michigan   Dep@,ent   of
                  Social Services.

                  Coordir-a@d  by   the   Neic,'obr,,r:riood   Health   Se--vices   of   Kent   County   Inc.
                  the   total   program   is   designed   to   build   a   p:-oto@    model    whereby    the
                  new lc7.q-co@t   test   and   follavi-up   procedures   can   be   made   available    to all
                  blacks @pic. within a community, which could tre-n be duplicated in
                       iL,-iities nationr..,-'-de.   Similar   programs   based   on   the   Grard   Rapids
                  @&.ods are      now wae-rway     an    Milwad-,ee,    Wisconsin;    @t    Palo    Alto,
                  California    and     Wichita,     Kansas.










                                 Association for Regio@l "@edical PrOgrarls
                                  Core Activity    (Al-Le:-ratives: Cperational  Project,
            @-us of Ac@--vitv:
                                                    Core ActivitY Or Develop=-ntal Cc,@nent)
              2-oiect Title:  si@Kic-cell screening

              @tu.s:  ongoir-cr
                                        iNeig'iiborhood H@th services of Yent County, Inc.

                                                   RObe.-- N. y@andian, M.D.
                 e--t Directo@-,, Title, Address'.       L
             Er-oi                                        ate Pathologist
                                                   Assoc-L
                                                   Blodgett y,@rial Ilospital
                                                   Grand :,a-oids, Michigan  49506
                                                   616'-456-5301
             Da@@es:  may-JiLne, 1971  (Tne screening cc.-=@ent actially began     late in
                ,v,ay, 1971, with a projected co-,Tletion date of August 31, 1971.
                p@-oval for release of fUndS for the total pilot study did not          ccm
                until July, 1971.)
             Fundirg:  ol  $8,000  (A  supplementary  awant  of  $2,000  was  a,@roved   bY
                YARVIP i@Sept--,-,ber.)

             Other @ds:  None.

                                                                      tam         b
             c@.@-ratir.g Agc..-icies &-id institutions:  CountY DePar    t Of  Pu lic
                @eal@,                         Midniga.,-i Depar @t of Social     Services,
                Areawide cc,-,pre-liensive- I-lealth PlanningAge.-icies servingthe area,
                                                                                 and a
                'v
                izdel City's C4-tiz@-i's Co@,,@4t@-e, Co.,@Luiiu@y Actio,,,I-.Programi
                    uritv hos-oital, a community clinic, practicing physicians
                sc7.,iools, churches, newspapers, and radio and television stations.
             Area Served:  City of Grand Rapids, iv-i&-igar,
              @a      mutation:  5,000 urban bladK aliildren (and their blood relatives)
              Co.,iaressional Districts:  45 - Mr. Gerald R. Ford (R)
              Cm-Linuation after  @iL Su-dwrt Wi-E-idr,-@:  YAR-,@L believes that the
                testi,i                                   co @ratcd into the routine
                ,-aborato:-y pro-cc-  s in the Grand Rapids hospitals, and that the
                Nei@-,bo@,i@ Health Services Board will provide its facilities for
                f=ther testing of those not included :Ln @,c first test, new r@,@-@bers of
                the m,=,u-ri-Lty, and those reaching testable age.  It is also expected
                                                     4S             i-iere will
                tna@- fmdina, Lor duplication of th,  rcdel elsc-v             ccne-   from
                @ei Cities and the Federal program developing in -Lhis area.






                                                     Ph.D., P-Ssc)ciate Coordinator, YAR@
          Core-Staf-@@ CO,-@Ct:  Gaetlane M, Larocque

          Date Pre-oared:  8/11/71

          Drafted bv:  Teresa Schoen








         Rec, i-on:   ,Iichigan Association for Regio@'-'          @Z@'cal Progra:,-.s

                     P.-c@_-::-Vitv:   Core Activity    (Al-Le  at-iv@-s:   Cper,-,tional ProjecL--,
                                                         Core '@C'@vity or Devel-c,n,-,@tal Ca...@ne-nt)
         Projec4L-- Tit--le:   Sickle-Cell Screan-i-na

                     O-,igoing

         s@;,sorinq institution:  ',.\Ieig:@rhood H@t:n Services of Kent County, Inc.

         Project Director, Title, z@-,3@-ess:           -@ber-,  N.   Yalba--.dian,   M.D.
                                                        Associate PaE-,ol@ogist
                                                        Blodgett    L@emrial     IlosDital
                                                        Grand             vichigan  49506
                                                        616-456-5301


         Dates:  imay-JiLne, 1971   (Tne scr-@-         ing c(i.@.-ie.-it aerially bega,-l    late in
           ,%@Lay, 1971, with a project--d co.-,,nletion date of AugusL-- 31, 1971.
           Approval for release o@L @Lunds for the total pilot stLdy did not                        ccm
           until July, 1971.)

         Ending:   01   $8,000   (A   supplementary   airo-a-it'-   o@L   $2,000   vias   approved   by
                   i @S e @o t   e

         O-L'ier F=.ds.  Ncne.


                         -%agencies ard -,nst-,Ltut;ors:      County Depar@p-,lt of      Pi,,blic
         Coo@-i-ating
           Health, Ca@.tv G@L@Lice o@L @-e Yichiga--l @--oar@j-a-.t of Social            Services,
           @ea@iide  Cc-,nr@-ie.-@ive  .1-lea'--Li   Planning   @-ga@c-,es   serving   the   area,
           iv@el   Ci-ty's   C4tiZe,,IS   Co.-,   4-ttoe,                                  and   a
                     i                      -,,,Lnity clinic, practf 6irg physicians,
                      I hosnital, a cc=
           se,icols, c7i,.urdies, news-o             and radio a.-id te-       sic.-i    stations.
                                           k@--s                          -evi

         Area Serve--':   City of Gra-,id Rapids, jvd&.,Igan
         Targ-at-.Po@nu'-Iation:   5,000 @.oa-q bl@c,<        4
                                                           &-ld:--e.-i (ard their blood relatives)

         Congressional Districts:   ',5           Mr. Geral@- R. Ford (R)

         ConL--inuatio:l after R7,-2 Su,-j@rl- Wi-E-ldrZJA.-.:  Y.@J@ -  b lievc-s that the
                                                                                    -E-le rou-a-ne
           tes-ung                                             cor-@ratc-,d  into             L
           laboratory  procedures  in  @,e  Grand  Ra.@i-(:s  I-,ospiL-lals,   ard   t:hal--   the
           Nei@r@@n,c<)d -@-@'Cal-th Services Board will provide its facilities for
           fu---Eier  testing of those -,ot included i-- ti-,c first test, ncw r@l@hers of
                 cc=,,.@.-'Ity,  and  -E-icso  reac7,ii,-ig  testa:Dle   acjc.   It   is   also   @cted
                  funding for dtknliccitio-i o@ ti-is iL-cdc-,! elsc-@i.-ie--e will ccn)e frcL-Ll
           t-ha4                                         L        -                L
           Yodel Cities and he i'ede:--al prog-ca,-q davelo-,Dir,@ in -@is           area.                             i
                                                                                                                       i


                                                                                                                       i



                                                                                                                       I




       Coro.-S@     Con-@----,@-:  Gaet-arc M.  ocque, Ph.D., Pssoci ate Coordinator, l@,,T

       D'@te Pre-,@-77cd:  8/11/71

       D,--a@ted b,,r:  Teresa Sc.r-@@--i





                                                                R,=


                                                                                  .@i :1 T   7I
                                                                           T:

                                          !,,13,  loi,-,@  a  re-loii@,.l               center,     7,ie @-@-Lna-011 o' stu       ot
                                 n@
                                             eiuc@l'-oi -'In its                              in
                                                                                                 iii-LLh a +, 6t,,,- 1 0  3 1 50 ",) 0
                             A.iiclu,,i,  'to co-,I,.I@ics ("1.1tsidero
                                                                                  -L,ie state averzL-e,  ancL served by less than
                                       7
                                        )er C                           I)el-oi@
                             70  active   D.-cimary   P,-qys-,,-Cil-.-Is-    'Fn I(/'70   n@    systematized    a-,o,-,--oach    to    education
                                                        a
                              ,q coronary (Yze @- s a7Q@liei to t-:3 e-.,Iti-l-c rtlx,-L!                        in tile    first I       years
                             O@L                  O-De--(. uion,  @Lur-,-Lei IL)y           400 hou---@ of consultant teac',Ii-@-  i,i-ere
                             delive-@ee@   to   'Li-le           of   0   oullyir7,    hos-oi-Lais    within    110    miles    o'    3rancl
                                                                             u




                                                                                                                          -is .Tere  t,,LuL7,ht
                                         ois: -         To    conserve     tiDe     for                      phys-Le-'iai
                             on  -LL(ie@  ho--.ie  grou@-,,icl  on  a  regular  basis  'car   the   sar,,e   Gi-:ou-0   of   consulluir-E
                                                                                2)   'Lneochiti,,- iiet'-,iodS IT
                             @-tr@.Iolo-ists     +_'ro      Grand      Ripias.                                   .e-,^e adjusted for
                                                                             -Practi   call
                                                                                               and sel @-suf, f iciency ere-.-e
                                      i@i-.,,act   on   -oalien@u   care.                 -ty
                                         1.          -
                             er,,-Ihazized.     Srall     -Grou-o      methods        irik@ic@u-orienta--Llion    are     uriisual     in
                             -nedic,q-1 education outside of                       resi-de-i-ic,,r I)-..-,o6-rctriso

                             @va,li.L@luion:   j-@Y cnzr'u review and fz'@ analysis, t,ie                                 rate fro;-ii
                                             infa.-cction cl--co-oi)e@d @Lro@,- 3L,,"j' (@-7-ce-course) to                (T)OS-I,-Coul-se).
                             Such    a    stylistically    significant    cha-@-e    has    been    rare    in     other     types     of
                             -oos-Lu-g-ca.,I@te    or    "refl-es@-ier"    vco    as@    The    final    i-iortali--'Ly    @.-te    obtained
                             is not si-,-iii-L@i-cantly different @Lro--,- ur'i'Xln centers.                 f @eclui-,,eness of the pro-grcini-
                             T,:as li-riited ,here equipment (a 1.@CU) .,@as not =esent, 'but tools without trained
                             personnel had little ir.@ict.   At the end of the Droiec'U -@ri-od,  8 b-l' the O/
                             hos-p@L'ix,lls       voted. self-sus@,Lini,@- -loLinds for the education visi-Luso

                             P.-cesonlu status:                 is currently --rundiia7, courses for hospitals new to tle
                                             s   a   c                                                      -1
                             systc-..io @iu@         entral orZanii,--.ation.         The crit- er-Ll i-, terdedendence o-P
                                            education and           cilities     recognized     in     the     first      hase      dictates
                             a broader responsiveness to rural cor.,,nuii-'ty need.                       Ihile    r@ii-ntainiiig    on    a
                             i-ion-cate--  orical   basis   tne   educational   linl,,a@,es   a!--ce,--tdy   f   ory,@ed,   stlo..Ln   Or
                             I inTza,,4es with hos-pital aOi@,,iinisJ---rai-ive services, the universities  -tit4 C@--T,
                                                                           L,  u
                             and    other    health     agencies     are     be,-ng     rapidly     developed.        the broader
                                                 L
                             enO--in-viei,T.  @'Lbe three r@x-Lior 400-bed hospitals in Grand Ri-,oids have becoi-ie a
                             s-u-bczF@,I-,us   of   t,@ro   ,,@,jo--   universi,,y   @-,@Ledical   schools,   and   area   hospital   'oocl-rds
                             are  be-,inninr@  to  ex-Dlo.-ce  ser.vice  a,-@j'  I  lia'uioii  in  -oa-,-,'Uial  -l'ul'L  i-liaent  of   the
                             regional    objective.    This    '.Yi?L'LP-@Lunied    project    has     functioned     thus     far     as     a
                             L.ia@or facilitator of chance 'oy                            providers -bo@e'uher, and as ,Ln
                             3-nr-ovato2: of an effective educational outreach pro                              net..,   to   the    medical









                     Re7ion:  i'@ichi-ai-i Association for -',e.-iork-Ll -medical '- o7,rz,@.,is

                     Locus o-F Activit7,,:  0-oeratioril  -@coject

                     Project Title:  A Cor,-orel-ip-nsive A-o@nro-ach to 'I@'e,"Iical Resource -DisuribuLioii
                       aiicl Ii,,prove-,,@nt iri--Luhin a CooT)erati-ve 'Iegi-oiial '@o:-@...uni'UY @Z'os-pi,,al Systeii-

                     Status:  O.-i-oing

                     ST)onsorin@,  Institution:  Blod-ett  ';'erorial  Hos-oital
                                                      0                  -

                     Project :)L--ec'Lor:  Craig Booher, l@i.D.
                                           Blod,-et'U 'immemorial Hospital
                                           Grand Pa-oi-ds, l,'.ich@,-an  4c,)50'o'
                                           6i6-456-5301

                     Dates:  Pilot Project :  April - August 1969
                              O@- oin,-, -@roject:  !ilarch- 1970 to date
                     Fundipa:  -Pilot Project:                     $  3,000-00
                                 OrZoing  @-oiect:  3  0  -   81yo $40,000.00
                                                     9  0 -  8  7i $38,000-00
                                                     9  1 -   8@72 $35tOOO*OO

                     G,ther Funds:  Ilone


                     coo-OL-,ratir@ A@encies and Insti-LLutions:  Allegan General Ilos-oi@t'al, CoriLTqur-ity
                       HosDitz.1 of @-1-fr -.Ra-oi-ds, Geroer ','emorial Hospi-tal of I;'renont, Oceam
                       Hospital at -hrt, @,ason County Hospital at Ludii-Gton, ionia County lie@norial
                       Hospital# Pennock HosDital at Fastin,,Ts, Unite.;i '@@,'@er!iorial Alios-oital at
                       Greenville, Reed City Hospital, CL-Lrson Ci-ty Hospital,              Co.-,,nunity
                       'fos-Dital, and in C,rand. Ra-oids, Blod,-
                                                                ett, Butteri@rorth and St. '.,.@ry's
                       Hos-,oi'L,als.  A-rew,,,,ide Con-,o@ehensive Health Planni@. Unit.  Grand Ra-pids
                       Area '@'edical Education Center, I,@ic.

                     Areas Served:  10 county rural area surrounded, Grand Rapi-ds.

                     'T@ir.7at Pon-alatio-,-@:  anDroxi.-nately 100 Dhysicians se@r@- a population of
                      >315tOOO T@ihich includes a federally-desigmted de-Dressed area.

                     Coii                               @:r. Gerald Ford
                        Eressioiial Districts;    ir' 5
                                                                    'Iutchinson
                                                             Guy VanderJa-t
                                                  ;ill 0    -@lf  ord  Cederberg

                                        r            a
                     ,,oii'uin,j.D,Iuion a-@'u--     I of Su-i-oort:  Part or full self-su-pl)ort ol@ the
                       educational  visits   (out   not the central staff functions) has been voted by
                       8 oi@ the 11 target hospitals,

                                  Coii-,Lact:  David              Re-,,)reseiixtive

                     Date -7"re@ired:  2/14/72

                     7)r,i--'tca 7@% @"cLllace -3. Doraiii,
                                    @oject '-'oo2:dire4..02?











                                   MISSISSIPPI REGIONAL MEDICAL PROGRAM
                               P 880 LAKELAND DRIVE  JACKSON, MISSISSIPPI 392i6 (6oi) 362-73II


               September 14, 1972






               Patricia Q. Schoeni
               Director
                      cations and Public Information
               Regional @dical Programs Service
               Parklawn Building
               5600 Fishers Lane
               Rockville, Maryland  20852

               Dear Pat:
               Here, in answer to your request, is another vignette on an activity
               of our program.  Perhaps you will find it interesting.  Bob Chambliss
               and James Daugherty attended the workshop, and I think Chmbliss was
               suitably impressed with the effort we made.  I'll try to get you some
               more dope before long, meanwhile keep the faith.

               Yours,,



               Roberf-C. Cotten
               Director of Corflmunication
                  and Information
               Wssiss'  i Regional @dical Program
                      ipp

               RCC/jec

               attachment











               Working J'or better health in Mississippi through Training, Education, and Demonstration







                      Mississippians suffering terminal renal failure now are receiving life-saving hemodialysis
                  treatments in a unique, MRMP-supported program that features the use of house trailers,
                  converted to artificial kidney units, and installed on the grounds of  community  hospitals.
                  The concept allows patients who have inadequate family  support  and/or  housing  facilities
                  to obtain treatment without having to be hospitalized, at a cost they can afford.
                      Three trailer units'are now in operation in various communities, serving a total of seven
                  patients. Each patient received initial treatment and training in how to operate  artificial
                  kidney machines at the University of Mississippi Medical Center in Jackson, home-base
                                                                                                      IV
                  for the state's artificial kidney program, which also supports three additional satlelite
                  kidney units in.      4-s-. Each trailer is designed to serve a capacity of eight patients
                  per week. Plans call for a total of ten trailer units eventually to be operational,  serving

                  an expected twenty-five new patients each year.
                      The trailers are comfortably furnished in a  pleasant,  home-like  atmosphere.  Patients
                  may have visitors any time and have the use of  a  telephone  and  kitchennette.  A  liaison
                  with the community hospital is maintained through nursing and technical personnel, although
                  they are called upon only in emergency situations, which so far have occurred infrequently.
                      The Mississippi Regional Medical Program supports the training of these nurses and
                  technicians  and provides backing for the coordination of various state and community
                  agencies, such as Vocational Rehabilitation, the Kidney Foundation of Mississippi, and civic
                  clubs. Community pride is an important ingredient in the trailer unit concept, and has
                  greatly cut the costs to individual patients. When the last unit becomes operational,
                  there will be a hemodialysis treatment center within thFrty minutes of the front door of

                  every citizen in Mississippi.







                                                    Back-up Sheet



                  Region --- Mississippi Regional Medical Program (the State of Mississippi)

                  Locus of Activity --- Operational Project

                  Project Title --- Decentralized Home Dialysis Centers

                  Sponsoring Institution --- University of Mississippi Medical Center, Vocational

                                            Rehabilitation, Kidney Foundation of Mississippi

                  Project Director, title, address --- John Bower, M.D.
                                                     Assistant Professor of Medicine
                                                     Director, UMC Artificial Kidney Unit
                                                     2500 North State Street
                                                     Jackson, Mississippi  39216
                                                     601-362-4411

                  Date Operational --- July, 1970

                  Funding --- $76,327.19

                  Area --- Trailer Units in Greenville, West Point, Columbia; additional satellites

                           in Tupelo, Pascagoula, McComb.  Program serves entire state.

                  Target --- 25 new patients per year

                  Other funds --- Community agencies purchase trailer units through coordinated effort

                  Continuation of Support --- Most likely continuation of support will be from state and

                                              local governments combined with support of community

                                              civic organizations.












                                            VIGNETTE



                    Thirty-seven per cent of Mississippi's 2,216,912 people (or just over
            820,000) are black, but of that number only 44 are practicing
                                                                            YU


                                                                                 o compound
            the prob em, the average age of the black doctor in the state is 55.  The Mississippi
            Regional Medical Program in July, 1972 provided a grant of $ 8,000 to support a
            workshop for the 60 black medical students now attending school in other states.
            The theme of the workshop was "Come Back and Get Involved", and stressed that  health
            care delivery in the region was "still a challenge".  The results of the three-day
            event were much better than those of a similar workshop which MRMP sponsored the
            previous year.  Turnout was above what had been expected, and the students' responses
            indicated a growing interest in and awareness of the needs of people in their home
            state.  MRMP also sponsored a black medical student preceptorship program, with a
            grant of $ 7,300, in the state during the summer in which 5 students had the
            opportunity of working directly with physicians in practice.  The Program is steadily
            increasing its committment to improve the region's health manpower shortages by  such
            activities as these.

            Status --- Contractual/Professional Staff Activity

            The Mississippi RMP covers the entire State of Mississippi, and has been  operational
            since July 1, 1969. Its committment level for FY 1972 was $  1,408,225.  These  funds
            were used during FY 1972 to support a total of 12 projects, of which one was in the
            area of general continuing education, one for training existing health personnel in
            new skills, 2 for training new health personnel, 7 for patient services and
            demonstration, and 2 for providing manpower development centers.












                                    ;A


                                        MISSISSlf'Pl REGIOI\IAI, NIEDICAL I)ROGRAM

                                        2500 NORTH STATE SI-REE.--F JACKSON, M SS SS PP 39216 (601  362-7311
                   A'-7T



                                                    viGNETri"


                 IVidespread ignorance of health  and  health  practices  is  one  of  the  factors
                 contributing to i@!LississippiIIs high  incidence  of  morbidity  and  mortality
                 from such "treatable" diseases as cervical cancer  hypertension and
                 diabetes.  Lack of public health awareness undoubtedly plays a role          in
                 givina Mississippi  the  highest  maternal  and  infant  death  rate  in  America.
                 In the  Fall  of  1971,  the  Mississippi  Reaional  Medical  Program  sponsored
                 a massive health exposition in  the  capitol.  city  of  Jackson,  as  a  means
                 of educating the  public  to  better  health  practices  and  to  new  developments
                 in treatment and  tie  delivery  of  health  care.  Over  sixty  thousand.  people,
                 from all ivalks of life and from all parts of the state, came to see
                 exhibits, demonstrations,  and  films  provided  by  more  than  SO  state  health
                 organizations and volunteer groups during the three-day event.  large
                 evenina crowds attended to hear such renowned medical authorities as
                 Dr. Paul Dudley l@'hite,  world  famous  heart  specialist  and  former  personal
                 physician to President Eisenlioiier,  and  Ih,.  lbbert  Q.  Marston,  Director
                 of the National Institutes of Health.

                 'nae decree of  public  involvement  and  participation  was  much  greater  than
                 initially expected. People  waited  in  line,  often  for  as  long  as  an  hour,
                 to have their blood  tested,  their  hearing  and  eyesialit  checked,  and  to
                 participate  in  screening  procedures  for  a  multiplicity  of  health  problems,
                 including diabetes, hypertension, cervical cancer and emphysema.  Thousands
                 of young people were introduced,  for  the  first  time,  to  a  wide  range  of
                 health careers.  Ihe  $10,000  grant  provided  by  DRIP  made  it  possible  for
                 a non-profit group to establish the Ifealth Expo as an event that will
                 continue, on its own steam., to educate  a,-id  inform  @ilississippians  about
                 health and the availability of care.

                 Status --- Contractual/Professional Staff Activity

                 The Mississippi MIP  covers  the  eitire  State-of  P4ississippi,  and  has  been
                 operational since July l-,  1969.  Its  committment  level-  for  FY  1972  was
                 $1,408,225, 'These funds were used  during,  @  1972  to  support  a  total  of  12
                 projects of  which  one  was  in  the  area  of  general  continuing  education,
                 one for training  existing  health  personnel  in  new  skills,  2  for  training
                 neiv health personnel, 7  for  patient  services  and  demonstration,  and  2  for
                 providing manpoiver'developmeiit centers.








                                                                           P? 7 1 )t] I) t-, t-)@) (III,: i r,l fin t'i













                                    MISSISSIPPI REGIONAL MEDICAL PROGRAM
                               P 2500NORTHSTATESTREET     JACKSON, MISSISSIPPI 39216 (601) 362-7311



                                               VIGNE'FTE


               Widespread ignorance of health and health practices is one  of  the  factors
               contributing to @lississippils high incidence of morbidity  and  mortality
               from such "treatable" diseases as cervical cancer, hypertension and
               diabetes. Lack of public health awareness undoubtedly plays  a  role  in
               giving Mississippi the highest maternal and infant death  rate  in  America.
               In the Fall of 1971, the Mississ' i  Regional  Medical  Program  sponsored
                                                ipp
               a massive health exposition in the capitol city of Jackson, as  a  means
               of educating the public to better health practices and  to  new  developments
               in treatment and the delivery of health care.  Over  sixty  thousand  people,
               from all walks of life and from all parts of the state, came to see
               exhibits,, demonstrations,, and films provided by more than 50 state  health
               organizations and volunteer groups during the three-day event.  Large
               evening crowds attended to hear such renowned medical authorities as
               Dr. Paul Dudley White, world famous heart specialist  and  former  personal
               physician to President Eisenhower, and Dr. Robert Q. Marston.%  Director
               of the National Institutes of Health.
               The degree of public involvement and participation was  much  greater  than
               initially expected. People waited in line, often for as  long  as  an  hour,
               to have their blood tested,, their hearing and eyesight checked, and  to
               participate in screening procedures for a multiplicity  of  health  problems,
               including diabetes, hypertension, cervical cancer and emphysema.  Thousands
               of young people were introduced, for the first time, to a  wide  range  of
               health careers. The $10,000 grant provided  by  HW  made  it  possible  for
               a non-profit Qroup to establish the Health Expo as an event that will
               continue,, on its own steanl to educate and inform Ndssissippians  about
               health and the availability of care.

               Status --- Contractual/Professional Staff Activity
               The Mississippi @IP covers the entire State of Ndssissippi,  and  has  been
               operational since July 1, 1969. Its camittment level  for  FY  1972  was
               $1.,408,1225. These funds were used during FY 1972 to support a total  of  12
               projects, of which one was in the area of  general  continuing  education,
               one for training existing health personnel in new skills,  2  for  training
               new health personnel,, 7 for patient services and demonstration, and  2  for
               providing manpower development centers.





               Working J'or better health in Mississippi through Training, Education, and Demonstration






                                                           MISSOURI


                Plantfor Improvement of Pharmaceutical Services  in  Missouri's
              Rural Health Care Institutions (Hospitals and Nursing Homes)


                   In the first year of this three-year project, t.@
                approximately 50 hospitals of 100-bed size or less  and  70
             nursing homes will be @e to determine:


                   1.  Current status of pharmaceutical services,,.,

                   2. Facilities available for providing these  services@,

                   3.  Local pharmacists available.
                   Cooperation of the hospitals and nursing homes was requested
             @-e         -@-.,Ietters.,-,Thirty-eight hospitals and 60
             nursing homes h-av@,agreed-to participate.
                   By using questionnaires developed by Project Director
             Wayne M. Brown for hospitals and nursing homes,  an  interview
             is conducted with the administrator, director of  nurses,  and
             pharmacist,  if available. @At-go the nursing stations and pharmacy
             or drug room are visitedil@@@t@@j,,,

                                              ave been visited.  Five have the
                   As of 21  7@.3i hospitals li
             services of a full-time pharmacist, 16 have a part-time
             pharmacist, and 12 have  the services of a  consultant.  Various
             drug distribution systems have been seen.@many hospitals are
             concerned and indicated they need help in improving their systems.
             It is believed that the services provided by the full-time
             pharmacist will, of course, be better than that provided by a
             part-time or consultant. It is hoped that a  program  can  be
             developed and implemented to improve what the  pharmacist  is
             doing in these institutions. This is  the  ultimate  objective
             of this project.
                   Thirty-nine nursing homes have been visited.  Eleven  have
             pharmacy consultants and the remaining 28 have no pharmacy
             service except for the actual providing of the drugs.  Of the
             11 consultants, 7 were spending some time in the  nursing  home.
             This time varied from a half-hour a week to one hour per month.
             In the other four, the pharmacist did not go to  the  nursing
             ho   s.

                   In nursing homes there is not a great deal of  pharmacy
             input.' In the next two years of the project, programs  will  be
             developed to help the pharmacist i@             in the institutions
                provide better service.









                                      Back-    heet




              Region:  Missouri Regional Medical Program

              Locus of Activity: Operational Project
              Project Title:  Plan for Improvement of Pharmaceutical
                              Services in Missouri's Rural Health Care
                              Institutions (Hospitals and Nursing Homes)

              Status:  Ongoing
              Sponsoring Institution:  University of Missouri - Kansas City
                                       School of Pharmacy and Division for
                                       Continuing Education

              Project Director, Title, Address:  Wayne M. Brown
                                                 Assistant Professor
                                                 School of Pharmacy
                                                 University of Missouri - Kansas City
                                                 Kansas City, Missouri  64110
                                                 816-276-1614
              Dates:  July 1 - June 30, 1971-72 (First year - evaluation)
                      July 1 - June 30, 1972-73 (Second year - program development)
                      July 1 - June 30, 1973-74 (Third year - reevaluation)
              Funding:  1971-72  $25,000 ($3,000 added for Green Hills Project)
                        1972-73  $26,500
                        1973-74  No funding
              Cooperating Agencies and Institutions:  Missouri Hospital
                 @ss@iation, Missouri 0 t@eopathic Hospital Association,
                  Missouri Nursing Home Association, Missouri State Medical
                  Association, Missouri Association of Osteopathic Physicians
                  and Surgeons, Missouri Pharmaceutical Association, Missouri
                  Nurses' Association, and the Division of Health of Missouri.
              Area Served:  The State of Missouri - excluding St. Louis County
              Target Population:  50 hospitals of less than 100 beds and 70
                  nursing homes.
              Congressional Districts:  William J. Randall (D), Richard Bolling (D),
              @ (,Wm. (Bill) Hull,-Jr. (D)@IDurwood G. Hall (R), Richard
               jigichord (D), Wm. L. (Bill) Hungate, Bill D. Burlison (D).
              Continuation after RMP SUP2or:o- ithdrawn:
                                            t W





    . 1, I I&%


                                         Page 2


              Core Staff Contact:  Dr. Warren P. Sights

              Date Pre2ared:  3/l/72

              Drafted By:  Wayne M. Brown








                                                            MISSOURI



                          School Heart-Sounds Screening Program


               Approximately two-,-and-one-half years ago  the  PhonoCardioScan
               Project began in Missouri, sponsored  jointly  by  the  Missouri
               Regional Medical Program and  the  Missouri  Heart  Association.
               Since that time, 45,000 young people  in  six  major  communities
               and numerous smaller communities  throughout  the  state  have
               been evaluated for  unsuspected  heart  disease.  The  program
               has tested first, fifth and ninth  graders,  and  more  recently,
               fourth graders, for the presence of  heart  murmurs  or  abnormal
               heart sounds.

                    More than 700 students have been referred to their
               physicians for follow-up  evaluation  because  of  unsuspected
               heart murmurs. Many of these turned out  to  be  of  no  major
               importance.  However/  many  significant  abnormalities  have
               been detected. Some of these  have  required  referral  to  a
               medical center for a more complete evaluation.  Some
                          to have a heart disease which required some restric.-
               tioh of physical activity; others-have had  to  be  placed  on
               prophylactic antibiotics to  prevent  infection  from  developing
                  diseased portions of the heart.

                    Two cases detected in the course of the screening
               indicate how iT@
                                      ,,the despot on,,@@ unsuspected  heart
               murmurs can be.     six-year-old@ ir     om St. Joseph, Missotri#
               who @-was_ activ-e.-,.:an A 6d,to be healthy-was  found  to  have
               an abnormal heart  murmu@;,an(I was referred to the  University
               of Missouri Medical Center, where s,he,,,-wa-s----f-ound---t-o -have -a "very
               serious restriction of flow through'th6  pulmonary  valve.@,"
               Immediate open heart surgery was necessary
               recovered rapidly,,,'@'@ has now returned  to  normal  activities
               with no abnormal cardiac findings.
                    A 12-year-old boy from  Centralia,  Missouri,  was  found
               to have a complicated inborn heart  defect  called  Tetralogy  of
               Fallot which is usually detected much earlier in life.  -Ro'Veve@r,
             -.because of certain unusual features it  had,not  been  detected.@
               This patient recently underwent  total  surgical  correction  for
               the abnormality and is now progressing very well.
                    An important by-product of this  program  has  been  public
               education. Many parents  have  learned  something  about  heart
               disease in children.  Thousands of volunteers have helped with
               the program and, through the assistance of  all  forms  of  news
               media, hundreds of thousands throughout the state have learned
               more about the importance of evaluation  for  the  presence  of
               heart disease in children. We have  also  been  able  to  predict






                                            2-


              the incidence of unsuspected heart disease in children -ilt,
                       and have determined the best ages for'@"6Afi@ren t-e.-@
                      to@4ain the best cooperation and the maximum yield.
              At the present time the ninth grade has been found to be less
              satisfactory than the first, fourth and fifth grades.







                                      Back-up Sheet


               Region:  Missouri Regional medical Program

               Locus of Activity:  Operational Project
               Project Title:  School Heart-Sounds Screening Program

               Status:  Ongoing
               Sponsoring Institution:  Missouri Heart Association
               Project Director, Title, Address:  Dr. Jack S. Sanders
                                                  Project Director
                                                  515 East High Street
                                                  Jefferson City, Missouri  65101

               Dates:  1969 - present

               Funding:   01 73,600
                          02 34,800
                          03 18,000

               Other  Funds:
               Cooperating Agencies and Institutions:     Missouri   Heart
                    Association, PTA'S, Local school administration staff.

               Area Served:  Statewide

               Target Population:  Grades 1, 5 and 9
               Congressional Districts:       2       prtz@t- sites L"@ma

               Continuation after RMP Support Withdrawn:
                         Within the next six months the screening part of
                    the program will end.  However, compilation of
                    important statistics and follow-up of  children  found
                    to have abnormal findings will continue for some time.
                    In most of the communities involved the  program  will
                    be carried on through local purchase of the testing
                    apparatus and through use of volunteers, who  are  now
                    experienced in the use of the equipment.

               Core Staff Contact:  Dr. Warren P. Sights

               Date Prepared:  3/7/72

               Drafted By:  Dr. Jack S. Sanders








                                                                   MISSOURI



                    A Cooperative Prevention and Management Program

                        for Cardiovascular Pulmonary Problems


                  This cooperative program among physicians, hospitals
             and MORMP staff in the northeast area of Missouri is tackling
             cardiovascular-pulmonary problems.
                  Each physician in the  northeast  district  has  received
             a booklet listing available speakers, topics and audiovisual
             materials on cardiovascular-pulmonary problems.  When physicians
             and hospitals request speakers or materials listed in the
             booklet, the MORMP staff arranges to bring the seminar
             to the physician                    This eliminates  hours  of
             travel, and lets the physician himself determine what his
             educational needs are.

                  Also involved in the continuing education programs are
             health and physical educators and leaders in school systems,
             and students at Northeast Missouri State College.

                  The staff tries to  improve  public  understanding  about
             cardiovascular-pulmonary disease,  with  special  emphasis  on
             prevention.,    speakers bureau is being  planned;  radio  and
             TV programs  and news releases will stress.









                                    Back-up Sheet


           Region:  Missouri Regional Medical Program
           Locus of Acti@:      operational Project
           Project Title-. A Cooperative Prevention and Progressive Management
                           Program for Cardiovascular-Pulmonary Problems
           Status: Ongoing.
           Sponsoring Institution:  Kirksville College of Osteopathic Medicine
           Project Director, Title, Address: Dr. Richard H. Beck
                                              KCOS - 704 W. Jefferson
                                              Kirksville, Missouri 63501



           Dates:  1971-72




           Fundiln   $40,000


           Other Funds:

           Cooj2erating Agencies and Institutions: Kirksville College of
                                                    Osteopathic Medicine





           Area Served:  Northeast Missouri
           Tar!let Po ulation: Health professionals, especially physicians,
                    p
                               for continuing education.  The entire population for
           ConS[ressional Districts:           public information.

           Continuation after RMP Support Withdrawn:




                                         -2-


            Core Staff Contact:  Drt. Warren P. Sights
            Date Prepared:  3/20/72

            Drafted by: Elaine Selcraig.






                                                                  MISSOURI



                    Southeast Missouri Radioisoto@Cancer Program


             This radioisotope program has brought a new type of  medical
             facility to the rural area around Cape Girardeau, Mo.  During
             the past three years, a completely equipped nuclear  medicine
             department has been established at St. Francis Hospital, Cape
             Girardeau. O'M@@Le t%     &0,441-@ne tJF SUAIA -k

                 The nuclear scanning process is simple, but yields  much
             information.  Technicians inject radioactive material into the
             patient's veins.  It accumulates and outlines the  internal
             structure of the organ. This movement is traced  with  the
             persistence scope, which records areas of material  accumulation
             by tumors, unhealthy tissues and cardiovascular lesions.
             Areas of increased activity show a greater accumulation of the
             isotopes.

                 The radioisotope project gives people an opportunity  to
             have an examination they would have to go to St. Louis  or
             Memphis to get otherwise. The scans conserve  physician  time
             in making diagnoses and eliminate many cases of  exploratory
             surgery.

                 For example, one man came to the hospital for  prostate
             surgery.  In a routine work-up, including an intravenous
             pyelogram, the physician found something wrong with the
             patient's left kidney. Before going ahead with  surgery,  the
             physician needed to know how serious this defect  was.  The
             patient had a scan taken. Movies recorded the  blood  flow
             through his kidneys and the camera also provided  Polaroid
             pictures showing different stages in the scanning  process.
             His physician looked at this information and concluded it was
             safe to go ahead with the surgery.

                 In June, 1969, eight months after the Project  started,
             the first satellite laboratory was set up at Southeast  Missouri
             Hospital with a complete well-counting system and a  rectilinear
             scanner. Close correlation between the two labs  has  been
             valuable in developing techniques and maintaining  quality
             control.  The satellite at Southeast is self-supporting.
             Several nearby community hospitals also are considering
             development of nuclear medicine departments.  Another  important
             offshoot of the project is training professional assistants in
             the nuclear technician program.







                                    Back-up Sheet


            Region:  Missouri Regional Medical Program

            Locus of Activity:  Operational Project

            Project Title:  Southeast Missouri Radioisotope Cancer Program

            Status:  Ongoing

            Sponsoring Institution:  St. Francis Hospital
                                     Cape Girardeau, Missouri

            Project Director, Title, Address:  Dr. Milton Shoss
                                               937 Broadway
                                               Cape Girardeau, Missouri  63701

            Dates:  1968-72

            Fundinq:  1969  75,200
                      1970  77,500
                      1911  43,000


            Other Fun s:

            Cooperating Agencies and Institutions:  St. Francis Hospital
                                                    Cape Girardeau, Missouri

            Area Served:  Southeast Missouri, southeast Illinois

            Target Population:  Resident of southeast Missouri and southeast
                                Illinois
            Congressional Districts: Pilit 1). btttlisoV'%
            Continuation after RMP Support Withdrawn:  Will continue a
                 gradual transition to fee-for-service basis, with cost of
                 scans being borne by patients.  Increase in number of scans
                 performed will also lower cost.  Satellite facility at
                 Southeast Missouri is already self-supporting.

            Core Staff Contact:  Dr. Warren P. Sights

            Date Prepared:  March 14, 1972

            Drafted By:  Elaine Selcraig








                                                               MISSOURI



                          Homemaker-Home Health Aide     ect


                Homemaker-Home Health Aide Project/h"@s trained a core of
           workers to do simple nursing procedures and  "personal care"
           services such as grocery shopping, preparing meals, light
           laundry and housekeeping.  T14-i
           ,.-pn,-.theildocto,gis referral to the chronically ill patient in the
           home,  Home4m@ r-Home Health Aides have al,*6'served families
           during a perloa of acute illness, emergency, or stress that
           threatened the family's ability to remain together.
                Homemaker-Home Health Aides have worked under the supervision
           and direction of registered professional nurses to keep the
           chronically ill patient in the home, thereby releasing a
           hospital bed for the more acutely ill patients.  Nine-hundred
           fifty days of nursing home care and almost 10,000 days of hospital-
           ization have been prevented during the two and one-half years
           the project has been funded.


                "Can Charley Brown keep coming back here?" the 4 year old
           towheaded boy asked.
                The Homemaker-Home Health Aide supervisor was making a
           routine visit to a home where a Homemaker had been assigned
           three days earlier.  "Charley" Brown was really Mrs. Edna
           Brown, a motherly, good natured Homemaker-Home Health Aide.
                The home was shabby, with bare floors, but there was
           a warm fire in a wood-burning heating stove in the corner of
           the living room.  The house was clean, the four children were
           warm, happy, and anticipating a good hot lunch.   I'Charley"
           Brown and Homemaker Project.had made it all possible.
                                       Government  issued commodity foods-
                                                                       dry
           powdered eggs, powdered milk, canned meat, cornmeal, lard,
           potatoes, oleomargarine, and raisins.         ey@l-BTowrr-@a-d-,
           r.QaLly-                      On the old wood range in the
           kitchei                      scrambled eggs with small chunks
           of the canned meat mixed in,         --vktit-d@@ fried potatoes,
                          crusty cornbread @-r-e@,@-th-e    @ri@
           and  i                        golden         rice pudding with
                plump raisins.


                The towhead went to call Mamma'fro       ]died
           just come home from the hospital.bhe day befu.Le.  She came out
           smiling and sat down with the four children.  "Charley" Brown
           beamed.





                                             2-



                The apartment was neat, clean, and well furnished.  There
           was a piano, but it hadn't  been  played  in  several  months.
           Mrs. D. was too busy taking care of          her   70-year-old husband@
           who had had a stroke.  Mrs.  D.  was  not  well  herself.  She needed
           to go to the doctor regularly, when it  was  possible  to  get  a
           neighbor to stay with John.  She was not making the improvement
           her doctor wanted her to make.

                Taking care of        was an exh              for a 69-year-old
           woman.@ N needed to  be  bathed  and  dressed  daily.  His  meals
           ,t,(5@d        repared, groceries must be shopped for, the laundry
           must           ut, the house made presentable.  It was just too
          (much           ieveryone agreed on that.\)

                A housekeeper was found, but she    didn't  stay  long.  She
           didn't know how to bathe a stroke patient, prepare a low-sodium
           diet, give range-of-motion exercises, or  use  a  Hoyer  lift  to
                                                                 I I- - --
           move the patient to a wheelchair,.                    L. -fter
           What could be done?  Put them-'       in a nursing home?  What
           shame.  They could both I        appy in the pretty little
         .1@@@apartment ,i;f there' was      one to help a  few  hours  aday

              @-@Then the doctor  remembered  Homemaker-Home  Health  Aide Project
           and called to request service for the couple.
                Thd next day t@             -t-cr---h-appem,@@ -,The Homemaker Aide

                                                                      bed bath,
                                                                     a front
           sunny window to look outside,    The                     ishes,
           dusted, shopped for groceries   and prepared the noon    meal.

                           @th-iTigs@,we-re-,-@,tter alreadyi@











                                    Back-up Sheet


            Region: Missouri Regional Medical  Program

            Locus of Activity:  operational Prc),ject

            Project Title: Homemaker-Home Health  Aide

            Status: Ongoing
            Sponsoring Institution:  @Visiting Nurse Association of Greene County

            Project Director, Title, Address:
               Maude Lee Tillman, R.N.
               Executive Director, V.N.A.
               2003 South Stewart
               Springfield, Missouri
            Dates:  Project initiated September 1, 1969
                    Project terminates March 31,  1972


            Fundia%:  First year  - $36,250.00
                      Second year - $82,843.00
                      Third year  - $39,000.00
            Other Funds:

            Cooperating Agencies and Institutions:
               Missouri Division of Health
               Missouri Heart Association
               Mo. Chapter American Cancer Society
               University of Mo. Extension Center
               Four local hospitals., practicing physicians, newspapers,,
                 S radi-oil and television stations
            Area  ervea:  Greene County, Missouri
                          Population 153,000
            Target Population: All families with an ill member in or out of the home
            -thAt would b-en-efit bv a Homemaker to hold the family together.
            congressional D-Tstrfdts:
             #7 - Durwara G. Hall-7R)
            Continuation after RMP Support  Withdrawn:
               It is believed that the project can  be continued on a fee-for-
            service basis paid b  the family receiving service.  Donations
                                 y
            and bequests are being requested to provide service for people
            who cannot afford to pay.






                                         -2-


            Core Staff Contact:  Warren Sights, M.D.
                                 Director of Operations,
            Date Prepared: 02-21-72

            Drafted PI: Maude Lee Tillman, R.N.







                                                                MISSOURI


                              Early Diagnosis and Treatment of
                              Children with Diabetes Mellitus


                   A  Research,  Education  and  Detection  (RED)  Project  in  the
             field of  diabetes  mellitus  has  been  in  progress  since  January  1,
             1970.  This  disease,  primarily  hereditary  in  nature,  is  on  the
             increase.  RED is the only way         @n-       to prevent or
             possibly delay the progression of this disease.
                       detection  and  research  program  is   aimed   specifically
             at children under  16  years.  In  the  past  two  years  more  than
             2,108 glucose tolerance tests have been performed in area detection
             clinic@in,-8 central Missouri town                                   I
             16.9%@wer@e found  to  be  abnormal.  Pollow-up   testing,   nutrition
             and  medical  counseling  were  an,integral  part  of  this   project.
                   Research  is  in  progress  to  determine  whether  good  nutrition
             and restricted concentrated sweets can prevent or delay the
             progression  of  the  disease,  especially  in  children  with  mildly
             abnormal tests. @@we are/further studying    I)the  relationship   of
             insulin values, growth hormone and chromium i,e7             how    these
             parallel the glucose level       different ages Haiti
                   Education is a must to be able to detect patients      in earlier
             stages of the disease and to have patients follow through correctly
             on  medical  management.  Physicians  and  allied   health   personnel
             need to be aware of the intricacies of the disease and its
             management to  present  it  to  the  patient  on  a  more  understandable
             level.  Information in this field is sent to personnel in a
             bimonthly bulletin after the allied health personnel have completed
             the eight-hour  course  of  instruction  (which  has  been  held  in
             eight communities,@,,.  Physician instruction is held in conjunction
            --w:tth coii  medical society meetings.
                   The public  health  service  and  the  Bureau  of  Maternal  and
             Child  Health  have  acted  as  community  coordinators  in  follow-up
             instruction  and  detection   in   certain   counties.   Environmental
             surveys of the family help determine the immediate needs of the
             community or the home.  Patients with specific dietary or
             insulin management  problems  often  may  be  helped  by  relating  to
             the specific problems found only in,,the home.

                   Educational material has become a growing concern.  V5
             ha*e p-r      -a Manual for Parents and
             @'Manual for@'@A2[ultsi4-,For the Fhysician and allied health
             personnel  are  the  Manual  for  Physicians  and  Medical   Students,
             Monograph  for  Nurses  concerning  diabetes  mellitus   in   children
             and  an  Instruction  Manual  for  personnel  responsible  for   teaching
             patients  of  all  age  levels.  As  funds  are  available,  a  bright
             pictured colored  book  for  children  will  become  part  of  their
             instruction.







                                            -2-



                      communities involved in this program,"          n,
            Princeton, Sedalia, Washington,  St.  Clair,  Mexico,  Jefferson
            City and Columbia, Missouri. The  Green  Hills  Area  in  nort'hwest
            Missouri is now being included in the educational projec
                   L.P.N.'s, 37 R.N.'s,  five  registered  dieticians,  five
            dietary aides and two nursing  technicians  or  nursing  home  aides
                                          Nurs
           ,.,,,have completed the course.    ing students  and  medical  students
            at the University of Missouri have  also  been  reached  through
            scheduled classes specific to  the  needs,  management  and  education
            of children.
               ,/Ongoing patient education pro]ects are now being carried on
                ix of the  eight  involved  towns.  D-iabetic detection programs
                now present in three of the eight towns.  Diabetes Associations
                now organized in Rolla, Mexico, Columbia, Jefferson City and
                Joplin-Springfield area through contacts made with our pro3ect.
           "Camp experience has also been available  over  the  last  two  years
            in the central Missouri area by the Robert L. Jackson Camp (or
            Camp Banting), held for two  weeks  at  Holt  Summit,  Missouri.  It
            is hoped that this will develop  into  a  state-wide  camp,  including
           @,,the St. Louis and Kansas City camps.  Children from 7-15 years
           I'@of age are able to increase in independence  and  knowledge  about
           ,@their disease by participating in camping activities in a
                erly supervised atmosphere.
            pro
                 Children with diabetes can have an active and productive
            life with vascular and neurological changes prevented    or   delayed.
            This is the goal of the RED Project.


                                                                            .4r








                                    Back-Up Sheet


           Region:  Missouri Regional Medical Program
           Focus of Activity:  Operational Project
           Project Title:  Early Diagnosis and Treatment of Children with
                           Diabetes Mellitus - To Delay or Prevent Vascular
                           Changes of the Disease

           Status:  Ongoing
           Sponsoring  Institute:  Department of Pediatrics
                                   University of Missouri Medical Center
                                   Columbia, Missouri

           Project  Co-directors:  Titles and Address:
                                   Calvin C. Woodruff, M.D.
                                   Professor

                                   Richard A. Guthrie, M.D.
                                   Associate Professor

                                   Department of Pediatrics
                                   University of Missouri Medical School
                                   Columbia, Missouri  65201
                                   Area Code 314 442-5111, Extension 647
           Date:  January 1, 1970 - January 1, 1972 (completion date of
                                                      project January 1, 1973)

           Funding:
           other Funds:  Department of Pediatrics
                         University of Missouri Medical Center
                         Columbia, Missouri
           Cooperating Agencies:  Division of Health
                                   Department of Public Health
                                   Bureau of Maternal and Child Health

           Area:  Central Missouri area
           Target Population:  Children from birth to 16 years of age
                                Physicians and allied health personnel

           Continuation after RMP support withdrawn:
                                Area hospitals to continue ongoing patient
                                education.  Continued communications through
                                bimonthly bulletin available by yearly
                                subscription or other Medical Center money.





                                        - 2-




          Core Staff Contact:  Dr. Warren Sights

          Date:  3/7/72

          Drafted By:  Richard A. Guthrie, M.D.








                                                                    MISSOURI



                       Mobile Rehabilitation Service Project


               A mobile rehabilitation team travels from Springfield  to
          outlying hospitals and nursing homes.  Th@ providescare which
          otherwise would not be available to rural residents.  Vocational
          rehabilitation services are offered through Springfield Baptist
          Hospital Rehabilitation Center.
               The staff has given 161 treatments to 80 patients since
          December@1119The staff now visits the following units one day each
          week:  Skaggs Community Hospital, Branson, Missouri; Barton
          County Memorial Hospital, Lamar, Missouri; West Plains Memorial
          Hospital, West Plains, Missouri; Ash Grove Nursing Home, Ash
          Grove, Missouri; Thayer Nursing Home, Thayer, Missouri;  Kabul
          Nursing Home, Cabool, Missouri, and West Vue Nursing Home,
          West Plains, Missouri. The three hospitals have  bed  capacity
          of 163 beds and the four nursing homes have a bed capacity  of
          322.

               In addition to rendering actual treatment to patients,
          instruc                    ie,&-      designated hospital personnel
             c        '@he work-- @t-wee-n.











                                    Back-up Sheet


            Region:  Missouri RegionAl Medical Program
            Locts of Activity:  Operational Project

            Project Title:  Mobile Rehabilitation Service Project

            Status: Ongoing
            Sponsoring  institution: @Springfield Baptist Hospital Rehabilitation
                                     Center
            Project Director,  Title, Address:
               Dr. Daniel L.  Yancey
               Project Director
               1211 South  Glenstone
               Sprin  field  Missouri
                    9      I
            Dates: @ 1971-74





            Fundi-n-a.: 01 - $20,000
                      02   @undecided
                      03
            other Funds:
             Hospital Support (Space, Equipment, etc.)
            Coo   ating A         nd Institutions:
               .Rer      gencies a
               Springfield Baptist-Hospital Rehabilitation Center




            Area  Served:  Southwest Area

            Target Population:  Health.Facilities, etc. in Southwest Area

                      n                           RahdAll (D),              1
            CongreSsio al Districts:  William J.               Durwood G. Ha 1 (R)
                                       Bill D. Burlison (D) +IID
            Continuation after RMP Support Withdrawn:

              Not now known.






                                           2-


            Core Staff Contact:  Dr. Warren P. Sights

            Date Prepared:    3/7/72

            Drafted by:    Elaine Sblcraig








                                                         MISSOURI


                                        COMPACT

                   (Cooperative Ongoing Medical-Health Participation
                               and Continuous Teaching)


           Practing physicians in the Greater Kansas City area are  becoming
           actively involved in continuing medical education programs  and
           seminars through the efforts of COMPACT.

           The one-year demonstration program, supported by  coordinating
           activities of the Kansas City Southwest Clinical Society and  the
           School of Medicine of the University of Missouri - Kansas  City
           (UMKC), improves the quality of community hospital specialty
           department meetings through planned sessions of joint  clinical
           review and combined resource medical audit on predetermined topics
           (arrhythmia, hypertension, etc.). Evaluation of the  sessions  is
           through questionnaires to participants.  Self assessment exams are
           administered to bolster the learning experience.

           COMPACT also coordinates visiting lecturers, or "docents",  of
           the UMKC Medical School with the continuing education programs  of
           physicians in private practice.  On October 26-30, 1971i two inter-
           nationally known cardiologists from London, England, Drs.  Jane
           and Walter Somerville, appeared extensively in the  community,
           appearing at five of the local hospitals, UMKC, the University  of
           Kansas Medical Center, Kansas City General Hospital, Wayne  Miner
           Neighborhood Health Center, as well as at dinner meetings of  the
           Greater Kansas City Society of Internists and the Kansas City South-
           west Clinical Society. It is estimated they appeared  before  436
           physicians in private practice, 13 academic physicians, 134 residents
           and interns, 40 medical students and 123 nurses. A  similar  visit
           on December 16-18 by "Docent" Reginald Hudson, M.D., internationally
           prominent in cardiac pathology, resulted in appearances  before
           163 physicians in private practice, 5 academic physicians,  88
           residents and interns, 110 medical students and 95 nurses.

           COMPACT also serves as a clearinghouse by providing a  quarterly
           calendar of the continuing medical education programs in the
           Greater Kansas City area. The calendar is designed to  inform  the
           practicing physician of medical education programs and to  help
           prevent duplication of efforts by planners of such  sessions.  A
           card file of all guest speakers is being established to  provide
           the highest quality speakers for future programs.
           COMPACT wants to involve as many of the private physicians  as
           possible in the Greater Kansas City area in improved  specialty
           department meetings and special programs of the UMKC School  of
           Medicine. Through involvement in continuing medical  education..
           and improved medical audit, the physicians of this metropolitan area
           will have increased the quality and level of patient care.







                                                        COMPACT

                                     Back-Up Sheet


           Region:  Missouri Regional Medical Program
           Locus of Activity:  Operational Project
           Project Title:  COMPACT (Cooperative Ongoing Medical-Health
                                    Participation and Continuous Teaching)
           Sponsoring Agency:  Kansas City Southwest Clinical Society
           Project Director:  J.H. Morris, Jr., M.D.
                              2220 Holmes
                              Kansas City, Missouri
                              AC 816 471-3999

           Effective Dates:   July 1, 1972 -June 30, 1973

           Funding:  $45,000

           Cooperating Agencies
             and Institutions:  University of Missouri - Kansas City;
                                Kansas City Southwest Clinical Society;
                                Kansas City Heart Association;
                                Community Hospitals

           Area Served:  Greater Kansas City

           Target Population:  1,500 physicians
           Congressional Districts:  #4 William J. Randal
                                      #5 Richard Bolling

           Continuation  after  RMP
             Support Withdrawn:   MORMP anticipates the activities generated
                                  by COMPACT will be continued by the Kansas
                                  City Southwest Clinical Society and the
                                  University of Missouri - Kansas City with
                                  support of community hospitals and area
                                  specialty societies.

           Core Staff  Contact:   Dr. Warren Sights

           Date Prepared:  1/25/72

           Drafted by:     J.H. Morris, Jr., M.D.










                                                                MISSOURI



                                  Cardiac Care Missouri


                 Cardiac Care Missouri   began in octobe@ 1971.  ,@t@'s  overall
           goal is to lower the death    rate  from  cardiovascular  disease   in
           southeast Missouri.

                 There are  25  counties,  including  25  ho'spitals, in the
           southeast region of the state. --,@--th-at-                          h
                                        -the first phase of the project@we,4.,@-@.@017@g
                      nly 13 hospital@.  Each of these hospitals has been
           personally contacted several times in an attempt to gain a
           greater knowledge of the present status, needs, and desires
           in coronary care in each of these hospitals.
                                  hospital  administrators,  chiefs   of   staff,
           and nursing service directors, i@ was.,Iea@fted-         the greatest
           need  apparently  lies  in  ursing  and  physician   education.   To
                                      n
                    this need,
                          coronary care@        L@o@    V"




           CAPE GIRARDEAU COUNTY:

                 coronary care training courses for nurses began at
           Southeast  Missouri  Hospital  and  St.  Francis  Hospital  in  Cape
           Girardeau.  The ROCOM System iq used as a teaching aid.
                 A-          bei:                  @ulance, rescue, fire
           and police personnel;/in   cardiopulmonary     resuscitation)in'J
           cooperation with the Cape County Ambulance Service.
                 "Earlv  Warning  Signs  of  Heari  Attack,"'  are  @ng
                       v staff and volunteers                         ons,
          ,,@,@'adio, television and newspaper,$

           BUTLER COUNTY
                 A coronary care course has been started in Poplar Bluff,
           with  28 students.  We  have  had  3  all  day  sessions.  Seven  more
           sessions are  scheduled.  We  have  been  asked  to  follow  with  a
           repeat course for those unable to attend this time, due to
           limited enrollment.  The four Poplar Bluff hospitals are
           cooperating in this effort to improve coronary care.  The medical
        ,,\,,,"staffs of these hospitals have met jointly to plan on a Community
           wide basis.


          ..,-MADISON COUNTY
                 In  Fredricktown.37  persons  participated  in  two   4ecture/
           return demonstrate      classes on CPR.
                               O@
                 Another class was presented on first aid and CPR.  Twelve
           persons including police, industrial and ambulance personnel









                                    Back-up Sheet


            Region:  Missouri Regional Medical Program

            Locus of Activity:  Operational Project

            Project Title.-  Cardiac Care Missouri

            Status: Ongoing-
            Sponsoring Institution:   Missouri Heart Association

            Project Director, Title, Address:
               Clifford R. Talbert, Jr., M.D.
               Cardiologist
               #14 Doctors' Park
               Cape Girardeau, Missouri 63701
               Phone: 314-334-4444
            Dates:
               October 1. 1971 (Fqnds.have been approved until July 1, 1972)


            Fundipl: $50,000


            other FuncTs:

            Cooperating Aaeacies and Institu'tions:






            Area Served: 13 counties in southeast Missouri
            Target Population:  25 counties in southeast Missouri
            Congressional Districts: 3,ltk @.. 't@kltovs (b)  *t%

            Continuation after RMP Support Withdrawn:







            Core Staff Contact:   Dk. Warren P. Sights

            Date. Prepared:.  3/3/72

            Drafted by:  Karen Hendrickson, R.N.







                                                                 MISSOURI



                             SIKESTON INTENSIVE CARE UNIT


                Intensive care, especially intensive  coronary  care
           is becoming a necessity in small  community  hospitals"with
           limited medical staff,@ few or no cardiolocrists,,dn-.
           and       limited nure(e specialists.  The nearest',@hospital to
           Sikeston  i               - 4--t-an--area is 150 miles  away.@
           @ transportation of the critically  ill  person  to  this  center
           would be extremely hazardous.
                The Sikeston Missouri Delta  Community  Hospital,  with
           approximately 200 beds serving a rural area of approximately
           150,000 people, proposed to set up a model  intensive  care  unit
           in the belief that a small community hospital can maintain a
           well-functioning intensive care unit.
                The  beneficial effects are shown in  these  results:
                1.   Patient care. The mortality  in  acute  myocardial
                     ihfarcts, which prior to the opening of  the  unit
                     was 36%, dropped to 11.6% (well in line  with  the
                     national average). Since the opening of  the  unit,,
                     only one patient below the age of 60 has  died  from
                     an acute myocardial infarct while in  the  unit.
                     Intensive respiratory care resulted in dramatic
                     im    ement in patients with  acute  respiratory
                      prov
                     problems such as crushed chests,  acute  respiratory
                     failure due to chronic pulmonary  disease,  respiratory
                     arrest, and etc.
                     Major vascular surgery can be performed  now  in
                     the hospital with good post-operative care in the
                     intensive care unit. A number  of  aortic  aneurysms
                     have been operated upon successfully.
                2.   Two-week courses (forty hours) of  intensive  coronary
                     care and intensive care are being given at six to
                     eight week intervals.  These courses consist of
                     lectures by the project director, a  vascular  surgeon,
                     a chest surgeon and the pathologist.  There  are  also
                     lectures and demonstrations by the inhalation therapist.
                     The course is implemented with the  Multi-Media  Rocom
                     System.  The trainees are given practical demonstrations
                     in cardiopulmonary resuscitation, are called to the unit
                     to observe any procedures such as  defibrillations  or
                     cardioversions, and are shown  autopsies.  At  present,
                     22 nurses have been trained from the staff of the
                     hospital and 19 nurses from other hospitals.





                                         -2-



               3.  The opening of the unit has generated interest  among
                   the practitioners in the hospital.  Several courses
                   in basis electrocardiography have been well attended.

                   The acceptance of the ICU by the medical staff  was
                   prompt and immediate. The treatment of  the  patients
                   in the unit is under the supervision of the attending
                   physician who, with the help of the intensive  care
                   nurse, is well able to handle most of the emergency
                   situations.  Cardiology consults are available on
                   request.

               4.  The interest generated in the community and  adjacent
                   areas using our hospital is obvious in donations which
                   helped buy the Rocom System for continuing coronary
                   care nurse training. A resuscianne,  an  electronic
                   heart and other teaching aids have also been purchased
                   for continuing nursing education.

               5.  Several nurses from small hospitals in the area
                   attended our training program, and with the basic
                   knowledge obtained through our course, they will
                   eventually be able to be used in their own  intensive
                   care unit.

               The Coronary Care Training Program has catalyzed  other
          activities in the hospital.  Emergency Room nursing personnel are
          being trained in cardiopulmonary resuscitation and monitoring of
          cardiac patients.  This training program will be extended to other
          areas of the hospital such as X-ray technicians and laboratory
          technicians so that, ultimately, any person being with or around
          the patients knows the basics of cardiopulmonary resuscitation.









                                       Back-up Sheet


             Region:   Missouri Regional Medical Program

             Locus of  Activity:   Operational Project
             Project Title:   Sikeston Intensive Care   Unit

             Status:@  Ongoinq

             S]2onsoring Institution: (Atslmvf-,

             Project Director, Title, Address:

           Carl G. Popp,- M.D.
           Project Director
           1012 North Main
          @Sikeston, Missouri    63801
             Dates:

                Approved July, 1970.    Unit opened, September, 1970.


             rundiEE: July 11 1970   - June 30, 1971 - $1121318
                       July 1, 1971  - June 30, 1972 - $ 40,000

             Other Funds: None

             Cooj2erating   Agencies and Institutions:





             Area  Served:   'Sikeston and surrounding area.

            @Targpt Population:    Approximately 150,000
             Congressional Districts:   #10   Mr. Bill ]3urli!3on (D)

             Continuation    after-RMP Support Withdrawn:
             The Intensive Care Unit   will function as-a division of the Missouri
             Delta Community Hospital, Sikeston, Missouri, after termination of
             the,project.  The Coronary Care Nur@e Training Program will be
             continued-as an in-s@ervice training program indefinitely by
                                        hospital and some of the nurse s eci&lists.
             thomedid4l   staff   of the                                  p




                                           -2-


            Core Staff Contact:   Warren P. Sights,  M.D.
            Date@ Pre2ared: March 8, 1972

            Dtafted by:   Carl G. Popp, n.D.






                                                                    MISSOURI


    10
                           Automated Physician's Assistant


             Residents of the small rural town of Salem  can  benefit  from
             a Missouri Regional Medical Program project,  the  Automated
            -Physician's Assistant.- This group of computerized  aids  is
             installed in the clinic of Dr. B.J. Bass.  Even though
                          'iles from the  University  of  Missouri-Columbia
             Salem is 130 m
             medical Center, Dr. Bass uses the automated  equipment  to  gain
             access to the'newest technology  and  information.  The  automated
             deviceer free Dr. Bass and his nurses to use  their  technical
             skills more effectively and to devote more time  to  patient
             care.
                 The automated equipment is linked by  telephone  lines  to
             a computer in the College of Engineering, University of Missouri-
             Columbia. With the computer's help, Dr. Bass  and  his  staff  can
             run tests that normally would require a patient to spend up to
             three days in the hospital, requiring much more time and
             expense.
                 AX1 patients are weighed  and have blood pressure and
             urinaiysis taken every time they come in, to  get  a  cumulative
             bulk of information over a period of time.
                 Examples of the automated tests  are  EKG  interpretations,
             automated patient history interpretations,  vision  and  hearing
             tests.

                 An automated pro ram does 14 tests  on  each  two-milliliter
                                 9
             blood sample. Standards have been set  for  the  normal  ranges
             for any one blood test, given an individual's  age,  sex,  diet
             and background. The computer  compares  new  information  with
             the established ranges; Dr. Bass can quickly  assess  what  is
             normal for each patient.
                 A spirometer tests the patient's lung capacity as he blows
             through a device which measures flow and volume.  Mathematical
             analysis of the speed and amount of exhalation aids diagnosis of
             respiratory ailments.
                 The computer comp3'.les a list of key symptoms the  patient
             has identified in his automated patient  history  procedure.
             With a thorough., computer-printed patient report  of  symptoms
             and test findings, Dr. Bass conducts  a  physical  examination.
                 All patient data is recorded in  the  computet's  memory.  Any
             of the information can be recalled  instantly  by'simply  punching
             the patient's number into the system.





  I t1.I.     I  .                       -.                         I I.           I
                                                                                   t
                                                                                   3
    'I
         .                        I                                                .I
                                                             I .                   I








                                    Back-up Sheet


            Region:  Missouri Regional Medical Program

            Locus of Activ@:  Operational Project
            Project Title:  Automated Physician's Assistant

            Status:  Ongoing
            S2onsoring Institution:  University of Missouri - Columbia
                                     School of Medicine and College of
                                     Engineering

            Project Director, Title, Address:  Dr. Earl M. Simmons
                                               University of Missouri
                                               Medical Center N307
                                               Columbia, Missouri  65201


            Dates:  1971

            Funding:  153,500

            Other Funds:
            Cooperating Agencies and Institutions: University  of  Missouri
                                                    Medical Center
                                                    University of  Missouri
                                                    College of  Engineering

            Area Served:  Southeastern  Missouri
            Target Population: Residents in southeastern  Missouri,  around
                                the Salem, Missouri, area
            Congressional Districts: RitAikrd  It,6(A (t)) -t I
            Continuation after RMP Support Withdrawn:

            Core Staff Contact:  Dr. Warren P. Sights

            Date Prepared:  3/15/72

            Drafted By:  Elaine Selcraig







                                                           MISSOURI


                             Biomedical Information Service.  Btal.%)


                  Missouri health professionals can take advantage  o  BMIS,
             a system that provides quick access to extensive medical
             information.

                  BMIS relies on the comprehensive facilities of the University
             of Missourils Medical School library, and on sources such  as
             the Poison Control Center of Childrents Mercy Hospital,  Kansas
             City; and the,Drug Information Center of the University of
             Missouri - Kansas City School of Pharmacy.

                  The heart of the system is a Mosler information system which
             stores more than a million pages from medical journals and
             monographs.  These are indexed by content and the index is placed
             in the computer. The system can retrieve any single  page  in
             seconds.

                  If a physician needs specific information on a  particular
             topic, for instance, he can telephone BMIS from anywhere in
             Missouri.  The computer searches through its memory and
             identifies all the articles about this specific subject.  The
             articles are retrieved and a printer converts the microfiche to
             standard pages. The BMI8 staff checks the library  and  other
             sources for additional information . These items  are  either
             mailed or transmitted by photo facsimile.  If a physician needs
             an answer it a hurry, the information can be relayed to him  by
             telephone, and hard copy is sent later as a follow-up.







                                    Back-up Sheet


             Region:  Missouri Regional Medical Program
             Locus of Activity:  Operational Project
             Project Title:  Biomedical Information Service

             Status:  Ongoing
             Sponsoring Institution:  University of Missouri  Columbia
                                     School of Medicine

             Project Director, Title, Address:  Dr. Warren P. Sights
                                               112 Lewis Hall
                                               Columbia, Missouri  65201


             Dates:  1971-72

             Funding:  30,000

             Other Funds:
             Cooperating Agencies and Institutions:  University of Missouri
                   Columbia - School of Medicine; University of Missouri -
                   Kansas City - School of Pharmacy; Poison Control Center,
                   Children's Mercy Hospital, Kansas City

             Area Served:  All of Missouri

             Target Population:  Missouri health professionals
             Congressional Districts:  All Missouri districts
             Continuation after RMP Support Withdrawn:  Fee-for-service from
                                                       users


             Core Staff Contact:  Dr. Warren P. Sights

             Date Prepared:  March 20, 1972

             Drafted By:  Elaine Selcraig





                                                                      MISSOURI



             Plan for Improvement of Pharmaceutical Services in Missouri's Rural Health
                           Care Institutions (Hospitals and Nursing Homes)

             In the first year of this three-year-project, approximately 50  hospitals
             of 100-bed size or less and 70 nursing homes will be evaluated to determine:
             current status of pharmaceutical services in the institution;  facilities
             available for providing these services; and, local pharmacists available.

             Cooperation of the hospitals and nursing homes was requested and thirty-eight
             hospitals and sixty nursing homes agreed to participate.

             By using questionnaires developed by Project Director Wayne M. Brown  for
             hospitals and nursing homes, an interview is conducted with the administrator,
             director of nurses, and pharmacist, if available.  The nursing stations and
             pharmacy or drug room are visited also.

             As of February 1, 1972, 33 hospitals had been visited.  Five have the services
             of a full-time pharmacist, 16 have a part-time pharmacist, and 12 have the
             .services of a consultant.  Various drug distribution systems have been
             seen.  Many hospitals are concerned and indicate they need help in improving
             their systems. It is believed that the services provided by the  full"time
             pharmacist will, of course, be better than that provided by a part-time or
             consultant.  It is hoped that a program can be developed and implemented to
             improve what the pharmacist is doing in these institutions. This  is  the
             ultimate objective of this project.

             Thirty-nine nursing homes have been visited.  Eleven have pharmacy consultants
             and the remaining 28 have no pharmacy service except for the actual providing
             of the drugs.  Of the 11 consultants, 7 were spending some time in the
             nursing home.  This time varied from a half-hour A week to one hour per month.
             In the other four, the pharmacist did not go to the nursing homes.

             There is not a great deal of pharmacy input in nursing homes. In the  next
             two years of the project, programs will be developed to help the pharmacist
             in the institutions provide better service.






                                   Back-up Sheet




             i-on:  Missouri Regional Medical Program
           Locus of Activity:  Operational Project
                                             ent of Pharmaceutical
           Project Title:  Plan  for  Improvem
                           Services in Missouri's Rural Health Care
                           Institutions (Hospitals and Nursing Homes)

           Status:  Ongoing
           Sponsoring Institution:  University of Missouri - Kansas City
                                     scnool of Pharmacy and Division for
                                     Continuing Education
           Project Director, Title,   Address: Wayne M. Brown
                                               Assistant Professor
                                               School of Pharmacy
                                               University of Missouri - Kansas,i
                                               Kansas City, Missouri  64110
                                               816-276-1614
           Dates:  July 1 - June  30,  1971-72 (First year - evaluation)
                   July I - June  30,  1972-73 (Second year - program developmen
                   July 1 - June  30,  1973-74 (Third year - re-evaluation)
           Funding:  1971- 72  $25,000 ($3,000 added for Green Hills Project)
                     1972-73  $26,500
                     1973-74  No funding
           Cooperatinq Aaencies and Institutions: Missouri Hospital
               Associatior          i Osteopathic Hospital Association,
               Missouri Nursing Home Association, Missouri State Medical
               Assotiation, Missouri Association Of Osteooathic Physicians
               and Surgeons, Missouri Pharmaceutical Association, Missouri
               Nurses' Association, and the Division of Health of Missouri.
           Area Served:  The State of Missouri - excluding St. Louis County
           Target Population:  50 hospitals of less than 100 beds and 70
               nursing homes.
           Conqressional Districts:  W'l illiam J. Randall (D), Richard Bolling I
           @(oWm. (Bill) Hull, Jr  .  (D)@IDurwood G. Hall (R), Richard
            iteichord (D), Wm. L. (Bill) Hungate, Bill D. Burlison (D).
           Continuation after RMP Support W@thdrawn:
            C6re Staff Contact: Dr. Warren P. Sights
            Date Prepared:  3/l/72
            Draf ted By: Wayne M. Brown








                                                               MISSOURI



                      Green Hills Cooperative Health Care Project


                  Twelve small community  hospitals  are  pooling  resources
             to improve the quality of service in the Green Hills area.
             The effort involves a communications network, training"!Iambulance
             attendants, continuing education  for  health  professions,  and
             improvement of emergency care for coronary and stroke patients.

                  Just one example of this cooperation:

                  The Executive Committee of  the  Green  Hills  Cooperative
             Health Care Project requested that the School of Pharmacy
             at the University of Missouri - Kansas City provide a program
             of continuing education in  pharmacology  to  nursing  personnel
             now employed.  It was their hope that, as a result of this
             instruction, patient safety would be improved and hospital
             costs reduced.
                  The programs were conducted by  four  professors  from  the
             School of Pharmacy. They  divided  into  two  teams  consisting
             of a pharmacologist and a clinical pharmacist.  The teams
             went to different hospitals and held conferences  from  9  -  12
             and 1 - 4.

                  it was believed that the pharmacist and nurse should
             be made more aware of drug administration problems and how
             to solve them. It was  also  thought  that  helpful  suggestions
             could be given to decrease common  drug  errors  in  hospitals.
                  Handouts were given out on intravenous solutions - their
             contamination and  incompatibilities,  adverse  drug  reactions
             and drug interactions. These  were  discussed  in  an  informal
             manner to allow the participants to get answers to any
             problems they were having.
                  Following the  corAp,16@ion of these programs  an evaluation
             with the Green Hills,@@-and the two teams will
                determine the effects of the program and,,x4hat type or
             types of programs       can follow.

                                    I











                                     Back-up Sheet


            Region:  MoRmp

            Locus of Activity:  Operational Project

            Project Title:  Green Hills Cooperative Health Care Project

            Status:  Ongoing.

            Sponsoring Institution:  Chillicothe Municipal Hospital

            Project Director, Title, Address:
               Dr. Joseph Conrad
               Project Director
               Chillicothe Hospital
               Chillicothe, Missouri
            Dates:  1971-74




            Funding:  01  -$30,194


            Other Funds:  Contributing Hospitals

            Cooperating Agencies and Institutions:
            Gentry County Memorial Hospital           Sullivan County Memorial Hospiti
            Noll Memorial Hospital                    Axtell Osteopathic Hospital
            Gen4 John J. Pershing Memorial Hospital   Ray County Memorial Hospital
            Carroll County Memorial Hospital          Wright Memorial Hospital
            Chillicothe Municipal Hospital            Putnam County Memorial;Hospital
            St. Francis Hospital                      Cameron Community Hospital
            Area Served: Northwest Missouri'

            Tar@et Population:   Population in area of 12 hospitals.

                  saional Districts:   W.R. (Bill) Hull, Jr. (D)
            Congre

            Continuation after RMP Support  Withdra@qn:

              Common Bond of Hospitals in a cooperative effort.






                                         -2-


            Core Staff Contact:  Dr  Warren P. Sights

            Date Prepared: 3/7/72

            Drafted by:   Elaine Selcraig




         DRAFT VICUTTE - MW OWIXTAIM STATES)

         THE IMSE PIRACTITIONER AS A PRYSIC'LAY"S ASSISTANT


              A Certain areas of rugged land and low population density in Idaho face
         the amw    obim as  many  rur.&I areas of America - few or no resident physicians.
                  Pr                                                 (,U,5tqm P)
         Rowe"r.@         tho'kountain states Regional Medical  Progra"ft, the'state of
         '14&bo has        a program           to@ extend @oo4icjil wW to many who
         otherwise have had to travel alias for basic medical attention.  This program,
         known as the Nurse Practitioner as a Physician's Assistant Progrant is involved
         in training highly.qualifie4 *ad  Motivated nurses to Act as physician's

         Assistants.
              The success of the program is directly related to the  cooperation  of  the
         medical &&4 professional bodies in the State.  From the start, the Idaho Medical
         Association# the Idaho Nurses Association$ and the Boar4o of Nursing, Xe4icine
         and pharmcy as well as the 'Idaho Rospital Association$ nursing educators *ad the
         c    sities involved were included in the development of the  project  and  kept
                                   /Ly the                          'Who acted as a.
         @inf"m4l of its progres@ u
         IIAJ#on between participants.
              TWO fmily practitioners   living in a c    nity of $09 people  and  serving
         a papule ion of wre than 6,000 dispersed over a 100 mile radius,    @     ogredd
         to **ploy the nurses as nurse practitioners upon  their  return  from  training.
              Since Idaho has so radical school and currently so physician assistant training
         prosraa,, the two selected nurses were entered at the Stanford University Medical
         Conter,which was offering its first pilot program for "pneralists.11  The
         States as             -1 ProgLo@unded the training of the two aurgdo.
         At Stanford,, the nurses underwent-three months of intensive training, followed
         by a ww mouth clinical experience with a family practitioner.  They a\f/e now
         @wo  tug on an internship basis with the employing Idaho physicians.






              The aura* practitioner works under the supervision of the  physician  at  all
         times   though this supervision my be through telephone contact.  The nurse
         practitioner duties include:         detailed system review and history taking;
                              examinations;                                pro-natal and

         volt child care; u~64-S chronic and geriatric aore; normal deliveries;           ig
         @nization and prevention progr                    Commas'ptat iab pzu,6cuu7'
                emrgency care, including suturing minor lacerations;@-        necessary house
         calls. The practicing nurse may write proic riptionsi but  these  most  be  counttr-
         signed by one of the physicians within 24 hours.  Physicians also review records

         of all patients teen by the nurse practitioner.
              During the 1971 legislative session, a change in the Nurse Practice Act
         of 'Idaho made it possible for the specifically trained nurse to perform those
         acts of medical diagnosis or prescription of therapeutic  or  corrective  measures
         which *@ be authorized by rules and regulations  jontly  promulgated  by  the  Idaho
         State Board of Medicine and the Idaho Board of Nursing which shall  be  idiplementod
         by the lds"o Board of Nursing. This revision to the Idaho  law  allows  the  trained
         physt,cisa's assistant to function effectively without the             constraints
         which could be introduced by licessure of physician atiistants or  by us* of

         rigid definitions in the Medical or Nursing Practice Acts.







                                           Back-up Sheet


         Region:  Mountain States Regional Medical Prograin/Idaho Office

         Locus of Activity:  Core Activity
         Project Title:  Nu@e Practitioners Pilot Project for Rural Idaho Areas

         Status:  On going
         Sponsoring Institution:  MSW -- see cooperating agencies, below

         Project Director, Title, Address:





         Dates:  October 1, 1970 to present




         Fund@:  MSRMP; training made possible by California RMP, Area III



         Other Funds:


         Cooperating Agencies and @itutions:  Council physician and other health pro-
                   fessionals, State Boards of Medicine, Nursing, Pharmacy, Idaho State
                  Medical Association, State Nurses Association State Hospital Association.



         Area Served:  2 counties in south central Idaho

         Target Pbpulation:  6,000+ nwal residents

         Conmessional Districts:  #1
         Continuation after IM Support Withdrawn:  MSRMP funded tra3-ning and has provided
                   program coordination and continuity.





         Core Staff Contact:  Mrs. Eileen M   ll,, R.N.


         Date Pi-epared:
                        February 14, 1972






        fLIleS arici  re@!@@ititioris j(liiit@v              by    tfie
        Idaho    State     Boird     of     Medicine     and     [lie     Idaho
        Board   of'   Nui@siiig   which   sliall   be    iijipleri-@ented    by
        the    Ictifit.)    Board    of'    Nursing."    This    revision    to                                                                  CA                                       IDAHO'S
        fdalio"s  Ntirsiri@,  I)ractice  Act   has   b(,c.T@i   ji,icigecl   by
                          n
        health  legislation      experts     to   1)@,  the       i-nost                                                               C.)I                           16"4'U rmN S E       PRACTITIONER
        pi@ogressive in ti-ie nation.        ](Ia)i(@)  law  @illo%vs  the
        trained pliysiciiii's assistant to                   effectively
        witlioL@l@ the restilt@ing                @vhicli    could     be                                                                         r-)
        ijitr(.)dLiced   by   licetisure    of'pli)7siciayi    assistants    or
        by  the  LISE  ol'  i-i.gid  def'iiiiti(@i-is  in  t@'ie  Medical   ot-
        Nursing I)ractice Acts.
             J.'Iie  rules  ,tiicl   fegijlatiol'is   ire   @i.pl)roacliing   a
        final  draft.  l@i  ad(lit  ion,  guidclii-@.es  f'or  cii@l)loyers  or
        agei@cies @itilizifig tiuj-ses in @@ll            @oles    will
        be iii@ide  @ivail,-tl)le  upon  reclti@-,,st  f'rc)rii  !fie  lci@ilio
        Board of iNu@-sjiig.





             III a(lditior@@  to  the   lial.)ilitv   @ns@,ti-ance   that   the
        11 LI FSOS carr@,  I'@)i  t@lieiiiselv@s,  (1-ir.  l(@@tho   p)iysicia[is
        pay a i-iiiii     f'ee i'(@)r aciclit@iori,,il iii@;uj-atite to c @over
        the iiiii-s(@ practitioner.





             TI@e  i@iui,se  p   ,ictitioner   mi.i@L   have   o@)portliriities
        f@@r CO@-itil)Lljl'@g eCILIcatic) jiist  @@@  ITIY  other   l@iealtli
        r.@rof'e.@si@)Tial  does,  DLiriiic,  tf@e   first   ycai's   intei-ii-
        ship,  the  TIL@L@SO  [)ractitioiier   @viIJ   have   a   great   de@il
        of   on-the-job   leari-iing   expei@ieti(-,@,,    As    she    becomes
        even   TYI(@i-c   I)roficient,   p@-eceptor@@tiil)s   wit@i   speci@il-
        ists will  be  aT-i-aric,ed  to  nie(,(  lier  iriclivi(.].tial  needs.


                                                                                                                                                                                       A PI]IOI'Pl@OJP'('7'
                                                                                                                                                                           7'0 Iyl@f]'R 0    R t,R,4 L 111@ @A L 771     R I,,'

                 -'[ie VVICHE Mountain I.;tatps  i@egiotial
                 M;.@dical PrcigrarT) encc)rrir)@iss(.@@@ Ida@io,
                 Montana, Nevada and VVvofi-iir,g. I  t   "
                 one of  56  Regional  Medicat  Prcjgrarris
                 throughout the  nation  @@tittiorizfd  b,@
                       Coii@jresS Lin(Jer Pt-. 89 239.













                                of,
                                                                                                                                                                                                                             CIIC, ii-icILI(filig
                                                                                                                                                                                                           t7
                                                                            of
                                                                                                                              l'ol- fliol-C  iiie(licl]       I)Ilt
                                                                                                                                                                                                                   i-@@ flotise calls
                                                                  witli                                                       (@oulcl l@ol t)c
                                                                                                                                                                                                                                   the I'lill-S,@  I)ra@ti
            @s (leii@                                                                                                    of
                                                                 l@y                                                                                                                                                     I)Y @@)II
                                                                           to                                   i-c@llocl(de(,]  @iii  ol(I               ili@l:) @i
            @i,avc@l          lo@            ii@;@i@-itii,,@@,@. Iiiis I)ioclii-i)e                                     @)e       1)@' [II(' IlLirSC'
                                                                                                                                            {call]                                                                                             lab   tests
                                                                                                                      viltLi@l@v                                                        li@l           fol-  LI                                        n's
                                                                                                                                 l@o  lii@ve  ill(@  sl.!I.Vi@@!@@s  @@f  LI           ii,ipe"-V    II (:)r                                  tile     litiTse
                                                                                                                                                                                                       caii                           \vlij@.@li sli@, was
                                                                                                                                                                                       ti-Liiii(@t@l iii a llos[)@t@ll SCrtill"@ Pl@@@i(IiII2  of-
                                                                                                                                                                                       S]I@@     11)0 IL:ItIIO@i         C)t' tile lio@LI)it@ll
                                                                                                                   @io  iii                 ati@] ci. i@illit@l)/                      fluxes c,,@ flild tile
                                                                                                                                                                                                   Lll-iysici@iii", I c@ vie@N, tile   r@ic@,)r(ls     @ii@
                f@roiTi  ilic        [lie
                                                                                                                                                      Iii-st                             itic,j)ts sLeii b@@  tli   ri,,irse t)iactiti(.)t-tei. 'f'li,e N@@ell
                                                                                                                                                                                                  iitirse pil@ici@itioller kil(@)",s [IC]- lililit@iti@),T.ls,
                         I)ita                                                                                                                                                         slid i@' she II-,is @ill@            of.                colistilis
                                                                                                                  @@@l]@)w @(I  by  @i         iiiot@tl-i                              tile
            tile                                                     III   the
                             o@" [lie
                                                                                                                        [@(@@v wci-lciii@4  oil  I'll]

            I'l-c@ iaiiiI  l@ @l' @l tile  I '.I i II ol    1
            St         I Iiiiv  i- I INJ  cli @t    ii Ii a I   @e -@7c (I t @i
                                                                                                                                                                                            -@IC ](I' 110 TIL]F i2 PI-@[Ctiti(@)IlCfS Ir@ @),iid  a  i'xed
                                                                                                                                                                                       lllolitlit@,           13illiril  is                            the
                                                                                                                                                                                                       ai@d   tli@T,,2  is  Tio   dit'f'eretitiatioii   in
                                                                                                                                                                                       cthal@@,@,s t@    @l@Nreci@ Serv@LCeS  pk:rf'Orlll(',(i          the
                                                                                                                                                                                                                             IC
                                                                                                                                                                                                    Laid  tile  iittrEe  pi@

            IV      1)(@)                                                                        is                                                       l@i-
                                  I @@d  ,)v I  @l 10@@         iaclitis  si@@                                            I  @'I  0       i@i w    LI                                                                  Liii,l lit)ii@)i [ier          fc)r
            the                 I'@)@
                                                              f@r)  the
                                                                                                                  @l@         @;ysl @ll   I view

                                      to   eti


                                                                                                                                                                                            DLI] itl@' ttIO 11) 7 1             soss
                                                                                                                                                                                       the  @@@ii-s   Pi-@icticc  @@i  iTtide  it  I)c)ssil)le  fbi-   the
                                             I'l  t] v  ii I I    i c@e \Ni ii,l                              I   I I,, cli   IC II @(I   I i@@ I I i(@I                                            ti-aii-icLi  iiiiise tc)            tliosc@ ,icts  of'
                                                                                                                                                                                                       l@osis or                                         or
                                                                                                                                                                                       Co@'re@,ltive  iiieast)i





                        The Nurse Practitioner as a Lhy@ cian's Assistant

             Certain areas of rugged land and low  population  density  in  Idaho  face  the
             same probl-em as many rural areas of America - few or no resident physicians.
             1-1c)-,,.,ever, with the help of the Mountain States Regional Medical Program (@ISRI%T)
             the State of Idaho has designed a proar@tm to  extend  medical  tare  to  many
             who otherwise have had to travel miles for basic medical attention.        This
             program, known as the Nurse Pracctitioner as a Physician's Assistant Program,
             is involved in training highly qualif4ed and motivated nurses to act as
             physician's assistants.

             The success of the program is directly  related  to  the  cooperation  of  the
             medical- and professional bodies in the State.    From the  start,  the  Idaho
             Medical Association, the Idaho-Nurses Association, and the Boards of Nursing,
             Medicine and Pharmacy as well as  the  Idaho  Hospital.  Association,  nursing
             educators and the communities involved we.re  included  in  the  development  of
             the project and kept informed of its progress by  the  MSPMP  who  acted  as  a
             liaison between participants.

             Two family practitioners living in a community of 899 people and se      rving
             a population of more than 6,000  dispersed  over  a  100-mile-radius,  agreed  to
             employ the nurses as nurse  practitioners  upon  their  return  from  training.

             Since Idaho has no medical school and currently no physician assistant
             training program, the two selected nurses were entered at the Stanford
             University Medical Center which  was  offering  '+-I  =.t  pilot  program  for
             11 generalists."  The MS@IP funded the training of the two nurses.  At
             Stanford,+ the nurses underwent three  months  of  intensive  training,  followed
             by a one-month clinical experience with a family practitioner.
             The @urse ?ractitioner works under  the  supervision  of  the  physician  a  all
             times, though this  supervision  may  be  through  telephone  contact.  Thetiurse
                actitioner duties include: detail.ed  syste@  review  and  history  @aking;
             @irlysical examinations; pre-natal and well-child  care;  chronic  and  geriatric
             care, normal  deliveries;  immunization  and  Drevention  programs;  emergency
             care,  including suturing minor lacerations; necessary house calls.  The
             practicing nurse may write  prescriptions,  but  these  must  be  countersigned
             by one of the physicians within  24  hours.  Physicians  also  review  'records
             of all- Datients seen b-@ the nurse practitioner.

             During  the 1971 legislative session, a change in  the  Nurse  Practice  Act  of
             Idaho made it possible for the  specifically  trained  nurse  to  perform  those
             acts of medical diagnosis or T)re@cription of therapeutic or corrective
             measures which "may be authorized  by  rules  and  regulations  jointly  promul-
             gated by the Idaho State Board of Medicine and  the  Idaho  Board@@jof  Nursin-
             which shall be implemented by the Idaho Board of Nursing."  This       revision
             to the Idaho law allows the trained physician's assistant to function
             effectively without the constraints  which  could  be  introduced  by  licensure
             of physician assistants or by use of  rigid  definitions  in  the  Medical  or
             Nursing Practice Acts.





                                                 Mountain States Regional Medical Program

                                                               Idaho Office






                CORONARY CARE       NG FOR SO@ST IDAHO AND EASTERN OREG


                       A unique consortium has developed to meet the need for trained
                coronary care nurses for southwest Idaho and eastern Oregon.  .   area
                hospitals, St. Alphonsus and St. Lukets Hospitals in Boise, Caldwell
                Meinorial Hospital in Caldwell and Mercy Medical Center in Nampa have
                formed a consortium to provide training to area nurses.  The Idaho Heart
                Association provides monies for this training and coordinates the project.
                     /Idaho also provides sane funds for the project and furnishes office
                space and secretarial assistance to the Nurse Coordinator.  Four six-week
                programs in coronary care-intensive care are held at alternating hospitals.
                N@es from outside the hospital consortium may take the training for a
                $100 tuition fee.  More than 160 nurses have been trained in coronary care-
                intensive care in the two-and-one-half years the program has been in

                operation.







                                               Back-up Sheet


          Region:  Mountain States RIP/Idaho Office

          Locus of Activity:  operational Project
          Project Title:  coronary Care Training in Southwest Idaho      Eastern Oregon

          Status:  on going
          sponsoring Institution:  Idaho Heart Association
          Pr,ojer-t Director, Title, Address:  Ray Willy
                                               Executive Director
                                               Idaho Heart Association
                                               2309 Mountain View Drive-
                                               Boise, Idaho

          Dates:  August, 1969 to present




          Funding:  Idaho Heart Association; MS@/Idaho; St. Alphonsus Hospital in Boise;
                    St. Luke's Hospital, Boise; Mercy Medical Center, Nampa; Caldwell
                    Memorial Hospital, Caldwell.

          Other Funds:


          Cooperating Agencies and Tnstitutions:  Same as above.  Area health professionals
                    assist in the teachirg through the coordination of a nurse Coordinator.




          Area Served:  Southwest Idaho - Eastern Oregon (300,000 population)

          Target Pbpulation:  All coronary patients in target area

          Congressional Districts:  #1
          Contirumt'ion after W Support Withdrawn:  Hospital consortium, Idaho Heart
                    Association, possibly other sources





          Oore Staff Contact:  Mrs. Wilma Secor, R.N.,, Nurse Coordinator


          Date Prepared:  February 14  1972
                                       5





                                                   Mountain States Regional Medical Program

                                                                  Idaho Office










                TREASUP,E VALLEY EXPERIMENTAL BEALTH SERVICES DELIVERY SYSTEM


                       In Ju-1y@ 1971, the Director of the Idaho office of,@'
                Fred  0. Graeber, M.D., was asked to also serve as temporary director
                for  the Treas@ Valley Experimental Health Services Delivery Systerno
                a  HSMHA contract with Boise State College for  the  development  of  an
                experimental model system of health  care,  combining  existing  compo-
                nents in innovative arrangements. Thxough  January  31,  1972,  when  a
                permanent director was appointed, Dr. Graeber served in this new
                capacity. An  advisory  camnittee  and  several  ad  hoc  c@ttees  were
                formed.  A work plan was formulated and articles of incorporation and
                by-laws were drafted. I.I.-MS-RMP/Idaho is presently providing office space
                to the permanent director and will continue to assist in the development
                of the project wherever possible.








                                               Back-up Sheet_


           Region:   Mountain States Regional Medical Program / Idaho Office
           Locus of Ar-ti@ity:  Core Activity
           Pr,oject Title,  Treasure Valley Exper@ntal Health Services Delivery System

           Status:  On going
           Sponsoring Institution:  Boise State College
           Project Dir-ector, Title, Address:  Douglas M. Mitchell
                                               Project Director
                                               Treasure Valley EHSDS
                                               P.O. Box 957
                                               Boise, Idaho  83701,

           Dates:  A@t 4, 1971 to present
                  (d@ con@mc+ was ti@n" by Boise S@ coiteqe)



           @ing:  HSHM contract


           Other Funds:  none at present  NSRT/Idaho contributing office space

           Cooperating @encies and Institutions:




           Area Served:  Treasure Valley - lo counties in Southwest Idaho and one county in
                         Eastern Oregon
           Target POPulatic)n:  300,000 u-rban and rur@ including large ChicanO POPulatlon
           Congressional Districts:  #1
           Continuation after RMP Support Withdr-awn:







           Oore Staff Contact:  Fred 0. Graeber, M.D.


           Date Pmpared:  February 14, 1972





                                                Mountain States Regional Medical Program

                                                              Idaho Office








               OONSUMER EDUCATION IN ATHEROSCLEROSIS


                      Too many people are ignoring the relationship of diet, exercise,
               and smoking to heart disease.,  In an effort to call these things to
               the attention of the general public,      /Idaho and the Idaho Heart
               Association prepared an attractive information leaflet
                         which was distributed to those who attended the Southwest

               Idaho State Fair in Boise during the last @eek in August,@ 1971.  A
               booth at the fair demonstrated coronary care monitors and other equip-
               ment.  Additional information on heart and related diseases was available
               for those interested.  The Idaho Heart Association has made this leaflet
               available in their own information racks in various locations such as

               hospitals and physicians' offices.







                                            Back-up Sheet


         ReL',iOn:  Mountain States Regional Medical Program/Idaho Office
         Locus of Activity:  Core Activity
         Project Title:  Consumr Education in Atherosclerosis

         Status:  On goang
         sponsoring Institution-  MS@/Idaho and Idaho Heart Association
         Project Director, Title, Address:  Williain J. Coffman  -
                                            Coordinator for Planning   Operations
                                            MSRMP/Idaho
                                            P.O. Box 957
                                            Boise, Idaho  83701

         Dates:  August, 1971 to present





         Funding:  MSRMP/Idaho and Idaho Hospital Association



         Other Funds:


         COO@@ing    @ies and Tnstitutions:





         Area Served:  Southwest Idaho and Eastern Oregon

         Target Pbpulation:  All persons in area

         Congressional Districts-  #1

         Continuation after @ Support Withdrawn:







         Oor,e Staff Oontact:  William J. Coffman


         Date Prepared:  February 14, 1972





                                                                                 FRED 0. GRAEBER, M.D., Director





                                        IDAHO DIVISION



                                        P.O. BOX 957, BOISE, IDAHO 93701
                                        TELEPHONE: (208) 343-4817







                 ACTIVITY BRIEF
                 NLIW 36
                 AWLJS7 2, 1971


                 tZT PROGRAM UWLD AT MOUNTAIN [WE AIR FORCE BASE
                 The Military Assistance for Safety in Traffic (MAST) program operated
                 at Mountain Home Air Force Base has been expanded to include inter-hospital
                 transfer of patients and pick up and delivery of blood, medicine and
                 human organs for transplant, ac               T-@re      ative's-,,,@
                                                -  The MAST program, whic7n utilizes military
                 equipment and medical personnel inproviding  emergency  medical  assistance
                 and evacuation, particularly in accident casesl has been in operation
                 as a pilot project on five military bases for n       a year            @n
                 Home Air Force Base,, seven rescue missions           flown               14, 4-@,
                 including the July 3rd air lift from an isolated area of a  @'L   boy   who
                 had broken his leg.  The important feature of this service is -Cne
                 attendance of a medical corpamnduring all missions flown by MAST.
                 Tne Idaho office of MSRMP has worked closely with MAST officials in
                 Washington, D. C. and at Mountain Home Air Force Base, and with Idaho
                 State Police and others involved in developing this Helicopter medical
                 service.  MSRMP/Idaho  m    s have attended all local and regional Kk3T
                 meetings and assisted in organizing site visits and briefings.
                 A committee to coordinate MAST activities for this area and to educate
                 professional and consumer groups about the availability of this
                 additional emergency medical service is            being organized#
                 Everett P@, Director  of  the  an@ency  Medical  Service  Division  of  the
                 Idaho De       t of Health  has been selected as          tor, an@
                 fcoL















                           WEI,,rFitN INI'ER'ITATE COMMISSION l,'Olt HIGHE[T EDUCATION







                                            Back-up Sheet


          Region:  Mountain States Regional Medical Program/Idaho Office

          Locus of Activity:  core Activity
          Pi,oject Title:  Military Assistance to Safety and Traffic (MAST)

          Status:  On going
          a2nsoring Institut'10n:  Mountain Hcme Air Force Base, Idaho
          Pr,oject Dir-ector$ Title@ Address:  Major Charles W. Bradley
                                            Chief, Safety Division
                                            Mountain Home AFB
                                            Hq. 347th Tactical Fighter Wing/Tac


          Dates:  July 1970 to present





          Funding:  De     nts of Defense, Transportation and Health, Education and Welfare



          Other Funds:


          Cooperating Mencies and Institutions:  Mountain Home Air Force Base, Idaho State
                   Police and other law enforcement agencies, Idaho Dep@ent of Health
                   (Emergency Medical Services division), MSRNP/Idaho




          Area Served:  Southwest Idaho

          Target Population:  Accident and inju-ry victims

          Con-wessional Districts:  #1, possibly parts of #2

          Continuation after RMP        Withdrawn:  MSRMP/Idaho support has been in
                   C(          meetings, facilitating comunications, etc.






          Core Staff Contact:  William J. Coffman


          Date Prepared:  February 141, 1972





                                                                                  FREO V. UMALStm. M.U.,





                                         IDAHO DIVISION
                                                i" 'N

                                         P.O. BOX 957, BOISE, IDAHO 83701
                                         TELEPHONE: (208) 343-4817



               ACTIVITY BRIEF

               NLfiBER 48
               FEBRJARY 2, 1972


                          'EDICAL SERVICES PLMIED FOR STNILEY BASIN AREA
               The town of Stanley is located in  the  Sawtooth  Mountains  near  Idahols
               primitive area. The population in winter is  only  47,  but  from  June  to
               mid-October, the population is  swelled  by  numerous  loggers,  summer  msi-
               dnets, tourists and hunters.  During this period, automobile accidents and
               injuries as well as hunting and  gunshot  accidents  take  their  toll.  The
               nearest hospital and physicians are 61 miles away, over an 8700 foot sLumiit
               via a twisting road, which is 2--2  1/2  hours  driving  time.  The  closest
               source of assistance is the forest ranger station in Stanley.

                                                                   Boise
               Mrs. Marie Osborn, a registered nurse,'@ivi                   is  a  summer
               resident of Stanley, approached both  MSRMP/Idaho  and  the  Idaho  Hospital
               Association@er  concern  over  major  accidents  and  emergencies  that   have
               occurred. MSRMP/Idaho and IHA,  working  with  the'coirmunity  of  Stanley,
               physicians in nearby Hailey and St. Alphonsus and  St.  Luke  s  Hospitals  in
               Bo-,se, @ developed a  refresher  and  in-depth  training  program  in  eimr-
               gency and trauma situations for Mrs. Osborn which         fit the requirements
               of                    lations for expanded roles in nursing
                                      State  Boards  of  Medicine   and   Nursing.   Co@ty
               initiative and involvement have been key  factors  in  the  development  a-
               this program. Stanley raised the funds to secure  an  aTrbulance  and  25  of
               the town's 47 residents volunteered to take the first aid training
                    @offered  by  Idaho  Falls  technicians.  Two  physicians  in  Hailey  am
               interested in Droviding back-up and  consultative  services  via  phone  and
               standing orders pertinent to anticipated situations.
               Wis. Osbom@ completed a six-week                  ional  practice  experience
               cit St. Luke's Hospital, and she                  riod of time in  the  trauma
               L,-U-r in the new St. Alphonsus Hospital.,                She            ly
               'E.tte,ndi% the first two-weeks of the Southwest  Idaho   Eastern   Oregon
               k,or,onary Care Tr               course in coronary-intensive care.
               Febru@ @ she ,               Harborview Hospital in Seattle for a  One-MOA'LWA
               pr,eceptoiship in emergency medical s                  the  cooperation  o
               Wash@on/Alaska RW.  Finally'r"@i@                 sane  clinical  experience
               with the two Hailey Dhvsicians in -Dreparation   for the provision of
               @diate assistance  to  accident  and  injury  victi=  in  the  Stanley  area
               summer*






                                    (,%Tl@',]?S'I'ATE COMMISSION T@Oft lllil[JEI(







                                            Back-up Sheet


          Region: Mountain States Regional Medical Program/Idaho Office

          Locus of Activity:  Core Activity
          Project Title:  Dnergency Medical Services for Isolated Rural Idaho Area

          Status'.  On going
          Sponsoring Institution:  MSRMP/Idaho and Idaho Hospital Association

          Pmject Director, Title, Address:





          Dates:   September, 1971 to present




          @ing:  MSRMP/Idaho, Idaho Hospital Association (Kellogg Foundation Grant)


          Other Fmds:  Other foundation mnies, private donations, contributions from
                    co@ty
          Cooperating Agencies and Institutions:  MSRMP/Idaho, Idaho Hospital Association,
                    Washington/Alaska RMP, St. Alphonsus and St. Lukets Hospitals in Boise,
                    physicians in Hailey, Idaho, cannunity of Stanley, Idaho Falls health
                    professionals


          Area Served:  Stanley Basin, near Idaho primitive area

          Target Population:
          Congressional Districts:  #2
          Continuation after RW Support Withdrawn:  MSRMP providing funds for training
                    only.  Local sources are providing all other funds.





          Core Staff Contact:  Mrs. Eileen M   11, R.N.


          Date Pm@:  Febru@ 14, 1972















                                                    Nassau-Suffolk



                                  HOME HEALTH  CARE



           It          apparent   f                  that many people in
           need of health care could be cared for at home  if  necessary
           services were available. For these people,  home  care  would
           prove a more humane, less costly procedure
                                  -of .. living at - home,--wh@,i@lel-p@l
           unnecessary overcrowding of hospitals and nursing homes.

                            some people are currently receiving  certain
           home care services         r-,@@sferious omissions remain in existing
           programs.  Of major concern is access to services, particularly
           for patients lacking adequate financial resources.

           In July of 1971, the Comprehensive Home Health  Care  Project
           was established        @@t.--to address,--th,is@--@prob-i-em-,--i-n..-a
           tho    h          tic-,-mann,,--r..-i-- The project'-,s,---primary,-,@g-o@zrl-@--is the
           develop          coordinated comprehensive home health service
           System for Nassau and Suffolk Counties.

                --T-- @-@STU.]aYING.,-,THE--@PROB=-AND BUT PI  ,.,A%--MODEL,--

           To develop a coordinated comprehensive system of home health
           services, -it 5 i-teee&s-a                @g present programs
           and  financing  patterns V',4            against the need@for
                   -'In addition to analysis of   6eds as perceived by
                                                  n
           Provider agencies, it is essential to analyze needs as inter-
          L_ireted by users or,potential users of home health  services.
           Such a study will be conducted by The  Health Management Group,
           a health management firm, under contract to the Nassau-Suffolk
           Home Care Council.

           During the first year, the study will examine various situations
           which might benefit from home care, including mental as well
           as physical conditions. It will consider all  types  of  home
           services needed such as nursing, homemaker, home health aide,
           physical therapy, occupational therapy, speech therapy, psychiatric,
           dental, optometric., "meals on wheels" and friendly visiting.

                                     ,Created with related organizations
           such as planning and coordinating agencies, professional
           associations and volunteer citizen and consumer groups.














                                           -2-


            Financing procedures will be investigated in order to identify
                         preventing  needed  services  from  being  rendered.
          .,Among programs analyzed will be Medicare, Medicaid, Blue Cross,
            private insurance and individual payment.

               a result of this study, a "descriptive model" analyzing
            the existing  service  system  will  be  created.  Proposals  for
            reorganization will then  be  formulated  in  a  "normative  model"
            and tested in group sessions involving both providers and
            consumers of service.  The aim of the group sessions will be
          ',\"to arrive at agreement on administrative   and   organizational
            changes necessary for the creation of an effective system of
            coordinated comprehensive   home care services.



            During the second year,@  proposed organizational models will be
             ield test@,       @@ne--,the-ir.



            During the third year, the final plan for a program of coot-
            dihated comprehensive home  care  services  for  the  residents  of
            Nassau and Suffolk Counties will be

            The Nassau-Suffolk Regional Medical Program, Inc. has been
            particularly concerned with  the  problem  of  home  health  care
            as an important part of its commitment to the over-all improve-
            m6nt of the quality and quantity of ambulatory health care
            services  oh  Long  island.  It  has,.therefore,  supported  both
            the initial development of the  Project  as  well  as  its  current
            operation. The proposal  for  the  Project  was  sponsored  by  the
            Federation of Visiting  Nurse  Services  of  Nassau  and  Suffolk
            Counties and  the  Nassau  Community  Health  Services  Foundation.














                                    BACK-UP SHEET



           1.   REGION - Nassau-Suffolk Regional Medical Program

           2.   LOCUS OF ACTIVITY - Operational Project

           3.   PROJECT TITLE - Comprehensive Home Health Care Project

           4.   STATUS - Ongoing

           5.   SPONSORING INSTITUTION - Federation of Visiting Nurse
                Services of Nassau and Suffolk Counties, and The Nassau
                Community Health Services Foundation

           6.   PROJECTOR, TITLE, ADDRESS:

                           Mr. Alan N. Fite, Project Director
                           1200 Stewart Avenue
                           Garden City, New York 11530
                           516-997-5060

           7.   DATES - July 1971 - June 1974

           8.   FUNDING - $285,113 (over a three-year period)

           9.   OTHER FUNDS:  None

           10.  COOPERATING AGENCIES AND INSTITUTIONS:

                Health Departments, visiting nurse associations, church
                sponsored home care services, Departments of Social
                Services and Mental Health,  hospital-based  home  care
                programs, and proprietary  homemaker-home  health  aide
                agencies.
           11.  AREA SERVED - Nassau and Suffolk Counties, Long Island,
                New York

           12.  TARGET POPULATION  - All Nassau-Suffolk residents who
                could benefit ft@m Home Health Care.

           13.  CONGRESSIONAL DISTRICTS:

                C.D.#                     Incumbent                Party

                 1                        Otis G. Pike             D-L
                 2                        James R. Grover, Jr.     R-C
                 3                        Lester L. Wolff          D-L
                 4                        John W. Wydler           R
                 5                        Norman S. Lent           R-C









           Back-Up Sheet (cont.)

                                        -2-


           14.  CONTINUATION AFTER RMP SUPPORT WITHDRAWN:

                N-S RMP believes that existing and additional home health
                services will begin to operate within the framework of
                the model created for coordinated Comprehensive home care
                services.


           15.  CORE STAFF CONTACT - Gladys Rothbe

           16.  DATE PREPARED - February 10, 1972

           17.  DRAFTED BY   Gladys Rothbell












                                 BACK-UP SIIEET



       1.   REGION    Nassau-Suffolk Regional @ledical Program

       2.   LOCUS OF ACTIVITY - Operational Project

       3.   PROJECT TITLE - Comprehensive Home Health Care Project

       4.   STATUS - Ongoing

       5.   SPONSORING I14STITUTION - federation of Visiting Nurse
            Services of Nassau and Suffolk Counties, and The Nassau
            Community Health Services Foundation

       6.   PROJECTOR, TITLE, ADDRESS:

                       14r. Alan N. Fite, Project Director
                       1200 Stewart Avenue
                       Garden City, New York 11530
                       516-997-5060

       7.   DATES    July 1971 - June 1974

       8.   FUNDING - $285,113 (over a three-year period)

       9.   OTHER FUNDS:  None


       10.  COOPERATING AGENCIES AND INSTITUTIONS:

            Health Departments, visiting nurse associations, church
            sponsored home care services, Departments of Social
            Services and  llental  Health,  hospital-based  home  care
            programs,  and  proprietary  homemaker-home  health   aide
            agencies.

       11.  AREA SERVED - Nassau and Suffolk Counties, Long Island,
            New York

       12.  TARGET POPULATION  - All Nassau-Suffolk residents who
            could benefit from Home Health Care.


       13.  CONGRESSIONAL DISTRICTS:

            C.D.#                       Incumbent                 Party

             1                          Otis G. Pike              D-L
             2                          James R. Grover, Jr.      R-C
             3                          Lester L. liolff          D-L
             4                          John W. Wydler            R
             5                          Norman S. Lent            R-C








      Back-Up Sheet (cont.)

                                    -2-

      14.   CONTINUATION AFTER PI.,IP SUPPORT WITIIDRAIA714:

            N-S RYP believes that existing and additional home health
            services will begin to operate within the framework of
            the model created for coordinated comprehensive home care
            services.

      15.   CORE STAFF CONTACT - Gladys Rothbell

      16.   DATE PREPARED - February 10, 1972

      17.   DRAFTED BY   Gladys Rothbell









                                                                            NEBRASKA
                                  .00RO.NARY CARE TRAINING  &  SUPPORT  PROGRAM.
                     .The Coronary Care Training and Support Program, existing at Bryan
                     Memorial  Hospital,.Creighton  Memorial  St.  Joseph's  Hospital,   and   the
                     University  of  Nebraska  College  of  Medicine,  has  completed  its  second
                     year  of  coronary  care  training.  During  this  period,  formal   training
                     programs were prov@ded for 116 nurses, 75 doctors. and 39 technicians.
                     Refresher courses  (presented on  an  outstate  basi  were  attended  by  388
                     nurses.  Five  technical  service  programs  hold  a@   Creighton   attracted
                     participation  from  115  persons.   Six   obe-hour   telephone   conferences
                     were  conducted  by  the  University  of  Nebraska  in  cooperation  with  18
                     hospitals.  The  total  number  of  personnel  participating  in  these  con-
                     ferences was 287. A workshop  field  in  Omaha  by  the  University  of  Neb-
                     raska was attended by 52 physicians.
                     In addition to the Coronary Care                d Support Program,
                                                                          ;Ls i
                                   prof es s iona Compaq
                     C                            ced--by,@he  Inter-Mountain   Regional   Medical
                     Programiin  response  td@requests  by,4phys-ke@  for   continuing   education
                                                                                                 e
                     materials on given procedures in coronary techniques      and   patient   car
                     audiq-cassettes have been furnished to physicians at      six locations@here
                     they are shared in the clinics and hos       als.
                     A recent survey of all  nurses  trained  @y       oronary    Care    Training
                     and Support  Program,indicated  that  70  percent  or  528  of  these  nurses
                     wanted some f            inu,'n co  narv  ed  cati  n
                                                , ft _g" @
                                  ? rm 5
                                           0 -t
                                         I&'
                                        A course" consisting   'of 6 prog rammed       instructural
                     lessons on electrocardiography        r@+eldl   o      nurses,
                                                                  f     th
                                   g mailed at the rate,of two          S.4           to      each
                     nursei A course of 120 lessons          follow  these, mailed at the rate-
                     of ten per month.
                     During  the  coming  year,  additional  activities  are  projected  with   the
                     nurse and @e physician continuing education material. .
                     .gn  expansion  of  the  nurses'  continuing   education   courseaplannedwhich
                         @@@iace copies of t-he -,our4p, irk   hospitals   throughout,the   state.
                                     iLncorp@t4-i.rilt-o      -klelcal libraries and made
                     available to all9tn4Vrses                                                NRMP
                     is currently in the process of obtaining AAGP certification of the
                     physician continuing education course'.so@@that--@,Physi:drdff"-@siti",-
                                                                 par     -a-t -o- rr- t-n-


                     At present, NRMP is undertaking follow-up.evaluation testing
                     'co4trolly-      t4              -for all persons having compl@            he
                     Coronary Care Training and Support Program.









                                             Back-up Sheet




                  REGION:  Nebraska Regional Medical Program

                  LOCUS OF ACTIVITY:  Operational Project

                  PROJECT TITLE:  Coronary Care Training & Support Program

                  STATUS:  Ongoing

                  SPONSORING INSTITUTION:  Nebraska  Regional  Medical  Program

                  PROJECT DIRECTOR, TITLE, ADDRESS:   Deane S. Marcy, M.D.
                                                      Project Administrator
                                                      Coronary Care Training & Support Program
                                                      700 C.T.U. Building
                                                      1221 "N"  Street
                                                      Lincoln, Nebraska  68508

                  Richard Booth, M.D.          Charles Hamilton,  M.D.        Stephen Carveth, M.D.
                  Project Director             Project Director               Project Director
                  Coronary Care Training       Coronary Care  TraLning        Coronary Care Training
                     and Support Program         and Support Program            and Support Program
                  Creighton Memorial St.       University of  Nebraska        Bryan Memorial Hospital
                     Joseph's Hospital         College of Medicine            4848 Sumner Street
                  2305 So. 10th St.            42nd & Dewey                   Lincoln, Nebraska
                  Omaha, Nebraska 68108        Omaha, Nebraska  -68105        68510

                  DATES:  January 1, 1970, became an operational.project

                  FUNDING:  02  $95,241


                  OTHER FUNDS:  None

                  COOPERATING AGENCIES AND INSTITUTIONS:  American Heart Association, Nebraska
                     Heart Association, Creighton University, Omaha, Nebraska, University of
                     Nebraska, Bryan Memorial Hospital, Lincoln, Nebraska,. Inter-Mountain
                     Regional Medical Program.

                  AREA SERVED:  Nebraska, Iowa, South Dakota and Kansas


                  TARGET  POPUIATION:   Nebraska

                  CONGRESSIONAL DISTRICTS:  #3  Dave Martin (R), #2  Charles Thone (R),
                     #1  John R. McCallister (R)

                  CONTINUATION AFTER RMP SUPPORT WITHDRAWN:  The   staff member responsible is
                     exploring the possibility of continuing the programs without NRMP funding
                     through such means as tuition fees paid by the participants benefiting from
                     the training.  He has also contacted insurance companies about assisting
                     the program financially.







                 CORE STAFF CONTACT:  Ronald D. Barnfield, Area.Consultant

                 DATF, PREPARED:  2/12/72

                 DRAFTED BY:  Darrell D. Buettow/Dawn Greene Muich







                                                                            NEBRASKA
                                            MOBILE CANCER  DETECTION@UNIT

                                    po@of the    Mobile Cancer Detection Un4             prove
                                                                                t

                                                                            e
                     cance  control,in  this  region   by   making   availabi  fre                  C"

                     ing_of_major cancer target     organs as well   as  cancer education.  The
                     Mob--L    1-ti-Cancer Target   Screening Unit   is the first of,         s@isdlm-
                     in the world.  One                                   of the Unit@  Is to
                     ulate  improved  medical  care  in  different  racial,  ethnic,  mino   Ity,   an
                     rural heterogeneous groups.,@

                                          the  majority  of  persons  do  not         periodic
                     cancer  screening.  Reasons  for  this  are  legion   and   include   socioeconomic
                                                             3 -1 - - -,
                     and educational factors,     @dentia-    ----@iom'proximity    to     physicians,
                     and  psychological  factors.  By  literally  bringing  the   detection   unit   to
                     the  patients'  doorstep,  preceded  by  an  education  and   publicity   campaign,
                     the common denominators of fear, anxiety, apprehension, denial a         nd
                     fatalism are often avoided.  The Unit provides multiphasic cancer
                     screening,  an  excellent  opportunity  for  cancer   education,   And   provides
                     the  patient  with  the  basis  for  a  communicative  and  supportive   follow-up
                     relationship with his personal physician.

                     The  Unit  is  60'  long  and  12'  wide.  It'contains  a  reception  room  where
                     automated  cahcer-medical  histories  are   ta   end   rooms   for   proctosig-
                     moidoscopy, a dental room for oral cancer screenings rooms for gynec6l-
                     OgLcal screening and a room for mammography.  Person@@l consists of recep-
                     tionists,(:j) or                 a dentist, social worker, nurses,  and,v
                                                    ical  society   endorsement   and   publi'city@a.,
                             -120 patients             each day-at p-r.         All patients are given
                     an   abdominal   examination/@a   complete   examination-of   the   skin,    oral
                     examination  and  American  Cancer  Society  information.  The   time   for   exam-
                     Lnation in  the  Unit  ranges  from  about  20  minutes  for  a  male  under  age
                     40  (the  cutoff  age  for  proctosigmoidoscopies).to  about  an  hour  for   a
                     woman  over  age  40  wholin  addition  to   proctosigmoidoscopemust   have   a
                     pelvic  examination  and  mammography.  gach  female   patient   is   taught   to
                     perform a self-breast examination and @rovided with American Cancer
                     Society   information    describing    self-examination.

                     The entire project  is  computer  adapted  so  that  within  a  period  of  48  to
                     72 hours,  a  full  report  will  be  sent  to  the  patient's  family  physician.
                     The report contains every piece of evidence pertaining to patient history
                     and  physical  findinas,   including   occupational   and   hereditary   neoplasm
                     hatards.  As  a  double-check,  a  return  postcard  is  provided   with   each
                     report which must be checked and signed by the patient-is physician, indi-
                     cating  receipt  of  the  report.  A  follow-up  call  is  made  on  failure   to
                     receive this  card.  In  each  case,  the  patient  is  urged  to  see  the  desig-
                     nated physician.

                     At  three  specific  sites,  932  patients  were  seen  with  a  confirmation  of
                     seven  positive  malignancies  and  320  abnormalities  in  27   possible   disease
                     areas or categories.









                   Th@:a@e-ptance and documented need at the three specific sites
                   was overwhelming in every instance, and it has been extremely
                   @ra@i:fy@ng_,,f_rom a medical standpoint that people have traveled
                   200 miles in some instances (-ru al locations) to take advantage
                   M-.--the--Mobile Cancer Detection Unit screening.,rThe patients
                   and physicians repeatedly express gratitude to.',@us for providing
                   this opportunity.



















                                     A:,,ICER DETECTID-
                      IIAOBIL-



                                                                                           --4


                                         7I








                                             Back-uD Sheet




                 .R=ON:  Nebraska Regional Medical Program

                  LOCUS OF ACTIVITY:  Operational Pro ect

                  .PROJECT TITLE:  A Proposal in Neoplastic Diseases:  A Mobile
                    Cancer Screening Unit

                  =US:  Ongoing
                  @NSORING INSTITUTION:  Creighton University School of Medicine

                        CT DIRECTOR, TITLE, ADDRESS:  Henry T. Lynch, M.D.
                                                      Professor and Chairman
                                                      Department of Preventive
                                                       Medicine and Public Health
                                                      Creighton University
                                                      School of Medicine
                                                      657 North 27 Street
                                                      Omaha, Nebraska
                          Initial RMPS support, January, 1970

                        NG:  02  $76,024

                        .-FUNDS:  $1000 from Massachusetts Mutual Life Insurance
                    Company on the contingency that the Unit be operational during
                    t-he-f-irst quarter of 1972

                  @-PERATING AGENCIES AND INSTITUTIONS:  County Medical Societies, Nebraska
                    -Medical Association, Public Health Service, Indian Community Health S6r-
                    itilce, Comprehensive Health Association of Omaha, American Cancer Society,
                    @en's Auxiliary Groups, Extension Organizations, Practicing Physicians,
                    -Churches, Newspapers, Radio and Television Stations.








                        SERVED,  Nebraska

                        T POPULATION:   Medically indigent of Nebraska

                  -MbiGRESSIONAL DISTRICTS: #3  Dave Martin (R)
                                            #2  Charles Thone (R)
                                            #1  John R. McCallister (R)








                  CONTINUATION after RMP SUPPORT WITHDRAWN:  Applications to the
                    Insurance industry as well as to the State Health Department
                    in Nebraska have been made.  At present a grant proposal is
                    being prepared to submit to the American Cancer Society  in
                    order to keep this project viable at the end of NRMP grant
                    support.








                  CORE-$TAFF CONTACT:  Deane S. Marcy, Coordinator NRMP

                  I)@TE-PREPARED:  2/12/72

                  I)RAFTED,.BY:--Darrell D. Buettow/Dawn Greene Muich







                                                           NEBRASKA
                                      LEARNING RESOURCE CENTER


                  The Learning Resource Center (Medical Media Library)  provides  multi-
                  disciplinary programs that represent a broad distribution  of  overall
                  .categorical diseases and all departments represented in hospital
                  structure
                               The Learning Resource Center has also designed and  imple-
                  mented inservice training programs covering a wide variety of  areas
                  for 15 hospitals in the state of Nebraska.

                  The media itself consists of: overhead  transparencies,  sound-slide
                  sets, and sound filmstrip sets. The library  purchases  only  commercially
                  produced media that are first previewed by Cote Staff, and approved  or
                  disapproved by two hospitals following their evaluation.  The library will
                  also purchase media upon request by a hospital.  The library has material
                  in the following areas:  housekeeping, food service, nursing service,
                  -inhalation therapy, aid training pharmaceutical service,  emergency
                  service, and particular emphasis on coronary and intensive care.

                  The goals of the Learning Resource Center are:
                       To provide commercially produced media to any health care institu-
                  tion at a minimum of cost.
                       To encourage health care institutions to develop  continuous  and
                  ongoing inservice education proarams for all types of employees.
                       To encourage health care institutions to  seek  outside,resources
                  for developing inservice programs.
                       To provide consultation to any health care institution  requesting
                  such consultation for evaluation of current ins6rvice program or  to
                  help design new inservice programs.
                       To encourage local hospitals to form cooperative  inservice  training
                  groups that can "pool" resources and ideas to promote better  inservice
                  training programs.

                  The Learnina Resource Center has acted as consultant for closed circuit
                  television ta many hospitals, and has encouraged the establishing of'revieii
                  committees to preview and evaluate media materials before the hospital uses
                  them in their inservice training procrams.  To date, this has been achieved
                  in 88 per cent of the hospitals in Nebraska.

                  As of November 1, 1971, the Media Library has received 3,715 requests.  We
                  are projecting that during the second year of operation, the library will
                  receive 4,164 requests.

                  The Learnina Resource Center has planned and coordinated  eight  inservice
                             0
                  training workshops throughout the State of Nebraska and  has  participated
                  in numerous lectures and presentations to groups on the  fundamentals  and
                  principals of training.








                                             Back-up Sheet



                  REGION:  Nebraska Regional Medical Program

                  LOCUS OF ARTIVITY:  Core Activity

                  PROJECT TITLE:  Learning Resource  Center

                  STATUS:  Ongoing

                  SPONSORING INSTITUTION: Nebraska  Regional  Medical  Program

                  PROJECT DIRECTOR:  John H. George, Director
                                     Learning Resource Center.
                                     Nebraska Regional Medical Program
                                     700 C.T.U. Building
                                     1221 "N" Street
                                     Lincoln, Nebraska  68508

                  DATES:  In July, 1971, the Learning Re source Center  became  a
                    Core Staff activity, and fully operational.  Prior to that, it was a
                    part of a funded operational (Communication Facility)Project from May,
                    1970 to July, 1971.
                  FUNDING:  01  $15,000

                  OTHER FUNDS: The Learning Resource Center  will  be  receiving
                    outside supplementary funding from the South  Dakota  RMP.

                  ,COOPERATING AGENCIES AND INSTITUTIONS:  South Dakota Regional
                    Medical Program, Nebraska Hospital  Association,  Nebraska
                    Television Council for Nursing Education,  Nebraska  Nursing
                    Home Association, National and  Nebraska-Iowa  Chapter  of
                    American Society of Hospital Food Service Administrators, and
                    the Nebraska Nurses Association.


                  AREA SERVED:  Nebraska an  South Dakota


                  TARGET POPULATION:  Nebraska and South Dakota

                  COIGRESSIONAL DISTRICTS:  #3  Dave Martin (R)
                                             #2  Charles Thone (R)
                                             #1  John R. McCall4Lster (R)
                  OONTINUATION AFTER RMP SUPPORT WITliDRAWiN:  The Director, Learning
                    Resource Center, is investigating the Dossibility of phasing
                    out the media library into one of the health associations, i.e.,
                    Nebraska Hospital Ass ociatioa or the Nebraska  Nursing  Home
                    Association.








                 CORE STAFF CONTACT:  John George, Director
                                      Learning Resource Center

                 DATE PREPARED:  2/12/72


                 DRAFTED BY:  Darrell D. Buettow/Dawn Greene Muich








                                                Back-uD Sheet




                    .@-G-ION:  Nebraska Regioial Medical Program

                    LOCUS OF ACTIVITY:  Operational Project

                    PROJECT TITLE:  A Proposal in Neopl.astic Diseases:  A Mobile
                      Cancer Screening Unit

                    .STATUS:  Ongoincr

                    B2-ONSORING INSTITUTION:  Creiahton University School of Medicine

                    P-@MJECT DIRECTOR, TITLE, ADDRESS:  Henry T. Lynch, M.D.
                                                        Professor and Chairman
                                                        Department of Preventive
                                                          Medicine and Public Health
                                                        Creighton University
                                                        School of Medicine
                                                        657 North 27 Street
                                                        Omaha, Nebraska
                    @ES:    Initial RMPS support, Januar , 1970
                                                         y

                    YMDING:   02  $76,024

                    'DTHER FUNDS:  $1000 from Massachusetts Mutual Life Insurance
                      Company on the contingency that the Unit be operational during
                      --he -first quarter of 1072
                      t-

                    @OOPERATINk-i AGENCIES AND !NSTITUTIOINS:  Countv Medical Societies, Nebraska
                      -Medical Association, Public Health Service, Indian Communlry Health Ser-
                      .@ice, Comprehensive Heal-th Association of Oaaha, American Cancer Society,
                      Vmen's Auxiliary Groups, Extension Ot@anizations, Practicing Physicians,
                      -Chxjrches, Newspapers, Radio and Television Stations.









                    :AREA--SERVED:  Nebraska

                    @GET POPULATION:      Medically indigent of Nebraska

                    -CONGRESSIONAL DISTRICTS: #3  Dave Martin (R)
                                              #2  Charles Thone (R)
                                              #1  John R. McCallister (R)








                    CO,NTINIUA'PION after @ip SIJPI)C,,r"i' WITIIDP-@,W,i:  Applic,'Iti-ons to the
                       Insurance industry as well as to Li,,@ State Health Department
                       in Nebraska have been made.  At present a grant proposal is
                       being prepared to submit to the American Cancer Society  in
                       order to keep this project viable at the end of NZIP grant
                       support.








                    CORE STAFF CON'-PAc,r:  Deane S. Marcy, Coordinator N@IP

                    DATE,PREPARED:  2/12/72

                    I)RAFTED BY:- Darrell D. Buettow/'Dawji Greene Muich








                   CORE Si',AUi' CC)N"PACT:  John Georcfe, Director
                                                  0
                                         Learnina Re-source Center


                   DATE PREPARED:  2/12/72


                   DRAFTED BY:  Darrell D. Buettow/Da@qn Greene Muich







                    CORE STAFF CONT-KCT:  Ronald D.  Barii'Lield, Area Consultant

                    DATE PREPjkRED:   2/12/72

                    DP,&FTED BY:  Darrell D. Buettow/Da@,:ii Greene Muicti












               New Jersey ift@ojmal Meclicai Procram




                                 Regional Radiation Automated Dosimetry Project


                    A $67,44S "Regional Radiation Automated Dosimetry Project" sponsored
               by the New Jersey Regional Medical Program will upgrade the treatment  of
               8,000 of New Jersey's 25,000 new cancer patients annually.  These  patients
               require radiation therapy which, when properly applied, can cure a pa-
               tient's cancer or at least reduce his suffering by destroying certain cancer

               cells.
                    To assure, safe, precise and effective radiation doses for their
               patients, 21 hospitals in New Jersey have formed the first state-wide  net-
               work linked by teletype to the Dose Distribution Computation Service  at
               New York's Memorial Hospital for Cancer and Allied Diseases.
                    Data on patients is forwarded by teletype to Memorial Hospitalls
               computer which analyzes the information and relays a treatment plan  back
               to the originating hospital. This plan assures the best  distribution  of
               radiation during treatment so that the cancer site receives the  maxinmm
               dose while adjacent healthy tissues receive only a minimum amount of  radi-
               ation.  Using the prescribed treatment plan, radiation therapy is then
               administered by the hospitals' supervoltage radiation units.
                    This unique network will alleviate some of the problems caused by  a
               shortage of radiation therapists in New Jersey by providing a system  for
               direct transmission and analysis of treatment lan data to  hospitals  with-
                                                             p
               out full-time radiation therapy personnel. In addition, the  system  will
               make it possible to calculate the treatment plans in one-fourth to  one-
               tenth the time it previously took, which means a significant  saving  in

               man-hours.







                                               Back-up Sheet


             Region:  New Jersey Regional Medical Program

             Locus of Activity:  Operational project

             Project Title:  Regional Radiation Automated Dosimetry

             Status:  Ongoing

             Sponsoring Institution:  New Jersey Regional Medical Program

             Project Director., Title, Address4   Louis C. flabich
                                                  Cancer Program Coordinator
                                                  New Jersey Regional Medical Program
                                                  7 Glenwood Avenue
                                                  East Orange, New Jersey 07017
                                                  201-674-7270


             Dates:  April, 1971 - March, 1974

             Funding:  01 year    $67,44S

             Other Funds:  None

             Cooperating Agencies and Institutions:  The following 21 New Jersey hospitals
                which participate in the dosimetry network - Atlantic City Hospital, Bergen
                Pines County Hospital, Beth Israel Hospital, Christ Hospital, Dover General
                Hospital, Englewood Hospital, Hackensack Hospital, Mercer Hospital, Monmouth
                Medical Center, Morristown Memorial Hospital, Mountainside Hospital,
                Muhlenberg Hospital, Newark Beth Israel Medical Center, Orange Memorial
                Hospital, Overlook Hospital, Riverview Hospital, St. Barnabas Medical Center,
                St. Elizabeth Hospital, St. Joseph's Hospital, St. Peter's General Hospital,
                and United Hospitals Medical Center, Presbyterian Hospital Unit

             Area Served:  Entire state

             Target Population:  8,000 new cancer patients yearly who require radiation
                therapy

             Congressional Districts:  #2 - Charles W. Sandman, Jr.(R); #3 - James J. Howard(D);
                #5 - Peter ff. B. Frelinahuysen, Jr.(R); #7 - William B. Widnall(R); #8 - Robert
                A. Roe(D); #9 - Henry Helstoski(D); #12 - Florence P. Dwyer(R); #13 - Cornelius
                E. Gallagher(D); #14 - Dominick V. Daniels(D); #15 - Edward J. Patten(D)

             Continuation after RMP Support Withdrawn:  The project will become self-supporting
                as the participating hospitals will pick up the cost, of operating the network
                after NJPNIP support is  withdrawn.

             Core Staff Contact:  Louis  C.  Habich


             Date Prepared:  February 10, 1972

             Drafted by:  Virginia L. Reaer












              Ne,w iepoey ]Ftegioimal Meclical Procrain




                           Comprehensive Stroke Care and Educational Program


                   Six hospitals in Monmouth and Ocean Counties are cooperating in  a
              "Comprehensive Stroke Care and Educational Program" for physicians  and
              nurses to improve patient care in this area, which has a large percent-
              age of the state's aging population and stroke patients.

                   Initiated in April, 1971 under a $25,800 grant from the New Jersey
              Regional Medical Program, the project covers preventive, acute and reha-
              bilitative aspects of stroke.
                   Physicians have attended a series of lectures on statistical and
              economic aspects of stroke; the anatomy, physiology and pathology,
              symptomatology and diagnosis of stroke; treatment of the acute stroke
              patient and rehabilitation of the stroke patient.
                   The nurse education phase of the project has included an acute
              stroke care course and a course in rehabilitative care of stroke pa-
              tients for nurse coordinators of stroke programs in the participating
              hospitals.  These courses were held at Jersey Shore and Monmouth Medical
              Centers, respectively, where actual tare was demonstrated and practiced
              in the centers' stroke units.

                   Durina the next project year, uniform records for stroke  patients
                        C,
              in all'participatiag hospitals will be developed so that the  diagnosis
              of cerebrovascular disease can be improved.  This will result in improved
              management and treatment of patients.







                                              Back-up Sheet


            Region:  New Jersey Regional Medical Program

            Locus of Activity:  Operational project

            Project Title:  Comprehensive Stroke Care and Educational Program

            Status:  Ongoing

            Sponsoring Institution:  Jersey Shore Medical Center

            Project Director, Title, Address:   Mrs. Hannelor6 Sweetwood
                                                In-Service Program Director
                                                Jersey Shore Medical Center
                                                1945 Corlies Avenue
                                                Neptune, New Jersey 07304
                                                201-775-5500


            Dates:  April, 1971 - March, 1974

            Funding-  01 year - $25,800

            Other Funds:  None

            Cooperating Agencies and Institutions:  Six hospitals in Monmouth and Ocean
               Counties - Community Memorial Hospital, Monmouth Medical Center  Paul
               Kimball, Point Pleasant and Riverview Hospitals

            Area Served:  Monmouth and Ocean Counties

            Target Population:  Educational aspect - physicians and nurses; direct care
               approximately 1,375 stroke patients in the two-county area

            Conaressional Districts:  #3 - James J. Howard(D)
               C.

            Continuation after RMP Support Withdraivn:  Cost of the continuing education
               programs will be shared by participating hospitals..  Cost of patient care
               will be absorbed by existing payment mechanisms.

            Core Staff Contact:  Agnes E. McGinnis

            Date Prepared:  February 16, 1972

            Drafted by:  Virginia L. Reger












              New Je@y ReclorRaj Moclical Proar





                              Establishment of Tumor Conference Boards



                   The New Jersey Regional Medical Program is assisting hospitals through-
              out the state to meet new and more stringent standards of service to cancer
              patients set by the American College of Surgeons.
                   ACS now requires that hospitals have active tumor conference  boards
              before their cancer programs receive accreditation.  The New Jersey Re-
              gional Medical Program's Tumor Conference Board Project has helped 33 hos-
              pitals to upgrade or establish such boards.
                   During the.three years of the project, which has been supported  for
              a total of $300,177, an estimated total of more than 12,000 patients have
              been brought under team review of the status of their disease,  treatment
              modes and rehabilitation plan.
                   Another aspect of the project involves the maintenance of accurate
              cancer registries, which include comprehensive, up-to-date records of
              diagnosis, treatment and management of each cancer case.  Registries also
              insure lifetime follow-up of cancer patients and serve as sources of  in-
              formation for future cases.

                   Several cancer educational courses for physicians also have emanated
              from the NJRMP's Tumor Conference Board Project providing the latest medi-
              cal information on cancer diagnosis,, treatment and management.








                                             Back-up Sheet


            Region:  New Jersey Regional Medical Program

            Locus of Activity:  Operational project

            Project Title:  Establishment of Tumor Conference Boards

            Status:  Ongoing

            Sponsoring Institution:  New Jersey Regional Medical Program

            Pro4ect Director, Title, Address:  Louis C. Habich
               i
                                               Cancer Program Coordinator
                                               New Jersey Regional Medical Program
                                               7 Glenwood Avenue
                                               East Orange, New Jersey 07017
                                               201-674-7270


            Dates: October, 1968 -  March,  1972

            Funding:  01 year   $117,770; 02 year - $121,332; 03 year   $61,075

            Other Funds:  None

            Cooperating Agencies and Institutions:  33 hospitals which have enrolled in a
               tumor conference board program - Atlantic City Hospital, Clara Maass  M6mor-
               ial Hospital, Cooper Hospital, Elizabeth General Hospital, Englewood
               Hospital, Hackensack Hospital, Helene Fuld Hospital, Irvington General
               Hospital, Jersey City Medical Center, Jersey Shore Medical Center,  Martland
               Hospital Unit, Mercer Hospital, Monmouth Medical Center, Montclair Community
               Hospital, Morristown Memorial Hospital, Mountainside Hospital, Newark Beth
               Israel Medical Center, Our Lady of Lourdes Hospital, Overlook Hospital,
               Pascack Valley Hospital, Paterson General Hospital, Perth Amboy General
               Hospital, Point Pleasant Hospital, St. Barnabas Medical Center, St.  Francis
               Community Health Center, St. Francis Hospital, St. Joseph's Hospital, St.
               Mary's Hospital, St. Michaells Medical Center  St. Peter's General Hospital,
               Somerset Hospital, Underwood Memorial Hospital and United Hospitals o
               Newark, Presbyterian Hospital Unit

            Area Served:  Entire state

            Target Population: Physicians, nurses and allied health personnel;  25,000  new
               cancer patients yearly

            Congressional Districts:  #1 - John E. Hunt(R); #2 - Charles IV. Sandman, Jr.(R);
               #3 - James J. Howard(D); #4 - Frank Thompson, Jr.(D)- #5 - Peter H. B.
               Frelinghuysen, Jr.(R); #6 - Edwin B. Forsythe(R); #7   William B. Widnall(R);
               #8   Robert A. Roe(D); #9 - Henry Helstoski(D); #10   Peter W. Rod ino, Jr.(D);
               #11   Joseph G. Minish(D); #12 - Florence P. Dwyer(g); #13 - Cornelius E.
               Gallagher(D); #14 - Dominick V. Dahiels(D); #15   Edward J. Patten(D)







            Back-up Sheet - Establishment of Tumor Conference Boards (cont'd)




            Continuation after RMP Support Withdrawn:  Hospitals will continue support for
               their own tumor conference boards and cancer registries.

            Core Staff Contact:  Louis C. Habich

            Date Prepared:  February 10, 1972

            Drafted by:  Virginia L. Reger












              New Jersey lEtecio3m&l Meclical Procram




                         Evaluation of the Status of Implanted Pacemakers



                  Eight hospitals have been linked bv teletype to the pacemaker evalu-
             ation clinic at Newark Beth Israel Medical Center to form a  diagnostic
             network which is saving the lives of cardiac pacemaker patients.

                  In April, 1969 the New Jersey Regional Medical Program funded  the
             pacemaker evaluation clinic at $29,247.  The following year a $S7,804
             grant made it possible to expand the evaluation project to include three
             affiliated hospitals and full regionalization occurred in the 03 year
             when an additional five hospitals joined the network under a $69,721
             grant.  With the eight affiliates functioning in collaboration with the
             base institution, the entire state, and its pacemaker patient population
             of approximately 2,000, now has access to this service.

                  A pacemaker is a battery-powered device, about the size of a  pack
             of cigarettes, which is implanted surgically in the chest to  stimulate
             the heart to beat at a relatively normal rate of speed.  The average
             pacemaker lasts almost two years and then must be replaced.

                  Evaluation through the new network has eliminated emergency surgery
             resulting from unpredicted pacemaker failure.  This fact is borne out by a
             report from the affiliated hospitals that during 1971 all pacemaker changes
             r6quired were made electively.  The net effect has been to reduce the cost,
             inconvenience and threat to the patient's life.  In addition, while the
             psychological effect of the continual need for emergency procedures cannot,
             be measured, elimination of this need is an obvious benefit to the patient
             and his family.







                                              Back-tip Sheet


             Region:  New Jersey Regional. Modica  Ilro@rim

             Locus of Activity:  Operational project

             Project Title:  Evaluation of the Status of Implanted Pacemakers

             Status:  Ongoing

             Sponsoring Institution:  Newark Beth Israel Medical Center

             Project Director, Title,  Address: Victor Parsonnet, @I.D.
                                                Director of Surgery
                                                Newark Beth Israel Medical Center
                                                201 Lyons Avenue
                                                Newark, Now Jersey 07112
                                                201-923-6000

             Dates: April, 1969 -  March,  1972
             Fundina:  01 year   $29,247; 02 year - $57,804; 03 year - $69,721

             Other Funds:  None

             Cooperating Aaencies and Institutions:  Eiaht affiliated hospitals
                          t,                           ?I
                Hackensack Hospital, Helene Fuld Hospital, Jersey Shore Ntedical Center,
                ,Nlorristotin Memorial Hospital, Overlook Hospital, Shore Nlemorial Hospital,
                Pascack Valley Hospital and Valley Hospital

             Area Served:  Entire state

             Target Population:  Estimated 2,000 patients with implanted pacemakers

             Conaressional Districts:  #2 - Charles l@'. Sandman, Jr.(R); #3 - James J.
                C>
                Howard(D); #4 - Frank Thompson, Jr.(D); @'S - Peter 1-1. B. Frolin,-,Iiuysen,-
                Jr.(R); #7 - William B. lVidnall(R); #).O - Peter W. Rodino, Jr.(D);
                #12 - Florence P. Dwyer(R)
             Continuation after RT%IP Support Withdrawn: Since the pacemaker clinics are
                operated on a fee-for-service basis, they are self-supporting.  Thus, the
                hospitals will be able to continue their affiliation in the network.

             Core Staff Contact:  Charles J. fleitzmann

             Date Prepared: February  10,  1972

             Drafted by:  Virginia L. Reoer
                                        C,













               Ne,w Jersey ]Eteglorial Meclical Prowrarn




                              liospital-Based Fa,,iiilv Health Care Service


                   A "Hospital-Based Family Health Care Service" at Middlesex General
              Hospital in New Brunswick is providing a new system  of  delivering  health
              care to 4,000 of the city's poor. The project  was  initiated  in  October,
              1971 with a $143,440 grant from the New Jersey  Regional  Medical  Program.

                   Comprehensive health care is provided to ambulatory patients by a
              "Family Health Care Team" of physicians, dentists,  nurses,  medical  techni-
              cians, nutritionists and social workers.  Patients  receive  basic  services
              such as general medical,  pediatric,  obstetrical-gynecological,  peripheral
              vascular, diabetic, eye and dental. Middlesex  Geiieralls  specialty  clinics
              are available to provide additional  services.  Whenever  necessary,  treat-
              ,rent is coordinated with inpatient services and home care.

                   This proaran is priTraril  aimed at replacing the traditional   hospi-
                           C.               y
              tal out-patient system in which patients attend a specialty clinic on a
              certain day, depending on their illness, age or sex.  At  the  Family  Health
              Care Center, patients are seen on an appointment basis.

                   One problem encountered in treating the poor is the shortage of
              health personnel, particularly physicians.  In order to alleviate this
              problem, the Family Health Care Center is expanding the role  of  the  reg-
              .Lstered nurse so that physicians can use their time  more  effectively,  As
              tfr.urse practitioners," the R.N.'s role is increasing in the management  of
              patients with chronic diabetes, hypertension, stroke  and  congestive  heart
              disease.


                   To help promote understanding of the program  and  keep  communications
              open between the center and the community, representatives  of  the  families
              ,.Ising the facility have been elected to the project's advisory  committee
                  comprise 5'1'6 of its membership.







                                              Back-tip Slieet


             Rc(yion:  New Jersey Reuional Modi.c@il Program

             Locus of Activity:  Operational project

             Project Title:  flospital-Based Family Ilealth Ctre Service

             Status:  Ongoing

             Sponsoring Institution:  @liddlesex General Hospital

             Project Director, Title, Address:  @Irs. Grace Evans, R.N.
                                                Director of Ambulatory Services
                                                Middlesex General Hospital
                                                180 Somerset Street
                                                New Brunswick, New Jersey 08903
                                                201-828-3000

             Dates:  June, 1971   @larch, 1974 (Actual operational aspects began in October.)

             Funding:  01 year   $143,440
             Other Funds:  Nliddlesex General Hospital New Jersey State Department of  Health

             Cooperating Auencies and Institutions:  None

             Area Served: City of  New  Brunswick

             Taraet Population:  4,000 urban disadvantaged

             Congressional Districts:  #15 - Howard J. Patten(D)
             Continuation after R@IP Support Withdrawn:  By the end of the third project
                year, sufficient experience will have been gained in facilities, services
                and personnel requirements and in per visit and per family cost analysis,
                that an accurate annual family cost can be determined for i@ledicaid reim-
                bursement and also for fee schedules for private patients and Blue Cross
                and Blue Shield reimbursement.  When the project development phase is
                completed in 1974, existina payment mechanisms will pay for the services.
                                          t,

             Core Staff Contact:  Agnes E. McGinnis

             Date Prepared:  February 10, 1972

             Drafted by:  Virainia L. Re-or












              New Jersey iFteoloimai Meclical Proar@



                                        Urban Health Component


                   The New Jersey Regional Medical Program's three-year old Urban Health
              Component, funded at $160,000, provides health planners to the staters
              eight federally-designated Model Cities Programs.  Under separate funding, the
              component provides similar assistance to 16 cities in New Jersey's  Com-
              munity Development Programs.

                   This project, which presently serves a population of 205,000 disadvan-
              taged residents in the Model Cities and an undetermined number in CDP'S,
              began in 1968 when urban health coordinators were assigned to the state's
              first three Model Cities.  Working with elected citizens' health panels,
              the coordinators identified the priorities for health services, developed
              an operational framework for action in the cities, and helped plan the
              health component of Parts I, II and III of the Model Cities applications.

                   Since the assignment of full-time urban health coordinators was  so
              successful., the project was expanded in April, 1970 to include New Jersey's
              other Model Cities.  To date, the staff has secured more than $8.4 million
              from sources other than RMP to fund health programs in these cities.

                   The Urban Health Component expanded again in 1971 when the NJRMP
              signed a contract with the New Jersey Department of Community Affairs to
              provide health planning assistance to the 16 cities in the state's 10
              Community Development Programs.  As in the federally-designated Model
              Cities, urban health coordinators plan and organize facilities and  man-
              power resources to increase the effettiveness.6f local health care delivery
              systems by involving citizens' panels, defining priorities and  securing
              operational grants through existing federally- and state-supported programs.







                                               '@lack-tif) Sliect


             Region:  New Jersey Regional Medical Program

             Locus of Activity:  Operational project

             Project Title:  Urban Health Component

             Status:  Oncoiiig

             Sponsorina Institution:  New Jersey Reciolial Medical Program

             Project Director, Title  Address:   Henry i%l. IVood, Director
                                                 Urban Ilealth Component
                                                 New Jersey Regional Medical Program
                                                 7 Glenwood Avenue
                                                 East Orinac, New Jersey 07017
                                                 201-674-7270


             Dates:  April, 1970 - March  1973
                                         .9

             Funding:  01 year - $211,000; 02 year - $160,000

             Other Funds:  $126,769 (New Jersey Department of Community Affairs);  30,000
                (local share)

             Cooperating Aaencies and Institutions:  New  Jersey  Department  of  Community
                Affairs, Model Cities Prourams, Comprehensive Health Planning, New Jersey
                State Department of Health, Department of Health, Education and I'lelfare,
                Department of Housing and Urban Development and State Law Enforcement
                Planning Agency

             Area Served: Eight federally-desialnated Model Cities and  16  cities  in  the
                state's Community Development Procyrams

             Taroet Population:  205,000 in Model Cities Prburams; undetermined number
                0                                             t,
                in Community Development Programs and other associated cities

             Conaressional Districts:  #1 - John E. Hunt(R); #2 - Charles IV  Sandman, Jl-.(R);
                C,
                #3   James J. Hoivard(D); 1'14 - Frank Thompson, Jr. (D) ; #8 - Robert A. Roe(D)
                #10   Peter IV. Rodino, Jr.(D); #11 - Joseph G. Minish(D); #12 - Florence P.
                Dwyer(R); #13 - Cornelius E. Gallaa.licr(D); #14 - Dominick  V.  Daniels(D)

             Continuation after I\IP Support tvithdra@vn: Contracts stipulate that  if  the
                Model City is favorably impressed with the Urban Health Coordinator's con--
                tribution, the city will take over his salary.

             Core Staff Contact:  Alvin A. Floriii, M.1).; James P. Harkness, Ph.D.

             Date Prepared:  February 10, 1972

             Drafted by:  Virainia L. Rc(Ter












              New Jersey neglojmal Meclical Progr@





                                         Statewide Data tank



                   The New Jersey Regional Medical Program has established the count-ry's
              first statewide computerized health care data bank.  Initiated in June,,-
              1971, the bank is supported by $18,500 in planning money from the NIRMP and
              $7,500 from the State Comprehensive Health Planning Agency.

                   Information collected by the NJ@IP on hospital facilities, services
              and manpower presently available for the treatment of major diseases,
              which account for 7S-80% of all deaths in New Jersey, has been programmed
              by the Hospital Research and Educational Trust, an affiliate of the New
              Jersey Hospital Association.

                   For the first time, all of the state's 102 general hospitals  have
              voluntarily submitted detailed data on specialized services they provide
              to their communities. Now that this data is available from  the  Trust,
              the hospitals will have a means of controlling costs by eliminating un-
              necessary duplication of expensive equipment.

                   The NJRMP will use the data to plan new programs.

                   The inventory of cardio-pulmonary-renal-vascular-cancer facilities
              and services will aid the CHP to determine the need for new  facilities
              and services and to plan their distribution to all parts'of the  state.
              Recently enacted "Certificate of Need" legislation requires the CHP  to
              authorize new hospital construction and medical services.







          A


                                              Back-up Sliect


             l@eoion:  New Jersey Regional Medical Program

             Locus of Activity:  Core

             Project Title: Statewide  Data  Bank

             Status:  Ongoin-

             Spbrisorina Institution:  Now Jersey Reuional Medical Program

             Project Director, Title, Address:  John Gary Collins
                                                Director of Statistical Services
                                                New Jersey Regional Medical Program
                                                7 Glenwood Avenue
                                                East Orange, New Jersey 07017
                                                201-674-7270


             Dates:  June, 1971 (continuing)

             Fundina:  $18,500
                   C,

             Other Funds:  $7,500 - Comprehensive Health Planning
             Cooperatina Aaencies and Institutions:  Hospital Research and Educational Trust
                       41  C,
                of New Jersey and State Comprehensive Health Planning Agency

             Area Served-.  Entire state

             Target Population:  All New Jersey short-term, general hospitals
             Conaressional Districts:  #1 - John E. flunt(R); #2 - Charles IV. Sandman  Jr.(R);
                #3 - James J. Hoivard(D) ; #4 - Frank Thompson, Jr. (D) #5 - Peter H. B.
                Frelinghuysen, Jr.(R); #6 - Edwin B. Forsythe(R); #7   IVilliam B. lVidnall(R);
                #8   Robert A. Roe(D); #9 - Henry Helstoski(D); #10 - Peter W. Rodillo, Jr.(D);
                #11   Joseph G. @linish(D); #12 - Florence P. Dwyer(R); #13 - Cornelius
                Gallac,her(D); I'TI4 - Dominick V. Daniels(D); #15 - Edward J. Patten(D)
             Continuation after @-IP Support Withdrawn:  Since the data bank is a source of
                basic planning data for the NJI\IP, support will continue.

             Core Staff Contact:,  John Gary Collins

             Date Prepared:  February 10, 1972

             Drafted by:  Virginia L. Reaer








                                                 Bicl@-til) Sheet


              Region:  New Jersey Regional Medical ll:r-ogram

              Locus of Activity:  Operational project

              Project Title:  Establishment of Tumor Conference Boards

              Status:  Onaoing

              Sponsoring Institution':  New Jersey Regional Medical Program

              Project Director, Title, Address:    Louis C. @labicli
                                                   Cancer Proaram Coordinator
                                                   New Jersey Regional Medical Program
                                                   7 Glenwood Avenue
                                                   East Orange, New Jersey 07017
                                                   201-674-7270


              Dates:  October, 1968  -  March,  1972

              Fundina:  01 year    $117,770; 02 year - $121,332; 03 year     $61,075
                    t,


              Other Funds:  None


              Cooperating Aaencies and Institutions:  33 hospitals which have enrolled in a
                 tumor conference board program - Atlantic City  Hospital,  Clara  Maass  @lemor-
                 ial Hospital, Cooper Hospital, Elizabeth General Hospital, Englewood
                 Hospital, Hackensack Hospital, Helene Fuld Hospital, Irvin-ton General
                 Hospital, Jersey City Medical Center,  Jersey  Shore  Medical  Center,  Martland
                 Hospital Unit., Mercer Hospital, Monmouth Medical Center, Montclair Community
                 Hospital, Morristown Memorial Hospital, Mountainside Hospital , Newark Beth
                 Israel Medical Center, Our Lady of Lourdes Hospital, Overlook Hospital,
                 Pascack Valley Hospital, Paterson General Hospital, Perth Amboy General
                 Hospital, Point Pleasant Hospital, St.  Barnabas  Medical  Center,  St.  Francis
                 Community Health Center, St. Francis Hospital, St. Joseph's Hospital, St.
                 i%lary's Hospital, St. Michaels Medical Center, St. Peter's General Hospital,
                 Somerset Hospital, Underwood Memorial Hospital and United Hospitals of
                 Newark, Presbyterian Hospital Unit

              Area Served:  Entire state

              Taraet Population: Physicians, nurses  and  allied  health  personnel;  2S,000-neiv
                 9>
                 cancer patients yearly
              Congressional Districts:  #1 - Joh@ E. liunt(R); T'r2 - Charles IV. Sandman, Jr.(R);
                 ,13 - James J. Ifoi@ard(D) ; #4 - Frank Thompson, Jr. (D) #S - Peter fl. B.
                 Frelinc,buysen, Jr.(R); lr'6 - Edwin B. I-orsytlie(R); tf7 @Villiam B. lqidnall(R);
                 @'8  Robert A. Roe(D); #9 - Henry 1-fel.stoski(D); #10  Peter 11. Rodino, Jr.(D);
                 r'rll Joseph C. iNtinish(D); #12 - Florence P. Dwyer(R); 113 - Cornelius E.
                 Gallagher(D); -'rl4 - Doi-iiiiick V. Daniels(])); t'r"15 - Edward J. Patten(D)







             Back-up Sheet - EstablishiTient Of 'I'Llmor Conference Boards (coiit'd)



             Continuation after RI@IP Support lllithdra@vn:  Hospitals will continue support for
                their own tumor conference boards and cancer registries.

             Core Staff Contact:  Louis C. Habich

             Date Prepared:  February 10, 1972

             Drafted by:  Virginia L. Reger







               Hospital-Based Family Health Care Service (cont'd)



                    A year-long pilot project, the Family Health Care Center will be
               monitored to determine if this system of health care delivery to the poor
               is feasible for community hospitals to undertake.  If it proves success-
               ful, efforts will be made to secure assistance to initiate similar,pro-
               grams in other hospitals.



















                             THE RMP NEW MEXICO LEUKEMIA-LYM-PHOMA PROGRAM



                  Currently in select cancer centers the median survival of acute childhood
           lymphoblastic leukem@lis approximately 3-1/2 years with a five year survival
           rate that ranges between 25 and 50%.  Of the five year survivors approximately
           one half may be considered permanently cured.  With intensive radiotherapy, patients
           in the early stages,,of Hodgkin's disease have a 90% change of being permanently
           cured.  Even      advanced disease,current approaches with intensive chemotherapy
           afford the possibility of cure.  In July @ 1972 the Director of the National Cancer
           Institute was quoted in an editorial appearing in the New England Journal as stat-
           ing "less than 15% of children with acute lymphoblastic leukemia throughout the
           country are receiving intensive chemotherapy with a curative approach".

                  In New Mexico approximately 2,000 new cancer patients are diagnosed each
           year.  Approximately 200 of these patients have leukemia or lymphoma.  The New
           Mexico Regional Medical Program Tumor Registry has identified that there are
           approximately 130 new patients with leukemia-lymphoma problems each year.  Approx-
           imately 10% of these patients are Indian and 20% Spanish-American.

                  The Leukemia-Lymphoma Program is striving for highest quality treatment of
           patients throughout the State of New Mexi,co.  Its purpose is achieved through
           the mobilization of existing manpower and facilities.  In most regions of the
           country management of these disorders is carried out at major medical centers.
           The achievement of cure in some hematologic malignancies makes it mandatory for
           all patients to receive the most current effective therapy.  Much of this manage-
           ment can be effectively carried out by the family vractitione  in a Eimall.com-
           munity through coordination of his efforts and those of    )program

                  We have established a team of physicians involved in cancer chemotherapy,
           radiotherapy, and supportive care for the cancer patient.  At the present time a
           total of  1
                    7@ ph
                        ,,Y@icians from all regions of the state are actively participating
           i  our @iLeu            --Program in the management of more than 200 patients.  A
           current evaluation of effectiveness of this program reveals that 441'a'r"e actively
           involved in the care of more than 80% of chi ren with acute leukemia throughout
           the state and more t    5    f   tients with Hodgkin's disease, wnigli-
                                     7
           two malignancies nav@   t e--p@j@:@ial ot-@cure.  Considr-rable effort has been
           spent in continuing education of physicians, nurses, C--ad paramedical personnel
           throughout the regions









      Region:               New Mexico Regional Medical Program



      focus of Activity:    Diagnosis and treatment



      Project Title:        Leukemia-Lymphoma Program for New Mexico




      Status:               Ongoing



      Sponsoring Institution:  University of New Mexico School of Medicine



      Project Director, Title, Address:  John H. Saiki, M.D., Asst. Prof. of Medicine
                                            University of N.M. School of Med., Albuquerque, N.M. 87106
                                            Telephone:  A.C. 505-265-4411, Extension 2465



      Dates:                Date of Initial RMP support:  9-1-70
                            Anticipated termination from RMP support:  9-1-75



      Funding:              RMP budget request - $26,000 - Fiscal year 1971-1972



      Other Funds:          National Cancer Institute - $26,000 of which $16,000 is specifically
                            ear marked to assist patient evaluation and treatment costs.
                            New Mexico Leukemia-Lymphoma Society - $4,800 annually.



      Cooperating Agencies and Institutions:

                            UNM School of Medicine and physicians throughout the State of New Mexico



      Area Served:          New Mexico with portions of Arizona, Colorado and Texas



      Target Population:  Patients, physicians and nurses











                  New Mexico Regional Medical Program has intensified its efforts in the
                  field of Continuing Education for Physicians in response to increased
                  demands upon the program.
                  A recently enacted law requiring Continuing Education credits for con-
                  tinued licensure to practice medicine in New Mexico is partly  responsible.
                  NMRMP is one of a few agencies @in the State with an active, viable
                  program in the area of continuing education.
                  In an effort to make programs more meaningful in terms of improving
                  patient care a
                         wh i ch'T. ,qLiestiorinaire was sent to all physicians    n
                                   d be most helpful to them.  Response was excellent.
                  A second, follovi-up questionnaire, dealing with specifics is in pre-
                  paration.
                  Most programs, which are given in communities throughout the state,  are
                  designed to be practical in nature, making liberal use of case  material
                  and are often t@g-followed by rounds at the local  hospital  the  following
                  morning.  Physicians have found the follow-up program with current
                  patients most helpful, and are able to relate what was presented
                  direc@ to patient care.
                  Opportunities to come to Albuquerque for an individual.learning  experience
                  are also offered. A number of hospitals, institutions and  agencies  are
                  cooperating to provide opportunities to observe and practice needed  skills
                  which the physician requests and to participate in clinics, classes, etc.

                  Several seminars are offered each year in Albuquerque which cover a  single
                  topic and are usually related to diagnosis and treatment.

                  The response to all programs has been excellent, @ NMR14P will  continue
                  to develop its continuing education potential to meet the needs of
                  physicians               to improve the quality of care-of its c-4;64






                  EMB/jah
                  2/14/72







                                                                   r





                       A training school for tile developi,iic.,nt of Emergency @leclical Service

                  Technicians has been established at the University of New Fic)xico by tile
                  Ne@i l,'iexico Regional Medical Program. The Program @-r three months' dura-
                  tion is designed to create an allied health professional who will function

                  in a fcishion,sinlilar,-to the Rei-,iote Duty @lilitayy Corpsman. They will viorl,,

                  under,medical supervision in remote health care clinics, in sophisticated

                  Emergency Vehicles, or in hospital Ei-,,iergeiicy Departments in smaller rural

                  hospitals. In view of tile lack of medical resources in ten counties  in

                  the state, they will become Diembers of a priority health care  delivery

                  system %@il,licii will provide im,)roved availability and accessability of riled-

                  ical services in those economically depressed areas        populations
                  are predominantly of Spanish-American and Indian origin. @y will@-1.1@"'

                  fuiictioni 'in satellite facilities that are tied to hospitals,of excellence)
                  by duplex micro-t,,,ave radio corriniuiiic(@.tioii,

                      The school has several features which rnal,.e it unique.
                      The trainee i's@ not entered-!,-n the school until a       contain ttecl

                  position for employment is identified,for-htm'at the  completion of  his

                  training. Additionally, he is recruited from the community in vihicii he

                  intends to Hear,. Ile will be ).ccepted cis a health professional in that
                  conimunity's subculture. Previous medical military experience is welcomed

                  but is not a specific requirement for admission to the school. [ligh school

                  graduates, men and women, are given favorable consideration if they have

                  shown an expressed interest and desire to ,,iork in the health delivery
                  field. Their rate of compensation upon employment is substantial enough
                               000 per yeai,) to provide status in tile community and ensure
                  ($6,000 to $8,

                  continued employment in the health industry.





                  Page 2





                       Tile training progrifii v,,@ is jointly funded by the Regional Medical

                  Prograiii-, tile State Departflient of Voca-Lion@tl Education; the Pi-esbyteri,--tn
                  Medical Services, Inc. ; The University of New Mexico, School of Modicinexl,.
                  ccknsists,Wapproximately 500 hours of training of which 120 hours are

                  spent in classroom and laboratory demonstration activity. The remainder

                  of the training is carried on in the clinical services of the  Bei-nalillo

                  County Medical Center and the Presbyterian hospital in  Albuquerque.  This

                  portion of the learning experience is essentially at  on-the-job  training

                                     Ultirtiately, academic credit    be awarded for tile

                  training in order to provide the opportunity for vertical mobility, iH  an

                  k4-uea.ti,ona,l sense.

                      The present class of 12  trai iiecs air I I be ei-rpl o@,cd i n Sandoval , Pi o

                  Arriba, Taos, Hidalgo, Grants, and Torrance Counties to work in tile niodel

                  system, designed by the Regional Medical Program t@-io years ago for- delivery

                  of priority health care services to rural coiaunities who have none.










      continuation after RNP Support Withdrawn:
                           National Cancer Institute and New Mexico Leukemia-Lymphoma Society



      Core Staff Contact:




      Date Prdpared:       9-18-72



      Drafted by:          Dr. John Saiki
                           joy Me rum







                                           TLMR REGISTIU PROGP.AM


                     Anmg the 1,016,000 Nev.; Mexico residents, there are about 2,500  new  cancer
           cases and 1,100 cancv--r deaths each year. Surgical treatmnt is  provided  in  any  of
           the State's 60 hospitals.  (         -twm.-and-.cjties.@i
           pathol      -t-,at--least@-have @.-d,-,cer-ti-fied-surgical---speciaU@-. There are  currently
           five cobalt units (mostly small) in New Mexico, but there has been  only  one  radiologist
           devoting full time to radiation            Until 197
           date chemotherapy often had to           ds of miles
                     At present, 51 hospitals                                      -eh-a@-@atL-d,
           ncn-pr-of-it-,,-,and,       ) participate in the New Mexico TL=r  Registry.  Each
           hospital receives special reports and regular mnthly and annual   reports  that   pe@t
           continuing evaluation of their cwn cancer experiences.  These  reports,  in  combination
           with direct telephone         cation (WATS line), give each hospital rapid and easy access
           to their own cancer registry informticn.    @sponse tims are  often  much  faster  than
           could be provided by a full-time in-house, tumor recristrv secretary;  the  variety  and
           complexity of reports are greater than she could attempt, and state-wide  data  can  be
           provided for comparison. Individual physicians also receive  reports  regularly  and  they
           way request information and special reports for continuing  education  programs,  staff
           metings "lay education program,
                     If each hospital were to.establish, staff, and maintain its own separate
           registry, the cost would be over $200,000 per year, according  to  Amrican  College  of
           Surgeons 1968 cost estimates @O .      bed@r.,.day.@@       t..600       .  it is
           unlikely that nmy of New Mexicols small hospitals could attract  and  keep  trained  tumor
           registry perscmel and there would be other problem such  as  lack  of  quality  control
           and lack of uniformity aTmng hospitals.,' Even if those problem could be  solved  at  the
           local hospital level, the  State  HeaIlth Departn-ent, Ccnprehensive Health  Plaming,  or
           som other central agency would need to establish and maintain an  office,  staff,  procedure:
           etc., for accmmiating the data, checking for duplicate registrations, preparing
           summary reports of prevalence, incidence, survival and mortality, etc.
                     There are scue who say that "not every hospital needs a  tumor  registry",  but
           throughout the world, registries are recognized as key  elemnts  of  cancer  program  that
           plan and deliver and follow through with highest quality  cancer  care.  The  Amrican  health
           care system is being asked to mmitor and evaluate the outcome  of  health  care,  cancer
           registries provide one model to accomplish that task.  It is also argued that "not every
           state (county, region) needs a central tumor registry". rIhe United  States  lags  behind
           nuch of the rest of the world in the deve       t of central  population-based  cancer
           registries, and as a result, much of the often-quoted cancer incidence  data  for  the
           U.S.A. are inexact extrapolations based m the data from the Connecticut Tawr Registry.
                     Many hypotheses about causes of cancer are derived from observations of
           differing patterns of cancer in various populations and geographic  regions  around  the
           world. The ethnic diversity of New Mexico makes it almost  unique  in  North  Amrica  for
           the collection of such information. Pre@nary  data  fran  the  NYNR  shows  that  breast,
           lung, and colcn cancers are higher awng Anglos than armng Spanish Amricans and Indians;
           gall bladder cancer is high amng Indians, etc.  The New Mexico TL=r Registry has
           recently been admitted to       rship in the International Association of Cancer  Recristries
           an organization that p       s comparative epidemiologic studies in all parts of  the  wor
                     The New Mexico TL=r Registry has been innovative  and  responsive  to  local
           conditions and needs and has produced a mique system that  has  attracted  cancer  experts
           frcm France, New Zealand, Hwaii and neighboring states.  A  consultant  fram  the  N.C.I.
           to the gove      t of Chile presented our system of tra3     "circuit-riding"  abstractors






           as a @l for collecting reliable cancer data in  sparsely  populated  areas  with  small,
           often understaffed, medical institutions.

                     The NMTR is designed to serve @of@ multiple purposes
           with overall efficiencies and econades to the regim's health budget.  The sTnall registry
           staff, with invaluable amputer assistance: (1) assists hundreds of physicians in
           providing follcw-through and continuing care for cancer patients, (2)  maintains  51
           individual hosi?ital evaluato@type turwr registries, (3) provides statewide data to the
           State Health Department and Ccnprehensive Health Planning Agencies, (4)  provides  cancer
           data to the United States Public Health Service Indian Health Service, (5)  provides  data
           for physicians interested in further study, and (6) provides a unique source  of  cancer
           statistics as a base for epideniiologic studies among Anglos, Spanish Azericans  and
           Navajo, Pueblo and Apache Indians.
                     in the ncrt-too-distant future (?1974-75) the New Mexico Tunor  @gistry  will
           probably be housed in the proposed Cancer lbsearch and Treatmit center  that  is  planned
           for the University of New Mexico Health Sciences campus in Albuquerque. The aiin  of  that
           center is to be a resource for the entire region and the  established  cooperative  tumr
           registry system can be one of tiie service,- that the center provides.  At the sam
           cancer epidemiology studies to test hypotheses derived from registry data will be
           expanded as a major research endeavor of ---,ie center. There is another unique situation
           in New @xico that m*es the availability of accurate cancer  statistics  and  a  patient
           follow-up system that can be utilized for clinical studies  particularly  fortuitous.  The
           $56,000,000 Los Alamos Meson Physics Facility is being built primarily  for  nuclear   sics
           research, but for the forseeable future, it will be the world's most intense  source  of
            qative pi@scns (pions) for radiation therapy.  Facilities with less intese pion
           ne
           sources are being developed at Stanford, Vancouver and Zurich, but many of the pre-clinical
           studies and eventual clinical trials of this new radiation Modality will be  done  here
           in New Mexico.  The New Mexico TL=r Regiqtry has provided data used in planning for
           both the Cancer Center and the Meson Facility and a close association with  both  projects
           wi 11 continue.

                     To date,, virtually all of the financial support for the New  Mexico  TL=r
           Registry has ccn-e frm the New @co Regional  Medical  Program.  A  contract  for  $27,150
           (direct costs) with the Bicmtry Branch, National Cancer Institute  was  obtained  in
           April, 1972, for the purpose of expanding the existing program into a cmplete population-
           based registry. It is anticipated that National Cancer Institute  support,  either  direct
           or through the Cancer Canter, will largely replace New Mexico Pegional  Medical  Program
           funding in about three years.
                     It should be noted here that the TL=r Registry participates  in  the  overall
           New Mexico Regional Program in a number of ways that-are not related to cancer.
           Ccaputerizaticn of Health Manpcwer Registers, production of niailing labels and
           cmwterizaticn of the New Mexico  Pegional  Medical  Program  administratimis  budget
           nxmtoring gr*w are specific exaiTples.







                                                                    NORTH CAROLINA


                                         Chapel Hill Homekeepers
                    In Chapel Hill many of the aged do not want to leave their homes  for
               hospitals or nursing homes, yet they cannot always meet life's routine
               demands.  Their problem was taken to the Chapel Hill Council on Aging,
               which brought at least a partial solution and a request for funds to the
               North Carolina Regional Medical Program.  The result is the pilot
               Homekeeper Training Program, a two-month course for semi-skilled home  and
               health service workers.  The importance of the program to town residents
               is demonstrated not only by interagency cooperation but by the town itself,
               which is acting as fiscal agent.
                    The program's benefits are three-fold:  it makes services available
               to many who need them; it provides a vocation and an opportunity for private
               employment to many who are unemployed or underemployed; and it reduces the
               need for or length of institutionalization. Homekeepers will  be  referred
               not only to the infirm aged but to the handicapped and those struck by
               sudden illness or family emergency. Requests for services  already  triple
               the number being trained in this initial effort.





                                                   Bac't.@-i-ip Sheet


                     Region: Association for the North Carolina llegionalil-ledical Program

                     Locus of Activity:  Core Staff Developmental Component

                     Pro-lect Title:  Chapel Hill Ilomekeeper Training Program

                     Status:  Ongoing
                     Sponsoring Institution:  Chapel Hill Council on Aging

                     Project Director, Title, Address:  Mrs. Bernice Hopkins
                                                        Executive Director
                                                        Chapel Hill Council on Aging
                                                        304 E. Franklin St.
                                                        Chapel Hill, N. C. 27514
                     Dates:  This program is funded from January 1, 1972 through May 31, 1972,
                            but it did not become operational until February 1, 1972.

                     Funding: $4,152

                     ,Other Funds:  None
                     Cooperating Agencies and Institutions:  Chapel Hill Council on Aging,
                     Home Health Agency of Chapel- Hill, Inc., Nursing Inservice Education
                     Program of the North Carolina Memorial Hospital, the Town of Chapel Hill, the
                     Chapel of the Cross (Episcopal church), local citizens, organizations and
                     radio and t.v. stations.

                     Area Served:  Town of Chapel Hill, N. C.
                     Target Population:  Unemployed and underemployed, to be trained to serve the
                     aged, handicapped, and those persons temporarily struck by sudden illness
                     and family emergency.
                     Congressional Districts:  4th  Nick Galifianakis (D)
                     Continuation after     Support Withdtaim:  It is expected that the agencies
                     involved and the Town of Chapel Hill will generate or locate funds for
                     continuing the Homekeeper Program after the initial pilot effort.  The
                     curriculum developed has potential for incorporation in  hospital inservice
                     education and community and technical college curriculums.  It is anticipated
                     that similar programs will be offered in other areas of the state.
                     Core Staff Contact: Miss Audrey Booth, R. N.9 M. S. N., Director of
                                         Professional Services, NCRNP

                     Date Prepared: February 11, 1972

                     Drafted:  Patricia M.,Jones






                                                                North Carolina
                      Adult Screening Program for Hypertension, Heart Disease  Possible
                                                                               31
                                     Impending Stroke, Diabetes, and Anemia
                   One out of every two North Carolinians will die of some  disease  related
                   to the circulatory system unless steps are taken to change current statistics.
                   Early case finding, referral, and treatment offer the greatest opportunity
                   to save these lives.  North Carolina leads the nation in devising a model
                   system which rapidly screens adults to detect signs of these diseases,
                   involves a minimum of medical manpower, and incorporates referral to
                   physicians and follow-up procedures which can considerably reduce the
                   incidence  of disabling and fatal events.
                   Funded  under a grant of $84,933 from the North Carolina Regional Medical
                   Program,  the North Carolina and Forsyth County Heart Associations are
                   conducting  apilot screening project with three  population  types:  low-
                   income  urban residents, rural residents, and employees in industry.  Initial
                   testing with members of senior citizens' clubs yielded more than the
                   anticipated 100 screenees per five-hour day.  The pilot project expects to
                   screen 40,000 adults in the six-month period.
                   Tests are designed to detect possible hypertension, heart disease, impending
                   stroke, diabetes and anemia.  They include the Electrocardiometer test
                   (based on lead 1 information), Blood Pressure Measurement, Carotid Bruit
                   Test, Blood Glucose Determination, and Hemoglobin test.  For  each  1,000
                   screened, from 30 to 200 are expected to test outside normal  limits  for
                   each of the five tests.  Testing time is less than ten minutes at a cost
                   of about $2.00 a person. .@The program is utilizing about 150  volunteers
                   ,.and two nurse-coordinators, as well as a small administrative staff.
                   Al@eo@ @@e-ing utilized.,'         gro  s of physicians and allied health
                                       -=.e, -$olunteer  UP
                                          ' cooperation of the me
                   personnel    secure the                       dical community in accepting
                   referrals and providing  for follow-up for the medically indigent.







                                                   Back-tip Sheet


                        -Loll: Association for the North Carolina Regional Medical Program

                     Locus of Activity: Operational
                     Proloct Title:  Adult Screening for Hypertension, Heart Disease, Possible
                                    Impending Stroke, Diabetes, and Anemia

                     Status:  Ongoing
                     Sponsoring Institution:  North Carolina Heart Association
                     Project Director. Title, Address: Robert N. Headley, M. D.
                                                      Associate Professor of Internal Medicine
                                                      Bowman Gray School of Medicine
                                                      Winston-Salem, N. C. 27103
                                                      919-727-4331

                     Datest  July 1, 1971 through June 30, 1974
                             $84,933 (July 1, 1971 through June 30, 1972)

                     Other Funds: None
                     C6operatin          and Institutions: Forsyth County Heart Association,
                        Bowman Gray School of Medicine, Stratford Kiwdnis Club, numerous local
                        clubs, organizations, civic and professional groups; volunteer group
                        of physicians and allied health personnel.
                     Area Served:  Forsyth County and Winston-Salem
                     Target Population: Winston-Salem aged and low-income persons, employees of
                        industries in the Winston-8alem area and rural residents of Forsyth
                        County.
                     Congressional District: #5, Wilmer Mizell (R)
                     .Continuation after RMP Support Withdrawn:  With the experience that will be
                        gained in this project, the North Carolina Heart Association will be able
                        to continue adult screening beyond Regional Medical Program funding
                        through plans that are already being developed and which will be ready
                        for implementation at the end of the Regional Medical Program funded
                        period.
                     Core Staff Contact:  John H. Young, III, 14. P. H., Assistant Director,
                        Project Development

                     Date Prepared:  February 11, 1972

                     Drafted by:  Patricia M. Jones






                                         Addendum t(, Ba(,Ic-up 131,eet
                  Region:  Association for the North Carolina Regional Medical Program

                  Locus of Activity:  Operational
                  Pro'ect Title:  Adult Screening for Hypertension, Heart Disease, Possible
                                 Impending Stroke, Diabetes, and Anemia

                  Status:  Ongoing
                     soring Institution: North Carolina Heart Association
                  Project Director, Title. Address: Robert N. Headley, M. D.
                                                   Associate Professor of Internal Medicine
                                                   Bowman Gray School of Medicine
                                                   Winston-Salem, N. C. 27103
                                                   919-727-4331

                  Dates:  July 1, 1971 through June 30, 1974
                  Funding:  $84,933 (July 1, 1971 through June 30, 1972)

                  Other Funds: None
                  Cooperating Agencies and Institutions: Forsyth County Heart Association,
                  Bowman Gray School ot Dieaicine, Strat ord Kixqanis Club, Winston-Salem
                  State University, Emmanuel Baptist Church, Radio Station WAAA, Model City
                  Commission, Comprehensive Health  Program, Reynolds Memorial Hospital;
                  Neighborhood Service Center System, Adolescent Service I-lental Health, Urban
                  League, Health Committee Alpha Kappa Alpha, Daughters of Isis, Sethos Temple,
                  Department of Social Services, Downtown Church; Housing Authority of the
                  City of Winston-Salem, Neighborhood's Advisory Council, Easton Manor,
                  North Hills, Cherryview, Ilorningside Manor, numerous local clubs, organizations,
                  civil and professional groups; volunteer group of physicians and allied
                  health personnel.
                  Area Served:  Forsyth County and Winston-Salem
                  Ta           tion: Winston-Salem aged and low-income persons, employees of
                  in            the Winston-Salem area and rural residents of Forsyth County
                  ConRressional District: #5, Wilmer Mizell (R)
                  Continuation after KIP Support Withdrawn: With the experience that will be
                  ga-ned in this project, the North Caro  @a Heart Association will be able
                  to continue adult screening beyond Regional Medical Program funding
                  through plans that are already being developed and which will be ready
                  for implementation at the end of the Regional Medical Program funded period.
                  Core Staff Contact:  John H. Young, III, M. P. H., Assistant Director,
                                       Project Development, NCRMP

                  Date Prepared: February 18, 1972

                  Drafted by:  Patricia M. Jones






                                                                 NORTH CAROLINA


                                 Wake CbufttX Community Health Care Task Force

                      With the assistance of the North Carolina Regional Medical Program,,
                  the 100-member Wake County Comunity Health Care Task Force is working to
                  establish a family health center program to reach rural and urban low-
                  income residents.  The Task Force, representing a wide spectrum of
                  community groups and interests, is applying for a federal grant of $750,000
                  to establish six hospital-based "outreach" centers which provide health
                  information and support, preventive care, out-patient diagnosis and
                  treatment, and rehabilitation.

                      The program will enroll between 5,000 and 20,000 people, depending
                  on money available, on a prepaid basis.  Enrollees will be from three
                  groups:  those who can pay for care, those who cannot, and those eligible
                  for a third party health program.

                      A great deal of NCRNP staff time has gone into gathering data and
                  consulting on program design.  The North Carolina Regional Medical Program
                  is also making $3,500 available to the Task Force for consultant time in
                  preparing the final draft for the grant application.





                                                   B@ cl@UP She@-
                                ociation for the North Carolina Regional Medical Program
                      Region:  Ass
                      Locus of Activity:  Professional Staff Activity
                      Project Title:  Wake County Family Health Center Program

                      Status: Ongoing
                      Sponsoring Institution:  Wake County Community Health Care Task Force
                      Project Director, Title, Address: J. Forest Barnwell
                                                        Task Force Chairman
                                                        Charter Industries
                                                        226 Hillsborough Street
                                                        P. 0. Box 25548
                                                        Raleigh, N. C. 27611

                      Date: May, 1971 - present
                      Funding:  $3,500d from developmental components funds
                                     i
                      Other Funds:  Raleigh Community Relations Council, several hundred dollars
                      for postage, etc.; Health Planning Council for Central Nortil Carolina, $1,000.
                      ooperatin@          and Institutions:  North Carolina Regional Medical Program,
                      Comprehens-         Planning, Baptist State Convention, North Carolina State
                      Board of Health, League of Women Voters, Raleigh Community Relations Council,
                      NCSU Urban Affairs Center, Wake County Pharmaceutical Society, Wake County
                      Health Department, Raleigh Public Schools, Wake County-Raleigh Headstart
                      Program, ESEA Programs - Wake County Schools; Wake County Department  of
                      Social Services, Urban Affairs and Community Health Center- Research Triangle
                      Area TB and RD Assoc.,, N. C. Department of Mental Health, Family Service;
                      Health Planning Council of North Carolina, Research Triangle  Institute,
                      J. C. Penney Co., Wake County Memorial Hospital Systems, Inc.; North Carolina
                      State University, Division of Continuing Educdtion; Medicenter; Carolina
                      Power and Light Company, Rex Hospital, Mechanics and Farmers Bank; Charter
                      Industries, Inc., Branch Banking and Trust Co., Wake County Courthouseo,
                      Wake County Commission
                      Area Served:  Southside of City of Raleigh and Wake County
                      Target Population:  5,000 to 20,000 low-income urban and rural residents
                      ConRressionAl District: 4th, Nick Galifianakis (D)
                      Continuation after MU Support Withdrawn:  Since RMP involvement is to secure
                       grant fl           eral government, continued funding is governed by
                      Section 314 (e) of the Public Health Service Act (42 U. S. C., 246 (e))
                      Core Staff Contact: I. Manly Fishel M. S.  P.  H.,  Assistant  Director,
                                           Project Development, NCREP

                                red:  February  11,  1972

                      Drafted by:  Patricia M. Jones






                                                                North Carolina

                                            E.dgemont Community Clinic

                   The Edgemont Community Clinic is a new approach to health care  delivery.
                   Located in an old house and serving the low-income area surrounding it,
                   the Clinic is open Monday and Thursday nights to provide free health
                   services. But the most innovative aspect of the Clinic is  the  community
                   health worker.

                   Edgemont's community health workers are a part of the community in  which
                   they work and spend much of their time in patients' homes. In  this  setting
                   they can determine the sociological and environmental factors which are
                   critical to health maintenance and health care as well as providing services
                   not otherwise accessible to the neighborhood people. These tasks  vary  with
                   individual and family need: dietetic instruction,  hygiene  education,
                   diabetic instruction, social services education and referral, and  perhaps
                   most important, interpretation of health care services and systems to  allay
                   fears and encourage patient cooperation in essential diagnosis and treatment.

                   During the clinic hours the health care workers are available to  provide
                   valuable information to physicians and other volunteer health personnel
                   regarding patient and family circumstances relevant to medical  problems,
                   and to interpret where educational and socioeconomic  differences  make
                   communication between staff and patients difficult. They also  take  general
                   histories and are currently being trained to take medical histories.

                   The Edgemont Clinic staff, which includes medical students,  consulting
                   physi4@ns, nursing students, and community health workers,  sees  about
                        .y'patients an evening for general medical assessment as well as
                   episodic and acute care. The community health workers assist  the  patient
                   in utilizing hospital or other facilities when referral is necessary,  and
                   insure, through follow-up, that patients receive and correct y use  any
                   prescribed drugs or treatment.
                   Support@d,,@y,,a $5,000 grant.from North Carolina Regional Medical
                   Program@@' tied 'Edgemont comunity health workers bridge the gap between
                   the community residents and clinic staff and aid in bringing an  underserved
                   population into the mainstream of health care. The NCRNP  grant  is  emon-
                   strating the viability of the community health worker as a functional
                   part of the community clinic model.







                                                   Back-up Slieet

                    Region:  Association for the North Carolina Regional Medical Program

                    Locus of A          Core Staff Developmental Component

                    Project Title:  Edgemont Conmunity Clinic

                    Status: Ongoing

                    Sponsoring Institution:  Lincoln Community Health Center

                    Project Director, Title; Address:  Mr. Jim Hughes
                                                       Edgemont Community Clinic
                                                       1012 E. Main Street
                                                       Durham, North Carolina 27701
                                                       919-682-1750


                    Dates:  October 15, 1971 to June 30, 1972

                    Funding:  $5,000  (The project received operational funds of $6,627 from
                       November 23, 1970 to June 30, 1971).

                    Other Funds:  Donations from a number of sources in the community

                    Cooperating Agencies and Institutions:  Lincoln Community Health Center,
                       Duke University School of Medicine, Duke University Department of
                       Community Health Sciences, Edgemont Community Center, Operation
                       Breakthrough (OEO), Durham County Health Department, University of
                       North Carolina School of Medicine, UNC School of Public Health,
                       Lincoln Hospital, Durham-Orange County Chapter of the AMA, Watts
                       Hospital and physicians, medical students, and nursing students from
                       local hospitals and educational institutions.

                    Area Served:  Edgemont Area of Durham, North Carolina

                    Target Pop liatiion:  5,000 low-income residents, half black, half white,
                       of the Edgemont area
                    Congressional Districts:  4th District - Nick Galifianakis (D)
                    Continuation after RMP Support Withdrawn:  The Edgemont Community Clinic
                       receives support to pay rent, utilities, and janitorial/secretarial
                       services from the community which it serves.  With the aid of NCRMP
                       Core Staff, a more permanent source of funds for staff salaries, now
                       being paid by NC@IP, is being sought.  This funding may come from
                       federal agencies, volunteer agencies, or community groups.

                    Core Staff Contact:  Patricia M. Jones, Communications Coordinator, NC@IP

                    Date Prepared,:  February 11, 1972

                    Drafted by.  Patricia M. Jones





                                                                North Carolina


                                            Family Nurse Practitioner
                   The Family Nurse Practitioner will play an increasingly vital role in
                   helping solve the health manpower shortage in North  Carolina,  especially
                   in communities beset by physician shortages.  In a health center or
                   clinic, a physician's office, or patient's home, this new breed  of  nurse
                   may be the first person the patient sees.
                   She takes a health history, does the physical exam, uses her own judgment
                   to start preventive screening or diagnostic  procedures.  She  coordinates
                   health care needs, makes proper referrals, provides  health  instruction,
                   counseling, and guidance.  If the patient has simple symptoms, she can
                   treat him, using standing orders from the doctor.  If his illness is more
                   complicated, she can refer him to the doctor and later handle his follow-up
                   caret  Periodically she may visit the patient in the home.
                   A pilot project was held last year for seven carefully,/selected  nurses.
                   Six are now the core of a two-county Comprehensive Health Services Program
                   with a central clinic at North Carolina Memorial Hospital and  two  rural
                   satellite clinics. In these rural areas, the  Family  Nurse  Practitioner
                   is part of a health team which also includes physicians and community health
                   wor  rs.
                   This year, through support from the National Center for  Health  Services
                   Research and Development, the University of North Carolina, and a $70,000
                   grant from the North Carolina Regional Medical Program, twelve more Family
                   Nurse Practitioners are being trained. These North  Carolina  nurses  are
                   from carefully selected practice sites, including a solo general practice,
                   a State hospital for the mentally retarded, a group medical  practice,  a
                   county hospital with satellite hospitals, and an organized system of
                   centers for providing comprehensive health care.
                   Rural patients and their families have shown ready acceptance of the Family
                   Nurse Practitioner, and health professionals and institutions  across  the
                   state are becoming increasingly aware of and interested in  this  expanded
                   nursing role.




                                                   Back-up Slieet

                        on-  Association for the North Carolina Regional Medical Program

                    Locus of Activity: Operational- Project

                    Project Title:  Family Nurse Practitioner

                    Status: Ongoing
                    .Sponsoring Institution: University of North Carolina,School of Nursing
                    Project Director, Title, Address:   Dr. Susanna L. Chase, Professor
                                                        Director, Continuing Education
                                                        School of Nursing, University of N. C.
                                                        Carrington Hall
                                                        Chapel Hill, North Carolina 27514
                                                        919-966-1411


                    Dates:  July 1, 1971 through June 30, 1974
                    Funding: $70,000 (Funding from July 1, 1971 through June 30, 1972)

                    Other Funds:  National Center for Health Services Research & Development,
                       School of Nursing, University of North Carolina-, Auxiliary Health Manpower,,
                       Division of Health Affairs, University of North Carolina

                    Cooperating Agencies and Institutions: Private physicians; Western Carolina
                       Center, Morganton, N. C.; Pinehurst Medical Clinic; Wake County Memorial
                       Hospital; Oranae Chatham Comprehensive Health Services, Inc.; UNC School-s
                       of Medicine, Nursing, Public Health       Health Services Research Center;
                       and-Wake Memorial County Hospital.

                    Area Served:  North Carolina

                    Target Population: Registered Nurses
                    Congressional Districts: #4 Nick Gali'Lianakis (Initial Training Center)

                    .Continuation after RNP Support Withdrawn: Other sources of funds currently
                    supporting this project plus an 'ncreasing interest on the part of North
                    Carolina educational institutions and health professionals should insure that
                    this program, if its viability continues to be demonstrated, will become
                    an institutionalized part of nursing curriculum.


                    Core Staff Contact: Audrey Booth, R. N., M. S. N., Director of Professional
                                         Services,   NC@T
                    Date Prepared: February 11, 1972

                    Drafted by:  Patricia M. Jones









                                                                            NORTH DAKOTA


                                    Dial Access Medical Librag
               More than 2800 medical messages have been transmitted  o.@physicians and nurses
                               through the (media of th6) Dial Access Medical Program pro-
               vided by the North Dakota Re-g-lonal Medical Program.
               Begun la emphasis
                           ,,I"69, the program has grown from a library of 250 tapes  to
                            +4'0 tapes covering a multitude of medical and health subjects.
               The user, referi                                available, selects Ih
                               ng to a listing of the subjects                         ktape
               he wants to hear, &4 plac't@ a phone call to the library operator, requests
               the tape be played over the telephone.  The,          tal) 's placed  on  the
                                 and the information is              are telephone lines.
                                 fie telephone connection is automatically terminated.

               The Medical School, University of North Dakota, has a@             this system in
               supplementing various lectures. Through the use of speakers  located  in  the
               lecture rooms, the telephone reception is replayed to the entire class.
               The program, originally developed by the University Extension of the University
               of Wisconsin., is being made available through cooperative arrangements  with
               the Wisconsin Regional Medical Program.
               The tapes, prepared b@,@'-au ities,                                     are
               continually reviewed and updated so as to pt                      ical infor-
               mation,xctat.Ig to tits subjee






                                            Back-Up Slieet


                   ion: North Dakota Regional ',Icdical Program

                Locus of A.ctivity:  Core Activity

                Project 'I'itle:  Dial Access Medical Library
                Status:  On Going - Being phased into a reduced NDRAP involvement by
                         requiring the user to pay telephone toll charges.
                Project Director, Title, Address:  J. A. Grim, NDRMP
                                                   1512 Continental Drive
                                                   Grand Forks, North Dakota  58201
                                                   701-775-5535

                Dates:  Feasibility status November 1969 - Operational status January 1, 1970

                Funding:  01 - $6,397       (No other funds)
                          02 -  6,170
                          03 -  6,170


                Other Funds: None

                Cooperating Agencies and Institutions:  University Extension, University

                     of Wisconsin, Madison, Wisconsin, and the Wisconsin RMP.

                Area Served: State of  North  Dakota

                Target Population: 600 physicians., Hospital In-Service and Directors of
                     Nursing Service (52 Hospitals), Dietitians.

                Congressional Districts:  #1 Mr. Mark Andrews (R)
                                          #2 Mr. Arthur Link (D)

                Continuation After @IP Saport is Withdrawn:  Phase down in 03 year has
                     started.  Cost of toll phone call is presently being paid for by the
                     useri  Sources for funding of the.program are being sought.

                Core Staff Contact:  J. A. Grim


                Date Prepared:  February 2, 1972

                Drafted by:  J. A. Grim











                                                                             NORTH DAKOTA


                                      Emergency Medical Services


               Emergency Medical Services is a high priority program  of  the  North  Dakota
               Regional Medical Program.(rJQt@MP),

               The need for this activity was recognized in the  early  planning  stages  of
               the NDRMP. Working in cooperation with  the  State  Highway  Patrol,  Highway
               Department, Registrar of Motor Vehicles and other state agencies, the NDRMP
               developed and provided an inexpensive colorful sticker indicating the phone
               numb%;, to call when requiring emergency assistance on the highway.  Over
               60010        of these stickers were distributed through                 state
               agencies andVbver@.-the-counter distribution.  The use of this number for
               emergencies jumped from 900 a year in 1967 to over 1;000 in 1971.  There
               was a monthly high of 1,256 calls for assistance in October, 1971.

               The demands on this service resulted in a dramatic expansion of the communi-
               cation facilities (telephone and radio) devoted to emergencies, the develop-
               ment of a capability data to meet the emergency, and an  expansion  of  the  service
               to meet state-wide emergencies, including assistance for farm accidents.

               The NDRMP is now serving on the North Dakota  Emergency  Medical  Services  Advisory
               Committee and assisting the North Dakota Committee on   T @Ta, American College
               of Surgeons with their @@Emergency Medical Technicia'@         ulancb training
               program. The EMT Program is being implemented with  the  cooperation  of  the  State
               Health Department, Committee on Trauma            NDRMP.  The NDRMP has arranged
               for meetings, provided staff support,,             administration
                                                                             T@d secre-
               tarial assistance, prepared and distributed press releases          iradio publicity,
               provided printing and mailing support,  and  sponsored  consultants.  Five  training
               programs are presently under way in various sections of the state.

               In addition, the NDRMP has cooperated with the North Dakota Heart Association
               in pla                participating in, training courses and demonstration pro-
               jects                  teach@ of cardiopulmonary resuscitation.

               During 1972, a full time NDRMP staff member will work with the State Health
               Department in expanding the present EMS activities, assist the CHP (b) Area-
               Wide Councils in North Dakotd.- and participate in the planning and evaluation
               Of EMS activities in North Dakota.







                                            BacR-LJp Sheet


               legioii:  North Dakota Regional @,ledical Program
               Locus of Activity:  Core Activity - Devolopniontal

               Project Title:  EMS (Emergency %Iedical Services)

               Status:  Ongoing and Expandina

                    oring Institution:  ND@IP

               Project Director, Title, Address:  John A. Grim, NDIZIIP
                                                  1512 Continental Drive
                                                  Grand Forks, North Dakota  58201
                                                  701-77S-5535


               Dates:  1969 - 1972

               Funding:  Staff Support - Non-operational

               Other Funds:  None.

               Cooperatina Agencies and Institutions:  State Health Department, North Dakota
                    Committee on Trauma, American College of Surgeons, @IEDEX, CIIP Area IVide
                    Councils, Hospitals, Newspapers, Radio and T.V. Stations, and, limited
                    to certain phases of the program, State Highway Department, Registrar of
                    Motor Vehicles, and State Highway Patrol.

               Area Served:  The entire state of North Dakota

               Target Population:  The 617,761 people of North Dakota

               Congressional Districts:  #1 Mr. Mark Andrews (R)
                                          #2 Mr. Arthur Link (D)

               Continuation after ND@IP Support is IVithdra.ivn:  NDRMP believes that this will
                    be A program requiring continual support, on a special and demand type
                    basis, until the state wide plan becomes implemented.  Even then the
                    NDPI,IP support, if available, may be required in this cooperative effort
                    to meet unusual circumstances.


               Core Staff Contact:  John A. Grim, NDPMP

               Date Prepared:  February 2, 1972

               Drafted By:  John A. Grim







                                                                           NORTH  DAKOTA


                                       Health Manpower  Study
               North Dakota has an excellent two-year basic science medical school  and  a
               number of good educational programs in various institutions for  training
               Allied Health Care profession als.
               Among the many changes in the educational process now being carried out
               or proposed throughout the country, there is an almost universal trend
               towards providing clinical training at an earlier and earlier stage in the
               medical student's curriculum. Additionally, a number  of  studies,  notably
               the Carnegie Report on Education, suggest that existing two year  schools
               develop into degree granting institutions or be discontinued.
               Recognizing the climate of change, the faculty of the North  Dakota  School
               of Medicine sought the advice of the North Dakota Medical Association
               leadership and other physicians.  They were in general agreement that a
               complete survey should be carried out as soon as possib le.
               It was generally agreed that the major emphasis of the survey would  be  to
               consider the future of the School of Medicine. It should  also  include  an
               overall study of the primary education and subsequent training o  al  persons
               who provide any type of health care  services.
               On March 18, 1971, a group of physicians in and out of the  medical  school
               met to discuss this subject.  The second meeting of a similar.group occurred
               in Bismarck shortly thereafter.
               Following this meeting on March 18, in a memorandum to Dr. Harwood, Willard
               Wright, M.D., Program Director, RMP, submitted some  suggestions.  In  this
               memorandum, he  oIutlined the following suggested procedures:
                    A.  Form a Steering Committee representing the Medical School, the
                        University, other educational  instit utions, physicians,  nurses,
                        other health care professionals, legislators, and prominent citizens.

                    B.  Look for Grant funds to finance study.

                    C.  Employ a Program Director.

                    D.  Study other developing and related programs.
                    E.  Be sure and involve as early as possible all health care pro-
                        fessional organizations, and other interested parties.
               The North Dakota Medical Association House of Delegates, the Medical School
               Alumni, the Medical Center Advisory Council, and  other groups endorsed the
               project.
               Th@o-aFd of Directors appointed Willard Wright, M.D., as Executive Director
               of 'tDM@) and employed Gary Dunn, M.A., formerly Assistant Dean, University of
               Ala      as Research Director.

                                         Conduct Of The Study
               The Initial activity of the research group was to collect and develop infor-
               mation on the present educational an d other resources available  and  what




                                                   -2-



               the apparent needs are in North Dakota, as well as  a  consideration  of  national
               trends and what types of support might be  available  from  out-of-state  sources.
               (Phase I)
               Advise and counsel was sought from persons representing the various professions,
               education and service institutions, state government, etc.  During the course
               of the study, every effort was made to ensure  that  all  interested  individuals,
               organizations, and institutions had an opportunity to participate.

               The North Dakota Regional Medical Program Regional Advisory Group were
              (briefed on the nature and progress of the  study  on  November  20.
                 e North Dakota State Health Planning Council held an Interagency Forum
                  November 5 and 6, and discussed the entire range  of  Allied  Health  Education
                  North Dakota.

               ,,'The Board of Directors of NDMRF meeting on December 9, 1971, and discussed in
              @@@detail some of the more important factors affecting the Medical School.
               They directed the Study Group to develop definitive information needed for
               in depth  consideration of the following two proposals: (Phase II)
                     1.  Development of a complete clinical training program wit
                         granting of M.D. degree in either three  or  four  years;
                         formulation of a clinical teaching staff; utilization of
                         community hospitals and medical  staffs  with  assistance
                         from full time education di-rectors and development o
                         residency and internship programs.

                     2.  Develop a degree granting school primarily for training
                        ,of family physicians with the student having an option to
                         continue in North Dakota or transfer to another, perhaps
                         more specialist oriented school.
               The Medical School faculty and Study Group met with the Board of Higher Education
               and explained the situation.  The Board agreed that some plan of action should be
               developed and further agreed to instruct Dr. Clifford, President of UND to forward
               a letter of intent to HEW indicating that the school of medicine, UND will be an
               applicant for appropriate funds available under the Health Manpower Act of 1971.
               December 20 1971, Mr. Earl Strinden, Bryce  Streibel,  Dr.  Wright,  Dr.  Eelkema,
               and Dr. Nelson met informally and discussed methods of keeping members of the
               State Legislature informed on the progress of the study.  Mr. Streibel formed a
               special nine man Legislative Committee as a part of the standing Legislative
               Research Council of which he is Chairman.

               The nine member Legislative Council Committee is composed of the following:

                                   Chairman - Oscar Solberg - Rolla

                          State Senators                   State   Representatives

                     Robert Nasset   - Regent          Art Bunker         -  Fa'rgo
                     Evan Lips       - Bismarck        Brynhild Haugland  -  Minot
                     Lee Christensen - Kenmare         Robert Peterson    - Williston
                     George Unruh    - Grand Forks     Ralph Dotzenrod    - Wyndmere





                                                     -3-



                On January 28, 1972, the Health Manpower Study Advisory Group, Special Committee
                of the Legislative Research Council, the Medical Center Advisory Council, Board
                of Higher Education, and the State Comprehensive Health Planning Agency,,
                         -the,.Phase II Report on the requirements and feasibility of a degree
                granting medical school for the state.@,k@(@@
                     A final report on total Health Manpower needs for North Dakota and an
                implementation plan for a degree granting medical school               finalized 4y
                March 18."'@@The report           giIven to the State Medical As5ociation, Board of
                Directors of the North Dakota Medical Research Fo        ation       other interested
                groups.                 L6,ki-@ I a:ttii6.                    af     se of action will
                            be              State Medical Association, Board of Higher Education,
                                      y
                and the State Legislature.









                                                                        NORTH DAKOTA


                               Intensive Care Unit And Education Program


               On October 27, 1971, the North Dakota Regional Medical Program, United
               Hospital, Grand Forks, the North Dakota League for Nursing, the Great Plains
               Perinatal Organization, and the Nurses Association of the American College
               of Obstetrician and Gynecologists-North Dakota Section, co-sponsored a neo-
               natal workshop,@,at@- the -Westward -Ho Motel,
               Over 124 nurses,, physicians, student nurses, licensed practical nurses,
               and MEDEX attended this workshop which included talks on respiratory dis-
               tress, use of oxygen, @.-the care of the critically ill newborn, intrauter-
               ing growth, high risk pregnancy, and maternal and infant relationship.
               Since then, the United Hospital of Grand Forks has met with the Agassiz
               Comprehensive Health Area Planning Group and have determined that they will
               initiate an intensive care unit for the neo-nate in the United Hospital
               and                                             veg h@
                    conduct continuing education courses to ser            ,,comprehensivo
               health Area.  The intensive care unit is now  ein








                                              Back-IJi) Sliect


                Region:  North Dakota Regional Medical Program

                Locus of Activity:  Core Activity

                Project Title:  Neo-Natal Workshop

                Status:  One-day Workshop in Grand Forks and Minot
                Sj,)onsorina Institution: North Dakota Regional Medical Program &  United
                     Hospital

                Project Director, Title, Address:   Sister Carol Neuburger
                                                    Assistant Director, Health  Education
                                                    1512 Continental Drive
                                                    Grand Forks, North Dakota   S8201
                                                    701-775-5535


                Dates:  October 27, 1971 thru 1572

                Funding:  "In Kind" support from United Hospital
                cooperating Agencies and Institutions:  United Hospital, North Dakota
                     League for Nursing, Great Plains Perinatal Organization, Nurses'
                     Association of the American College of Obstetricians and Gynecologists-
                     North Dakota Section

                Area Served:  Eastern part of North Dakota and western part of Minnesota

                Target Population: Agassiz Health Planning  Area  (approximately  200,000
                     population)

                Congressional Districts: #1  Mr. Mark Andrews (R)
                                          #2  Mr. Arthur Link (D)

                Continuation After PNIP Support is Withdrawn: United Hospital of Grand Forks,
                     North Dakota will continue the workshops and operate the intensive care
                     unit for the neonate for the area.

                Core Staff Contact: Sister Carol Nouburger,  Assistant  Director,  Health
                     E ucat on

                Date Prepared:  February 1, 1972

                Drafted by::  Sister Carol Neuburger








                                                                                  NORTH DAKOTA


                                            In-Service Education


                The North Dakota Regional Medical Program was requested to assist individual
                hospitals and nursing homes in setting up an in-service education program for
                their personnel on various aspects of nursing.  Larger hospitals with good in-
                service programs have been of assistance to surrou     nding hospitals, bu  t many
                have not been able to take advantage of the programs offered.  As a result, the
                North Dakota R gional Medical Program, in cooperation with the
                                e                                                                 a State
                                                                         in-servica   t_t@q
                School of Science in Wahpeton, planned a-p                         e   0
                serv:Lt-e p@rs-on@- in         the hospitals and  nursing  homes  in  the  state.

                The course "Introduction  to  Teaching  Techniques"  is  taylored  to  the  needs
                of in-service personnel in the hospitals and nursing homes.  The course includes,'
                preparing  instructional  objectives,  importance  of   objectives,   identifying
                terminal behavior, how people learn, principles of learning, four-step        method
                of teaching, analyzing occupations for teachable content, determining -wh@at--,t-o@
                -teaeh, individualized learning, communicating in,@@th-e--@ci,aS4s-room, use of,.,questions,
                motivation of the student, learning readiness, keeping records and reports,
                            ins@-tion-al-@-sheets, progress- charts, audiovisual teaching aides,
                testing as means of evaluation,
                and use of grades and records.
                This first course was held in Bismarck and Fargo.  Between each sessionz, the
                participants read assignments and prepared course work for discussion             trans-
                lati6n into actual pr  actice.

                The instructor for the course was Mr. Odin Stutrud, vocational teacher coordinator
                from the North Dakota State School of Science in Wahpeton.  Forty participants
                attended the course.


                Two additional workshops on the teaching aspects of coronary care are being
                offered utilizing the ROCOM Equipment t@-ac-i-l,-it,ate--tear-hi-ng,-"coTona@ry--c.-ar- e@
                                                                           t, t he  coronary   care
                                                                             .-Will be  taken  over
                by the institutions in the state.






                                              Back-Up Sliect



                Region:  North Dakota Regional Medical Program

                Locus of Activity:  Core Activity - Developmental

                Project Title:   Introduction to Teaching Techniques

                Status :  Ongoing
                Sl!onsoring Institution: North Dakota  Regional  Medical  Program  and  North
                      Dakota State School of Science in I'@alipeton, N.D.

                Project Director, Title, Address:  Mr. Odin Stutrud
                                                     Vocational Teacher Coordinator
                                                     North Dal-Iota State School of  Science
                                                     IVahpeton, North Dal@ota  58075

                Dates:  1972-1973

                Funding:  Staff Support - Non-operatioiial

                Other Funds:  None
                Cooperating Agencies and Institutions:  North Dakota Regional Medical Proaram,
                      North Dakota State School of Science in lqalipeton, N.D.

                Areas Served:  North Dakota Region
                Target Population: In-service Directors  in  hospitals  and  nursi.ng  homes
                Congressional Districts:  #1 Mr. Mark Andrews (R)
                                            #2 Mr. Arthur Link (D)

                Continuation After ITNIP Support Withdrawn:  The hospitals and nursing homes will
                      take over teaching coronary care ijitliin their own institutions after having
                      a background in teaching techniques.  The "Teaching Techniques" Course will
                      be offered by North Dakota State School of Science on a contract Or fee basis.
                Core Staff Contact:  Sister Carol Neuburger, Assistant Director, Health Education

                Date Prepared:  February 1, 1972

                Drafted  by:  Sister  Carol  Neuburger






                                                                      NEORMP


               PREVENTIVE AND REHABILITATIVE NEEDS OF THE UNDER 65 HOMEBOUND

           Through a grant by the Northeast Ohio Regional Medical Program, the
           Youngstown, Ohio Visiting Nurse Association is studying the needs
           of homebound persons under 65-years of age.  Working with a team
           composed of a physical therapist, speech therapist, and social
           worker, the Visiting Nurse Association is concerned with finding,
           evaluating and referring to existing health care providers and fa-

           cilities those individuals in need of care.

         @'Under the direction of Nellie Grant, R.N. the team uses a variety
           of means to find homebound persons not presently receiving care.
           Many contacts are made through appeals to the public via the news
           media and through -Special communications sent to all health and
           welfare agencies in the community.

           The Model Cities Program of Youngstown has been particuarly insttu-
           mental in locating homebound persons and has included a question
           regarding homebound patients in a survey conducted in the Model
           Cities area of Youngstown.  Service organized parent groups, clubs,
           neighborhood centers, the Council of Chur@s, and Community Action
           Center have also been responsible for making a large number of

           referrals.

           Studies are cu-rreiiti-T-b-e-ing,@-undeT-t@en- to test the effectiveness of
           current methods of reaching all homebound persons under age 65 in

           the area.








                                       BACK-UP SHEET




         egion:  Northeast Ohio Regional @ledical Program

        Locus of Activity:
                        Core Activity

        Project Title:  '    a
            Preventive and Rehabilitative Needs of the Under 65 Homebound

        Status:   ongoing

        Sponsoring Institution:
            Visit ing Nurse Association

        Project,Director, Title 3Address:
                               Nellie Grant, R.N.
                               Visiting Nurse Association
                               518 E. Indianola Ave.
                               Youngstown, Ohio
        Dates:
              July,  1971  June, 1972




        Funding-

            $ 2 8 , 61 5

        Other Funds:



        Cooperating Agencies and Institutions:
            Visiting Nurse Association, Model Cities Program, all media,
            Multiple Schlerosis Society, Library Outreach Project, Community
            Action Centers, Metropolitan Housing Authority, Goodwill Industries,
            Service Club, Youngstown City Health Dept.

        Area Served:
            Youngstown Model Cities area





        Back-Up Sheet    Page-2



        Target Population:

                 several. thousand


        Congressional Districts:


               #19




        .Continuation after RMP Suppo-rt llithdraivn:

            N/A






        Core Staff Contact:


            Jean Baird, R.N.




        Date Prepared:


            Feb. lll 1972



        Drafted by:


            Fran Koneval








                                                                          NEORMP

                COMPREHENSIVE OUTPATIENT STROKE REHABILITATION PROJECT


           Since its inception in October, 1970, the  Comprehensive  Outpatient
           Stroke Rehabilitation Project in the Lake County area  of  Northeast
           Ohio has provided services for over  60  stroke  victims.  Improvement
           has been significant in terms of shortening the length of hospita
           stay, improving the course of rehabilitation, and  studying  the  course

           of the disease.


           nder the direction,,of--J -George Furey, M'@D,i@@i the program  is  housed
           in the Lake County Society for Crippled Children and Adults, and was
           begun as a demonstration project to develop and apply a  concept  of
           more efficient care for stroke patients in an area where present
           services were insufficient.  Funding                     through   the

           Northeast Ohio Regional Medical Program.
           The project utilizes a team  approach  to  stroke  rehabilitation@on'sis
           of a physician, physical therapist, speech  therapist,  occupational
           therapist, and social service counselor, all housed conveniently at one
           facility.  When a patient is referred by either his physician or other
           interested party, his,needs are studied and he then receives instruction
           in those areas of rehabilitation which best suit him.

           Lake County has only three hospitals, and more than 6    of stroke
           victims in the area are treated at the two divisions  of  Lake  County
           Memorial Hospital. Because of limited  facilities,  hospital  stays  for
           a stroke patient average eight days shorter than  other  Northeast  Ohio
           hospitals, and rehabilitation facilities after  discharge  were  minimal
           prior to the project's start.






           Comprehensive Outpatient Stroke Rehabilitation Project - 2

           It is hoped that increasing public awareness of the medical benefits
           and social economics of the project will make it self-supporting by
           1973 and that the rehabilitation potential of many stroke patients

           will be encouraged.








                                         BACK-UP SliEET




        Region:  Northeast Ohio Regional @ledical Program

        Locus of Activity:
                                Deinonst-ration Project

        Project Title:
                 A Comprehensive Outpatient   Stroke Rehabilitation Project
        Status:
                 Ongoing
        Sponsoring Institution:      The Lake County Society for Crippled Children
                                                 Adults


        Project_Director,   Title, Address:   J. George Furey, @I.D., Medical Director
                                              Lake County Society for Crippled Childre,
                                                      and A ults
                                              9521 Lakeshore   Blvd.
                                              Mentor, Ohio  44060

        Dates:    October, 1970     June,  1972




        Funding:     $36,174 (Oct., 1970 - June, 1971)
                     $48,233 (fiscal 1972)


        Other   Punds:



        Cooperating Agencies and Institutions:
              All area hospitals





        Area   Served:


                Lake County, Ohio





        Back-Up Sheet    Page 2



        Target P
                all stroke victims in Lake County


        Congressional Districts:






        ,Continuation after R@NIP Support Vtithdrawn:
            N/A







        Core Staff Contact:
            Sandra Knott, R.N.




        Date Prepared:

             February 15, 1972



        Drafted by.


              Fran Koneval








                                                                          NEORMP


                      CONTINUING EDUCATION OF NURSES IN CORONARY CARE

          In July@' 1970, the Northeast Ohio Regional Medical Program joined  in
                 SI
          support of a program for continuing education of nurses in coronary
          care which was initiated by the American Heart Association!8 Northeast

          Ohio Chapter.

          Under the direction of Simon Ohanessian, M.D., Cardiologist, and a
          Senior Clinical Instructor in Medicine at Case Western Reserve
          University School of Medicine, the project is designed to avoid costly
          duplication of effort and resources through shared, coordinated planning

          and instruction.


          The course consistsof an intensive four-week course with periodic
          advanced seminars for registered nurses after completion of the initial
          four-week course. Each course is 120 hours in length,  with  80  hours
          devoted to classroom instruction and 40 hours spent in  coronary  care

          units for supervised clinical experience.

          The ultimate goal of the instructional program is to prolong the lives
          of patients with acute myocardial infarctibn and other acute  car  iac
          condition8,through systematic education of nurses in Northeast Ohio
          in the disciplines necessary for care of patients admitted to intensive
          coronary care units. There are now approximately  300  monitored  beds

          in Northeast Ohio.






          Continuing Education of Nurses in Coronary Care -. 2

          A special two-week course is offered to licensed practical nurses in
          the area in order to give them the knowledge, skills, and attitu es
          to function optimally as a member of the coronary care team.  These
          courses are offered under the supervision of a registered nurse in

          a coronary care unit.

          The program has already been initiated in several of the major hospitals
          in the 12-county area, and it is hoped that it will ultimately serve
          as a foundation for future expansion into a univetsity-based program

          in cardiovascular nursing.








                                         BACK-UP SI-IEE'R




        Region:  Northeast Ohio Regional Medical Program

        .Locus of Activity:    Operational Project

        Project  itle:  Continuin(i Education of Nurses in Coronary Care


        Status:     Ongoing

        Sponsoring Institution:
                     American Heart Aseociation, Northeast Ohio Chapter

        Project,Director,   Title, Address:
                                               Simon Ohanessian, M.D.





        Dates:
                     July, 1970    June, 1973



        Funding:     $8S,381 (fiscal 1970-1971)
                     $65 008 (Fiscal 1971-72)



        Other   Funds:



        Cooperating Agencies and Institutions:
                           all area hospitals





        Area   Served:
             12-county Northeast Ohio area





        Back-Up Sheet    Page.2



        Target Population:
                       4 , 5 0 00 0 0

        Congressional Districts:
                       #13   #14  #16   19   20   21   @22   23






        Continuation after RNIP Support I-,' ithdraiqn:


                     N/A






        Corb Staff Contact:
                  Sandra  Knott, R.N.





        Date Prepared:

                  Feb. 15, 1972



        Drafted by:



                 Fran Koneval








                                                                      NEORMP



                                      LASER TV TRANSMISSION


          Inter-hospital communications in Northeastern Ohio are being  stepped
          up thanks to a laser system developed at the Health Sciences  Communi-
          cations Center at Case Western Reserve University through the  combined
          efforts of faculty and students of CWRU Schools of Medicine and En-

          gineering.


          Grants from the Cleveland Foundation and from the Northeast Ohio
          Regional Medical Program made possible the purchase of a return  link
          and evaluation system to be added to an existent one-way laser  system
          used to transmit video and audio signals from Lakeside Hospital to

          the Veterans Administration Hospital.  Project director  is Dr.
          William T. Stickley, Associate Professor of Medical Education and
          Acting Director of the Health Sciences Communications Centeri

          When fully operative, the laser will provide capabilities for  offering
          intet-hospital communications which could be used for@; noon )Conferences,
          patient demonstrations, courses, and special events for  professional
          education of health sciences personnel. Future plans include  the
          installation of cabling in the Schools of Medicine, Dentistry,  Nursing
          and in University Hospitals and the possible application of the  system
          to other hospitals in the 12-county Northeast Ohio area.

          initially, the laser will be used for a patient-care program  designed
          by Dr. J. S. Gravenstein, Professor of Anesthesiology at Lakeside
          Hospital. The system will facilitate communication between  nurse
          anesthetists And surgeons at the Veterans Administration Hospital  and
          anesthesiologists at Lakeside Hospital.  The laser will provide the
          capacity for immediate communication and consultation needed in  some








          Laser TV Transmission - 2

          operating room instances and for constant patient monitoring by
          anesthesiologists at Lakeside Hospital.

          The laser av-tv system was developed by Dr. Yoh-Han Pao, Professor
          and Head of the Division of Electrical Engineering and Applied
          Physics and graduate students John W. Allen and Jonathan P.
          Freeman at Case Western Reserve University.








                                      BACK-UP StiBET




        Region:  Northeast Ohio Regional Medical Prograin

        Locus of Activity,
                             Core Activity


        Project Title:     LaAer Tv Transmission


        Status:
                  ongoing
        Sponsoring Institution:
                         Case Western Reserve University


        Project-Director, Title, Address:    William T. Stickley, Ph. D.'
                                             Yoh-Han Pao, Ph. D.
                                             Div. of Research in Med. EdLIcati6n
                                             School of @,tedicine, CIVRU
                                             2119 Abington Road
                                             Clevela d  4106
        Dates:






        Funding:
             $8,500 per,-Year


        Other Funis:

            W.K. Kellogg Foundation and Cleveland Foundation
        Cooperating kgencies and Institutions:
            Case Western Reserve University, VA Hospital, University Hospitals




        Area Served:
            Cuyahoga County




        Back-Up Sheet     Page 2



        Tar

                           2,000,000 +

        Conaressional Districts:

                             20 , # 21 ,22 , 23





        Continuation after RMP Support I'lithdra@vn:








        'Cote Staff Contact:


                         Leonard Chansky



        Date Prepared:



             Feb.  15@ 1972


        Drafted  by:
               Fran Koneval









                                                                            NEORMP



                     DISCHARGE PLANNING FOR CONTINUITY OF CARE


          Mrs. V. is an 84-year-old woman with  diabetes,  a  peptic  ulcer,  and
          cardiac difficulties.  Recently discharged from the hospital, she

          lives alone and refuses to be placed in a nursing home for care.
          She requires a complicated medical regime, and supervision and assist-

          ance in preparing special diets to keep her alive.


          She was referred to a special hospital coordinator, who made arrange-
          ments with the Visiting Nurse Association  and  the  Homemaker  Service
          in Lorain County, Ohio, to help Mrs. V  meet  her  needs.  A  container
          was devised by the Visiting Nurse to enable Mrs. V to remember to
          take her medications. It was marked  with  different  colors  for  each

          day of the week, and subdivided into four cup-like divisions to
          indicate the time of day each medication was to be taken.  The container
          for Friday was colored red so the patient would remember to save a
          urine specimen for the Visiting Nurse to test on  her  weekly  visit  to

          the home.


          Mrs. V and many other residents of Lorain  County  are  learningto  meet
          their medical needs through the Discharge  Planning  for  Continuity  of
          Care Program sponsored by the Lorain County Health Department, and
          funded under a grant by the Northeast  Ohio  Regional  Medical  Program.
          The aim of the project is to establish  a  fully  cooperative  discharge
          planning program which will insure adequate  care  for  the  continuing
          health needs of patients from all hospitals in Lorain County-








          Discharge Planning for Continuity of Care - 2


          Under the direction of Betty Wolfe, R.N., the project began in
          September, 1971, and currently is being administered through Elyria
          Memorial Hospital. By 1974, project administrators hope to  have
          the discharge planning program operative in all Lorain County hospitals.


          Referrals for patients who will need post-hospital care and treatment
          are made by personal physicians, therapists, and other interested
          parties to the nurse coordinator, who confers with the patient's
          physician to determine the individuals needs.  Arrangements  are
          then made with various agencies to provide special s@ervices and

          equipment to insure optimum care to the individual.  In many cases,

          this includes nursing services therapy programs, social  service
          counseling, dietary consultations, transportation, and coordination
          of outpatient visits.  Programs are tailor made to fit each patient.


          Through this program., individuals who are not aware of the many
          community agencies  iio can be of help'to them are put in touch with
          everyone who can assist them in meeting their health -requirements.

          This program is being studied as a model by the Regional Medical Program
          in the hope that it can be expanded to other areas of their 12-county

          Northeast Ohio region.








                                       BACK-UP SliEET



         eg,ion:  Nort)ieast Oliio Regional @ledical Program

        Locus of Activity,
                        Core Activity
        Project Title:
             Dischar e Planning for Continuity of Care
                    9
        Status:
                  Onaoing
                    t,
        Sponsoring Institution:
            Lorain County Health Department, 880 S. Murray Ridge Road, Elyria, Ohio
        Project-Director, Title, Address:       Betty Wolfe, Program Dire ctor
                                                9880 South Murray Ridge Road
                                                Elyria  Ohio   44035



        Dates:
            June, 1971   July, 1972




        Funding:
            $ 3 7 , 64 7


        Other  Funds:



        Coopdrating Agencies and Institutions:
            Lorain County Health Department, Visiting Nurse Association,
            Lorain County Hospital (and generally all health and social
             service agencies in Lorain County)



        Area  Served:
            Lorain County




        BErck-Up Sheet   Page 2



        Target Pol)ulation:
               2 7 0 , 0 0 0

         ongressional DistTicts:

               Ohio #13






        Continuation after RMP Support Vlithdraiqn:


            N/A





        Core Staff Contact:


            Martha McCrary



       .Date Prepared:
            February 7, -1972




        Drafted by:


             Fran Koneval








                                                                       NEORMP



                         LORAIN COUNTY COMMUNITY HEALTH CENTER


         Through a planning grant by the Northeast Ohio Regional Medical Program,

         the Lorain County Community Health Center is working toward the

         development of a comprehensive health care program for up to 28,000

         Lorain County residents who are below the national poverty level  and

         who are presently receiving inadequate medical care.


         Following two years of volunteer effort by a large number of residents

         and representatives of community and county agencies, the grant

         provides for a full-time administrator/planner to study the needs  of

         Lorain County's indigent population and obtain the necessary federal,

         state, and local funds to operate the comprehensive health center

         program. Frederick Richards was hired on November 1 and  has  already

         set plans for financing and construction of the facility into motion.

         He hopes to have construction underway by 1974.


         Lorain County is a rapidly expanding industrial and rural area of

         250,1000 people, with over 28,000 people below the national poverty

         level.,' Current outpatient facilities at two Lorain County  hospitals

         are limited, offering services only one morning per week, and neither

         facility has a dental clinic. At present, Lorain County has  no  pre-

         natal clinic, and no preventive medical care program for the indigent.


         Plans for the center propose general family medical and dental care

         Special services would include a well-baby clinic and immunization

         program, obstetrical and gynecological care, an x-ray department  and






          Lbrain County Community Health Center - 2


          laboratory, a comprehensive mental health program, with programs on
          alcoholism and drug addiction, a health education program, hearing
          evaluation  visual testing, pharmacy, and day care center for children.








                                         BACK-UP SI-IEET




        Region:  Northeast   Ohio Regional @ledical Program

        Locus of Activity:
                             Core Activity

        Project Title:
                         Lorain County Community Health Center

        Status:     Ongoing

        SponsorinR Institution:
            Lorain County Community Health Center, Inc., 1536 East 30th Street,
           'Lorain    44055
        Project,Director, Title, Address:

            Albert A. Fisk, @I.D., President
            Lorain County Community Health Center, Inc.
            1536 East 30th Street
            Lorain, Ohio  44055
        Dates:

            July, 1971    June, 1972



        Funding-.
            $26,780


        Other Funds:



        cobVeTating Agencies and Institutions:
            Hough-Norwood  Health Center, Cleveland; Lorain County @lental Health
            Board, Lorain Cpunty Commissioners, Lorain County @ledical Society,
            United Community Services of Greater Lorain County, the Lorain
            County Health Department, Lorain City Health Department, Lorain County
            Neighborhood Association
        Area Served:

            Lorain   County





        Back-Up Slieet   Pace 2



        Target PoRu ation:
                      up to 28,000

        Congressionai Districts:

            Ohio #13






        Continuation after R,@@IP Support Withdrawn:
            Possibly OEO or other HEII funds






        Core Staff Contact:
            Martha E. McCrary





        Date Prepared:

            February 7, 1972



        Drafted


            Fran Koneval









                                      BACK-UP SHEET



       Region:  Northeast Ohio Regional Medical Program

       Locus of Activity:
                       Core Activity
       Project Title:
            Discharge Planning for Continuity of Care
       Status:
                 Ongoing
       Sponsoring Institution:
           Lorain County Health Department, 880 S. Murray Ridge Road, Elyria, Ohio

       Project Director, Title, Address:
                                              Betty Wolfe., Program Director
                                              9880 South Murray Ridge Road
                                              Elyria, Ohio    44035



       Dates:
           June, 1971   July, 1972




       Funding.
            37 , 64 7


       Other Funds:



       Cooperating Agencies and Institutions:
           Lorain County Health Department, Visiting Nurse Association,
           Lorain County Hospital (and generally all health and social
            service agencies in Lorain County)



       Area Served:
           Lorain County






       Ba ck-U  Sh et   Pa e 2
              p   e       9



       TaVget Population:
              270 000


       Congressional Districts:
              Ohio #13






       Continuation after RMP Support Withdrawn:


           N/A






       Cbre Staff Contact:


           Marthd McCrary




       Date Prepared:
           F6bruary 7   1972




       Drafted by--


           Fran Kon6val









                                     BACK-UP SHEET




       Region:  Northeast Ohio Regional Medical Program

       Locus of Activity:
                           Core Activity

       Proj6ct Title:
                      Lorain County Community Health Center

       Status:  Ongoing

       Sponsoring Institution:
          Lorain County Community Health Center, Inc., 1536 East 30th Street,
         .Lorain  44055.
       Project Director, Title, Address:

          Albert A.. Fisk, M.D., President
          Lorain County Community Health Center, Inc.
          1536 East 30th Street
          Lorain, Ohio  44055
       Dates:

          July, 1971   June, 1972



       Funding:
          $26 780

       Other 'Funds:



       Cooperatifig Agencies and Institutions:
          Hough-Norwood Health Center, Cleveland; Lorain County Mental Health
          Board, Lorain County Commissioners, Lorain County Medical Society,
          United Community Services of Greater Lorain Count , the Lorain
                                                           y
          County Health Department, Lorain City Health Department  Lorain County
          Neighborhood Association
       Area Served:

          Lorain County




                 eel    P ge 2
       Back-Up Sh        a



       Target Population:
                     up to 28,000

       Congressional Districts:

           Ohio #13






       Continuation after RMP Support Withdrawn:
           Possibly OEO or other HEW funds






       Core Staff Contact:
           Martha E. McCrary





       Date Prepared:

           February 7, 19@72



       Drafted b@.

           Fran Koneval









                                      BACK-UP SHEET




       Region:  Northeast Ohio Regional Medical Program

       Locus of Activity:
                       Core Activity

       Project Title,
            Preventive and Rehabilitative Needs of the Under 65 Homebbund

       Status:   ongoing

       Sponsoring  Institution:
           Visiting Nurse Association

       Project Director, Title, Address:
                              Nellie Grant, R.N.-
                              Visiting Nurse Association
                              518 E. Indianola Ave.
                              Youngstown, Ohio
       Dates:
             July,  1971  June, 1972




       Funding,

           $ 2 8 61 5


       Other Furds:



       Cooperating Agencies and Institutions:
           VI-siting Nurse Association, Model Cities Program, all media,
           multiple Schlero8is Society, Library Outreach Project, Community
           Action Centers, Metropolitan Housing Authority, Goodwill  Ind-dstries,
           Service Club, Youngstown City Health Dept.

       Area Served:
           Youngstown Model Cities area





       @Back-Up Sheet   Page,2



       Target Population:
                several thousand


       Congressional Districts:


              #19




       Continuation after RMP Support Vlithdrawn:


           N/A





       Core Staff Contact:


           Jean Baitd, R.N.




       Date Prepared:

           Feb. 111, 1972



       Drafted by-


           Fran Koneval









                                        BACK-UP SHEET



       Region:  Northeast Ohio Regional Medical Program

       Locus of Activity:
                               Demonstration Project

       Project Title:
                A Comprehensive Outpatient   Stroke Rehabilitation Project
       Status:
                ongoing
       Sponsoring Institution:      The Lake County Society for Crippled   Children
                                                Adults


       Project Director,   Title, Address:   J. George Furey, M.D., Medical Director
                                             Lake County Society for Crippled Children
                                                     and Adults
                                             9521 Lakeshore Blvd.
                                             mentor, Ohio  44060

       Dates:    October, 1970    June,  19 72




       Funding:     $36,174 (Oct., 1970 - June, 1971)
                    $48,233 (fiscal 1972)


       Other   Funds:



       Cooperating Agencies and Institutions:
             All area hospitals





       Area   Served:


              Lake County  Ohio






       Back-U  Sheet   Page 2
             p



       Target  Po.pulation:
               all stroke'victims in Lake County


       Congres.sional Districts:







       Continuation after RMP Support Vlithd-ra'wn:
           N/A







       Core Staff Contact:
           Sandra Knott, R.N.





       Date Prepared:

            February 15, 1972



       Drafted by:


             Fran Koneval








                                       BACK-UP SHEET



        Region:  Northeast Ohio Regional Medical Program
        Locus of Activity:   Operational Project

        P oiect Title:  .Continuing Education of Nurses in Coronary Care


        Status:    Ongoing
        Sponsoring Institution:
                    American Heart Aseociation, Northeast Ohio Chapter

        P 6i6ct Director, Title, Addr6ss:
                                             Simon Ohanessian, M.D.






        Dates:
                    July, 1970    June, 1973



        Funding:    $85,381 (fiscal 1970-19 1
                    $65 008 (Fiscal 1971-72)


        Other  Funds:



        Codperati@g Ag6ncies and Institutions:
                          all area hospitals





        Area  Served:
            12-county Northeast Ohio area





       Back-Up Sheet    Page.2



       Target Population:
                      4,500,000

       Congressional Districts:
                      #13, #14, #16 ,  19 , 20 , 21 , @22 ,23





       Continuation  after RMP Support Vllthd-rawn:


                    N/A






       Core Staff Contact:
                 Sandra  Knott, R.N.





       Date Prepared:

                 Feb. 15, 1972



       Drafted by,



                Fran Koneval








                                     BACK-UP SHEET



       Region:  Northeast Ohio Regional Medical Program
       Locus of Activity:   Core Activity

       Project Title:     Later Tv Transmission


       Status:   ongoing
       Sponsoring Insti tution:
                        Case Western Reserve University


       Project Director, Title, Address:    William T. Stickley, Ph. D.
                                            Yoh-Han Pao, Ph. D.
                                            Div. of Research in Med. Edi4cation
                                            School of Medicine, CWRU
                                            2119 Abi aton Road
                                            Cleveland-44106
       Dates:






       Funding4
            $8,500 peryear


       Other Funis:

           W.K. Kellogg Foundation and Cleveland Foundation
       Cooperating kgeficies and Institutions:
           Case Western Reserve University, VA Hospital, University Hospitals




       Area Served:
           Cuyanoga uounty





       Badk-Up Sheet    Page 2



       Target Population:

                         2,000,000

       Congr@essional Districts:

                          #20, #21, #22, #23





       Continuation after RMP Support Vlithdrawn:








       Core StAff Contact:


                       Leonard Chansky



       Date Prepared:



            Feb. 15, 1972

       Drdfted b@.
              Fran Koneval







                 Vignette Description:

                                                                            NORTHLANDS


                 MINNESOTA HEALTH CARE OPINION SURVEY

                 A comprehensive survey recently conducted by Northlands RMP, Comprehensive
                 Health Planning, and Blue Cross,  revealed  attitudes  held  by  Minnesotans
                 toward health care.  The study included 2,000 door-to-door interviews
                 and 5,000 mailed questionnaires, which  were  sent  to  physicians,  medical
                 students, hospital trustees and administrators, and others involved in
                 providing health care.  Among the results were the following significant
                 findings:

                      In relation to problems facing
                                                       society, the highest priority "s.@
                      @igned to health care problemi-@l-mi-one@an's@,-"
                      Costs associated with health care  such  as  hospital  charges,  health
                      insurance, physician and dentist fees, represent a major concern to
                      all groups surveyed;
                      The quality of health care is not considered a major problem by
                      consumers and providers, but there is a concern for the continuation
                      of this level of quality;
                      While the findings tend to reflect a rather positive picture of
                      health care, they also indicate some gaps, deficiencies and
                      weaknesses;

                      The findings indicate a  considerable  willingness  by  both  consumers
                      and providers to permit a physician's assistant to perform a number
                      of services traditionally provided by physicians;

                      There are mixed opinions among the consumer and provider groups
                      regarding the idea of national health insurance;
                      There is a strong difference of opinion within both consumer and
                      provider groups in respect to prepaid group medical practice;
                      No definite patterns emerged   identify,@. differences  of  opinion  in
                      the various geographic areas of Minnesota nor between the various
                      consumer and provider groups;
                      The study shows that there is a general\-,acceptance by-.         s  of
                      providers'participation in seeking solutions to health care problems
                      in Minnesota.








                                               Bac@,-Up Sh e@t



            Region:  Northlands Regional Medical Program, Inc.

            Locus of Activity:   Core Activity

            Project Title:  Minnesota Health Care Opinion Survey

            Status:  Professional Staff Activity
            Sponsoring Institutions:   Northlands Regional Medical Program, Inc., Minnesota
                  Comprehensive Health Planning Agency, and Minnesota Blue Cross-Blue Shield-MII.
            Project Director, Title, and Address:   Russell N. Hill, Ph.D.
                                                    Evaluation and Data Officer
                                                    Northlands Regional Medical Program,  Inc.
                                                    375 Jackson Street
                                                    St. Paul, Minnesota  55101
            Dates: Survey conducted in Spring, 1971 and published and  released  in  November,
                  1971.

            Funding:  02 $25,000
            Other Funds:  Funded also by Minnesota Comprehensive Health Planning Agency
                  and Blue Cross-Blue Shield-MII.
            Cooperating Agencies and Institutions: The Minnesota Health  Care  Opinion  Survey
                  Advisory Committee included representatives from the Minnesota State Medical
                  Association, Minnesota Hospital Association, Institute for Interdisciplinary
                  Studies (Mpls.), Minnesota Planned Parenthood, University of Minnesota
                  Hospitals (Mpls ), Eitel Hospital (Mpls.), Henry Ford Hosi)ital (Detroit),
                  Duluth-Miller H@spital Research Complex (Duluth), Charles'T. Miller
                  Hospital (St. Paul), University of Minnesota (Department of Public  Planning
                  and Program in Health Care and Hospital Administration), as well as
                  representatives from Northlands Regional Medical Program, Minnesota Blue
                  Cross-Blue Shield-MII, and Minnesota Comprehensive Health Planning Agency.

            Area Served:  State of Minnesota
            Target Population:  The respondents were divided into two broad categories:
                  health consumers and health providers.  The health consumers were further
                  divided into "general consumers" and "specific consumer groups".  The
                  health providers were divided into "medically oriented groups" and "hospital
                  related groups."  Interviews were conducted with 2,000 health consumers
                  and 5,000 health providers.
            Continuation after RMP Support Withdrawn:  No, but study may possibly be
                  updated in two years.








                          MOBILE CORONARY CARE UNIT PROGRAM


               Heart attacks kill more than 500,000 persons each  year  in
          the United States and of that number better than half die before
          reaching a hospital and the benefits of a  modern  coronary  unit.
               Proving that this high mortality rate could be  reduced  by
          speeding intensive heart care directly to the patient  was  the
          purpose of the Columbus Heartmobile, a  feasibility  study  funded
          through the Ohio State Regional Medical Program.
               The vehicle has proven that premise, but what's  more  has
          lead to improved emergency medical care for all residents of
          the city. As a result of the project, three mobile "trauma
          units" complete with portable coronary care unit  equipment  are
          now serving Columbus and all fire department  emergency  squad,
          men receive in-depth training in heart-saving techniques,
               The mobile coronary care unit program was funded as a
          feasibility study and the
          1968 through June         p@s an  operational  project  from  April@
                           ,o 1971,@sponsored by the Ohio  State  University
          College of Medicine in cooperation with the Central  Ohio  Heart
          Association.
               The specially designed van was equipped with  the  features
          of a modern hospital coronary care unit,  including  electrocardio-,
          graph, defibrillator, and heart-lung resuscitator plus a telemetry,
          unit for transmitting the patient's electrocardiogram  to  a  h6s-
          pital.
               Staffed by members of a specially trained crew of the Col @ us
          Fire Department Emergency squad, a physician  and  occasionally  a
          nurses the Heartmobile began 24-hour service in  April.  1969.  It
          served a six-square-mile area encompassing about  half  the  daytime
          population of metropolitcin-Columbus.
               The van was alerted at its base at OSU Hospital  by  calls
          from the Central Fite Department. After  stabalizing  the  patient's
          condition at the scene of the attack, the emergency  team  could
          transport the victim to the nearest hospital with a  CCU  while
          administering continuing care.
               Evaluation of Heartmobile runs revealed that the time-lag/
          between heart attack and trea@ment did make a difference. Of 1,000
          calls examined at one point,(346 of which were cancelle@,en route)
          59 deaths prior to hospital admission  were  reported  the  majority
                   were sudden deaths due to coronary  artery  @isease.  There
          were 58 cardiopulmonary resuscitation@'with seven long-term survivors.
          Over half of the myocardial infarction patients required therapy for
          serious arrhthmias while within the vehicle.
               The impact of the feasibility project reached  far  beyond  the
          patients who received treatment in the  original  Heartmobile.  At
          the program's termination, the City of Columbus assumed sponsorship
          of the vehicle to assure continuance of the service4 A 64-hour course
          was developed to train all emergency squad personnel in heart treat-
          Mont techniques with the van utilized as A  training  unit.  By  a







          of 1971, three additional mobile "trauma units" equipped with
          portable CCU equipment had been purchased to serve the entire
          City of Columbus.






                                                                     OHIO



                     CORONARY CARE UNIT NURSES' TRAINING PROGRAM


                More than 600 nurses have received training for the  specialize
          duties in hospital coronary care units through a program funded  by
          the Ohio Regional Medical Program and sponsored by the Central  Ohio
          Heart Association. In operation since May, 1969, the project is
          directed by George C. Morrice, M.D., a cardiologist in Newark,  Ohio.
                The purpose of the project is to help hospitals provide
          qualified nursing staffs for this special type of intensive care
          unit which is being utilized by many hospitals to provide  optimum
          care for heart attack patients.

                Initially, the training program was offered through a two-
          week course held at the Ohio State University Hospital in  Columbus.
          Nurses received instruction in all aspects of nursing care and
          equipment management currently in use in coronary care units.
          Topics covered includw.- @ coronary care concept; anatomy and
          physiology of the heart and circulation; fundamentals of  electro-
          physiology; drugs and treatment; pathology and physiology of  myo-
          cardial infarction; cardiopulmonary resuscitation; the  complications
          of myocardial infarction; arrhythmiasi nursing considerations,  an
          the psychological aspects of treatment. The nurses also received
          practice on "Rescui Annie" and "Arrythmia Annie" mannikans"  learned
          to operate monitoring equipment and underwent clinical  experience
          in established CCUS.

                in the program's second year, in order to make the  training
          available to nurses who could not come to Columbus for the  two-week
          class, courses were implemented in 12 more hospitals in nine designate
          ficore areal? or central communities in the region. To staff these course,
          18 local nurses received special in-depth training as  instructors.

                These classes, held over a 20 to 30-week period, offered basically
          the same curriculum as the original course. To supplement  lectures
          and demonstrations, however, a multi-media instructional system  con-
          taining CCU film strips, tapes and slides in a portable unit was  ob-
          tained for circulation among the core are classes.

                Overall, during the project's three years of operation,  some
          643 nurses representing 47 counties and 84 hospitals in Ohio completed
          the training program. It is estimated that approximately one-third to
          one-half of the nurses trained are currently working in coronary care
          units..

                Funding for the program     the Ohio State Regional  Medical
          Program, wh+",.,amounted to $169,76o@    @@'*e'xpire@,june 30, 1972,,
          Because of @success           training        @ support
                       a@sumed by the Central Ohio Heart Association.
                In the upcoming months, the project staff plans to place  in-
          creased emphasis on assisting community hospitals in  establishing
          their own CCU training programs so the courses can become an  ongoing
          inservice educational activity.










                                                                         OHIO



                   Training Program for Directors of Medical Education


          A Training Program for Directors of Medical Education is offered by the Ohio
          Regional Medical Program.  Developed originally by the Continuing Education
          Program of the Ohio State Regional Medical Program, the DME Training
          Program is based upon the concept that cornr-,iunity hospitals are educational
          institutions.  The program deals specifically with three areas: (1) educational
          activities, (2) interrelationships between education and other hospital activities,
          and (3) collateral activities.  It is a basic three-month program with an optional
          but highly r ecommended fourth month Preceptorship with an experienced
          Director of Medical Education in a community hospital.
          The functions of a DME vy from hospital to hospital but the essential responsibilities
          common to most community hospitals are explored.  A systematic approach to
          developing education programs in con=unity hospitals is stressed and training is
          both didactic and experience-centered with two-way continuous feedback and
          evaluation.

          The first few weeks are spent becoming familiar with-the role of the DME in a
          community hospital including the functions and responsibilities as well as re-
          quirements in terms of behavioral characteristics: art of communication,
          interpersonal relationships, maturity of judgment and self-concept.  Whenever
          possible, a patterned learning sequence is followed.  However, the available
          time devoted to the program by cooperating Directors of Medical Education vary@
                  as will the available time of consultants in Education and in the Behavioral
          Sciences.  Conferences, sermnars and selected professional meetings also
          influence the sequence to some de7,ree, but all areas described in an accompanying
          syllabus are covered during the trainee's program.  Consultants are selected from
          the Social and Behavioral Sciences, Adult Education, as well as Medical Education
          so that the trainee recognizes the interrelationship of the cultural, social,
          psychological and environmental factors with the delivery of health care.
          The tuition for the program is $500 per month, and in addition to program content,
          the fee includes guest faculty parking permit, library privileges, recreation card,
          desk space, secretarial assistance, travel expenses to program-related conferences
          and seminars (off campus), consultants' honoraria.- membership dues in medica
          education organizations, certain journal subscriptionfees and selected textbooks
       .,--@-which to begin a core library in the field of medical and allied medical education.
             ormation or application forms may be obtained from the Ohio Regional Medical
        ly@,
          P@ogram.








                                                                       OHIO





                                Patient Care Conferences

          Patient Care Conferences are aimed at holding hospital-based educational conferences
          with a goal of improving patient care.  Participating in the pilot program was Grandview
          Hospital in Dayton, Ohio, which continues to hold monthly conferences.  Operating on
          the premise that the quality of care in an institution is directly related to the quality
          of its educational program, the Patient Care Conference concept was designed as
          an interdisciplinary program inclu ing not only nurses but LPNs and other  allied
          health professionals.
          Using a problem-solving approach, a case abstract of a specific, but anonymous,
          recently Hospitalized patient is presented to the participants along with a description
          of the nursing care problems encountered with that patient.  After presentation of
          facts, the participants are divided into small groups and asked to recommend
          solutions to the problems presented.  The groups recovene after an alloted time
          and each presents its suggestions.  The remaining time is spent evaluating the actual
          and recommended metltods of care with emphasis placed on the fact that the
          particular case presented is not of prime importance, but is used as a means to relate
          patient care problems in general, as well as potential solutions.
          Any interested health related persons can arrange to attend a session of the Patient
          Care Conference for first-hand observation, or contact the Ohio Regional Medical
          Program for further information in setting up such conferences.








                                                                              OHIO




                                Postgraduate Preceptorship Program


            The Ohio Regional Medical Program in cooperation with the Center for Continuing
            Medical Education of the College of Medicine of The Ohio State University and the
            Ohio Academy of Family Physicians, is offering short Preceptorships for prac-
            ticing physicians. Originally begun by the Continuing Education Program of the
            Ohio State Regional Medical Program, the Preceptorships are continuing to be
            offered through ORMP.
            The Preceptorships are of one, two or three weeks' duration in the physician's
            field,of interest, and provide an opportunity for the physician to acquire new or
            refresh present knowledge or skills. The program is structured to allow ample
            opportunity for free and informal discussion. Preceptorships may be in a single
            field or in combined fields of interest a nd are available in most practice areas.
            Applicants are asked to state in advance what they wish to learn (educational
            objectives). This information is submitted to the Preceptor so that the training
            experience can be individualized as much as possible. The Preceptee subsequently
            is involved in the evaluation of his experience based upon his original educations
            objectives.
            The Preceptorships have been approved for a minimum of 10 credit hours by the
            Ohio Academy of Family Physicians and for a mimimum of two days postgraduate
            credit by the Ohio Osteopathic Association. The Preceptorships are also creditable
            under Category 4 for the 1972 Physician's Recognition Award.
            A tuition is charged, which in addition to course content, includes registration,
            parking fees, noon meals and library services. The Preceptorships are open to
            out-of7,state physicians with the stipulation that Ohio physicians will be considered
            first.@Infor  'tion,@or -applicatio-n-,jLq;rms maybe obtained from the Ohio Regional
            Medical 'Program







                          MOBILE CORONARY CARE UL@IT PROGRAM


                Heart attacks kill more than 500,000 persons each year in
           the@'United States and of that number better than half die before
           reaching a hospital and the benefits of a modern coronary unit.
                Proving that this high mortality rate could be reduced by
           speeding intensive heart care directly to the patient was the
           purpose of the Columbus Heartmobile, a feasibility study funded
           through the Ohio State Regional Medical Program.
                The vehicle has proven that premise, but what's more has
           lead to improved emergency medical care fo r all residents of
           the city. As a result of the project, three mobile "trauma
           units" complete with portable coronary care unit equipment are
           now serving Columbus and all fire department emergency squad-"
           men receive in-depth training in heart-saving techniques.
                The mobile coronary care unit program was funded as a
           feasibility study and then as an operational project from April,
           1968 through June, 1971, sponsored by the Ohio State University
           College of Medicine in cooperation with the Central Ohio Heart
           Association.
                The speciall  designed van was equipped with the features
                           y
           of a modern hospital  coronary  care  unit,  including  electrocardio@
           graph, defibrillator, and heart-lung resuscitator plus a telemetry
           unit for transmitting the patients electrocardiogram to a hos-
           pital.
                Staffed by members of a specially trained crew of the Col @ us
           Fire Department Emergency Squad, a physician and occasionally a
           nurse, the Heartmobile began 24 hour service in April, 1969-. It
           served a six-square mile area  encompassing  about  half  the  daytime
           population of metropolitan Columbus.
                The van was alerted at its ba se at OSU Hospital by calls
           from the Central Fite  Department.  After  stabalizing  the  patient's
           condition at the scene of the attack, the emergency team could
           transport.the victim to the nearest hospital with a CCU while
           administering continuing care.
                Evaluation of Heartmobile runs revealed that the tiTne-lage
           between heart attack and treatment did make a difference. Of 1,000
           calls examined at one point, 346 of which were cancelled, en route,
           59 deaths prior to hospital admission were reported, the  majority
           of which were sudden deaths due  to  coronary  artery  disease.  There
           were 58 cardiopulmonary resuscitation with seven long-term survivors.
           Over half of the myocardial infarction patients required therapy for
           serious arrhthmias while within the vehicle.
                The impact of the feasibility project reached far beyond  the
           patients who received treatment in the original Heartmobile. At
           the program's termination, the City of Columbus assumed sponsorship
           of the vehicle to assure continuance of the service. A 64-hour course
           was developed to train all emergency squad personnel in heart treat-
           ment techniques with the van utilized as a training unit. By  fall







                                     mobile "trauma units,, equipped with
          of 1971, three additiona                                   I
          portable CCU equipment had been purchased to serve the entire
          City of Columbus.





               Ion:                            Ohio State Regional Medical Program
             Locus-.                           Operational Project
                ect Title:                     Mobile Coronary Care Unit Program
             Status:                           Past Operational
             Sponsoring Institution:           Ohio State University College of Medicine
                                               in cooperation with the Central Ohio
                                               Heart Association

             Prolect Director,                 James V. Warren, M.D.
             r
                      -Address:
                                               Chairman, Department of Medicine
                                               College of Medicine
                                               Ohio State University
                                               N1013 University Hospital
                                               410 West Tenth Avenue
                                               Columbus, Ohio    43210
           'Dates:                             Feasibility study, April, 1968-through
                                               June, 1969
                                               Operational Project July, 1969 through
                                               June 30, 1911
             Funding:                          Feasibility study        $167,702
                                               Operational Project      $269r580

             Other Funds:                      None
                    ting  Aq                   Columbus Fire Department, Dave Ellis
                                               Design  Corporation,  Ohio  State   University
                                               Hospital.
             Area served:                      Metropolitan Columbus
             Tar2    o ulation:                Columbus residents
                 ressional Districts:          12
             Continuation after RMP            Sponsorship assumed by City of Columbus
             su2port withdrawn:                at  project's  termination  with   Heartmobile
                                               incorporated into the Fire Department
                                               Emergency  Squad.  Mobile  CCU  expanded  with
                                               addition  of  three  "trauma  units"  equipped
                                               with CCU capabilities and fire squadmeh
                                               trained it heart-saving techniques.
             -Core Staff Contact:              Marilyn Fitch, Assistant Director
                                               Communications

             Date Prepared:                    6/l/72
             Drafted by:                       Marilyn Fitch






                                                                     OHIO


                     CORONARY CARE UNIT NURSES' TRAINING PROGRAM

                More than 600 nurses have received training for the specialized
            duties in hospital coronary care units through a program funded by
            the Ohio Regional Medical Program and sponsored by the Central Ohio
            Heart Association. In operation since May, 1969, the project is
            directed by George C. Morrice, M.D., a cardiologist in Newark, Ohio.
                The purpose of the proj@ct is to help hospitals provide
            qualified nursing staffs for this special type of intensive care
            unit which is being utilized by many hospitals to provide optimum
            care for heart attack patients.
                Initially, the training program was offered through a two-
            week course held at the Ohio State University Hospital in Columbus.
            Nurses received instruction in all aspects of nursing care and
            equipment management currently in use in coronary care units.
            Topics covered include: the coronary care concept; anatomy and
            physiology of the heart and circulation; fundamentals of electro-
            Physiology; drugs and treatment; pathology and physiology of myo-
            cardial infarction; cardiopulmonary resuscitation; the complications
            of myocardial infatction; arrhythmias; nursing considerations, aAd
            the psychological- aspects of treatment. The nurses also received
            practice on "Rescui Annie" and "Arrythmia Annie" Tnannikans, learned
            to operate monitoring equipment and underwent clinical experience
            in established CCUS.
                 In the program's second year, in order to make the training
            available to nurses who could not come to Columbus for the two-week
            class, courses were implemented in 12 more hospitals in nine designated
            it core ar6a" or central communities in the region. To staff these course,
            18 local nurses received special in-depth training as instructors.
                 These classes, held over a 20 to 30-week period, offered basically
            the same curriculum as the original course. To supplement lectures
            And demonstrations, however, a multi-media instructional system con-
            taining CCU film st@ips, tapes and slides in a portable unit was ob-
            tained for circulation among the core are classes.
                 Overall, during the project's three years of operation, some
            643 nurses representing 47 counties and 84 hospitals in Ohio completed
            the training program. It is estimated-that approximately one-third to
            one-half of the nurses trained are currently working in coronary care
            units.
                 Funding for the program for the Ohio State Regional Medical
            Program, which amounted to.$169,760, will expire June 30, 1972.
            Because of the success of the training program support after that
            time will be assumed by the Central Ohio Heart Association.
                  In the upcoming months, the project staff plans to place in-
            creased emphasis on assisting community hospitals in establishing.
            their own CCU training programs so the courses can become an ongoing
            inservice educational activity.









                                                he-et



                                                        egional
            egion:                          Ohio State R        Medical Program
            Locu's of Activity:             Operational Project
            Project Title:                  Coronary Care Unit Nurses'
                                            Training Program

            Status:                         Ongoing
            Sponsorinq Institution:         Central Ohio Heart Association
            Project Director,               George C. Morrice, DI.D.
            Title, Address:                 Director, Cardio-Pulmonary Division
                                            Licking County Memorial Hospital
                                            1320 West Main Street
                                            Newark, Ohio   43055
                                            (614) 3 4 4- 0 331
            Dates:                          Funded as an Operational Project from
                                            5/l/69 through 6/30/72

            FundinSI:
                 5 1/69 through 6/30/70     $120,590
                .7/l/70 through 6/30/70        41,679
                 7/l/71 through 6/30/72         7,500
                                            1 69 , 76 9
            Other Funds:                    Matching funds for last year of
                                            operation from Central Ohio Heart
                                            Association $70500.
            Cooperatinq Agencies            Central Ohio Heart Association,
            and In.,        s:              Ohio Heart As sociation, Ohio State
                                            University Hospitali 84 hospitals
                                            in OS-RMP region.
            Area Served:                    Entire OS-RMP region of 61 counties
            Target Population:              600 nurses in 61 counties
            Congr essional Districts:       4,8,7,12,17,16,18,15,6,24,10
            Continuation after PJ4P         Central Ohio Heart Association will
                ort withdrawn:              maintain program in modified form.
                                            Classes actually conducted by project
                                            staff will be reduced while more effort
                                            will be placed on assisting hospitals
                                            in setting up their own CCU educational
                                            programs so courses will become an ongoing
                                            in-house activity.
            Core Staff Contact:             Marilyn Fitch, Assistant Director,
                                            Communications


                               -7 / -7 1)
                                            h-rnf@@ livt Marilvn Fitch









                                                                                OHIO




                                  ostgr@td@ t@e Prece torship Program

             The Ohio Regional Medical Program in cooperation with the Center for Continuing
                               of the College of Medicine of The Ohio State University and t
             Medical Education                                       I                       he
             -Ohio Academy of Family PI-.iysician's, is offering short Preceptorships for  prac-
             ticing physicians. Originally begun by the Continuing Education Program of the
             Ohio State Regional Medical Program, the Preceptorships are continuing to be
             offered through ORMP.
             The Preceptorships are of one, two or three i#eeks' duration in the physician's
             field of interest, and provide an opportunity for the physician to acquire new or
             refresh present knowledge or skills. The program is structured to allow ample
             opportunity for free and informal discussion. Preceptbrships may  be  in  a  single
             field or in combined fields of interest a nd are available in most practice  areas.
             Applicants are asked to state in advance what they wish to learn educational
             objectives). This information is submitted to the Preceptor so that the training
             experience can be individualized as much as possible. The Preceptee subsequently
             is involved in the evaluation of his experience based upon his original educational
             objectives.
             The Preceptorships have been approved for a minimum  of  10  credit  hours  by  the
             Ohio Academy of Family Physicians and for a mimimum of two days postgraduate
             credit by the Ohio Osteopathic Association. The Preceptorships are also creditable
             under Category 4 for the 1972 Physician's Recognition Award.
             A tuition is charged, which in addition to course content,  includes  registration,
             parking fees, noon meals and library  services.  The  Preceptorships  are  open  to
             out-of-state physicians.with the stipulation that Ohio physicians will be considered
             first. Information or application forms may be  obtained  from  the  Ohio  Regional
             Medical Program.











                                                     Back-up Slieet

              ReRion:  Ohio Rcgi.c)nal     Medical    Program

              Locus of Activity: Core       activity

              Proiect Title: Postgraduate Preceptorship Program

              Status:  Ongoing


                                           nonq
              Project ]Director.  'ITitlie, Aftdacdtresss: Rose Lee Kennedy
                                                           Assistant Director
                                                           Comprehensive Health Service Center Development
                                                           Ohio Regional Medical Program
                                                           1760 Zollinger Road
                                                           Columbus, Ohio 43221


              Dates: July, 1971
                  din :  Self-supporting except for program staff time.
                   erati               s and Institutions:  Center for Continuing Medical Education of
                   the College of Medicine of Ohio State University; the Ohio Academy of Family
                   Physicians; Ohio Osteopathic Association.
              Area Served:  Ohio (open also to out-of-state physicians with the stipulation that Ohio
                   physicians will be considered first)
              Continuation after                                  n:  It is anticipated that the program will be
                  incorporated into the continuing medical education offerings in selected co                        unity
                  hospitals.
              Congressional Districts:  All 24 congressional districts in Ohio.

              Core Staff Contact:  Rose Lee Kennedy

              Date Prepared-- 5/31/72









                                                                          OHIO   VALLEY


                                   RURAL PRIMARY CARE COORDINATION



              Cooperative funding by the Ohio Valley and Tennessee/Mid  South  Regional
              Medical program and the Southeastern Kentucky Regional Health Demonstration, Inc.
              is giving impetus to a primary health care project serving a rural area on
              the Kentucky-Tennessee border. As a result of the project,  residents  in  the
              Frakes, Kentucky, and Clairfield and White Oak, Tennessee, areas will  for  the
              first time have full-time health care available to them.
              Planning for the program was based on a study conducted by the Universitv
              of Kentucky Department of Community Medicine and sponsored by OVRMP  which  re-
              vealed that over 57 percent of the households have incomes of less than Z'?3,000
              a year. Since there are no physicians living in  these  Appalachian  communities,
              the 4,500 area residents, not surprisingly, have had to travel to other tommu-
              nities to obtain medical care.  The survey found that the cost of medical care
              and lack of transportation were major reasons for this population  not  receiving
              medical tare.

              A by-product of the survey, for which local residents served  as  interviewers,
              was "An Interviewer's Basic Handbook," written especially for use  in  similar
              studies which plan to utilize resident/interviewers having widely divergent back-
              grounds and educational levels.
              Staffing for each of the three clinics in the project will consist  of  a
              full-time nurse Dractitioner, a patient assistant, a health aide,  an  automobile
              driver, and an outreach worker.
              A physician will serve each clinic the equivalent of l-2 days week@   and
              the specially trained and certified nurse practitioners will  maintain  preven-
              tive, health surveillance, and limited emergency services in the  clinics  the
              remainder of the week.  Plans also include establishment of  dental  services,
              with a dentist, dental assistant, and aide  to be shared by the three parti-
              cipating clinics.

                                                                            14,
              The clinics moved from part to full-time operation in January,, 1972, and
              already over half of the area's residents are now using the clinics.  In
              addition to acute ambulatory care, preventive medicine and health education
              are integral components of the clinic's programs.
              The project is sponsored by United Health Services of Kentucky and
              Tennessee.  An executive board composed of 18 local residents has been or-
              ganized and is responsible for overall program coordination  and  administration.
              The Boatd's basic aim is to link the clinic programs to existing resources
              in neighboring communities to avoid unnecessary replication  of  existing
              specialized services.








               Region:  Ohio Valley Regional Medical Pro(yram

               Locus of Activitv:  Operational Project

               Project Title:  Rural Primary Care Coordination

               Status:  Ongoing

               Sponsoring Institution:  United Health Services of Kentucky & Tennessee

               Project Director, Title, Address:    Steven A. Kabin
                                                    United Health Services of Kentucky
                                                     and Tennessee
                                                    Health Planning Office
                                                    Frakes, Kentucky 40940
                                                    606-337-5810

               Datet:  Summer, 1970-summer activity, part time clinics until present.
                       Full-time beginning January, 19,72.

               Fundia&:   1970-$11,607;   1971-$9,500
                         FY 01-860,000

               Other Funds:  Tennessee/Mid South R,'AP - $40,000
                              Appalachian Re-ional Commission - $58,000(This may be increased)
                              Local funds

               Cooperating Agencies and Institutions:  Appalachian Regional Commission of
                    Kentucky, Tannessee/@'Lid South Regional Medical Program, Southeastern
                    Kentucky Regional Health Demonstration, Inc., ADDalachian Regional
                    Hospitals, University of Keiituckv DeDartment of Community Medicine,
                    Tennessee Valley Authority, Vanderbilt University School of Medicine,
                    Tennessee State Department of Public Health

               Area Served:  Bell and V7hitley Counties, Kentucky; Campbell and Claiborne
                    Counties, Tennessee
               Target Population:  Rural poor
               Congressional Districts:   #5 Kentucky    Mr. Tim Lee Carter (R)
                                          #4 Tennessee - Mr. Joe L. Evins (D)
                                          #2 Tennessee - Mr. John Duncan (R)

               Continuation after P,.MP Sup ort 14ithdraim:
                    Expected to be largely self supporting within three years

               Core Staff Contact:  Mr. Collin Hyde

               Date Prepared:  2/14/71

               Drafted by:  Pamela Hoskins







                                                                    OHIO VALLEY




                                      LOUISVILLE HMO PLANNING


          An organized coalition of 30 widely different organizations in the Louisville,
          Kentucky area has produced                       nning Grant Steering/Liaison
                                     the Louisville li@,10 'Pla
          Committee.  The specific role of the Steering/Liaison Committee is to coordi-
          nate preliminary planning for the H@MO develoDrient in the Louisville area.  The
          impetus to form the committee came from the initial efforts in the fall of
          1970 by the GrouD Health Association of America (GIIAA) to begin organizing a
          prepaid group practice in the Louisville area and a subsequent rise in community
          interest in health maintenance.
          Following four months of activity involving an increasing nu,.-t.oer of local in.di-
          viduals and organizations, an organizational meetina was held in February of
          1971 to form the committee.  At that meeting Plans were also begun for an area-
          wide conference on alternative methods of health care delive  , and an apdli-
                                                                      ry
          cation for an HMO plannina grant was subsequently developed.
        'The purpose of the conference of health care delivery systems, held in October,
          1971, was to outline the range of options available in planning H@10's and thus
          set the stage for the work of the Steering/Liaison Committee.  Moderator of
          the conference was the noted Dr. Avedis Donabedian, University of Michigan
          School of Public Health.
          Studies conducted in the initial stace determined Possible 11@@O candidates and
          identified those areas with the greatest need for improved care.  Also beina
          completed is the  collection, analvsis, and evaluation of health care resources
          data and the identification of at least 7,000 families willinc, to subscribe to
          such a health care Plan.  The results of these studies are being made available
          through the Steering/Liaison Cori,.Tni-ttee  to groups wishing to develOD IliNIO'.s.  To
          date GHAA and the Jefferson County @tedical Society have initiated such develop-
          mental work.
          As a further refinement of the overall Planning function, several sub committees
          have been formed, including Benefit Package, !location and Facility, Public Re-
          lations and Recruitment, Legal, and Finance.  The information coming out of the
          work of these subcommittees is expected to provide additional assistance to the
          GHAA and Medical Society efforts.
          Work of the Steering/Liaison Committee i.- suT)T)orted by the HSMHA HMO DeveloDment
          Grant with some additional support from GHAA, the 'University of Louisville, and
          the AFL-CIO Labor Council.
          ',Memb&rship of the Steering/Liaison Committee includes the following sponsors of
          the conference on alternative systems of health care delivery:
               Blue Cross-Blue Shield; Falls Regional Health Council; Greater Louisville
               Central Labor Council (AFL-CIO); Groun Health Association of America-
               Hospital Council of Metronoli-tan Louisville; International Chemical
               Workers Union; Jefferson County @iellical Society; Louisville Area Chamber
               of Commerce; Ohio Valley Pelgi-onal. Medical Program: Park-DuValle Neighbor-
               hood Health Center; United Auto ',,Ior'L'-Iers-C,@ll Committee; United l@liy Llbor
               Participation DeT)arl-rient; University of Louisville School of 1-@edicine.









         Since the conference, the following organizations have also joined the Steering/
         Liaison CoT,-,7.ittee:


               CoTnri)unity Services - A'-qL-CIO: Falls City Medical Society; Flovd and
               Clark County, Indiana, Central Labor Council, AT,L-CIO; Health In-
               surance Council; Health and Welfare Council, L7,4; International
               Union of Electrical Workers; Jefferson County Teachers Association'.
               Kentucky Association of Older Persons; Kentucky Dental  Association;
               Kentucky Nurses Association; Louisville Dental Society.: Louisville
               And Jefferson County -Community Action Comraission; Pe@ion Eight
               Mental Health-Mental Retardation Board; Social Securitv Administration;
               and the Visiting @,Turse Associat4-on.  A continued effort is being made
               to involve consumers in,the Dlanning of the H@10.










                                             BACK-UP 8REET



          REGION:   Ohio Valley Regional Medical Program

          LOCUS OF ACTIVITY:    Core Activity

          PROJECT TITLE:    Louisville HivO Planning


          STATUS:   Ongoing
          SPONSORING INSTITUTION:    Falls Region Health Council, Louisville, Kentucky

          PROJECT DIRECTOR, TITLEI A DDPESS:    Jack Chamberlin
                                                Project Coordinator
                                                Falls Region  Health  Council
                                                434 South Fourth Street
                                                Louisville,  Kentucky   40202
                                                (502) - 583-8367

         .DATES:   July 1. 1971 to June 30, 1972
          FUNDING:   01  $59,700 (Planning grant from HS@HIA HY@O Development Grant)

          OTHER FUNDS:    Group Health Association of America - $30,500-, University
                          of Louisville - $1,000- AFL-CIO Labor Council     $8,700.

          COOPERATING AGENCIES AND INSTITUTIONS:     Community Services    AFL-CIO; Falls
                  City Medical Society; Floyd and Clark  Countv  Central  Labor  Council,
                  AFL-CIO; Group Health Association of America; Health Insurance Council;
                  Health and Welfare Council, 17-'; Hospital Council of Metropolitan
                  Louisville; International Chemical Workers Union; Internationa  Union
                  of Electrical 1-lorkers-. Jefferson County Medical Society; Jefferson
                  County Teachers Association; Kentuckv  Association  of  Older  Persons;
                  Kentucky Blue Cross-Blue Shield; Ken tuckv Dental Association; Kentucky
                  Nurses Association: Louisville Area  Chamber  of  Commerce;  Louisville
                  Dental Society; Louisville and Jefferson County Coipmunitv Action
                  .Commission; Park-DuValle Neighborhood Health Center; Recion Eight
                                                                            0
                  Mental Health-@fental Retardation Board; Social Securitv Administration;
                  United Auto 14orkers-CAP Council; University of  Louisville  School  of
                  Medicine; Visiting Nurse Association.

          AREA SERVED:    Greater Louisville, Kentucky,  Metropolitan Area

          .TARGET POPULATION:   General Population
          CONGRESSIONAL DISTRICTS: #3 - Kentucky -  Mr.  Romano  L.  @4azzoli
                                      #4 - Kentucky - Mr. Gene Snyder (R)
          .CONTINUATION after R,@ SUPPORT  @-IITHDRk@-N, Funding is from IIS@IA, not   @T







                                                -2-


         CORE STAFF CO.NTACT:.  Mrs. Evangeline Hebbeler, Program Development SDecialist

         DATE PREPARED:   March 31, 1972

         DRAFTED BY:   Pamela Hoskins








                                                                     OHIO VALLEY




                                       LOUISVILLE HMO  PLAINNING


          An organized coalition of 30 widely different organizations in the Louisville,
          Kentucky area has produced the Louisville HMO  Planning  Grant  Steering/Liaison
          Committee. The specific role of the Steering/Liaison  Committee  is  to  coordi-
          nate preliminary planning for the HMO development in the Louisville area.  The
          impetus to form the committee came from the initial efforts in the fall of
          1970 by the Group Health Association of America (GHAA) to  begin  organizing  a
          prepaid group practice in the Louisville area and a subsequent rise in community
          interest in health maintenance.
          Following four months of activity involving an increasing nu,,-.oer of local ind4--
          viduals and organizations, an organizational meeting was held  in  February  of
          1971 to form the committee.  At that meeting nlans were also begun for an area-
          wide conference on alternative methods of health care delivery,  and  an  apdli-
          cation for an HMO plannin- grant was subsequently developed.
          The purpose of the conference of health care delivery systems, held in October,
          1971, was to outline the range of options available in Dlannincr H@tO's and thus
          set the stage for the work of the Stedring,/Lialson Committee.  Moderator of
          the conference was the noted Dr. Avedis Donabedian, University of Michigan
          School of Public Health.
          Studies conducted in the initial stace'determined possible lil'!O candidates an
          identified those areas with the greatest need for  i-moroved care.  Also  being
          completed is the  collection, analvsis, and evaluation of health care resources
          data and the identification of at least 7,000 families willina to subscribe to
          such a health care plan.  The results of these studies Are being made available
          through the Steer-i-ng/Liaison Cor@,.nittee  to groups iqishing to develop H@@10's.  To
          date GHAA and the Jefferson County Medical Society have initiated such develop-
          mental work.
          As a further refinement of the overall planning function, several sub committees
          have been formed, including Benefit Package, Location and Facility, Public Re-
          lations and Recruitment, Legal, and Finance.  The information coming out of the
          work of these subcommittees is exoected to provide additional assistance to the
          GHAA and Medical Society efforts.
          Work of the Stoering/Liaison Committee ig- supported by the HS'LIIHA HMO Development
          Grant with some additional support from CHAA, the University of Louisvillc, and
          the AFL-CIO Labor Council.
          Membership of the Steering/Liaiso n Committee includes the following sponsors of
          the conference on alternative systems of health care delivery:
               Blue Cross-Blue Slil:eld,z Falls Regional Health Council; Creater Louisvi le
               Central Labor Council (AFL-CIO); GrouT) Health Association of America;
               Hospital Council- of Metronoli-tan Louisville; International Chemical
               Workers Union; Jefferson County @le-aical Soc iety;. Louisville Area Chamber
               of Commerce; Ohio Valley Pegi.onal 'NI.cdi.cal Program: Vari@-DuValle Nei.glibor-
               bood Health Center; 'United Auto '.,Ior',,,crs@CAII Committee; United Way Labor
               Participation Department; University of Louisville School    of Medicine.









         since the conference, the following organizations  have also joined the Steering/
         Liaison Committee:


              Community Services - AFL-CIO: Falls City Medical Society;  Floyd and
              Clark County, Indiana, Central Labor Council, AFL-CIO; Health In-
              surance Council; Health and Welfare Council, LP,4; International
              Union of Electrical Workers; Jefferson County@Teachers Association;
              Kentucky Association of Older Persons; Kentucky Dental Association-,
              Kentucky Nurses Association; Louisville Dental Society: Louisville
              and Jefferson County Community Action Commission; Region Eight
              Mental Health-illental Fetardation Board; Social S-ecuritv Administration;
              and the Visiting Nurse Associat4-on.  A continued effort is being made
              to involve consumers in,the planning of the 4MO.











                                              BACK-UP SIIEET



           REGION,  Ohio Valley Regional Medical Program

           LOCUS OF ACTIVITY:   Core Activity

           PROJECT TITLE:   Louisville HMO Planning

           STATUS:  ongoing
           SPONSORING INSTITUTION:    Falls Region Health Council, Louisville, Kentucky

           PROJECT DIRECTOP,, TITLE, ADDRESS:   Jack Chamberlin
                                                Project Coordinator
                                                Falls  Region  Health  Council
                                                434 South Fourth Street
                                                Louisville,   Kentucky   40202
                                                (502) - 583-836 7

         .-DATES:   July 1, 1971 to June 30, 1972
           FUNDING:   01  $59,700 (Planning grant from HSNIHA HY.0 Development Grant)
           OTHER FUNDS:   Group Health Association of America - $30,500: University
                          ot Louisville - $1,000; AFL-CIO Labor Council      $8,700.
           COOPERATING AGENCIES AND INSTITUTIONS:     Community Services    AFL-CIO; Falls
                  City Medical Societv: Floyd and  Clark  Countv  Central  Labor  Council,
                 .AFL-CIO; GrouD Health Association of America; Health Insurance Council;
                  Health and Welfare Council, L7j; Hospital Council of Metropolitan
                  Louisville; International Chemical Workers Union; International Union
                  of Electrical @qorl@-ers: Jefferson Countv @-ledical Society; Jefferson
                                                          I
                  County Teachers Association;  Kentuckv  Association  of  Older  Persons;
                  Kentucky Blue Cross-Blue Shield; Ken  tuckv Dental Association- Kentucky
                  Nurses Association,. Louisville Area  Chamber  of  Commerce;  Louisville
                  Dental Society; Louisville and Jefferson County Communitv Action
                 'Commission; Park-Du\lalle Neighborhood Health Center; Region Eight
                  Mental Health-@fental Retardation Board; Social Securitv Administration;
                  United Auto Workers-CAP Council;  University  of  Louisville  School  of
                  Medicine; Visiting Nurse Association.
           AREA SERVED:   Greater Louisville, Kentucky, Metropolitan Area

           TARGET POPULATION:    General Population
           CONGRESSIONAL DISTRICTS: #3 - Kentuckv - Mr.  Romano  L.  @,lazzoli
                                      114 - Kentucky - Mr. Gene Snyder (R)
           CONTINUATION after MT SUPPORT @IITHDRA@@IN:   Funding is from IIS,@A, not    @T







                                                -2-


         CORE STAFF CONTACT:   Mrs. Evangeline Hebbeler, Program Development SDecialist

         DATE,PREPARED:   March 31, 1972

         DRAFTED BY:   Pamela Hoskins






                                                                   OKLAHOMA


                                   INERGENCY MEDICAL SERVICE SYSTEM


                 Five coun ties.in,the predominantly rural, northwest quadrant of Oklahoma
                 have begun d-e@@ve-l@o'pment of an Emergency Medical Service System.  Although
                 still in the         stages, the interest of local physicians and ambulance
                 personnel coupled with ORMP's support has established a basis for future
                 growth.
                 Of the problems facing the area, the lack of  adequate  training  and
                 equipment for ambulance personnel is one of  the  most  urgent.  Some
                 areas are as much as an hour from the nearest medical  services,  so  in
                 many cases, emergency care must be initiated long before  arrival  at
                 the nearest emergency room. Until now this  has  not  been  possible,
                 because the ambulance personnel were not qualified nor did they have
                 the equipment to deliver such care.
                 The absence of any            communications among the  hospitals  an
                 emergency vehicles is another urgent problem. With only  A  few  services
                 located in the area, coordination of activities is a  necessity,  but
                 any communication link that would  facilitate  this  coordination  is
                 still virtually non-existent.
                 A survey, funded by ORMP, is currently in progress.  Its  purpose  is
                 to determine the specific needs and problems of the area  by  talking
                 with local physicians, hospitals, and providers  of  ambulance  service.
                 Furthermore, the survey will establish the feasibility of such a
                 coordinated emergency medical service system in a rural area.

                 ORMP's involvement also includes presentation of the  first  training
                 course for ambulance personnel in the area.  The  2-hour course,
                 developed in Tulsa by the American College of Surgeons  -  Committee  on
                 Trauma, is designed to raise the abilities of the ambulance technicians
                 to initiate qualified emergency care,o,,immediately. The first  class
                 is already filled, as local ambulance personnel are  anxious  to  enlarge
                 their own capabilities.

                 The course utilizes lectures, demonstrations,  and  practical  exercises
                 to increase the skills and understanding of  an  ambulance  technician's
                 functions and responsibilities.  In  addition,  each  student@ill  serve
                 a full shift in a       ncyservice area/,during the            third  of
                 the course. This         , s    ended to develop an appreciation  of  the
                 interdependence of the  ambulance-emergency  unit-patient  relationship.
                 ORMP is also assisting  in stimulating public interest  locally,  through
                 a series of feature articles highlighting local needs and @eltp'fffg
                 solutions. Ultimately the success of  a  cooperative  Emergency  Medical
                 Service System will depend upon the support of the  people  using  it
                 and paying for it.








                                                BACK-UP SHEET



                     ion:     Oklahoma Regional Medical Program

                   Locus of  Acitvity:   Core Developmental Component
                   Pro    Title:     Emergency Medical Service System - Okeene

                   Status:     Ongoing
                   Sponsoring Institution:     Oklahoma Regional Medical Program
                   Proiect Director, Title  Address:     Bill Dotter, M.D.
                                                         General Surgery
                                                         P.O. Box 389
                                                         Okeene, Oklahoma  73763

                   D,ates:  Initiated January 1972
                   Fu  in      ORMP has committed funds not to exceed $3,000

                   Other Funds:    None

                   Lcoo          ency and Institution:      American College o    urgeons
                   100@
                        Committee on Trauma; Area Hospital and Ambulance Services
                   Area Served:    Sections at Blaine, Garfield, Major, Dewey, and
                        Kingfisher counties.
                   TarRet  Population:    Consumers and Providers of EMS in the area.
                   Congressional District:     District #6, Representative John N. "Happy" Camp
                   Continuation after ORMP Support:      Support being developed locally
                   Core Staff Contact:     Dr. George Cooper, Coordinator, Division of Planning,
                        Research, and Development.

                   Dat      ared:     2-14-72

                   Drafted by:    Brian Nasky









                                                                      Oklahoma Pl,,P
               VIGNETTE #2
                  I                                                   (Project i'r-2R)


               p  ar                                       secondary

                                                           - P@culs
               -Heart Disease
                                                           - Patient  Care Demonstration
               -Remote Monitoring
               -Impact on tiorbidity/Mortality             -   Training
               -'gegionalization                           - Inter-regional
               -Rural


                    Continual electronic heart monitoring services    comparable to

               those available in large urban  hospitals  are  being  introduced  into

               Oklahortia's small comlnunity and rural hospitals is a result of a

               8tate-wide coronary care program initiated  by  the  Oklahoma  Regional.

               Medical Program.


                    Under the direction of Dr. Charles W. Robinson, Jr. cardiologist

               at the University of Oklahoma School of  Medicine.,  about  43  monitor-
               equipped beds for heart attack victims, or attack-threatened patients,
               in 28 small community hospitals have been linked by special telephone

               lines to 12  central  monitoring  hospitals,(CMU's).  These  figures
               include a few beds in neighboring towns  of  Kansas  and  Arkansas  and
               2 central monitoring hospitals in  Arkansas.  By  mid-1972  a  total  of

               59 beds will be equipped.


                    Dr. Robinson describes the program  as  "a-boon  for  small  rural
               hospitals which cannot afford the services  of  the  highly  trained
                                                             I
               personnel required to operate an independent coronary care unit."
               Specially trained nurses in the central monitoring units help monitor
               remote patients, and, when an  abnormality  is  detected,  confer  with
               local staffs by telephone "hot lines."  The  iri  ortance  of  immediate
                                                                p
               coronary care sterfis from the fact that most heart  attack  victims








                                               2-

              who die, do so within the first few hours.


                   The general hospital mortality rate from acute coronaries

              (myocardial infa-@--ction) is about 30 percent.  With coronary care

              units, this is usually reduced 15 to 20 percent.  An October, 1970

              survey of Oklahoma hospitals by the project staff showed,that

              46 percent of that State's hospitals with 50 beds or less had no

              facilities for coronary care, and 33 percent of hospitals with 51 to

              150 beds had none.  Besides training fgr nurses, the project also

              provides continuing education and training for physicians and para-

              medical personnel, including preparation of Job Corps students as

              coronary care technicians.











                                     REGIONAL UROLOGY PROJECT



                     During the three years of this project 2,242 patients with cancer
                of the prostate have been identified.  A retrospectrum methodology
                was utilized whereby all patients admitted to the 176 hospitals in
                Oklahoma for any reason who had a diagnosis at sometime of cancer
                of the prostate during the three year period of 1967, 1968, and 1969.
                In addition admissions at forty-four hospitals in bordering states
                where Oklahoma residents are likely to go for hospitalization (i.e.
                Fort Smith, Arkansas) were reviewed.
                     This is being done by a field staff of registered nurses  specially
                trained for this project.  A twenty-two page system profile form was
                designed for computer utilization for this purpose. The nurses utilized
                the hospital medical records to complete this @orm.9@This project
                represents a joint effort of the Department of Urology and the Department
                of Biostatistics and Epidemiology.  The statistical consultants have
                selected three hundred patients from the total for a more in-depth
                study including follow-up information. This sample is  a  representative
                of the total and is sufficiently large enough to inidicate statistical
                significance having a 13% sample.
                     During the in-depth phase the physicians of the three hundred
                patients were interviewed and records of subsequent hospitalizations
                were reviewed and the patients and/or their families interviewed.
                     The objective of this project is to measure the level of genito-
                urinary care in Oklahoma. This includes screening for  early  diagnosis,
                diagnostic techniques, treatment procedures for bDth care and palliation,
                complications of drug therapy, adjunctive therapy, chemotheropeutics,
                irradiation etc. This information is then used in  continuing  education
                programs primarily for physicians but also other health professionals.
                     In -the---@ -atter..-phases the project i s bei ng expanded to i ncl ude cancer
                of the bladder, penis, testes and kidney.
                     It is anticipated that this type of project can provide a base
                for developing a state wide tumor registry.  Another "spin off" may
                be the development of a medical record designed for computer analysis
                using the RUP form as a prototype.
                      urrently sponsored by the Oklahoma Regional Medical Program,,,
                @is cooperating with the Veterans Administration Cooperative
                Urological Research Group through the National Cancer Institute.
                The NCI is currently considering funding of this project in its
                expansion to other GU malignances.










                                                BACK--UP SHEEI'



                     ion:     Oklahoma Regional '@ledical Program
                   Locus of Activity:    Terminating Project (Future funds sought from NCI)

                   Proiect Title:,   Regional Urology Project

                   Status:    Terminating May 31, 1972
                   Sponsoring Institu tion:    Oklahoma Regional Medical Program
                   Project Director, Title  Address:     William R. Parry, M.D.
                                                         Project Director
                                                         Department of Urology
                                                         Oklahoma University Health Sciences Center
                                                         P.O. Box 26901
                                                         Oklahoma City, Oklahoma  73190

                   Dates:    June, 1969 to May, 1972

                   Funding:


                   Other Funds:    None
                   Cooperative  Rencies and Institutions:      All Oklahoma hospitals; 44
                        hospitals in bordering states; National Cancer Institute; Oklahoma
                        Urological Association; Oklahoma State  apartment of Health.

                   Area Served:    State of Oklahoma
                   Target Population:     Cancer patients; various ethnic groups (Indians  blacks)
                                                                                            9

                   ConRressional Districts:     All Districts, Representatives Albert, Belcher,
                        Camp, Edmonson, Jarman, Steed.
                   Continuation after bMP Support:      Proposal has been submitted to the
                        National Cancer Institute for funding beginning September 1972.
                   Core Staff Contact:     Vickie Holloway, R.N., Program And Project Development

                   Date PrepAred:     2-14-72

                   Drafted By:     Brian Nasky






                                                                           OKLAHOMA


                                                CORONARY CARE


                   The establishment of a remote coronary monitoring network that covers;
                   46 beds in 32 community hospitals across the state is probablyr,QRMP's
                   most innovative contribution to improved patient care.
                   Initiated three  years  ago,  the  project  has  surpassed  its  original
                   goals  on  approximately  one-quarter  of  the  requested  funding.   The
                   major influence in the  success  of  the  project  has  been  the  interest
                   and support generated by the small hospitals in communities throughout
                   Oklahoma.

                   BasicAlly,  the  system  gives  smaller,  rural  hospitals  the  coronary
                   care capabilities  of  larger  metropolitan  hospitals  at  a  very  minimal
                   expense.  When patients in the smaller hospitals are placed in the
                   remote  monitoring  unit,  which  includes  EKG  monitoring  equipment,  the
                   monitoring signal is read at  bedside  and  on  a  screen  in  the  central
                   monitoring unit many miles away.  A tfained_,coronary     care nurse
                   watches the signal-."              t-he-rq@" from     @116mote monitoring
                   units on a bank of -r-reens.  She is trained    to  notice  any   variations
                   which may be the first sign of a coming arrhythmia.
                   The same telephone line over which the EKG signal is transmitted
                   carries  a  communication  link  between  the  units.  Should  a  problem
                   develop, specialists in the central monitoring unit can signal and
                   talk to personnel at the patient's bedside.  Although final decisions
                   rest with the physician  in  the  remote  monitoring  unit,  he  does  have
                   the opportunity to  consult  with  specialists  who  are  in  effect  "on
                   the scene".

                   In most cases  the  small  hospitals  can  offer  qualified  coronary  care
                   at a cost of little  more  than  the  equipment  and  the  telephone  line.
                   Very seldom is there a need for additional personnel.
                   Realizing that having the hardware makes no difference if the personnel
                   caniti      use,@@"t. the project has held extensive training courses
                         MR"
                   for -Dhvs@cians and n-urse,                of  the  state.  Their   training
                                            hysiology, reaain
                   includes      Stu       p                   g EKG charts,   knowing   the
                   proper care in various emergencies, xis@'e of medication,,(a-n
                   faeets--.o@f,-c",o,-ronary care The  additional  training  turn@'the   hardware
                   into invaluable tools for improving patient caret

                   What,y'ou have, in effect, is a trained coronary care team - some
                   in the remote monitoring  unit  at  the  patient's  bedside,  and  the  rest
                   @,@n 4 central monitoring unit many miles awa ) Through training,
                                                                   y
                   teamwork, and use of  the  hardware,  the  coronary  patient  in  even  the
                   smallest of hospitals can  receive  care  equivalent  to  that  in  a  large
                   medical complex.








                                                BACK-UP SHEET



                      on:     Oklahoma Regional Medical Program
                   Locus of  Activity:   Operational Project (Entering Evaluative Phase)

                   Proiect Title:    Coronary Care


                   Status:     Ongoing
                   Sponsoring Institutions:     O@ ; Hospitals on the remote monitoring network

                   Proiect Director:    Charles Robinson, M.Do
                                        Project Director, Coronary Care
                                        Department of Medicine
                                        Oklahoma University Health Sciences Center
                                        P.O. Box 26901
                                        Oklahoma City, Oklahoma  73190

                   Dates:    June,, 1969 to May, 1972 (operational phase)
                             June, 1972 to May, 1973 (planned evaluation phase)
                   Funding:    3 year funding $516,233 ($190,000; $216,233; $110,000)

                   Other Funds:    Most hospitals pay for the leased telephone line an
                        some of the equipment.
                   Cooperative Agencies and Institutions:      Oklahoma Heart Association;
                        Hospitals on the remote monitoring network.

                   Area Served:    State of Oklahoma
                   Target Pop  lation:    Providers and consumers of Coronary Care.
                   ConRressional District:     Districts #1 through #6, Representatives
                        Albert, Belcher, Camp, Edmonson, Jarman, Steed.
                   Continuation after 0 @ Support:      Networks will become self-supporting.
                   Core Staff Contact:     Frank Bexfield, Chief, Division of Review and
                        Evaluation.


                   Date Prepared:     2-14-72

                   Drafted B@:     Brian Nasky








                              SOUTH DAKOTA REGIONAL MEDICAL PROGRAM
                              216 E. CLARK
                              VERMILLION, SOUTH DAKOTA 57069
                              (605) 624-4446






                              February 17, 1972



          Ms. Patricia Q. Schoeni
          Acting Director
          Office of Communication and Public Information
          PHS/HSMHA/RMPS
          Parklawn Building Rm 11-22
          5600 Fishers Lane
          Rockville, Maryland  20852



          Dear Pat,
          In glancing over the vignette I sent you earlier this week
          I noticed that there was an omission on the back-up sheet.
          Under the heading of Funding-04, there is an * after the
          individual amounts.  However, there is not a reference for the
              At the end of the second page  there should have been another
            indicating that this is the funding level requested in out
          FY'73 application which was just filed with RMPS.
          Thought you might like to knnw that the * did mean something.
          Will try and get the other vignettes I mentioned in my
          February 14 letter to you soon.


          Sincerely yours,


          Patricia O'Connor
          Health Information Specialist





                                                                        South Carolina


                                      NUCLEAR MEDICINE TRAINING

                 A training program for r@iologic technicians supported by the South Carolina
            Regional Medical Program@mg designed to help close the health care gap in nuclear med-
            icine by  providing  technician  trainin      e-,
                                                   9.1
      @l@@@,@@@,,,@j'is'underway at Self Memorial Hospital in Greenwood, S. C.

                 Self Memorial has engaged in radiation trai               es for sev             n a
            limited local basi@@.with SCRMP assist_a                       to expand              ian
            training statewide              a"dvaiiced   0    ntinuing@-in-struction,@fo-,               d
                            I

                 Nuclear medicine, the discipline concerned with the diagnosis, treatment and
            clinical investigation of diseases utilizing internally administered radioactive  isotopes
            and sophisticated electronic detecting equipment, is one of the most  useful  and  rapidly
            growing branches of  modem  medicine.  Technicians  assist  physicians  in  handling  much
            of the equipment used.

                 In the practice of diagnostic nuclear medicine, radioactive substances are qiven
            orally or intrave                      These materials then  act  as  tracer  doses(throughout
            the bod           an be detected       ri       by various kinds of nuclear medicine equip-
            ment.                                         A

                 Some examples include use of radioactive iodine to diagnose disorders of the thyroid
            gland and other radioactive materials to diagnose abnormalities of the brain, liver, bone,
         @and various blood disorders including anemia.
                 In the therapeutic division of nuclear medicine, very large doses of radioactive
            material are used in the treatment of cancer and other diseases. The handling of isotopes
            in respect to storage, preparation for administration and transferral is a part of the study
            program.

                 The project is under the direction of Dr. William A. Klauber,


                 Doctor Klauber says, "The primary objectives of the new project at Self Memorial
            are to provide the specific training necessary to insure that the number of trained nuclear
            medicine technicians in South Carolina keep pace with the rapidly increasing d@mand  in
            their field; to insure better patient care; to stimulate a greater awareness of the advances
            in this area useful in hospitals of all sizes throughout the region and provide for the ul-
            timate self-sufficiency of this program."
                 The instruction is available to     'Pt%technologists, laboratory technologists,
            and registered nurses in the state-4i       p Ik rily concerned with upgrading performance
            of each participant to the degree necessary to fulfill specific needs of the institution
            where they are employed. Any hospital in the state, may select and send a person for
            training in @,one or a combination of @ courses                                    t@-iirjtii@f





                                           BACK-'UP SHEET


            Region: South Carolina Regional Medical Program

            Locus of Activity:  Greenwood, S. C.

            Project Title: Statewide Continuing Education Program in Nuclear Medicine

            Status: ongoing

            Sponsoring Institution: Self Memorial Hospital, Greenwood, S. C.

            Project Director, Title, Address: William A. Klauber, M.D. , Self Memorial Hospital,
            West Alexander Street, Greenwood, S. C.  29646, 803-227-4190.

            Dates: Date of initial RMPS support: 7/l/71
            Anticipated termination of RMPS support:  6/30/74

            Funding: RMPS direct cost this budget period: $25,000.

            Cooperating Agencies and Institutions: Medical University of S. C. , Upper Savanna
            Development Program, S. C. Hospital Association, Comprehensive Ti:lealth Planning,
            S. C. Chapter the ASCP and ART, SCRMP Medical District Committee for District 2,
            and representatives of S. C. Technical Education Program.

            Area Served: Geographical area of South Carolina

            Target Population: Radiologic technologists, registered nurses and physicians.

            Congressional Districts: William Jennings Bryan Dorn (D)

            Continuation after RMP Support Withdrawn: The Project will be entirely self-supporting
            as of the beginning -of the 04 year by placing whole activity on a fBe basis.

            Core Staff Contacts: C. W. Bowman, Associate Coordinator, SCRMP

            Date Prepared: February 11 , 1972

            Drafted     Charles R. Wyrosdick






                              CARDIOPULMONARY       RESUSCITATION       TRAINING

                 A stat                                          aining   Progra "O develo-pr'-6iiT61'ng'
                       ewide Cardiopulmonary Resuscitation Tr
                                                                               rA
            r@, 'ng                                                            e e  ency life-saving
                   ,)for physicians, hospital and allied health  personnel    in
            techniques of mouth-to-mouth breathing and closed chest heart massage procedures
            has had spectacular success in South Carolina.

                 The project started August 1, 1968 under auspices of the South Carolina Heart
            Association and supported by a grant from the South Carolina Regional Medical Program,,@'

                 Subsequently, 69 hospitals and clinics participated in the program that included
            at least one hospital-based training program being conducted in 38 of the 46 counties
            in the state.

                 Thirteen workshops were  held  and  794  instructors  were  qualified.  Training  courses
            totalled 639 with a combined attendance of 18,169 persons.

                 The Instructors are fairly evenly distributed throughout the state and        yai able
                                                                                                  I
            for instructing others that meet the requirement standards set by the@,,"6.@R Task'Force of
            the South Carolina Heart  Association  and  those  of  the  American  Heart  Association.  The
            lists of names,and addresses of these instructors are available to all allied health,
            -Medical and.Plara-medical     encies in the state.

                 Trainees have included emergency rescue and industrial safety personnel, ambulance
            personnel, nurses, inhalation therapists, coronary care unit nurses, physicians, dentists
            and dental assistants.

                 The CPR techniques can revive victims  of  heart  attack,  suffocation,  electric  shock,
            drowning and many other incidents that may result in sudden death.  Dr. Ambrose
            Hampton, Jr., of Columbia, a chairman of the Heart Association's CPR Task Force says,
            "if a trained rescuer can reach a victim within four to six  minutes  after  his  heart  stops
            beating, there is a 40 percent chance of restoring life.

                 The grant support for the CPR project from SCRMP ceased fuly 1, 1971.  However, as
            planned and envisioned for all RMP-supported projects . the CPR program is continuing
            in South Carolina under auspices of other agencies.

                 In meeting the ob        s of phasing out SCRMP support for CPR tral-ning, the
                                 of@,
            Medical University            in  their  schools  of  Medicine,  Dentistry,   and@rsing   have
            added the training to the curriculum as,have all the schools of nursing in the             he
             @"'d,'@Association of Rescue Squads
                                                        had their training officers complete courses to
            serve as faculty and instructors within their organization.







              VIG%TETTFs #1                               South Carolina P@IP
                                                         (Projects #15 Lrid 16)


              Primary                                       Seco d@arX

              - Stroke                                      - Patient Care Demonstration
              - Impact on Morbidity/Mortality               - Team Approach
                                                            - Reha ilitation



                   A dramatic reduction in.death rate of stroke patients in the

              Columbia (S.C.) Hospital recorded over the past  year  has  been  attrib-
                                                                           I
              uted to a special stroke unit established as part of    the Acute  Stroke

              Management Demonstrati-or, Project supported by the South  Carolina  @IP.


                   Dr. Ro'i)ert R. Taylor, Jr., project di-rector, compared a  previous

              death rate of 52 percent among all. hospitalized st-.coke patients  prior
              to opening of the unit.to the death rate, over  a  26-month  period,  of
              19,percent within the special  unit.  These  results  he  attributes  to

              an innovative "stroke tea@' approach for handling victims of acute
              cerebral vascular (stroke) disease.  An extremely high incidence of

              the disease in central South Carolina was  the  basis  for  establishing

              the project in August, 1  8.


                  -A complementary RMP activity, the  Stroke  Recovery  and  Rehabili-
              ta@ion Project, was established simultaneously  in  the  hospital  under
              the direction of Dr. Joseph W. Taber, Jr.  He and Dr. Taylor coordinate
              the team of stroke nurses, a speech  tlierapist,'discharge  planner  and

              public health nurse.


                    The acute stroke project provides co;npre liensive study of the
              patient's condi-tioii,optimum nursing, and, if necessary, corrective
              surgery.  intensive rehabilitation undc-r'-the companion project is








                                               -2-



              b.,.gun on patients shortly after admission to the unit and has resulted

                                                         I
              in a reduction in hospital stays from an average of 21 days to I    ays.

              The service area of the project covers a 50 mile radius around Columbia

              with a population of more than 335.,000.




                                                                       South Carolina




                              POISON INFORMATION CENTER OPERATING

                A computerized Poison Information Center, designed to provide data within four
           to fifteen seconds to South Carolina's physicians and dentists, is in  operation  at  the
           Medical University of S. C. in Charleston.

                The Center, a first step in the  planned  development  of  a  comprehensive  medical
           and pharmaceutical information system for the State, is supported by the South Carolina
           Regional Medical Program.

                Located in the  Medical  University  Hospital  Pharmacy  and  operating  around-the-
           clock since October 1, 1971 the new PI Center  has  the  capability  of  providing  imme-
           diate information concerning poisonous plants and animals, household products, pes-
           ticides, herbicides,, cosmetics, commercially available drugs and chemicals and
           proprietary drug products.
                When a request is received,the computer responds almost instantaneously with
           the name, formula, potential toxicity, symptomology, prognosis and treatment of
           potential poisons.

                All physicians and dentists in the State have been advised of the special telephone
           number for the PI Center at MUSC. However, callers require identification before the
           Center will dispense poison control information.

                Persons calling the Center who cannot be identified as a physician or dentist are
           told to take the victim, along with the poison to their family doctor or to  the  nearest
           hospital emergency room.

                The capability of the Poison Information Center is expanding to include computer-
           ized information on adverse drug reactions and drug interactions @'@'a's the SCRMP support-
           ed comprehensive system swings into operations

                The Center has the capability to provide original journal article  information  (150
           journals monthly) concerning  drug  therapy,  indication/contraindications,  drug  inter-
           actions, and adverse drug reactions.

                During its first three months of operation, the Center responded to more than 100
           requests for information from across the state and the  requests  are  increasing  daily.





                                                                                       SOUTH DAKOTA



                                             COPDNARY CARI', TRAINING PROJECT


                      In  an  effort  to  deal  with  South  Dakotals  leading  cause  of   morbidity   and
                 mortality., the Nebraska-South Dakota Regional Medical Program formulated an
                 Operational  Project   to   train   4h@health   personnel   in   improved   coronary   care
                 delivery.  The Coronary Ca-re Training Proiect,@ begun in April @ 1970,.
                                       -0       onal Project si  :nc"             tion  of  the   Ne   r@ka
                 has continued as        perati                     e the separa
                 and South Dakot@"-@ in July 1971.
                      Of the 6,500 resident deaths in South Dakota in 1970, almost 40'-o were due
                 to  heart  disease.  The  difficulties  in  treating  the   Coronary   patient   are   further
                 magnified by the rural nature of the State with its commnication and transpor-
                 tation  problems,  a  lack  of  advanced  coronary  tare  training,   and   a   population
                 which has a significantly large number of older -persons.
                      The Project is divided i                 eams., One team is-@@,c@ted at@Si(
                 Valley-Hospital in Sioux Fall
                                                                                           @,@s ani
                 surrounding area.  The Universit) 0         outh Dakota School of Medicine team         operates
                 from Vermillion in providing training       to  the  hospitals  east  of  the  Missouri   River.
                 The  third  team  is  at  St.  John's  McNamara  Hospital  in  Rapid  City  and   provides
                 basic training and              field work west of the Missouri River.
                      Several types of training are provided by the Project.  Basic training courses
                 are taught  on  either  a  three  evenings  per  week  for  four  weeks  basis  or  a  one-
                 two  evenings  per  week  for  thirteen  weeks  basis.  An   intensive,,training   course   is
                 currently offered at St. John's McNamara and another w441 beRTii at           Sioux Valley
                 in  Marcht  'tiese  courses  meet  daily  for  three  weeks  and  provide  more  clinical   as
                 well as class room experience.  Several refresher workshops                ,yinposia  are
                 presented du @ g the year.             act,--c,,ontent@.rE@   courserit-ies    with    the
                 needs of the health personnel,whe-,are.,to,be@@@-,i             The  final  type   of   training
                 provided  by  the  Project  is  with  the  Roche  Laboratory's  ROCOM   Un-it.'-At   Sioux
                 Valley Hospital,  the  IRDOOM  is  used  as  a  supplement  to  the  basic  course  and  is
                 available for use by                        coronary care uni                  .   The   Medical
                 School  places  their  ROCOM  Unit  in  a  hospital  for  a  six-weok  period.   The   visuals
                 of the ROCOM are the fotal point of this course;@             local physicians, trained
                 nurses, and members of the Project team provi@            @     supplemental     lectures.
                 More  than  1,500  physicians,  nurses,  and   allied   health   personnel   have   participated
                 in at least one of the various types of training provided by the Proiect during
                 the past year.  Physicians who attend the symposia are able to earn credit through
                 the American Acadeiny of Family Practice.
                       In  add@              t-r ining i-n@l  e,@-area-@@@           @2 t          )er     - --ie
                 Project    sta            ticipated in two EmergencyMedical Training woi                s(con-
                 ducted   duri"            instructors in(the area o'f)cardiopulmonary physi           gy.  They
                 have given                tures  and   demonstrations   on   cardiopulmonary   -resuscitation.
                 In-service   education programs on pacemakers, cardibanatomy and physiology, and
                 arterial blood gases have also been given.
                        Du-ring thef     years  @.f the Project)there have been several positive results.
                  The confidence apd abilities@of those dealing with the coronary patient, especially
                  the nurse,, have been greatly,)increased.  In the 47 hospitals in          eastern South
                  DakAta, the Project has helped in establishing(twenty-@ive)coronary car6/monitbred






              CORONARY CARE TRAINING PROJECT--2



                     t
              bed uni s   E         other hospitals are currently 4ft           s     estab
              lishing units,w@th-t-he--P@j.ect.!s-assistanc&. This increased knowledge  and
              ability on the part of the nurse           'one factor which resulted in
              legislation being introduced in the 1972 session of the South Dakota legis-
              lature to extend the role of the nurse as outlined in the State's Nurse
              Practice Act.  The quality of care being received by the patient in the South
              Dakota hospital has definitely been upgraded. It  ia  estimated  that  deaths
              resulting from heart disease have decreased from 3-1-40,@,  e
                                                                         p r hospital as  a
              result of the additional coronary care facilities.










                                              Back-up Sheet

                                     CORONARY CARE TRAINING  PROJECT

              Region: South Dakota Regional Medical Program
              Locus of Activi@:  Operational Project
              Project Title:  Coronary Care Training Project

              Status:  Ongoing
              Sponsoring institution:  The University of South Dakota School of Medicine,
                   Vermillion; Sioux Valley Hospital, Sioux Falls; and St. John's  McNamara
                   Hospital, Rapid City.
              Project Director, Title, Address:   Warren Jones, M.D.
                                                  Associate Director
                                                  Coronary Care Training Project
                                                  School of Medicine
                                                  University of South Dakota
                                                  Vermillion, South Dakota 57069
              Dates:  April, 1970-July, 1971 - Operational Project of the Nebraska-South Da(ota
                      July, 1971-to present - Operational Project of the South Dakota RMP
              Funding:   01  $119,480 (School of Medicine, $57,615; Sioux Valley,  $25,615;
                             St. John's McNamara, $36,2SO) (April 3, 1970 - December 30, 1970)
                         02  $58,205 (School of Medicine, $28,809; Sioux Valley, $11,271;
                             St. John's McNamara, $18,125) (January 1, 1971 - June 30, 1971)
                         03  $120,000 (School of Medicine, $57,790; Sioux Valley,  $25,788;
                             St. John's McNamara, $36,422)
                         04  $104,662 (School of Medicine, $45,844; Sioux Valley,  $29,868;
                             St. John's McNamara, $28,950)*

              Other Funds:  None
              Cooperating Agencies and Institutions:  South Dakota Heart Association, American
                   Academy ot Family Practi&e- (the physicians who participate in the symposia
                   can receive credit from the AAFP), 65 South Dakota hospitals (public, private,
                   state, and PHS), practicing physicians, nurses (R.N. and L.P.N.), newspapers,
                   and television stations.

              Area Served: State  of  South  Dakota
              Target Population:  All South Dakotans; especially those in rural areas.
              Congressional Districts:  #1, Mr. Frank Denholm (D); and #2, Mr. James Abourezk (D)






                                                 2-


             Continuation after RNP Support Withdrawn:  At this time, it is anticipated
                  that the Project will run until Tu-1y, 1973.  At that time the Sioux
                  Valley and St. John's McNamara units will probably be absorbed by their
                  respective hospitals.  The future of the Medical School unit after
                  July, 1973 is uncertain at present.

             Core Staff Contact:  John A. Lowe, M.D.,, Director
                                  South Dakota Regional Medical Program
                                  216 East Clark
                                  Vermillion, South Dakota 57069

             Date Prepared:  February 11, 1972

             Drafted by:  Patricia O'Cormor








                                             Back-Up Sheet

                            EMERGENCY MEDICAL TECHNICIAN TPAINING WORKSHOP

                                                (140 hour)


            Region:  South Dakota Regional Medical Program

            Locus of Activityi  Core Activity
            Project Title:  Emergency Medical Technician Training Program

            Status:  Completed
            Sponsorinz Institution:  The University of South Dakota School of Medicine,
                  Vermillion; McKennan Hospital, Sioux Falls; and State Department of
                  Health, Pierre.
            Project Director, Title, Address:    George R. Halter
                                                 Assistant Director - Education
                                                 South Dakota Regional Medical Program
                                                 216 E. Clark
                                                 Vermillion,, South Dakota 57069

            Dates:  December 8-22,, 1971

            Funding:  01   $1000
            Other Funds:   EmerRency Employment Act-Salaries and expenses of the
                           twelve students.
                           Department of Transportation - matching funds with MUHS
                           counties for ambulances.
            Cooperating Agencies and Institutions:  Sioux Falls Ambulance, Minnehaha County
                  Civil Defense Unit, p@             physicians  newspapers, and television
                  stations.
            Area Served:  Counties in the AW Project (At the present time the exact
                  South-Dakota counties to be involved in this p  'ect have not been deter-
                                                                 roi
                  mined.  They will probably be Millette, Todd,, and Bennett, in addition to
                  at least one other.)
            Target Population:  Persons in the MJHS counties.
            Congressional Districts:  #1 - Frank Denholm (D) - where the course was taught
                                       #2 - Mr. James Abourezk (D) - some of the counties
                                             involved are in his district








                                                    2-


            Continuation after @   @ort Withdrawn:  At this time it is difficult to
                 speculate on this as it is an area into wnicn SDRMP is just beginning
                 to direct its efforts.  Past work in this area has been done by the
                 Department of Transporation in cooperation with the South Dakota State
                 Department of Health.

            Cote Staff Contact:  George R. Halter
                                 Assistant Director - EducAtion
                                 South Dakota Regional Medical Program
                                 216 t. Clark
                                 Vermillion, South Dakota 57069

            Date Prepared:  February 29, 1972

            Drafted by:  Patricia O'Connor








                                                                                  SOUTH DAKOTA



                               EMERGENCY MEDICAL TECHNICIAN TRAINING WORKSHOP


                  'Ihe South Dakota Regional Medical Program in conjunction with the
             University of South Dakota School of Medicine, the State Department of
             Health, and McKennan Hospital in Sioux Falls, recently SDonso            Emergency
             Medical Technician Training Workshop at McKerman Hospit@l.",-T
             wexe students in the course.  The graduates of the 140-hour workshop will be
             driving ambulances in those counties which are participating in the Minimum
             Uniform Health Services (MJHS) Project to serve counties which currently lack
             adequate emergency medical personnel and services.
                  The training program began on December 8th and concluded on the 22nd.
             Members of the McKennan Hospital stdfflvarious Sioux Falls physicians-
             representatives of  the  Sioux  Falls  Ambulance  Servicerthe  V.D.  Control  Section
             of the State Department of  Health,-and  the  Minnehaha  County  Civil  Defense  Unit
             provided the  classroom  instruction.  Also  instructing  were:  Dr.  Robert  H.  Hayes,
             State Health Officer; and Dr.  Joseph  D.  Welty,  Assistant  Director,  SDRMP  Coronary
             Care Training Project, The University of South Dakota Scho6@ of Medicine.
                                                                         (, 0.l@ IRA,
                                          classroom instruction wa6--,          .  Areas   covered
             included bleeding  and  cardio"-"pulmomry  resuscitation,  extrication  and  lifting,
             shock and burns, psychiatric emergencies, childbirth, fractures, and environ-
             mental in uries. Each student also  spent  80  hours  in  clinical  observation  of  the
             Recovery, Obstetric, Surgical,  Coronary  Care,  Intensive  Care,  and  Emergency  Wards
             of McKennan andViding with the Sioux Falls Ambulance Service.
                  This course is the latest in a series of  EMT  Courses  to  be  presented  in  the
             State. Seventy-two hour training  programs  have  been  given  in  South  Dakota  during
             the past two sumers. The  first  of  these  was  in  August@  1970  at  the  School  of
             Medicine in Vermillion. The second was  at  St.  John's  McNamara  in  Rapid  City  dur-
             ing June,@ 1971.  Both were cosponsored by the School of Medicine and tie State
             Department of Health in conjunction with the Department of Transportation and
             under the standardized requirements of the National Highway Safety Act.
                  'Ihe workshop was also part of the initial phases of the NUHS project.  The
             students will be assigned as ambulance drivers in three-man te@, one per county.
                ambulances                              provided for  by  matching  funds  from  the
             county to which they are assigned  and  the  Emergency  Health  Services  Section  of
             the State Health Department  in  cooperation  with  the  Department  of  Transportation
             and the South Dakota Highway Department.  Funding for other parts of the MUHS
             project was presented to the South Dakota State Legislature during its 1972 session.
             The Project was unanimously  passed  by  both  houses.  The  ambulance  drivers  were
             hired through funds provided bv the Eederal Emetg                ent Act,.
                                           s@@ George R. Ha  er, Assistant Director oi
             Education for SDRW@                                            the 72-hour courses4
             Assisting him with the clinical phase of the training was Dr. Michael Rost
             McKerman Anesthesiologist.







                                                                          SOUTfi DAKOTA



                                             Rosebud      ect


                 Four University of South Dakota Medical School students will be spending
            this summer at the U.S. Public Health Service  Hospital  on  the  Rosebud  Reservation.
            Funds for this project are being provided by the South Dakota Regional Medical
            Program (SDRMP).
                 The idea of having some of the medical students spend their summer at
            Rosebud was developed by 2nd year medical s           "ke Haley of Mitchell, who
            grew up in the area of the Reservation.  He            @ other students-i@
                                                                r
                                                                   c        am@
                                                         t
            in the project and then approached the Regional M d  a  Progr                possi-
            bility of.@      funding the project.  OE&bruaiT    9th, the  Regional  Advisory  Group
            of SDRMP heartily endorsed the program @ approving its fu            The  project  will
                      add to the education of the medical students, Z-Idti@- w@ll  greatly  benefit
            the health care delivery system at Rosebud.  Though other medical students have
            previously participated in sumer work on the Pine Ridge and Eagle Butte Reservations,,
            none have been to Rosebud.  The hospital at Rosebud has S5 beds.  It serves apprbxi-
            mately 25,000 outpatients and has 17,000 active charts.
                  During the summer the one first-year and three second-year students @@ assist-4
                                    I
            the five Public Heal@ Service doctors by administering physicals and taking his-
            tories,       freein  the doctors for work in other areas.    The students       also
            conductira survey   9as to the  incidence  of  pulmonary      e 4T?@g the Indians.  No
                                                                    d'
                    of this nature has be                   eviously      e     0  @u
                                          en undertaken pr                        e
                            t some of@.the Indian Youth in pursuin@ e     rs-@ in -med@icine - or a. par@.







                                 Community Health Worker Training Program


                  Many residents of the impoverished Hamilton District of Harrisburg,
              Pennsylvania, are getting personalized health care for the first  time.  This
              care is being brought about through the efforts of ten Community Health Workers.

                  These worker  virv              st,    r @'rd'd n- Et ... t@,et-ves,) started training
              in Janudry, throu@ a $9,000 grant  from the Susquehanna Valley Regional  Medical
              Program.  After several weeks of classes, they conducted a door-to-door survey
              of the one and one-half square mile District.  This survey was designed to get
              Community residents to be tested for Sickle Cell Disease and lead  poisoning.
              (Preliminary results of the survey indicate that 80 percent of the families
              visited agreed to testing.)

                  Although the workers' initial contact with the community was aimed at
              bringing residents to the newly-created Hamilton Health Center for tests,  it
              also served to make residents aware of the Center's existence and the person-
              alized care it offers.

                  Through the training program, the Community Health Workers are being
              taught how to establish @ rapport with the residents.  Once this rapport is
              formed, it is expected that the Workers will be able to determine  residents'
              needs. If they can be met through the Center, the Worker will  refer  clients
              there. If not, she will advise families assigned to her whom to  contact  for
              assistance.


                  Selecting the trainees from the Hamilton District serves a  double  purpose.
                                                                  v
                                                          r
              First, it is expected that persons who have         1              will be  most
              capable,QL relating to @ other residents.  Second, the training   program provides
              an excellent starting point for someone desiring a health @career)@ who is
              unable @'to@           @more costly educational programs.
                  After the first ten Workers have completed their 12-week  training  program,
              the Hamilton Health Center, Incorporated, plans to continue training  through
              314B funds so that an adequate number of Workers will be available to meet the
              tommunity's needs.










                                        Rural Health Service


                   I* until. several years ago, when a farmer in rural Columbia or Montour
              County- @eriously ill, he faced an extended hospital stay.  Even though heim-,
              recovers* enough to convalesce at home, there was no physician nearby to
                           Since then things have changed.
                    The Columbia-Montour Home Health Service, supported by  a  grant  from  the
              Susquehanna Valley Regional Medical Program, began training home health aides
              to supply skilled nursing care, therapy, and preventative medicine in the home.
                    Last year, 17 home health aides made over 5,500 visits.  They were able to
              care for patients with a number  of  different  illnesses:  heart  disease,  non-
              communicable diseases  diabetes, stroke  injuries, chronic diseases  arthritis,
              cancer., and others. Most of the patients (3 out  of  4)  wore  over  65.  Noarly
              20 percent were on medical assistance.
                    To receive home health service, a patient must  have  written  orders  from
              his physician. Then, every two months a  report  on  the  patient's  progress  is
              sent to the physician for further medical orders.
              Status:   Operational as of 10/70

                        lst year    $15,900
                        2nd year     13,100
                        3rd year     10,000







                                                   Tennessee Mid-South Regional
                                                         Medical Program

              A young mother gave premature birth to her twins. Physicians  at  a  rural
              community hospital knew they would lose one of them and  possible  both.
              There was only one thing left to do. A call was placed  to  the  Intensive
              Care Nursery at the University of Tennessee Memorial Research Center
              and Hospital. Within five hours both twins had been  transported  to  the
              nursery by Volkswagen bus.  Today, both of the twin girls are alive
              and healthy.
              This is a story of just one of many mothers in the East-Tenhessee Appalachian
              Region who is thankful to the Intensive Care Nursery.  Since  the  Infant
              Intensive Care Unit was set up in October 1971, 278 babies have beet saved.
              Many have been transported from rural areas for treatment.
              One of the unique features of this service is the transporting  of  these
              infants in distress in a converted Volkswagen bus. It  contains  a  portable
              isolette and other equipment necessary to sustain life until  the  infant
              reaches Knoxville.
              Two years ago the pediatrician in charge discovered there was an alarming
              infant mortality rate in Eastern Tennessee. The rate  of  25.5  compared
              to 11.7 in the entire United States. The figures  revealed  highest  death
              rates were in counties with inadequate equipment and  few  physicians.  Many
              of the mothers received no pre-natal care and many had  insufficient  diets.


              Concern by the pediatrician led to the development of the  Infant  Intensive
              Care Unit, and his attempt to share information gained through its develop-
              ment throughout the region.
              The Tennessee Mid-South Regional Medical ProgramA as approved  funds  to
              allow a physician-nurse team to travel to rural ospitals  in  the  area.
              They will try to upgrade skills and to evaluate the health  care  facilities
              and make practical suggestions regarding equipment.
              The physician and nursing staff has participated in  many  teleconferences
              and seminars sponsored by TMS/RMP. Nurses from all areas  of  Tennessee  and
              Kentucky participate and observe in a one-day training program in  the  ten-
              bed Infant Intensive Care Unit at Knoxville.

              Effects have already been far reaching. Many of the  nurses  and  doctors
              in isolated regions have adapted their nurseries in an attempt  to  give
              newborns a better chance at life. Many of the  hospitals  have  purchased
              warmers.  Some have changed feeding and bathing methods.
              The unit currently serves an area that stretches in a 200-mil6 radius
              around Knoxville and the staff also provides a 24-hour telephone counseling
              service to physicians.







                                                   Tennessee Mid-Sou-Lh Regional Medical
                                                                  Program


                     A two-year study designed to allow nurses to do follow-up care
                     on patients with high blood pressure at the Alton Park Health
                     Center has been approved by the Tennessee  Mid-South  Regional
                     Medical Program@,-,@

                     The Center is located in  a predominately black area of
                     Chattanooga, and average  family income is $8,500 to $4,000 a
                     year.  Hypertension, or high blood pressure, is a serious
                     problem among blacks. According to  national  statistics,  one
                     in four has high blood pressure and three in four  with  high
                     blood pressure have heart disease.

                     Currently, the center treats 1,000 patients with  high  blood
                     pressure but many do not bother to be treated and many do not
                     continue treatment on a regular basis.

                     However, hypertension can be serious.  Many people with hyper-
                     tension die not only from stroke, but also from  heart  attack
                     or heart failure.

                     There are not enough physicians to take care of  people  with
                     hypertension.  The TMS/RMP is hoping to find a way to alleviate
                     this problem by assigning tasks previously carried out by
                     physicians to specially trained nurses.

                     Three nurses at the center will be responsible  for  follow-up
                     care of hypertensive patients. It is hoped  the  project  will
                     demonstrate that close care of patients will lead to lower
                     morbidity rates in the Alton Park Health Center area.

                     Two family health workers will also be involved in the program
                     at the center which currently serves over 33,000 people in
                     this area of Chattanooga.







                                                                 -South Regional
                                                   Tennessee Mid
                                                          Medical Program


               Residents of three rural Appalachian communities will have full-time
               health care available for the first time this year.  The  Tennessee
               Mid-South Regional Medical Program has approved a grant which  will
               allow clinics in Frakes, Kentucky and Clairfield and Duff, Tennessee
               to operate daily.
               Each clinic will be staffed by a full-time nurse practitioner, an
               assistant, a health aide, an automobile driver and an outreach worker.
               Doctors will visit the clinics on a weekly basis, but the nurse practi-
               tioher will be able to perform some duties without direct physician
               supervision. She will be a specially trained registered  nurse  who
               has received additional certified training as a nurse practitioner.
               The three clinics, prior to funding, operated on a part-tim6 basis.
               More than half of the 4,500 residents of the region are now using them.
               Many people have not had any full-time care because there has been  no
               medical service available.  There is not one resident doctor in the area,
               Many of the people, over 57 percent, have incomes of less than  $3,000
               a year, do not oqn motor vehicles and are unable to travel out of  the
               region for medical care.
               The program will also emphasize good dental health and a dentist, dental
               assistant and aide will also be hired. Education in health  areas  and
               prevention of health problems are t-wo other aims of the program.
               The project was planned by residents of the three communities in an
               attempt to find a solution to their health need problems.  A board, made
               up of citizens of the three communities, will be responsible for the
               distribution of funds and they will administer the program.
               The Clear Fork Community Development Projects, Inc. is located in  the
               Clairfield Tennessee Community Center. The White Oak Clinic  in  Duff,
               Tennessee is in a 12 foot by 60 foot converted house  trailer.  The
               Frakes, Kentucky clinic is currently located in the basement of the
               Post Office.
               The project has also received funding from the Ohio Valley Regional
               Medical Program.








                                                    Tennessee Mid-South Regional
                                                           Medical Program


              Health professionals in 65 health facilities are now  continuing  their
              educations without leaving their employment.  An  extensive  teleconfer-
              ence system was set up by the Tennessee Mid-South Regional Med:ical
              Program in November 1970 to enable health professionals to continue learning
              without sacrificing valuable time and money traveling.

              A teleconference is really a group telephone  conversation.  A  lecturer
              can speak to many professionals in the region by using a conference phone.
              The hospitals participating also have conference phones and  there  ore,
              there is a two-way communication between lecturer  and  audience.  This
              system is one method being used to disseminate information to health
              personnel outside academic institutions.

              In November 1910, bight  hospitals and 40 people participated in the
              teleconference network. Today, 65 health  facilities  are  participating
              and as mnay as 400 perople have taken part in a  single  teleconference.

              Currently, there are two series being presented.  An eight-week program
              on beginning librarianship is being attended by 66 "students"  in  four
              states.  Also, a hine-week overview for medical record personnel is
              being held in the Middle Tennessee area.

              The Tennessee Hospital Association is now planning a  nine-month  state-
              wide course on "Modern Techniques for  Supervisory  Development."  This
              course will emphasize cost containment and supervisory techniques.

              A clinical content teleconference is also an integral part of the total
              program.  These conferences are presented separately for three networks.
              Each month there are at least four programs on each network aimed toward
              the health care professional.

              The programs are planned by curriculum,,committees comprised of  health
              professionals from the areas 8erved,and TMS/RMP",)core staff.









                                                   Tennessee Mid-South Regional
                                                         Medical Program


                     Patients discharged from the Oak Ridge Hospital of the Methodist
                     Church in Oak Ridge, Tennessee will now be assured of continued
                     care.  A liaison nurse will serve as a link between the hospital
                     staff and health centers in the community to insure continued
                     health care for patients who require it.

                     The Tennessee Mid-South Regional Medical Program has funded
                     this project to see if it will result in reduced re-hospitaliza-
                     tion and shorter hospital stay for some patients.

                     The liaison nurse will act as a bridge between the private
                     physicians and the patient and those providing direct community
                     service.  She will also educate the nursing staff of the hospital
                     to make them aware of patient needs for further health care
                     outside the hospital complex.

                     She will serve an area that includes Anderson, Campbell, Clai-
                     borne, Roane and Scott counties.








                                      CARDIOPULMONARY RESUSCITATION


                     Many people in East Tennessee are alive today because ambulance
                attendants and health professionals have learned how to care for and
                treat heart attack victims in emergency situations.

                     The East Tennessee Heart Association in cooperation with the Tennessee
                Mid-South Regional Medical Program is training health professionals  and
                emergency medical personnel in the use of cardiopulmonary  resuscitation
                techniques.  Since the program began in January, 1971, more than 180 health
                professionals have attended all-day sessions in Knoxville.
                     Health professionals are taught intubation techniques, open heart
                massage, drug therapy, and mouth-to-mouth resuscitation.  Many of the
                health professionals have returned to their own hospitals throughout
                East Tennessee and Southeastern Kentucky and have instructed their staffs
                on use of these methods.
                     According to Mrs. Gertrude Killebrew, inservice education  director
                at New Tazewell, a week after the staff completed the training, a patient
                went in to cardiac arrest. She said if they had not had the course,,  no
                one would have known what to do.
                     Over 2,000 ambulance attendants, rescue squad personnel and  police
                and firemen have taken the three-hour course offered for them in  mouth-
                to-mouth resuscitation techniques.
                     Mr. George Duell, Jr., of the Jellico, Tennessee Rescue Squad  says
                members of his department used artifical respiration prior to taking
                the course.  They now all use the mouth-to-mouth resuscitation met hod
                and have had some "saves" as a result.

                     Miss Edna Workman of Knoxville is one of the women saved by an
                ambulance attendant who took the cardiopulmonary resuscitation course.
                Her friend, Juliaette Jones, who accompanied her to the hospital praised
                the work of the attendant.
                     "He knew how critical it was," she said, 11 and gave her mouth-to-
                mouth resuscitation all the way to the hospital.  The experience pointed
                up the necessity of people knowing what to do in an emergency situation."

                jpc

                September 26, 1972

                Tennessee Mid-South Regional Medical Program









                                             CANCER REGISTRY



                     Cancer patients, physicians and thirty Tennessee hospitals are
                currently being helped by the cancer registry project of the  Tennessee
                Mid-South Regional Medical Program.

                     Since the program began, records of more than 7,000 cancer  patients
                have been fed into a computer at the Meharry Medical College in Nashville,
                Tennessee.

                     According to Project Director, Dr. Charles Trabue, accumulation  of
                this information provides a service to the patients, serves as a  source
                for investigative work by physicians writing scientific papers an
                allows hospitals and physicians to evaluate results of cancer care at
                their facility.

                     The program encourages and promotes life-time followup care of
                cancer patients. Participating hospitals receive forms each  month  from
                the cancer registry listing patients treated at their facility who  are
                due for annual re-examination.

                     All information gathered by the cancer registry is available to
                any of the participating physicians.  He may use this information for
                scientific research or to evaluate methods of cancer care at his hospital
                as compared to methods at other participating hospitals.

                     Hospitals belonging to the cancer registry can effectively  notify
                people of the need for re-examination and through this, can play the
                role necessary for it to provide comprehensive health care to the  health
                consumer.

                     The dancer registry also makes other information available to hospitals
                and physicians during the year. Each hospital receives a  complete  list
                with data on all patients treated at their facility four times a  year.
                Once a year, physicians are sent lists of patients he has  treated.  Each
                month, the registry publishes a site review giving pertinent data on  all
                patients in the registry who have cancer of a specific organ with a brief
                scientific article relating to cancer of that organ.




                ipc

                September 26, 1972

                Tennessee Mid-South Regional Medical Program








                                          EMERGENCY MEDICAL SYSTEM


                      A coordinated trained emergency medical service system is now operating
               in Tennessee.

                      Dr. Robert Lash, head of Emergency Medical Services at the University
               of Tennessee Memorial Research Center and Hospital, has brought together
               trained physicians, nurses,, paramedics, rescue squad people, cardiopulmonary
               resuscitation personnel, Red Cross volunteers and a  contingent of the
               Tennessee National Guard  medical  battalion  to  form  a  coordinated  emergency
               medical service system in East Tennessee.

                      The system demonstrates the value of forming cooperative arrangements
               between health professionals.  The cardiopulmonary resuscitation people
               were trained by the East Tennessee Heart Association wi@---h funds from the
               Tennessee  Mid-South  Regional  Medical  Program.  Rescue  squad  and  Red-Ctoss
               volunteers received training  from  the  Red  Cross.  Nurses  have  been  trained
               in coronary care and emergency medical treatment by the University of Tennessee
               Memorial Research Center and Hospital through continuing education courses.
               Emergency Medical Teams have also received training at the Hospital.  Company C
               of the medical battalion of the Tennessee National Guard received Army training.

                      Dr. Lash said most of these people  have  been  trained  during  the  past
               two years. He  brought  them  together  to  form  the  coordinated  emergency  medical
               corps.

                      The corps will be available  in  case  of  disaster  in  Tennessee.  Some
               members are trained in ski  slope  and  mountain  rescue.  The  teams  are  also
               available for use at large public gatherings in the Knoxville area.
                      Currently, the team is workirg at all home football games at the Univer-
               sity of Tennessee in  Knoxville.  During  the  season  opener,  over  50  persons
               were treated for various injuries and illnesses.  The most serious was a
               heart attack.

                      One man, accorindg to Dr. Lash, fell  on  the  track  while  leaving  the
               stadium after the  game.  His  heart  had  stopped  beating.  The  medical  team
               worked on him with the emergency equipment and  he  is  now  a  patient  in  the
               coronary care unit at the University of Tennessee Hospital.

                      "He would have been dead,"  said  Dr.  Lash,  "if  the  equipment  and  trained
               personnel had not been available."
                      At the names, fifteen teams  of  trained  medical  personnel  patrol  the
               stadium which holds 80,000 patrons.  There are four vehicles available which
               have been converted to mini-ambulances  to  take  injured  or  sick  from  the  stands
               to four mini-emergency  rooms  set  up  within  the  stadium.  If  hospitalization  is
               necessary, five fully equipped ambulances are also available.

               ipc

               October 1, 1972

              Tennessee Mid-South Regional Medical Program.





                                                                                            TEXAS




                                                 Project GRO
                      (Grass-Roots Organization    for Health Services Education)

             Patients in at least three  large  geographic  areas  of  the  vast  Texas  region
             have already felt the  results  of  shared,  expanded  and  improved  education  for
             health professionals.  Approximately 1800 registered nurses, physicians, licensed voca-
             tional nurses, nurses aides and other allied health personnel typical of
             rural Texas have learned new patient care skills at 23 works@ops and
             t@,af educational sessions conductedias of February, 1972@,)within their
             own hospital  or  at  a  nearby  institution."  Attendance  and  active  participation
             has been termed excellent  by  both  the  community  health  providers  who  learn
             new skills and health professionals who travel from the larger resource
             institutions to  share  their  knowledge  and  the  latest  treatment  modalities.
             Begun  in  September/1971,  this  cooperative,  coordinated  health   service   educa-
             tion is available because three groups of approximately ten community hospitals
             each agreed with theiRMPt@concept of sharing expenses and efforts to bring -the
                                   'i@-  by the health providers in the three di  eren
             kind of education nee e'd                                                        rural
             areas.
             Project GRO is a prime example of RMPT's new program ac     tivity.   Its    purpose
             is to extend  health  services  education  into  the  smaller  community  hospital
             groups, and,more  than  that,  to  establish  a  self-supporting  system  for  continuing
             this  training  with  person-to-person  linkages  between  resource  centers  and  health
             personnel in the outlying, inaccessible areas.
             Under the project's first year plan, three hospital groupings are organized for
             cooperative sharing of  a  local  health  professional  as  a  coordinator  of  health
             services education.  Located  in  county  groupings  west  of  Fort  Worth,  in  the
             Huntsville-Lake  Livingston  area,  and  in  extreme  northeast  Texas,  each  group
             averages  ten  hospitals,  representing  collective  capacities  of  500  beds  plus
             the addition of area nursing homes.
             The local education coordinator determines current needs and implements educa-
                    sessions  within  this  interdisciplinary  pilot  program.  To   arrange   quality
             training, the  coordinator  acts  as  planning  liaison  between  the  hospital  group
             and  institutional  resource  centers  willing  to  provide  specific,  needed  education
             programs  to  allied  health  professionals.  Visiting  faculties   of   physicians,
             dentists,  nurses,  speech  therapists,  occupational  therapists,   physical   therapists
             and others have presented sessions including coronary care, stroke rehabilitation,
             burns treatment, inhalation therapy and speech therapy.  Related subjects have
             ranged from  library  reso@rces,  nursing  care  plans  and  inservice  training,  orderly
             training and legal aspects of nursing to virological and immunological studies
             of human neoplasia.  The latter was attended by 200 physicians  nurses and hospital
             personnel in the West Cross Timbers Council.
             Interest continues high by the  health  professionals  who  are  eager  to  learn  and  by
             multi-disciplinary health professionals who have enthusiastically shared their
             expertise.  In short, project GRO is growing into a healthy success.
                 fourth hospital group staff ready to join this cooperative venture of hospitals
             in rural Texas' at the beginning of Project  GRO's  second  fiscal  year-,i@n-Septenib'e@,
             1972.






                                                                               TEXAS







                               MEDICAL PHYSICS ORGANIZED, COORDINATED



             "MediQal Physics in a Regional Center", a Regional Medical Program of
             Texa  funded project which is based at The University of Texas M. D
             Ande@on Hospital and Tumor Institute at Houston2has improved radiation
             patient care in Texas by standardizing procedures and providing-patient
             treatm.@itdata
             One of several outgrowths of this project has been'the       a-ti" o f
             the statewide organization, Texas Regional Medical Physicists,
             In collaboration with this organization and M. D. Anderson Hospital s
             Physics Department, one of the major elements of this project is the
             calibration of radiation measuring instruments.  Members of this organiza-
             tion are encouraged to bring their instruments for calibration at Workshops
             which are held twice yearly.  Between sessions, members may mail thermo-
             luminescent dosimeters to verify exposure rates of radiation therapy
             machines.  A fee is charged for this service in the hopes of making the
             entire program self-supporting when RMPT funds are phased out at the end
             of the current fiscal year.  The M. D. Anderson Hospital Physics Depart-,
             ment facility, which is available for this service, has the support of the
             National Bureau of Standards and can promptly provide these services because
             of its proximity to its members.
             At bi-annual@.meetings of the Texas Regional.Medical Physiciststcommittees review means
             of standardizing procedures.  The subjects of some of the meetings held to
             date include "Calibration of Radiation Therapy Machines;  X-rays, 10 Kev to
             35 Mev;  Electrons, 5 to 50 Mev-  Cobalt-60 and Cesium-135 Irradiators" and
             "Room Planning and Facility Design for Radiation Installations".
             This RMPT project not only provides instrument measurement but also data on
             individual patient's treatment as well.  A centralized computer calculates
             the distribution of radiation dosage used in treatment.  From the resulting
             isbdose curves printed by the computer, radiologists can determine the
             amounts of radiation delivered to the tumor and surrounding tissue.  This
             data is available for patients treated by interstitial, intracavity or
             external beam radiation.
             Graphical information such as the contour or placement of sources is trans-
             mitted to the Center by mail or telecopier.  The resultant isodose distri-
             bution is returned by the same means.  Twenty-one telecopiers operate in the
             network.  The system is available for physician communication, but the Center
             offers no clinical advice.






             In addition, a project staff member regularly publishes a bibliography
             of physics journals containing articles of interest to physicists in
             the health sciences.
             A central list of participants available for consultation is also main-
             tained.  Some of the areas ,-f specialty include external beam dosimetry,
             leak testing of sealed sources, radiation accidents and decontamination,
             radiation protection measurements, etc.
             Other  pro'grams related to diagnostic radiology and nuclear medicine have
             been developed more recently.






































                                                    2







                                                                               TEXAS







                                    IDENTIFYING ELEL(CTI[R@IltC-IAAL HAZARDS
                                                         L n mL- t'

               Identify,ing electrical hazards in hospitals, the major goal of an@RMPT
                                                                          shed.
               project(@,,-in@the.j%@Co@-@d,i,@ 1--@---E)ffi,ce@@ has been accomplix
               target spitals were visited and sufficient information gathered  to
               develop                report.  This information, intended to help
               elimina                vide     tii,,uing, prevent           on to
               hospital personnel involved,       disseminated              to all
               interested hospitals and clinics.
               Overall results of project efforts will lessen a major health concern
               in Texas, reducing the problem of electrical hazards in m dicaal electronics
                     nta@i.on.
               "Electrical Hazards in Critical Care Areas" seeks to provide useful infor-
               mation to the medical community about hazards of electrical apparatus in
               hospitals, critical care unit electrical systems and safety areas of
               medical-elettronic engineering concern.  In the process of gathering,
               assessing and disseminating  information, the increasing hospital responsi-
               bilities in the area of electronic services, their potential hazards, and
               the need for adequate monitoring are being stressed.
               T@he        @@r"@ogram will improve health manpower understanding and the
               use of latest advances in surveillance,and    of sophisticated electrical
               systems.
               Project efforts have been developed and coordinated i  cooperation with the
               Texas Medical Association/, Texas Hospital Association7and Texas Nurses
               Association, and The University of Texas Department of Electrical Engineering.
               For example, contact with the THA Su  Committee on Electronic Hazards has been
               made and liaison will continue.  THA  as recently taken action in the elec-
               trical safety area and RMPT project personnel are coordinating their
               efforts with T[IA.  Sources of support for the continuation of this program
               are being sought as an integral project effort.
               The project's electrical,consultant and a biomedical instrumentation techni-
               cian visited              Si  target hospitals selected for testing of
               electrical outlets in pdtient care areas and medical electronic equipment
               in specialized critical areas.  Earlier, major hospitals in both Dallas and
               Houston were visited to assess their existing electrical systems safety
               programs and to plan the extent of the project tests.
               The project resulted from concerns expressed by the Heart Task Force and
               is receiving guidance from a Medical Advisory Committee composed of Task
               Force members.





                                                                                               TEXAS





                                       DENTAL REHAB METHODS EXTENDED


               Many ckrice-r rehabilitation patients  in  Texas  have  another  common  bond  -
               the inability to resume  an  active  role  in  society  because  of  the  residual
               effects of treatment  required to arrest their disease.
               While extensive  surgery  and  radiotherapy  have  prolonged  the  lives  of  many
               patients with cancer of the head and neck, some of these disfigured
               patients are  in  danger  of  losing  their  personal  and  professional  lives.
               A project in its third year of funding by the Regional Medical Program
               of Texas has helped to effect rehabilitativ                            e
                                                              ,-e procedures for thes  patients
               and to extend the use of restoraC@@6-methods throughout the region.
               The  "Reduce  Complications  Following  Radiotherapy"  project  is  based  at  The
               University of  Texas  Dental  Branch  at  Houston  with  support  from  The  University
               of Texas  M.  D.  Anderson  Hospital  and  Tumor  Institute  at  Houston.  These
               institutions, close neigh!,,,)rs in the Texas Medical Center, are a central
               focus of the project.
               While the  project's  original  purpose  has  been  to  reduce  complications  of  head
               and neck cancer patients following radiation therapy, efforts have since
               focused on sharing these new methods of managing patients and bringing the
               d@tist into  the  health  care  team  to  achieve  a  lower  incidence  of  complica-
               tions.  Because  the  first  objective  has  been   substantially   accomplished,,
               the project staff is focusing on informing the clinicians throughout the
               state of the problems that        exist)with  special  emphasis   on   radiation
               patients,              i  @@o @t w@ltechniques  &Valid  to  manage   and   prevent   the
                        ,eand on shar ng,ne
               problem@,
               Needed changes have been effected and are still ongoing in this once neglected
               field.  Target  groups  include   radiotherapists,   radiologists,   dentists,   head
               and neck surgeons, pathologists, and internists in Texas as well as the various
             @maj.-@,a,nd,.sm&I.I) radiotherapy centers in Texas.
               Information emphasis  is  on  training  the  local  dentist  to  provi  e  consultation
               and methods of  management,  and,  above  all,  to  approach  the  dental  problems  of
               the head and neck canter patient without fear or reluctance.

               @With  thi
                        s  knowledge  and  the  closer  working  relationship  between  dentists  and
               physicians, another  goal  is  being  accomplished  -  to  continue  to  increase  the
               quality  of  living  and  qualitative  survival  following  successful  treatment   of
               head and neck cancer.
               Interregional  activities  have  also  been  conducted  at  five  major   professional
               meetings  of  clinicians  and  interest  has  been  stimulated  to  establish  similar
               programs.  "Refresher  Course  Booklets"  concerning  various  types  of   oral   care
               for the  head  and  neck  cancer  patient  undergoing  radiation  have  been  published
               and distributed as part of the interregional efforts.
               @ RMPT support endL(,August 31, 1972, it- is  ,p@li,a7rtne@d,tftat,,individual  support
               from local institutions can@--,be-,uti,l,iz-ecl in@ the main@     6-f- these  patients.





                                                                                   TEXAS



                                 STRENGTHENING INHALATION THERAPY

                                       PATIENT CARE PROGRAMS


              The Texas Hospital Association has almost completed a two-phase educa-
              tional program to help regional hospitals organize and strengthen
              inhalation therapy patient care programs.
              Funded by the Regional Medical Program of  Texas,(f@r fiscal year 1971-1972,
              the first phase of the inhalation therapy  educational project included
              four two-day institutes conducted in the East Texas Chest Hospital, Tyler.'
                           ;  Hendrick Memorial Hospital, Abilene,'           4. 1:@9-7-1-;
              Memorial Medical Center, Corpus Christi; Dec-,@@@           and St. Joseph
              Hospital , Fort Worth             -2.
              Hospital administrators, nursing directors, nurses and other hospital
              personnel attended the sessions to ga4@@practical, organizational and
              clinical applications i      -r--t-o,Oevelop effective inhalation therapy
              patient care programs.
              The second phase involved clinical experience workshops held in two-week
              sessions in five Houston hospitals including The Methodist Hospital, The
              M.D. Anderson Hospital and Tumor Institute, The Veterans Administration
              Hospital, St. Joseph Hospital and Heights Hospital
            "These  in                                         ---iperience to t   two-day
                       hospita          ps served as follow-up 6
              institutes.  A.,total of fou,r were held during October-4'Novemb,e   entry,
              "4-F
              Lectures, demonstrations, supervised laboratory observations and    practice
              were used in the five clinical settings to provide versatile experience
              in inhalation therapy administration and first-hand insight into the organi-
              zation and functions of inhalation therapy departments.
              Each  hospital'/whose personnel attended the two-day institute, selected
              one or two employees to participate in the clinical experience phase.
              Participants were then qualified to assist the hospital administrator,
              nursing director, and medical staff to organize and develop the inhala-
              tion therapy patient care program.
              Inhalation therapy is a relatively new and rapidly expanding specialty
              involving the administration of oxygen and other gases and drugs to treat
              patients with cardiopulmonary diseases and other respiratory disorders.
              Attendance and response to the inh@,tion therapy educational activities
              has been reported as excellent by (THA,4  The association will tabulate and
              analyze the project from "baselineil--information collected before and after
              participation by hospitals.  The information will be studied to compare
              progress in improving inhalation therapy patient services and to develop
              an operational plan for hospitals.









                                                                                      TEXAS




                                        STROKE PROGRAM RESPONDS

                                           TO OUTREACII NEEDS


              The primary purpose of the Stroke Demonstration Program, based at Presby-
              terian Hospital and The University of Texas Southwestern Medical School
              at Dallas, is to demonstrate comprehensive, progressive care of the stroke
              patient and provide education to physicians, nurses  and  allied  health
              personnel
              The multidisciplinary team of health  specialists)@'includes  neurology,
              nursing, speech pathology, occupational therapy,  physical  therapy  and social
              service,@.iu,-,c=pre-h-e4vsive education effort on.,,the.-l-atest techniques for
              -treaty -and .- r@@bi l@,itat-@o,n ... o-f-,---@t@@-S-trc)ke
              Regular stroke workshop conferences for physicians in the North Texas area
              and for nurses from across the state are conducted by the project director,
              a neurologist, and the education director, a registered nurse.
              The two-day physician's workshop, "Diagiosis and Treatment of the Stroke
              Patient", discusses all phases of medical and surgical management and the
              rehabilitation of stroke patients)and draws physicians primarily from the
              areas of North and East Texas.
              While a two-day program based within the stroke unit is superior  Dr.,,N6@,@li'
                      reach programs as an                                      n' '@ e@U
              favoysout                     excellent alternate mode  for  conti  ulng    ca-
              tion, and he acknowledges the  increasing need to take the program to the,
              doctor.
                      is  on taking the stroke  team's one-day post-graduate  education
              program           into the outreach area at least monthly, depending on    the
              number of on oing nursing rehabilitation workshops and other commitments.
              ',-Another@l,,effort is to interest the larger area hospitals in developing stroke
              care hos ital training programs. (", There are some 36,community hospita,ls@out-
                      p
              side,@of Dallas,with-in-the North Texas area with 100 beds or more,which the
              project @e-terr  hopes to reach'i
              Area physicians have been invited to spend a working day or more in the
              Presbyterian Hospital Unit.
              The five and one-half day nursing workshop conferences are conducted on a
              semi-monthly basis.  They aru also held at the Presbyterian Hospital and
              include a field trip to a long-term rehabilitation center, the Dallas Insti-
              tute of Rehabilitation.  Response to the nursing workshops,, has k       r   'r       @q
              good;  attendance is usually booked six months in advance.  I%L-.n@enrsing renabi-
              litation               @-ea-4y been taken into la number of outlying communities
              and other institutions within the Dallas metropolitan area.  14hil'e the one-day
              program is              t as detailed or comprehensive as the regular nursing
                                     0
                       j@
              workshop,, i  ' to'u-@yv  ue @eyb                 Nurses become aware that some-
              thing tan be done for stroke patients;    they receive literature and become
              knowledgeable about inservice education   possibilities.







             Education for nurs    and allied health personnel now includes more
             nursing home perso;  -,I in the workshops.  Participation by these,nur5es,
             is increasing and oil,e result has been nursing inservice educatio4h"i@"
             nursing homes conducted by workshop participants.
             The Stroke Demonstration Program is now in the final year of a three-year
             funding period.  RMPT support will be phased out at the end of the 1971-1972
             fiscal year, but it is fully expected that the program will be continued.












                                                 -U  Sheet


                 ion:  Regional Medical Program of Texas
               Locus of AC         Core Activity and operational Project
               Project Title:  Grass Roots Organization for Health Services Education

               Status:  Ongoing
               Spohs                      1)  Mid Trinity Valley Council for Health
                                                Resources Development
                                          2)  West Cross Timbers Council for Health
                                                Resources Development
                                          3)  Northeast Texas Council for Health
                                                Resources Developmen
                                          (Each of the three councils averages
                                             10 hospitals representing collec-
                                             tive capacities of 500 beds)

               Project Director:   N.  Don  Macon
                                   Director, Community Health Proqrams
                                   Regional, Medical Program of T6xas
                                   1600 Holcombe, Room 1005
                                   Houston, Texas 77025

                                   713-747-9442
               Dates:   September 1971 - September 1972
                        (Proposed funding is for a three-year period at $225,000.)

               Funding:  $75,000
               Other Funds:  The three hospital groups or councils are assessing nominal
                 mefb-ership fees to accrue partial operating funds beginning the second
                 year.
               Cooperativ  Aqencies and Institutions:
                 The approximately ten member hospitals within the three hospital groups
                 and various member  nursing/convalescent homes and central resource
                 institutions such as The University of Texas medical and nursing schools;
                 Texas Womah's University Nursing schools, larger hospitalsliand other RMPT
                 projects who have supplied personnel to conduct multiple health services
                 education workshops and seminars.
               Area served:  1)  Huntsville-Lake Livingston area in East Texas
                              2)  Stephenville area west of Fort Worth
                              3)  Extreme Northeast Texas
               Target Population:  Health professionals and allied health personnel








               within the hospital groups and areas described above.

            Congressional Districts:
               #   IRep. Wright Patman of Texarkana
               #   2Rep. John Dowdy of Athens
               #  17 Rep. Omar Burleson of Anson
               #   6Rep. Olin Teague of College Station
               #  11 Rep. Bob Poage of Waco.

             Continu,-Ition after
               RMPT support will diminish at the rate of  25  percent  per year beginning
               the second year.  Thus, RMPT pays 100 percent the,first year, 75 percent
               the second year and 50 percent the third year.  Each of the three groups
               of hospitals assumes the gradual deficit and, beginning   the fourth year,
               pays 100 percent of cost.  The diminishing cost to RMPT   provides funds
               during the second and thir,ul year for implementing three additional groups
               of hospitals.









           @e Lo n-   Virginia Regional Medical Program, Inc.


           Locus of Activitv:  Core Activity



           Project Title:   Public Education on Sickle Cell Disease

           Status:  Ongoing



           S22nsoring Institution: Vir@inia. Regional Medical College, Virginia State
                                       In
                                   College, Medical Collece of Virginia


           Project Director, Title, Address:    Mrs. Evelyn Jemison
                                                Associate Professor of Bio ogy
                                                Virginia State College
                                                Petersburg, Virginia


           Dates:    I December 1971     30 November 1972 (Sickle Cell Screening & Study)
                     1 September 1971    31 August 1973 (Core Staff activities)



              dill     01 $6,200


           Other Funds:  None


           Cooperating Agencies and Institutions:  Virc,-inia State College Medical College
             cf Virginia, State Department of Education, State and County Health Departments,
             Community Action Program, Model Cities Programs.





           Area Served:  Statewide program with concentration in areas of predominantly
              hi.Lyh Black r)-,-oula-Lion: Norfolk, Pc)rtsiiioatti, Nev@ipo@-t j\lc-ws, Hampton, Roanoke,






           Target Population: Black population and Health Professionals (Core Staff aspect of
                               program) 3000 Black Students (Sickle Cell Screening)


           Congressional Districts:  # I Mr. Thomas N. Downing (D)
                                     # 2 Mr. G. W. Whitehurst (R)
                                     # 4 Mr. Watkins M. A@bitt (D)
                                     -# 6 Mr. Richard H. Poff (R)

           Continuation after RMP Support XVithdrawn:










           Core Staff Contact:  Mrs. Harriet Peoples, Assistant in Allied Health,
                                Virginia Regional Medical Program, Inc.


           Date Prepared:



           Drafted Bv:  Tandy T. Shields, Editorial Assistant









           Region    Virginia Regional Medical Program, Inc.



           Locus of Activity:   Operational Project



           Project Title-  Cardiopulmonary Resuscitation Training
           Status:   Ongoing


           Sponsorino, Institution: Virginia Heart Association, Inc.



           Project Director, Title, Address.-  J. H. Stone
                                               Virginia Heart Association, Inc.
                                               Richmond, Virginia



           Dates:  1 March 1970 - 28 February 1973




           Funding:  (unavailable at this time)


           Other Funds:   Virginia Heart Association


           Cooperating Agencies and Institutions:
                     Virginia Heart Association and Community Hospitals throughout
                     the State.






           Area Served:   Statewide Program.






           Target Population:   Reduce deaths of Cardiac Arrest Victims through
                                training and retrainino- of hospital and ei-nergency personnel.


           Congressional Districts:   All




           Continuation after RMP Support Withdrawn:  At the end of RMP support, the
            project funding is to be assumed by the Virginia Heart Association, Inc.









           Core Staff Contact:_  Mrs. Ann S. Cann, Communications & Community Relations
            Officer, Viroinia Regional Medical Program, Inc.


          Date Prepared:



          Drafted Bv:    Tandy T. Shields, Editorial Assistant







                       Cardiopulmonary Resuscitation as an Emergency Measure


             A program to train health professionals and emergency personnel in
         closed chest heart massage (cardiopulmonary resuscitation or CPR) is
         making quite an impact on the State of Virginia.  The program is sponsored.
         by the Virginia Regional Medical Progran-v@@'and conducted through the  Virginia
         Heart Association.

             The aim of the CPR program is to train  instructor  training  teams  from
         community hospitals (generally two physicians and  two  nurses),  who  @-,e'then
                      train other hospital and emergency personnel in their home
         communities.  To date, S.             (600) instructors have trained almost
         f            a4W (15, 000) persons affiliated with oile,-
                (127) hospitals throughout Virginia.

             Since the requirement of emergency training under the new "Safety Act,
         instituted by the Department of Labor in June 1971, industry has shown
         considerable interest in CPR training.  Important advances have been made
         in helping  @high  risk  industries  @  implement  basic  emergency  systems.
         A total of 1222 industry and emergency personnel were trained during 1971.

             To give insight into the remarkable success of this project: in one small
         urbaii hospital (E',O beds), the term CPR was barely known until the, VRMP
         program was launched. Since the hospital  team  was  trained,  there  have  been
         four cardiac arrests--with three  successful  resuscitationsr  The  survivors
         are all less than 50 years old and have returned to useful, productive  lives
         in their community.

             The CPR program will be continued and maintained through cons@Lant
         retraining of hospital and emergency personnel.  It is hoped that further
         CPR program activities can be a part of core staff efforts  in  other  emergency
         health services areas.








         Sickle Cell Anemia


            Long overlooked both on National and State levels is the area of Sickle
         Cell Disease.  In support of this statement, attention is called to the
         President's Health Message.

                "It is a sad and shameful fact that the causes of this disease
                have been largely neglected throughout history.  We can not
                rewrite this record of neglect, but we can reverse it.  To
                this end, this administration is increasing its budget for
                research and treatment of Sickle Cell Disease five fol , to
                a new total of $6, 000, 000.

            Shortly after Nixon's speech, the Blue Sheet Drug Research Reports
         featured a'4 I./2 page report on current research in the field of sickle
         Cell anemia.  The following paragraph appeared:

                "Another type of program is dev eloping in Virginia.  Under
                the leadership of the Governor's Special Assistant, William
                Robertson, and Dr. Robert B. Scott of the Medical Colleo-e of
                Virginia, the State is becoming involved in wide-sprea
                screening of the black population.

            Upon seeing this report, Virginia Regional Medical Program staff
         ii-nmediately consulted Dr. Scott and Mr. Robertson to discuss ways
         in which VRMP might aid the sickle cell program.  It was decided that
         our main thrust would be in public education.

            VRMP con-imunitv liaison staff were oriented in certain aspects of
         sickle cell disease and its effects on potential carriers.  This informa-
         tion is'@i@seminated to the black population, to health professionals,
         and other interested groups.

            Presently underwaN, through direct efforts of the VRMP, is an attempt
         to incorporate the tbpLC of sickle cell anemia into high school biology
         curriculums.  Meetings have been held with rer)resentatives,o @,h
         State Department of Education, and -v@@av@ll"f@,,responseo  er@e,r@eeived.-,
         To implement the program, one school district in  "each VRMP subregion
         has been selected for pilot study.

            The second aspect of VRI\AP involvement is the fundin@ of a sickle cell
         program at Virginia State College in Petersburg. The $6, 200 grant is the
         first one made in the State for determining the frequency of sickle cell
         trait carriers.  This sced i-nonev will aid in the beginning of a five-vear
         study, which will encompass public education, mass screening and
         eugeni@.-tt)couns--Iing services for all black Vir@inians.







                 Treatment and Reliabilitition of Stroke Patients in a Rural Community


             Man rural communities in Virginia r@  miles away from hospital facilities,
                ly          I
                               kA,,
                           iiiiiti-es-"cont@a-in@aiiy older citizens who are prone to strokes.

         In an attempt to improve care and rehabilitation of stroke patients in such

         communities, a pilot project has been initiated in Virginia.  In t e target area

         are a privately owned medical center and two nursing homes.

             The project links health professionals in the rural area of Blackstone,
         Virginia, with the Medical College of Virginia in Richmond.  The strategy is a
         multidisciplinary approach with two-way consultations, patient referrals,
         and reciprocal personal visits in order to up-date knowledge and skills of the

         health provider.  Identified as the four major stages of activity are:

             1.  determining past treatment methods;

             2.  studying and implementing new treatment methods;

             -3.  evaluation of what has been learned; and

             4.  application of findings to other rural areas.

             One of the key efforts of the stroke program is patient rehabilitation.  To

         accomplish this@, health providers, institutions, and families of the patients
         are all working together.  In addition to continuing education programs for
         the participating physicians, core and project staff hold monthly sessions for all
         ar@a nurses and i-iursing assistants.  Families of stroke patients     also

                 attend    .  Subjects discussed are acute care of the stroke patient,

         emotional status of patients and families, aphasia and dysarthria, working

         with patients ,vith speech problems, positioning and exercises for the patient,

         and trans fer and a.-nbulation training for stroke patients.







            Providing physical therapy consultation are graduate students in tl-ie Medical

         College of Virginia School of Physical Therapy, and speech therapy has been

         provided by a speech therapist on the Virginia Regional Medical Program staff.




                                                                   WASHINGTON/ALASKA



                                     MOBILE INTENSIVE/CORONARY CARE UNIT


                  Sixty-six victims of heart attacks in Seattle, Washington, owe their lives to
               the immediate, on-the-spot intensive care-provided by the City  Fire  Department
               and its Mobile Intensive/Coronary Care Unit system in the first 18 months of
               service. Hundreds of other residents  had  life-threatening  situations  averted
               by prompt response to their calls for help.
                  The fullqequipped mobile van, known as Medic I, or one of  the  10  smaller
               aide cars,  11 staffed by trained firemen, can reach the scene  of  a  cardiac
               emergency within two to five minutes and begin their  life  saving  treatment
               immediately. The large van can continue the treatment while  the  patient  is  on
               t e wa                                                        often a  crucial
                    o@ t
                h     ,Vospital.  Previously, heart attack victims were
               one t       hours away from this intensive hospital care.
                  This demonstration project for cardiac emergency care  proved  so  successful
               that Seattle and its citizens have how taken ovpr the funding for  it;  at  least
               five nearby communities. are establishing similar emergency  services4,  and  its
               training course for personnel has stimulated three community colleges to
               introduce classes for emergency medical technicians for  the  area's  firemen,
               policemen and ambulance attendants. Medic I crews  themselves  have  held  500
               cardio pulmonary resuscitation classes for more than 10,000  ordinary  citizens,-
               and,,so far, 30 firemen have completed a total of 500 hours in a trauma care course.
                  The Mashingto@./Alaska REgional Medical Program provided the bulk  of  the
               money 4($243,57  - to-introduce the system, with a strong assist from the STate
                Division of Health,     the STate Heart Association, and  Harborview  Medical
               Center administered by the University of  Washington.Subsequently  more  than
               $200,000 was contributed by civic groups and private citizens to insure continuation
               of the service,(.,foll-dWih4 the--lead-,in per@iod.)
                 The City Fire Department is responsible for communications,  response  of  the
               ai&cars, dispatching, personnel matters and v-.hicle maintenance. During the
               first 10 months of operation, a physician- accompanied Medic I on each run, now
               the paramedical fire department personnel travel with the van and rely on
               monitoring by a physician through radio and telephone contact.  Resuscitation of
               circulatory arrest is carried out by the staff under  standing  written  orders.
               Originally Medic I operated out of Harborview Medical Center, now all of the
               14 hospital coronary care units in the city participate in the program.
                  Averaging 250 runs a month, Medic I made 3,058 runs in the  first  18  months
               at an average cost of $72 per run.  A lurge number of patients with ventricular
               fibrillation were treated - 324 in the initial months, 36  percent  of  these
               patients being resuscitated with.a long-term survival rate o       percen





                                                                          WASHINGTON/ALASKA





                                       HOSPITAL SHARING


                Fifty-five    percent of the residents in the  Willapa  Harbor  area,  a  lumbering  and
             fishing  region  on  the west coast of  WAshington  state,  had  sought  medical  services
             outside  their  area  in one year and 37 percent had not been  able  to  see  a  doctor  when
             they  wanted  to.   Only one physician, close to retirement, resided in the area serving
             nearly 9,000 people  '  The administrator of  the  small  hospital  became  concerned  about
             what  was  happening  to medical care.  He telephone,  @he Seattle  offices  of  the  Wash-
             ington/Alaska REgional Medical Program,130 mile@@   "io@ eth, asking for help.

                That was in 1969.    Two years later,  the  picture  had  changed  radically@'due  to
             W/ARMP response to his call for  help.  Today  the  town  has  two  resident  physicians',
             A Health Board'@    Ielected@  A  Comprehensive  Health  Planning  agency  is  functioning
             Mi'litary helicopters fly emergency cases  directly  to  6  specialized  care  center@,fihd
             an unusual cooperative  arrangement  between  the  39-bed  Willapa  Harbor  Hospital  and
             Virginia Mason's 300-bed medical center in Seattle is proving to be a model for
             coordination of medical care throughout the entire region.
                In September of 1971,  the  State  Hospital  Association  established  a  special  task
             force to inventory  existing  shared  programs  betweh  hospitals  and  "to  study  methods
             of  developing,  expanding  and  financing  additional  inter-hospital  sharing  activities
             on a local, regional and state-wide basis."
                What happened to Willapa Harbor should  happen  to  other  small  towns  who  face  a
             typical health care problem - the uneven distribution of resources and manpower
             between large cities an  rura  towns.
                First W/ARMP's Comirunity Health  Services  activated  a  citizen's  group  to  conduct
             a survey.outlining the residents' health  needs  and  wants  and  assisted  them  in  carry-
             ing out the recommendations,vviiuc'  ---Ul                  u@tui-e.    Practical     advkn-
             tages for local patients and  hospital  staff  in  sharing  the  resources  and  expertise
             of a big city medical center   @ were soon demontrated.,,@,
                A "hot-line" for consultation was set up between the two hospitals.  Transportation,
             both by air and  land,  was  coordinated.  Continuity  of  patient  care  was  established.
             A drug inventory and development of  a  formulary  resulted  in  savings  of  $5,000  in
             a one year period. Unit price  of  one  drug,  for  example,  dropped  from  82*to  32t.  A
             local pharmacist was encouraged to provide daily hospita  service.
                Continuing staff education  is  another  big  plus.  Nurses  wore  trained  in  coronary
             care and  the  region's  lumber  company  provided  the  equipment.  Inhalation  therapy
             equipment and  technics  were  updated.  Regular  nursing  seminars  have  been  extended
             to include another small hospital staff  45  miles  away  and  rotate  between  the  three
             hospitals.  Willapa Harbor Hospital morale became high.
                "Virqinia Mason is learning from this experience,, too," says that hospitals
                              "It's a professional boost for our staff who are challenged by
             what- they --s- -e-e --and 1 earn i n a di fferent envi ronment.

             W/ARMP is producing a 20 minute film  which  CHS  field  staff  will  use  in  explaining
             the concept and possibilities of hospital sharing in other communities. .


                                                   ....




                                                                     WASHINGTON/ALASKA










                                      STROKE NURSING PROGRAM



               For three long years, the elderly stroke patient had lain in his bed in a
            nursing home,,unable to speak.  A nurse's aide, who had attended a local course
            in restorative patient care decided to apply some of her  newly-learned  skills.  In
            a short time; she had the patient up and walking, able to perform voutine daily
            activities.  Soon he was talking, too.   In a nearby nursing home, an  R.N.  decided
            to help a wheel-chair patient regain the use of his left hand, which he had not used
            for 19 years.  Her success, too, was added to the store of incidents which demonstrate
            the direct results of a locally-initiated training course of restorative care.
               January, 1972, marked the fourth anniversary of the Central STroke Nursing
            Program, begun in the Centralia College in WAshington state in 1968 and the
            only rehabilitative course in the state for licensed practical nurses and nurse's
            aides as well as for R.N.s.

               Since then, nearly 300 nursing personnel have completed the 12 week courses;
            the program has been extended to cover the neighboring county; and courses to
            involve physicians, patients' families and nursing home and hospital  administrators
            are scheduled this year.

               In 1971, 15 R.N.s, eight L.PN.s and 37 nurse's aides participated in 144 hours of
            classroom instruction and 179 hours of laboratory experience.  After each  person
            completes formal training, Course Instructor Gail Wrzetinski, R.N., makes a  follow-
            up visit to the home institution.  Last year she gave 500 hours of follow-up
            visits, including one and two day session for the entire nursing staff in some
            institutions.

              Skills taught in the course include exercises for strengthening muscles, learning
            causes and treatments for various chronic illnesses, working with speech and
            communication pr-oblins and how to institute crafts and other activities for mental
            and physical stimulation.

              The first courses at Centralia College were the result of one local resident' s
            dissatisfaction with the care given his uncle. They were planned and funded by,  the
            college, the State Heart Association and local hospitals ana nursing homes.  The
            following year, WAthington/Alaska Regional Medical Program granted funds to expand
            the program to the next county and enlarge the scope of the courses.
               "We must get over the idea of a nursing home as a place to go and die," said
            Mrs. Wrzesinski.  "The attitude of people who work in the nursing home is most
            important.  More people should visit nursing homes and find out what is going on
            in them. Our experience shows that one concerned citizen can help  to  revolutionize
            the treatment.''




                                             I"                     @



                                                VIGNETTE



                     Under the sponsorship of the  Regional  Medical  Program  for  Western

                New York The Rural Externship Program has  become  an  effective  means  of

                directing health manpower toward delivery  of  primary  care  in  underserved

                rural areas. The program places  teams  of  Health  Science  students  from

                a variety of disciplines in a number of rural  health  care  settings  for  a

                period of eight weeks during the summer.  By so doing, the project

                provides rural communities and community  hospitals  with  access  to  Health

                Science students and a means of attracting them to careers in rural

                medicine. At the same time,  the  program  provides  Health  Science  students

                with A powerful exposure to primary care, And  to  health  care  settings  not

                currently utilized in their formal clinical curricula.
                     During the summer of 1971, the Rural ExternshipCp@laced    22  students

                in 11 communities in outlying areas of Western New York.  During the

                eight weeks they spent on assignment, the  students  q6re  exposed  to  over

                50 prof easional Oreceptors. The Regional -Medie&.I-@,@@@Preg@r-am@@-for--West-ern--New
                -yo@  played the central tole in coordinating the program, identifying

                suitable preceptors, overseeing student selection, developing program

                guidelines and methods for evaluation,  raising  local  funds  to  subsidize

                the cost of student stipends,  and  developing  outside  financial  resources

                to carry out the program.  Gene Bunnell of the            core  staff  served
                as co-director of the project during 1971 along  with-'iwarren  Perry,  Ph.Do,

                Dean of the School of Health  Related  Professions,  S.U.N.Y.  at  Buffalo.

                @,,@iw,l@WNY core funds were used in a developmental  fashion  to  establish  this

                innovative student-oriented program.  In addition, $9,000 in local contri-

                butions was raised in addition to obtaining  a  $20,000  grant  through  the

                Appalachian ReRional Commission.

                     PM/WNY"hopes to see the Rural Externship expand in                1972








                                               -2-



                to include 50 Health Science students.  Also planned is close coordination

                of activities with the National Student Health project, sponsored by the

                Student American,Mbdical Association.     IWNY is hiring a full time director

                to coordinate and expand-the program in the future.
                    The program has many benefits for both student and community.  During
                their ext-ernship, students receive a first hand exposure to the rural
                health care system and to the health problems of these communities.  In
                addition, our evaluation of the 1971 program strongly indicates that the
                Rural Externship is a means of positively influencing students' career
                choices:  specialty and preferred locations.  At the same time students
                augment existing health manpower in rural areas and assist in giving atten-
                tion to critical aspects of health maintenance:  continuity,6f care,
                prevention and follow-up. The presence of Health  Science  students  stimu-
                lates rural communities to consider their manpower needs and ways of
                improving the organization and delivery of health  services.  Finallyi  the
                program provides a means for bringing new ideas to rural practitioners
                who often suffer from professional isolation. This  contact  with  students
                may, in fact, encourage health professionals currently practicing in rural

                communities to remain in those settings.

                                 rt, RNP/WNY believes that the Rural Externship  represents

                a concrete and meaningful way of making the training of Health Science

                students responsive to the primary dare needs of rura  areas.




              -7//
                                                                  WESTERN NEW YORK



                                     Treatment of Skin Cancer

              An effective cure for skin cancer has been developed  in  Buffalo.  Edmund
              Klein, M.D., Chief, Department of Dermatology,        at Roswell Park
              Memorial Institute has poineered a new method of treatment in which a
              cream containing an anti-cancer drug, topical  5-Fluoroucil,  is  applied
              to the skin.
              Each year in the United States 4,000 people die of skin cancer and
              100,000 new cases appear.  In addition, at least 5 to 10 million people
              develop very early stages of the disease.  Until  recently,  skin  cancer
              was.treated by a laborous surgical procedure  Now, applications of the
              cream@cure skin cancers in fp -_ur weeks or less.  The cream is also   ry
              helpful to the doctor b          makes skin cancersINvisible at very
              early stages                                      c
                          ,(which would otherwise remain undete te
              Since this simple procedure is readily usable by the  community physician,
              the PMP for WNY supported a project funded as of March 1,  1970  to  dis-
              seminate the method and materials on a large scale throughout our area.,
              and through analysis of data received, to develop this region as a model
              in skin cancer treatment for the  entire  nation.  The  Buffalo-Rochester
              Dermatologic Society formed a six-member "liaison committee."  These
              liaison directors trained      community physicians and provided  a  link
              with the canter treatment center at Roswell Park in Buffalo.
              Many physicians in various parts of the region who already had specialize
              training in the use of skin drugs were eager to cooperate in the project.
              They used the materials and provided information  necessary  to  establish
              the feasibility of large-scale use of the cream  by  community  physicians
              in this region.
              The feasibility of general use of the cream by  community  physicians  was
              established.             t-@ it is now marketed commercially  by  several
              pharmaceutical'@ompanies and is available to all physicians.






                                                                 WESTERN NEW YORK



                                  Area Health Education Center

              Residents of Erie, Pennsylvania  and the surrounding area will benefit
              from improved delivery of health care and the advantages of a health
              science center right in their own location  by the establishment of the
              Lake Area Health Education Center (LAHEC).  Through the efforts of the-,,;,
                                                             the deans of the health-
              science schools of the State University of New York at Buffalo, the
              director of the Roswell Park Memorial Institute in Buffalo, and admin-
              istrations of the three major hospitals in Erie, Pennsylvania  came
              together to discuss methods of establishing the center.
              The Regional Medical Program recruited a full-time director for the
              Center, Michael C.J. Carey, w@,- c'ame. aboarcl.Ju@ne@@li,--1971.  Since his
              arrival, the organization of the center has moved along quickly.  L&HEC
              is the first area health education center to be funded by the Veterans
              Administration, and will soon achieve the status of a public nonprofit
              corporation for educational And scientific purposes.
              To better meet the health needs of the Erie, Pennsylvania  area, com-
              mittees are being established for medicine, dentistry, pharmacy, and
              allied health professions.  Local colleges will coordinate their health-
              science programs through IAHEC so they can train the health personnel
              that are most needed in the  area.
              As a measure of the local interest in the development of I.AHEC, the
              Erie, Pennsylvania  hospitals, the Veterans Administration, and the
              Regional Medical Program have all made monetary commitments to the
              Center.
              Mr. Carey has been active in discussing the development of the area
              health education center in Washington.  He has also been invited to
              many areas across the country to review the development of IAHEC,and
              help other areas establish their own Centers.








                                            Back-up Sheet



              Region:  Regional Medical Program for Western New York

              Locus of Activity:  Operational Project (locally supported for I year,
                 through carryover or rebudgeted funds)

              Project Title:  Topical Chemotherapy Treatment for Precancerous Lesions
                 and Cancer of the Skin


              Status:  Terminated

              Sponsoring Institution:  RMP/WNY

              Project Director, Title, Address:   Edmund K ein, M.D.
                                                  Chief, Department of  Dermatology
                                                  Roswell Park Memorial Institute
                                                  666 Elm Street
                                                  Buffalo, New York  14203
                                                  716-845-3163


              Dates:  March 1970 - February 1971

              Funding:  I year from carryover funds, $47,454 direct costs

              Other Funds:  Research supported in part by the Albert and Mary Lasker
                 Foundation, New York City, N.Y., Research grant #CA 08578  from  the
                 National dancer Institute, and Research grant Y@AI 09479 - 01,  from
                 the National Institute of Allergy and Infectious Diseases, NIH,
                 Bethesda, Maryland, Research grant #T-429 from the  American  Cancer
                 Society, New York City, N.Y., Research grant G-64-RP-15  from  the
                 United Health Foundation of Western New York; the Marge Tinjanoff
                 Fund, Buffalo., N.Y., and the Arcade Community Chest, Arcade,  New
                 York.

              Cooperating Agencies and Institutions:  Buffalo-Rochester Dermatalogic
                 Society, Roswell Park Memorial Institute, National  Institutes  of
                 Health, practicing physicians, newspapers, radio and television
                 stations, pharmaceutical companies, county medica  societ es.

              Area Served:  Western New York and Rochester regions

              Target Population: the 3,300,000 residents of Western  New  York  and
                 Rochester regions; community physicians who serve  this  population.

              Congressional Districts:   38, 39, 40, and 41 in Western New York
                                         23 and 24 in Pennsylvania





              Continuation After RMP Support Withdrawn: The cream  is  now  available
                 commercially.





             Core Staff Contact:  John R.F. Ingall, M.D.$ Executive Director, RMP/WNY

             Date Prepared:  2/10/72

             Drafted b_y:  Sandra Berlowitz





                                                                                        WESTERN  PENNSYLVANIA





                                                   PAP SMEAR SCREENINGS



                           Routine  Pap  smear  screening   has   been   recognized   as   an   effective   means
              of  determining  cervical  cancer,  the   third   leading   cause   of   death   from   cancer   in
              the United States.   Six such screenings, combined with a program to train
              registered  nurses  to  collect   the   cervical   smears,   were   carried   out   in   Western
              Pennsylvania by county units of the American Cancer Society, cooperating hospitals
              and  the   Western   Pennsylvania   Regional   Medical   Program   (WP/BM)   in   1971   And   1972.

                           Almost                   women   in   Clearfield,    Clarion,    Crawford,    Jefferson,
              Somerset  and   Greene   Counties   were   screened   in   free   public   programs.   Repults   of
              five   screenings   (ai   ti.-           ip        Crawfo@county     screeningaare     not     in
              yet) @       uncovered     four          positive   smears,ca   women   @   were    referred    im-
              mediately    for     treatment.

                           In  five  of   the six  areas,  nurses   specially   trained   in   Pap   smear   collec-
              tion   participated   in    the screening   programs.   In   many   cases,   women   preferred    a
              nurse to Perform the      Pap  test although physicians were available.

                        ../This              one  of   the many   advantages   in    training    registered   nurses
              to perform Pap testst                              f-.Iwhom-                                      n,
              m                                                                                      -an.   Ot'  er
                                                                                      Y CLL     L@in
              advantages include:       1)  because    the Pap  test  is   largely   a   technical   skill,   nurses
              can be                md  efficiently   trained   to   perform   the   procedure;    2)-ph-ye     &
              6ft@rr give-...the  rea@on,                                                     having      nurses
              collect the Pap smear'--                        3) hospitals can adopt t@e policy to screen
              all  female  inpatients   of   proper   age,   thereby   insuring   that   a   certain   percentage
              of the female population is screened.
                           Almost a third of the             women   screened(in   areas-@lfrom.-@-ich-,--resu-Its
              are,,.,c@@d--au&..,infa              i s., -a-va i-I a-b I e, 'ad  never  had  a   Pap   test.   Another
              significant  number  of  women  had  not  receii@e'd  a  Pap  test  in   four   years   or   more.
              Combined  with  the   nurse   training   And   screening   efforts   were   public   education   pro-
              grams  designed  to  encourage   women   to   continue   scheduling   regular   Pap   tests   an
              O&kformi@ monthly breast self-examination!
                           The public education programs involved a variety of media.                I@ilms    on
              cervical  cancer  were   shown   on   cable   television   and   at   screening   sites@
              v                      ..d ir                                            n   one   area.
              articles  and  brochures   publicizing   the   screenings   and   outlining   the   need   for   Pap
              tests   and   breast   self-examination   T,


                         *In  addition,  a  survey  was  conducted  i@   a   teaching   hospital   and   an   ambu-
              latory cake facility in June, 1972 to determinelevidence               @@4cr@-support  t
              assumption  that  many  women  in   Western   Pennsylvania,   even   those   cared   for   in   these
              facilities,   do   not   have   adequate   histories   of   cervical   smear   screening.   Four
              hundred  interviews  were  conducted,  half  in  the   teaching   hospital   and   half   in   t   e
              ambulatory care center.

                           it  was  found  that:50.5  percent  of   the   women   surveyed   at   the   teaching
              hospital  and  35  percent  of   the   women   interviewed   at   the   ambulatory   care   center
              either  had  not  had  a  Pap  test  in  three  years  or  had  never   received   a   Pap   test;
              "N.Tant-       percent of the women interviewed at the teaching hospital and 11
              percent  of  the  women  surveyed  at  the   ambulatory   care   center   had   never   a   a   Pap
              testa










                                                   2


                                                              participate  in  a  program  in
           which properly trained female paramedical  personnel  or  nurses  would  obtain  the
           Pap smeArs,';7,1 percent of the teaching hospital interviewees and 80 percent  of
           the ambulatory care center interviewee@'

                     The results of both the interview and feelings expressed by  partici-
           pants in the six Pap smear screenings seem to indicate substantial patient  ac-
           ceptance of the nurse in performing the Pap test.


                    *At this time, a proposal outlining a comprehensive program to prepare
           nurses to screen for cervical cancer is being submitted to the Wdstern Pennsyl-
           vania Regional Medical Program.

                     The project, if funded, would train nurses to collect Pap smears; at-
           tempt to initiate a program that would screen all hospital female inpatients,
           eventually expanding to other health care facilities; encourage the medical
           community's acceptance of the nurse in collecting Pap smears; and demonstrate
           the expanded role of the nurse in gynecological nursing. The main goal  of  the
           project is the reduction of the number of deaths from cancer of the cervix in
          "@'Western Pennsylvania by 50 percent.







                                          VIGNETTE BACK-UP SHEET




                Region:    Western Pennsylania Regional Medical Program


                L4ocus of Activity:    Core Activity

                Project Title.      Somerset County Pap Smear Program


                Status:    Completed

                Sponsoring Institution:     Somerset County Unit, American Cancer Society


                Project Director:      Ms. Shirley Schweitzer
                                       Somerset County Unit, ACS
                                       Somerset, Pa.  15501
                                       (814) 445-2584




                Dates:  April 3 to April 8, 1972



                Funding:  None  (Assistance provided by training nurses to collect Pap smears)


                Other Fund.:  (Services provided by cooperating agencies)


                Coolperating Agencies and Institutions:   Somerset County Unit of the American

           Cancer Society; Boswell Medical Associates; Pennsylvania Division of the American

           Cancer Society; and the WP/RMP.


                Area Served:  Somerset County


                Target Population:  911 women in a rural area in Western Pa.


                Congressional Districts:     #12




           Cont   tio       RM               n:  American Cancer Society will
                                      screenings.  other factors are as indicated
        probably continue to sponsor such
         on the other screening fact heets.






                             ct:     Ruth Mrozek, R.N.
                  m S  ff Con a@     Nursing Specialist in OncolOgY
                                     WP/RMP




                             September 21 1972
                 kP're @ ed'




              Drafted b      Maureen Ryan







                                        VIGNETTE BACK-UP SHEET




               Region:   West6rn Pennsylvania Regional Medical Program


               Locus of Activity:   Developmental Component       (Planning Study)


               Project Title:   Punxsutawney Pap Smear Program


               Status:   Screening completed; Reading of slides completed


               SponsorinjZ Institution: Adrian Hospital Association, Punxsutawney, Pa.


               Proiect Director:       Mrs. Ruth Fleckenstein, R.N.
                                       Adrian Hospital Association
                                       Punxsutawney, Pa.     15767
                                       (814) 938-4500




               Dates:  April 6,, April 13, April 20, and April 27, 1972



               Funding: $1,46(t,   *(WP/RN:P trained nurses to collect Pap Smears)


               Other Funds:   (in-kind services contributed by cooperating agencies)


               Cooperating Agencies and Institutions:     Punxsutawney Jaycee-ettes; Adrian

           Hospital; Nurses Alumni Association; and the Jefferson County Unit of the American

           Cancer Society; and Magee-Womens Hospital, Pittsburgh.


               Area Served:  The town of Punxsutawney and surrounding area in Jefferson County.


               Tarizet Population:   681 women in a rural area



               Conjzressional Districts:  #22




           *Core Activity







              Continuation After RMP Support Withdrawn:    Incorporated into the screening
           program was the training of registered nurses to perform the Pap smears.  It is
           hoped that by training the nurses, Pap smear screening:will become a regular
           service of the hospital for female inpatients.  Therefore, subsequent screenings
           will be built into general health care costs.










              Proj%ram Staff Contact:       Ruth Mrozek, R.N.
                                            Nursing Specialist in On6ology
                                            WP/RMP




              Date Prepared:    September 20, 1972




              Drafted bY:   Maureen Ryan
                           WP/RMP Communications Assistant






                                        VIGNETTE BACK-UP SHEET



               Region:    Western Pennsylvania Regional Medical Program


               Locus of Activity:   Developmental  Component             (Planning.Study)

               Proiect Title:      Meadville Area Pap  Smear Program


               Status: Screening completed;  results  to  be completed

               Sponsoring Institution:    Meadville City Hospital and Spencer Hospital, Meadville.


               Proiect Director:         Jean Clegg, R.N.
                                         Meadville City Hospital
                                         751 Lib6rty  Street
                                         Meadville, Pa.  16335
                                         (814) 336-3121



               Dates:  June 5 - June 30  1972




               Fundiniz: $2,500   *(WP/RMP also trained nurses to collect Pap smears)


               Other Funds:
                               (in-kind service contributed by cooperating agencies)


               Cooperating Agencies and Institutions:    Meadville City Hospital; Spencer

           Hospital,41 Crawford County Unit of the American Cancer Society; and Magee-Womens

           Hospital, Pittsburgh.


               Area Served:   The city of Meadville and surrounding area in Crawford County


               Tarizet Population:   1,250 women in a rural area in Western Pa.


               Coneressional Districts:      #24





           *Core Activity







              Continuation After RMP Support withdrawn:   Future efforts to be conducted

          by the American Cancer Society.  Efforts will be made to encourage hospitals to
           take Pap smears on all female inpatients, thereby making screening part of general

          care costs.









              Program Staff Contact,     Ruth Mrozek  R.N.
                                         Nursing Specialist in Oncelogy
                                         WP/RMP



              Date Prepared:    September 22, 1972




              Drafted by:   Maureen Ryan







                                          VIGNETTE BACK-UP SHEET



               Region:    Western Pennsylvania Regional Medical Program


               Locus of Activity:    Core Activity

               Proiect Title.     Greene County Pap Smear Program


               Status:    Screening and results completed

               Sponsoring; Institution:  Greene County Unit of the American Cancer Society


               Proiect Director:     Mrs. Lewis Vance, Mrs. Walter Atalski, Mrs. Harold Craft
                                     Members of the Education Committee
                                     Greene County Unit, American Cancer Society
                                     Milliken Building - 51 W. Hig     treet
                                     Waynesburg, Pa.    15370



               Dates:  April 30, 1972



               Fundiniz:  None        (Nurses trained to collect Pap smears by WP/RMP)


               Other Funds:   (Services contributed by Carmichaels Clinic and American Cancer Society)


               Cooperating Agencies and Institutions:     Carmichaels Clinic; and American

           Cancer   Society




               Area Served:     Greene County


               Target Population:     179 women in rural area of Western Pa.


               Conjzresgional Districts:     #26








              Continuation After RMP Support Withdrawn:    American Cancer Society is likely

           to stage such screenings periodically in the future.  If the concept of nurses taking
           Pap smears becomes well accepted for female inpatients, expenses could be built into

           general care costs.









              ProjXram Staff Contact:     Ruth Mrozek, R.N.
                                          Nursing Specialist in Ond6logy
                                          WP/RMP




              Date Prepared:     September 21, 1972





              Drafted by:      Maureen Ryan






                                        VIGNETTE BACK-UP SHEET




               Reizion:  Western Pennsylvania Regional Medical Program


               L4Dcus of Activity: Developmental Component             (Planning Study)


               Proiect Title:    Clarion County Pap Smear Program


               Status:     Screening and results completed


               Sponsoring  Institution:   Clarion Osteopathic Hospital, Clarion, Pa.


               Proiect Director:      Dr. David Humphrey, Radiologist
                                      Clarion Osteopathic Hospital
                                      214 S. Seventh Avenue
                                      Clarion, Pa.  16214
                                      (814) 226-9500



               Dates:  June 1, 1972




               Fundinlz:  $700       *(Nurses trained by WP/RMP to collect Pap smears)


               Other Funds:  (In-kind services by cooperating agencies)


               Coo,perating Agencies and Institutions:  Clarion State Teachers College;

           Clarion Osteopathic Hospital; Clarion County Unit of the American Cancer Society,,

           and Magee-Womens Hospital, Pittsburgh.


               Area Served:  Clarion County


               Target Population:    341 women in a rural area of Western Pa.



               Congressional Districts:    #22






           *Coke Activity






              continuation After RMP Support Withdrawn:   Future screening efforts are likely to

          be undertaken by the American Cancer Society.  If drea hospitals adopt a policy to
           screen all female inpatients, Pap screenings could be built into general care cogts;i








              Program Staff Contact:    Paul Martin
                                        Area Liaison Representative
                                        WP/RNP



              Date Prepared-  September 21, 1972




              Drafted by-     Maureen Ryan






                                        VIGNETTE BACK-UP SHEET




               Reizion:   Western Pennsylvania Regional Medical Program


               Locus of Activit3c.  Developmental Component           (Planning Study)


               Project Title:   Bucktail Area Pap Smear Program


               Status:   Completed


               Sponsoring Institution:    DuBois and Maple Avenue Hospitals, DuBois, Pa.


               Prolect Director:          Dr. Ernest F. Getto
                                          DuBois Hospital
                                          DuBois, Pa.  15801
                                          (814) 371-2200




               Dates:    April 30, May 6, May 12 and May 18, 1971




               Fundiniz: $1,173


               Other Funds!  None    (in-kind services were provided by cooperating agencies)

               Cooperating Agencies and Institutions:  Young Womeng Club of DuBois; DuBois and
           Maple Avenue Hospitals; and the Clearfield County Unit of the American Cancer Society.



               Area Served:   The town of DuBois and surrounding area in Clearfield County.


               Tarizet Population:   1,524 women in a rural area


               Conp-ressional Districts,      #23






              Continuation After RMP Support withdrawn:        It is anticipated that the
           Clearfield County Unit of the American Cancer Society will continue to sponsor
           such programs from time to time.  Built into the public education and information
           aspects of the screening was the importance of regular Pap tests and monthly
           breast self-examination which hopefully encouraged many women screened to schedule
           future tests themselves.  If the project (The Preparation of Nurses to Screen for
           Cervical Cancer)which is in the process of submission to WP/RMP is funded, area
           nurses are likely to be trained to collect smears from female inpatients and the
           screening can be built into general costs of the hospital.  (In this first screening
           that WP/RMP was involved in, physicians collected the Pap smears)




              Proj%ram Staff Contact:           Ruth Mrozek, R.N.
                                                Nursing Specialist in Oncology
                                               WP/RMP



              Date Prepared:     September 20, 1972



              Drafted b-y:   Maureen Ryan







                                       Back-up Sheet


                 Region:  Wisconsin RNP
                 Locus of Activity:  Developmental Funds

                 Project Number:  #32

                 Title:  Health Care Delivery System R&E

                 Status:  New Project
                 Sponsoring Institution:  Marshfield Clinic Foundation

                 Project Director, Title, Address

                               John H. Mitchell, M.D.
                               Dept. of Comunity Medicine
                               Marshfield Clinic
                               Marshfield, Wisconsin 54449

                 Dates:  3/l/72 to 8/31/72

                 Funding:  $25,691

                 Other Funds:  None

                 Cooperating Institutions:

                               Marshfield Clinic
                               St. Joseph's Hospital
                               Marshfield Clinic Foundation
                               Blue Cross-Blue Shield

                 Areas Served:  Greater Marshfield Area

                 Target Population:
                               40,000 people living in Greater Marshfield area.

                 Congressional Districts:


                 Continuation After RNP-Support Withdrawn:



                 Application References:


  r





                 Project #32 Continued







                 Other Re  rences:








                 Specific Evaluation Reports:








                 Core Staff Contacts:







                 Date Prepared:  1/26/72

                 Drafted By:  F. Wenzel










                                                                             Project #31
                                                                              (Wisconsin RIT)







                      The 16th Street Community Health Center (HOPE) is located in the

                 Inner City--South, and contains over 74,000 people in an area of 7.15

                 square miles.

                      Approximately 19,400 families live here. one-fourth of  them  earn

                 less than $5,000 per year, and of these less than one-fifth receive some

                 form of public assistance. About 12.,Vl. are over 65, with one of every
                 20 persons over 75.  One dwelling unit of every thirteen is overcrowded.

                 Approximately 10,000 of its residents are of Latin AmericAn descent.

                      HOPE has engaged in many activities relating specifically to  this

                 community.  It has been determined, both through objective criteria and

                 the articulated perceptions of the local community, however, that the

                 most important need in the community is primary care, especially for

                 adolescents and adults.  Secondly, many people are motivated to seek

                 proper health care, but lack an appropriate knowledge of health,  espe-

                 cially in the areas of self-care prevention of illness.  Hence, there is

                 also a considerable need for community health education activities.



                      The specific objectives of this project are to:
                           -- provide primary health care to persons in ;the local
                           coumnity who are unable, financially or otherwise, to
                           obtain care elsewhere

                           -- demonstrate the capability of a nurse practitioner
                           to function as the focus of a primary care system

                           -- develop relationships between the Health Center and
                           other sources of primary and secondary care, both public
                           and private, which facilitate patient  service













                                              - 2 -




                          -- demonstrate the effectiveness of using community  health
                          workers as outreach personnel collaborating with a  nurse
                          practitioner

                             develop coumnity group health  educational  activities

                             demonstrate the effectiveness of using community hea t
                          workers as organizers of community health education  groups

                          -- upgrade the skills of Center staff, and community health
                          worker personnel in other southside agencies, through an ini-
                          tial and an ongoing training program


                     In general, the Community Health Contact Center activities  will
                include:

                     I.  Direct Patient/Family Health Services

                          -- entry into health care for persons identifying own needs
                          for service
                             a.  triage (medical and health history, evaluating  of
                                 signs and symptoms)
                             b.  treatment of minor illnesses
                             C.  first aid and treatment of minor injuries
                             d.  appointment to Center or other local medical c inics
                             e.  referral to diagnostic or treatment resources-

                             management of chronic illness
                             a.  assessment of current status
                             b.  evaluation of and assistance with management in  the
                                 home
                             C.  patient-family education regarding care
                             d.  assessment of temporary illnesses

                             physical examinations and immunizations

                             follow-up of patients
                             a.  receiving Center services
                             b.  referred to other resources

                             family health management
                             a. counseling it child-bearing, rearing  and  management
                             b.  health supervision and education
                             C. referral and collaboration with other  persons  and
                             agencies serving family

                             patient advocacy

                             assistance with and arranging for babysitting and transportation










                                                 3



                             assistance with obtaining prescriptions, equipment, transla-
                          tor or interpreter

                          -- assistance with filing health and social service aid applica-
                          tions

                    II. Community Service (These services are "outreach" in nature  and  re-
                         flect the Center's attempt to respond to community needs  identified
                         by local residents.)
                          -- assistance in organizing people to meet their own needs
                          (babysitting, transportation)
                          -- providing resources for health-related education (first aid,
                            'ght              e
                          wel   -watching, ven real disease)

                          -- arranging for local screening and testing programs  (multiphasic
                          screening, TB screening, lead poisoning)

                   III.  Relationships of Center with Other Health Care Resources
                          -- development of arrangements with major public sources of  medica
                          care (Milwaukee County General Hospital, Children's Hospital,
                          Milwaukee City Health Department).  These relationships wou    en-
                          able a nurse in the Center to treat some patients on the spot, pro-
                          vide some patients with medical care at the Center through  expan-
                          sion of clinics, providing some patients with informed care on
                          arrival at the hospital or clinic.

                          -- develop relationships with dentists and doctors in the neigh-
                          borhood which provide "crisis" appointments for some patients,
                          continuing care by private practitioners for selected patients,
                          and patient education to facilitate home management

                          -- develop arrangements with hospitals (Mt. Sinai Medical  Center,
                          St. Luke's Hospital, St. Mary's Hospital, etc. medical and  nursing
                          staffs) to provide inpatient care for selected patients, and co-
                          operation to help implement needed services for patients

                          -- foster communication and cooperation between local health centers
                          and clinics to coordinate patient services, develop needed  patient
                          services and implement conminity education programs.  In  addition,
                          this relationship would assist in staff development ptogrdms,  and
                          resolution of commn problems.










                                            Back-up Sheet




                  Region:  Wisconsin RMP
                  Locus of Activity:  Operational Project - Milwaukee Inner City    South

                  Project Number:  #31

                  Title:  Health Center - Inner City South

                  Status:  New Project

                  Sponsoring Institution (Grantee):  H.O.P.E., Inc.

                  Project Director, Title, Address:

                                Mr. Greg Kusiak
                                16th Street Community Health Center
                                1036 South 16th Street
                                Milwaukee, Wisconsin 53204


                  Dates:  9/l/72 to 8/3/75
                  Funding:      72-73              73-74              74-75
                              $109,951           $112,322           $il6,995

                  Other Funds:  None

                  Cooperating Institutions:

                                Marquette University College of Nursing
                                University of Wisconsin-Milwaukee School of Nursing
                                State Department of Health and Social Service
                                The United Community Service
                                Independent Learning Center
                                Esperanza Unida
                                Federation of Community Schools
                                Milwaukee Health Department
                                Milwaukee County General Hospital
                                Social Development Commission

                  Area Served:  Milwaukee Inner City - South

                  Target Population:
                                74,000 people, largely Mexican-American, living in an area of 7.15
                                square miles, 60,000 of whom live in an area of 3 square miles

                  Congressional District:  Fourth

                  Continudtion After FM Support Withdrawn:














                                               - 2 -




                Appli6ation References:







                Other References:






                Spedific Evaluation Reports:







                Core Staff Contacts:






                Date Prepared:





                Drafted By.-











                                                                       Project 32





                     Society today is vitally interested in the cost, availability,  accessi-

                bility and quality of medical care. Committees are being formed,  books  are

                being written and proposals are being formulated all which relate to the

                medical care system. However, one major deficiency that exists is  the  develop-

                ment and accessibility of concrete data and information to assist the medical

                community and state and federal agencies in making specific  devisions.  In-

                formation on regionalization, utilization, referral patterns, disease entities

                and specific costs are difficult to obtain.  That data which is presently

                available is often from large prepaid programs with a selected patient popula-

                tion and are not all encompassing in their services nor the population  which

                they serve.
                     The lack of organized information has led to the proposal for the

                development of a research planning and evaluation section within the Marghfie  d

                Clinic Foundation. Definitive data on costs of medical care,  utilization  of

                services, specificity of disease patterns and other tangibles will be  evaluated

                so that intelligent decisions and planning can be carried forth to assist  in

                the development of a model regional health care delivery system.

                     Since the Marshfield Clinic is the main source of medical care for  ap-

                proximately 40,000 people for which it gives primary, secondary and  tertiary

                care through numerous methods of payment, an immediate data bank is  present.
                A data system has been developed which includes all patients covered by  the

                GMCHP.  This system will provide part of the important data for studying
                changed in medical care patterns and the problem related to financing medical

                care.  A great deal of data is also available on non-plan patients who

                are seen at St. Joseph's Hospital or the Marshfield Clinic. There  is,  however,












                 no research section within the above institutions to use the currently
                 available data and develop new studies and evaluation of the delivery of
                 medical services on a broad base  regional  level.  The  plan,  in  general  calls

                 for the development within the Marshfield Clinic Foundation of a section

                 devoted to this broad purpose.
                      The short range objective of the proposal is to assemble the staff an
                 begin outlining studies of the health  care  system.  The  data  that  is  presently
                 being generated in conjunction with GMCHP  plus  the  records  of  the  Marshfield
                 Clinic, St. Joseph's Hospital and Blue Cross-Blue Shield will allow  or start
                 jW of an immediate systematic study of  some  of  the  health  systems.  other  data
                 sources within  the area and state will also be  used  as  well  as@the  non-GNCHP
                 patients.  The  data from these programs will be made  available  to  all  areas  of

                 the state and nation.

                                     rous reasons that-@oulA.       w for the success of  t  is  pro-
                 gram. ", Within the GMCHP area all physicians are  cooperating with  the  plan,  and
                 almost all medical care for GMCHP patients  can  be  traced.'  Another  reason.-is
                 that the population is stable and is of mixed ethnic religious and national
                 background. Approximately fourteen  percent  of  the  population  fall  under  OEO's
                 guidelines as economically distressed,  and  approximately  twenty  percent  of  the
                 patients are covered under  Medicare  and/or  M6dicdid.  Information  on  all  these
                 groups would be available plus those under the prepaid and fee-for-service

                 program.
                      The developmental award has four principal objectives:
                            1.  Allow hiring of the personnel for the research planning and

                            evaluation section within the Marshfield Clinic Foundation.
                            2.  Begin definitive and in-depth research programs on the health














                                              - 3 -




                           care system and regional planning.
                           3.  Develop complex computer programs to assist in the research

                           designs.

                           4.  Provide temporary funding during which a three-year project
                           proposal will be written and submitted to WRMP for further  develop-

                           ment of the section and its studies.

                     Some of the primary research efforts that would be undertaken  during  the

                developmental period and would extend into and be part of the  three-year  pro-

                ject proposal  are as follows:
                           1.  Quality medical care:  What is it and how can it best be evaluated?
                               There is much discussion of quality of medical care and yet there
                               is no good definition of what good quality is and how it can  be

                               determined particularly on the regional level.
                           2.  Cost of medical care:  From the existing system and data presently
                               available, specific costs for medical care can be determined  on
                               patients within the immediate area. This would provide  data  on

                               the cost for total comprehensive care over a period of time.
                               Dependent variables that could be observed are:  the family,
                               disease specificity, sex, age., ethnic nationality, educational
                               level, income level, urban-rural area and numerous other para-
                               meters.  Through cross-correlation of the above data, through
                               the comparison of the prepaid and the fee for service plus Medi-

                               care and Medicaid and hopefully other federal fundings, the costs

                               and financing of medical care could be evaluated.
                           3.  utilization of medical services and facilities:  Medicare has
                               mandated utilization review committees and pending legislation












                                                - 4 -



                              is doing the same.  The central Wisconsin area provides a natural
                              laboratory for research on the methods of the delivery of health

                              services and the utilization of medical services  by  patients.

                              This would include not only patients within the immediate area

                              but also throughout the whole region of central and northern

                              Wisconsin. It could also include  =re  specific  services  that

                              are over-utilized and under-utiliz6d by various groups of con-

                              sumers and providers. This should lead to a  peer  review  system

                              which would then be part of the research project.

                          4.  outreach programs:  Through the diagnostic mix and referral pat-
                              terns specific information on the unmet needs of the  rural  area
                              and potential services that should be provided to areas of central

                              and northern Wisconsin would be defined.  This in time should lead

                              to relationships and cooperative services on  a  =re  organized

                              regional basis.
                          5.  other studies: Methods of record linkage,  patient  flow,  health
                              education, screening techniques and other projects as deemed

                              worthwhile could be explored.

                     In summary, with the new developments in health care  delivery  systems,
                changes should not be made for the sake of change alone but on the  basis  of
                predetermined studies and data. All the components of a  total  medical  care
                system are available and accessible for research in the  Marshfield  setting.
                With the GMCHP in operation and expanding plus other sources of data, this
                research endeavor should be fruitful. The principle needs  at  this  particular

                time are start-up funds for staff development and program planning.





          FORM    15                                                        RMP       Wisconsin

                                             PROTECT SUMMARY
          1 yr. report              3 yr. report           Date of initial RMPS  Support  (mo.  yr.)  9     1970
   Project Title                                           Anticipated Termination RMPS Support        8    1971
                                    Final Report                                                      -
          Colposcopy Project         Project No.           Geographic Scope       State of Wisconsin
   Disease Category            None                        Related Federal Programs       None

   I-Tealth Care Focus                                     Objectives  Reduce medical costs   2 improve   com-
                      All women over 20 years of age
   Target Group(s)  in Wisconsin                           fort of  patient  through  improved  testing
   Primary Purpose                                         technique.
   Progress: Project successfully terminated                       ;Almost  everything  people  are  trying   to
              September, 1971.                             do--decrease the cost  of  medical  care,  bring  thi
                                                           advancements  of  medical  science  and  technology
                                                           to  the  community  level  for  implementation,   eep
                                                           the health and  welfare  of  the  patient  foremost
                                                           in mq')nd--is exemplified by the  recent  success  oJ
                                                           the  Wisconsin  Regional  Medical  Program's  Colpos-
                                                           copy Project.

                                                           Evaluation of the project has shown that the
                                                           cost of a  uterine  cancer  examination,  done  as  a
                                                           result  of  an  abnormal  Papanicolaou  (PAP)  smear,
                                                           can be reduced as much as 93 percent.

                                                           The project, under the direction of Dr. Adolf
                                                           Stafl of the Medical College of Wisconsin, is
                                                           part of Wisconsin Regional Medical Program's
                                                           Gynecologic  Malignancy  Program  under  the   direc-
                                                           tion of Dr.  Ben  M.  Peckham,  Chairman,  Departmeni
                                                           of  Gynecology  and  Obstetrics,  University  Hospit.
                                                           als, Madison, and Dr. Richard F. Mattingly,
                                                           Chairman,  Department  of  Obstetrics  and  Gynecolol
                                                           Medical College of Wisconsin.

                                                           It is a good example  of  how  Regional  Medical  Pr(
                                                           grams are  succeeding  in  bringing  the  advancement
                                                           of technology and science  to  the  local  level  foi
                                                           general implementation  in  an  effort  to  keep  the
                                                           costs of medical care  at  a  minimum  and  patient
                                                           care at an optimum.

                                                           Colposcopy is  a  procedure  used  in  the  detection
                                                           of uterine  cancer  following  a  PAP  test.  If  the
                                                           PAP test            indica@                @abnorma@,
                                                           the colposcopic  examination  is  used  in  place  of
                                                           a  diagnostic  conization  procedure.  It  is   esti-
                                                           mated that 750 cases  of  uterine  cancer  will  be
                                                           found in Wisconsin in 1972 and approximately
                                                           43,000 cases will  be  found  in  the  United  States

                                                               ci-nfl 'knc hplnpd train six t)hvsicians





          FORM 15                                                           RMP        Wisconsin

                                             PROJECT SUMMARY
          1 yr. report              3 yr. report           Date of initial RMPS Support (mo. yr.)_

   Project Title                                           Anticipated Termination RMPS Support

                                     Project No.           Geographic Scope

   Disease Category                                        Related Federal Programs

   I-Jealth Care Focus                                     Objectives


   Target Group (s)

   Primary Purpose

   Progress:                                               Proposal:
                                                                , vho have become  highly  proficient  in  uti-
                                                           lizing  the  technique.  They  are  located  at  St.
                                                           Francis Hospital and the Gunderson Clinic, La
                                                           Crosse; Marshfield Clinic, Marshfield; St.
                                                           Elizabeth Hospital  An!"e  n  and University
                                                                    I      0         s  to ;  ntly training
                                                           Hospital   Madis n.           re e
                                                                                         ,_p
                                                                       s            il  '-?ue
                                                           several phy icians         :wa k  e  County  General
                                                           Hospital,
                                                           "Several of the hogpitAls have been able to
                                                           develop a cost  analysis  which  reflects  the  sav-
                                                           ings to both the  hospital  and  the  patient,"  Dr.
                                                           Stafl               "St. Francis Hospital at La
                                                           Crosse estimated that the average cost of a con.-
                                                           zation is approximately  $493,  $319  for  the  hos-
                                                           pital, $24  for  anesthesiology  and  $150  for  the
                                                           surgeon                '"With  the  introdudtion  of
                                                           the colposcopic procedure, the total cost was
                                                           reduced to only $35.11





              V  I        It 7                                                    I)rojoct #15
                                                                                (IVJ,scolisill


                 riii,ary                                       Seconda,.
                                                                - Access Iiiipro@rc-,rilent
                 -  A\IBUIATORY C-AIZE                          - Coiiibiiiatioi-i Traini.ng/Patieiit Care
                 -     IL-Y DISF:ASE
                   , KID,\                                      - Comprehensive Care
                 - Legislation                                  - lioino I-lealth Care
                 - @laiipoljor                                               'k
                 - PATIEK.F/PUBLIC    EDUCKFIO,\'               - organ Bai-i's
                 -. Prevention )i-id    Screening               -. Regional
                 - REDUCTION  IN   HEkLni   CARE- COSTS

                                                                li year 6iiter the final staues of
                    in   Wisconsin,   about   140 persons      eac
                 -r enal (kidney) disease who   are judged good candidates for kidney trans-
                 plants or artificial kidney machine dialysis.  Until recently, the latest
                 advances  in  care  of  such  patients  were  high  in  cost   and   not   uniformly
                 available Statei,,,lde.  I\Ioi\r, a carefully organizaed, comprehensive renal
                 di sease program sponsored by the Kidney Fo,,indation of Wisconsin and
                 supported by grants from the Wisconsin Regional @,ledical Procram (i@'R\,IP)
                 totalling more than $1 million, is beginning to change this picture.
                     The  program  is  designed   to   develop   a   Statewide   cooperative   kidney
                 transplant  program   to   prevent   tissue   mismatches   and   reduce   expensive,
                 long delays in transplantation; and to establish a program of dialysis
                 located within patients' homes and in strategic community hospital
                 dialysis units.  A prevention and early detection program is noii under-
                 way, providing local physicians with information and ine  ensive testing
                                                                                     XP
                 kits for detectiiic, 'kidney   disease.  As a result of the pro ett a
                 "Catastropl-iic Costs" bill has been introduced into the State Legislature
                 to  establish  a  program  supplementing   the   high   costs   of   treatment   for

                 families of modest means.









                                               -2-

               In February, 1971, a large dialysis training facility began operat-
            ing ati\ladison Methodist Hospital, with a capacity to train 20 to 30
            patients per year, along with their spouses  in performing dialysis at
            home or in community dialysis centers.  The substitution for hospital
            space and staff substantially reduces costs (from $20,000-2S,000 to ab.out
            $7,000 per patient each year in Wisconsin).  As of December 31, 1971, 11
            individuals had successfully completed the training and performed 1-iemodialy5is

            at home.

               The project is planning distribution of dialysis centers -.:or most
            economic use of machines and staff.  The Madison facility and a post-
            graduate trainina proaram at Milwaukee County Hospital also provide
            education and training for physicians, nurses, dietitians, and technicians
            on the latest knowledge of renal disease and its management, dialysis
            equipment and establishment of dialysis units.
                As part of the Statewide transplant procram, three tissue typing labs
            have been established in Milwaukee and Madison to ensure successful trans-
            plants by pairing kidney patients with coitipatible.tissue from deceased
            donors in the State.  As of April, 1971, 2SO donor/recipients had had
            407 tissue t)Tings performed by'-the labs.  Current information on
            potential reci ients, prepared by the Marquette Biomedical Computer
                          p
            Center, is provided to transplant surgeons each week.











                         iViscoi)sin
                 Locus of Acti@,i@ty  OI)critiOll,-Il P"c)jf-'ct

                 Proi ect I\kLiil,),or  l,'l 5
                         CO!IIPI-Ollcllsive Reiial Disct-@(,, I-)i-oc,rani
                 Title:                                       C>
                 Status: , 'Oii@,oi.ii(T (i\7.ote: termiii-atiii,, I)roject, "Tissue T)Tillg,"  being
                           phased i-@o     5).
                                         ]I: li\'idiiey l'Otill,@,-ttioii of I'@7i.scoii@iii
                 POTI-I;Orina II- tiCtltio
                 r ject Di-rc@c-co-@,  itl     @@]Lc@ss:  (Co-directors)
                           Ricliard F@,. Riesclb?cl-i, @I.D.,
                           Assi.stAjit Professor
                           University of I,,isconsin @\IeCiical Scl,,.ool
                           @ladisoii l@iscoiisi@ii S3706
                           (i@hoiie:  AC   608-262-1722)
                 and
                           Ari,j-n B. ivei-nsteiii.1 @,I.D.
                           Associate Professor
                           University of Wisconsin Medical Scliool

                 Dates:   6/70 - 8/73
                 1-7ujidiiia:  01                            02
                   (dco)   $4SO,000                       $469,234
                              92)155
                           (rebudactina)
                                 0     C,
                           IVilson cut
                           $S30,807
                 Otl)cr Fiuids:  Kicbicy Foui-iclation lias p.,      'd soiiie fund-raisiii
                                                              rforme                       9.




                        @ladison  \Ietlioclist  Hospital
                        Mili..,au'l@ce County Hospital
                        Kidney Foundation of I't'iscoiisiii

                 Area  S6-i-ved:  Stateiiide
                 lal5iot Poptil.,iti-oii:  Anjiu@il-ly, about 140 pe),-sons cacli ),ea@ i@l-io develop cr,.Ll-
                 stz                    , pl@us all tliosc I)otciiti,,i]. ]@i.cljie), patients screened
                 be(             b project's                 iii(I eirly (101-.Octioii





                   2                  Vi('jictte #7


             ,@oiiQrcss-ioii,il- Di@st-i-icts:  All
             Conti.rili@tioii ,\4-tcy ]?,','@,p Sl,,iil,)o-,-t l@T.,\U') expects that the l@icliio),
                              01-
             .'o ilici@,,                                     iqitli tjie "Catasti-or)liic
             Costs" 'Bi@ll- (S,21lato I,,593---. l@i.sconsiii lei,,isattirc) as oiie source of
             funds. I- -Lr passed, 'c'jic l')ill A@oiil.cl increase 'clic present level of State
             assi.stL@lico from about @l,,300 per   to a l,ase of $1.0@000 per family.
             'llic bill i..-Oold also os'c@ibl-isli a l@i.cliiey I)j,seasc Boi-rd of professionals to
             certify r;-qtj-e;lts (cli(,ibl.e for assist-mice) a3icl trcatinc@iit centers.

             I)plic,4tioii l@\cfercjices:
                   Coiitiiiuation AI)plicati.oii dated 9/i/70, pp. 181-237
                   Tri.ei-,niLb-,i Application dated 9/71, foi-ni IS-6

             Otlier Rof orciices:
                   R'xll'S Si,@.1--@ ry of jVfl-iiversary j\I)I)Ilcatioi-i for July, 1970 Revieij
                   Coin-nittecp pp. 14-15

              ocif ic F@ 7@ Itiation PP-Inort,-; -
                   Site Visit Report - Decoi,.iber 8-9, 1970., pp. 18-20
                   Report of Site Visit Teay,- (oji Project :'lS), April 21, 1971.

             Core Staff Coiitacts:
                   @1r. Roy Ragatz (,NladisoD)  AC 608-26')-2851

             and
                   @ir. 14. Scott Ai.-nsi@ortli
                   Executive Director
                   Kidjicy Fouii(latioii of I'@'isconsin
                   AC 608-241--1279

             Date  Prepared:

                   11/10/71

             Drafted By:

                   Teresa Sclioen





          F ORM 15                                                          RMP        Wisconsin


                                             PROJECT SUMMARY
          I yr. report              3 yr. report           Date of  initial  RMPS  Support  (mo.  yr.)  9  1969
   Project Title                                           Anticipated Termination RMPS Support  8        1972

     Nurse Utilization                Project No.  17      Geographic Scope  State of Wisconsin
   Disease Category           None                         Related Federal Programs         None
                        Intermediate Care of Medical
   Health Care Focus Surgical Patients                     Objectives To  design  a  system  of  patient  care
                       Nurses,.Ph sicians, Hosp. Admin,
                                sty
   Target Group (s)_ Niarm4ci     s & Engiiieers                based on patient needs.

   Primary Purpose     Provision  of  service  for  patien:s

   Progress:
                                                           Proposal:
     The project was successfully terminated in              Thein@'e"e'ds and wants of the patient rather  than
     August, 1972.  A                                        what health personnel  think  he  should  have  is
     par,@and                                      t,        the  basis  for  this  Wisconsin  aT  project.
     fe     thank
                                                             Started in 1969,  the  project  was  developed  to
                                                             meet the needs of  the  patient  through  the  re-
                                                             design of the traditional hospit        setting.
                                                             The needs of the  patient  were  looked  At  first,
                                                             not last, and  the  means  of  providing  this
                                                             service came next in line.

                                                             Two-way  supply  cabinets  were  installed  enabl-
                                                             ing personnel to  stock  the  cabinet  from  the
                                                             corridor  rather  than  entering  the  patient
                                                             room.  A  center  communications  system  was  de-
                                                             signed allowing  a  non-health  person  to  moni-
                                                             tor patient requests directly and to allow
                                                             easy access  to  health  personnel  anywhere  in
                                                             the  facility.  In  short,  many   innovations
                                                             were made  to  more  efficiently  utilize  health
                                                             and  allied  health  professionals  and  equipment
                                                             allowing for  improved  care  and  more  bedside
                                                             nursing care by hospital personnel

                                                             In September,, 1972,  the  Wisconsin  RNP  received
                                                             an award for the project from the Gerar
                                                             L@ett Foundation which is administered
                                                             through  pollster  George  Gallup.  The   award,
                                                             the first ever  presented  to  a  Regional  Medical
                                                             Program, is made annually to encourage
                                                             vations designed  to  improve  patient  care  and
                                                             reduce the cost of health care.  More than
                                                             1,000 ideas were reviewed by the Awards
                                                             Committee.