ALBANY
-_---
Regi.on :
o
t
*a
jI Site Visit
-
Review Cycle: October 1972
TvDe 'of AnDlicat ion :- Triennial
-_
.I& LA
Rating: 303
RECOMMENDATIONS FROM
- /x/ Review Committee
I!/ Council
7
RECOMMENDAT I ON
The National Review Committee concurred with the site visitors in
recommending three year's funding (triennial status) for the program's
06, 07, and 08 years, approval of the developmental component for
three years in the reduced amounts of $30,000 (06), $45,000 (07),
and $60,000 (08), continuation of program staff and seven ongoing pro-
jects, and the implementation of 13 proposed projects. The Committee,
paralleling the recommendation of the site visit team,  recommended
that Project 1/23, Health Career Incentive Program, have ARMP support
terminated by December 31, 1973, because it is counter to WS policy
to support health careers recruitment projects.
Further, the Committee advises, as did the site visit team, that iZRQ
carefully review projects #24, f31, and 643. In the case of project
124, further refinement and integration with other health activities
are suggested.
specifically directed at the health needs of the Albany region.
Project #43 was looked upon as too expensive on a cost/benefit basis
and possibly duplicative of work which has already been done in other
RMPS .
The total request and recommendations are as follows:
Project #31 was viewed as too global in nature and not
Direct Costs
. Year
06
07
08
-
Requested
$2,426,921
$2,646,254
$3,060,317
Recommended*
$1,618,000
$1,783,090
$1,940,725
'* The recommended amounts include Developmental Component monies in
the amounts of $30,000, $45,000, and $60,000 for the 06, 07,and 08
years respectively.
CRITIQUE
The ARMP has made substantial progress since last year's site visit.
The RAG has been expanded and restructured in a manner which insures
greater community and less university participation in the program's
decisionmaking process.
representation. The new RAG Chairman, Dr. James Bordley, 111, was
identified as a particularly capable and dedicated man who made a
major contribution to the program's rapid development.
The RAG now includes greater minority
Further, the Committee concurred with the site visitors that the
appointment of Dr. Girard Craft to the position of Deputy Director
provided the impetus required to coordinate the large and
program staff into a cohesived unit capable of administering an
enlarged program.
The Committee shared the site visitors' concerns about the program
staff's lack of fiscal management competence in light of the program's
many projects.
a fiscal specialist in the interim period between the site visit and
the Committee's review.
iveness to site visit recommendations and assured increased staff
competence in an area which had been seen as a deficient.
They were pleased to note that the ARMP had hired
This tended to reflect the program's respons-
The Committee shared the site visitors' emphasis that the AR-MF"s
excellent projects should be converted into a more integrated program.
There was a consensus that this would be done in light of the com-
petence of Dr. Craft, Dr. Bordley, and Mr. Robert 11. Briber, Vice
Chairman of the RAG.
In summary, the Committee accepted the report and recommendations of
the site visitors as expressed in the site visit report.
EOB/DOD 9/26/72
Component
PROGRAM STAFF
CONTRACTS
DEVELOPMENTAL COMPONENT
OPERATIONAL PROJECTS
Kidney
EMS
hs/ea
Pediatric Pulmonary
Other
TUTAL DIRECT COSTS
COUNCIL RECOMMENDED LEVEL
COMPONENT AND FINANCIAL SUlWARY
   TRIENNIAL APPLICATION
I i Committee Recommendation for
Current Annualized .     Requ
Level Year    1st year
774,592 I 768,230
,~ 90,000
75,314 I 1,568,691
I 2,426,921
900,000
900,000
;t for Tri
2nd year
787,563
    X
90,000
1,768,691
nnial Council-Approved Level
3rd year
--
1st year I 2nd year 1 3rd year
731,225
I X
X X x
30,0001 45,000 1 60,000
90,000
I I
    Site Visit Report
Albany Regional Medical Program
   August 1-2, 1972
Site Visit Participants
Consuit ants
John Kralewski, Ph,D., Chairman, Associate Professor and Director,
Division of Health Administration, University of Colorado Medical
Center, Denver, Colorado, RMPS Review Commi,ttee Member
Adelbert L. Campbell, Acting Coordinator, California Regional Medical
Program, Area 9
Granville W. Larimore, M.D., State Director, Florida Regional Medical
Program
John S. Lloyd, Ph.D., Associate Coordinator,
Program, Area 5
Alton Ochsner, M.D., Ochsner Clinic,New Orleans, Louisiana
Robert C. Ogden, President and General Counsel, North Coas
California Regional Medical
Insurance Company, Spokane, Washington, WAC Member
WS Staff
Thomas C. Croft, Jr., Financial Management Officer
A. Burt Kline, Jr., Public Health Advisor, Eastern Operations Branch
Frank Naeh, Acting Chief, Eastern Operations Branch
Miss Elsa J. Nelson, Senior Health Consultant, Division of Professional
Mr. Robert Shaw, Program Director for Regional Medical Programs Service,
and Technical Development
Region 11, DHEW
Regional Advisory Group
c James Bordley 111, M.D., Chairman, Executive Committee
Robert M. Briber, Vice Chairman, Brecutive Committee, Executive Director
Peter Crawford, Director, Community Medical Care Program, Executive
Robert A. Dyer,  Executive Committee Member
Marjory A. Keenan, R.N., Associate Professor of Nursing, Russell Sage
Hudson-Mohawk Association of Colleges and Universities
Committee Member
Colhge, Bcemtive Committee Member
Ccmmlttee Member
Department of Health,  ]Executive Committee Member
Planning Commission, Executive Committee Member
F. Donald Lewis, President, Heart Association of Eastern New'York, Executive
Daniel P. McMahon, M.D., Regional Health Director, State of New York
Paul F. Robinson, Associate Executive Director,  New York State Health
0
-2-
Regional Advisory Group (continued)
Eitgene H. Bohi, General Manager, WAST Television, Menands, New York
Ruth Buchholz, R.N., Directorof Nursing Service, Columbia Memorial
Hospital, Hudson, New York
Charles Eckert, M.D., Professor and Chairman, Department of Surgery,
Albany Medical College, Albany New York
Elizabeth B. Haile, Schenectady, New York
Thomas L. Hawkins, Jr., M.D., Executive Vice President and Director,
John C. Marsh, Vice President-Treasurer, Blue Cross of Northeastern
Thomas W. Mou, M.D., Provost for the Health Sciences, State University
John Murphy, Administrator, Saranac Lake General Hospital, Saranac
William H. Raymond, M.D., Johnstown, New York
Bernard Siegel, Vice President-Business 6 Finance, Albany Medical College,
The Rev, John R. Sise, Cooperstown, New York
Seth W. Spellman, D.S.W., Dean, James E. Allen, Jr. Collegiate Center,
Jerome C. Stewart, Executive Director, St. Clare's Hospital, Schenectady,
Marie N. Tarver, Executive Director, Model Cities Program,' Poughkeepsie,
David E. Wall, Hospital Director, Veterans Administration Hospital,
Harold C. Wiggers, Ph.D., Executive Vice President and Dean, Albany
Albany Medical Center Hospital, Albany New York
Hew York, Inc., .Albany Mew York
of New York, Albany, New York
Lake, New York
Albany, New York
State University of New York, Albany New York
New' York
New York
Albany, New York
--- Medical ---- College, Albany,.New York
Director
Michael A. Nardolillo
Nathaniel McNeil
Lawrence N. Fuchs
Peter Jones
Harold A. Rodgers
Ursula Poland
Bernard H, Rudwick
Donald C. Walker, M.D.
Bette Hanson
Henry Tulgan, M.D.
Mary C. Bromirski, R.N.
Freyda M. Craw
John A. Olivet, M.D.
Donald E. Schein
PROJECTS
Title
South End Community Health Center
Carver Comprehensive Community Health Center
Training for the Delivery of Home Care
Health Career Incentive Program
Migrant Health in Columbia County
Medical Library and Information Service
Community Health Education Service
Design and Development of a Comprehensive
hergency Health Care System
Rural Community Health Guides
County-wide Cardiac Monitoring System
An Expanded Concept of Home HFalth Care
To Have a Voice -- Post-Laryngectomy Rehabilitation
Cooperative Training Program for Allied Health
Professionals
lhis Week in Health
1. 1
- ./
- 3-
Catherine Harwood
Jane6 Heron
Glster Anne lswlor
Dorothy Paul
Leo J. Roy
Capital Area HMO Planning Council
Upper Hudson Regional Coalprehensive Health
Schoherie County Comity Action Program
Council of Conununity Service6
Haria College
Community Me6Ical Care Program
Heart Assmi8tion of Befern Hew York
Plenning Organization
Frsnk M. Uooleey, Jr., M.D.
Oirsrtl d. Crsft, W.D.
J. Clrrk Winslow
Byron E. Eowe, Jr., M.D.
William P. Xeluon, 111, W.D.
Ward L. Oliver, M.D.
John Be Phillig~, M.D.
&OM We POhly W.D.
Paul L. wad-, Ph-D.
Robert J. Ambrasino, Ph.D.
Raymond Forer, PhA
Anne 14. Anzols
Ilrrpa Wilheh, R.P.T.
Arthur A. DeLtloa
Jeremiah Blantan
DBte L. Morgan
Roy E. Perry
Henry J. Zarzyckl
William C. Batchelder
Robert W. O%eill
Albert P. Irfredette
Robert B. blershall
Crrl merle
wily IC. ROrebawh, R.1.
Director
Deputy Mrector
Aaainiefrative Aselstant
Associate Coordinator, Morthern Mvieion
Aeeociate Chrdinstor, Eastern and
A680~late Coordinator, Western Mvision
A8sociarte Cootdinator, Southern Mvislon
Ehrelaation SpeciaUat , Educational Paychologist
Evaluation Speciallet, Sociolaglet
Coordlnator, Comaaunlty Health Education
Coordinator of flhysical Therapy
Acting Coordinator, Hurrbg
Mrector, Copeolunlty Affairs
Cormmrnlty Affairs Specialist
Community Affairs Specialist
Community Affair8 Specialist
Community Affaire Specialist
Mrector, Information Service
Mrector, Public Reutione
Coordinetor , Inatructlonal Conpnunicat ions
Flocal Specislist
Fiscal Spcclalirrt
Interface Divieiona
A86ocbte &omdinatW, Central mVi8iOll
fi8ltStia s@eChli8t , EdUC8timli PBychOlogiSt
-4-
INTRODUCTION:
The Albany Regional Medical Program was site visited in June 1971 and
at that time the site team was concerned over the program's rather
narrow and unimaginative thrusts, baaed largely on a two-way radio
contlnuing education program.
structure of the program in terms of minority representation,  the
lack of a deputy director and indeed the lack of any depth in admin-
istration, a weak RAG, and a dependent relationship on the Medical
School.
These deficiencies were called to the &W"s attention when their
grant was awarded last year and they immediately began to restructure
their program to implement these suggestions.
As the current site visit report will indicate, the ARMP supcessfully
restructured the RAG and involved it in the program's development,
strengthened the program staff, attracted the interest of the region's
health professionals and, in all, met with considerable success in
overcoming moat of the deficiencies noted by the site visit team of
1971.
specific events which highlighted the activities of the past; year.
h
The team was also concerned over the
,
The turnabout in the program$ direction can be traced to some
September 1971 - A meeting between the Directorj RMPS, and
the ARMP Coordinator, the RAG Chairman and four members of
the RAG'S Executive Committee. At this meeting, the Director,
RMPS, provided specific guidance to the key personnel of the
ARMP and outlined what they would need to do to enhance their
succc~s as an RMP.
.
September 1971 - Mr. Jeremiah Blanton is appointed as the
AM's first black professional program staff member.  In
his role as a Community Information Coordinator, Mr, Blanton
begins to provide an important link between ARMP and the
region's black communities. In retrospect, it is possible
to see that the ARHP involvement in improving the availability
and accessibility of health care in the region's black commu-
nities can be traced to this appointment.
,
December 1971 - Mr. Roger Warner, Evaluator, Arkansas RMP
visits the ARMP to advise on matters related to the program's
organizational structure, review process, and project development.
. 3anuary 1972 - Dr. James Bordley assumes the post of RAG Chairman
following the resignation of Dr. Harold Wiggers, Dean, Albany
Medical Coll.ege.
Chairmen since it began operation in 1966.
This was the program's first change in RAG
Dr. Girard Craft Is officially appointed as Deputy Coordinator
to Dr. Woolsey.
INTRODUCTION (CONTD)
Dr. Bordley, former Chairman of the RAG Executive Committee,
and Dr. Craft, former program staff member, as a result of
their past experiences, brought outstanding competence to their
new positions,
in two vital areae and the major ingredients for radical change
had been added,
At this juncture, the ARMP had gained strength
.
January 1972 - The W, at Dr. Bordley's urging, votes to meet
nine times per year instead of four rimes per year,
,
January 1972 - The entire RAG membership, now expanded from
27-37 members, is broken into four "goal oriented" task forces
to more closely involve each member in the review process rand
program development.
.
February - June 1972 - The RAG Task Forcee meet
times per month; the RAG Executive Committee meets twice monthly,
and the full RAG meets monthly.
is as follows:
two to three
The product of these meetings
,
52 project proposals reviewed and ranked relative to ARM"s
$oals, objectives and priorities
.
47 project proposals approved with varying degrees of
priority
.
23 projects voted for inclusion in the June 1972 appli-'
cation for triennial support
During thie period of furious activity, Dr. Craft coordinated,
'channeled, and guided the program staff energies while, at the
same time, Dr, Bordley motivated the BAG, its Executive Committee,
and its Task Forces to successfully meet the tremendous work load
being forced upon it by the need to review the projects being
developed by the ARHE' program staff ,
,
,
April 11, 1972 - Roger Warner, at the request of the ARMP, Visit8
the region to review and comment on the progress made since his
December consultative visit.
ceived significant progress.
His report reflects that he per-
INTRODUCTION (CONTD)
.
April 30, 1972 - All ARMP support for the Two-way Radio and
Coronary Care Unit terminates.
At`thie point,.all vestiges of
past project efforts ends and the ARMP entered into a new era
which involved only projects which had I been developed since
the previous year'e site visit.
December 1971 - July 1972 - Throughout this extended period,
the ARMP staff worked in a dedicated fashion to assist the
52 project applicants to refine their original concepts into
sound project proposals.
.
The following site visit report will document the impact of the
changes reulting from the above events and will attempt to point out
aome residual deficiencies and some of the problems that remain to
be resolved.
RMP: ALBANY PREPARED BY: A, Burton Kline DATE: 10/72
1. Gw~s, ObJectlves and Rrioritle~ (8)
At the tinre of the June 1971 eite visit AFiMP was found to have two
long-range program goal8 and oeven short-range obJectives as follows:
aoSlS
1.
-
To promote and influence regionel cooperathe arrangements
for health rervicerr in 8 =mer which wlll permit the best
In modem health care to be available to all.
2, To assure the quality, quantity, an8 effectiveness of
profesriaarrl and allied health mpower o
1.
To eqlore and encourage Innovetlve methods of health care
delivery with particular attention to improving delivery
In abdically deprived urbrrn and rw51 do~ticer.
To mbilize conomr-provider participation in the identi-
fication and oolution of local and regional health pgoblems.
lo recruit health IBalDpwer snd Iralprave lto dietrlbution and
utilization.
2.
3.
4.
To Introduce methods to relieve overburdened health profss-
siaarls o
5.
To engage in the education and treinlng of health peraonnel
with particular attention to continuing educaticm and to
the fraiabg of personnel to fila Eeo0(plised gap$ In aritfcal
To promte pub110 education in health errtterrr.
To further the process of regional cooperative arranlgementr.
At thrt time the rite virrit team felt that the i@MP needed "a aet of
operating objectlvelr which are quantifiable and maeurable, tine-
dependent, and r8nked la priority orders"  This rtcoaaarendation -8
capoeyed to the Coordlrator vis the Rw[F1s Advice Letter.
W-8 o
6.
7.
At the time of the August 1972 eite visit the following goals and
obJectives for &BiiP wre gre0eDted:
aaAL It
To ilnprove the delivery of health care.
OWTIVE A:
health care vlth parflculss attention to medically deprived
urban and rural collmuu3itlee.
0- B:
of health care dellvery through the utilization of personnel
In new roles.
To improve the acceesibility of comprehensive
To design and implement Innovative methods
OBJBlcTIvE C:
OBjBcTIvE 0:
IC:
OBJECTIVE A:
tralniw program for members of the health team.
OBJBXIVE B:
the quality of health care delivered.
To imrove emergency healtb eervlces.
To increase public ay~reness in health nrstters.
To monitor and Improve the .quality of health care.
I
To plen, promote and conduct educational and
To design and develop mchanlsms for evaluating
GOAL III:  To belp eolve the health manpower problem.
0- A:
OBJECTIVE B:
OBJECTIVE C:
of health -power .
To recruit health manpower.
To lncreaee the efficiency I, of health manpower.
To iqprwe the dlstrlbution and utilization
WiL IV:
To further the process of regional cooperative
ar#~ngenrcnte.
OBJECPIYE At   To mobilize conaumr and provider p&ticipation
in the identification md eolution of local and regioaal health
problem.
-9-
.....*-..--
The goale ana lanprange objectives were prioritized 88 follows:
Very Bigh Priority
   I -A
   I11 - c
High Priority
Average Priority
nr - B I1 - A
I -c 111 - A
I -B I -D
IV -A
11 - B
Projected activities end elreaw funded prodects were listed under
each of the goals amd objective6 to which they pertained and the
aiistribvticm -6 a6 f0-Z
Very High Priority ObJectlve8:
7 proJect8
46$ or proJect funds
High Priority Objectives:
Average Priority ObJectlvee:
In sm, the goale sad obmtlves have been restated and prioritized
eince the 1971 site visit end the progrese be been eignificant.  As
the program mturer, there should be a continued effort to further
refine these goals and obJectivee in terma which can be -re easily
quantified and mesoured and mre specifitslly rebted to the identi-
fied health Deed0 of the Albany region.  The current gwls and
obJectlvee were developed by thb ARMP program staff and approved and
prioritized by the 1w).  !hey bave been publlllrhed throughout the region
vie their newsletter, the Albany Regional Medical Program Report o
10 proJectrr
6 projeofe
3546 of project funds
1% of project funds
Recomeaded Action
8ce pages 27-30.
RWD: ALBARY PREPARED BY: A. HJRTON KLIXE WTE: 1O/T
2. Aacomplishments and Implementation (15:)
The change in the goal8 and objectives of the RAG has been reflected
in the change in activities and emphasis of the program staff.  The
program staff now ha8 mre direction and enthusiasm to operate within
that direction.  The reault has been the stimulation of 52 new pro-
posals and the development of new and fruitful relationships between
ARWP and several community organfzatiane which had not previouely
been 8 part of the ARMP process.
A significant accomplishment of ARMP has been the phasing out of old
proJects and the development of ngr funding support for the continu-
ation of successful programs.
Schenecta is now supported by Ellis Hospital. The Coronary Care
d Program hae made a great contribution to the menpower pool
of the region and continues at a reduced level under the auspices
af the Heart Associatdon and a coneortitun of community hospitals with
some ARHP program etaff support as faculty.
ARMP'b olderst project and most successful in terms of regional impact
and acceptability, is being continued as a program of the Albany
Medical College.  The program staff is proud to have been able to
phase out of 6uCce6Sful projects and direct Its energies into new
activities.  Pruvider groups have Long looked to the ARMP for technical
and professional assistance, now as the program Btaff broadens Its
spectrum of activities in conjunction with its new directions, con-
8umer groups are also becoming acquainted with the ARMP and are
eeeking aseistancedn the development of new programs.
The Cancer Coordinator Project for
The Two-Way Radio Project,
See pages 27-30.
- 11-
0
3. Continued Support (10)
At the time of the June 1971 eite visit it was recommended that
"meehanislpl for the phase out of RMP support shoula be developed
for the ItPo-Way Radio an8 Coronary Care Training activities with
the underetanaing tbt:
1.
RMP funds for the TWo-Way Radio wfll not be forthcoming
for longer than 18 months.  ARW! financial input for this
operation mast cease by March 1973?
lilo more tban one  year'^ terminal support for coronary care
unit trsining cm be borne by RMP.  Other 8ourcei of
~~pp~rt murt bo found by September 1972: "
2.
Tbeae reconrmendations were mpde in the Advice Letter of August 1971,
with the exception that the Two-way Radio operation was to ceaeer by
September 1972, rather than March 1973.  Both of theee prodects
were phscred out in an oraerly faehlpn and each is now sustained,  In
whole or in part, rlth fund6 provided by sources other than RMpEi.
This was acc~li6hed by April 30, lgp, welb in advance of the
aeedline given in the Aitoice Letter.
'Phe region% propoml review criteria aontaln items which refer to
the need for cmtinued support after RMP funding.
progoslsl addresses this pointc  The ARMP poUcy is to reduce or
terminate funding to aay prodect which cannot produce adequate
assurance of continues support by the en8 of the flret'par of AMP
Xu adaition, each
fWdfi3gs
... .
,.
AMP;. ALBANY PREPARED BY: A, XIRTON U,INE INTE: lo/$
4. Minority Interests (7)
Objective I-A, "To improve the RCCeSt3ibi1ity of comprehensive health
care with particular attention to medically aeprived urban and rural
comnunltles", ha6 four top priority projects.
themselves to the health problems of minority groups and minority
comunities.
relationships with minority communities is reflected by 80me of the
uneasy alliances which exist between the provider8 and consumers who
are Involved in BOW of the projects.  Until the minority community,
l.e., those involved in the direction of projects and those who are
the recipients of the benefits of these activitiee, have worked with the
MMP for eome period of the they will retain some degree of skeptieism
with respect to the ARHP's sincerity In Its efforts to help them.
their confidence. Tf;ey should bear this in mind in all their
future effofEs with projects involving minority members who have
becbme conditioned to being suspicious because they have been
the victims df insincere efforts in the past.
The progI%ttustaff has only one black professional and one blsck
eecretary. Staff need6 mre buck professionals as .well as support
staff. The Coordinator seems most anxious to get more minority
representation on ataff, but needs assfstance in this regard.
Three of these address
The fact that these project8 grow out of the new
                                            me
. ApMp will need to work closely and faithfully with these groups to Kin
Since the top priority proJects of ARMP address themselves to minority
interests, considerable effort should be made to Increase minority
representation on the RAG.  The site visit team acknowledges and lauds
the efforts mde to date to improve minority representation on the
RA6; hcwever, it is Important tbt the trend be continued beyond its
present status.
minority professional involvement in the RMP process.  He my need to
seek outside consultation in this regard; however, he may find it
poesible to use sone of the gooa people he has already involved.
ldinorlties need to be involved, particuzSsly on hi8 Executive Committee,
and In working on prodect development.
instrumental in assisting other providers in the region to Improve their
services to and their relationships with minority groups.
The Coordinator must seek innovative approaches to
lche program staff could be
See pages 27-30.
- 13-
2. Coordinator (10)
Although Dr. Woolsey, the Coordinator,  is not what one would consider
to be an outstanding Administrator, he has built a capable organization
and hss proven his leadership capabilities by re-orienting the program
from the categorical projects previously developed and displayed last
year to a totally new program thrust designed to strengthen the health
care delivery system.
tation, appear to be solidly behind the program and the aaministration
and appear to be functioning 86 a cohesive unit, even though the
organization lacks clear cut job descriptions and well defined lines
of authority and responsibility.  Dr. Woolsey's succes8 in this regard
has, in part, resulted from the efforts of Deputy Mrector, I?$-. Girard
Craft, who wae appointed by the RAG last January.
great deal of organizational experience and has provided a focal
point for staff direction and coheeion.
greatly aided in his attewtto restructure the program by his close
working relationship with the RAG and the leadership which has been
displayed by Dr. Jams Bordley, the Rf# Chairmsn, as well as the
Executive Cormaittee.
The prcgram staff is conunltted to this re-orien-
       I)r. Craft has a
Dr. Woolsey has also been
Reconmended Action
See pagee 27-30.
6. Frogram Staf'f (3)
Although som program etaff changes have taken place during, the past
year, much remiins to be done.  The staff is currently overweigheed
with physician talent and lacks skills in other areas such as finan-
cial mnagement and general program administration.  Similarly, the
lack of well defined job descriptions and work assignments still allow
the perpetration of wh8t appears to l% at least some duplication of
effofi, especially between the community affairs staff and the area
health coordinatws.  The program staff provides a good basic full-
time resource with diversified talents and the site visit team felt
that Dr. Craft herd =de substantial progress in developing the staff
into a cohesive production unit.  The team also felt that I&. Craft's
- 14-
6. mgram Staff (Conti%) .
plans,for future program staff reorganization were sound and that
he Will continue to strengthen the organization as he Implements these
plans.
7. Regional Advisory Groug (5)
The RAG has been greatly expanded within the last year and is now far
more representative of the region.  Membership from the Albany Medical
College hss been neduced to a reasonable percentage, and program staff
m~mbere no longer serve on the RAG.
usual frequency (monthly) aver the past nine months with an excellent
level of participation and dedication during a period of great change
and redirection of the prcgram.
decline now that the puah is aver.
The RAG has met with more than
The attendance and attention my
The R4G has playea an effective role in establishing objectives and
priorities and Its Executive Colmnittee has, Wring this period,
exampled true leadership.
ite Chalrmn spend8 one day a week in the ARMP office.
call for adequate representation of the interests, institutions and
groups in the region.
It has met twice a month, and, in addition,
                The RAG bylaws
.. .
,.., . .
..:..: : ~. ..
. .-
I.
. ..
.. ./
..
. -.
8. Grantee organization (2)
Albany Medical College, the Grantee Organization, provides adequate
and effecttve fiscal administrative support.  All of the prqram
staff of ARMP are employees of the Albany Medical College and
participate! in its fringe benefits including Insurance and retire-
ment programs*  The physicians on the AR#p staff hold faculty
appointments and are expected to give some teaching time to Albany
Xedical College.
freedoes on programmtic action without restraint or veto.
The grantee appear8 to have given the ARM' full
Albany Medical College hae a mandatory retirement age of 65, but
we were told that this would not apply to employees of W;
although at 65, thoee with faculty status would laere it unless an
exception (1 year) vas granted or emeritus rstatus vcrt;ed.
See pages 27-30.
0
9. Participation (3)
Asrticipation of professional and voluntary health agencies in ARMP
is Juaged to be quite satisfactory.
involved in the program are:
of Sew York, whoae two District Branches 111 and IV within the region
are represented on the RA5; (2) Hospital$, while the Rew York State
Hoapital Aseociation is not represented officially there are three
hospital administrators on the RAG together with a VA hospital
adndnletrator who serves in an ex-officio role.  Nursing homes are
also represented; (3) Official Health Agencies both State and local
are represented in the mambership of the RAG3 (4) Educational
representation Including the State Univereity eystem is included on
   Amry the agencies and groups
(1) the Medical Society of the State
Bursiing and Allied Health are also well represented on
The Model Citiee Rwrarn. Catholic Charities, the Albany
council-of) Community hrvicee ala; piticipste in ARMP; (7) voluntary
- 3.6-
RMP: ALB!UY PREPARED BY: A. BURmR KLRPE: wm: 10/72 1'
9 o Participation (Contd)
Health Agencies:
on the RAG 8118 the TB and RD Association as well as other voluntary
health agencies are included In the-membership of ARMP's consultant
groups o
The Hew York State Heart Aseociation is represented
See pagee 27-30.
10. Local Phnning (3)
For reasons, which are described as "political" In a broad sense,
there are no ClW "b" agencies vithin the area encompassed by the
&IMP.
by Ita Associate Mrector who also serves as a member of' the RAG'S
Executive Committee.  ARMP mintsine workin& relationships with
several councils of social agencies within its area and with the
State and local health departments.  These groups have enhanced
local health planning input because of the absence of CHP "b"
agencies in the area.
ipation in local planning activities is considered to be satisfactory.
The State CHP "a" agency is, however, repreeented on the RAG
In view of the circurnstsnces, ARMP'n partic-
- 17-
.
11.
Assessnrent of Resource6 and Needs (3)
The AR#p has ha8 a history of compiling an excellent data base upon
which to plan and implement its program.  Ironically, as of 1971,
this data base was extensive; however, the program had not &eveloped
in such a way that it could meet the need6 the data brought to light.
In 1gP when a program developed to meet the needs which had been
previously iaenfified by the data base,  it tl&6 learned that the pro-
gram was no longer maintQining the data base as current as it had
been done in the past.  Eowever, it was iadicated that it had been
mrintained at a level eufficient to guide the program in its emphasis
and priority estebliehmcnt. Unlike the situation 8 year ago, thi6
excellent 6ouTce of data is being ursed by the ARMOP for project
devolopm?nf and Is being shared with other agencies in the region.
Generally, the ARMP programmatic efforts are consonant with the
identified need8 of the region and the current development is being
guided by a taLcntet!l and representative RAG which, as a body,  has
a firm hand on the health pulse of the region.
Recommended Action
See met3 27-30.
12. Management (3)
The Coordinator directs the prcgram staff in a style which might be
described as somewhat "over participtlve management".
belief is that one who expresses an interest and desire to do a
specific task is more likely to be swccessful at that task than one
who receives it as en arbitmry assignment.
accounts for the extremely high morale exhibited throughout the
program staff.
to a specific task which needs to be done to further the prcgram's
etated goals and objectives when there le no program staff member who
expresses a willingness to undertake the task.  There wag evidence
that the question ie academic, since the etaff ha6 a great loyalty
to the Coordinator, is made up of long-term profeesionale, has high
morale, and appears dedicated to the enhanceaent of the ARMP program.
The scape of the efforts put forth by the program ataff in the past
Hie essential
This approach, in part,
However, 8 valid question would be to ask what happens
- 18-
1.2. Hansgeinent (Contd)
year are testimony to the fact that, in this instance at leaet, the
Coordinator's etyle appear8 to work well for him,
Since the BRMP, now embarking on the fiscal mnagement and surveil-
Wce of projects scattered throughout the region, needs to modify
its program etaff competencies in a mnner consistent with the
programtic change which be recently taken place.  The ARMP needs
to eupplement its current staff competencies wlth people having
skills in fiscal administration and .in ''in house" personnel management.
For a progrsm which has grown as large and complex 88 the ARMP,
there is a need for more formslized direction of program staff efforts
snd an Increased utilization of prodect data and surveillance infor-
m%tlon for mkbg enlightened decisions with respect to reducing
eupport, terminating eupport, and rebudgeting of funds to support new
initiatives which my be required to accelerate the accomplishment of
program's etafed goele.
Identified by the key &IMP people and they are currently taking steps
to enhance the staff's competency in these areeta.
The need for these competenclea has beer,
-
Recommended Action
See pages 27-30.
13. Evaluation (3)
There is 8 Regional Program Staff Planning and Evaluation Section
cunsisting of three part-time evaluation specialists, one of whom is
the Cbeirmn of the Sectim.
results of evaluation bve been used in the region'e decieionasklng
procese.  While the reconnnendatiane and suggeetions of the Planning
snd Evaluation Section are built into the ARMP'e proposal review
procedures, it appears that their recommendations and suggestions do
nat have 88 much Impsct on the final declsicm as they should.  The
&IMP should consider placing more eqhasla on the skills these people
briag to the programand utilize their talents in program planning.
F'urthermore, the RAG and Coordinator should make use of the efforts
It is difficult to diecern how the
- 19-
13. Gvaluatlon (Contd
  he PLanniag and Evaluation Section in their determinations
  rding the extent to which ARWP funded sctivlties
to the attalnmnt of the region's goals and obJectivetr.
Recoramended Action
See pages 27-30.
14* Action Plan (5)
As previously indicated, the region *has stated its goals and objectives,
oritized them, and they are congruent with RMPS directions.
oposea and actually funded operahianal projects, piarming and
lity etudies, and central regional semice activities have
lateti to the region's goals and objectives.
Although the AMP appears to be on course at the moment, it is suggested
that they could enhance the probability of staying on
  ram develops if they Were to carefully asses8 sad
e
n'a current and prodected needs and, from this, develop a short-
   plan to serve 8s 8 guide to enlightened decisionmking.  Each
proJecf, as It passes through the local review procees, could be
assessed from a technical standpoint, buJ; could sleo be sstreesed in
light of how it fits lato the overall plan the ARMle" has developed to
insure that it continuofa to address the ref3lon's real problem.  The
hazard associated with sw.h a plan le that it my beconre outdated and,
as Lsuch, ineffective.  If 6uCh a. plan were de@igned, provIBlon8 ahould
be mde to insure that It reraains current.
wbich lies wlthln the competencies of the ARMP program etaff and its
RAG 8nd should be seriwsly considered nhce it will tend 'bo insure
arzximum involvemrnt of many of these people in the pursthft of an even
more effective program aurveillance.
for the conduct of monitoring and of the prodect activl
Lo be a sound beginnfog for an effective and systemtic
This appears Or, be 8 task
The preliminary plan developed
-20-
-
RMP: NLBAIOY PREPARED BY: A. IWRTON KLINE wm: 10/p
14. Action Plan (Contd)
progrese.  The ARMP should be complimented for its awareness of the
problem and for taking the initial steps which Will insure a good
orientation for project directors.
15. Dissemination of Knawhdjxe (2)
The --has alwaye been heavily involved in the dissemination of
new knowledge and technical mterial for providers through its Two-
Way Project.  It alao Beem to have a good communicatlms relation-
ilhip with other educational inetitutims In I the region.
@e of its top new projects, being eponsored by &!W York State
EdUcatiOn Department, Will disseminate new knowledge sbout health'
occupations to secondmy school educators and counse1ors.
The public informtion officer on the program staff reports high
"pickup" of new6 releasee to local media.
target  group^, considerable time and effort should be given to
developing ways of dieseminating information to these groups. There ,
is a need to be able to Identify the cornunity health education
component in a11 proposals.
-- I
With new emphasis on new
Wfth colllmunity underetanding and appropriate utilization of new
resources generated by the new proJects, better health care should
result for people who previourrly had been neglected and deprived.
Consideration ehould be given to widening the distribution of the
fine ARMP Reweletter o
The ARMP should be applauded for having a Health Educator on its
-21-
I-
RW: ALBARY PRFSAREDBY: A. 33URLWm MTE: lO/p
15. Dissemination of Knowledge (Contd)
staff.  These special skills and talents should be utilized in
program stecff development activities as well ae community activities.
See psgee 27-30.
16. Utilization of Msnpawer and Facilities (4)
Several of the high priority projects encourage the better utilization
of existing rcsourcee.
will develop a satellite type ambulatory care center etnd more fully
utilize the resources of St. Peter8 Hoepital.
sharing should be encouraged.
Several proJecte and activities of the program staff are directed
at training and utilization of allied health mnpower.
should have closer monitoring and evaluation to insure effectiveness
of training and proper utilization after training.
The South End Community Haalth Center ProJect
This kind of regource
These projects
0
Recommended Action
See pagee 27-30.
Rwp: A1;BABY PREPARED BY: A. BURT08 gLIloE WTE: 1O/P
17. Imrovement of care (4)
The grogram currently being conducted by the ARMP places heavy emphasis
011 the improved access to health c8re for people who are underserved.
The low Income groups in the inner city areas of Albany and Schenectedy
have had the availablllty of health care enhanced by the eetabliehment
of cornunity health centere in the area.  These centers have been
mde goseible by the coordhmtlon and mobilization of exletlng resources
in the community.  The ARMP did the coordln8tlng and provided partial
sygport to the conduct of these activities.
satellites of established hospitals, will fend to strengthen the
relationships bertween prinary care and specialty care.
In the rural area of Chateaugay (Rranklin County) the ARMP prcgrsm
staff provided the needed profes8ional competence to secure a physical
plant, state llceases, etc., so that the Ilation8l Health Service Corps
was able to place two pbyelcians, a dentist, and a dental hygienist
into (L remote cornunity which, up until this time, had not had access
to health care services.
In a Joint project with the OEO, the ARMP helped develop the curriculum,
underwrote 50$ of the cost8 ($10,000) for the training of Primry Care
lursee.  After their training ha8 been completed, the ARMe Will a8sume
the role of proper placement of these highly trained nurses, i.e., they
wlllattelqpt to locate the communities which have the most critical
need for the nurses and which expreae a willingnee8 to accept them
In this rather new role.
In all, the recently implemnted proJects, the projected activities,
the program ebff servicee, and the program staff feasibility studies
reflect a recognition of the need to inrprcme the quality and quantity
of health care throughout the region.  The reccgnltim of the need
appears to be accompanied by the development and implementation of
efforts which will help meet the needs in the Albany region.
Theae activities, as
,
i
Recommended Action
See pages 27-30.
-23-
RMP: ALBAloy PREPARED BY: A. BURTOR KLINE wm: LO/V
18. Short-Term Payoff ( 3)
It fa apparent that nrany of the activities currently in progress or
projected will bring immediate relief of those who currently require
health services. There are plans to enhance the effectiveness of
the monitoring and surveillance of projects to feedback the infor-
Pgticm required to gauge prospective payoffa from each of the
activities.  This procedure is in its infancy at present; however, 8s
the
the syietemtill imprave since there appears to be a. great sensltivity
8pfong the key people In the program to the need for such monitoring.
becolaes more sophisticated it le reaeonable to expect that
See pages 27-30,
19. Reg1 onallzat I on
(4)
One of the primary concerns voiced by the site visit team of 1971 was
the region's fallure to regionalize its activities.
enough, one of' the prinrsry concerns of the site team of 1972 is that
the program's activities are so geographically spread out that there
is a need to consolidate BODE related aetlvities under a multi-project
umbrella to siqplify their administration and fiscal control.
ALUIP, if anything, mer reacted to the need to regionalize and must
nm look tmrd the orderly assembling of projects by loglcaf grouping
to insure that it Is possible to relate the program's goals and
obJectives to the effort8 underway, and those which can be expected
to be introduced Into the system na? that there is widespread interest
in the ARMP throughout the region.
tralized Its bae of opersrtionsl from Albany to points scattered
throughout the region, mat beein to pay cbaer attention to improving
linkages and to 8 more comdimted approach to the prwision of health
care on a regiawide basis.  This problem is perceived by the key people
in the program an8 as the program settlee Into 8 mre routine course
of Cpoing bU6i~e8S it le reasonable to assume that the "shot-gun" region-
allzation Kill give way to a more tightly knit program conducted on a
regionwide baee.
Recom-nded ActIan
gee pages 27-30.
Interestfngly
0
!be
The MUP, now that it had decen-
~-I----------------I---o------"--I------"-----
- 24-
-
          PREPARED BY: A. BUR'JBN KLINe DATE: 10/72
RMP: ALBANY J.
20. OTHER FUNDING (3)
The current group of projects reflects an excellent input ftom
funding sources other than RMPS. Approximately 30X.of the total
request for project support (or $800,000) has been acquired from
other community agencies or charities.  This can be attributed to
a sensitivity to the need for this type of outside support and to
the administrative skills of the Deputy Coordinator in negotiations
which involve the input of dollars from sources other than the
ARMP .
-25-
RMP: ALBANY PREpAp,I;;D BY: A. B1RTON KLINE I DATE: 10/72
SUMMARY
The ARMP has made substantial progress since last year's site visit.
me RAG has been expanded and restructured in a manner that wi1-2.
insure greater community and less university participation in the
program's activities and provisions have been made to include more
minority groups.
and energy to the program and has been instrumental in creating
excitement and enthusiasm over the program among the entire RAG
membership.  It is clear that RAG now establishes priorities for the
projects and assumes responsibility for the program's activities.
In addition to these changes at the policy making level,  substantial
changes have taken place at the organizational level.  Dr. Craft,
a physician with considerable experience fm medical group practices,
has been appointed Deputy Director of the program and under his
leadership, the program staff is being restructured and reformulated
into a strong operating group.
the program has been completely reoriented from what could at best
be described as unimaginative to a new array of "interesting" projects o
It is evident, however, that these projects have been hastily
conceived and do not as yet fit together 'into a coordinated effort.
Similarly, the program staff, although strengthened since last year's
visit, still remains somewhat lacking in their ability to monitor,
evaluate, and, in general, manage- these projects. It was also
noted that some of the proposed projects must be excluded from the
program due to RMPS' policies.
The site team, therefore, recommends that project numbers 23, 31, and
43 be excluded from consideration and that the budget be accordingly
reduced. Furthermore, in order to force the organization to rethfnk
and restructure the remaining proposed projects, we recommend that
the project budget be reduced from the requested $1,653,329 to
$950,000 for the first year, $1,045,000 for the second year, and
then $1,249,500 for the final year,
RAG will have to again review the projects and reformulate them to
a program scheme.
The RAG Chairman is devoting considerable time
As a result of the above changes,
Under thio funding scheme, the
In terms of the program staff budget, we recommend that the program
be funded at the present levels with a 5% increase per year for the
second and third year and a $20,000 one position increase in the
second year to be carried also through the third year.  This will
allow some program expansion but will encourage a reallocation of
the present budget and a reorganization ofr the present staff.
-26- I
RMP: ALBANY PEEPARED BY: A. BURTON KLINE DATE: 10172 .
The site team recommends.that, as part of their total funds, the
ARMP has a developmental component identified for th,ree years in
the reduced amounts as follows:
  01
$30,000
-
02
7
$45 , 000
03
-
$60,000
We also recommend that the university be requested to furnish space
for the program in return for the 52% overhead that is being charged,
and that the space rental funds requested in this application therefore
be removed from the budget.
above budgets be accompanied by the following advice and recommendations
to the program.
The site team further recommends that the
1.
-27-
RECOMMENDATIONS
The site visit team recommends that the ARMP be funded for three years
in the reduced amounts as follows:
01 operational year    $1,618 000
02 operational year    $1,783,090
03 operational year    $1,940,725
Specifically, the site visit team makes the following recommendations
and suggestions.
1.
Project #23 is a health careers recruitment activity and is not
permitted under RMPS policy.
A Special Report to the National Advisory Council--Regional Medical
Programs Service (dated May 11-12, 1971) it states "RMP grant funds
are not to be used for direct operational health careers recruitment
projects."
ARMP support during the next 12 months.
On pagb 38 of a booklet entitled
It is recommended that this activity be phased out of
2
.
The program development appeared to be hastily conceived and,  as
a result, there emerged a general feeling among the site visit
team members that the program now faces a need to consolidate their
project activities, to integrate those activities which, on a region-
wide basis are interrelated, and to, insofar as possible, reduce the
fragmentation of efforts resultant when activitieslprojects are
conducted in a somewhat autonomous fashion.
3.
Project %24, Design and Development of a Comprehensive Emergency
Health Care System, appears to need additional developmental work.
It is suggested that, prior to initiating this project,  the advice
of competent people with specific expertise in the area of emergeecy
medical care be obtained.
Physicians to Clinical Practice, was viewed as too global in nature
and not sufficiently directed at the priority health needs of the
Albany region.
benefit standpoint and possibly duplicative of similar work done by
other RMP programs.
what is available before venturing forth too far in the production
of visual materials.
Project 631, Orientation of Non-Practicing
Project #43 was considered too expensive from a cost/
  It is strongly recommended that ARMP explore
-.
4.
The ARMP is becoming extensively involved in the management of
grants to support the conduct of many projects.  This is a relatively
new function for the program and will require increased program staff
-28-
-
RMP: ALBANY PREPARED BY: A. BURTON KLINE UTE: 1O/P
I
5.
6.
7.
8.
competence in the financial management discipline.
size and the increasing complexity of the tasks to be performed by
the program staff brings about a need for additional expertise in
orgaaizational structuring and personnel management.  It is recom-
mended that future recruitment activities place high priority on
securing staff members who will increase the fiscal, administrative,
and personnel management competencies of the existing staff.
The Albany Medical College (AMC) expects that llRMp program staff
members holding faculty appointments will spend 10% (approximately
four hourslweek) of their time teaching for the college.  It is
recommended that this mutual understanding be documented in the
form of a written agreement between the AMC and the ARMP.
the site visitors viewed this arrangement to be mutually beneficial;
however, there was a feeling that a written agreement should be
prepared to serve as a safeguard to protect the interests of both
parties. This agreement should clarify any misunderstanding which
could develop in the event there are changes in the administrative
hierarchy of either the college or the program.
The significant
!\
Most of
The ARMP faces a need to update and revise the current RAG bylaws.
At present they are silent on the RAG'S role in hiring/firing/
appointing the ARMP Coordinator and they empower the grantee to
appoint RAG members.
to reflect the recent RMPS policy statement which defines the roles
of the grantee, the RAG, and the program staff,
was sent to all Coordinators on June 13, 1972, as part of highlights
of the June National Advisory Council meeting.
It is recommended that the bylaws be updated
This statement
It is recommended that a document which defines the relationship
between the AMC and the ARMP be prepared to guarantee a clear under-
standing on the part of both parties with respect to their roles
in the conduct of the ARMP.
against misunderstandings of this relationship which could potenti-
ally arise and also will provide guidance for the actions of new
people which come into the system when there are administrative
changes in the hierarchy of either party.
This document will be a safeguard
The site visitors, as a group, perceived a need for the ARMP to
more specifically identify its operational objectives, to delineate
the tasks necessary to achieve these objectives, and to assign the
conduct of these tasks to particular job classifications.  Specif-
ically, it is recommended that the program staff be tailored to the
._
-29-
RMP: ALBANY
i
needs of the program rather than gearing the program,to the com-
petencies and interests of the existent program staff.
9. The site visit team noted that the ARMP Coordinator and four other
staff members were quartered in the AMC while the remainder of the
program staff had their offices in a nearby aff-campus building.
This arrangement was questioned from an administrative standpoint
in light of the difficulties it imposes on the Coordinator and the
program staff in terms of communication, management, supervision,
  etc.
to consolidate its offices in one location.
10. The site visit team expressed concern over the high overhead rate
being charged by the AMC.
belief that the college was providing services which could not be
  purchased at a lesser cost, it is recommended that a cost analysis
  study be conducted to document these statements.
Force which recently studied the current relationships between the
  AMC and the ARMP concluded that the current arrangement was,  "at
this time" the best arrangement for the program. However, this
report made no apparent reference to a costbenefit analysis and
this leaves the conclusion open to question in this particular
It is reconrmended that the program attempt to find a means
Since the program staff expressed a
,
The RAG Task
0 aspect.
11. There was an expression of concern over the future development of
the program from the standpoint of monitoring, surveillance and
evaluation of interrelated activities. It is recommended that the
RAG designate a subcommittee of its members to maintain close watch
on the course followed by the program during its upcoming imple-
mentation period,  The subcommittee should be responsible for the
evaluation of the impact of all funded activities (i.e. Program
Staff, Planning and Feasibility Studies, Central Regional Service
Activities, Operational and Developmental Component projects) on
the regional goals and objectives.  The subcommittee should work
closely with the Planning and Evaluation section,
vide a mechanism for continuous programmatic evaluation Is? viewed
as a matter of high priority since the program is in the early
stages of its development and attention to these important matters
at this time could prevent difficulties in the future.
The need to pro-
12. The site visit team recommends that the rental money from the ARW
program staff budget be removed and that the AMC be informed that
they are expected to provide quarters for the ARMP staff in light
of the overhead monies they are currently receiving from the program.
RMP: ALBANY PREPARED BY: A. BURTOE nm MTE:  io/^ -
h
The report of this site visit team would not be complete unless it
was clearly pointed out that the ARME', complied in fact and in
spirit, with the recommendations forwarded in the Advice Letter
following the 1971 site visit.  Further, it should be noted that
although the ARMP still has problems to resolve, that it has, in
fact, been successful at bringing about a dramatic tuqabout in
the program's direction and thrust.
operating on the inside, looking out at the region's health pro-
blems; this year it is operating throughout the region and is
looking at its own inside administrative problems which have been
brought about as a result of the many health activities that have
been initiated throughout the region.
healthy one.
While a year ago it was
This type of change is a
:. .
REGION: Albany RMP -'.
/J
OPEIWi'lONS B&U'CII: Eastern
NUIBER: 00004
COORDINATOR: Frank M. Woolsey, Jr, M.D.
LAST RATING:
-..
TYPE OF APPLICATION:
3rd Year
I_. I_
1 Triennial /. - 1 Triennial
-
2nd Year
-
/ / Triennial / - / Other
-
Regional Office Representative:
Robert Shaw
Management Survey (Date):
c-
Conducted: 1970 w/"
Scliedul ed :
..
or
Last Site Visit: June 2-3, 1971
(List Dates, Chairman, Other Committee/Council Members, Consultants)
' Chairman - John E. Kralewslci, Ph.D, (NRC)
Consultant: - Joseph G. Gordon, Vice Chairman, North Carolina RMP RAG)
Edward D. Coppola, M.D., James P.Harkness, Ph.D., Deputy Coordinator,
New Jersey RMP, Roger Warner, Director of Planning 6r Evaluation,
Arkansas RMP. '
t
Staff Visits in Last 12 Months:
Ocr.  1971
Nbv.  1971
Dec.  1971
(List Date and Purpose) c
April 1972 !status. 4
To provide staff assistance to the region in its efforts to
develop clearer goal8 and.objectives which would ultimately
,lead to a more viable program which could acquire triennial
Recent evcnts occurring in geographic area of Region that are affectin
u1"' program: The region currently does not have any CHP (b) agencties andgthere
are movements at this time to getlhem established in one or two areas. The
ARMP is assisting in their dtbvelopment with the thought that, in so doing, they
will have good warking relationships with che emerging complementary agencies,
The National Health Service Corps recently 'designated the town of Chateaugay in
the Northwest corner of Franklin County (one uf the ARMe's Interface Division's
counties) as a location for the placement of three health prof+siondls,  The
ARMP staff provided the required expertise and staff time required to secure
the operational .headquarters for these workers', ,the licenses and certificates
Isequired by New York State law,etc,,to permit this placement to take place
effectively. This early placement is the A     ion brought forth good
workinx rela tionsnips between. $he .W. and      .representative in the
Region 11 office and, indirectly, enhanced    ratn's working relitionship
with a number of Region 11's regional offi
.r
SOUTHERN DiV.
. --
e
e
-3-
Demographic Information
Population of the Region: 1,993,261
Population densiryigis 20l-jper -squarecmike.
Population of Albany County: 285,618
Population of Albany: 114,873
Rural population: 46.72 of total
Urban population: 53.3% of total
Minority Facts
% of entire region's population:
X in Albany County:
% in Albany: 12.5% (14,359)
4.3% (85,710)
5.4% (15,423)
Region: Albany
Review Cycle: 18/72
$ 774,592 $ 768,230
--
-0- 90,000
.
I 75,314 1,568,691
I $ 900,000
$2,426,921
I
I
90,000
      '*
1,768,691
$2,646,25,
I
90,000
..
2,158,691*
c
  i
  f
-I
!
!
i
!
i
i
i
i
i
I'
I
i
1
.
I
I
I
i
I t
$3,060,317 I
I
i
, The division cannot be
COU?:CIL RECOMMENDED LEVEL
be in the program staff and project art
reliably forecasted .
..
. . ... , ,., .,.--
XPENT YflC1T ION 0; COMPONENT
__ mL
..
15) 11) (4) (11
CONT+ hlTHIhl  CGh'l. BEYChDf  PPPR. NOT   I )uE(rc kO1 I
mpa. PERICDI  BPPR. PERICCJ  PREVIDUSLY  'I PPw1nust-r I
CF SUPPOPT 1  CF SUPPORT I  FUNOED    I APPROVtO I
1 I
I I
I I
1 I
,'
!
, . ;:. ',
,.
, ..
v ,
I .,
..
,.
IQW
1
coco
DOCC
-
I'
8RfPKOU,T OF RFNt 51
07 PRCGPAP PERXLD
IFICATION OF COWPOLENT 1 CONT;-iITHIh/ CChT. BEYGROI LPPU;-NOT I NEW# NOT I ZND YEAR I
         b &PPR. PERlCCl APPR. PERIOCI PREVlOUSLY I PREVIOUSLY I OIRECT 1
CCSTS !
i OF SLPPC
)RT I CF SUPPCRT I FUIYOEC I AFPRCVEO I
t I I I 1 !
I I I
I I I I I I
.. .
-.
PkGICN - bLI.AT
HI4 oooc4 10/?2 PLC 4
nw s-u 5rt- J t ULW 2- I
45) 42) t 4) (1)
IOWTlFICATION OF COMPONENT I CCNT. )tITHIh( CChT. BEVChOf APPR. hOT I NEW* hCT I 2N0 YtAR I
           I APPP. PERICtl bPPR. PERIOCl PREVIOUSLY I PREVIGUSLY I OIRtCl 1
           I OF 'SUPPORT I CF SUPPORT I FUNDEO I AFFRCVEO I CCSTS I
I
043 THIS YEK IN HEALT). 1
  ESTIWTED GRObTH FbhDS I
                    I
I I I
        I I
       I I
I I
I I I
I -_- 1 ____ ~lI?LJ~-L-,-U5L~~kL------
I I I
I
--------
s710.9nn. I 7
. . - - __-_ - - - I
' ----+---Oo I ' I I
1 Slr798r142 I S2~958r651 I
- __ TCTAL 1 _, . I $lr160t509 I-. . __ ___
1
.^..__. c- i. :. .. . -. . .- . . -: . .. . . .-I
.%.. ....
IDEN1 IF ICATI Gh CF  CCPFChCRf
@REAKOUT OF RI.PUEST
08 PPCtPbP PERlCC
I
,
REGION -  ALBANY
klr COO04 10172 PP6E 5
I
PPPS-CSW-JIOGPZ-1
BREAKCUT CF  REEUEST
013 PPOGPLH PFRftlk
REGlDN -  ALBANV
RU QOOOI  10172 PAC 6
1 PUPS-OW-JTOGRZ-I
I
r,
cr
I
--
-22-
Region: Albany RMP
Review Cycle: 10/72
-
HISTORICAL PROGRAM PROFILE OF REGION
The Albany RMP received a planning award in June 1966 and its operational
award in April 1967.  The program's Coordinator from the outset has been
Dr. Frank M. Woolsey,  Jr. and his orientation and background experience,
prior to becoming a part of RMPS, was in the field of Continuing Education
for Physicians, specifically he believed in the use of two-way radio
communication for this purpose. The program's single-minded approach to
the improvement of health care for  the residents of the Albany region
began to cause concern to RMPS by May 1969,  At that time, the National
Advisory Council expressed concern about the over concentration of this
aspect of the region's program which they believed was retarding the program's
overall development. Further, there was a feeling that this activity
was too closely linked to the Albany Medical College's Department  of
Postgraduate Medicine and that this close relationship obscured the
accomplishments of the ARMP.
out projects after the three year support period was also a matter of
concern at this time.
The region's apparent inability to phase
In September 1970, subsequent to a site visit,  there was continued
concern about the program's failure to develop new activities,  to
phase out activities, i'.e., the two-way radio network and to regionalize
the program's operations.
conducted outside the confines of the Albany area and this was in its
embryonic stages with little visible progress.  It was noted that the
RAG met only four times per year and that 11 of its 27 members were
associated with the Albany Medical College and seven were on the ARMP's
program staff.
not representative of the community at large and, as a result of its
composition, doomed to a myopic vision of program development. During
this period in the region's history the goals, objectives and priorities
of the program were somewhat diffuse, global and, generally, not
indicative of an organization that had given serious thought to where it:
was going or how it intended to get there.
At this time, there was only one activity
Thus, it was apparent that the RAG was somewhat inactive,
Subsequent to the site visit of June 1971, the AEUQ began to enter into
a new era.
of the entire region (see RAG Chairman's report submitted with the
current application), i.e., the program staff participation was eliminated,
the Albany Medical College members were reduced to two members, the
meetings were increased to nine times per year and the RAG Chairmanship
passed from Dr. Harold Wiggers, Dean of the Albany Medical College to
Dr. James T. Bordley 111, a practicing physician from Cooperstown, N.Y.
During this recent period the ARMP concentrated its efforts in several
identifiable areas, e.g,, goals, objectives and priorities were developed
and clearly articulated and the RAG was subdivided into four Task Forces '
which were assigned the task of studying, developing, reviewing, and
implementing activities which would assist in the accomplishment of a
specific goal.  The program staff and RAG members worked together to
solicit, develop, review and initiate projects and activities which
would generate a broad-based, viable, regionalized program.
The RAG was expanded to 37 members who were representative
i
Y
-13-
,
HISTORICAL PROGRAM PROFILE OF REGION (Continued)
To speed up the review process and to provide additional RAG involvement,
the RAG Task Forces met twice each month to review projects for submission
to the Executive Committee of the RAG and, ultimately, to the full RAG
for final ranking (prioritisation) and funding. An ARMP program staff
member was given a prlmary responsibility to follow through and assist
in the development of each potential project.
assistance and continuity of communication between a potential project
director and the ARMP. As a result of this intensive effort, the
program was able to develop and review (prior to the submission of the
current application) a total of 47 projects.
projects, 23 are included as part of the current proposal.
This approach provided
Of these 47 developed
It is of interest, in light of past criticism about the program's
failure to phase out old activities, that all previous projects have
been phased out.  The phasing out was done in an orderly fashion and
all the old activities are still being conducted in whole or in part
with financial support from sources other than RMPS.
In summary, this brief history indicates that there are two identifiable
periods in this region's history, the period from June 1966 - June 1971
and the period since June 1971, i.e., the era of transition which has .
seen the two-way radio phased out and 23 new activities developed
throughout the entire region and submitted foL coneideration with the
present application.
-14-
STAFF OBSERVATIONS
Principal Problems
The program is entering a new era and is somewhat inexperienced in
grants management.  They are working on agreements of affiliation;
however,%at present they are not sophisticated.
planning a method of project surveillance, monitoring etc. but it
has not yet been tested thoroughly. The program staff, essentially
unchanged from past years, needs increased administrative competencies
which are consistent with the current and projected program.  They
need to squarely address the problems and techniques of rebudgetting.
Most all of the aforementioned deficiencies are potential problems
and may not develop since the ARMP Director and Deputy Director appear
to recognize them and are in the process of taking steps to prevent
the program from encountering these types of problems which arise
when there are many projects being conducted simultaneously,
The region is
The ARMP, in order to permit all pbtential project directors to have
a chance to acquire funds, has extended project development assistance
(using program staff) to everyone who has applied,  i.e. they have done
no preliminary screening except for a few cases in wfiich the project
was completely out of the program's area of activity.  This has placed
a tremendous load on staff and reviewers which has been made possible
only by efforts above and beyond the reasonable call of duty,  Admini-
stratively, this mementurn and workload cannot be carried on indefinitely
screening of all potential projects to save work on the part bf all
parties involved.  Testimony to this approach is illustrated by the
fact that (in the current application) support is being sought for
only 23 of the 47 projects which were completely developed and
evaluated by the RAG.
.
__ and the ARMP will have to develop a suitable technique for initial
In summary, the ARMP faces the problems associated with coming to an
accomodation with the new approaches they are using in the imple-
mentation of a new program, Thecoordinator and his deputy are cognizant
of these problems, are attempting to resolve them, and, in time, will
probably do so.
retrench because they have, in fact, come too far in too short a time
period.
However, at present, the ARMP faces the need to
Issues Requiring the Ateention of Reviewers
Most of these were brought out under the category of problems; however,
the reviewers should probably be aware of this regionts need and desire
for guidance for future development.
carefully scrutinizing their past efforts, detecting deficiencies,
and then pointing out means by which these oversights or errors might
be corrected in the future,  Otherwise, the problems the region faces
and the issues the site visitors may wish to pay close attention to
are those which may arise out of the development and implementation of
a sophisticated program by a group of highly skilled and dedicated
professionals who find themselves engaged in an activity which is
somewhat new to them.
This can best be accomplished by
0
,
f
Region: Albany
Review Cycle 10/72
Principal Accomplishments
1. The RAG has been revitalized.
the membership to 37 to include new members who would provide broader
representation of the region's health interests.
RAG member involvement each new member was carefully selected, was
provided an orientation to the role he was expected to play, and was
then assigned to one of the RAG'S four task forces.
forces are set up to initiate, develop,  and review activities or
projects which would tend to advance the grogress in the goal area
the group was assigned to pay close attention to.
forces met twice per month and the full RAG, which evaluated the
reports and recommendations of the task forces, met monthly.  In the
past there were no task forces, only quarterly RAG meetings and rather
casual RAG member involvement. In the current situation each member
is kept well informed and immersed in program activities.
This has included an expansion of
To increase individual
The four RAG task
Each of the task
2.
Through the revitalized RAG, the ARMP developed four clearly stated
goals, set their objectives and prioritized
each of the four major goal areas.
3.
which reached into all areasof the region.
in terms of the new goals and objectives.
With increased assistance from the RAG,
4.
All past projects were phased out in an
the objectives within
a new program was developed
The projects were evaluated
orderly fashion and each is
now sustained in whole or in part with funds provided by sources other
than RMPS. This was accomplished by April 30, 1972.
5.
able to assist potential project directors in the development of
effective projects. Dr. Girard Craft was officially appointed the
Deputy Director and has been instrumental in providing the ARMP with
more directed and coordinated staff efforts.
was assigned primary responsibility to follow through on the develop-
ment of a project from its inception to its submission to the RAG for
a funding decision.
the staff member was then assigned to the role of monitoring its
progress and providing eontinuous feedback to the ARMP on its status.
This approach permitted greater staff involvement and better
communications with project directors and potential project directors.
The program staff was realigned and enlarged (slightly) to be better
Each program staff member
*
In the event the project was approved and funded,
6.
development and permitted it to be the beneficiary of project support.
This was accomplished, in part, by adding a full time black professional
staff member who could and did relate to the minority community and
assist in the development of projects which would serve these undev
served residents of the region.  Beyond this,  the ARMP was successful
in attracting an outstanding black to participate as a RAG task force
chairman.
The ARMP has successfully involved the black community in the program
-tb-
,-
-
7.
were studied by a subcommittee of the RAG and was found to be
complementary and mutually supportative.  The subcommittee reported
that each understood its respective role and the interests of the
ARMP program development could best be served by continuing to have
the Albany Medical College serve in the role of grantee.
The relationship between the ARMP and the Albany Medical College
Review Committee
e
r"7 Site Visit
REQUEST:
requested support in the following amounts:
Review Committee considered BSKMP's triennial appl ication which
04 - $1,387,'617
05 - $1,463,310
06 - $1,567,610.
__uII RECOMMENDATIONS:
to award tri enniat . status
and provide funding at the following level:
04 - $l,lSO,dOO
Comrni ttee concurred with the site vis.i tors I recommendation
to disapprove the devel opmental component,
05 - $1,23'3,500
06 - $1 ,316,600.
Committee also recommended that a thorough evaluation, including a site
visit, be held at the end of the 04 year, to assess the Region's progress
toward rneeti ng the reviewers program concerns and to determi ne the 1 eve1
of Funding for the 05 and 06 years.
REGIONS STRENGTHS:  The review of the Program began with a report of the
site visitors' findings which delineated the RMP's accompl istiments,
program p?ans and organizational problems.
ments are a strong and dedicated Coordinator, a highly capable program
staff, a well-developed and relevant set of goals and objectives, and a
new approach to program development.
promulgation of the program goals and objectives to the health providers
and .institutions of the Region through the distribution of a prospectus
to 8,000 individuals and agencies.  Their program plan, which solicited
sinal 1 ($25,000) proposals around the goals and objectives, appeared to
revjewers to present a realistic method of developing activities whose
resu'l ts can be evaluated at the end of one year to enable the RivlP to
focus its resources on the most pramising activities for future expansion
and development.  The site visitors also reported that the RMP, through
Dr, Stoneman's involvement as a faculty member and his ability in relatfng
to university representatives, has maintained the original interest and
Among the Region's accomplish-
This approach involved the
Region Ri-State RM 00056
Review q8%-%3]-72 -
Page 2
backing of Washington, St. Louis, and Southern I11 inois Universities in
the program. The St. Louis-based medical sclioals have been brought closer
together as-a result of the RMP's categorical projects.  Reviewers also
noted that the BSRMP's Emergency i4cdical Systein`proposal in St. Louis and
two health service/education activities build on existing relationships
of the RMP with groups such as an interagency council on allied health
in St. Louis, the Southern Illinois University, and local hospitals.
The Committee observed that while the original projects were highly
categorical  the proposals in the present subiiiission reflect a trend
toward more comprehensive activities.
are more concerned with heal th care del ivery problems in underserved
areas, both rural and urban.
CRITIQUE:
serious problem which adversely affect ids program operation at the
present time.
southern Illinois area. The 1llino.is RtP hss not. until recent
extended much program assistance to the aiva under question.
within  the last tcjo months, the Illinois RMP leadership now appears
desirous of assuming the entire state as its service area.
of these develop:ne.nts, some Committee members questioned the need for a
Bi-State RM).  The response frorn those Committee rncinbers who visited
the RMP Sndicat`cd that both the medical referral-patterns in the
southern part of the State, which relate to Sb. Louis, and the
relationships of the three medical schoo'ls which originally substantiated
the need for a separate Region still  exist.
WIP now has developed an organization which is strengthening the
relationships among the providers, rnedic;ll schaol s, and community
groups, and which cannot  be easily discounted.
Comifiittee that the issue be resolved by bringing the two KMPs together
and declaring areas of primary and joint concwn.
Committee recomrriended that additional prograin staff funds be provi ded
in order to permit the Coordinator an opportunity for promoting catalytic
activities in the southern Illinois area.
In acldition, the newer proposals
Despiie all these positive points, the BSRMP has several
One is the threat to the BSRMP from the Illinois RMP in the
However,
In the light
In addition, the Bi-State
It was suggested by
In the nieantime,
The second major probl em area i s organization.
the RAG is large, overly provider-oriented and inactive.
working cownittees and had delegated much GT its responsibility to the
university-dominated Scientific and Educatiorral Review Committee (SEKC)
and Administrative Liaison Committee (ALC).  It was recommended by both
the site vis~itors and Review Committee that 1) the ALC be made advl'sory to
the RAG in fulfilling its fiscal responsibilities; 2) the SERC should
be abolished and the Program Review Cominitttcc cha.irmen and the Executive
Committee, join to determine how the proposals fit into the overall
program.  The RMP should also decrease the size of the RAG, establish
working committees of the RAG around the Program's objectives and give
the RAG membership greater responsibility.
is concerned, Committee agreed that a formal structured process should be
established, records of review be consistently maintained and the
inanagetnent of the process by staff be improved.
Comini ttce agreed that
It has few
As far as the review process
The management style of the Coordinator vias also discussed.
Dr. Stonemix? is a strong and able 'IeacloiA, his effectiveness is reduced
because of the tim he dcvotcs to a palAt--tine private practice in
plastic stirgcryo his occasiunLil teach.i!q and a cumhersome progi*inm staff
organization in which practica'l ly evciryone reports, diwctly tu him.
The fact that hc bas no effect-ive deputy and does riot appear to have
the conTidunce in his staff to dc'ieyate -iiuich of the "inside" responsibility
is a further drain on h-is tiix ilnd eriergies,
agreed that an ii:iportant qual'ity of a guod Coordinator is delegating to
and developing a staff  others rep1 ied that Dr. Stoneman's strengths
in other dress made him a" capable Coou.d.inaLolA.  Hovever Committee fel t
strongly thac the Coordinator hc a full-i,ime position and also
reconwnded that a deputy coord i nil. tor w i th strong riianngemen t ski 1 1 s be
hired.
he1 d by facu'l ty of each of the three un-ivws-i Lies  Cuiiimi ttee agreed with
the site visitors that if the RiQ w3ni;s the111 to continue to be involved
that full -tim posi t.ions woul d be WiBre val ~db'l e t.o tire RMP.
The last area of mjor conccrii of review was the highly provider and
categorical-disease orientation of the program.
objectives are riioi'e cornpreheii.jive in na1;ui-e (iiianpowcr  health care
del ivery systems `etc. categor i cal rnedi ca7 care is sti 11 7 i sted
fourth in a rarrkjni; of seven prugra:n areas.  Some of the associate
coordinators cotitl'nue to have categorim1 titles. The Pruitt Igw
project has been the only project funded uiitil thfs year which addressed
the health care nseds of the undcrscrvcd vrbsn papu'lat-ion and it has not
been wc'i 1 -managed   Committee recoinmended that in I .igI.it of RNPS'
deeiiiphasis of traditional categorical it-ltwests and the KMP's pressing
needs -in the urban and rural underserved i!wiis3 that the RVP should yr've
greater at teriti on to more coiiiprelicnsive p'iq~ranis .  Consumers and ii1.i riori ty
members have not been involved in the development or" goals and objectives
and are generally under-represented on decisionmaking and review groups.
Commi ttee fel t strongly that minority, wim and Consurner participation
needed to be more actively integrated in the Program.  Special assistance
should be given to orienting time ineinburs and to bringing the community
group: and institutions with ~h<ch they are involved into a working
re?ationship wi tli the RMP.  It was also yecoinmended that the Coordinator
add more minorities ta program staff and LhaC the knowledge of present
staff be better utilized to assess speclal need areas. Review
Committee a1 so agreed with the site vi sitow that the supplemental request
for $90,000 to obtain a needdassessrnent from CHP(b) agencies was not
the best way to secure consuille;n input and should be disapproved.
While
Wh-i'le some Comniittce rnetiibers
blith regard to the part-time asmiate coordinator positions
-4
lu'iiilc the higher priority
-- COiKLUS3OH:
Region that it is expected to make the changes recoininended above.
thorough evaluation, including a site vis-it should he made next year to
determi ne the KMP `s progress.
developmental component this year until tlic RAG could prove it hds obtained
the maturity to handle the responsibility.
Finally, Commi ttoe approved tr'lennial status but warns the
                        A
Commi ttce a7 so wi thhe'l d approval of the
      The furiding recoininendation
Page 4
for the 04 year ($1 $1 50,000) incl udcs funds to hire a Deputy Co~rtlinator
and to give Dr, Stoneinat1 some f'lexi hi? ity in the proguU(3in staff budget
(~~0~~~~) to a1 IOH him to take advantage of cata'lyt.ic opporluni ties.
e
MCOB:DOD:lO/3/12
e
..
Component
Pediatric Pulnunary
Ledel 03 Year
  S9243-I-3-
$51 7,962
49,392
"
356,759
$924,113
650,126
I
I1 53 3
621,978
   1
25,000:
I
1
'I
$1 9 387,617
4
b
696 ,lo(
"
127 >21(
640 ,OO(
OB
744,000
-
133,610
690,000
1,567,610
   Counc
1st year
  03
1 ,l 50 ,OOC
1 - Appove d
2ild year
-I YaLIlyPul
05
$1 ,230,500
.eve L
3rd year
06
->.--
;I ,316,601
COUNCIL RECOM4ENDED LEVEL
.
e
0
KEGION: &-.ate *
I
1
NUMBER: ZJ! 00056
COORDINA'I'OR: Wiiliam Stoneman, 111, P1.D.
LAST TWTING: 266
TYPE OF APPLICATION:
/m/ Triennial / - / Triennial
3,rd Year
-
-
-
2nd fear
Triennial / - / Other
-
1- /
OPCRRTIONS BMNCfI :  id -Cant i n?nt
-.-
Chief: YIichael J, Posta
Staff for RMP: Dona E. Houseal,
Operations Officer : , C-
Bar-11- PR F'
R- Office
Prcgraa Djrector
Regional Office Representative:
Ray Maddox
Management Survey (Date) :
La'st Site Visit:
(List Dates, Chairman, Other Comniittee/Council Members, Consultants)
April 10-11, 1969 Storm Whaley, Chairman; Luther Ekady, Jr,, M.D.;
John F. Stapleton, M.D.; Maurice Van Allen, M.D.
,?
Staff Visits in Last 12 Months:
(List Date and Purpose)
May 18-19, 1972 - Orientation of RMPS Staff to the RMP and Technical
Assistance for the RMP,
Ray Maddox, Regional Office Pr0gra.h Director - August 20, 1971; October 26-27,
I
1971; January 17-20, 1972; March 17; 1972; May 30, 1972 (W Site Visit)
fkcent events occurring in geogrnphi c area of Region that are affecting
MlP jrograrn:
--- -_I_p
II_
I&. David. Derge recently appoint& President of Southern Illinois University
at Carbondale.
agreement with Washington and St. Louis Universities.
A $1,040,000 Experimental Health Services Delivery System award grqted to
Health Delivery Systems Inc. of St. Louis.
Gubernatorial electiors will be held in both'rjllssouri and Illinois in
Southern Illinois University reaffirms its consortium
Nove~er .
RM 00056
I
-2- ,.
..
Covering 31 counties and City Of St. 'Louis - Missouri;j-overlap cith -8lo.Ri.I
-1
50 counties in Illinois ; some interface and overlap
with Xllinois RNP
-3-
Demographic Information
Population Characteristics:
The Region centers around the Missouri and Illinois area around
metropolitan St. Louis.
but the Region encompasses mre than 30 adjacent Missouri counties and
about 50 counties in the southern half of Illinois.
Missouri and Illinois RMps account for an additional 30 counties and
population of about 650,000.
The following is a sunn~lry of population distribution:
Definite boundaries have not been established,
Overlap With the
Missouri
St. Louis county and city
8, 9, 10 (30 counties)
Congressional Districts
Less overlap
1,573,600
Illinois
Congressional Districts
plus scattered other areas
20, 21, 23, 24 (50 counties)
1,852,300
240 500
mem
Approximate combined population 4,130,800
@ Selected Population Characteristics :
State of Missouri
Total. Pop. % Urban $ Rural % White % Non-White Density Average Per Capita*
4,677.5 m. 64 36 91 11 68
State of Illinois
Total Pop. % Urban % Rural % White % Non-White Density Average Per Capita#
11,114.0 m. 80 20 86   14 198 iygE
1,882,900 80 20   4,088 m
St, buis Metropolitan Area
Total Pop. % White $ Non-White Density Average per Capita*
Springfield, Illinois
Total Pop. X White % Non-White Density Average Per Capita*
120,800 93 7 3 D 606
@Average for U. S, is $3,680
-4-
Page 2 - Demographic Ir$omtion
Average Age Distribution
Missouri Illinois St. Louis U.S.
                              55
                                    10
5
$ Under 18 33 34, 32 35
56 53
10 15
$18-64 55
% 65 + 12
Health Education Institutions
Medical Schools :
St, Louis University
Washington University
Southern Illinois University (developing)
Dental Schools: St, Louis University
Washington university
Southern Illinois University
(students will enter Fall 1972)
Pharmacy :
Nursing Schools: 15 Professional
St, Louis College of F'harmacy
4 Practical
.v
Approved Allied Health Schools : 26 _. -. *
-_
(includes cytotechnology, medical technology, radiologic
~ -, -_
technology, physical therapy , and medical record librarian)
Pertinent Health Data
Hospital Facilities (Cornunity General)
Missouri
46
(includes 1 VA Hospital)
St. Louis
  26
Manpower
Other Counties Illinois
20 80
Physicians (active, non-Federal; includes 0.D.s) :  4,627
Licensed Practica; Nurses (active): 3,822
Graduate Nurses (active) : 9,920
_. .
Component
OPERATI ON.4.L PROJECTS
Kidney
. EXS
hs/ea
Pediatric Pulmonary
, Other
TWAL DIRECT COSTS
-
COWCIL RECOXMEXD~D LE~EL
COMPOXEiT A..DTIXAVCIAL SU!=>V3Y
  TRIEWIAL APPLICATICS
Current Annualized
Level
,- Year
$ 517,962
.. 49,392
356,759 .'r
X
$ 924,113
$ 924,113
$1,412,617
dd-
t for Trieimial ,
2nd year 1 3rd year.
t
$1,463,31 $1,567,610
c0ur.c
1st year
i
\
-
!-ApDroved
2nd year
1.
- --
.
..
VI
JULY 21r1572
OREAKCUT CF  RECUEST
04 FRCGRdH  PER100
--
I
4
I
JULY 2191972
'1 APFR. PRICC
I Of SUPPOUT
I
COO0 PRCGRIN STAFF I
DO00 CEVELCPRENTAL COYPChthT I
                         I
OC8 CGCP REG IhFCRb'dTICh SYSl
CCS PEALlk SLRV Et CAPE fCR I
012 CCPChAPY CAFE TRLIhlhC PI
- -
ILI!FCPibLlLUGt;t-I
AI;!?R-l!5LLeESJ_I
  Eu?ukl!mm-
CEBIhPC.!LEL;P-I
014 CLIh Ah0 CYIC CETECT CAN1
BREAKCUT CF REQUEST
05 PROGRAM PERIOO
REGIC~ -  ~I-STATE
RU COO56  16/72 PAGE 3
RLPS-CSP-JTCSP2-1.-
(21 (4) (1)
CChT. BeYONDI APPRO h0T I NENr hOT I ZNO YEAR I
APPP. PERICE1 PREVIOUSLY I PHEVIOUSLY I OIRECl
tf SCPPCRT I PWOEC
I I I I
BREAKCUT CF  PEOUEST
05 PRCGRAP  PERIOD
JULY 21~1972
REGICN -  eI-STATE
un ooosb  1c172
PFPS-C PAGE SC-Jl 4 CGPZ- 1
(51 ti?) (4) tlt
lOENl1FICbTION CF CWPOHENT I CCW. WITHIkl Cthh BEYCNOI LPPR. ha7 I ~EYI NOT I 2(iC YELR I
             I APPR. PERICDl APPR. PEPtCCl PPEVICGSLY I PREVICUSLY I CIRECI I
              I CF SLPPCRT I CF SL'PPCPT I FChCEC I APPRCVEO I CLSTS I
I I I I I I
I
W
I
JULY 21~1972
IOENTIFICdfION OF CCPPCbEhT
COO0 PACCRAH STLFF
----
C2F USE CF SlC btC RCC TC AC
BRE~KOUT tF REQUEST
06 PHCGPLk  PERlOC
REG~CN -  El-SlAtt
RP 00056 ic/tz PdCE 5
R J4 P S - C L P- J t C** C 2- 1
JULY 21.LS72
BREbKtUT CF REOUEST
06 PRGGRLC PERICO
(5) (2) 14) (1)
IEENTlFICATfOh CF CCWPCLEhT I CCNTo WITHfkl CChT. BEVChlDl IIPPR. hOT I hEWa BOT' 1 3RC YEbR I
              1 APPRO PERlCOI LPFR. FEiiIOCl PREVICUSLY I PREVIGLSLY I DIRECl I
               I CF SirPPCRT 1 CF SCPPGRT I FUNCEC I APPRCWD I COSTS I
I I I I I f
B I-SflIE
1Ct72 )&E 6
PCPS-CI~-JlLCP2-1
I 1ClAL I
I ALL TEAPS I
lGIREC1 CCSTS I
I
I
I
I .-_
I
                   -.i--u&LL-
I SU.W~B~CZ~~~-~A~-L--
034 SYS IPR CEAlH CEPT OAIA I I' I I I
-ELrErLr I -I.--
        I I 1 I
I
I t I I 1
UNSPECIFIEO GRCYTH FUNCSI I i
1 S3r24CrllS I
I I S60.006 I $101.632 I $lrC209f?Z I
1 Sf5'3.COO I
          I
TClbL I
. . -.
'. I
i
I
F
10
I
a
                    PAGE 1
REPUEST CCTOEER 1972 REVIa CYCLE
             R)IPS-O SR- JTUGRS-3
JULY 24.3932
P 6 1 C.hJ.U!! EQIO_CPBQW-R3lG
SUIJHARY BUOGET BY TYPE CF SUPPORT
REGION 56 BI-SYA1E PRP SUPP YR 04
cEsa H IC-CU~TINENT
RnPS RPPS RVPS RRFS TOTAL
0 I DEQ INC IR ECT TOTAL OIRECT OLRECT DIRECT
3RC YR ALL 3 VRS
CLICC#LIT
tic. ' TITLE SUPPORT YE& 1Sf YP 1ST YR IS1 YR 2ND YR
CORPOIIENT
10.850
c -CCkTIhUEO CI ,NEXT-P46- _-
..
JULY 24wlF72 REGLCkAL WED IC& PROCRAHS SgRV ICE
LISTIN6 CF ADOITICLAL FUHES PA6E 3
                                              RWPS-OS+ JTOGRB-3
pwp SUPP YR 04 RE-1 CCTOBFR 1972 REVIEY CYCLE
REGION 56 81-ITA7E
DESK WIC-COhlINENT
OTHER OTHER TOTAL
GRANT RELATED INC_OCE     SlLTE      LCCL     FEQE-RLL
                                 MON-C tOERAL
                                                              DIRECT    TOTAL f!!-f
IhT EREST 07bEk       FWlrDS       FWDS       f UNO S       FLhDS    ASSISTANCE   TkIS PEPIOG
UlVPONENT    RRPS
hLCr6ER    TCrPL
-I__-
.' LEU RCT PPEVlOUSLY APPROVED
R
115 .513
-
DCCO 115.513
999
hEW SUE-TCTlL
115.513 119 9513
CONTINCATION BEICNO APPRCVED PERItO CF SUPPCRT
COO0 985.816 9e5.816
015 35.390 35.390
0 16 is. esc . 15.850
     14.729 14.729
oia                                                                           I
019 22.094                                                                 22 ~054 vi
+J
I
--- -
0 20 221451 221491
? 02f 33 e366 33 e366
~-* 3,-~ ~ - - -
.
-_.-
022 2t.345
023 25,000 25.000
2 377%
__-_ ~ ---
-
024 22.734
-
25.1665 --
I__---
--
025 211t65
OZb 21 e620 2ima
P
-7 7 JULL2_41197 2
LISTING OF ADDITIONAL FUNCS
,:?'*. --- -
'> J:,
Ru;1
---_ REGION - 56 ------ 61-STATE RHP SUPP TR C4
DESK PIliCChTlhthT
'AGE 4
YEST OCTOBER RM lSUW.kC-!. PS-OW-JTO GRB- 3
-
--
- ____ __~ _________
CTHER CT PER TOT AI.
_I__ CCtPthE)tT RPPS CAdhT PELCTEC LhlLOPIE    S?b?E CQcA 420R A_L.NT)_h-EE-DE PAL 01 RE C T T CT AI. HI_NQS
  NUWBLR     TGTAL I LTEREST CTHER     FUhOS FUNDS FUhCS FUN c s--   ASSISTANCE   THIS PERJOO
                                                                           26 s399
53,326 53r320
033 26 s3S9
034
CChT. BLYCNC SUe-fCTdL
1.41E.Slt i .45e *Sib
APFPCYEC NGT PREVIGUSLY fUNDED
60 rOOO
014 6CvC00
-
c_
I
F
NOT PREV SUB-TOTAL
-- a\
60.000 I
6QiQQ0
-
CCNTIhbATIOh LIlHIN AFPRCVEC FEPICO CF SUPPCPT
5s 366
lllr6lO
72,428
008 5.3.5.5
009 111 1610
012 12142e
?
-
-
CChT. UITHIk SUE-TOTAL
189 e4G-
ie5,466
REEION TOlALS
I 1.823.833 1,623733
d
e
1971-72
          BI-STATE WVIP
ALLOCATION OF DOLLARS AND STAFFING RESOURCES
1972-73
Region: EH..;S@te
m 00056
lh1.W~ % Of Total
&Om staff $542,083 58.7
Projects 382,030 41.3
Developmental Component - -
            $924,113 100.0
Total
Dollars % of Total
$ 650,126 46.9
621,978 44.8
115 513 8.3
$1,387,617 . 100.0
Positions (F.T.E.? Dollars % Of
                   Total
Central
Field
Positions (F.T.E.) Dollars $ of
                   Total
19 (18.00) $264,865 61.1
6 ( 5.25) 60,256 13.9
19 (18.25) $295,726 61.1
6 ( 5.25) 67,300 13.9
Total
University 10 ( 6.50) 108,373 25.0
(29.75 $433,494 100.0 35 (29.75 $484,326 100.0
F.T.E. )
F.T.E.)
35
10 ( 6.50) 121,100 25.0
-18- Region: Bite -
Review Cy c 1 e :
HIS'I'ORICAL PROGRAM PROFILE OF REGION
The BSRMP began its planning in an area rich in pedical resources and
complex in government structure and inner clky,problems.  The initial
planning a& was made in April 1967,
(Washington University and St, Louis University respectively) acted
as co-coordinators until Dr. William Stoneman, a plastic surgeon and
faculty rnember at St. Louis University, was appointed Coordinator in
November 1968.  A consortium of the Region's three universities
(Washington, St, Louis and Southern Illinois) delegated the grantee
- responsibillties to Washington University. Early concern of reviewers
dealt with 1) the need for more minority members on the RAG, 2) the
question of meaningfMinput from a RAG whose membership was so large
(56 members), and 3) the heavy categorical emphasis.
latter, the RMP had structured its planning and proposal development
utilizing a mechanism of eight program cormittees and associate
categorical directors on Program Staff.
Drs, Danforth and Felix
With regard to the
'
University people were heavily involved in the Scientific and EZiucationdl
Review and Administrative Liaison Conrmittees. .r.iXlring its second planning
year the RAG'S Executive Ccaranittee developed recamnendations which sought
to involve its members mre directly in the planning and direction of the
program by increasing its mership, holding more meetings and studying
the RMP in depth.
After a preoperational site visit, the RMP applied for and received,
operational status in 1969.
Director, Dr. Stanley Olson,to St. Louis L_-- to meet . -- with -- Rlvrp representatives __ - -_
                                                                           -
He foGd intense se aration of the two St. his medical-schools
which had shared a !&tory of not being particularly ifiei%sGB-in
serving the comunity.  It was hoped that the IMP might serve as a catalyst
in getting the schools to pull together in an attempt to improve the health
care delivery system.
Program Staff and five prajects for its first operational year,
activities included:
Problems in getting the RMP going took RMPS
The program received an award of $881,387*for
Project
#2
Radiation
Support
#4 Comprehensive Diagnostic
.Demonstration Unit for Stioke
#5 Nursing Demonstration UnLt in Early Intensive Care of
Acute Stroke
#8  Cooperative Regional Infomtion System for the Health
Professions .n
#9  Health Surveillance, Education 9 Care for Residents
of Pruitt Igoe
0
-19-
Page 2 - Historical Program Profile of Region Region: Bi-State
Review Cycle: Sept/Oct 1972
The new Southern Illinois University School of Medicine appointed a
Dean and plans were made.to add.associate coorWiators fram S. I. U.
to the. staff.  ~o~l~-_-~.~-_to~surface in 1970 with the S. I. Ua
Medical School in Springfield where both Il&& and &-State U@s
pianned to establish subregioml offices in the area.  The IUnois
RpBp placed a Subregional Coordzna'cor ;in Springf"l;S$d for a time, but
neither RMP presently has staf'f in that area,
In reviewing the FW1s application for its second operational year,
RMPS staff was concerned that the projects proposed had minimil impact
outside the existing system and did little to inprove the existing
inequities.  Reviewers noted that minority and consumer input on RAG
had been increased, the Executive CorrPnittee was reorganized, and
evaluation arad outreach capabilities were added to Program Staff.  The
following projects were funded:
#2 Radiation Therapy
#4
Diagnostic Demonstration Unit for Stroke
#5
Nursing Dmonstration Unit for Stroke
#8
Regional Information System for the Health Professions
#g Pruitt Igoe
#12 CCU Nurse Training
The RMF' is presently in its 03 year.
triennial support last year, Council believed that an additional year
was needed in order for the RMP to realign itself in order to develop a
propam more in line with the RMPS mission.  While Bi-State had gained
increased consumer participation in its program, most of the f'unds in the
application were destined for institutional rather than conanunity ventures.
In addition, continuation and approved but unfmded projects appeared to
be more of the "same old thing'.'"  Reviewers were also concerned about the
continued categorical emphasis and the actual contrlbution of the
categorical associate directors based in the medical schools.
reconmended that the RMP give further attention to the f'ragpntation of'
the Region in relation to the Illinois RMP.
time the Coordinators of the Wo programs have met with Southern Illinois
University and Dr. Stoneman prepared a statmnt concerning BSRMP
involvement in this part of the Region.  As a result of this, S,  I. U.
has reaffirmed its corrpnitment to the consortium,  The BSRMP is actively
recruiting for the two S. I. U. associate aoordinatorsMps  and the
positions rmy be filled by the end of September.  Dr. Stoneman also has
s&neom in mind for the regional field coordina'cor position for the
SpringfiWi area.
Although the RMP requested
It was
Parenthetically, since that
-20-
Page 3 - Historical Program Profile of Region Region: Bi-State
Review Cycle: Sept/Oct 1972
-
A managent assessment vlsit was held in April1972,  The team found
the RAG and Executive Conrmittee to be inactive and its members Uninf'omed.
The powerful comittees created by the consortium of the three medical
schools appeared to have assumed almost total au$hority for both the
program and administrative aspects of the RMP.    team's-recam&dations
included:
program staf'f, 3) improving fiscal repwting procedures, ard 4) developing
a property management system.  The RMP's response to these recommendations
is expected before the time of the site visit,
r
1) giving the RAG more decisiormking authority, 2) reorganizing
The RMP was awarded $1,450,757 for a 15-month budget period ($1,160,604
on an annualized level).
groups of activities:
This figure includeq'ms for the following
A, ProgramStaff
B. St. Louis EMS project
C.
Tho health services/education activities (Casbondale and
,St, Louis)
D,
#2
#4
#5
#a
#9
#12
#I5
#16
E.
Other approved projects
   Radiation Therapy
   Comprehensive Stroke Unit
   Nursing Demonstration Unit - Stroke
   Regional Information System
   Pruitt Igoe
   CCU Nurse Training
   Sanoking and Health
   Physician Continuing Education for Patient Management
Three-months of support for 17 new one-year activities
included in the triennial application,
,-,.
- ._
._
.- .
..
: . -I
.- .
- ..
., ..-
.- .
-21-
DEPARTMENT OF HEALTH, EDUCATION, AND \\'ELFARE
MEMORANDUM PUBLIC IIEALTII SEKVICE
HEALTH SERVICES AND MENTAT, HEALTH ADMINIbTRATI
TO
ECT:
DATE:
The Site Visitors of the Bi-State RMP
August 15, 1972
b
Operations Officer
Mid-Continent Operations Branch
SWf Review of the Bi-State Triennial. Application, lnvr 00056
A staff,review of the Bi-State Triennial Application was held Monday,
July 31, and was attended by the followilyj; people:
-lene Hall, Office of Planning and Evaluation
Loren Hellickson, Office of Systems Managerent
Dona Houseal, NLd-Continent Operations Branch
Margaret Hulbert, Division of Professional am't Technical
Jennie Peterson, Mid-Continent Operations Branch
Pat Schoeni, Office of Comnunications
Me Stubbs, Grants MansySement Branch
Jone Williams, Mid-Continent Operations Branch
Developmnt
StaEf mt to discuss the RMP's accomplishments, problems and issues
for the visit.
The EnVIP's request for the triennium includes:
04 05
core 650,126 696,100
Projects 621,978 640,000
Developmntal
Component      115 3 513      127,210
ma      $1,412,617    $1,463,310
Staff noted that the request for the developmntal
  ermisslble amount of $92,400 (computed on the
   t of the 03 year direct cost ftmd$ng level).
06
744,000
690,000
'133,610
$1,567,610
component exceeded *
basis of ten
A. Accomplishments
The Bl-State RMP has taken a new approach to program development which
found noteworthy.
als around ideas generated by the RAC, appeared to present a
Their plan, which sollcited small ($25,000 range)
realistic method of developing activities which would be relevant to
eglon's goals, objectives and priorities.  In addition, some of the
- 22-
Page 2 - ?he Site Visitors of the Bi-State RMP
I
projects address regional health care delivery problems in ways
which are more innovative and which may have mre immediate payoff.
Examples include primary health care progm for children and an
urban populatioquse of the pediatric.nurse practitioner, and an
investigation of techniques of iqroving ambulatory care.
,
In addition to those examples of program staff assistance described
in the RAG Report (pp. 42-45) and in the Core Activities sm
(p. 137), RMPS staff noted that the Bi-State RM?? provided staff
assistance in developing the Experimental Health Services Delivery
System application, which was recently approved and hded by the
National Center for Health Services Research and Development, HSIWA.
.
I B. 'Problems and Issues
1.
in two parts.  The f'irst response has been submitted by the grantee
agency and was included in the site visit packet.  The second to be
sent from the Coordinator and the RAG, will be available to you at
the time of the site visit.  In regard to the first, members of the
. management assessment team reiterated their belief that the problem
basically lies in a difference of philosophy betweenqRMPS and the ,
Bi-State RMP as to who should control the program -RAG or grantee
(the Consortium).  While the RMP maintains that the Consortium
reviemprojects only to assure good stewardship of federal funds,
the management assessment team's observation was .that thek fiscal
control overlaps into program areas.
schools would recornend f'urding only for projects which suit their
special interests and that the RAG would be either Unwilling or too
weak to oppose the medical establishment.
Fom 14 indicated minimal involvement of RAG in project monitoring.
The Region's response to the management assessment report will be
'
.-
The team feared that the
Staff also noted that
Staff noted that of the 23 projects in the application, ten are
university-sponsored ard another five are associated with university-
affiliated hospitals.
2. Staff examined the goals and objectives and concluded that the
RMP needs a clearer understanding of the separation between goals,
objectives and activities.  The rationale behind the matching of
goals, objectives and a.ctivities with each other, as well as the
progression from one year to the next (with some goals and objectives
being added or dropped) was unclear.
I
3.
problem will be to gather more information md possibly make sugGestions
to RMPS staff as to how this might be handled.
responsibility of the team to settle this issue.
"he charge to the site visit team with regard to the turf
It will not be the
Incidentally, staff
W.'
-23-
e
o
Page 3 - The Site Visitors of the Bi-State RMP
lev& that Dr. Creditc . Coordinator of the Illinois RMP, had
sent letters (copy attaclA) to the Illinois CHP "b" agencies
requesting their impressions on the boundary problem.  Of the
74 RAG members, 46 are from St. Louis, five frm Missouri and 23
f'rom Illinois.
4. Staff thought there was a need for more minorities on program
staff and the RAG,
the RAG (8) and Executive Committee (2) to be low.
They also found the representation of women on
5. It was noted that Dr, Stoneman is President-Elect of the
St. buis Medical Society.  Since Dr, Stoneman also carries out
a part-tkne practice in plastic surgery, staff thought it imperative
for,him to consider both hiring. a strong Deputy Director and
reorgmizing staff to allow him more time for overall program
direction and development.
Planning.
Attachment
6. Staff was also concerned with the categorical emphasis as
exhibited in the categorical associate directors on program staff,
the program ccPnmittees and a number of the projects.  Some staff
members indicated a need for mre projects which would provide
the consumer with information on how to better enter and use the
health care system.
consumer involvement on the health care delivery comdttee,as well
as the amount of collaboration with CHP ''b" agencies in subregional
They were also curious about the extent of
DonaE. Houses
Component
LOGRAN STAFF
INTRACTS
iVELOPMENTAL COMPONEh!
'ERATI ONAL PROJECTS
4
Kidr.ey
EXS
hs/ea
Pediatric Pulmonary
Other
)TAL DIRECT COSTS
-
COMPOXENT ANDFINAXIAL SWY
TRIENNIAL APPLICATION
,
o
I
Rcgion: l%-St%>e
c
1st year
Current Annualized
Level c3 Year
I
$ 517,962
. 49,392
I
650,126
I_-
115,513
621,978
..
1
$ 924,113
;t for
2nd y
-
inial,
3rd year
$i 744,000
133,610 '
690,000
e.
'.
.
*
Committee Secomendotion for
Counc
1st year
i
c
1 -Approved
2nd year
\
..
-4 .
*
I
Ld
1
1
JULY 21r1572
OREbKCLJl CF  RECUEST
04 FRCGRLd  PER120
JULY 2191'577
BREPKCUT CF  REOUEST
04 PFCGRPM  PtRlCO
12) (4 1 (1)
                                                                       I
I CF SilPPCQT I CF SUPPCRT I FLNCEC I APPRCVED I CCSTS 1 CCSTI I I
I 1 I I I I I I
(5)
IEENTXFIC4TICh CF CCPPChEhT I CCNT. WITHIhl CChT. BEYCNOI LPPR. hCT I hEbt. ACT I 1ST YEPR I 1S7 YEbH I
I 4PPR. PERZCDI APFP. PERfCCl PliEVICUSLY 1 PREVICUSLY I OIPECT I IhCIPECT I ICTLL f
', j
1
JULY 21.1972
c
(51
ICENTIFICPfIOh CF CCWFGNLlrT 1  CChT. WIlHIhl
                      I  4PFR. PCRlZCl
                      I  CF SLPPCRT 1
                     I           I
034 SYS LPR CEA7h CERT CATA I           I
BREIKCUT I:F  Pc9UfST
05 PRCGPhP  PERIOD
PEGlCN - PI-STATE
HU COG56 1C/7i PACE 4 .
RPPS-C SP- J? C'i i- 1
I2 1 (4) (1)
CLh7. BcYCNDl LPPR. IsCT I hEW9 hU7 I ZhC YFbR I
APFP. PfPICCl PDFVICLSLY 1 PREVICUSLY I CIOEC? I
CF SUPPCRT t FLhCET. 1 APPPCVEO 1 CCSTS I
       I I I I
        1 I I I
I
u?
I
JULT 21,1972
IOENTIFZC~~lON OF CGHPChEkf 1
I
                   I
COO0 PlCCRbM STAFF I
tSl
CCWr Utfklk(
        I
        I
APFR. PFRtGO
CF SLPPCRT 1
BREAKOUt C'F REOUfSt
06 FRCGPLM  PERIOD
RE6ICN - &l-StAtt
RC 00056 1C/tZ
PACE S
RMPS-CSC-JlCCR2-1
JULY 2191572
EQEbKCUT CF  REOUESI
06 FRCCHIIC  PERICO
(51 121 (41 (1)
ICEHflFICATlth CF CCCPCkEhl I CCNT. UlfPIhI CChl. BEYCkDI 6PPH. hCf 1 hEW* hCT I
                1 APFR. PERlCCI b1.FH. FEPIOCI PREVICUSLY 1 PREVLCLSLY I
                 I CF SLPPCRT I CF SLPPCRT I FUhCEC I APPRCVEO I
I I 1 1 I
3RC YEJH I
ClRECl t
CCSTS I
I
I
I ICldL I
I PLL YELGS I
ICIfiCCT CCSlS I
I I
I I
I
..
4
cd
I
I-
h)
I
(I E 6 I CE &LED IV_CSRQCf!!2LSLR_VICf
---
                                                                           PAGE 1
REGION 56 61-STATE PWP SUPP YR 04 REPWST CCTOBER 1972 REVXEY CYCLE
                                                                           RUPS-0 S?l-JTEGAB-3
CESK U IC-CON1 IkEhT
F? JVUI_z411~-77
.P.\ SUMMARY BUOGET BY TYPE CF SUPPORT
-
@
____--
RHPS RCPS RPPS RPFS TOT&
DIRECT OIRECT DIRECT
C&RPCNLAT O@~~~ INCIRJCT TOlA-L
3RC YR ALL 3 YRS
COUPONEN1
hC. TITLE SUPPORT YEAR 1ST YP 1Sl YR 1ST YR ZND YR
UNSPECIF 1EO GRCYTH FUhOS c22 68.C22 86.044
02 25.CCC
25.000 -
- 25.000
ICv85C __ 3.472 14~322
-. 10.850
.
I
-CChT IhUEO Ch RFXT-PPGE- .-
---
CChT IhliPT lCR h ilk IN PPPRCVED PER IGD CF SUPPORT
. L-7A.1 603 5* 3tC
I
.
!
_.._._._ ____ - . - .
- ___ . . . __ __ ... __ _____-._..~-----------.-.------
T
___ __._-.-
. . . .. . - .- . . - ---.. .- -
.- ..
.
.- . . ,-
. ..
. . . . .. - .. - - .- . .
1
7
..
-
. . . . - . -
. -. ..
COORDINATOR :
Mr . Paul Ward
Staff for RMP:
~a-8 S&th. Ralic Health Advisor
-
- 3rd Ycar
Triennial / __. J Triennial
Triennial / - / Other
-
Chainnnn, Other Cormnittee/Council M
Clark W. MiLlikan, M.D., ChactlFlDBht
Joseph W, Hess, M.D., ReWI
Henry M. Wood, Director of Urban
Rock, MOD,, Cha&rmn 6u\
avens, MOD. I Cadfdl.Wtnr
Regional Office Representative:
Ronald Curria
Management Survey (Dare) :
Conducted: , ' c-
S ch edul ed : -
or
tants)
RMP
participate in AH
to meet with Califor
e and t~ eattend
CALI FORNlA
kAND PACNALLY -2-
ST'&l'@E COUNTY OUTLINE MAP
SIZC 8% x 11
,Total Population r19,953,100
Population Density s 128 per $4. mi.
WTROPOLfTAN AREAS ' t
$, Urban8 91' * '
I Il+bRural 9%
..
al i nas-Mont erey
anta Barbara
tockton (San Joaquin)
San Bernadino
State and County #
Califohia - Sub Areas
Population and Counties (1970 Census)
, Cmerf - Calif. RMP comprises 9 sub areas, 3 in the Northern part and 6 in
the Southern part, each centered around a medical school or develop-
ing center.
Northern Areas Counties
Area I - San Francisco
                        11
I1 - Davis-Sacramento 20
111 - Stanford (Palo Alto) 11
                       42
Southern Areas
Area IV - UCLA 7
' v - usc (LOS Angeles) 1
  VI - Loma Linda 4
                           2
j VIII - Imine 1
j PX - Watts-Willowbrook 1
I
I
1 VII - San Diego
                  16
Totals 58
-
3,029,800
1,448,200
2,644,100
7,122,100
1
I
1
1 1,406,700
  6,882,000*
  1,162,800
  1,432,400
  1,42O,400
    526,700
' 12 ,.831,000
  19,953,100
I
1
,
Total population since the Census is probably over 20 million.
*Parts of Los Angeles County overlap with other areas.
I
-5-
California - Sub Areas
Population Iq' County (1970 Census)
     (in thousands)
290.2
13.6
22.2
. '6.0
104.6
194.5
fU64.7
123.8
250.1
556.2
18.2
2644.1
of
42 Counties (Nor thera)
Area 11 - Davis-Sacr~~Q,to -
(20 Counties) '
S is k i y on
Modoc
Shasta
Teh ma
Las swn
Glenn
Butte
Colus a
Plumas
Sut ter
YO10
  33.2
'. - -7.5
  77.5
  29.5
  15.0
  17.5
102.0
  12.4
  11.7
  41.9
  91.8
__
Solano
sacr amento
Yuba
Sierra
Placer
Amador
Alpine
El Dorado
Nevada
169 . 9
631.5
44.7
  2.4
77w3
11,s
  *5
43.8
26.3
1448:2
31c-.
-6-
i
California - Population by County (1970)
(in thousands)
Southern Areas
Area IV - UCLA-L.A.
(7 Counties)
Madera 41.5
Tulare 188.3
Freeno 413.1
King A- 64.6
Kern 329.2
San Luis Obispo 10%7
            264 3
Santa Barbara .I
           1406.7
Area VI - Lorna Linda
(4 Counties)
Mano 4.0
Inyo 15.6
San Bernadino 684.1
Rivers id e
459 . 1
1162.8
-
Area VI1 - San Dieao
(2 Counties)
Sari Diego 1357.9
Imp e r i a1
74.5
1432 o 4
-
Area VI11 - Imine
' Orange County 1420.4
Area IX - Watts - W.
Ventura County 376.4
(part LOA.) + 150.3 (e)
          526.7 .
,
I
Total of 16 Counties (So. Calif.)
I-
I.
'1
r:
I
i
i
7\
REGIONAL CHAMCTERTSTICS
__L-
FACILITIES MID RESOURCES
s CHOOLS
(Cont'd) - -
-
-
-
Enrollment
           G r ad ua t e s
(1969 /70) (19 69/70]
Lo cat ion
No .
. Schools
."
-.
-
-_
- - .-.
-and-- - (8)
-hmtl Linda U.-Sch-of Ned  .-'-' ' 381 -- '
- -=- '--._a- -i...--.- rr- - - ~
'89 Lomi- Linda
69 Palo Alto
Stanford Univ. Sch of Med.    342 .
Univ. of Calif. Col. of Med   445 78 Los Angeles
Univ. of Calif. Col. of Med   254 58 Lrvihe
Univ. of Calif. Sch of Med.    5 16 . 126
Unfv. of So. Calif.       302 72 Los Angeles
Uniy. of Calif. Sch. of Med. 99               ..I        Oavt s
Charles C. Drew .. Postgraduat;-Sch.m of Med.  Developing.   Watts-W. L.l
San Francisco
. Univ. of Calif. Sch of Med. 101 -- San Diego
-- -
Dental . - (5) Loma Linda, U. of Calif,LA, Univ. of
                   Sout liern Ca 1 if . , San 'Franci sco MC . ,
Pharmacy (1967/68J- (3) __ , Coll. of the Pacific, SF
Schools o_f.Public Health (3). .  U. of Calif. Berkalw; 0. of Cal. LA,
                   . Loma Lidda.
Nursing Schools o
Professional Nursing
c.
I-. o
-.
1 -- _-
I
..
i
Practical Nursing
Number 67 The rrw anh . I
I' Junior Colleges.
-
Allied Health SchOols - (Approved Programs) * ~ -_
Cytotechnology 6
Number 6
7
..
Medical technology
-
65 ( 2 at VX hosp. Long Beach'& LA)
..
Number
$\
Radiologic Technology
Numb e r
110 ( 2 at VA hosp. &os Aogeles !nd(SP)
-
Physical ther,apy
7
-
Number
c---- - . &--- '
I.
Medic81 record Librarian - 2
------*, . -
..
?X..&. .-
Note;
See Manpower Table for sources - page 8,
..
1.
-7
'
Soul.ces:* Directory of ~pprdvcd Allied Medical Educetional
Program Council on Medical Education, her. bled.
Assoc. Chicago 1971.
6
.-
..
&LZTIES _*I__ ., .* .--- .-
AND RESOURCE,S (Cont 'd)
..... . 'I.
. . *-
..
._._
...
-..
..
.. , .:. - ,
..
... ..
.......... . 1. -..
. .' ,
..
' , -.-..
..
...
...
...
..
I.' ' HOSPITALS-
......
..' , -
...
*. .
..
,.
.. *
, .*
..
. ,..
. ., '7 : , '
.I
I. . f.
.. .." ...
..
...
.,
...
Skilled Nursing Ho!nes
Personal care Ho!tlcs
with Nursing Care
tOng-terrn &re. Units
Source: NCHS -
1148 17,354
45 1 16,015
' 108. 5,991
A Plss t er J?ac i 1 i 1: i es Inventory
County and Metropolitan Area Data Boo!:
Pi-IS- Number 2043 - Section 2, Nokmbcr 1970
*Thrre are approximately 35,224 ph';sicians in the Region, includff.ng
all but about 100 Osteopaths and" about?. 91,961 nu.rses oe whom
57,700 are active,
7
  COMPONENT AND FINANCIAL SUMMARY
ANNIVERSARY APPLICATION DURING TRIENNIUM
Component
ent
ic Pulmonary
Ctirrent
Annualized
Funding
TR Year 01
04 operatlonal
year
$ 4,313,532
859,896
586,692
3,196,786
$10,043,175
r
I
$10,043,175
r
Council-
Approved
Level For
TR Year
-~
$10,043,175
Region's
Request For
TR Year 02
05 operational
   yeas
( 377,930 1
Recommended
Funding For
TR Year -
/-/ - SARP
I-/ - Review.
Committee
Recornend - d
Level For
Remaindez.
of TrieMiar!
I
LUIPCEC - - LWbXCEC AWAPCEO ** PEOLESTFn _R~OCESTEDREXQUFSfEO REOgESTEC *
   C9/Y IylL/72 TCI'JL __ ** 01/73-12/13 01/14-12/74 01/75-12/75 TOTAL
IO s
bYAP CEC AYAPCEC - __ 06 Cl
C! c '1 ** 05
-
CC W PCh EN I-"--
hC TlTLE
c1----- -- c2
-
it
o c--
.-
                                                                           281 O?
                                                                      22284 42974
122 STPCLE PEStCIbl
-123-SfRnKE-VOLkRTEE *3- le173
                                                     *I 2267G 34972 574C2
124 STCCKE VCLLNT
-12E-VCl Ih PESCCIbL                                        1'1 65870 10ai22 1735f2
                                                                           1487-51
126 VOLUNTFER STRUK                                         +* TfS-73 5 1 0
                                               ** , e7144 122551 209695
~~~~~~E Cb                                         **-4b1?9~17358
1278 LA CO EH "FD CA                                                                           51698
C-127C LA CC EM MEC CA                                            IC r)tse
  12e EP PED CARE PLb
129 EYEP CAQE CRITI
                                                    +* 193258 26429 3 457551
130 CUP 1bCY CF CUh                                                                           102645
Yl7P At-F P CGCCJJP                                                  +c 27300 75345
                                                         *+---- 14 94 2 P- 152219            2S6648-
.. 132 CCwPPEVEHSIVf C
-133--PtitS SPEC IdL IS----- ---                      ** 5c49c 52023 1c2522
                                                     ++- 152 171704672 356843
134 PARAMEDIC EM CA                                                                           156022
                                                              ** 77852 78 110
135-1 CCL f 5 C EL1 hUFS
* l3C AtJTRIlIOh AhC C                                           .* 122327 124436 24t 763
-n bREb V
> 138 PECIdTRIC LLPSF *+ t3754--- - b7454
'-TTT-CCPP10N-flCKCE--------------- -- --- - ----- o *- -1 C233C lC7943
*e 21561 C23E1
120 VClLhTEEPI Ih 5 I ** zeio3
lzlP0 KE-VOCUYTEE ZUBlO
                                                  L* tooso
                                18173-
-* *- ltSL4- 1766334 6 17-
0
             2t 3 5 3 7- $1, '.
. *- IN
--
    13418 5 -7-132 35-266 I3e-
** liSiSOTU18i%527 1 .
w
--__- -_- - ~ ---
-- -
-- -
-- -
-
131208
210273 .
-0
...
...... ._~ ........ . .. ... - .. ....
.... I . -. .....
_-_- L?
    0'
-___ 0.
RE6ION - CUIMRNIA
aR oooi~ iom PAGE 4
__ . _. __ . .- --- AHPS-CSM- J:OGR2-1 ,
I
.-
I CURRENT I I
I INOIPLCT I TOTAL I I .- __ 0
I COSTS 1
U
L24r980
~ $26.875
- $1 81173
. $27 152
I
I .--
I
I _--
I
I--
     [ _---
      I
S17.381 I __ I_L
      I
281.381 I I. -
      I
$96.786 I
      f
$92.286 1
       i
1173.171 I.____,
3362.2431I
        I
$63.122 I
        I
$178.195 I
        I
:$212.258 i
$141.962
$30 -576
.-
Q
Q
$2001991 1
       I
$64.944 I
       I
$157.607 I
       1
       I
J143.123 I
       I
t
~ 594.969 I'
sa7.537 I
. _- .-
I
i
I !
I
r-'
OI
t
I
i
i
0
0
0
a
0 --
-
I
c
0
0
0
0
0
0
0
0
'I"
0
0
0
;o
'0
, ~,.
0
0
0
..
.' .
0
0
0
Q
0
.-.
.I
0
0
0
0
0
          . .... . ........ ......
. . -. --
...... .. ...
         -. -- c.
.- i
.-
,.
---- .!
i3
- - --?-- -
0.
I
I
Ih)
Q
,I
1'
.....
- 21.-
           P.L. 89-239 in 1965, the California State Department
          with the active participation of representatives of
the California Medical Association, the California Hospital Association,
the deans of the eight scbools of medicine, and voluntary health agencies
and resources, organized a "Coordination Agency'' for the purpose of
developing an overall plan for cooperative medical arrangements through-
out the State.
a1 programs proceeded at each of
e Coordination Agency developed
ic areas of responsibility for each of the medical centers, and
ated other questions.
of cooperation relied heavily on systems analysis
dinating agency submitted an application to RMPS
e and goals as described above,
s criticized the proposal, feeling that it was "poorly tied
e chronological plan for development,  and
question raiaed by the
-regton"--a question not ,
el advised against RMP creating a central
coordinate a group of "subregions .I'  The Region
tructure and UCLA withdrew the planning
eceiving operational grants.'
appltcatioa it had Ladependently sub'mitted. The vrtriou8 medical centers
ther to break up into several
corporating the recommendations of the site
a'nonprofit corporation and changed its
ee on Regional Medical Programs (CCRMP),
1 Education and Research Foundatton (CMIERF) ,
u
a1 Advisory Council, was submitted.
The
nonprofit corporation, as the grantee.
area offices were organized and baaed with the administrative
           eight medical schools. Area a, the most
eration" is based at the Drew Postgraduat
grant in the amount of $223,400 was made
1 Ward was appointed program coordinator
her site visit team visited the region in February 1967 and
eased concern about the apparent lack of cooperstion'amng the
agion and little evidence of overall planning.
- 22 -
Historical Program Profile of Region (cont.)
The region organized along the lines of its original plan and a site
visit team went out in March 1967 to review progress and the "revised
application."
of UCSF--Area I, UCLA--Area IV, USC--Area V, and California Medical
Association and California Hospital Association.
planning grants during the first year added the areas of Davis--Area 11,
San Diego--Area VII, and Stanford--Area 111.
The region's first operational grant was made effective July 1, 1968,
including nine projects out of a total of 21 submitted, which included
planning for the Northeast San Fernando Valley.
-
The full year award for planning included the areas
Three supplemental
In April 1969, the CCRMP was site visited for the purpose of evaluating
progress of the overall program and to review in depth the individual
program staff requests.  The site team was impressed with most of the
are68, particularly Area I--San Francisco, Area II--Davis, Area I?--
Los Angeles, Area V--UCSA, Area VIJ--San Diego, and Area 'VIII--1rvine.
Most impressive was the evidence of true peripheral involvement. During
the visit, Area IV (UCW) raised the question of the possibility of
making each area a separate region; there was little support for this
position outside of Area IV.
Subsequent review cycles have included supplemental project requests
from this region, resulting in several program and technical site visits.
With the award of the continuation for the third operational year, on
September 2, 1970, the region was supported at the direct cost level
of $7,548,457 which included a carryover from previous years unexpended
balance of $480,168.  The base level at that time wa6 $7,068,289.
In April 1971, all regions were notified of national funding constraints
which would require reduced budgets.
designated A and B. A, reduced the programs to the $6.2 million level
and plan B was presented at a $10 million level in the hope that
additional funds might become available.
,
California submitted two plans
In June 1971, the site visitors and the Review Committee t2 J - ,LIS
felt that the $6.2 million plan A was viable and represented good
decisionmaking, The $10 million plan developed, should funds become
available, proposed the activation, of several previously approved,
but unfunded activities which would require careful screening in vi&w
of the region's new program direction in response to new ._ RMPS _- priorities.
The Council, however, recommended a level of funding at $10,043,175 on the
basis that the CCRMP and its subdivisions had demonstrated a high level
of competency in decisionmaking.
.- -
The CCRMP 04 operational year originally Sept. 1, 1971, through
August 31, 1972, was extended four months to Dec. 31, 1972, due to
STAFF 0 13 S [i RVA'I' 1 ON S
-
princii)al Prob lenis :
1.
2.
Continued support to t..e weak areas fo; the purpose of s-rengthening
and raising the areas to CCRMP standards,
has been made with this problem and only Area VI--Lom Linda,
Area VII--University of California--San Diego, and Area VIII--
University of California--1rvine--are considered weak.
Although the CCRMP has made a great improvement in preparing
budget sheets (forms' 16's), there appears to be an administrative
problem at the central office with regards to budget.
Considerable progress
___I
- .- - -_ - -.-
- - - __.
Princiual Accomplishments:
1.
2.
3.
The CCRMP central office has undergone an organizational reorganiza-
tion which has permitted the provision of a much broader range of
technicak asslstance to area offices in the first year of
anniversary review status.
A regional kidney disease program plan with speciffc component
objectives has been developed, and' priorities have been established
among these objectives.
One of the new program emphasis of the CCRMP is on manpower
assessment.
regional health services/educational activities pan.
They have been sponsoring programs to develop a
Issues Requiring Attention of Reviewers:
It might be well to keep in mind the CHP/RMP controversy.
FUNDING H ISTORY
(Direct Cost Only)
Planning Stage
Grant Year Period Funded (d.c.o.)
11/1/66--12/31/67 (14 ~8,)   $ 1,368,137
1/1/68--2/28/69 (14 mos.)     2,613,500
   Operational Stage
(overldps with p stage)
Period Funded (docoo.)
7 /1/68--6 130169          $ 2,917,144
7/1/69--8/31/70 (14 mos.)     8,012,055
9/1/70-98/31 /7 1          7,548,457 *
9/1/71--8/31/72           8,956,936
o 9h1/71--12/31/72 (16 mos.) 12,180 , 123 **
& award statement was issued reducing this amount to $6,292,065 plus
$703,509 react thor ized unspent ,
This amount includes HS/EA and EMS supplementala funded at $1,9&0,153
and $100,000 respectively,
-.
Region: Ca1ifori:j.a TWP RM 00019
Iieview Cycle :-OsJoher 1972
.---.
/ X / SARP
Type of Application : Anniversary
_.I_
during trieiitiium
Rating : 355
7-
--
- / j Site Visit I/ Council
The Staff Anniversary Revi.e:.;r Panel recoinrnends a $9,351,175 direct cost
funding level for the CCRTiJ' 02 year anniversary application (I-/I/73-12/31/73).
The above figure includes $800,000 or the developmcntal funding request
and $322,000 direct cost earmarkecl. funds for kidney disease activities.
The SAP2 recoininendation does not exceed the National Advisory Council
approved funding Level of $10,043,175 for the 02 year. This reconmendation
was reached from the following conclusious
-
Althoagh the CCPJIP has made good progress during the past year it was  the
e consensus of the reviewers that the program did not merit an increase over
-.
the ihtional Advisory Council approved .funding level. Also, an in depth
discussion of the problems related to the region's kidney disease activities
resulted in the following recomnendations:
1.
2.
Projects 87K, 87L, 8751, and 87N, which are new proposals to begin in
FY 73, have not received appropriate technical review utilizing
outside consultants as prescribed in the guidclines. Therefore,
the region is to be notified that these proposals cannot be considered
and approved for funding at this time. If the region wishes to have
them reviewed locally by outside technical consultants,  WIPS will
supply the region with a list of consultants. If these projects
are reviewed by outside technical consultants and approved, the region
may then resubmit them according to the method outlined in the
guidelines for consideration for supl;lemental
funding.
Projects 875, 88C 88D, 88E and G8F did not receive appropriate
preclearance and technical review prior to approval by CCT;MP RAG,
although the region was informed of the necessity of such action
in the May 3, 1972, Guidelines, However, since these projects
are currently operational, this requirement will be waived. The
region is to be notified that it may choose to continue support of these
projects by appropriating monies from its operational budget, but
no earmarked kidney monies have been approved for support of these
projects ,
3,
4 `I
Project-s 86, 878,
original projects
California Kidriey
th a t c on 1: i nu a 1: i o 11
-2-
C7D, 8712, 87F', 87G, 87k1, 87L, and 89 are trhe
begun in FY 72 Tollowjiig Council. approval of the
Disease proposal. The region is to be notified
of these projects j'Li approvecl for FY 73 at a
funding level of $322,000, Any greater st1Fpoi-t of these projects is
inappropriate in that we have received no justification for an
increased funding level when guiclel incs cull. for a decremental
funding pattern in the 02 and 03 years.
Because of tile coiifusion regarding tlic cui-reiit status of the CCiS\IP's
kidney activities staff from F$WS will mcike a consultation visit
to assess the situatjoii on Octobcr 2 and 3,
7he $9,951,175 fundjn;: recomencla?ion 17a:; dccjdccji on when SAlIP anticipated
that CCWP wor?Ld resubiliit t-he LIW lcidncy proi)o::al s 87K, 87L, 8717, oiid
87h7, and deductcd 592,000 (requeqtcd amouiit for these acrjvitics) from
the I':atiori?l Advisory Council. approved levcl of $10,043,175. This
maneuver wil 1. keep the CCZPIP with-in the Couric i 1. opprovcd level or the
02 anniversary year
Other spectfic conceriis noted by Slip2 relative to severa~ of the nine
CCRhiP area programs wcrc:
1.
2,
3.
4 .
5.
6,
Areas 1, Til, and VI, are not requiring writtcn assurances from
program sponsors of conformance f.o Title VI oi the Civil Rights Act.
Area 'IrIl has a half-time coordinator. SAPV believes the coordinntor's
position should 3e a full-time job.
SARP yues fLoned the practice of salaried chai.rmen or consultant
panels i.n Area V.
Area I11 has a 12-menber faculty advi.sory cornrnittce which reconinlends
approval or disapproval of all DIP proposals for funding and advises
the coordinator. SAW believis that thi.s corriinittee is functioning
in the same capacity as the Arca Advisory Group, Additionally, it was
noted that tlie dean of the medical school appoints new Area Advisory
Group members. Because of these two factors, it appears that the
medical scliool may be dominating the program,
Several of the areas are not following proper review and matiageinent
procedures; i.e., failure to distribute review and procedure
criteria to applicants andlor failure to review expenditure reports
from operational activities,
Evaluation procedures are weak or nonexistent in Areas 111, IV, V
and VII; i.eo, Area TI1 has no overall program
Area IV, V a.nd VI1 do not have FAG involvement
evaluation, and
in program evaluation.
- 3 -,
7. Area I oplxars to be in violation of 1;illPS policy guidelines by
  supporting basic i.ierlicnl education training; i .e., the Area is
  sirpportiiig medical residents in a faiiiily practice prop-am.
8. SAW nc,Yd t-he sickle ccll request froill Area LX. Although there
  i.s no clearly clcined 1rt.iPS poli-cy rcgarrljng support of this kind
  of activity, it was noted that siniiltlr pr'ojcct-s rom otlier IIIlPs have
  been advised by tlic Xational Advisory Councfl to seek Eunding
  frorii tlic Sickle Cell Anemia PI-ogram, National Center for Family
  Planning Services :JSPiIYi.
IWPS /WOE
9/6/72
ney
e2
iatric Puhonary
.er
DIRECT COSTS
Current Cccncil -
$ 4,313,532
859,896
586 ,G9.2
<
3 , 195 , 786
I
8,956,906
_.
$10,043,175
i?egion s
Rcrjxcst For
TI: Ycar 02
(05 operational
  year)
$ 4,112,556
800,000
4,814,402
( 6?3,&14
( 492,457
(
-
( 110 000
...
(
1
1'
1
1
1
11,022,559
$ 4,112,586
4,114,132
( 322,000 1
>'<( 4.92,457 )
-
c 1
$<( 110,000 )
( 1
9,351,175
%ARP gave no specific recommendztions on these projects e
Region Central Eew York
Review Cycle 10/72
Type of Application :
Anniv er sar y b e f o r e
Tr i ennium
SARP
a Site Visit
lbting 779
Recommenda tions From
/x/ Review Committee
/i' Council
RECOMMENDATION: The Committee agreed with the site visitors in recommending
approval of the anniversary request for the 05 year in a reduced amount of
$889,000. This amount includes the continua tion of Project #6--Home Dialysis
Training Program with no increase in funding above its 1972 level. The
Committee paralleling the recommendation of the site visitors and outside
technical reviewers disapproved Project #38--Coopera tive Organ Bank with
advice to follow the Kidney Guidelines and develop a regional plan for renal
disease.
The recommended funding level would permit the region to actively recruit
a well qualified staff and at the same time not permit the program to be
overburdened by a large number of projects.  Committee also recommended
the scheduling of a Management Survey visit to evaluate and strengthen
the region's fiscal capabilities.
The total request and recommendation are as follows:
Year &quested Recommended
05 $1,420,349 . $889,000*
Critique - The SNkEWP has made a valiant effort during the past year  to
remedy the deficiencies noted during the 1971 site visit.
the year the program worked
arrangement for him and an even greater handicap to a program making
an attempt to bring about required changes.
The region has established new goals and objectives which are consistent
with national goals, but still fail to directly reflect the local health
needs.
but still needs to strengthen its representation to insure additional
imput from young providers, minorities, nurses and allied health members.
*Includes $16,000 for koject #6--Horne Dialysis Training
For most of
with an Acting Director which was a difficult
The RAG has been expanded to include more consumer representation,
$429,000 for recruiting and hiring an adequate program staff
$469,000 for support of project activities.
.
II
e
c
e
-2- .
Unquestionably, the program's highest priority is to fncrease its program
staff size.
health planners, nurses, fiscal managers .and workers in the allied health
areas. In the area of fiscal management, the program has an overriding
need to. strengthen its competencies in light of the unexpended funds
accumulated during the past year. The Management Assessment visit will
help the program to identify its problems in more specific terms and
will provide guidance to the implementation of possible solutions.
It requires competencies which can be provided by physicians,
In summary, the program did well during the past year in light of the
circumstances; however, it faces a need to correct many deficiencies
if it is to become a mature RMP. It must abandon its emphasis on the
"mini-contract"  mechanism and place its faith on acquiring a program
staff which is capable of generating and implementing a plan which will
address some of the region's pressing health needs.
seen as a year in which the CNYRMP acquires a program staff which is capable
of developing and implementing an integrated, coordinated group of activities
which will result in a solid RMP program in the Central New York region.
?%e recommended funding level has been carefully scrutinized and was broken
into two distinct categories, i,e., program staff and project support.
The Review Cownittee felt strongly that the CNYRPIP wouJd be well advised
to place its priorities in the coming year to these two categories in
the proportions indicated and to view the nepr future as a "staffing up
and planning" period. Implementation should be relegated to a point in
tine which comes after the program has acquired a program staff with a
wide range of competencies and has developed a sound plan for the future
programmatic efforts to be undertaken by the CNYPaP. In so far as possible,
they should avoid the "piecemeal" approach which charaterizes the mini-
contracts efforts .
The year ahead is
There was considerable discussion by the Committee concerning the site
visitors recommendations.
EOB/DOD 9/25/72
  COMPONENT AND FINANCIAL SUMMARY
ANNIVERSARY APPLICATION BEFORE TRIENNIUM
Component '04 Year
05 Year 05 Year
/-/ SAW /y/ Review Committe
f
$489,102
PROGRAM STAFF I ' $444,908
DEVELOPMENTAL COMPONENT
OPERATIONAL PROJECTS
1
Kidney
$889,000 combined
EMS
hs/ea
Pediatric Pulmonary
Other
r TOTAL DIRECT COSTS
- ~.
$850,000
*Committee does not
specifically discuss
these projects .
CENTRAL rn PORK
c
REGIONAL MEDICAL PROGRAM
SITE VISIT REPORT
August 9-10, 1972
I. Site Visit Participants
Consultants
Dorothy E. Anderson, R.N., M.P.H., Site Visit Chairperson, Review
George E. Scheiner, M.D., National Advisory Council,  Professor of
F. M, Simmons Patterson, M.D., Executive Director, Association for
Committee, Associate Coordinator Area V,  California RMP
Medicine, George town University
North Carolina RMP
, RMPS
-
Frank S. ksh, Acting Chief, Eastern Operations Branch
Robert Shaw, Program Director, DHEW Region I1
Nicholas Manos, Emergency Medical Service Task Force, Division o'f
Jerome J. Stolov, Public Health Advisor, Eastern Operations Branch
Professional & Technical Development
Central New York RMP
John J. Murray, Coordinator
Ernest Carhart, M.D., Medical Advisor
Sandra Anglund, Public Relations
Marjorie Jordal, Assistant Director for Administration
Walter Curry, Bnergency Medical System, Coordinator
Robert Wheeler, Ph.D., ENS Consultant
Nicholas Collis, U.D., Director Health Service/Education Activities
Ottilia Nesbit, Health Planner
Robert Schneider, Evaluator
Lawrence Polly, Audio Visual Maintenance
John Koch, Technical Assistant, Eearmtag Resource Center
Suzanne Murray, Librarian
Larry Rummel, Community Coordinator (Fast)
Micheal Reich, Administrative Assistant Trainee
CNYRMP Executive Committee
Clarke T. Case, M.D., Chairman, Physician (Surgeon) Private Practice*
Gordon J. Cunrmings, Ph.D., Rural Sociologist, Cornel1 University*
Horace S. Ivey, M.A., Director of Social Service Department, Upstate
Bruce E. Chamberlain, M.D., Physician (Surgeon) Private Practice*
* Central New York RAG Members
Medical Center*
-2-
. -2
Barbara Bates, M.D., Consultant, University of Rochester
Irwin K. Stone, M.D., Physician (Gen. Prac.) Jhergency Room *
Virginia McAllister; B.S., SUNY Agricultural 6 Technical College, -
Gertrude Cherescavich, Project Director of Nurse-Clinician Program
Betty Katona, Acting Nurse Coordinator
Helmon Rubinson, M.D., Physician Coordinator
Sister John Nicholas, lbrse-Clinician Student
Maryanne Miraglilo, Nurse-Clinician. Student
Benjamin Levy, M.D., Preceptor, N. Y. Telephone Co.
Robert F. McMahon, Preceptor, General Practitioner, Syracuse
Professor & Chairman, Department of Health Technology  *
CNYRMP Primary Patient Care Committee
McDonald Dixon, Foreman, Revere Copper & Brass, Inc. *
Herbert K. Ensworth, M.D., Physician (Internist) Private Practice/Ithaca *
Robert Gelder, M.D., Physician (Surgeon) Private Practice in Sidney,
Jerome Wayland Smith, Oneida Ltd., Silversmiths, Secretary of Company *
Robert Westlake, M.D., Chairman, Physician (Internist) Private
New York *
Practice - Syracuse * __
CNYRMP Regional Kidney Disease Meeting
B. A. Bernstein, M.D., Physician Private Practice - Syracuse
Dorothy Bruno, staff - Senator Lombardi - Albany
Paul Bray,  staff - Senator Lombardi - Albany
Thomas Flanagan, M.D., Physician, Private Practice *
Ron Fonda, Syracuse-Onondaga Planning Office
John Harding, M.D., Binghamton
Bucky Helmer , NY- Penn
Gerald Hoffman, Legislative Assistant - Senator Lombardi
Edward C. Hughes, M.D., RMP, Chairman Planning & Priorities Committee
A. 0. McPherson, Upstate Medical Center
Stephen Kucera, M.D., Johnson City
Otto Lilien, M.D., Department of Urology, Upstate Medical Center
Honorable Tarky Lombzrdi, ChiAirman, Senate Health Committee
Jason Moyer,  Medical Director - Binghamton General Hospital
Ms. Harriet Morse, Executive Director - Senate Health Committee
Zahi Nia Makhul, M.D., Department of Urology - SUH
Richard Schlesinger, CHP, ALPHA, Syracuse
Richard Schmidt, M.D., Dean, Medical School, Upstate Medical Center *
Edward T. Schroeder, M.D., RMP Project Director, Home Dialysis
Ronald D. Smith, M.D., Utica
CNY RAG *
Training Program
* Central New York RAG Members
-3-
11. INTRODUCTION
The Central New York Regional Medical Program (CMTSRMP)  site visit
was conducted following the receipt of their application for one
year's support in the amount of $1,420,349 direct cost.
application requests support or the continuation of six projects
and ten new activities.
ously been funded as nine separate projects and are now administra-
tively merged under two new project numbers.
The
Of the ten new projects, two had previ-
The charge to the site visit team was:
1.
To review the region's overall progress since the last site
visit in June 1971.
2.
To determine the newly appointed Director's role in program
direction.
3.
To determine how regional needs and resources are identified
and analyzed.
4.
To evahate the monitoring and surveill.ance of ongoing program
activities.
5.
To study the roles of RAG and its committees in program direction
and to relate them to the recently published RMPS policy governing
these relationships.
6.
To review the region's mini-contract activities and obtain
progress reports on those projects which have recently been
initiated as supplementary activities.
7.
To arrive at a funding recommendation which would include the
region's kidney activities as well as its general programmatic
activities.
111. Conclusions and General Impressions
The site visit team was fortunate in having three members who took
part in last year's visit.
had made many positive changes since the last site visit.
The site visitors noted that the region
The region has established new goals and objectives which are c.on-
sistent with national goals, but still fail to directly reflpct the
local needs. The RAG has been expanded to include more consumer
representation,but still needs to strengthen its representation to
include more input from young providers, minorities, nurses and allied
health members. The Becutlve Committee has also added consumers.
The team found the RAG Chairman to be dedicated and knowledgeable
about the total program.
-4-
-
The recently appoint,ed Director has generated a new enthusiasm
within the RMP and has been successful in achieving a greater
visibility for the program throughout the entire region.  The
program staff needs to be expanded.  It requires competencies
in the physician, nursing and allied health personnel areas.
The region has made a sincere effort to comply with the recorn-
mendations set forth in the 1971 advice letter. However, a
.?hysician Associate Birector has nut been appointed.
The team was favorably impressed with the CNYRMP's ability to
involve CHP "b" agencies as an aid to the program in its project
review and program planning.
While the site visitors noted the program's progre.ss and its new
direction, the following deficiencies and concerns were reported
to the region during the feedbacklsession.
1.
large enough to effectively implement a successful RMP program.
The following positions and competencies are recommended.
The site visitors Felt: that the present program staff is not
a.
b.
C.
d.
e.
A full-time physician in the role of an Associate Director.
In the recruitment process the program should attempt to
attract an individual who would bring strong administrative
and public relations competencies to this position. It \:-
,$' - -.
- '\
!
. ,I
was noted that the CNYRMP has successfully recruited a
Medical Consultant; however, his primary value is as a
family practice consultant and, as such, does not fill
the program's needs for strengthening its administative
and public relations capabilities.
There is a need for the recruitment of program staff  in
the roles of Assistant Director for Operations, an
Assistant Director for Administration, and an Assistant
Director for Program Planning and Development.    I
There is a need for a Nurse Generalist to aid the
Manpower Coordinator in the planning and development of
health service/education activities.
The utilization of community resources could be enhanced
by the hiring of a Community Coordinator for each of  the
area's subregions.
Evaluation is an important aspect of a successful RMP and
although this is currently being done, there is a need to
enhance this apect of the program's operations,  Consideration
should be given to the recruitment of an experienced full-time
Evaluator.
t 2  I.
i   _,
\
-5-
In summary, there is a need to enlarge the staff in a manner which
will provide the competencies outlined.
there should be an attempt to recruit minority candidates who can
provide the balance and insights which will be helpful in program
development.
communication link with the minority groups in the CMlRMp area who
have a-need for the benefits which can be provided through the
auspices of the RMP.
In the recruitment process
In addition, minority staff members can provide a
2. The site visit team recommends that no additional mini-contracts
be initiated. It was noted that these contracts required an
excessive number of program staif man-hours to monitor and evaluate.
In light of the small program staff, the efficiency of manpower
utilization must be optirnal  and in using the mini-contracts
approach, the manpower/dollar administrative costs appear unwarranted.
3.
specifically reflect the local needs of the region.
that the program systematically identify the needs of the region,
develop short and long term objectives to meet these needs and,
in the process, redefine its goals and objectives  in a manner
which more specifically addresses the region's pressing health
problems.
4. There is evidence that a programmatic thrust is developing in
one of the subregions; however, there is a need to coordinate the
relationship between program planning, operational projects, and
program staff activities to capitalize on these positive developments.
The CNYRMP's goals and objectives are broad and fail to
It is recommended
5.
from various sectors of the region. Specifically, there is a need
for greater representation from young providers, minorities, women,
and allied health personnel.
The RAG membership needs a greater balance to provide insight
6.
CNYW grant application packet.
scheduled for a complete analysis at a later date; however,  there
should be the immediate implementation of a formalized appeal
procedure for all grant applicants.
There is no formalized appeal procedure provided in the current
The region's review process is
7. Project 1/38, The Cooperative Organ Bank is disapproved. The
project, as presently conceived, demonstrated a lack of coordination
and integration with other renal activities and fails  to meet the
region's total needs for a kidney program.
8.
for continued support at its present level.  It was noted that the
goals of the training unit are not clearly stated and that the
project will not attain maximum efficiency until such time as this
has been accomplished.
Project 86, Home Hemodialysis Training Program is recommended
-6-
9.
New York.
In its present form the agreement of affiliation is to be with two
private phpicians rather than with a nonprofit corporation or
institution as required by grants management policy.
10.  The CNYRMP Bylaws fail to comply with the RMPS policy which
sets forth the respective roles and responsibilities of the grantee,
the RAG, and the program staff.
the form of a News, Information and Data (NID) publication on August
30, 1972 and has been sent to all regions.
the Council of the Upstate Medical Center is given the authority to
appoint RAG members upon the advice of the RAG.  The Bylaws require
modification to turn the authority for RAG member appointment over
to the RAG, thus making the RAG a self-perpetuating body.
Project #40, Satellite Clinics Serving Rural Areas of Central
I .C
This project is disapproved on administrative grounds.
This policy was formally issued in
Under the current Bylaws,
11.
capabilities.
future to evaluate the situation and to provide constructive
guidance.
of expenditures and the resultant lapsing of funds.
The region has a need to strengthen its fjscal management
A Management Survey Visit will be scheduled in the
The site visitors expressed concern over the low rate
Funding Recommendation
The site visit team recommends approval of the anniversary request
for program staff and projects in a reduced amount of $889,000.
The team recommended $429,000 for program staff salaries and
$460,000 for project activities.
amount would be sufficient to permit the active recruiting of a
well qualified staff and, at the same time,' not permit the program
to be overburdened by a large number of project activities.  The
site team is impressed with the program's need for an enldrged staff
which will increase its competencies to develop a solid program.
This must be the region's highest priority in the upcoming year.
__
It was believed that this
W: Central Bew Yak PREP. BY: Jerow stolov WTB: 10/p
1. GOALS, O-TIYEG, ABD PRIORITIES (8)
The region'e new goals and objective8 represent a new direction which
le consi6teat with the RUPS lat8S1011 statement; however, as noted
earlier, they do not reflect local health needs.  The objective8 were
developed by the Planning & Prioritlee Comdttee created in December
1971.  The Conrmittee waa chaired by I&. IMwarBp Hughes, Director of
Counnunity Medical Service (Hen York Medical Society).  Other mmbere
of the ComPaittee were choben because of their personal knowledge of
the region's health needs.  The Committee had repreeenLativc8 from
both coneumere and providers.  The CEP "13" and the CHP "A" agencies
were also invited to participate In the formulation of the region's
new goal8 and objectives.
The Planning &Priorities Committee wed the foll0~1~ basis for the
formulation of the gosla an8 objectives:
1.  The data arrde available at the RAC) meting of December 2, 1-971.
2. The stated goale and priorities of the CHP "A" end Crrp "B"
  agenciee.
3.
Mini-contract proposals which had been submitted by health pro-
fessionals.
In the region perceived to be their problem areas.
This procedure enabled the region to see what people
4. Tbe Elwps d80iOn statement.
5.
Data provided by the Community Medical Servicee (New York Medical
society) o
On bfarch 2, 1.972 the following goals and objectives were approved:
1.
"Improvement in the eystem of health care del.ivery by asslating
in the evaluation of existing health systems and in the develop-
ment and evaluation of potentially effective alternative health
care Byatenre with p8rticuLar attention to the rural, inner city,
and elderly medicelly dleadvantaged . "
2. "Increasing the aVt%llabllity, efficient utilization and capacity
  of health care permanel while providing for their continuing
  competency. ''
"Strengthening regional cooperative errrallgements in order to
make mximmn we of available resources."
3.
RMP: Central Hew York RW?ARED BY: Jerome Stolov DATE: lO/P
Although these objectives are listed in priority order, the Planning
and Priority Committee hopes to formalize explicit priorities by the
end of the calendar year.
In addition to a lack of explicit priorities, the site visit team
found no evidence that the program had establiehed short or long,
tem goals.
The final statement of the goals and objectives was mailed to 5000
health professionals in March 1972, at the time the requests for
grant applications for 1973 were circulsted.
of intent were submitted.
the CIYRMP's goals and objectives.
health providers had Under8tOod and eccepted the region's program and
8 further indication of the broad nature of the stated objectives.
     Approximtely 57 letters
This was an indication that the
Of these, only 15 failed to fall within
h examination of the CayRMp grant application reveals  that 52% of
the region I s requested operational activities 8163 directly related
to their highest priority objective of improving primary patient
care for the medically deprived rural, inner city and elderly
_-
__
t. * -
---
residents of the region.
The region has msde an honest attempt to revise its goals, obJectives,
and priorities; however, it has been handicapped by the resignation
of' ita former Coordinator, operstlng for the better part of the year
with an interim Coordinator, a smll staff, a RAG which requires
restructuring and a number of other disadvantages which have combined
to mke progress difficult.  Now that the new Coordinator has been
named, the situation should begin to stabilize and the coming year
should see the evolution of more specific and more meaningful goals
and objectives.  Once this h8s been accomplished the program should
begin to take on a more positive outlook.
Recommended Action
-3-
IYI u
RMP: Central Hew York PRBARED BY: Jerome Stolov DCITE: lo/=
It should be recognized that this program had only three professional.
stPrff members for most of the year abee the Last site visit; however,
the site visitors were able to daentify BOW noteworthy accomplishments.
'phe RbfP's new Spanish-speaking Eealth Qhmer worked closely with the
H-Perm EX) Coordinator and Model Cities: staff in Bingbmton.
work resulted in tire: development of 8 proposal to Mode1 Cities to
fund an Ambulatory Care Clinic.
Her
The Library Coordinator stbulated hospital8 to apply for library
improvement grants.
each received $3,000 $rente.
As a result of her efforts, three hospitals
The Emergency Medical System Consultant developed an Icforlmation Guide
to be used in working with the New York S=kbte Bureau of Emergency
Service8 and the CEPs in the development of local and regional plans
for the delivery of Eaerrgency Health Services.
IPhe C!RYRMP program staff gbnned and tmplemented two training programs.
"he purpose of the first progrcbrn, &dieation Education Program,
to update nursing home personneL with respect to the proper utilization
of recently developed medicationfie
in Beptember l9'/", and will address itself Lo the training of nursing
honu? personnel to enhance their skills as activities Leadere.
Som? activities initiated by the CNYRMP have been extended or repli-
cated throughout the region.
Pulaski Model Rural Ambulatory Care Center, operated tn conjunction
with the Family Practice program at St. Joaeph's Hospital in Syracuse,
is being replicated by the C. S. Wilson Hospital. in Johnson City,
New York.
hensive rural health care system at Baoner-Keseon Hospital  in
Susquehanna, Pennsylvania. Thisp development is a tribute to the
efforts of the QJYRMB to move its expartbe to areas outside Syracuse.
The second program will take place
0
The etts visit team noted that the
This hospital has submitted a proposal to create a compre-
The Nurse-Clinician program @rrovides another example of a project
being extended throughout the region.
of the first class were from Syracuse while less than ona-fourth (22%)
of the participante in the second clam came from Syracuse.
regionalization aspect of this program effort was viewed positively
by che dice visitors.
Two-thirds of the participants
The
- 10-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
2. ACCOMPLISHMENTS AND IMPZEMENTATION (15) (Contd)
In addition, the region plans to work with the other New York State
RMPs in such joint efforts to enhance its activities in public
relations, program evaluation, and cancer registries.
A unique coordinating board has been developed in which the RMP
program staff and members of the NY-Penn Health Management Corperation
work together to insure integration and cooperation of all planning
and implementation of programs in that subregion.
CNYRMP is fulfilling, in part, its role as a coordinating health
agency. I
In this way the
A mini-contract has been given to the Neighborhood Health Center in
Utica.
to inner city residents and in moderating health costs by providing
primary care outside of a hospital emergency room.
only other alternative left to theae inner city residents.
This has resulted in making health care more readily accessible
This had been the
The Pulaski Rural Ambulatory Care Center has increased the availability
and accessibility ot care for people living in Northern Oswego County.
Many of the 200 patients per week which are seen in this center had
formerly been patient8 of a Pulaski general practitioner who is now
ret ired.
The Librarian, EMS Consultant, and Health Planner have given pro-
fessional aseistance to those people in the region who have requested
their help.  For example, the Medical Consultant, who recently joined
the CNYRMP, is providing professional assistance and consultation to
those engaged in family practice care.
Up until now, the CNYRMP has not been involved in peer review mechanisms
and has not specifically examined the quality of health care being
rendered in this region.   However, the minutes of the Executive
Committee meeting held on May 25, 1972, states the following:
Executive Committe directed the staff to consider the problem of
quality of care as a priority for the next program year and to direct
efforts of the program staff in the establishment of means of measuring
quality care and upgrading that care when it is found inadequate."
In light of this mandate, the program can be expected to address this
aspect of health care in the near future.
"The
--------------
Recommended Action
-11-
RMP: Central New York mPARED BY: Jerome Stolov DATE: 10/72
3. CONTINUED SUPPORT (10)
All proposals submitted to the ClDYRMp must give evidence of possible
sources for continued funding. In the course of examining the
projects preeently being funded, the site visitors observed that
during the evaluation of the Nurse-Clinician project, the phasing in
of tuition was strongly emphasized.  The Model Rural Ambulatory Care
Center is expecting that patient fees and local fund raiaing will
aid in phasing out RMP support for this activity.
of funds i8 being accomplished and the need to accomplish this is
recognized by the region.
Thus, the recycling
On the negative side, the site visitors noted that the Dial Access
project will not be self-eustaining since it is having problem in
finding sources of continued support.
find alternate mans of supporting this activity or will need to
accept the fact that it has failed to demonstrate its value to the
uiera.
The region will be forced to
The St. Regis Reservation Clinic, Project #31, has not shown evidence
that the CNYRMP staff has adequately negotiated formal agreements
with funding institutions which define the extent of their present
and future participation.
avoid problems which can arise when there are misunderstandings of
responsibilities and authority.
A major problem which ha8 confronted the Home Dialysis Training project
has been its lack of 8ucce8s in locating financial support for each
patient .
%is must be done if the region is to
Of the sixteen proposals submitted for funding, very few had realistic
plans for continued support.
reviews. For this reason, the region faces a true need to recruit
a full-time staff person who is skilled in administrarive negotiations
which will result in the acquisition of continued support for  the
worthwhile activities initiated in the region by the RW.
This was a mjor factor in several CHP
- 12 -
-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
4. MINORITY INTERESTS (7)
As mentioned in the section on goals, objectives and priorities,  the
number one priority of the CNYRMP relates to improving the system for
health care delivery to rural, inner city, elderly medically disadvan-
taged, and etc.  To accomplish this, the region will need to add
minority members to ita ataff  who
necessary to work wtth the mQnority groups.
will bring the insights and Linkages
The population of the entire 17 county region is about 3% minorities.
The site team observed that only three out of 17 mini-contracts were
targeted to the inner city populations, while the majority of projects
appear to serve rural residents.
The CNYRMP has not significantly improved the quality of care delivered
to the black minority populationa.
priority project was the St. Regis Reservation Health Clinic for
Indians.
However, the region's highest
An example of RMP supported activities that resulted in training members
of minority groups was the funding of the training of a nurses aide
and a LPN for the Utica Neighborhood Health Center.  The St. Regis
Reservation Clinic, Project #31, also has a training component far
local manpower development from among the local Indian population.
In January 1972, a Spanish speaking Health Planner was added to the
CNYRMP program staff.
model city agencies, community action programs, and the Spanish
Action League.  She has also made contact with the Mohawk Nation
which resulted in CNYRMP funding a mini-contract to this group.
is fair to assume, baaed on her early accomplishments,  that this
staff member will make a significant contribution to the future efforts
of this program.
Her assignment was to work with consumers,
It
As of June 1, 1972, the Central New York professional program staff
had three females and three male members. One of the females
represents the Spanish speaking minority group.
-13-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
The present Director has been with the CNYRW since 1968; however,
he has only been in hi8 new position since July 1,  1972.
October 1, 1971 through July I, 1972, he waa serving as the region's
Acting Director.  While he was the Acting Director he was successful
in expanding the W's minority membership and in gaining the appoint-
ment of the directors of the region's three clpp "by' agencies to the
RAG.  He employed a management consultant to help him develop an
organizational chart which was consistent with the new CWYRMP direction.
In this process the duties of program staff membems were! redefined
through the development of job descrfptions.
for several of the staff memhers and provided ti guide to the type of
competencies the program needed to seek in ice future recruitment
effort 8.
From
This resulted in changes
A paragraph in the annual report of the RAG statea, "John Murray,
Assistant Coordinator, WBI named Acting Coordinator and hrre done a
remarkable job in adapting our program ro the evolved E;zpzR national
mission, as well as local neede. He ha8 instilled in ell of us a
new enthusiaem for IMP.*'  It was apparent that he had acquired  the
respect of the local health community and, on this basis, was appointed
to the role of Director in July. The stte visitors were concerned
because he has failed to establish an effectively functioning program
staff.
authority and his etrategy in not filling the Associate Director,
Assistant Director for Program Planning and Developant and the
Assistant Director for operc3tions positions.  The Director planned
eo consider existing program staff aw potential candidates  for the above
positions.  The team felt that the program needed these positions  filled
with well qualified health profesaionale in order to establish an
effective staff. On the basis of the Coordinator's viws toward the
delegrrtion of authority and hie failure to seek highly experienced
health profeesionele for the key program positions mentioned, the
site visitors believed there is a need for the Director
his approach and to attempt to strengthen the progxam through improved
adminis tre t ivo pracedurtnr
The visitors questioned the Director's failure to delegate
The Director's good working relationship with RAG la actested to by
the fact that the RAG'S Ad Hoc Selection Committee nominated him to
be the program's  DireCtorv, and the full RAG utieaimusly voted to
approve this nomination.
In summary, the site visitors viewed the kb3ctoFL. with ambivalence.
-14-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 r
5 COORDINATOR (10) (Contd)
They perceived him as a man who related well with people, groups, and
institutions throughout the region and, in so doing, represented the
CHYRMP in an excellent fashion. On the other hand, they saw him as
a man who lacked the managerial skills to recruit and properly utilize
the program staff.
Assistant Director for Operations who could effectively build and
properly utilize the staff.
This reinforced the need for an "in-house"
6. PROGRAM STAFF (3)
The former Director and many of the staff have left in the past year.
This has left the program vastly understaffed.  Both the new Director
they have carried in recent months.
it is impossible for them to continue at this pace.
the top priority this program faces is the enlargement of the program
staff with qualified individuals to fill the key staff vacancies
which have been mentioned repeatedly throughout this report. The
site team nored that a physician associate director has not been
appointed' as recommended in the 1971 Advice Letter.
=..
_i
. -4
and his remaining staff are to be commended for the heavy work load
_.
_x
It is also quite apparent that
Unquestionably,
The team learned that at the present time a member of the program
staff has been designated to serve in the dual roles of Assistant
Director of,Operations and Coordinator of Emergency Medical Services.
This practice is contrary to RMPS policy and is obviously too much
for one man to handle effectively.  In addition to those positions
requested by the region, the site visitors recommend that consideration
be given to hiring a well qualified nurse and an allied health pro-
fessional  to balance the range of competencies of the program staff
which is expected to carry out a bcoad-based public health program
consistent with its stated goals and the overall mission of the RMPS.
Recommended Ac t ion
-15-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
7. REGIONAL ADVISORY GROUP (5)
The present CNYRMP RAG breakdown is as follows: 13 practicing
physicians, 14 members of the public at large, 7 hospital admin-
istrators, 5 educators, 4 government officials, 3 CHP "b" agency
directors, 2 lawyers, 2 nurses, 1 dentist, and 1 head of a social
service organization. The RAG has good geographic representation.
There are five minority members on the CNYRMP RAG.
program goals,  there needs to be greater representation from these
groups.
fifth member is a representative of the Spanish-speaking community.
There are no Indian representatives and this must be corrected in light
of the program's need for input from this segment of the population.
The site visitors also noted that there,were only three female
members on the RAG and felt that this should be increased. The
Binghamton Model City Agency, the Oswego County Migrant Health Care
Committee, and the Community Action Program of St. Lawrence County each
have representation on the RAG and this was viewed as an excellent
means of getting inputs from throughout the region.
In light of the
Four out of the five minority RAG members are black;  the
Four of the five minority members serve on CNYRMP Technical Review
Committee
Minority representation on the Executive Cornittee needs to be
increased.
and one minority member serves on the Executive Committee.
With the establishment of a new Planning and Priorities Committee,
along with a new Review and Evaluation Committee, more RAG members
are going to be more directly involved in the decisionmaking.
increased involvement and dec ent ra li za t ion of the dec is ionmaking
process was viewed as a step in the right direction.
This
The Executive Committee meets bi-monthly and not  less  than one week
prior to each RAG meeting. The recommendations of the Executive
Committee are presented to RAG and are subject to questioning and
reversal by the RAG.
in the program and, as such,  is an aid to enllghtened actions which
will strengthen and coordinate the program's activities.
The RAG Chairman is knowledgeable and involved
The site visitors learned that the RAG exercised its authority in
at least one instance by approving a project which had not been
recommended for funding by the Executive Committee.
The site visit team was unable to determine whether the RAG provides
guidance to the program staff.
man of the RAG is in telephone contact with the CNYRMP Director.
Hywever, it was noted that the Chair-
-16-
e-...*-
-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
.-.
7. REGIONAL ADVISORY GROUP (5) (Contd).
on a weekly basis.
and the Director
established a bridge beeween two segments of the CWRHP which will
enable them to work in a more coordinated fashion.
This close communication between the RAG Chairman
was viewed- as constructive in the sense that it
..
The reorganization of CNyRMp's EUG resulted in the establishment of
the following standing committees:  Nominating, Executive, Planning
and Priority, Evaluation, Manpower, Primary Patient Care and Coordi-
nating Eoard for the NY-Penn area,  In addition to the standing
committees there are Ad Hoc Committees on matters related to kidney
disease, emergency medical services, and cancer.
In'summary, the RAG has undergone some dramatic changes during the
past year and has made some prcgress; however, there is still a long
way to go to acquire a KAG which can effectively fulfill its mission
as defined by RMPS.
the News, Information and Dara (NID) bulletin issued by RMPS on
August 30, 1972 should serve as the guide to the future efforts to
revitalize this body
Tfie process of restructuring must continue and
-I
-_
-------
8. GRANTEE ORGANIZATION (2)
The Research Foundation provides support through the Upstate Medical
Center Business Office in the areas of purchasing, personnel, and
grants administratton.  They kave also assisted the region by giving
special assistance in areas stich as mini-contrac t formulation and
negotiation.
Office more for additional legal advice, personnel recruitment,
preparation of salary schedules which are consistent with the job
descriptions which have emerged on the new organization chart as a
result of the management consultation which had been contracted to
study this aspect of the program.
"lie region plans to utilize the Upstate Medical Center's
The bylaws, however, need t:, rake into account the recently formalized
relationships required by RNPS between the grantee and RAG.
has been forwarded to all regions in an August 30, 1972 issue of News,
Information, and Data (NLD). According to the RMPS policy, the RAG has . .
the responsibility of selecting and appointing its own members. The
current bylaws specifically give the Council of Upstate Medical Center tht.-, '
responsibility to appoint RAG mvnbers and this must be modified.
%is policy
r.
--------------------_____________^_____
-17-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
9. PARTICIPATION (3)
The CNYRMP Program Director meets with staff and board members of
the four CHP organizations in the region on a monthly basis  to
discuss program activities and plans.  Both the Binghamton and
Syracuse Model Cities agencies electedme delegate each as members
to the CNYW RAG.
Board of Directors of the Community Action Programs. Many CNYRMP
RAG physicians serve in official capacities in various committees
of the New York State Medical Society.
Still another indication of participation is the 134 applications
which were requested for the mini-contracts and the 57 letters of
intent which were actually submitted to the CNYRMP. In previous
years, proposals numbered from 5 to 10 per year.
contracts, although they have many drawbacks, do serve to involve
and interest more people in the activities of the program.
In addition, there are also members from the
The use of mini-
Although four out of seven members of the Executive Committee are
from the Syracuse area, the mini-contracts and proposed projects
which were approved for funding resulted in a prograrc with geographical
balance. No major interest group appears to be exercising arbitrary
control over the program's activities.
e
..............................................
Recommended Action
10. LOCAL PLANNING (3)
When the RMP receives an inquiry or letter of intent for a proposal
the CHP is immediately contacted.
both the RMP and the local CHP planning groups to further develop the
proposal,
the representative CHPs for them to review in light of their
role in regional health planning.  In the past this procedure was
carried out in the month preceding the submission of the CNYRMP's
annual application; however, the CNYRMP is currently attempting to
give the CHPs and their om RAG more time to act on CHP comments by
having the proposals reviewed on a continual basis throughout the year.
Joint: meetings are then held with
When the proposals are completed, the request is sent to
-18-
c
-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
10. LOCAL PLANNING (3) (Contd)
The CNYRMP plans to work closely with the local CHPs on a major
project for gmergency Medical Services.
recently been provided to the CNYRMP to conduct such an activity.
The current plan is to contract with the local CHPs for setting up
EMS councils and hiring local EMS Coordinators. It is interesting
to note that the region hopes to utilize this project effort as a
vehicle for the establishment of a CHP "b" agency in an area which
does not have one at this time.
Supplemental funds have
There is evidence to suggest that the CNYRMP has been successful
in its attempts to gain participation from other health agencies
in the region.
c.
. ..<
-r
-_
.". I '
Recommended Action
-1
.F ,
' ... . .
. . ...,.
. . ,
~. i,' :
..
. :.<.a
, .-,
..>,-
- 19-
RHP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
11. ASSESSMENT OF NEEDS AND RESOURCES (3)
As cited in the section on goals and objectives the region uses  five
sources to identify its regional and subregional needs.
the site visitors failed to see haw these sources of identifying
needs could be integrated to provide the information required to
generate a well directed programmatic thrust. In addition, the site
vieitors found only a few examples of present program staff activ-
ities which were in anyway related to the health care problems which
had been identified by the five input sources.
the recently established Planning and Priorities Committee will be
able to synthesize this information in such manner that they will
be able to establiah priorities and refine the objectives in light
of the current information. ThLs is crucial to the CNYRMP if it
is to be successful at re-orienting ita program SO that  it can
effectively implement activities which will alleviate the region's
amst pressing health needs rather than continue to pursue the path
of doing "good works" in a fragmented, isolated, and uncoordihated
f ashion.
However,
It is hoped that
The region also plana to recruit four cornunity coordinators for
its dysignated subregions and also a health system planner.  It is
hoped that the above personnel will help in the assessment of needs
and in the identification of resources, so the program can develop
a rne&ingful plan of action for the program's future activities.
12, MANAGEMENT (3)
With the small staff that has been available to the  Director,
CElyRMp ha8 bean engaged in an impressive number ot ectivities.
the sire visit team obaerved that program staff activities did not
appear well coordinated.  It was observed that the Learning Resource
Center personnel and the Librarian were people who could have been
used to assist the manpower coordinator in hi8 tasks. There were no
indications that such a working relationship existed or was developing.
the
However,
-20-
RMP: Central New York PBEPARED BY: Jerome Stolov DATE: 10/72
12. MANAGEMENT (3) (Contd)
As was mentioned in the section related to the Coordinator, the
proper utilization of staff appears to be one of his major weaknesses.
It is hoped that experience and confidence will help him to improve
his management skills.
The region requires a monthly financial report and a bi-monthly
progress report.
and semi-annual progress reports.
aid the program to have current fiscal data which can be used for
effective rebudgeting and enhancing its capabilities to capitalize
on opportunities to move rapidly into activities which will advance
the program.
balance of $417,339 which speaks to the
management capabilities.
In the past they required quarterly financial reports
This procedure should eventually
However, at this time, the region has an unexpended
need to improve its fiscal
Each project and mini-contract has been assigned to a program staff
member.
contract when the initial letter of intent was received. In addition,
the staff member arranges for technical review and is also required
to give the results of the technical review back to the project
director and to assist him in making changes which are required as
a result of the review process.  This approach places a heavy work-
load on each staff member and prohibits him from utilizing his time
to assist in program planning and development.  It is on this basis
that the mini-contract approach is viewed as an ineffective approach
to project development by this region at this time;  It reduces staff
to a role in which they are forced to react rather than act on matters
related to program planning and development. Further, the volume of
contracts under review results in a workload which tends to delete
staff time to the point that activities can become fragmented, disjointed,
and uncoordinated rather then syntherieed into a solid program which
addresses the region's needs.
The program staff member was assigned to the project'or
Job descriptions have been developed without stating the requtred
qualifications,  It was noted that the Assistant Director for
Administration was appointed to this position and there are indications
that she does not have the qualifications and abilities to perform
effectively in this role. This is evidenced by the fact that the
program has accrued $417,339 in unexpended funds during the past year.
The team consequently recommended that a Management Survey Visit be
scheduled early next year to provide the region with constructive
assistance in the handling of its fiscal management activities.
-21-
RMP: Central New York, PREPARED BY: Jerome Stolov DATE: 10172
.13. EVALUATION (3)
The site visitors observed that the region followed last year's advice
and designated a program staff person as its evaluator.  However,
the training and experience of the evaluation director was  in the
field of education and not in analysis. The CNYRPIP RAG report recog-
nizes the program's weakness in this area by stating the following:
"Evaluation has been an extremely difficult problem for this W,
although we believe that the problem is shared by many others through-
out the region.  We are hopeful our two-pronged effort to correct
this problem will bear fruit:  (1) Reorganize our Evaluation Committee
along subregional CHP area lines and involve RAG members on site
visits; (2) Institute an interregional RMP effort in evaluation,
spearheaded by our organization, to bring standardization and more
expertise to all of the evaluation efforts in the Upstate New York's
The site visitors expressed concern that only one project had been
evaluated prior to the RAG'S approval of the submission of the
CNYRMP's annual application to RMPS. Although, the visitors recog-
nized the evaluation of the Nurse-Clinician project, it was felt this
procese should have been done prior to the deadline for submission,
The evaluation of this activity was viewed as quite superficial and,
in fact, was no more than pzogress reporting and discussion.
0
The new charge to the Review and Evaluation Committee is to eite visit
each project twice during a 12-month period.
jects, the Committee must also assees program staff activities and
RAG functions. A task and a timeline plan for the Review and Eval-
uation Committee has been established.
In addition to the pro-
The region is to be encouraged to implement the plan of the Evaluation
Committee as portrayed in the task end timeline chart given to the
site visitors. There is also to be involvement of total staff in the
evaluation process, so that all proposals can be conrtnuously evaluated
for continued funding or termination.
is quite poor; however, there are signs that the future will see a
substantial improvement if the current plan is successfully implemented.
The track record for evaluation
-22-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 t
14. ACTION PLAN (5)
As stated earlier, 52% of the project requests are related to the
CNYRMF's first objective, to improve the health care delivery of the
rural, inner city and the medically disadvantaged,  but there is a
need for greater community involvement and commitment.
The site visitors felt that the newly proposed activities were not
realistic in view of the types and numbers of program staff presently
on board.  They further felt that theutilization of the mini-contract
approach was unrealistic at this time and, in a sense, placed the
cart in front of the horse. In this approach the RMP was asking the
region-at-large to develop its program rather than developing its own
program which it could present to the region's residents for their
ratification.
program is viewed as rightfully originating from the RAG members who
should represent the region's health interests and not directly from
people in the region seeking financial support to "do his thing"
through a mini-contract.
In view of the region's iequest to recruit ten key program staff
members and recognizing that their planning and evaluation
committees are undergoing reorganization, the CNYm's application
which requests funds to manage 16 projects and 20 mini-contracts
appears to be more than they can successfully accomplish during
the next program year.
on "Projects'' and does not involve the implementation of a
coordinated, integrated program.
The region's involvement in the formulation of the
-
Most of the current action plan is focused
In summary, it appears the region needs to find a new approach to
program development and it is hoped that new staff will alleviate
the need to look for short-cuts and will permit the development of a
well constructed action plan which effectively and methodically
attempts to alleviate the health problems of the region.
Recommended Action
15. DISSEMINATION OF KNOWLEDGE (2)
An example of program staff disseminating skills is represented by
the work of the Library Coordinator. Requests for inter-library
loans were increased to 5,127 or 56.5% over the previous year. The
Biomedical Communications Network handled 343 computer searches or
-23-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
15. DISSEMINATION OF KNOWLEDGE (2) (Contd)
or 64.9% more than last year.
throughout the region some of  the means they might employ in order
to obtain additional funding to enhance their operations. Three
hospitals have received National Library of Medicine improvement
grants as a direct result of  the work and training done by the
CNYRMP Librarian.
She also taught hospital persounel
16. UTILIZATION OF MANPOWER AND FACILITIES (4)
Increasing the availability, efficient utilization, and capacity of
health care while providing for continuing competency is a major
objective of the CNYRMP. Several projects, namely, the Generalist
Nurse Practitioner Training Program, health service/education
activities, medical emergency technician training and Health
System North directly address this objective. These projects
represent 34% of the total requested project funds.
Examples of approved mini-contracts for the current funding year
which include the utilization and/or training of allied health
personnel are:
1)
Creation of a Neighborhood Health Clinic (an LPN and a
community worker/nurses aid was hired with RMP funds).
2) Training professionals and paraprofessionals to work as
a team in remotivation and reality orientation.
3) Geriatric Day Care Center.
4) Homemaker service for the Madison Company.
5) Establishment of satellite medical centers.
6)
Expansion of Volunteer Childrens' Clinics to rural areas.
7)
Comprehensive Home Care as a follow-up to Pulmonary
Rehabilitation.
-24-
-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 ;
16.
UTILIZATION OF MOWER AND FACILITIES (4) (Contd)
It is difficult to determine how much these activities will benefit the
population in underserved areas.  In an attempt to reach the underserved
areas, the region is setting selectivity standards or applicants to the
Nurse-Clinician Program,
applicants from rural and ghetto areas wifl receive high priority in
terms of being the beneficiaries of the training provided in the Nurse-
Clinician Program.
The region through its health service/education activities is attempting
to involve the health education institutions.  The site visitors learned
that CNYRMP is involving the Maxwell School of Government by having its
Masters Public Health Administration candidates participate in evaluation
and planning studies.
School is commendable, providing the staff can adequately supervise this
endeavor.
These standards will attempt to insure that
The idea of training interns from the Maxwell
A bibliography on geriatric patients with chronic respiratory disease
has been assembled by CNYRMP staff.
Overall, the region is making a sincere attempt to utilize existing
manpower and facilities and, in this instance,  the mini-contract
approach may have been somewhat helpful to them in their efforts.  On
the other hand, the approach to this problem is handicapped by the
shortage of program staff and the need for a more systematic approach
which a larger staff could make possible.
17. IMPROVEMENT OF CARE (4)
The CNYRMP has utilized studies and data supplied by the CHPs.
ALPHA CHP "b" agency, for example, has established improved ambulatory
care as its main priority.  Both proposals, #19 - Pulaski Model Rural
Ambulatory Care Center and P40 - Satellite Clinics Serving Rural Areas,
address the problem of improving ambulatory care which the CHP agency,
from its vantage point, recognizes as the area's major health problem.
The
-25-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
17. IMPROVEMENT OF CARE (4) (Contd)
Attempts to exploit transportation services are best shown by the
CNYRMP mini-contract to the Geriatric Day Care Center in Canton.
This proposal has enabled the contractor to bring patients to and
from the day care center.
this area.
resolved by the CNYW intervention.
on this effort.
        There is no public Transportation in
Thus a simple, but highly significant problem has been
The CNYRMP should be commended
'Jhe CNYRMP is currently working with a Neighborhood Health Center in
Utica, the Pulaski Model Rural Ambulatory Care Center and  the Rural
Urban System of Health Care in an attempt to amplify the capabilities
of each of these programs to being better ambulatory care to the areas
they are serving.
18. SHORT-TERM PAYOFF (3)
The St. Regis Reservation Clinic appears to promise early access to
improved health services within the next year.
already making additional services available to its rural population
and is receiving assistance from the CNYRMP in this effort.  It is
too early to evaluate the impact the Nurse Practitioner Training
Program will have on moderating costs of health care; however,  it
appears that this effort will add to the efficient utilization of
personnel and result in an increase in the accessibility and availability
of health care services in the region.
There is reason to believe that the EMS project will enhance the
availability and quality of health care in the next two or three years.
The region has already begun activities which are designed  to attract
individuals and agencies to participate in its Bnergency Medical
Service (EMS) project. It is hoped, that through involvement in the
EMS activity, the people and organizations in the region will develop
linkages with the CNYRMP which will result in additional activities
which can be worked on in cooperative fashion.
The Pulaski Clinic is
In the overview, the CNYRMP has been making a contribution to the
improvement of care in the region; however, this contribution will
become more significant as the program continues to restructure and
-26-
-
RMP: Central Mew Pork PREPARED BY: Jerome Stolov DATE: 10/72
, 18. "SHORT-TWM PAYOFF (3) (Contd)
increases the size and competencies of its program staff.
riding problem faced by the CNYRMJ? is the shortage of program staff
and, until this is resolved, the programmapic efforts will suffer.
Under the staffing circumstances this program has faced during the past
year, the accomplishments in this area are commendable.
Recommended Action
The over-
~~~__~~__~~~_~~~~_~~____,,,,,,,,,,,,,,,,~'~~~~~
-27-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
19. REGIONALIZATION (4)
Both the EMS project and health services/education activities are
examples of activities aimed at multiple provider groups,
the Nurse-Clinician project is located in a single provider insti-
tution, the students come from all parts of the region.
Although
The CNYRMP plans to assign program staff to each of the four CHP
subregions.
will be in a position to encourage sharing of facilities and manpower
on a regionwide basis,
These coordinators, by proper exchange of information,
The Health System North project is an example of how new linkages
are being established with the University Health Science Center in
Syracuse by providing for an on-going rotation of medical students,
interns, and residents throughout the CNYRMP's northern area to
provide health care in a section which is particularly short of
physicians.  This has proven to be an effective means of providing
health care services to the underserved residents of this isolated
portion of the region.
New linkages between northern Oswego County and St. Josephs Hospital
Health Center in Syracuse, and between the rural Susquehanna County
in Pennsylvania and C. S. Wilson Hospital in Johnson City, New York
are also being established. The region believes these preliminary
negotiations will assist it to extend its program more effectively
throughout the region in the future.
The EMS project is expected to create a regionwide and ultimately
a statewide network for communication and transportation for the
enhancement of Emergency Medical Services and Ambulance Transportation
Centers throughout all of New York.
The region appears to be making headway in the extension of the
benefits it can bring to the Central New York area.
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 -
20. OTHER FUNDING (3)
The CNYRMP has attracted other funds when planning Project #46,
Health System Notth.
summer fellowship program because RMP funds could not be used to
pay for this type activity.  As mentioned earlier, three hospitals
have received National Library of Medicine improvement grant funds
as a result of assistance provided by CNYW staff.
The E. J. Noble Foundation paid for the
The team, however, was disappointed to note that several of the
new projects being proposed appear to be mere extensions of
activities normally conducted by other agencies.  In spite of this,
the CNYRMP approved them for RMP funds.  For example, Project t28,
The Well Baby Clinic and Project 845, A Coordinator for the Spanish
Speaking Coummunity, appear to be services that should be provided
by the County Health Department and the County Mental Health Board
respectively.
be in need of closer contact with RMPS and to become more familiarized
with the specific nature of the RMPS mission.
The Dial Access project is being terminated in September 1972.
from the CNYRMP staff indicate that the hospital is exploring other
governmental or commercial sources of funding; however, it does not
appear that this program will be able to become self sustaining.
Once again, it is possible to speculate that this project could be
sustained if the CNYRMP program staff was sufficiently large and had
the competencies required to provide the necessary assistance to the
project director to help him find alternate sources of support.
has apparently been a useful service to the region and may be the
victim of inadequate RMP staffing.
Thus, the CNYRMP program staff and the RAG appear to
___
Reports
This
The Nurse-Clinician Training Program, which is entering its second
year of CNYRMP funding, has been encouraged to charge tuition for the
training being rendered and thus become independent of the need for
RMP support.  It is hoped that this can be done successfully so the
activity will not collapse when RMP funds are withdrawn.
The development of the St. Regis Reservation Clinic gives no evidence
of having generated funds from any sources other than W.
Dialysis unit is also failing to meet its funding needs because there
has been no success in having the A. C. Silverman Hospital incorporate
the expenses of the unit into its per diem rate.  The CNYRMP, in light
The Home
-29-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
20. OTHER FUNDING (3) (Contd)
of the failure to secure the backing of the A.  C. Silverman Hospital,
is attempting to organize a Dialysis Buyers' Cooperative as an aid
to renal patients.
There is concern over the Pulaski Rural Model Ambulatory Care Center
which has been funded by the CNYRMP for one year.
to generate patient fees. It is encouraging to note that a local
fund raising program has provided some funds and that five acres of
land have been donated to it.
major funding problem still remains unresolved.
It has been unable
These are temporary steps and the
The mini-contracts, on the other hand, as a precondition to funding,
have been generating other private, local, state and federal dollars.
For example, one mini project is utilizing National Health Service
Corps personnel to provide family centered primary medical care is
also receiving CNYRltP support.
Overall, the CNYRMP has not been successful at acquiring other sources
of funding for projects they have initiated.
program addresses the need for administrative/fiscal competence and is
successful in bringing this expertise to bear on the development of
projects in their formative stages --- the ability to sustain activ-
ities will be limited, as is now the case.
Until such time as the
Recommended Action
,
-30-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72 o
Renal Disease Activities
The CNYRMP has funded the Home Dialysis Training program, Project #6
and two feasibility studies which are currently in operation.
requesting support to initiate Project 822, Cooperative Organ Bank
of Central New York.
It is
The Dialysis Buyers' Cooperative feasibility study was found to be
lacking specific objectives.
working relationship between the patients and a local Kidney Foundation.
At this time, the region lacks a Kidney Foundation and an effort should
be made to encourage the establishment of such an agency which once
established, could be helpful to the region's entire kidney program.
The study also lacks evidence of a
The Comprehensive Areawide Kidney Service feasibility study for the
NY-Penn area appears to dovetail its objectives with those of the
Dialysis Buyers' Cooperative feasibility study.
objectives that could be measured at the end of one year.
could also benefit if it were able to work with a local Kidney Foundation.
Since most of the region's proposed activities are directly related to
the functions conducted by the Kidney Foundation, they would be well
advised to place high priority on efforts to get the placement of a
local Kidney Foundation activity in their area to supplement the
entire kidney program.
The Home Dialysis project goal of training 12-15 patients per year
appears to be non-specific.
New York is in the range of 60 to 75 patients per year.
capacity of the Home Dialysis two-bed unit and the stated number of
personnel far exceeds the anticipated number of patients who need to
be trained.  In addition, the training facilities are now located in
high cost, high overhead hospitals.
region should take cognizance of cost factors in all future decisions.
It too has no specific
This group
The end stage renal population of Central
The training
The site visitors believe the
The goals of the Cooperative Organ Bank, Project 122, are too general.
It was reported that only six tu nine transplants will be done in the
first year.
be a far larger number of organs potentially available and therefore
it follows that a greater number of transplants should be possible.
The past year only three transplants were performed and only 14 trans-
plants have been done in the past four years.  Unless the goals are
elevated and unless the numerous organizations who are involved such
as the Hemodialysis Committee, the Transplant Committee,  the Consumer
The project proposal leads one to believe that there would
-31-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
Renal Disease Activities (Contd)
Cooperative Committee and the Organ Retrieval Committee are coordinated,
the region will be unable to care for its renal failure patient pop-
ulation.
this type of fragmentation.
It was therefore recommended that a Regional Kidney Proposal be
developed with a time goal that is realistic and related to the com-
munity needs.  Any future kidney planning should include provision for
care of patients throughout the entire Central New York region and not
be limited to the urban areas, i.e., Syracuse, etc. The Central New
York area is uniquely suited for Home Dialysis and for this reason
this aspect of the region's kidney program should be expanded.
No kidney program can expect to be successful in light of
With regard to the Organ Donor Program, it was suggested that this
program needs to relate to other CNYW programs in the region.  As
an example, the Organ Transplant Center should utilize the Emergency
Medical Care program to relate to communications and transportation
of the organs.  The trauma surgeons and neurosurgeons working in
emergency services represent the greatest resources for donor kidneys.
They must be included in the planning for the program in order to
capitalize on the advantages they can bring to increasing kidney
donations.  The Organ Donor Program needs to develop a procedure
list, permission forms, develop sterile containers for organ trans-
portation and develop a perfusion device which can be placed in a
centralized location and in a location which is well known to all
potential users.
developed.
donation which will further increase the supply of organs needed for
the region's renal failure patients.
A cost and recovery schedule should also be
Lastly,there needs to be lay education in regard to organ
-32-
-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
SUMMARY
The sense of the site visit team was that this program made a valiant
effort during the past year to remedy the deficiencies noted during
the 1971 site visit; however, the obstacles which they faced were
insurmountable.
with an Acting Coordinator and this was a difficult arrangement for
him and an even more severe handicap to a program making an attempt
to bring about required changes. Under the circumstances, the
Director (now officially appointed) and his small staff must be
cornended for their personal commitment and sacrigices made during
this period to improve the program.
The future for this program is viewed as promising in light of some
positive developments noted during this visit.  First and foremost,
Mr. John Murray has won the confidence of the RAG and has earned the
role of Director and, in this sense, can now begin to operate more
effectively.  Although the site visitors are convinced that Mr. Murray
needs to sharpen his administrative skills, they share the respect and
admiration of the local officials who selected him for this new role.
Time and experience will bring him confidence and his dedication and
determination to generate an outstanding RMP in Central New York will,
in all probability,be realized to the benefit of the 'region's
residents and RMPS.
For most of the year the program was forced to work
The program has added three new staff members and they will certainly
reinforce the efforts of the currently overworked small staff.
region is requesting ten new professional staff members and, in this
request, the site visit team lends a strong endorsement.
recruiting program should bring the competencies Mr. Murray needs to
build the effective program he desires.
The
A selective
There is little doubt that the program needs to enhance its planning.
It must specifically identify where it wants to go and determine the
best way to proceed. To effectively accomplish this, the.Director
must receive help from the established Priorities Committee, Evaluation
Committee, his RAG, and from the new staff he is planning to recruit.
It ie essential that he make maximum use of these resources to develop
a sound plan.
In the area of fiscal management, the program faces a definitive need
to strengthen its competencies.
matter which needs to be addressed and resolved at the earliest possible
moment.
deficiency.
This must be recognized as a priority
Effective planning will be an aid to the resolution of this
-33-
RMP: Central New York PREPARED BY: Jerome Stolov DATE: 10/72
SUMMARY (Cont d)
In all, the program faces a challenging year ahead; however, the
site visitors feel the potential for success is on hand and are
optimistic that the CNYRMP will have success in their efforts.
______-__._.-- -_-
NTJKEIEX: 0050
COORDINATOR: Mr e John Mtir
LAST PATING: 226
I-^ ---__.-
Regional Office Representative:
Robert Shaw
TYPE OF APPLICATEON:
17 I_ Triennial -- i-7 Tri.ennial 5-
t
Last Site Visit :
June 3, 1971
-.
Effie 0. Ellis, M-D.,
Survey
(Date) .
?,
None \i
I
Presidents Amerlc.an Medical Association; Member of
RHP Review Committee
Henry Lemon, M,D., Member of W Review Committee, Professor of Medicine
                Nebraska Medkal School
Alfred L. Frechette, N.D., Conmissioner of Public Health, Massachusetts
            Department of Public Health
F. M. Simons Patterson, M.D., Executive Director, Association for the
            North Carolina RMP, Durham, North Carolina
William Lawrence, M.D., Chairman RAG, Alaba RMP, Internal Medicine-
            Cardiol.agy, Bjmningkam, Alabama
ELSE Jean Schweer, R.N., Director of the Division of Continuing Education,
            University of Indiana School of Nursing
                Chairman TRMP RAG Committee
Staff Ykits Ln Last 12 Months:
June 13-16, 1972 - Jimy Roberts, M,D.and Jerome Stolov
June 8, 1972 Robert Shaw CW@P RAG Meeting
April 12, 197? Marian E. Leach, P.Hu, DPDT, Staff Assistance regatiding health
March 22-21r. 2.972 J. Stolov, Executi.ve Committee Meeting February 2-5, to
December 1971-J. Stolov RAG meeting and Staff Assistance followup of advice
Staff assistance regarding health service/educational activities
service /education acttvitfes
observe mini. cont.ract negotiation
letter
Recent event;& r~xm-ring in Aeograp1g.c area of Region that are affecting
I.
:
July E, 1971 Experimental Health Services Delivery System Funded for
the Ny Perm Area (southern tier of CNY) $275,000
-2-
2.
Approved National Health Service Corps Sites (Cato Meridian, Chenago,
Transfer of Neighborhood Health Center transferred to Medical Center
Maxwell School in Public Administration offers degree in Public Health
Memorial, Barnes Kasson, W. Winafield [Little Falls
Hospital] Faxton Hospital Chateaugay, N.Y.)
(Upstate Medical Center)
Program 7/72.
3.
4.
4
-4-
DEMOGRAPHIC INFORMATION
Population characteristics:
age distribution
rural, urban, minority, income level,
Health education institutions
Pertinent health data
Geography:
The Central New York Regional Medical Program is comprised of 15 counties
in Central New York, plus two counties in adjacent northern Pennsylvania.
The boundaries were determined by Medical Trade Areas, Medical Education
and part graduate educational patterns and to conform with the boundaries
of the State Health Department regional efforts.  The Region is approxi-
mately 96 miles wide in its East-West perimeter and 271 miles long from
the Pennsylvania State Line on the south to the Canadian Border on the
north.
populated Regions in New York State.
square miles.
Geographically, it is ore of the larger but relatively thinly
The total land area is 26,016
Population: Approximately 1,800,000 Population density 68/square miles
Approximately 60% Urban
Approximately 97% white
INCOME - Average Income per Indlvidual, 1969
United States $3680
State (of RMP) $4421 (NY)*--SMSA - $3154
AGE DISTRIBUTION - Median Age Approximately 30
Percent of Total by Specified
Age Group, 1970
Age Group State U.S.
Under 18 yrs.        33 35
18 - 65 yrs.         57 55
65 yrs. & over       10 10
METROPOLITAN AREAS
Name of SMSA Population
                  (in 000's)
Total 1,263.0
Binghampton NY-Pa. 298.0
Syracuse, NY ** 629.2**
Utica - Rome, NY 335.8
** - 197G Census for Metro area - increased
City of Syracuse - 197,000 total population;
from 564,000 in 1960
incl. 21,000 Negro (about 10.8%)
.,
. ..
..
.. .
:. .
. ,.
, ...
... ,. '.
..
i ". .
.. . .
..
Y
-5-
FAGIL I T I ES
-__I_
1
1.n New York State there are 48 hospitals with general medical and
surgical. beds or a totai of 7,564 acute care beds and four hospitals
with extended enre IacilCties with 472 beds,  in the Central New York
region.
tions have less tliari 1.25-bed rural character of the area, and the need
for smaller hospitxl units to ser've large geographic areas. The
largest portlor! (60%) of beds is, of course, predominately in the group
of hospitals which have a larger than 200-bed capacity.
It is sipnlficant that more than 60 per cent of these institu-
In Pennsylvania there are five hospitals in the area with a total number
of beds of 475. Four of these hhve under 50 beds and the Robert Packer
Hospital hac 305 beds.
Packer Hospf td, die Gurhrie Clinj c which has approximately 50 full-time
practicing ptryaicions organized in a group practice.
'There is associated directly with the Robert
Personnel
Physicians - '2here are approximately 2,700 M.D.s (133/100,000 and
approximately 15 D.0.s
Nurses - There arc 2pproximately 15,000 registered nurses of which only
about 9,OOc) are active.
Peptinent Health Data
MORTALITY RATES, CY 1967
MORBIDITY - ILLEIESS RATES (1965 - 1967) Deaths per 100,000 Population
--.-1-
Rates per .l??qersons, by $e Group Cause RMP (State) U. S.196
Pera:,ns w, X with
364.5
Age
Group act1 te cond. chronic cond. Heart Disease 437.4
-- -.-. -_------
I
Age 14, EaSL N.East
Group Ge%a5-,G$L IJ . S . Eeog .Reg. U. S. Cancer 186.4 157.2
All Ages 1'94.9     190.2 47.0   49.5 Vasc. lesions 88.8 102.2
45-64 yrs, 119,9     124.5 64.5   71.1 All causes, 1019.4 935.7
(aff. CNS)
--c
65 & over 107.9 103.4 80.6 85.6 all ages
45-64 vrs. 1143.9 1.143.5
65 & okr 6168.8 6042.5
-6-
HEALTH EDUCATION INSTITUTIONS
COUNTY-INSTITUTION
St. Lawrence
Clarkson College
St. Lawrence University
SUNY ** College at Potsdam
SUNY Agriculture & Technical
Institute at Canton
Had is on
Colgate University
Hamilton College
SuMl Agriculture & Technical
Institute at MOrrisVf1le
Cazenovia College
Tompkins -
Cornell University
Ithaca College
Broome
SUNY University Center at Binghamton
Broome County Technical Institute
Onondaga
LeMoyne College
Syracuse University
Onondaga Community College
SUR Upstate Medical Center
PROGRAM
(Special note of paramedical programs)
Technical Institute
Liberal Arts
Liberal Arts
Nursing (2-year program)
Lib era1 Arts
Liberal Arts
Nursing (2-year program)
Practical Nursing
Medical Laboratory Technology
Nursing (2-year program)
Sloan Institute of Hospital
Administration
Graduate School of Nutrition
Physical Therapy
Health professions programs in
planning stage
Medical Technology
Dental Hygiene
X-ray Technology
Liberal Arts
School of Nursing, Special Medical
Dental Hygiene, Medical Laboratory
Medicine, Nursing, X-ray
Education Programs
Technology
Technology, Medical Laboratory
Technology, Graduate School
-7-
Cor t land
SUNY College at Cortland
I.
Oswego
SUNY College at Oswego
Health Education
Liberal Arts
Oneida
Utica College (of Syracuse University)
Mohawk Valley Technical Institute Nursing
Medical Technology
Cayuga
Auburn Community College
Associate Degree Program
Jefferson
Jefferson Community College
Associate Degree Program
Hospital Schools of Nursing
(Three-Year Diploma Programs)
CITY
-
COUNTY -HOSPITAL
0
-
St. Lawrence
A. Barton Hepburn
St. Lawrence State
l-r
Cayuga
Auburn Memorid.
Broome
Binghamton General
Binghamton State
Charles S. Wilson
Onondaga
C rous e- Irving
St. Joseph's
Oneida
lrlarcy State
St. Elizabeth's
Utiea State
Jefferson
Mercy
House of Good Samaritan
Ogdensb ur g
Ogdensburg
Auburn
Binghamt on
Binghamt on
Johnson City
Syracuse
Syracuse
Marcy
Utica
Utica
Water town
Water town
-,IC
L:. .>
hi./e2
Pedi Zt ri c Pu lxonary
GI ECT
COSTS
04 Year *
c_--
S 341,745 .
196,000
\537,745 /
- .--
s 850,090
* - per award dated 12/3/`
`05 Year
653,205
( 44,660
( 91,062
(- ,142,320
( ' --
( -- "
- ~~
1,420,349
c
/--/ so
-
I
I
3
I
1
..
._. _. . . ,
8
-_ ---
PYPS=CSt'-<TCFkF&T %
PFGlONbL VCDICbL PROGRAMS SFRVlCE -__
FUhClhG PISTFRY LIST
AUGUST 211972 _- - -
__c__-
REGICA 50 CENTRIL NY RHP SUPP YR C4 OPERATlOhAL CRANI (DIRECT CCSTS ChLYl ALL RECUEST ANC bWbRCS AS CF JUNF 30. 197
7
    AEARCCC LWbRCCC - AWAPOEO - bUbRCEC ** REOCESTEO- REOLE.:TED PECLESTEO RECUESTEC a
bWbRCJC.-
9
10
I1
c7-
0e
Ct c3 04 ** 05
01
__-
ear~ ~~VENT--
IC/Il- 12/72 TCTAL - ** C1/73-12/73 01/74-12/74 01/75-12/75 TOTAL
**
-.
__ hC- - -TIT!! -- .-
1293572 ** 489102 4esic2 11
COO0 PPCGFbV STIFF 4525rO 2 4 4-5 c c 4 e65 75
             164100 20 1800 14440C 51c3cc **
                      7 100 7ZOC 215CC **
                                                        114ecc **
OC4 -FLYILI PPbCl LE               iexc
006 HCCE CIdLYSIS T 43200 1460C 10?ie 7ti2e **
                                                              rr5oo **
                   z12co 11 30c- ISCCC
009 CICL CCCESS -
                                      53433 +* sftei
-_ __--
act CCPEC CLPS TELC
421500 ** - -
-
. 002 PEkAr! CONSLL SE l631CC 131CC - __ 753cc __
-003 -ENIICb CTY TU)LC?2CC
-- -
43800 - __ 33000 -
                            18300 **
41200 41200 **
       14R00 105400 **
38000--_ __
35259
35259
005 VC N SUPEPV tC-
-
~OS~Y~i@SD DEYC
-O11--REC- LPhG FESCP 90600
56687-
7487C-- I 74870 ** __
5?4??
43632 4?C32 ** 5c355 ' 50355
      4c33c ** 35312 35312
4C??C
57320 57326 **--- 2205C 22090
              10000 1OCCO
              172 00 17200
is4cc
6000
?CS_CS ZOSCS ** . 6460 bit0
-018 __ bPEb tfALTF ECU ____ .. - -
015 FCCEL PLPIL Are
02L NLPSE CLlNIClAh' --
0224 PlrRCEhCY CtC IC
0226 EPERCEhCI PEClC - ~-
                                          107250 107250 **
02ZC-YRCENCY MEDIC 2S5CC **
0220 EPFRCEPCY PECIC -.
022E -US PUN IC- EDU
022F ErS FUPLlC EWE
-_ --. ----
-
c
6000 ** 1-
                                                  %-
-
723Tn~&Iini33S3~~ N 215c-l 215C7 **
                                                                2c2c **
                                              35cc 3scc **
                            , lC25C __ 10250 ** - f
024 -l-EbCfk- SVSTEM Y -
2-026 kEALTi- S'fSlEt C                                  iszc
f 027 - l-LbLTi- SYSTEP L                     - - -
i
ROO0 ~ aooc ** __
7672 ____
-
-
-028 rEbLin SYSTFP h
84582-
6137 ___ - C135 *+ __ -
** e45e2
033 CCVk'UNITY I-EbLT - -_ - -_ - . -
' -037--PtrEihL LRt?bA .SYS
  039 hFALTI. CIllrTEPb
041 CCCFClkllCP FOR
043 CEPIATRIC DAY C
044 CEhlRAlLY bCk F
OIS HEbLTH SYSTEM E
046 MEbLTH SVSffM W
038 CfJOPEalTlVE flRt I. 446bO . *+see -
I
--- ++ 2483 1 266331
                                                                           64730
                                                                       64730                          14550
- ---- ** -
           I* 14990                         19685
              lSt8f ___
         ** -
** 2525e                         ZS25&
** 44840                         44840
** 14232C                    i 142320
84C16
-
. - 040-SATELLITE CLlhI --
- 042-b E L L _IC I'b"-c_L 1 A _--__ _______ - .-
--
94016
__ - _- ~ -** -
**
1_420349
- TOTAL - 3724CL 1 112800 645100 __ 1135796 __ 3266096 .?* -142C349-
-
i
.
BREAKOUT OF  PtUUEST
05 PROGRAM  PEHIUU
REGIW - CENTRM  NI
RM 00050  10/72       PAGE 1
I
RMPS- OW- J Toc~z- 1
- 11 -
Region: Central New York RMP
Review Cycle: 72
e
HISTORICAL PROGRAM PROFILE OF RE(=
In March 1966, the Upstate Medical Center Council, appointed by the
Governor of New York, selected a 15 member RAG and approved the
Research Foundation of the State University of New York as the Fiscal
agent for the applicant institution.
pointed as acting Program Coordinator.
Dr. Richard H. Lyons, was ap-
In December 1966 the Region's planning grant application was approved
for two years support at the amount requested.
In November 1967 the Region submitted its continuation application
for 02 year of planning and requested additional funds to expand
Core and Planning activities. In addition, the Region requested
three years support for 4 projects:
in Nursing, Project 2 - Rehabilitation Consultation Service,
Oneida County Tumor Conference, rind Project 4 - Family Practice Pro-
gram.
activities were approved and an award granted.
At the recommendation of the RIPS Committee, a site visit was conducted
to this Region in March 1968, by Dr. Edwin L. Crosby, Dr. Stanley W.
Olson, Dr. Dan A. Mitchell, Dr. Philip A. Klieger, DRMP, Dr. Veronica
L. Conley, DRMP, and Mr. Robert Is. Jones, DRMP. In their assessment
of the Region the site visitors had difficulty in determining the
overall strategy of the Region which appeared to consist of identify-
ing perceived needs, especially those of physician6 and hospitals,
to take steps such as epidemiological surveys and meetings that would
identify the most critical needs, and then to call upon the resources
of the State University of New York to meet those needs.
seemed to be representative of the Region and the medical professions
endorsed the regional medical program concept.
Project 1 - Continuing Education
Project 3 -
Both the continuation application andthe four operational
The RAG
The Region submitted in August 1068 a renewal planning grant applica-
tion requesting support for core and planning activities for a five-
year period.  At the recomaendation of RMPS National Advisory Council
a sire visit was conducted to this Region in January 1969, by Dr. Henry
Lemon, Dr. M.J. Musser and Mrs. Sarah J. Silsbee, DRMP. During this
phase of development it appeared that the RAG was representative of
the medical needs and interests of the Region.
believed that representation froin the 34,000 underprivPleged people
of Central Syracuse should be added to the RAG from the Neighborhood
Health Center Council.  Bylaws for the RAG were being developed and
a study of the practice of making the Upstate Medical Center President
the RAG Chairman had been requested by Dr. William Bluemle, President
SUNY Medical Center.
The visitors, however,
The visitors believed that a major defect in RAG organization was
the lack of a functional executive committee that could help the RAG
develop policy guideline8 and act on behalf of the RAG on declsjons
rckyul ring i nimediate at tention by the Coordinator.
Procedures for
- 22 -
the review of grant proposals and defined responsibilities in the
review and decisionmaking process had not been well developed.  Although
a large number of RAG subcommittees had been organized,  few were active.
It was apparent from the operational projects submitted that there
had been insufficient coordination to date. There did not appear to
be a regional plan or an obvious strategy for further development of
programs in the Region.
identifying those physician continuing education activities related
to the Upstate Medicel Center from those of the RMP.
peared to be little integration between the nurse in-service training
program at the Center and the W's nursing continuing education
project.
The visitors found difficulty in clearly
There also ap-
The visitors recornended that the University Medical Center (U.M.C.)
give priority to the recruitment of physicians for core staff (there
were none other than the coordinator).  The IMC responded that until.
vacant departmental head positions were filled it would be difficult
to interest physician8 in faculty appointments.  That once vacant
departmental head positions at the Center are filled, top priority
would be given to filling the Regional Medical Program positions.
In June 1969, the Region was granted an award combining the planning
and operational grants which consisted of Core and 8 projects.
for an additional project (#12 - Prevention and Effective Recovery
from Cardiovascular Illnesses Through Knowledgeable Nursing Instruc-
- tion) was requested.
In February 1970, the Region requested funds for a continuing Medical
education project in Rural Pennsylvania but no additional funds were
recomended.
Support
During the July 1970 review cycle Council approved at a reduced level,
project 45 - Medical Library and Information Service.
submitted a supplemental operational grant application in November
1970.
The Region
The National Advisory Council recommends funding of the Mobile
Stroke Rehabilitation Servfce - Qroject 2R for an additional year.
Two other projects were not recomended for funding.
On April 1971
the Region-had to reduce its funding $59,507 since RMPS had a reduc-
tion in our apportionment.
In May 1971,  the Region submitted a triennial application, and requested
or its 04 year of operation $1,413,928 d.c,
the Region was site visited by Effie 0. Ellis, M.D., Henry Lemon, M.D.,
Alfred Frechette, F.M. Simmons Patterson, M.D., William Lawrence, M.D.,
Jean Schwer, R.N., and RMPS staff.
Major recommendations of &e site visitors were:
associate director, the RAG to expand its membership, a program priority
and decisionmaking process to be developed, and a program plan to be
Consequently on June 3-4
the appointment of an
cil recommended only one year fuildiag.
After receiving
Dr. Lyons resjgned. Mr. tiurray was appointed Acting
- 13 -
In December 1971, $537,745 d.c. was awarded to the Region for 10/1/71 -
9-30/72.
the August advice letter.
Later that month staff visited the Region to follow up on
The turning point in this Region's history appeared to be when
Region requested from its constituency ideas for mini contracts of
less than $5,000. It received 134 proposals. In February,staff was.&
able to observe the negotiation process involved in awarding these
contracts. On March 1, 1972, the Region moved into new quarters.
Under the implementation of the 3 cycle review system the Region has
been extended an additional 3 months.
At the request of                commended and the Director
approved a level o            th period which when prorated
over a 15-month pe             The rationale for approval
was the need to implement Health Systems North Projects 23, 24, 25,
26, 27, 28, 29, and 30 and to aid the Mohawk Nation through support
of Project 31,  The Region was also permitted to expand its area
health education cooperative efforts in Projects 18 and 30 (Project
30 was part of Health  System North).
recommendations from a member of the Professional Technical development
staff following a special consultation visit April 12, 1972,
Since the Region received funds to expand its health service/educational
activities, Reviewers felt that the Region's request for special
education monies for Projects 34, 35, and 36 were duplicative.
sequently, staff requested to visit all the sub-regions to review health
service/educational planning efforts.  The decision to have a site
visit team review efforts to date was recommended. Although staff
felt the Southern Tier could utilize funds, this decision would have
to be delayed until after the site visit.
1
This decision was based on
Con-
The Region did, however, receive approval of its "Emergency Medical
Service Activity Project" 29A-F for $261,705.
June 21, 1971.
This amount was awarded
The Region, as of August 1972, now has
Recently,we were informed that Mr.
for its 04
L&
D-5
year which terminated December 31, 1972.
executive dire ct o r .
n, '7J."
- 14 -
STAFF ' OBSERVATIONS
I
Region: Central New York RMP
Review Cycle: October
Principal Problems : !
1.
2.
3.
4.
5.
A program plan must be better defined and measurable over time
Better project monitoring is needed
The Program staff coordinating health serviceleducation activities
needs to be more effective
The goals and objectives need to bemre specific
Continued support of ongoing projects appears weak
Principal Accomplishments
1.
2.
3.
4.
5.
6.
7.
New Coordinator aFpointed
RAG expanded
New organizational structure
Active CHP-B participation
Greater access to RMP funds for disadvantage groups
Participation of many groups in CNYRMP as observed through the
mini contract and project proposal submission
The review process appears workable and equitable
Issues requiring at tention of reviewers
1.
2. What data was used to aid RAG in its decisionmaking?
3. Is the Executive Cormnittee balanced in terms of representation
4.' What is the recruitment plan of the coordinator?
5.
6.
What is the program plan for CNYRMP?
d
and effectively functioning*?
Will expenditures be lapsed as in thepst?
Since, as reported on p. 80 of the CNYRMP Anniversary application
only one project evaluation was completed, the program's evaluation
process should be thoroughly reviewed.
A special effort should be directed to correlate the relationship
between program planning, operational programs and the inter-
action of program and etaff activities.
Projects still appear to have been developed spontaneously rather
than based on need and a regional plan.
7.
8.
e
Wian: ~~/@YWG Operations Branch: MJDXCWTINE~JT
mmber: oo040 Chief: Michael J. Posta
Coorctinator: THOMAS A. NIQBW1S, M.D
Staff or RMP:
(Executive Director)
Mary E. Murphy, KDB Oper. Officer
mid O'Flaherty, MalB, Back-cq~
Charles Barnes, C2-m
rrabert: WalkingtcOn, OPE
Last Rating: 294
~ionaZ Off icfs Representative
3rd Yqr (Program Di_lrector)
- Daniel wster
ManaggoEslt su.rvq: Mtative-+aly '73
: (Dates,
, Camittee/Council ms, ~sultants)
9-20, 1971: Philip T. White,M.D., a?(zirman Review CarmittOEj
Mrs. Florence W. Wycbff, National Advisory Council.
Jessie B. Barber, Jr. M.D.,Cbarsultant
Hurrpkrrey H. Hardy, Jr.,M.D., Consultant
: (Date & PUrIpse)
t 1971 - July 1972:
Ttxhnicdl CansultatiOn & Site Visib
(FOR - mcogrinn Director) - 20
1, ThaMs A. Nicholas,M.D. as of 7-1-72
it&., Grand Jmctim, Colorado
, Fort Collins, Colorado
of $102,OOO(in cycle) to serve
2
F7EG! Region VI11
Two entire States, overlap with Colorado portion of Intermountain
overlap with lJyoming portion of Mountain States
Counties: Colorado 63; Wyomi,ng 24
'qngressional Districts:
Coiorado 4; k'yoming 1 at large
-3
REVIEW CYCLE: Oct~bor 1572
GEXElUPHY - - Colorado&aming RMP encxq sses the entire states of
Qlorado and wyanins (201,400 square miles)
Colorado - 97,400
P@'nhc~ - 104,000
E'OPWI~ (1970 Census)
lbtal: 2,539,700 Density:
Sb Urban$ Colorado - 78.5 WLGming: 60.5
% Non-Wte: Golorado - 4.0 Wyaning: 3.0
- 2,207,300
- 332,400
Colorado - 20 per sq. mi1.e~
t3laning - 3 per sq. miles
INCDE (1969) :
% 18 SS:  coloradb.36; Wyaning-37     Amage/per individual
% 18-65 FS:   Colarado-55; ytaning-54      CO~OIZIO - $3,680
9; wyaning-10 @Onhg - $3,447
- Per 100,000 (1969)
m1.0.
Heart Disease 291.0 %:4 ?&5
cancey                  125.2    130.2   157.2
Vascular lesions (Aff .Chs. 1    82.1    91.4   102.2
All causes, all ages        828.1   881.0   935.7
Scbl - Wv. Colarado, School of Medicine
: Golo. - 2; wyo. - 0
. - 16; V&O. - 1
Qlo. - 16; Wyo. - 2
Physical Theraf?y: Oolo. - 1; Wp. - 0
mty Geneydl and V. A. Generdl -
NO. of Beds
Golo. !!EA
mlo. %.
-
74 27             -!ET7      1825
2 1                 593      174
5 2 679 1 698
..
,*
-L-
NuRsINGANDPF3smALcARE~
No.
skilled Nursm Hems ?E
Personal CaXe ms
18
22
(with nurse. care)
mng term Care Units
7
5
REVIEW CYCLE: OctoDer IYIL
No.
%
147 5
565
of
330
95
!!!FEE5
Physicians - Ncm-Federal M. D.'s and D. 0's (1967)
                      297
Adcl~e: CO~OX& - 3248; Wycming
Inactive: Colorado - 258; eLg - 29
Bt3-0: Colo. - 165 Active per 100,000 pap.; Myo. - 94 active per 100,000 pop.
u. s. Ute: 132 per 100,000 ppula-
Licensed practical Nurses
PROGWM STAFF
CONTWCTS
DEVELOPNENTAL COMP .
t
Current
Annualized
1:unding
TR Year 04
-
Component
..
OPERATIONAL PROJECTS
Kidney
. ENS
hs/ea
Pediatric Pulmonary
G ther
Counci 1 -
Approved Region s
Lcvcl For Ilcqucst For
TR Year
TR Year QT
-
COMPONEhT AND FINANCIAL SUMMARY
AIWI~ERSARY APPLICATION DURING TRIEIWIUM *
1,102,346
      I 1,403,991
*NAC level raised by $150,000 (specid action NAC 6/72)
MTAL DIRECT COSTS
COUNCIL-APPROVED
LEVEL
Recormended
Funding For
TR Ycar
/-/ - SARP
/x/ Review
Committee
//Yes /I/ No
Recomer.ded '
Level For
Rcrnsindcr
of Triennium
-
Supplemental funds of S40,OCO for Pediatric Fdmnary Project continuatim.
J
.
1,292,346*
. . ._
. -.
RREAKCUI OF  PCQMST
06 PPCGPAW PERIljD
REGION - CnLbMlOlrC
Rlr 00040 10172 PltE I
R I4 P 5- C CI Ir- J 'ICE- P 2- 1
I
i I
I I I
                   I
         I
I
1
&OW PROGRIU STAFF CYRFP I I I I
i
I
5
n
Region: ~lorado/wi/csnincl
Review Cycle: &tabes 1972 -
-9-
- 10-
STAFF OBSEWATIONS
Principal Problans'
1. Minority and "True Consm" representation on RAG needs increasing.
2. Increased mimrity representation on staff especially in professional
3. ch?iW? program Staff is small (20). FMp has indicated need to increase
4. Evaluation of Prgram Staff activLties needed, as 51% of budget is
5. RAG lacks invdvementr. in the evaluation process.
6. Overlap of regional activity with Intexmuntab and Pbuntain states.
catxgory,needs attention.
staff.
used for p-qam activities.
Principal &ccrmplismts
1. Program Staff has been stimulating project activity to a greater
degree, rather than waiting for project proposers to initiate activity.
2. Wuaticm prccess in reg& to projc4 activity has considerable
visibility and irrrpact.
3. CWXQ Staff has exadlent cooperative mrking relationship with other
health agencies.
4. Program has changed qhasis fm categorical approach tc~ that of
improvinS the quality, quantity, and accessibility of health care
services in Colorado and wychning.
5. Subreqionalization is underway, with offices active in Canon city, ~010.
am3 Dubois, WYcRTling.
Almsa, Colorado.
Offices are ready to open in Caspe_r, wycanins and
Tentative plans are for an additional subregion in
Grand Jundon, Colorado.
6. Fomr RPI; Chainfan, "cas A. Nicholas, M.D., appinted new Coordinator
7/2/72.
Issues requirinq attmtion of reviewerg
For information only
Need for ,tiAl; to appoint an Evaluation Ccmdttec.
~nsider "Turf ~roblem" (overlap W s) remmmdations as presen'ced at
7/20/72 mting.
a. That an Inter-Rqional Executive  Council be established
1.
2.
1) to approve by majcrity vote all new program Conep-
2) fa review regularly aM3. infonmlly evaluate on-goinq
p3mpsd for overlap areas.
pr0grm.s in overlap areas.
b. That m's hundaries be re-aligned and areas of owlap mng
three BP s be identified.
Director) of each of other tm RMP S.
c.  hat each FAG expand its msnbership to include the coordinator(Esrecutive
For attention
is requesting an increase in funding above W approved level.
Xditional funds will alluw for ptentid growth neaded and will assist in
-11-
Coloredo/Wyaming RMP Continuation Application StafS Review
August 4, 1972
Mary E, Murohy, R.N., M.P.H,, Chairman
cheel J. Poata (?COB)        James Smtth (WOB)
Harold O'Flaherty (M3oB)       Peggy Noble (WCrB)
Ywanrte Green (KOB)          Annie Dicks (GMR)
hard Reeae, M,D. (DPTD) Eva Spell (OSM)
fie Krila (DPTE))
omendation:
a rreomiended funding oE the Colorado,fWyoming application
Bt the National Advisory Council approved level of $1,292,346,
645 below the
the request of the K!OB and by special action of the ,June
2 National Advisory Council, the approved funding ravel for
the Program was raised from $1,102,346,
of $150,000 plus the $40,000 supplemental funds for the Pediatric
                       level to $1,292,346.
s substantial increase, it waa felt, would provide Colorado/
mfng RMP sufficient latitude for expansion.
The approved request
ojecta: 3) Rural
, 1130, and 2) Health
e Rural end Urban Genetic Counseling and Screening  Project
questa funding in the amount of $112,826 (d.c,), Major
emphasis of the genetic screening is on Tey-Sachs Disease,
peculier to the Jewiah race, and on Sickle Cell Anemia, pecull~s
ion were thanght to
he too large, especially
ion which would be
terest on Sickle Cel L
mlta, the question was raised as to the availability of other
elopmental component funda have already been used to initiate
ject fllenning,
alation has been atimlating interest arid fund-raising, with
ubsrantfal gm1, in order to further the project.
It wae later learned that Denver's black
- IZ-
Page 2
-
The genetic and counseling clinic is to be located in Denver.
However, staff with modest screening equipment will travel
throughout the area.  Patients will be referred to the Denver
clinic for specific tests which cannot be done by the mobile
staff.
Staff recormnded that if the project becomes operational,
screening be extended to include a broader spectrum of disease
categories.
The Kealth Program for Migrants and Rural Poor raised concern
regarding the stipend item of $75,000 on Form 34-1 (page 16).
The stiped6 are to be paid to nursing and medical students
*,$lo deliver health services to the target group. The activity
vat3 interpreted as stipends or "basic educetion" vhFch is
adverse to RMPS guidelines.
and should become operational,
requires re-evaluation.
The project is worthy of merit
The funds allotment to stipends
Questions were also raised regarding the previously approved,
bat unfunded, Project #17, graining in Diagnostic Ultrasound
in Community Hospitals.  Concern was expressed as to the need
of smaller hospitals for as refined a technique.  Such a technique
would require very experienced personnel for equipment operation
and result interpretation. A low priority, as given the project
by the UG, was staff concensus.
Radiation Therapy Planning by Time Sharing Corfputer, Project #21,
is planned for extensive expansion.
feasibility of costly expansion in training in relation to the
actual need for such facilities,
Dr. Keese questioned the
Relative to the application, it was noted that the priorities
are more finite in scope than are the objectives,
objectives not been prioritized?  An apparent reason for this
basic fncongruity could be the fact that the prFoi-tics are
consonant: with the proposed projects.
Why have the
The region has been successful in securing Local funding for
conthuatfon of projects whose funding has been terminated by
KMP .
The Ck%i is broadening its horizon through subregionalization
and several key Ereas have been identified through regional
planning needs.
Generally speaking, the RAG composition is satisfactory, although
it was felt that more "true consumer" representaticn, as well
as minority types, is desired.
-13-
FROM : Director
Regional iiledi cal Programs Service
SUB.JECX: Action on September 5-6 Staff Anniversary Review Panel Recommendation
Coricerni ng the Colorado/\dyomi ny Regional Fkdi cal Program Application
Ri4 00940, 10/72
Rejected
' 7mq-
.
REVIEW CYCLE: October 1972
TYPE OF APPLIChqmhni versarv
within trienni uiii
.--
RECO~lllKEIDATIOi\iS FROM
I /' SARP        - /T REVIEW COMMITTEE
- /T SITE VISIT     - /T COUNCIL
RATING: 290
- FUNDING ---1__ --I". RECOI-?I4Ei~lDATIO?l: ._..----- I"--
furidins for the Colorado/l4yoniinq RMP in the amount of $1,292,346 for the 05
The Staff Anni versa!*y Review Panel (SARP) recornniended
operatronal year.
This aicount rncludcs $91,800 for the kidney project k29,
The recommended amount
application request of
.,
$1,403,997 *.
-l--__-l__ RATIONALE:
sufficient financial lati tuck for the projected expansion of Program Staff and
activities within the Region.
funding level far CW/WP was raised in June '1972, from $1,102,346 to $1,292,346
as the result of a special action by Council.
I___ CRITIE:  SARP concurred with Staff regarding its assessment of the Colorado/
Nyoiiling RM?.
tiencral Pract-itioner, is well known to most staff meinbers having served as RAG
Chairman for Cld/kMP. He is also a RAG member on the Intermountain RMP. Dr.
Nicholas' interests, talents and knowledge of RMP are in his favor.
with interest and anticipation that the C!d/RMP is observed during the coming
year.
SARP felt that the recoinmended amount would provide the Prograin
The National Advisory Council's approved
The new Coordinator, Dr. Thon:as Nicholas, a former active rural
It will be
The priorities as established by the RAG appear consonant with project activity
Concern was expressed that the RAG did riot have its own Evaluat.ion Committee.
In view of the fact that 51% of the CW/K!4P budget is spent on Program Staff and
staff activity, an evaluation by RAG was considered top priority.
The RAG should place more emphasis on increasing its minority representation.
"True consumer" representation could also be improved.
thirteen "publ i c members", the inajori ty represent publ i c leaders  top managemen
etc.  The need for representation froiii the allied health field was also stresse
The CW/RMP is very much aware of RMPS' urgent request regarding increased
minority representation on the RAG and committees, as well as on Program Staff.
Although in compliance, re-emphasis is needed,
Subregionalization has made significant progress during the past year.
Cooperative working relationships exist w-i th CHP(a) and (b) agencies and should
continue in view of the establishment of subregional offices.  Caution should b
exercised on the part of CNJRMP in avoiding duplication of service or in
assuming CHP functions. Sharing of subregional coordinator's time with
universities or planning agencies raised concern.
Kidney project #29 - Pediatric Hemodialysis _I-- ---l__l___------ for the Rocky Mountain Region, has
made satisfactory progress and presen.ts no problems at this time,
emphasis is being placed on outside sources of support, during RMPS funding
Although the RAG lists
As more
e
-
Col orado/Wyomi ng
period, as we1 1 as fol 1 owing I thi rd party payriient resources requi re i ndepth
exploration.  The exact source of such support should be explicitly stated.
New Project  f17, Training in Diagnostic Ultrasound in Coinmunity ---_I- Hospitals,
previously approved but unfunded, was consi clered a most sophir,ti cated and
expensi ve pi-ocedure for general use in communi ty hosp-i tal s ,
evidence of the participating hospitals' actual need for such a procedure
should be provided.
Project /I21
as to the need for ex-terisive expansion.
their need and desire for such serv'ices.
Docuinented
- Radiation .----- Theray _..I__ Plauning --I__- I by _I I_---- Time _.-- Shar-i2 Cornputer, _--- raised concer
             Participating 5sp.i tals should documer
Project $30, Rural and Urban __I_- - Genetic -__- Counseli I" - II_. ti:? and Screen-inq, was recently
revised,
evidence of hyperlipidemia, fami 1.ics v~i th puliironary emphyseina for a1 pha
trypsin inhibitor deficiencies, and families with a high incidence of cancer.
Lesser emphasis will be placed on the cletecticn of sickle cell heinoglobin arid
fay-Sachs carr-ier states .  Staff was unenthusi as ti c regardi ng the project i n
rclatjon to the Region's priorities.  One 31.~3 giveti as a target for developmer
was Scottsbluff; Nebraska.
prevent any future ones, a documented request froin the area, as well  as from tl
Nebraska RPI? should be avai 1 ab1 e.
Stuay-eyhasi s \,ri 11 be on fami 1 i cs wi th coronary disease for
In view of past "turf" problems aitd in order to
8
RECOMI.1EI\IDATIONS: ----..-..---    Encourage CW/P,MP RAG to establish an Eva1 uation Comini ttec
2. Evaluate Proqrain Staff and Proqram activities. 3. Emphasize the need fO'i*
1 a
e
more mii-rori ty representation on RAG, comini ttees and Program Staff. 4. App0.i r
more "true consumers" and a1 1 ied heal th representatives to RAG. 5.
CMP Functions in relation to subregionalization and proceed cautiously.
Consider
MCOB 9/7/72
i
Currcnt
Region: Col oradolWvomi nq
Rcvicw Cycle: October
i
Coun ci 1 -
Compnent
PROG?A'*I STAFF '
o
COSTRAC'I'S .
cow.
OPERt?TIONAL PROJECTS
.-
.' Ki$ncy
hs/ea
Pediatric Pulmonary
Qzher
TaTAL DIRECT COSTS
COL'N*2I L-P.PPROVED
LEVEL
G-f
ID
  COMPOXENT AND FINANCIAL SUMMARY
ANNIVERSARY APPLICATIOS DURING TRIENNILN
Anxu a 1 i z e d
Fuztiing
TR Year - 04
,492,506
107,260
96,000
406,580
1,102,346
1,292,346*
Ap p r Gv e d
Levcl For
TR Year
Region ' s
Request For
TR Year C5
-
635,915
1 10 ,000
565,275
i 97 ,800 )
( 1
( 1
( I
c I
1,403,991
1,292,345
*NAC level raised by $150,030 (Special acticn NAC 6/72)
SupplemeKtal funds of $40,000 for Pediatric Pulmcnary Project
con ti nuation.
Y
I
..
. *..
(;]l;.cf: Lee E. Van Winkle
or
      --- Not Scheduled _____
S ch c du 1 e d,:
,,=%
\ Last Sitc Vjsit: June 23-24, 1972
Philip T. White, M.D. - Chairman
John R. F.` Ingall, M.D.
W. Lester Henry, Jr., M.D.
Jurij Savyckyj , M.D.
3/7/72 - PURPOSE: i.
Staff Visits in Last' 12 Months:
Indoctrination bf newly assigned operations staff member
to the Georgia W.
.facilities and services task force.
2.
TO attend a portion of the region's
6/8-9/72 - PURPOSE: .
8/15-18/72 .. PURPOSE:
Verification of review process.
Visit to selected'projects, health access stations, area
facilities, etc.
-.
Kecent events occurring in geofiraphic area of Region that are affecting
RMP program:
During the early spring of 1972, the State government was reorganized which has
created a Board of Human Resources.  The board is comprised of the State Health
Department, which includes the =(a) agency, Vocational, Rehabilitation, Mental
Health and the Department of Public Welfare.  This is a different group of people
from those whbm the region had to plan with previously.
are having much less to sly about directions taken by public health than prior to
the reorganlzation.  Thefafore, GRMP has to involve a totally new group of people
in planning.
Ga.
Physicians in the state
-2-
1
The Governor is personally very interested in the health access stations
and is exploring ways in which he can supplement these activities with
state funds.
The 18 area planning development commissions in the state have, for the
br
first time, been designated the official planning groups for health for
their portion of the state.  Their turf have been finalized and there
have been assignments of health planners who are supported from other
than GRMP funds.  Since these groups have previously done primarily
economic and recreational type of planning, it is essential that public
health planning input is obtained as early as possible in each area.
.r
~
The region's five subregional offices tie in with these area planning
development colrrmissions boundaries. c
There is increased utilization of the Governor's planning office, which
is separate from the CHP(a) agency.
A new CHP(b) agency has become operational in Southwest Georgia.
I-
-3-
STATE OF
H
the w8et and with north-
is tribution:
-5-
entire state; interfaces
Pldrfdra to the south.
with Alabama to
Congressional Districts: 10
Census) - 4,589,000
Density: 79 per sq. mile
U.S.
Under 18 - 37% 35%
18-64 yrs. 55% 55%
65 61 over 8% 10%
income - $3,040 (compared with $3,680 for U.S.)
:
Atlanta - 1,373.6    Columbus, Ga. - 234.3
August8 - 249.8 Savannah - 183.0
(4) Total population - 2,040,700
     - 3,395,860 742
NoneWhite - 1,193,140 26%
        1969/70
Enrolled Graduate
a1 Schools - Emory University School of Medicine 333 75
     Medical CortPiZege of Georgia, Augusta 418 98
Atlanta
1 School
- 2 Emory and Medical College of Georgia
- 2 university of Georgia, Athens; Pharmacy, Mercer Univ.
Southern School of
Atlanta
-- University based:
th Services, Atlanta; Emory University School of
Georgia State University,
ied Health Professionals.
: Cytotechnology - 2
Medical Technology - 15
Rsdiologic Technology - 23
Physical Therapy ------
Medical Record Librarian - 2
Community and Junior College*: El
Professional Nursing Schools
27-(18'af them based at Colleges
and universities)
.ght Jr .
Colleges
Practical Nurse Training
44 - majority are
vocational schools
I
Current . .
. COMPONENT AND FINANCIAL SUWRY
ANNIVERSARY APPLICATION DURIMG TRIEhYIUM
Component
PROGRAM STAFF
COXTRACTS
b
DEVELOPMENTAL CONP. .
0 PE RAT I GUL PROJECTS
Kidney
EbfS
hs/ea
I
Pediatric Pulmonary
Crher
TOTAL DIRECT COSTS .
COUNCIL-APPROVED
LEVEL
Annualized
Funding
663,310
60,130
.' 135,086
rd
1,704,474
X
2,563,000
3,032,490
Council-
Approved -
Level For
TR Year 2nd
(05 Year
Region I s
Request For
. TR Year -&
'8 (05 Year)
' 705,704
NONE
*.
  177,986 '
2,137,934 .
( 114,334 1
( . 478,000
( 75,000 1
( 33,300 )
( 1
3,021,624
Recomaended .
Funding For
TR Year 2nd
A05 Year)
/-/ Review
/-/ SARP
'- :--
Committee
.,
3,032,490
3,032,490 d v..,
I
I
Re com=r.dcd
Level For
Reminder
of Trienniun
1
..
-_--.-
e
OI3Y 51tU Cb VHCG AHtA FAtILIl I I I I !
.-
I
t 5) (2 t (48 (1 1
IDENTlFICATICh OF CCWPObEEtT I CDNT. WITHlNl CONT. 8EYONnl APPR. NOT I NEUI NOT I' CURPENT I CURRENT 1
I APPR. PRICDI APPR. PERICDl PREVIOUSLY I PREVICUSLY I ClRECT I INDIRECT 1 TOTAL I
                I CF SUPPCRT 1 CF SUPPORT 1 FUNOEO I APPROVED I COSTS I COSTS I 1
                   I I I I
02CG AREA FACILITIES FOR CON I I I I
I I I I -- --
1 I I
....
BREAKOUT OF REQUEST ____ I
- 05 PROGRAM PCRIGO
.- ___- - -
I'
I APPPCVEO I COSTS I COSTS I f
                                       I --- -
                                        I
tSB (2) i 4) ill
,-
fDENTIFXCA7lON CF COWPONENT I CChT. NXTHXNI CCNT. UEYONOl APPR. NOT I NEW. NOT I CURRENT 1 CURRENT I
I APPR. PER1001 APPR. PERXCOI PREVIOUSLY I PREVIOUSLY I DIRECT 1 XEtDIRECT I TOT& 1
I OF SUPPORT 1 Q SUPPCRT I FUNDED
                  I I I I I I I
055U ERER UED SERVICE WLURBUI 1 I I 1 I I
--- rlaLQQiL 1 *lfih.QQLJ
                                            I I I1
                                    I I I I I
a2L.-
-
\
- .. - .....
.... ... ..
. .-
. -...-..- ........... -__ ....... . -----.I-----. -.
...
.--- ........... _- .......... _..-- .. - .. *__ -- - --.- . __ -
.. ... ........ .- . I
I
,-
.
.
. ._- ......
I
. '.. )-r
     0
$
,
I -.. .-
..
I
....
< ..
L_
           ......... .......
-. . - _. .-
-- . -.. ............. -- ..
-
..
....
..
. ,I
?. . >.?
,.( i..' ._. 1 .L . _.
I.
e
.. . ..- -.._ - -...- ._ .. .. - . --. ~ -.- - - . - -.
- ..
                               REGION -
BREAKCUT CF REQUEST RH 00046
-
06 PRoGRkr PERtQO --
-- - .- ..
1 TOTAL    I
1           1-
1 ALL WLRS 1
lotRCT COSTS I
I
-.-
-a
..-
BREAKCUT OF REWEST-- ,_
. .. 06 PROGPIH PERIOO
(2) I43 ir,
CCNT. BEYONO1  APPR. *Of   I NEY. NOT
APPR. PERICCI  PREVICUSLY  I PREVICUSLY
OF SUPPORT I PWDED ___ I APPROVE0
I I
I I
.
__-_ ._ . . . .__..- -.--
..
... .
.. .
..
.-_. . .-. ^.. . . . ,
., .
*.
, ....
-- . . . _- .
-.
..
.,
.-
_I_---
--_.--.
I~
_-_. .
____.._._.__. -
1
i
i
I
k.
'i
1
t
I
I
i
!
1
i I
I
, ,
t
I
I
I
I
AMs StPVICE ____I____ -I__
KMPxLoS*-JTCFh, S
ALL RECUEST bhC bhbRCS AS Cf JbLE 30, 157
R
CEtlCIbL tEOICOl
-. - -.---_ - _I
FUhOlhC HI>., LIST
REGlOh 4b CEOFGIl, FUp SLPP YP 04 CPEPPT IChIL CPbNl--!CIRCT COSUNLV) b
          WARDED AkAfiOtO AIybPOEO AhPRCEC ArARCEC __ ** >CUSTC RECU-E~EC RFouESTO REQUESTED b
v
7WFt h EN t 01 02--- - 0, c4              ** 05 CC or
- - NO TITLE - - --- - 09/71-12/12 TCTbL  ** -0J/'733Z/l3 C1174-12/14 C1/7+12f75 fCTbL IO
- CCCC ___ PRCGFAP - - ._ __ SlbFt 770000 761 300 64R400 8~C7 3cc_s1c7 ** 1C.lC4 734107 1440401 la
ci90 CEV AREA PRG tis CttCC m700  **
                                                  21284  **
- DO02 b hUFSE MlCYIFE                                                      *+
o
** (1
120506 i205000 ** 117986 177906 355972
.--
0000 CbELtFIEhTbL F
-
DO01 IUPP OLEO Pi2 IWAC 2?281
OCC3 irFPcu% FPIW~R 1os7e iom *+ I
0004 IVPQOVFD PP I'AR 10530 10.S30 **
                                   7920 79zC **
DO06 I~PROkEO PQ IPAR    cos a0 - fcicc c --- 4 1 CC- 25731 238231 *+
001 - CCAFEFENCfS- fCR
0015 COhF FCR IHPPOV
OOlC CCPF FCP IPCPCV
-13 ocS.-tcr y L F. I TTS 3 L 7
931s -._-_ 931s **
-
- OClA .CCM FCP IIPPOV -. - **- lCCOC LOO00 20000
** 10000 10000 2OOCC I
                                                     . ** 10000 10000 2000e
002 POST RES10 TR P io 400 20000 fO400 *-
C034 VI 51 11 hG CChSLL ** 3COOC 30000 60000
c_ -- - - - --
- 003 ~ISIT~G cnNsu - qaao_- __ -_ 245CC 2lCCL _____ 43333 91833 +*- .
,-
- 00.8- V 1s IT ING CONSbL ** ______ 15000 * 15000 3oacc
004 IhrEeiie sEw t 23100- 23?00- ieoc 4e2cc r
4
/.
t
I
i
OC5 COLURLS UC EYtR 367CC 42_POO 21300~ 10750 **
cce crcao c\r& tb0 E 86800- I_ 105100 -
3 067 C k' I U h3- f 1 ON S 522SCC 359scc 14PtCC !O27000 **
                                                  z04500 I*-
                                  12600-- __
5 - 011 CC ECUlP SR HCS 19700 34200 - lO0OC t3tCC **
                                            i&
t9bCC 1A37CC 1270C 256000 ** gyl
                                    f
2-010 CPPf PPG SThDE
-
_I- - -___ --
013 SIAIEIIOE CINCE - tZ55CC - 40 1300 234100 219 133. 1080033 **
- 013~-STbTthlEE CANJE ** 122550 122550 24:JCO i
- 0131 STLD CA FPOGPbC - -- - - -- - __ 5ooc 5cco
- 013L SThC -_ Cb CPrCPPC ** fa 0-c scqo . 10000
0131 SThC C4 PROG6AP ** scoo 5COO lCOC0
OL3E SThG Cb F?CG&AP ** ..act 5000 10000
- 013F SThtFWlCE CdWCE
0136 STbC Cb FPCC A6
14CCC .
10000
__
- ** 1000 taco -
** 5000 5000 10000 *
-- I -
--
---
**
I-
5000 5000 tocco j..
, 013J STUI: CI PPOCPPM **
5650 __ ._ 5450. 109CO
                              10000
                         ICCCC *
- ~ __    - *+   -
--- I        *I  -_ 5000 - soco
- __ ___ - -
- 013b STbC Cb FPCC bF
- 0132 SThC CC PPCC bP
-_ 014C-REC-PFCl~~RIC R %* 333cc 13332 466?2
C13Y ZTtO C4 FPCG 4P ** COO0 50CC
014 PEG FEClalPIC P 133600---- 170800
015 TPhG PFG MFC SP 387CC 685CO 44?CC 151500 ** 1
Olt Plbh ClT HSP S
017 COWC PUB INFO A ictcc 23ccc 43600 **
OZCB 4PEA FACILITIFS ** 153CC 19 3CO
11410C- 733?? 451eP3 **
.--
- 28200-- I__ -- __-_ - - 28200 ** ~ _____- - -
--- -- -
396COP .
- -_-
- 020 AREA FACILITlES - 84200 t8lCC - 249564 4ClEC4 ** ___
- 023C_CPE~.@tC ll_!TtES *I 1_57GO 1_5_700 314CO
la O'CE C?FP FACILJIIFS ** 5170C 51 700 ' 103400
                                                                         **                                   lC60CO
10 02CG bPEb FACILITIES ** 53000 53000
                     -- -- - --I----- -_ - __ -** 12zcc lzzac- 24400
704CC .
- -- 352CC ?520C L --
- II_.OZCF AREA FACILITIES - - -
9 - G2Cl 4REA FACILITIES
6 021 CEV SYS CF cc 1
            13600     13600 272CO L
4CZCC -+L. I                                              L
- o 020s LPEC FICILITIES . **
seoc
* - OZCV - APE* --__ FlCILtllES ** MOO 11600
9 -~__ 022 PHvsroicuLcR. __ ..-.-2610o - 14JCC
531CC WO5C A02750 I*
I
.I
I-
-
-
It
!
I
i -'
!'
023 SN FAIL TRN DE 3moo 79400 67200
                                                      SOZOO-* o
--mncfiriorrm CY 43ECC ?64c7---
                                                            217333 **
**67600 6'ICCC
027 CCCPLNITI HYPER                  64000 133333 __
028 CEV CCCPP STATE             moo l4lOC               511cc **
--027RFCOPWUNITY H'tP
-0 2 9 7 COP- ED -S ER V-CFi4O-b -19 80 0-* *
030 FAClCITY PLANNI 51cc 3242C 38120 **
-C3 CTf 8C I L-I TV-CI A h-b
-0llA CVd 4REd fbCfLf
0310 CVA APFI FACILI
-0 3 1 F - CV b bR EA- F AC I L I
031G CLA bPEb f4Clll
O3lP CVb dPEb FACILl
-03lP CVd-4PFA FACfLl
0315 CVA APE4 FACILI
-032 STeOKE 4RFb fAC
0321 STPOKE ARE) FbC
73 2N7 T FdlTTm n-Fb C
C3ZT STPCNE AFEC FPC
L
25040
I
** 2:coo
          27600 552CV
** 27606
** lJFOG 19800 39600
* *- (r16003160C 632CO-
                                   34800
*c lTC00
**
r:
                        dq05C 379560 2.IU10 ** .
031 CAPC IOV4SCbL4Q. - _- - ---
         17400
415 6-72) C E
o **
           SC~OO i
L 3400 13400 26800 c:
73 TJTbL-IUTFTCI11
- **tlCOC- 2190b *MOO-
.* 12500 125CO 25qa
                          11200
                         556CC 1
                            53200 Ii
                          325CO i
                                    35oco
                              mi00
** -- -13400 ~ 13406
** i4oac L40CO 28000
*I -- 15000- 15000 3CCCO. c '
10 t 7 6 39 76.644 7 6-* *-- -
** 56CC 5toc
                278CO
** 27800
     zoccc 266CO
*t 22161 10333
** 35000
I
-~
-
I I IZ?Q---f 13 2y9-* *--
E-036 --a KICNEY CIISEAS---
$ 0368 FECICNLL NEPI-PC _--...-- -
** - 2 2 1 t 7 -0 3 f 332 5 00- k
** 3 too0 e
-C!G PEtlChAL hEPtiPC
03t~ PE~AL iaEt FICI
-0 3 t X-6 E h A 13R T-bF A C I
037 AREA FACILITIES
-037E PES CIS IAEA FA
0375 PEZ 015 /REA FA
-0371 RESP 015 AREA 7
-63e-E vE fiGV7. LPETUU
03614 EWEPC CbPE FOR
-C41' CETECT AhC ECfM
-042 FLbh SlUC SYS c----
C42R PLAh ZlkC 5YSTE
-0 4 20-F L A N-S T W TSV 51 E
043 PAfrEFT bhC FA?
0436 PAllENf AND PAY
043F FATIEhT tNC fbH
-C43C PlilIEhl AhC FbP
043'4 PATIENT AVO FAH .* 13000
--
\.
268CO-
        41291 **
41291- -
_--_-....-- -
-. __._-_--
** 17600 16400 34000
** 93000--. 93000
186455 **
I
* 1860CO
1~64~s
037x UESP crs APE& F
102SC- --- lO2S0 ** ---
         4e2ec ** --
.- 482ac--
-- _--I_ ---._
** 55oc __I__ ___- . 9?.C$-.--
0418 cftec AND ELI~~
3998 *
** 170CC 17390
.L 5 570 0 29255 e4555
                     61100-
                              11600
10000 1600 16300
                            3 13ccc
50?3-2--*__-lrC332 ** ___
        461CO \
150cc-
12oco--
2
**
**
*+
-- -----
--
2300
L
--
---I__ -- -..____ _--
82-04 5-PP CG-T C--F X P P h C-
I4CCC IIICCC **
!
~ i.
i
-4
..
,
j J
1
-18-
Rcgion :
Review Cycle: IW/L
/-
11IS'TORICAL PROGRAM PROFILE OF REGION
Georgia Regional Me'dical Program's initial planning year began on
January 1, 1967, the region became operational on July 1, 1968 and
it obtained triennial status on September -1-',- L971,
GRMP includes the largeet geographic
River, and is characterized by large rural areas sparsely populated
with small hospitals and generally inadequate health facilities and
services. This region is looked upon as one of the more progressive
regions, and has a good concept of the probleuis and resources existing
within its boundaries.  No really serious problems have plagued this
region,
area east of the Mississippi
-I
One concern during GRMP's early stages of development was its weak
evaluation process. The region responded extremely well to this concern
and now has an excellent evaluation process. An evaluation specialist
wag added to the staff.  New directions now allow each approved program
element to have a specific evaluation'plon drawn up by the program
assessment coordinator and the project director at the time of pro3ect
design.
Implementation of the plan occurs shortly after funding.
Last year, program involvement with other Federal programs (CHP, Model
Citkes, Appalachia and OEO) was rather limited and consisted of
cross-representation on advisory groups and cross-review of applications.
GRMP is now participating with these agencies in developing their
health program in addition to reviewing their applications and serdng
on the advlrsory groups.
The primary, care problems of the underserved urban population was  one area
Of concern that GRMP has not, until recently, addressed to any degree.
Developmental component money is now being channeled into projects
centered around health care delivery to the rural and urban poor. Four
access stations make use of allied health professionals  to assist
physicians to better serve patients in their geographic areas that are
remote foom the physicians' office.
Originally, the Steering Committee consisted of six members of which
only one was a non-physician.  In order to correct this situation, the
Bylaws Committee recommended that the membership be increased from six
to nine members with at least four of the nine being non-physicians. This
recommendation will become effective in the fall of this year.
Lack of stimulation of activities at the Local Advisory Group level is
a problem that the region dealt with through its subregionalization process.
GRMP developed the "area facility" concept which basically provides-miRimal ,
financial support to selected larger community hospitals for the purpose
of expanding and extending appropriate health services to the smaller
-19-
ale and health professionals in their area. Thirty area facilities
ntinuing education and categorical diseaee are presently supported.
aa Facility Concept is explained on pages 1 thru 7 of the present
the week of August 14-18 and will be available to report on this
cation. Staff, at the request of GW, plans a visit to the region
of the total program along with the region's health access stations,
tc,, when the application is considered.
elve projects have successfully been terminated by either receiving
rt from other sources or having had elements  that were absorbed into
rojects o
The Phyeiology for Nurisng Instruc tors Course (Project 522)
minated by Council because it was difficult to see the relevance
    project to the goals and objectives of the program and how it
could relate to increasing the availability and accessibility of health
care.
The duration of most of the terminated projects was two and three
years.
GW has been considered by Staff, Committee and Council to be a strong
program with good management and organizational strengths, excellent
leadership, involved and conrmitted State and local relationships, Excellent
ation exists between the two medical schools.
e emergence of Emergency Medical Service activities through $100,000
supplemental funds to provide the planning for a total EMS system
June 8-9, 1972 visit.
-20-
Region : Georgia
Review Cycle: 10/72
STAFF OBSERVATIONS
Principal Problems:
Recommendations from last year's review cycle revealed GW's problems
to be those of a weak evaluation process, lack of program development
to serve the health needs of the underserved urban population,  the need
for broader lay representation on the Steering Committee and lack Of
staff assistance to other Federal programs in developing their
health programs.
Principal Accomplishments
GRMP has the capacity to adjust readily to changing priorities.
present application reflects definite response to the specific
recommendation,s in last year's advice letter.
force reorganization to allow greater responsiveness to the new mission
of RXP and reflect the three lirajor program areas of interest to GRMP,
additions to and change in the Steering Committee structure, and
some slight reorganization of program staff to permit the setting up
of an operations division.
              The
There has been a task
GRMP has matured to the point where emphasis is now being placed
upon working with larger community groups responsible for local and
area planning, such as CHP(b) agencies and Area Planning and Development
Commission of which there are 18 in the state instead of working with
the Local Advisory Groups.
National Health Service Corps in site selection and in obtaining
medical and dental society approvals for placement of health professionals
in areas where health services are inadequate because of medical
personnel shortages.
GRMP staff is cooperating with the
Three program areas which reflect GRMP's thrust for meeting local and
national priorities are manpower development and ultilization, specialized
services, and primary health services.  Taek forces in these areas of
competence develop goals, objectives and priorities.
recommend. appropriate strategies for reaching these goals and objectives.
GRMP should be noted for the rapidity with which it was able to move
into primary health care by ultilizing developmental component money
for planning and implementing the access shation concept, a regional
midwife service and pbnning a multicounty rural primary care system.
They also
Overall, GRMP is characterized as being one of the better managed and
organized regions.  No previous problems have existed to decrease its
funding during the past year.
. - ._
I ..
.. .
-_
-2 1-
Issues Requiring Attention of Reviewers
GRMP has an approved triennial program of which it is requesting
the second year funding.  The request does not exceed the N.A.C.
level.
is to fund the region at the approved level for its second
triennium year.
Staff '8 reconnuendation after reviewing this application
SCOB/DOD/RMPS
8/10/72
~
.a
I-
>
n
P
fD
u. 0
0 n,
n 'd
l-t l-t
0 n,
a a
8/ rt
fD
W
0
?tl
e
i
1
..
.. . .. .
.'
i
1
F. ... ,' .: r. I;
1,
~ _,. .... -*.
7 5, , 1; 'j
c
r:
i
r'
.-
J
1
.Region HAWAII RM 00001
Reivew .Cycle October 1972
Type of Application Triennium
Rating 309
Recommendations From
rn Review Committee
.-
-
SARP
Site Visit Council
endation:
The Committee agreed with the site visitors and recom-
mended, that the RMPH's triennial application be approved.
Funding Levels
05 Year 06 Year 07 Year
(1/1/73--12/31/73) (1/1/74--12/31/74) . (1/1/75-42/31/75)
$1,805,488 $1,689,213 $1,670,577
-..
0- I/           150,000        150,000
$1,805,488       $1,839,213      $1,820,577
request for the 05 year was not approved.
Total funds recommended for RMPH include earmarked funds  for
kidney project #47 and the Pacific Basin Area.
recommended for the kidney project W47 is $15,000 less than the
site visit recomendations.
The fundiiig
/
Because the RMPH has not completely satisfied the management
and review process requirements of RMPS, .the developmental
:
levels in the following amounts for the Pacific Basin Area.
Committee endorsed the site visitors recommendations that
KMPS earmark funds from the RMPN's three-year recommendea
05 Year    $299,700
06 Year    $288,221
07 Year    $299,110
e was impressed with the site visitors' favorable report on the
progress of the R4PH during the past year.
change in the direction of the progfcam along with increased productivity.
There has been a significant
The Conmittee com,endcd the increased Insolvcraent of the F,7iPH in
the PaciLi.c Basin, The gosls, ob,ject:.ives and priorikics of the
Basin are reflected by the unded prctjec Ls a /\iso, the represcntatives
of the Basin are beginning to consider themscLlves a part of the FNPI-I,
and are atteixpting to see hos: the Basin can relate to tlie program of
lawaii,
Areas of concern requi.ring IW'S at tenticin during the conling ycnl- are:
Region: Hawaii RM OOe' '
Review Cycle: Octobe
Component
GRAM STAFF & PROJECTS
LOPMENTAL COMPONENT,
EMS
hs/ea
Pediatric Pulmonary
Other
TAL DIRECT' COSTS
COUNCIL RECOMMENDED LEVEL
._
COMPONENT AND FINANCIAL SUMMARY
  TRIENNIAL APPLICATION
Current Annualized
Level 04 Year
$1,405,185
$1, 102,000
Requt
1s t year
(05)
$1,886,223
. 287,583
( 90,488)
c 1
c 1
( 1
c' "
$2,264,294
,t for Triennial .
2nd year I 3rd year
(06) (07)
j1,780,150 $1,420,276
287,583 287,583
39,213 20,577
Committee Recommendation for
Counc
1st year
0
,730,000
-0-
75,488
, 80 5,488
.-Approved
2nd year
(06)
I , 650 , 000
150 , 000
39,213
1,839,213
,eve 1
3rd year
(07)
. , 650,000
>SO , 000
20,577
. , 820,577
JcIncludes $1,470,645 direct cost.for EMS project.
These
funds are for two years but were totally awarded during
the 04 year for RMPS administrative purposeso
t
VI
t
SITE VISIT IiEPORT
REGIONAL MEDICAL PROGRAM OF WLWAZI,
GUAM AND THE TRUST TERRITORY OF THE
August 7-8, 1972
AMERICAN SAMOA,
PACIFIC ISLANDS
,
Site Visit Participants:
Leonard Scherlis, M.D., Chairman; Member of the Regional Medical Programs
Review Committee; Professor of Medicine and Head, Division of Cardiology,
University of Maryland School of Medicine, Baltimore, Maryland
Mr. Edwin C. Hiroto, Member of the National Advisory Council on Regional
Medical Programs; Administrator, City View Hospital, Los Angeles,
Ca 1 i f ornia
Mr. Kenneth Barrows, Bankers Life Company; and Chairman, Regional
Advisory Group, Iowa RMP, Des Moines, Iowa
William I. Holcomb, M.D., Private Practitioner; and Member, Regional
Advisory Board, Oregon RMP, Eugene, Oregon
- -c--. .- . _._ ._
RMPS Staff:
Mr. Richard L. Russell, Acting Chief, Western Operations--Branch, DOD
&. Calvin Sullivan, Western Operations Branch, DOD
Mr. Ronald S. Currie, Program Director, RMP, Office of the Regional
Edward 5. Hlnman, M.D., Director, Division of Professional and Technical
Health Director, DHEW Region IX, San Francisco, California
Development
RMP of Hawaii Staff:
Masato Hasegawa, M.D., Executive Director
MrW3*Chnar A. Tunks, Deputy Director
Alexander Anderson, M.D., Consultant in Medical Care and Quality of
W,riClyde Winters, Consultant in Medical Information System
Miss Susan Chandler, Assistant Director, Community Health
Mrs, Rosie K. Chang, Assoc. Director, Allied Health Manpower
Miss Manolita DeJesus, Office Manager
Satoru Izutsu, Ph.D., Assoc. Director, American Samoa, Guam & Trust Territory
Kame Kaku, M.D., Biostatistician/Epidemiologist
Mr. Ross Ramelmeyer, Assoc. Director, Planning and Systems Analysis
Miss Florence Katz, Assistant Health Planner
Mr. Michael Rodolico, Assistant in Systems Analysis and Evaluation
Mr. Norman Kuwahara, Assoc. Director in PPBS and Comptroller
Medical Care
Page 2 - RMPH Site Visit Report, RM 00001
RAG Members in Attendance:
51
4
Mr. Edward C. Bryan, Chairman, RAG; Executive Committee Member; Castle 9
Mr. Ollie Burkett, Vice-Chairman, RAG; Executive Committee Member;
William M. Peck, M.D., RAG Representative fromMicronesia5 Trust
t;
Cooke, Inc., Honolulu, Hawaii *
Hospital Association of Hawaii, Honolulu, Hawaii
Territory of the Pacific Islands, Office of the High Commissioner,
Saipan, Mariana Islands
Public Health, Agana, Guam
.,
Mrs. Betty S. Guerrero, RAG Representative from Guam; Department of
Hn. Curtin A. Leser, RAG Member; Hawaiian Electric Company, Honolulu, Hawaii
Mr. Stanley B. Snodgrass, RAG Member; Administrator, Convalescent Center
Mr. Albert Yuen, RAG Member; Admin. Vice Pres., Hawaii Medicai Service
Mr. Harold H. Ajirogi, Sr., RAG member and Executive Committee member;
Mr. Ligoligo K. Eseroma, RAG Representative from American Samoa; District #l
of Honolulu, Honolulu, Hawaii
Association, Honolulu, Hawaii
Program Officer, East-West Center, Honolulu, Hawaii
House of Representatives, Legislature of American Samoa, Fagatogo,
American Samoa
Herbert Y. H. Chinn, M.D., RAG member, Alexander Young Building, Honolulu,
Hawaii
. .-- .- -
pthers :
William E. Iaconetti, M.D., President, Hawaii Medical Association,
Mrs. Sylvia Levy, Officer, Comprehensive Health Planning, Department of
Miss Edith Anderson, Dean, U. H. School of Nursing, Honolulu, Hawaii
Mr. David Pali, President, Waianae Coast Comprehensive Health & Hospital
Mrs. Claire Ho, President Elect, Hawaii Dietetic Association, Nutrition
Mrs. Mary Lee Potter, Executive Director, Hawaii Nurses Association,
Terence Rogera, Ph.D., Dean, U. 11. School of Medicine, Honolulu, ,Hawaii
Mr . James Bunker, Exec. Vice Pres iden t , American Cancer Society, Hawaii
Livingston Wong, M.D., Alexander Young Bldg., Honolulu, Hawaii
Mr. Jerrold M. Michael, U. H. School of Public Health, Honolulu, Hawaii
Mr. Mark Sperry, Assistant Director, Health & Community Services Council
of Hawaii, Honolulu, Hawaii
Mr. George Moorhead, Assoc. Director, Health & Community Services Council
of Hawaii, Honolulu, Hawaii
Mr. Pat Boland, Asst. CHP Officer, Comprehensive Health Planning,,
Hono lu lu , Hawa i i
Miss Margaret Makekau, Asst. CHP Officer, Comprehensive Health Planning,
Honolulu, Hawaii
Honolulu , Hawa i i
Health, Honolulu, Hawaii
Board, Znc., Waianae, Oahu
Branch, Department of Health, Honolulu, Hawaii
Honolulu, Hawaii
Division, Honolulu, Hawaii
,
0
Page 3 - RMPH Site Visit Report, RM 00001
Others, Cont.:
H. Tom Thorson, Exec. Director, Hawaii Medical Association, Honolulu,
Hawaii
Mr. Raymond Lilly, Administrator, Waianae Coast Comprehensive Health
Center, Waianae, Oahu
Mr. Robert W. Rhein, Asst. Administrator, Waianae Coast Comprehensive
Health Center, Waianae, Oahu
Mr. Alexander Charter, Project Director, RMPS; Vice President, -Syracuse
University, Syracuse, New York
Miss Jane Arakaki, Consultant Dietitian, Hawaii Dietetic Associatibn,
Maunalani Hospital, Honolulu, Hawaii
Mr. William Coops, Administrative Officer, Research Corporation of the
University of Hawaii, Honolulu, Hawaii
INTRODUCTION
The main section of this report follows the RMP Review Criteria and
concerns primarily the activities of the RMPH in the State of Hawaii.
A separate section is included on the RMPH activities in the Pacific
Basin.
1. GOALS, OBJECTIVES, AND PRIORITIES (8)
The current goals, objectives and priorities were established in
0
1971 and represent a change from an emphasis on categorical diseases to
the development of a program to assist in the improvement of the health
care delivery system.
flexibility in programming.  The criteria for setting priorities on
projects and staff activities are in line with the State's CHP efforts,
especially those relating to the accessibility of better health service to
the medically underserved areas of the Region.
reevaluate the current goals and objectives and update them if necessary.
The goals are broad and allow the RMPH considerable
The RMPH RAG plans to
The team was extremely encouraged by the current program direction
of the RIQH. There was, however, concern that the RMPII might well find ,
itself werextended in terms of its organizational capabilities. The
team emphasized that the RMPH must realize its full responsibility for
successful programs, a responsibility which includes more than financial
support and RMPH goals.  RMPH grant recipients 8hould be made aware that
their projects are part of the RMPH and must conform to the established
RMPH procedures and reviews. This concern will be discussed further
under the Action Plan.
Page 4 - RMPH Site Visit Report, RM 00001
Recommended Action:
should be realistic in terms of what can actually be accomplished rather
than what it would like to have accomplished.
In reevaluating its goals and objectives, the RAC
2. ACCOMPLISHMEWTS AND IMPLEMENTATION (15)
Tbe RMPH's efforts of past years are now resulting in concrete program
  The RMPH has definitely established its own separate identity
results.
as a cammrnity leader in an extremely complex social environment,  In the
process of development, the program has gained support and involvement of
the community's power structure, or t8establishment,t8 and the conanunity
itself, or the %onestablishment."
staff has been developed.
of all key staff in some of the major program areas.  The change in'
direction, enthusiasm, and productivity of RMPH is impressive.
considerable progress has been made by the RAG in taking corrective
measures in response to the Review Process Verification and Management
Survey Visits conducted by RMPS staff in May 1972.
A competent, dedicated and.enthusiastic
There has not been, however, adequate involvement
Further,
Recommended Action:  The RMPH be encouraged to continue to build on its
experiences and successes thereby strengthening its administrative and
review processes to develop a fluid and adaptable structure so that the
RMPH is able to be flexible to
achieving its goals o
3. CONTINUED SUPPORT (10)
   The team found this to be
and could not identify a clear
meet the different needs that arise in
a particularly weak segment of the program
RMPH policy aimed at developing other
sources of funding for successful activities.
evidence that decremental funding had been considered in reviewing
proposals.  It is expected that the cancer chemotherapy project will be
funded by the American Cancer Society and the National Cancer Institute
upon completion of its fourth and last year of RMPH support.
Further, there was no
The Medical Care Review Organization project has been supported since
June of 1971 by the NO, HSMHA, as an experimental project.
discussing long-term funding of this project, RMPH representatives reported
that eventually the participating hospitals would share the cost.
or not the private physicians would be willing to share the costs is not
clear at this time.
In
Whether
Recommended Action: The RMPH should require grant applicants to incorporate
plans for developing other sources of funding for successful activities from
the inception of the project.
the possibility of applying decremental funding to the projects in the
triennial application.
FLlrther, consideration should be given to
L
I *
Page 5 - RMPH Site Visit Report, RN 00001
0
4. MINORITY INTERESTS (7)
   It is difficult to address "minority interests" in Hawaii as the
term is defined on the mainland.  Of the 750,000 people of the State,
150,000 are Hawaiian or part Hawaiian, most of which are at the bottom
of the social and economic scale. Other minorities include descendants of
the people brought in from China, Japan, Puerto Rico, Portugal, and the
Philippines to work in the plantations.
but unable to obtain land.  The team believed that the RMPH is addressing
the r'minority interests" by placing high priority on making better healtb
care accessible to people in medically underserved areas, as evidenced by
the RMPH support of the Waianae Coast Comprehensive Health Center project.
The Waianae District historically has had one of the poorest health profiles
in the State, according to standard measures of health, including incidence
of serious commtnicable diseases and chronic health conditions, incidence *
of restricted activity and bed days, lack of prenatal caE,e, and incidence
of infant mortality.
These minorities are land oriented
Recommended Action: The RMPH should be encouraged to pursue its interest
in addressing the problems of the medically underserved areas.
5. COORDINATOR (DIRECTOR) (10)
There was no doubt of Dr. Masato Hasegawa's dedication to the RMPH.
A significant amount of the program's accomplishments was attributed to
the strong leadership he provides in the community and his ability to
bring together diverse groups,  Further, Dr. Hasegawa relates well with
the RAG, especially its chairman, with whom he has regular and frequent
meetings. Prior to the visit, one of the concerns of the team was that
the Director was not allowing his deputy to function in an effective manner.
RMPS staff members noted a marked change in the degree of responsibility
the deputy had assumed in implementing changes in response to the manage-
ment survey and review process verification visit
conduct of the site visit.  Dr. Hasegawa openly admitted that in the past
he had not delegated appropriate authority and responsibility to the
deputy.  Further, he stated that he realized appropriate delegation was
necessary.  While the team was encouraged with the Director's change in
attitude,  there was some evidence that it might be some time before the
deputy's responsibilities and authority would be fully established.
conflict, apparently one of personalities, exists between the deputy and
comptroller. Further, the deputy, in a private session with RMPS staff,
reported that he does not have access to fiscal information from the
RMPH comptroller. The arrangements are that if the deputy needs fiscal
0
reports, and in the
A
-
Page 6 - RMPH Site Visit Report, RM 00001
information, he must ask Dr. Hasegawa who in turn gets it from the
comptroller.
separate meeting which will be discussed later, also voiced concern
about not being able to get information from the RMPH comptroller.
The withholding of information by the comptroller appears to be condoned
by the Director as a way of controlling the type of information he wants
released to various individuals.
7
Representatives of the Hawaii Medical Association,  in a
L
Recommended Action:
to use more effectively the deputy and for recognizing the need to delegate
more responsibility and authority accordingly.
deputy's role be fully clarified and documented for the RAG and program
staff.
cmications between RMPH staff and the RAG and strengthening coordina-
tion of effort and communications among the program staff.
The Director should be complemented on his decision
It is recommended that the
The team sees an effective deputy as a mechanism for improving
6. PROGRAM STAFF (Formerly known as CORE STAJ?F) (3)
The team found a competent, dedicated and enthusiastic staff.
Although it was reported that the staff consulted with one another on
individual projects and program areas, the team did not believe that staff
involvement was adequate in a number of key projects, especially the
Emergency Medical Service System, Hawaii Medical Care Review Organization,
Waianae Coast Comprehensive Health Center, and the Pacific Basin Program.
In view of the nature and significance of these programs, there is a need
for total commitment of much of the staff.
wondered if Dr. Alexander Anderson, Project Director of the Hawaii Medical
Care Review Organization, was or would be actively involved in other RMPH
activities.
involvement of the deputy, and believes that he should be able to assume
greater responsibility in the coordination of staff activities in program
development.
meetings should be held so all staff members have a general idea of the
total RMPH program.
Along these lines, the team
As noted earlier, the team was pleased with the increased
If not already being done, perhaps periodic formal staff
Recommended Action: A concentrated effort be made to commit staff efforts
in a coordinated manner to further strengthen the RMPH program development
as reflected in all its major project activities.
7. REGIONAL ADVISORY GROUP (5)
The team was extremely impressed with the RAG chairman, Mr. Edward Bryan.
There is no question of his commitment to and involvement with the program.
RMPH is fortunate to have his leadership. The discussions with Mr. Bryan
and other RAG members convinced the team that the RMPH RAG is well aware
that it should have the responsibility for setting the general direction
of the RMPH and formulating program policies, objectives, and priorities.
e
Page 7 - RMPH Site Visit Report, IiM OOOOZ
Confusion exists, however, about the role of the Executive Cornittee,
especially in the RMPH's review process.
Executive Committee may be relieved of its current responsibility of
review and approval of applications.
the RMPH process plans for early involvement of CHP.
was impressed with the willingness and ability of the RAG to assign
relative funding priorities to projects.
Mr. Bryan indicated that the
The team was pleased to note that
         Further, the team
   The team reaffirmed the findings of the management survey visit and
review process verification visit. The reports of these visits included
the recamnendation that the RMPH revise its bylaws and strengthen its
review process.
RAG had been formed and had drafted a revised set of bylaws.
efforts to strengthen the review process had already begun.
The team was pleased to learn that a committee of the
In addition,
The revised draft of bylaws will require additional work, and the
need for advice from someone knowledgeable in bylaw preparation was
evident. The visitors realized, however, that this first draft had been
prepared in a short period of time.
There was evidence that the program staff is increasing its efforts
to keep RAG members better informed of the overall administrative and
program operations.
that all RAG members have access to an adequate system of two-way
conummications. As the body which has the responsibility for setting
program direction, policies, and priorities,  the RAG must have access to
an effective mechanism to comnmrnicate its decisions to the program staff.
Also, and equally important, there must be an adequate mechanism by which
the program staff transmits to the RAG and its committees  the information
they need to make decisions.
The team stressed the need to continue this effort so
0
A major concern expressed over the composition of the RAG was a  lack
                           Of the 37 RAG members from the
of adequate allied health representation.
State of Hawaii, 34 are from Oahu and the remaining three represent the
Maul, Hawaii and Kauai county medical societies.
of the State of Hawaii representatives on RAG are hospital administrators
or serve on the board of a major hospital.  In addition, most of the
physicians on RAG have at least one hospital affiliation.
Kuakini Hospita1,for example, appears to be represented by at least four
RAG members, including three members of the Board of Trustees and the
Chief of Surgery.
health interests are not represented and there appeared to be minimal
consumer representation.
the RAG and the increased involvement of the Council is commendable.
Approximately 25 percent
As a result,
In contrast, voluntary health agencies and allied
The acceptance of the Pacific Basin Council by
Page 8 - RMPH Site Visit Report, RM 00001
Generally, the team was pleased with the strength, inv6lvement and
codtment of the RAG and was extremely encouraged with the administrative
and programmatic changes which have occurred since the last site visit.
There was evidence that the RAG as a whole is assuming some of the authority
previously held by the Coordinator and Executive Committee.
which the RMPH is taking can only be commended and encouraged.
Recommended Action:
The direction
a.
The RMPH be encouraged to continue to refine its revised bylaws,
giving close attention to the issues raised in the management survey and
review Verification reports.
clarifying the role of the Executive Committee to insure that it acts in
behalf of and not instead of the RAG.
seeking professional guidance in the wording and structure of the bylaws.
Perhaps legal council could assist.
Special attention should be given to
Consideration might be given to
b.
The RMPH review process should be finalized with special attention
given to the issues raised in the review process verification report.
Attention should also be given to eliminating unwarranted duplication in
the process.
c.
d;
Additional allied health personnel be added to the RAG.
The adequacy of representation by voluntary health agencies and
."
.. - %*
, -j
consumers be explored.
*.
e. The RMPH continue its efforts in strengthening communication
between the RAG and program staff.
8. GRANTEE ORGANIZATION (2)
Dr. Richard K, C. Lee, Executive Director, Research Corporation of the
University of Hawaii, the grantee, was not present during the visit.
team assumed that he was heavily involved with two major Federal site
visits to the University's Medical School. Mr. William Coops, the
grantee's administrative officer, however, actively participated during
most of the visit.
RMPS of its favorable acceptance of the management survey report and a
willingness to work with RMPH in implementing the report's recommendations.
The primary concern of RMS was that the RMPH Executive Committee had
usurped some authority of the grantee.
grantee since Dr. Lee served as an ex officio member of the Executive
Committee.
The
Prior to the sire visit, the grantee had notified
This had been sanctioned by the
be
in
During the visit, Mr. Coops stated that the grantee finds the RAG to
a very active and concerned group and, as a result, feels comfortable
permitting the RAG to do some of the grantee's work.
e
Page 9 - RMPH Site Visit Report, RM 00001
  The team found no widence that the issues raised by the management
survey report would not be satisfactorily settled.  The clarification of
the role of the Executive Committee, as noted earlier, should further
clarify the relationship between the RMPH and the grantee.
Recommended Action:
Advisory Group Responsibilities and Relationshipsf1 should be considered
by the aMpH in revising its bylaws.
The recent "RMPS Policy Concerning Grantee and Regional
9. PARTICIPATION (3)
  With the exception of allied health interest, the key health interests,
institutions, and groups appear to be actively participating in the program.
The team believed that Dr. Hasegawa had been instrumental in bringing these
many groups into the program.  Representatives of a number of professional,
voluntary, governmental, and consumer groups attested to their involvement
with the RMPH.
Association of Hawaii; Hawaii Nurses Association; The University of Hawaii's
Schools of Medicine and Public Health and East-West Center;  the American
Cancer Society; the Health and Community Services Council of Hawaii, a
private agency which represents 115 public and private groups; Waianae
Coast Comprehensive Health Center; and the Health and Community Services
Council of Hawaii.  As indicated earlier, the team believed that the RMPH'
has involved the "es tablishmentl* and ffnmestabliehment .I'
Recammended Action:  There should be more active involvement of the
allied health groups in the REPPH.
Included were the Hawaii Medical Society; Hospital
0
10. LOCAL mANNING (3)
  As reflected in the Review Process Verification Visit Report,  the
area of cooperative endeavor with Hawaii CKP agency is one that requires
increased attention.
basis.
CHP early in the review process as recommended by the review process
verification visit report.
CHP rcAt' a gency docls have county committees on all but two of the
Hawaiian Is lands.
Planning to date appeared to be on a fragmented
The team was encouraged, however, by the RMPH plans to involve
Although there are no CHP W' agencies, the
CHP in Hawaii is preparing a budget proposal for the next fiscal
year which, if funded, will more than double the existing CHP agency
staff of three professionals.
be part of the A agency staff.
As presently proposed, all personnel will
i
I
Page 10 - RMPH Site Visit Report, RM 00001
!&e proposal would add me full-time staff person, a research
-
associate, to Mrs. Levy's imnediate staff.
would establish what are being termed as State Assisted B agencies.
Under this concept, full-time planners will be assigned to the counties
of Hawaii and Maui, the windward side of Oahu and a half-time planner would
be asskgned to Kauai.  This staff will assist with the development of a
statewide health plan for Hawaii.
that the State Assisted B agencies will develop into full-fledged
independent B agencies,
In addition, the proposal
.
'
I
Over a period of years, it is anticipated
In May 1972, RMPH employed and Associate Director for Planning and
Systems Analysis for the purpose of developing long and short-range plans.
The systems approach at this time is in the embryonic stage, and appeared
rather confusing.
of CHP and other appropriate connmrnity groups, and the coordination of
RMPH program staff in program development will result in an effective
planning mechanism.
Hopefully, this approach coupled with the involvement
Recommended Action: The RMPH be encouraged to continue its increasing
efforts to develop an effective planning mechanism.
Future staff and/or
site visits to the RKEW should pay special attention to the systems
approach.
11. ASSESSMENT OF NEEDS AM) RESOURCES (3)
--.
Dr. Hasegawa reported that the data available from CHP had been
gathered primarily by the RMPN.  While there was no evidence of a scientific
1
approach to assessing needs and resources, the team noted that the RMPH
seemed to know what needs to be done.
in the Management Reporting and Evaluation System (MRES) being conducted
by the University of Washington through a RMPS contract, should strengthen
the RMPH's planning and assessment practices.  MRES is a group of processes
that serve as mechanisms for directing, planning, monitoring, and reporting
the effects of a =...its personnel, its efforts, its resources. The
major output of the system is the productiori of timely and practical
information which enables coordinators and Regional Advisory Groups  to
effectively apply the decisionmaking processes.
Recommended Action: RMPH should continue its efforts to work more
closely with CHI? in assessing needs and resources,
The participation of the RMPH
12. MANAGEMENT (3)
In view of the recent Management Survey Visit,  the team did not
.believe it necessary to question the fiscal management of the program.
The need for better coordination of program staff in programs and project
development has already been discussed.
appeared adequate.
The monitoring of projects
e
Page 11 - RMPH Site Visit Report, RM OOQOY.
13. EVALUATION (3)
i
Evaluation was considered to be a serious deficiency of the program.
The new Associate Director for Planning and Systems Analysis  is also
responsible for evaluation of project and program activities.
recruiting for a medical economist to insure a relationship of the RMPH
to the total economic system of Hawaii and provide measures of cost
effectiveness and cost benefit to insure that the delivery system has
a measurable ecrmomic component built-in.  An evaluation subcommittee of
the RAG has been established and is currently in the developmental stage.
Another subcommittee of the RAG, also in the developmental stage,' is  the
Implementation Connittee, which about five months ago initiated the site
visit mechanism to ongoing and potential projects.
the program staff to provide project progress and expenditure reports to
the RAG and its committees at each of their respective meetings to a,td in
the evaluation of projects.
RMPH is
There is a need for
Recomnended Action:
to evaluate project activities and to assess how they will contribute to
regional goals and objectives.
providing information on progress and evaluation results to program
management, the RAG, and other appropriate groups.
The RMPH should continue to develop new techniques
Special attention should be given to
14. ACTION PLAN (5)
0
The RMPH has established priorities for project funding. First
priority is given to ongoing projects and second priority to the new
projects.
While all of the projects have a sense of reality to them and are in
keeping with both RMPH and national objectives, the team believed that the
magnitude of the program proposed would seriously tax the current
capability of the RMPH.
Also, priorities have been set within each of the two groups.
Some of the RMPH's key projects,  such as the Emergency Medical Service
System, have been rapidly thrust upon the RMPH, which has responded
admirably.
adequate time to evaluate the significance of their potential involvement
with the EMS, Waianae Coast and Pacific Basin activities.  Although these
individual programs represent different types of joint involvement with
a number of other agencies, they are the primary responsibility of the
RMPH, and, therefore, will require the total commitment of much of the
program etaf f.
There was a question, however, as to whether RMPH had had
  The EMS program at this point is only a "paper system," and the
full impact of RMPH's responsibility of making it il truly comprehensive
system may not be fully realized.  The RMPH ha6 a responsibility of
seeing that the EMS Advisory Council must be broadly represented to
incZude those interests which are necessary to the successful development
e
Page 12 - RMPH Site Visit Report, RM 00001
of a quality operational system.
elements.
'. Society Ccnunission for Heart Disease report on myocardial infarction.
Also, the relationship of the Physiological Data Monitoring System
project to the EM3 project should be carefully examined and coordinated.
The overlap between the two projects must be compatible.  The RMPH
plans to fund the EM5 project, which is sponsored by the Hawaii Medical
Association through a contract.  Currently, the HMA and RMPH are having
some difficulty in negotiating a contract.  The morning following the
site visit, RMPS staff was asked to meet with the following representatives
of the HMA:
Herbert Y. H. Chinn, M.D., Member of RAG, Past President of the Hawaii
Medical Association and Chairman of the HMA-EMS Executive Committee;
Thomas Y. K. Chang, M.D., Assistant City and County of Honolulu Physician,
Director of the City-County Ambulance System, and Assistant Director for
Equipping Ambulances in the EMS Project; George Mills, M.D., Member of
RAG and Executive Committee of RMPH, Past President of HMA, and Hawaii
State Senator; and H. Tom Thorson, Executive Director, HMA.
problems seems to be that the HMA is hesitant to be placed in a position
of having to answer to the RMPH.
concerned that the RMPH plans to hire a physician on its program staff to
"keep an eye on him.''
information from the RMPH comptroller regarding the RMPH fiscal policies.
There was much discussion as-to who would resolve the differences between
the HMA and RMPH in contract negotiation.
would have to be worked out between the HMA and the RMPH Executive Committee.
RMPH should assure that the system-
gives appropriate attention to the trauma, drug, psychiatric, and medical
t
Regarding the latter, advantage should be taken of the Inter-
h
Livingston Wag, M.D., Project Director, EMS Project;
One of the
Dr. Wong, the project director, is
MVIA representatives said they were unable to get
Dr, Mills suggested that this
Although the RMPH will support about 15 percent of the Waianae
Coast's total program, the team believed that the RMPH has a major
responsibility in working with the development of the total program.
The future of the Waianae program can be potentially exciting, or potentially
troublesome, for the RMPH.
President, Waianae District Comprehensive Health and Hospital Planning
Board, Inc., the RMPH has been an exceptional stimulus and catalyst
toward the development of the total program.  The role that RMFH has
played seems to be well recognized and appreciated by the community.
the project continues to develop successfully, WH, no doubt, will receive
much of the credit.
should be thwarted and the provision of health services should be delayed,
the community may look to RMPH for explanation.  It seems, therefore, that
the RMPH would want to provide close surveillance and assistance to the
other segments of the project,
absorb a considerable amount of program staff's time, the team believed
the investment would be most beneficial to the community and, therefore,
the RMPH.
Based on the testimony of Mr. David Pali,
If
On the other hand, if the progress of the project
While support of this nature may well
Page 13 - RMPH Site Visit Report, RM 08001
Another concern of the team was the lack of any clear relationship of
                                                      It
                   Review Group pointed out the'need to
the Hawaii Medical Care Review Organization project to other projects.
appears that many of the MCRO activities might be applied to the other
projects.
relate MCRO to the Oahu Patient Origin and Utilization Study.
It was noted that the CHP
In discussing the RMFB's plan for renal disease,  the team noted that
there seemed to be a problem of two competing hospitals, each wishing to
perform identical functions.
team that the problem had been solved and there would be no duplication.
The RAG chairman assured a member of the
Reconanended Action:
a. The RMPH carefully reevaluate the magnitude of its triennial
plan, giving special attention to the RMPH's full responsibility to its
major program components to determine how best to utilize organizational
resources, especially program staff.
b.
A mechanism be developed to utilize the Report of Inter-Society
Commission for Heart Disease Resources in establishing the Emergency
Medical Service System.
   e. That the RMPH and RMPS provide close surveillance and assistance
as necessary on the progress of the EMS project.
d.
     The relationship of the Hawaii Medical Care Review Organization
to other RMPH activities,  and the relationship of the Physiological Data
Monitoring System project to the W project be explored further.
15. DISSEMINATION OF KNOWLEDGE (2)
The team expressed no concerns over this segment of the program.
Provider groups and institutions and education and research institutions
have been contacted and involved.
16. UTILIZATION MANPOWER AND FACILITIES (4)
   Existing health facilities will be more fully utilized through
projects such as the EMS, and Monitoring of Physiological Data projects.
Productivity of physicians and other health manpower should be more fully
utilized as a result of projects such as Manpower Utilization and Restraint
of Costs in Hospital System, Hawaii Medical Care Review organization, and
Upgrading Bedside Nursing Care in Rural Connmrnity Hospitals.
allied health personnel is demonstrated to some extent in the Dietary
Counseling and Outreach Service and the Waianae Coast projects.
The use of
The team
Page 14 - RMPH Site Visit Report, RM 00001
believed that there was a need for greater allied health activity in the
program related directly to Hawaii.  (The use of allied health persdTink1
in the Pacific Basin program is clearly demonstrated.)  In addition, the
manpower programs of the RMPH could be strengthened through a better
integration of programs.
Reconmended Action:
in its programs as related to the State of Hawaii.
tion of manpower programs for physicians, nurses, and allied health
personnel should be explored.
17. IMPROVEMENT OF CARE (4)
r
The RMPH should reevaluate allied health involvement
Further, the coordina-
All of the projects, in various ways and degrees, are aimed at the
improvement of care.
18. SHORT-TERM PAYOFF (3)
It is reasonable to expect that some of the projects will increase
*_
the availability of and access to services.  The Waianae Coast project is
a prime example.  The Medical Care Review Organization is to establish an
ongoing system for quality of medical care review.
medical economist is being recruited to address the economic component of
the delivery system.
As noted earlier, a
19 o REGIONALIZATION (4)
  In view of the geography of Hawaii and the fact that the majority
of the population is in Honolulu, the team elrpressed no concerns over this
aspect of the program.
.
coordination is the Waianae Coast Health Center Project. The membership
of the Regional Advisory Group and its standing cormittees indicate
regional involvement.  Major health, business, labor and educational
organizations are represented.
application, 13 are outside of Honolulu. Further, there are program
staff activities and operational projects which are specifically directed
to Hawaiian Islands other than Oahu. The Pacific Basin program, of course,
is an example of successful regionalization under most unusual circumstances.
20. OTHER FUM)ING (3)
One example of joint effort and multi-agency
Of the 24 performance sites shown in the
  The only two concrete examples of other sources of funding were the
American Cancer Society's intent to support the chemotherapy project and
the support of the Waianae Coast project by state and Federal funds.
team was disappointed, as noted earlier, that there was no clear RMPH
policy aimed at developing other sources of funding.
The
Recommended Action:
continued support which could be used in the review and evaluation
The RMPH should develop a clear policy regarding
processes.
Page 15 - RMPH Site Visit Report, RM 00001
PACIFIC BASIN
The team was extremely pleased with the increased involvement of the
RMPEI in the Basin which by its very nature presents an unique challenge.
The Basin covers a geographical area of mer three million square miles,
is populated by 228,000 people who speak ten languages and live on 105
of the 2,147 islands.
distinct and separate in regards to people, culture, and government.
More than 50 percent of the population have no ready access to health
care.
Guam, American Samoa and the Trust Territory are
The goals, objectives and priorities of the Basin are reflected by the
funded projects, Constant Care Unit on Guam, Health Assistant Training,
Improvement of Health Services through Otology, and Health Information
System on Guam.
specific health needs, availability of resources and the problem of
vast distances were taken into account.
In developing priorities for project selection, the
Perhaps the most significant accomplishment to date, excluding the results
of individual projects, is that the representatives of the Basin are
beginning to consider themselves as a part of the RMPH, and are attempting
to see how the Basin can relate to the program of Hawaii.  Mrs. Betty
Guerrero, the RMPH RAG representative for Guam, for example, wanted to
know if Guam could become part of the Hawaii EMS program.  Dr. Wong, the
Em project director, said "we will have to talk."
funds by RMPS as part of the RMPH award, has definitely helped close the
credibility gap between the Basin and RMI?H.
planning."
The earmarking of
The Basin was "tired of
The RMPK is supporting operational projects.
The team commended the enthusiastic leadership provided by Dr. Satoru
Izutsu, Associate Director for the Pacific Basin.  His ability to provide
program direction and to identify with the cultural diversity of the area
is impressive.
spend between 10-25 days a month in the Basin.
The vast territory Dr. Izutsu covers requires that he
The RAG for the Pacific Basin is the Pacific Basin Council which is composed
of ten RMPH RAG members from Guam, American Samoa and the Trust Territory
and 12 members of the now disbanded Pacific Basin Advisory Committee.
health organizations are represented.
Key
Deliberation of Pacific Basin matters are solely the prerogative of the,
Council and its representatives in the RMPH RAG are the primary contacts
for Dr. Izutsu. Because of the cost of travel, one member from each area
of the Basin is designated, by fellow Council members, to attend RMPH RAG
meetings in Honolulu.
Page 16 - RMPH Site Visit Report, RM 00001
The three representatives from the Basin, Mrs. Guerrero from Guam,
Dr. William Peck from Saipan, and Mr. Ligoligo K. Eseroma from Amerfcan
Samoa indicated that the Pacific Basin Council had adequate input in the
RMPH.
possibility of changing the RMPH title to "Regional Medical Program Area."
He said such a change would satisfy the Government of American Samoa.  The
Council finds meeting in Honolulu a practical and desirable arrangement.
It is intended that Council members will convene a day prior to RAG
meetings so that RAG members from Guam, American Samoa, and the Trust
Territory may attend both meetings.  Travel costs per Council meeting
are $5,500.
becoming actively involved in the program.
Comprehensive Health Planning is established in each area of the Basin.
A CHP plan has been completed for Guam.
really activated-there have been three CHP planners in the last three
years.  Just recently, American Samoa got a new planner who previously
was the assistant to the CHP planner on Guam, Mrs. Guesrero, Mrs. Guerrero
believes it will take American Samoa about three years to develop its CHP
plan.  Dr. Izutsu is actively involved with the Comprehensive Health
Program Council for the Trust Territory which involves representatives
from all consumer, provider, and governmental groups.
In general, the site visitors were highly impressed with the development
of the Pacific Basin Program, and believed much had been accomplished with.
limited staff and budget. -
Mr. Eseroma, in a note to the Chairman of the team, questioned the
It appeared that the key health interests of the Basin were
American Samoa's CHP is not
The team recommended that the Pacific Basin Program be approved in the
amount requested ($299,700). Further, the team endorsed the specific
identification of funds by RMPS for the Pacific Basin Program.
'
CONCLUSIONS AND RECOMMENDATIONS
The team was favorably impressed with the change in direction, enthusiasm,
and productivity of the RMPH.
is capable of managing a three-year plan, they were concerned with the
magnitude of the proposed plan.
transitional stage of organizational as well as programmatic development,
and the proposed program might overextend the present capabilities of the
RKPH. The team believed that during the coming year the RMPH will have
adequate opportunity to demonstrate that it has developed the efficiency
and strength required of a mature and stable organization.
has not completely satisfied the management and review process requirements
of RMPS, it would have been inappropriate for the team to consider a
developmental component request for the 'initial year of the triennium.
While the team believed that the program
The RMPH is currently in the midst of a
Since the RMPH
. f
e.
Page 17 - RMPH Site Visit Report, RM 00001
The team recommended that the RMPH be approved for triennium status,
including the Developmental Component, for the second and third year of
the triermium, provided:
c
I.
11.
111.
IV.
The amounts requested for each year be reduced.
for detailed amounts.)
The RMPH be site visited prior to the beginning of its next
operational year.
RMPS provide close surveillance and assistance to the EMS program.
The following advice and recommendations be relayed to the RWH.
(See page 18
A.
B.
C.
D.
E.
F.
G.
H.
I.
In reevaluating its goals and objectives and the magnitude of
its triennial plan, special attention should be given to the
RMPH's full responsibility to its major program components.
The RMPH is encouraged to continue building on its experiences
by strengthening its administrative and review processes.
Consideration be given to developing other sources of funding
for successful projects, and decremental funding of projects be
applied where appropriate.
RMPH be encouraged to pursue  its interest in addressing the
problems of the medically underserved areas.
The Coordinator be complemented on his efforts to more
effectively use his deputy.
A concentrated effort be made to commit staff efforts in a
coordinated manner.
RMPH be encouraged to continue to refine its revised bylaws
and in doing so, consider the RMPS Policy Concerning Grantee
and Regional Advisory Group Responsibilities and Relations.
The review process be finalized with special attention given
to the issues raised in the RMPS review process verification
report.
Efforts to strengthen communications between the RAG and program
staff should be continued.
05
sv
Request :?ecammend s
I
06
sv
Request Recouraends
Initial Appllcetfon
Ri dney
GRAm, TOTAL
$2,173,806 $1,730,000 $2,067,733 $1,800,000
90,488 90,488* 39,213 39,213*
$2,264,294 $1,820,488 $2,106,946 $1,839,2 13
07
sv
Request Reconmen&
$1,420,276
287,583
1,707,859
  20,577
$1,728,436
$1,121,166
1,408,749
  20,577
$1,429,316
287,583
$ 114,219
  184,901
$ 299,110
$1,707,859 $1 , 800,000
$1,650,000
150,000
1,800,000
$1,820 , 577
20.577*
41,350,890
1,500,890
$1,521,467
150 000
20,57 7*
$ 114,219
184,901
$ 299,110
Ini tial App licstlon
Program Staff 8nd Projects
Develop-tal component
-Subtot8 1
.M&ey
WAND mAL
$1,886,223 $1,730,000 . $1,780,150 $1,650,000
287,583            -0 -          287,583        150,000
2,173,806       1,730,000       2,067,733       1,800,000
90.488 90,488* 39,213 39.213*
$2,264,294 $1,820,488 $2,106,946 $1,839,213
* Pendfhg RMPS acceptance"af RMPH technical review of kidney application, see page 20.
,
t.
.r.
c
Wwaii Program
Program Staff and Projects
Developmental Camporient
Kidney
-Subtotal
TOTAL
Pacific Basin
Administration
Projects
TOTAL
Rovaii (Excluding Kidney)
Pacific Basin
Kidney
TOTAL
GRAND TOTAL
$1,586,523      $1,&30,300       $1,491,929      $1,361,779
287,583            -0-          287,583        150,000
1,874,106       1,430,300       1,779,512       1,511,779
$1,818,824 ' $1,550,992
90,488 90,488* 39,213 39,213*
$1,964,594 $1,520,788
$ 107,700 $ 107,700 . $ 110,880 $ 110,880
                      177,341 177,341
192,000 192,000
$ 299,700      $ 299,700       $ 288,221      $ 288,221
2,173,896       1,730,OCO       2,067,733       1,800,000
$1,874,106 $1,430,300 $1,779,512 $1,511,779
                                    288,22 1
299,700 299,700 288,221
39.213*
90,488 90.488* 39,213
$2,164,294 $1,820,488 $2,106,946 $1,839,213
I
$1,408,749
299,110
1,707,859
  20,577
$1,728,436
$1,500,890
299,110
1,800,000
20.577*
$1,820,577
Page 19 - RMPH Site Visit Report, RM 00001
0
1
J.
RMPH be encouraged to continue its efforts in developing an
effective planning mechanism, including closer association with
CHP .
K. Continue to develop new techniques to evaluate project activities
  and to assess haw they will contribute to regional goals and
  objectives .
L.
A mechanism be developed to utilize the findings of the Inter-
Society Cananission for Heart Disease Resources in eatablfshing
the EM3 system.
M.
The relationship of project activities be further explored.
N.
Additional allied health personnel be added to the RAG,  and
reevaluate the allied health involvement in programs relating
to the State of Hawaii, and explore the coordination of man-
power programs for physicians, nurses, and allied health
personnel .
0.
The adequacy of representation of voluntary health agencies and
consumers on the RAG be explored.
P.
Develop a clear policy on continued support of successful
projects which could be used in the review and evaluation
0 processes.
RATIONALE FOR FUNDING
As noted earlier, the team believed that the Pacific Basin program should
be funded in the amounts requested.
The team could not endorse a developmental award for the first year of
the triennium, but believed that in a year's time,  the RMPH will have
reached a stage of maturity which would justify a developmental award.
The recommendation for support of a "Triennial Award" is believed
necessary to encourage the RMPK to continue in the direction in which it
is moving.
the team believed a second rejection could hinder the progress being made.
In view of the rejection of the previous triennial application,
For the Hawaii segment of the RMPH 05 year, the $1,730,000 recommended
for program staff and projects represents a $842,445 over the current
$887$555 for the same purpose.  The team had to consider that the RMPH
has already been awarded $1,470,645 for the two-year EMS project;  the
administration of the EMS project will require considerable RMPH
staff effort.
Page 20 - RMFH Site Visit Report, RM 00001
In arriving at the total amount of $1,730,000 it wae understood thZt the
;r
amount requested or the kidney project woul  be added, if RMPS accepted
the RMPH technical review of that project. 8 The amount reconmended was
not based on the deletion of individual project budgets.
team did specifically include in the 05 year Llmount,funds for the Pediatric
Pulmonary Center at the suggestion of RMPS staff, in view of the history
of Pediatric Pulmonary funding by RMPS and its effect on the RMPH.
J
However, the'
The amount recommended for the 06 and 07 years permits an $80,000 increase
over the 05 year, and includes $150,000 for a developmental component.
- .--------I -._I--_.._C&__ __
-
- -
_-
(Project #47--Dialysis and Transplant Center
Since the site visit, RMPS staff has determined that this project conforms
to the Kidney Guidelines, received favorable outside renal technical
review and has supportive RMPH RAG and CHP comments.
The RAG, however, did not resolve differing recommendations of the renal
technical reviews regarding the procurement of a liquid scintillation
system.
potential of mixed leukocyte culture as a retrospective measure of
incompatibility, largely in a living related donor population, but
doubted that this procedure is essential to the overall success of the
cadaveric transplant program.
systqwhich would be principally used for leukocyte culture studies was
r econrmended.
Two of the technical site visitors recognized the research
Deletion of the liquid scintillation
The third technical site visitor recommended funding of the liquid
scintillation system, on the basis that from the use of some equipment
there will result direct service-related advantages for patients with
respect to both donor/recipient selection and post-transplant
management .
RMPS staff noted the existence of liquid scintillation equipment at the
University of Hawaii.
project is about $15,775.
conflict regarding the reluctance of Kuakini Hospital, which has done
only two transplants since 1971, to agree to support St. Francis
Hospital as'the only PHS funded tertiary center for the treatment of
end-stage renal disease on the Islands.
the relationship of both hospitals to the project should be clarified.)
The amount budgeted for similar equipment in this
Further, it was noted that there has been some
Before funds are made available
RMPS /WOB
9-19 -7 2
-----
Review Cycle: OC;T. 1p~2.
REG I ON : HAWAII OPERATlONS BRANCII:
NUMBER: 00001
COORUINA'rOR: Masato Hasegawa, M.D.
&lef: Richard Russell
Staff for mp: Calvin L. Sullivan
..
--
-
LAST RAT IN(; :
TYPE OF APPLICATION:
-
2nd Year
-
/ / Triennial / - / Other
-
- 3rd Year Regional Office Representative:
/r/ - Triennial / / Triennial
Management Survey (Date) :
May 15-18, 1972
Conducted:
or
Scheduled:
Last Site Visit:
--
(List Datcs, Chairman, Other Comr,iittee/Council Mmbers, Consultants)
August 7-8, 1972
Mr. Edwin Hiroto
Leonard Scherlis, M.D.
Mr, Kenneth Barrows
William I. Holcmb, MmD.
RMPS Advisory Council
RMPS Rek.ew Committee
Consul tan t
Cons ul tan t
Staff Visits in 1,3st 12 Nonths: --
(List Dtt$ and ) 1- ose
Dr. Haro
Mr. Richard Russell and Mr. Ron Currie - Met with WH Program Staff,
November 1971.
Management Assessment Visit - May 15-18, 1972
Review Verification Visit - May 15-18, 1972
DPTD site visit to limited care facility of St. Francis Hospital, Honolulu
Margu!LYeg - Jet with RMPH RAG, November 1971.
seases.
*AULA
>
a. HllllAU
2
,
PART
,
/
.. ..
.. . c.
, .,
..
/
HEW Regional Office
-
. ..
/ .>
HAWAII
IX
Regional Delineation:
State: `Hawaii, American Soma,c.Guam and Trah Territory
Counties: 5 (Hawaii)
Congressional Districts : 2
Subregions : Territories
Overlap/in terf ace
DEMOGRAPHIC INFORMATION
769, 900
Population
Hawaii
GW 86,900
American Samoa 27,800
Trust Territories(approAmate 97, 600)
approximately 900,000
Age Distribution
Percent of Total by Specified Age Group, 1970
U.S.
Age Group       Hawaii -
Under 18 yrs.     38 35
18 - 65 yrS*      56 55
6% 10
65 yrs. & over
INCOME - Average Income per Individual, 1969 & 1970
1969 19 70
State (of RMP) $3882 $m5*
United States 36 80 39 10
*State of Hawaii ranks 6th
MORTALITY RATES, CY 1967 & 1968
Population Density
104 per sq. mile
% Urban - 83
% Non-White - 61
Metropolitan Area Populatic
*Honolulu - 613.1
(mainly p olynes i an)
Deaths per 100,000 population **
Caw e
Heart Disease
Cancer
Vasc. lesions
-
- RMP (Hawaii)
196 7
- i968 -
168.3 162.8
                   U.S.
                  364.5
98.5 98.5 157.2
-
46.3 44.2 102.2
(aff. CNS)
All causes, all ages
45-64 yrs.
65 & over
** Utes generally
population).
&mica% because of age distribution (mu& younger
519.4 935.7
827.6        1143.5
5102.6        6042.5
RMOOO 01
-4-
KEGIONAL CHARACTERISTICS (Cont'd)
FACILITIES AND RESOURCES
SaiOOLS
Schools No. Enrollment
Medicine (and Osteopathy) (1)
(19 69 / 70)
University of Hawaii 75
Graduates Lo cat ion
(1969/70)
Sch. of Medical Sciences --
(2 yr. school of basic med. sci.)
1970171
86
--
Nursing Schools
Professional Nursing
-- Honolulu
Number
Practical Nursing
Number
Allied Health Schoola
Cy to technology
Number
Medical Technology
Number
Radiologic Technology
Number
Physical Therapy
2:l at Univ; 1 at community college.
3:l at community college.
(Approved Programs)b
---
5 (incl. 1 at Army MC-Tripler)
2 (Honolulu
---
.. :.
.., .
.... .
.. ..
~
.. -
..
._
Medical Record Librarian ---
RM 000 01
L-, -
I.
REGIONAL CHARACTERISTICS (Con t ' d)
FACILITIES AND RESOURCES (Cont ' d)
HOSPITALS
Nan Federal Short and Long-term general hospitals, 1069 & 19 70
Number'of Beds
Number
                       19 70
21 22 2384 245 3
                         872
1969 1970 - 1969 -
-
Short term
Long term (and special) 7 6 9 32
V.A. General hospitals 0
Number of Hospitals with
Special facilities
# of facil.
Intensive CCU 8
Cobalt therapy 3
Isotope facility 6
Radim therapy 7
Renal Dialysis 5
in patient
Rehab-in patient 3
Source: her. Hospital Assoc. 1970 Guide Issue August 19'
NURSING AND PERSONAL CARE HOMES,  1967
Nmber
Skilled Nursing Homes 12
Personal care Homes
with Nursing Care 24
Number of Beds
    909
178
8 5 41
Long term care units
Source: NCHS - A Master Facilities Inventory County
and Metropolitan Area Data Book PHS - Number
2043 - Section 2, Nov.  1970
- I> -
I. REGIONAL CHARACTERISTICS (Cont'd)
  FACILITIES AND RESOURCES (Con t ' d)
MANPOWER
profession
Nmber
%Tot a1
RM 00001
-
Ratio
per 100,000
Physician - active (pt. care)       9 34 100.0
general practice                           20.0
medical specialties                        21.0
other (active) 82 130
s urgi cal spe ci a 1 ties
Physician - inactive
Osteopath
Total active MD & DO
27.0
Professional nurses
active 2 334 32 1
. ;Inactive 204
Lic. Pract. Nurses
actively empl. in nurs. 1319 176
not enpl. in nurs. 2 44
Medical techno logis ts
Radiologic technologia ts
Physical therapists
Medical record librarians
GROUP PRACTICES
Sources:
Distribution of physicians, Hospitals, and Hospital Beds in
the U.S., 1969; American Medical Association, Chicago, 1970.
Health Manpower Source Book, Section 20, PHS-NIH-BEMT, 1969
Conponent
1st year
Current hnual ized
       01; Year
Level
-
I
I
$ 513,297 $ 692,244
        (107 , 100)
24,705 0
207,523
537,553 -
3XTMCTS
b
EVELOPWTAL CO~&ONENT
IUXAL PROJECTS
Kidney (90,425 I./)
EMS ( 21 1
hs/ea I -O- 1
Pediatric Pulmonary ( 32,285 )
(192,007 )
Other
I
I
. $1,079,555 $2,26&,294
OTAL DIRECT COSTS
OWCIL RECOAMHEKEED LEVEL I 1
jt for Tri
2nd year
$ 717,456
    0
(110,&80)
287,593
1, 101,907
(39,213)
(77,335 j
$2,106,9&6
1 COUR
nnial
1st yljar
$ 743,929
    0
(114 , 219)
287,513 '
*.
696,924
(20,57 7)
i
c
$1,728,436
JX yez
-7
AUGUST 18r1972
-
........ -. . _-
BREAKOUT OF REOUEST
OS PROGRAM PERIOD
REGION - HAWLII
RM 00001 10/72 PAGE 1
RRPS-CSM-JTCGRZ-1
                                                                    I
I APPR. PERIOOI APPR. PERIODI PPEvxnusLv I PREVIOUSLY I DIRECT I INDIRECT I TOTAL I
                 I APPROVD COSTS I COSTS I I
15) It1 I41 (1)
IDENTIFICATION OF COMPONENT I CCNT. WITHIN1 CONT. BEYOND1 APPR. NOT I NEUI NOT I 1ST YEAR I 1fT YEAR I
I OF SUPPORT I OF SUPPORT I FUhDED
I I
-1 I
I -- I -_
I I I
I
                                I -- I
COO1 PACIFIC BASIN AOHlNISTR*l I I I
I S5flAd54 I I I S5E4IY
I I
          I
-_
COO0 PROGRAM ADRINISTRATION I
TlON I SlplrlpD I ItlOf.lOO1_211.3921L
I I1 S69-I I I1 S69L.2441 I1 59OdUJ I I I'lRZlU,lfiz)I,
          I _. I I 1- I I
      I I I I
       982r285.I sat7as I ~21.677 I
                I I I I I
        I I
I $66046 I Suf946 I SlZJLQs I II
     I I I I I I
I
UPg2LSZiU=L
-_ DO00 DEVELGPfiENTAL COCPONENT I
011 A REGICNAL APPRObCH TO Pi
015 COOPERATIVE CHEMCTHERAPYI
  020 CONSTANT CbRE UNIT
st- I s2- I I I SZ6-3 I I
-
AQlAm- I
                    I
,,lWXiRAB
--
- -047 REGIONAL RENAL 011
I
I
I
I
I
                       I
I I I
I
.J -. ..... - .............
....
........
.......
-
...
WGUST lee1972
- . __- - - - - - .
IOENTIFICATlON OF COMPONENT
-
COO0 PROCRAP ACUINISTRATICN
IS)
CONT. WITHIN1
APPR. PER1001
OF SUPPORT I
I
I
OREAKOUI OF REOWST
06 PROGRAM .PERIOD
I21 141 (11
CONT. BEYONO1  APPR. NOT   1 NEW* NOT I
APPR. PERIOOl  PREVIOUSLY  I PREVIOUSLY I
OF SUPPORT I  FUNOEC    I APPROVE0 I
I
I
1 I
I I
REGION - WAYAIl
RH 00001  lot72 PA6E 2
RIPS-OW-JTOGRZ-1
-
ZNO WAR I
OIRECT I
COSTS I
I
I
BREAKOUT OF REQUEST
07 PRCGRAW PER100
REGION -  HAWAII
RM 00001  10112 PAGE 3
- RIPS-OSW-JTOGRZ-1
(1)
                                                                           I
                                                                           I
                                  I I I I I          I
                                                                      I t
  COO0 PROGRAM ADMINISTRATION I I I I I
I I sbzplllo I          s1.Bzp.By) I
                                                            I I I
               I slbu.4aw I s3u-
  COOL PACIFIC BASIN AOMINISTRAI I I I I
                 I II 2 I It s743&911        I1 s-11
                                                                        I t
                I $W I I AB-
                                                                        I
            OThL 15UL2lL-
__ DO00 OEVELGPCERTAL COCPGNEkT I I 1 I I-
   c-1
011 A REGIONAL APPROACH TO PI I I I I I I I
                                                                        s-0 I
                             1 I I I I I
-JRlATRII:PULntblAPrRE I
               I s4fdmr
015 COOPERATIVE CHEMCTHERAPYI I
029 CONSTANT CARE UNIT I I I I I I ! !
              (2J ( 4)
I OF SUPPORT I OF SUPPORT I FUNDEO
                               I TOTAL
                          I ALL YEARS I
I APPROVED I CCSTS I IOIRECT COSTS I
IS1
IOENTIFICATION OF COMPONENT I CONT. WITHINI CONT. BEYONOI APPR. LOT I NEW. NOT I 3RO YEAR t
                1 APPR. PERlOOl APPR. PERIOOI PRFVIOUSLY I PREVIOUSLY I DIRECT I
I I
. run
--
' PR[)C;RIIIL
J
_-
I I I I I I I s21.866-
027 KOOLAULOA DIETARY COUNSEl I I I I I I I
I I I I I I I s21.866-
027 KOOLAULOA DIETARY CoUNSEl I I I I I I I
                               rsl+kO I $55- I Sl+fL477 I
028 HEALTH INFOPMATICN NETWOI I I I I I I I
AAkuu!m-l
--029 INTENSIVE CARE NURSIkG I I I I I I I 1
_RI[lTHEc
030 WAIANAE COAST COMPREHENSl I I I I I I I
               1 I s3 RI
                                                                 I I
031 UPGRADING OF RURAL NURSII I I I' I
JYJLtlLWWFR                                                                           I
               1 S12W9 I
032 PHYSIPLOGICAL DATA HONITl I I I 1 I I
031 IMPRCVEMENT OF HEALTH CAI I I I I I I I
DRIYCL
                       run I $24348 1 sie.444 I
                                      I 1 I I I
039 HLTH INFO SYS FCR COWPREI I I 1 I I-. I 1
                    1 s(16.6341
041 HAYAII MEOICAL CPRE REV11 I I I I I I I
                                               1-145 I
HENsIULXBY                          $75&&0l 1 11 $291.338 I
                                                           I I I
-tuL-
042 HEALTH SCREENING FOR THE1 I I I I
                                                                           I
.ELOERI_Y
  f CE I rw I s-1 1-
043 WOLOKAI HORE HEALTH SERVl I I I I I
044 OAW PATIENT ORIGIN AND I I I I I I I I
                                                                        IAL
                    I I I I I I I
-Jml.uAucLmJnY
045 IMPROVEO HANPOYER UTILIZl
              I s9ao I $9-0 1 s-0 1
                                                                        I I
-LxEn
947 REGIWL REkAL DIALYSIS I I I __ I I I. --
                   I I I I I 1 I I
12-
I
S86.464 I
-1
NC w s14dML
SlW 1 Sll&j.l9 1  mal
*- TRiiNiNli I I
I sY
AMI --- s-1 SW7I
                     I I rsl+kO I I $55- I I Sl+fL477 I
028 HEALTH INFOPMATICN NETWOI I I I I I I I
AAkuu!m-l
--029 INTENSIVE CARE NURSIkG I I I I I I I 1
_RI[lTHEc
030 WAIANAE COAST COMPREHENSl I I I I I I I
               1 I s3 RI
                                                                 I I
031 UPGRADING OF RURAL NURSII I I I' I
JYJLtlLWWFR                                                                           I
               1 S12W9 I
032 PHYSIPLOGICAL DATA HONITl I I I 1 I I
031 IMPRCVEMENT OF HEALTH CAI I I I I I I I
DRIYCL
                       run I $24348 1 sie.444 I
                                      I 1 I I I
039 HLTH INFO SYS FCR COWPREI I I 1 I I-. I 1
                    1 s(16.6341
041 HAYAII MEOICAL CPRE REV11 I I I I I I I
                                               1-145 I
HENsIULXBY                          $75&&0l 1 11 $291.338 I
                                                           I I I
-tuL-
042 HEALTH SCREENING FOR THE1 I I I I
                                                                           I
.ELOERI_Y
  f CE I rw I s-1 1-
043 WOLOKAI HORE HEALTH SERVl I I I I I
044 OAW PATIENT ORIGIN AND I I I I I I I I
                                                                        IAL
                    I I I I I I I
-Jml.uAucLmJnY
045 IMPROVEO HANPOYER UTILIZl
              I s9ao I $9-0 1 s-0 1
                                                                        I I
-LxEn
947 REGIWL REkAL DIALYSIS I I I __ I I I. --
                   I I I I I 1 I I
12-
I
S86.464 I
-1
NC w s14dML
SlW 1 Sll&j.l9 1   mal
*- TRiiNiNli I I
I sY
AMI --- s-1 SW7I
I
0
I
- .
I
__ - - __ - -___ _-___-_ - - -. __ __ - - - - -
i
f
                I'
RUQS-OS~TCIF~~W I
I.
____----
aECIEhtL YEGICIL PPOCRICIS SERVICE -. __ __
ALGEST ir1972 __.
-----
FUhDIhG HIClCPY LIST
PEGIOR 01 rswrrr PYF SUFP YR 04 CPFRITIONIL CRANT lOIRECT COSTS ONlI) ALL RECUEST bhC bWbRtS AS CF JUhF 30, 197 6
T
AwAPDEO_ Ah A P C E-G AWIP CEC IhbRCEC-- __ AUAPCEC ** ~EQIlESlEC_-REOLESTEO REObSTEO RECUESTEC 6
                                                                           m
CCYFChi%T Or c2 O? c4 ** E5 Ob- 07
--
NO TITLE 10/71-12/72 TOTAL- ~ ** 01/73-1_2/73 01/14-12174 C1/75-12175 TClrl 10
_____ __ - _____. -
__ . . - - __
*I I,
COO0 PPCGRBP STIFF 3F29CC 3e35cc 3ecccc 5777-1 i 1734112 ** 584544 606576 62971C is20a30 12
~ -__ .___
CEO1 PACIFIC eASiN A 5016C 55i60 ** l0770C ii08e0 114219 332759
0000 CEVElCFwEYTCL C
003 Panwoirok AWO E lC0CC
CC7 CAnOIC-FlL"C4bF 487CO ZOOOU 5560G 174LOO **
-i508---rE-n- PDYTiJE E 53CCC 12c3cc 97 1OC 270400 **
2c79e? e6zt49
287583,
**-- 287583
____-I__-
.-CCZ--lRhG PEHae -CbST-<0300 761 oo--- t2CCC i7escc **
                                                                 45eoc **
--0O4 -- (EL E C LUFS WU d I(---- i55CC XiCC 457cc **
,_-________I_---
W3CC 1650C - _I .
--_I_
                                                                47tCC **
-01C --CCL EOCIP TRh 14---`---38?00- 446CC 1lCCC 55tOC **
                                 2 100 3700 5800 **
9600- ___- ____ ___. .
005 CCl: CLIP AhD 1
15962C
77335 ______..
011 PECSCICL IFFFCA 2109co 114tCC E27CC--- - S4RC? LC3C53 ** -- 8ZZ8E-
-
013- -RHILB CA TZTRPHC
015 REG CCCPERLTIVE 377crc 92ccc 123375 253079 ** 64CC46 t.4csc___
C2C CCLSTALT CAPE L 50200 4tlCC 5F114 155414 ** tiett
21866
__ __ - -_ _-
_- - . ____
. . ....... - --
-26848(_. . _ ?be48 ** -.
- CEP 1CA1. C*hCER _____~ ______ -. -
022 kELLTk tSS1STW 23~62 23862 **
027 KCCLALLCd 51ET4
OZd CECICAL LIPRPPY
029 IhTFhSlVE CIRE
030 h4l4NIE COAST C
415ei 4.735~ 55540 144477
__
**
-. _-
46eoe 46808 I* 62831 41581 104412 o
@?el= E5C15 ** 43232 43232 86364 .
14115 14715 **_ 14300-_-- __ 143CO i
1'5252 15252 ** 2C148 - 26 14 29 1 4_e___ .. 70444 i
f
--
154593 154593 ** 1tSFIC 178412 348324
_-___-____
iiezi9
031 UFCPICINE OF RU ___ -
"-032 PtcrSlCfCGlCrL-C--------- -- 47274 47274 ** t317E 65Cil
5 037 WPRCVFYENT nF . -.
O~R --M@AC~F ASSISTA~ __-- - COCCC ccccc ** 1Cl695 106780 112119 320594
C3S HLTH IhFO SYS F 25300 25000 ** 4me 44413 46634 133345
040 EVERCEhCY YECIC 147C645 1470645 **
C41 IJAhAII PECICdL ** 24200C 249457 . 2568A 1 751338
042 PEALlk SCREEhlN- I* 68196 70895 73575 2130Ct
                                                                           -- 13820
044 CllHU PITIENT CR ** 1382C                         262 150
045 IWFPCVEC WIffPOY ** 85050 137050 900 5 G
__
- - -
..043-- rctc_rII I-CCE FEL- - - 48531 - 25009- - - 1500P_ 88531 _____
047 --Kidney ** -9- -392T3-----70577-
                               5494110 ** -2264294 2106946 1728436 6099676 -
..
**
I____---
- TflTAL - E67SCO 914700 83570C - 28 75 e 30
-_ -
... ........... 3`. .. -
. ... ....
..~ .. -. .- -
- __ - --
- _- __ . .
r
__ . __ .. .-
_____.~ .......... __
...... ............ __ . .- ... __ ....
- ~--. . . ..
~
........ ....
..
-
... - - . - - ... ......... -
- 12 -
The RMP of Hawaii, Trust Territories, Guam and American Samoa was
established with a planning grant under the University of Hawaii
School of Medicine in July 1966.  Little progress was made in  the
first year as the Coordinator, Dean Windsor Cutting, was unable to
spend time on RMP activities.  During the 02 planning year, the
RMPH'pffices were moved out of the University's Leahi Hospital and
into a "neutral" building at the Queens Medical Center.
for a new Coordinator became apparent.
Dr. Masato Hasegawa became Coordinator.
trician and prominent member of the medical community with an interest
in community medicine.
            The need
Dr. Hasegawa is a pedia-
In April 1968,
In October 1968, the grantee changed to the Research Corporation of
the University of Hawaii , since the developing school of medicine
did not have the staff and time to devote to establishing a fully
operative RMPH.
The RMP became operational in September 1968, and had continuing
education as its major thrust, using regional resources in the
absence of a fully developed medical school.  The RMPH goals also
included development of "advanced health systems" which would im-
prove the delivery of health  care.
Dr. Hasegawa, in only a few months, began do involve diverse
elements , overcome earlier hostility and develop a separate identity
for RWH,
ment of the medical society, hospitals and paramedical personnel
had been accomplished.  Further, program staff had become stronger,
but it was evident that the Coordinator required administrative
assistance. The RAG had become more representative, however, there
was diminishing involvement of the previously vigorous  chairman.
Planning activities in the Pacific Basin had been initiated as a result
of a $30,000 award specifically for activities in the Basin.
-_
At the end of the first operational year increased involve-
During its first two years of operation, (9/68-9/70}, the RMPH made
considerable progress.  The RAG'S role and influence, however, was
stillnot clear,  Established policies and procedures plus an Ad Hoc
Evaluation Committee provided hope that RAG effectiveness would be
improved.
categorical committees which appeared to have veto powers that
weakened the role of the RAG.
The Executive Committee was the strong force, as were the
Progress continued to be made toward developing the general principles
of regionalization.
the achievement of goals and objectives.
being developed.
allowed the RMPH to look at program rather than projects and to real-
istically consider program priorities.  There appeared to be a broad-
ening and deepening involvement of RMPH with providers of health
The RMPH had developed a frame work for planning
Methods of evaluation were
Also, there was increased sophistication, which
,. 1. . .-
. I.
..
..
=_
. 2. :
.. .-
- 13 -
services and with the community.  In 1971, however, RHPH appeared to be
making little progress toward the solution of problems noted during the
previous year.  It appeared that the RMPH had failed to follow through
on past recommendations from RMPS. In August 1971, therefore, the
LGational Advisory Council recommended that the RMPH not be approved for
triennial status.
program staff and operational projects.
component had been approved for the previous year, the Council believed
it should not be approved again until the following conditions were
met:
Funding was approved for one year only to support
Although, a developmental
1.
The region identify specific objectives and priorities that relate
to the health needs of the region.
anticipated accomplishments in terms of a realistic time schedule.
The RAG develop its bylaws and assume their responsibility for
directing the planning and operational activlties of the RMPH.
That a deputy or associate director to help administer the day-
to-day operations of the RMPH be employed.
That the objectives delineate
2.
3.
4.
That the RAG Technical Review Committee and categorical committees
be given an opportunity to have input in the planning and
operational activities of the RMPH.
procedures and responsibilities of these committees should be
clear 1y delineated .
Clearly defined operating
5.
That evaluation mechanisms to be implemented to relate to projected
accomplishments indicated in specifically identified objectives.
That the RMPH clearly identify its comitment to the Pacific Basin
and develop a feasible plan of action for this area.
That a feasible regional plan of operation be developed that will
meet the health needs of the region, based on measurable accomp-
lishments at specific periods of time of program development.
6.
7.
In November 1971, as a result of a visit by the Directlor, RMPS, the RAG
baane more aware of its role and new directions and responded by re-
budgeting some of its  funds to provide greater support to activities
more in keeping: with its goals and priorities.
In May 1972, RMPS staff conducted a Management Survey Visit and a
Review Process Verification Visit to the RMPH.
the review proeess and the management process would require considerable
strengthening before they could be fully certified by RMPS. ,
Staff found that both
. . . . .
-.
- 14 -
There was a clear need for revised bylaws which would spell out the
duties and responsibilities of the RAG and each of its codttees, in-
cluding a clear statement on the role of the RAG as the policy and
decisionmaking body of the program.
In June 1972, the RMPH was awarded $1,470,645 for support of a two-year
Emergency Medical Services System Project to be conducted by the Hawaii
Medical Association.
The RMPH may participate in the testing and evaluation of the Management
Reporting and Evaluation Sys tern (MRES) developed by the WashingtodAlaska
RMP.
and plans; evaluation and fiscal and technical procedures.
MRES is designed to aid the RMP in identification of health needs
The RMPH submitted a kidney proposal to RMPS on August 1, 1972.
extended deadline was granted for this submission.
An
- '15
Region 00001
Keview Cycle : October lo
Historical Profile: Pacific Basin
By invitation of the RME'H in 1968, the governments of Guam, American
$moa and the Trust Territory joined Hawaii in creating a Pacific Basin
Area. A chief of Planning and Operation was added to program staff in
January 1969. The proposal to implement RMPH in the Pacific Basin was
not totally funded by RMPS, instead $30,000 was earmarked for planning
purposes.
With a small budget and a staff of one, the thrust during the first
three years was to ascertain whether the Pacific Basin areas could
utilize RhF' programs. Five project proposals were submitted. One
was funded, Constant Care bit-Guam. The project "Rehabilitation in
Caleaatrophic Mseases" was extended to Guam and the trust territory.
In 1971 the RMPH RAG approved fbnds
unfunded projects (#21,22) .
1972 for the Pacific Basin Area.
the Pacific Basin will be to improve total health care services.
Problems areas might be seen as the level of funding and how this
money is shared by the sub-regions of the Pacific Basin, recruitment
of qualified personnel for funded projects and the distance between
the island units.
part of the RMPH RAG to allocate funds for the Basin.
relationships on Guam are strained.
In April 1972, the Pacific Basin Council was created.
directors and priorities are made in eonsultation with this group.
for two previously approved, but
$156,412 were made available in April
  The future thrust of the RMPH in
Further, there appears to be some reluctancy on the
CHP-RMPH
Program
- 1.6 -
1) Management and REView
a) Bylaw revision
b) Definition of role
Process needs considerable strengthening:
of RAG and of committees (see reports)
i
2) Cooperation with CHP agencies
I
Principal Accomplishments :
Increased programing in Pacific Basin
Coordination of the development of an EMS system
Strengthening of Staff compentencies
Changing emphasis of program from categorical to a total health care
system6
I.
Strengthening RAG
Zssues Requiring Attention of Reviewers:
1) Issues of concern per MSV and RW reports
'/
.
1
I. .". ._, ."
Prior to .
Triennium
September 30 7 October 1, 1971
Alexander Schmidt, M.D. - Chairman
C. H. Adair, Jr., Ph.D.- Consultant
Luther G. Fortson, JK., M.D. - Consult
W. Fred Mayes, M.D. - Consultant
..
- Member of Conkittee
DATE
-
. 4-5, 1972
2-3, 1972
y 27-28, 1972
- PURPOSE
Staff t&s%stance
ant
. Staff Assistance
Staff Assistance .,
-
I&. Stonehill, Coordinator, resigned, effective April 30, 1972
Dr. Steven Beering became Acting Coordinator May 1, 1972
Acceptance and growth of  the AAGs (Area Action Group) around,the State.
This has incorporated many kinds of health providers throughout the region.
-2-
- Formalization of
   the Tuberculosis
relationship with the 5 existing CHP(b) agencies,
and Respiratory Disease Association and the Eidians
Heart Association.
- Formation of 2 new CHP(b) agencies with IRMP assistance.
-
Expansion of Statewide plan for Medical Education to include new center
around the State
Increase acceptance of Il" by various Health agencies, especially the
Indiana State Medical Association.
A large influx of health dollars in Indiana (several million) especially
in Indianapolis and Gary.
(an increase from 7 to 9 with the 10th projected),
-
-
-
Transfer of large funded projects to local funds, e.g., coronary care
and stroke projects.
r
z
-3-
DEMOGRAPHIC INFORMATION
*e
l%e region encompasses the entire state; interfaces with Ohio Valley
to the south;
Counties: 92
Congressional Districts: 11
Population: (1970 Census) - 5,193,700
Urban: 65% Density: 143 per sq. mile
Rural: 35%
U.S.
Age Distribution: Under 18 - 36% 35%
         18 - 65 yrs. 54% 55%
         65 & Over 10% 10%
Average per capita income -
$3,691 (Compared with $3,680 for U.S.)
Metropolitan Areas: (8) Total Population - 3,061,000
Anderson     - 137.5    Laf ayet te     - 108.3
Evansville   - 230.7     Muncie      - 127.9
D
- 629.0 South Bend - 277.9
Gary Hammond
East Chicago
Indianapolis - 1,099.6 Terre Haute - 172.7
Race: White - 4,830,141 93%
   Non-White - 363,559 7%
-
19 69 ,/ 70
Resources and Facilities
Medical School - Indiana University School of Medicine 885 2 14
Enrolled Gradute-
Ind i anap o lis
Dental School - Indiana University School of Dentistry
Pharmacy - Purdue at Lafayette and Butler at Indianapolis
39 1
89
Allied Health School - Indiana University Medical School,
Division of Allied Health Sclences Indianapolis
Accredited: Cytotechnology -2
      Medical Technology - 20
      Physical Therapy -1
Radiologic Technology - 26
Medical Record Librarian - 1
Professional Nursing Schools Practical Nursing
28-(17 are University of College Based)
17-(Mostly Vocational
  and Technical)
?
-4-
.*
IhDIANA
Current Annualized Level
Roviaw Cyclo:
Sept. /Oct. 1972
' Request For
Cocponent
Pir,OGRri\l STAFF
Kidney
EEIS
hs/ea
Pcdiatric Pulmonary
Other
TOTAL
DIRECT
COSTS
COLJKCIL-APPROVED LEVEL
,
i-
04 Year
379 ,4.42
100,000
--e-
641,969
.
4
1,121,411
1,100,000
!.I
Fy 71 annualized level
n5 Year
417,890
505,000
603,806
( 11,532. 1
( i ---- 1
(.. ; ---- 1
( ---- .I(  1
1,526,696
-c
Request Funding For
Year
..
I
/-/ Yes
-
/-/ No
-
1
1
lb
I
1. '
i
,
BREAKOUT OF REQUEST
05 PROGRAM PER130
REGION -  INDIANA
RN 00013  10/T2 PAGE 1
RUPS-OSt4-JTOGRZ-l-- -
11)
                                                                        I
I APPR. PERlOOl APPR. PER1001 PREVIOUSCV I PWEVIOUSLY I DIRECT J INDIRECT I TOTAL I
                                                                        I
15) I21 (4)
lDENTIFICATJON OF COMPONENT 1 COM. WITHIN1 CONT. BEYOND1 APPR. NOT I NEW* YOT I 1ST YEAR I 1ST YEAR I
               I OF SUPPORT I OF SUPPWT I FUNDED I APPROVED I COSTS I COSTS 1 I
                         I -I- -- I I I
COO0 PROGRAN STAFF I I I I I I
                    I
009 NElGH6ORHOOO HEALTH CENT1 I I I I 1 I I
f I
----,--,~1,,,19ZZ1SP~l,,-- U?.LBPD-Irrl6rUIP-l,A.LQS3.a2neL---
v
i
-9- Region : Indiana
Review Cycle: Sept/Oct. '72
HISTORICAL PROGRAM PROFILE OF REGION AND PRINCIPAL PROBLEMS
Indiana Regional Medical Program's initial planning grant was
awarded January 1967.
January 1969.
The region requested triennial status to begin January 1972, but
was denied this request by the Oct./Nov.  1971 Committee and
Council. The application submitted had been written before
the region had developed its data base and a set of objectives.
The action plan for subregionalization had not been described
and discrete activities could not be evaluated. There was a
lack of overall planning and the activities and projects
proposed did not constitute a sound program.
The operational grant was awarded
The region is currently funded at $1,121,411.
The region has always been weak in the areas of planning and
evaluation, and this weakness still remains.
There has been a Lack of involvement by IRMP with other health
agencies in Indiana receiving federal funding.  There is
concerted effort by the staff to rectify this situation.
The program staff has been small and very fragmented, but RMPS
staff feel confident this will. be resolved by the new leadership
of IRMP.
The RAG has never been as committed to or involved in SRKP
as is required. The RAG needs to be restructured.
Proposed activities and projects were never based on a scientific'
study of needs and resources.
i
I
The region has always r lied on
the "bubbling up" of activities and projects.
f
There has been a lack of strong leaders'liip and supervi$ion for
the program staff.
IRMP has, in the past, been dominated by the Medical Syhool.
The region's review process is inadequate and does notimeet all
of the RMPS minimum standards and requirements. However, the
staff has already begun to revise and update the review process.
The region submitted a triennial application for this kurrent
review cycle.  RMPS staff reviewed the application
that it did not present a 3 year plan.  Staff
Dr. Margulies that the August 1972 site visit
that the region
triennial, they
that would lead
-10-
be advised that instead of going with a weak
should resubmit a strong anniversary application -
up to a much stronger triennial request next
year. Dr, Margulies concurred with staff`s recommendations
and the region was so advised.
that the triennial application was prepared without the direction
of a coordinator.)
accepted our advice and resubmitted an anniversary application.
(It should be noted, however,
IRMP and the Indiana Regional Advisory Group
Accomplishments :
- The subregionalization effort is taking Indiana RME' out from
Medical School domination.
- The region has begun to move from being a categorical program
to activities addressed to health care delivery and regionalization.
- A new and much stronger working relationship with the State
Medical Society is beginning to develop.
- Appointment of Dr. Steven Beering as Acting Coordinator.
- Reorganization of program staff, currently underway.
Issues Requiring Attention of Revicwers:
The region is requesting continuation funding for one year based
on RMPS staff recommendations.
$1,121,411which is the NAC approved level.
$1,526,696 which includes an increase for program staff salaries,
continuation of three projects and request for funding of eight new
projects.  Contractural services in the amount of $505,000 in the
program staff budget for feasibility studies,
and planned programs to support the subregionalization activities
and to build for a strong triennial application next year are
also requested.
They are currently funded at
The region is requesting
central region services
- RME'S staff feel that the region should not have funds to support
sickle cell projects other than small amounts for planning and
feasibility studies.
- An increase is needed in program staff salaries to hire staff to
fill some key vacancies.
- Staff recommends a funding level of $1,200,000 for the one year
continuation. A suggested breakdown is:
$500,000 for salaries and wages, fringe benefits etc.
300,000 contractual services
200,000 for continuation projects
200,000 for new operational activities
licvj ew Cyclc: October 1972
----
RflPS STAFF BKIEFlKG DOC1JMENT
OP~-R.~'~IO.YS BIWXII : Eastern -_
*e
Chief: Frank Nash
R: Manu Chatterjac, H.D. Staff for RW: CoWtanc@ Woody
                         Spencer Colburn
                        Lyman Van Nostrand
char 181 ~arnes I_
3rd Year Regional Office Representative:
William McKQnas
-
ennial / - / Triennial
Management Survey (Date) :
Conducted:
Scheduledt
or
Chairman, Other Committee/Council Members, Consultants)
'*
Sinter Ann Josephine, Review Comnittee, Chlirwoman
It. Wchael BICOLILUL~, Council
Dr. Willfam V~W, Coruultant
ification Review Process
area of: Region that are - affcctj?l:
College of Physicians terminated
e granted an additional $72,000
inue the Program until the University of Maine takes complete
Lubec activity was funded at $20,000 as a dewzlopteental component"
funded ut a lave1 of $85,000 for the firrt year of planning.
BANGOR
-3-
Popufatfon:
The estimated 1970 population is 992,048
a) 512 urban
b) Roughly 99% white
c) Median age: 31.6 (U.S. average 29.5)
Land area: 31,012 rquardi milao
Health lrt~tirticlr:
a)
b) Rata for csncer--182/100,000 (high)
c) Rate for CNS varcular lesionr--l26/lO0,OOO (high)
PaCtlLtie6 statietico:
Mortality rate for heart lliseaa --463/100,000 (high)
a) No medical schools
b) Sewn Schools of Nursing,, one is univarsfty-bared and one
is broed at a junior college.
Three Schools of Medical Technology
c)
d) No Schools of Cytotechnology
e)
Eight Schools of Xray Technology
E)
There are 58 horpitals,  five are federal and 53 are non-federal.
Of the non-fadaral horpitels, 45 are lrhort term with 3,508 beds
and eight are long Lerm with 4,802 beds.  The five federal hos-
pita18 hsve a tot81 of 1,189 beds.
Perronnal sratirtico:
a) There are 1,078 HIIS (ll0/lOQ,OOO) and 221 DO8 (22.5/100,000) in
Mine.
b) There are 3,856 active nurses (393/100,000) in Maine.
Per Capital Income! (1970): $3,257
1970 Population
992,048
203,211,926
Currcnt
Cocponent
G ? 2 Ri, -1OXAL i PROJECTS
Kidney .
ZJS
t.s/ea
V
I
Peziztrlc Pulmonzry
ICT.4L DIRECT COSTS '
. ...,a n7.r iizcd
Fmding
TR Year 04
960,000
78,653
416,855
1 1,503,872
Council -
~pproved
Level For
TR Year - 05
Region' s
'Request For
TR Year 05
*.
~
$785,720
(75,ow
96,000
-
$1,676,096
$1,646 394
gc comcnd ed
Funding For
TR Year
-
;-/ SARP
/-/ Review I
-.
C0m.i t t e e
'1
1
L
lei526 181576 ** it
                                                  1 7 5C?&
-u3?8-FS mm?rTC C 1-2 5 7 cc d.
D31B bftb FLHlLV NCP                                             ?17F1 **
0338 )SEA TEAY NUPSI 31191
                                        91 6 6-93 C f l-**
C3LC HfEA ~4F~ClTH Ir 31CtC 31t60 +*
                                      2 0 38 4 52'038 4 5-* *
734C' bFCI ChbL-lPPPO3
-036C- +SfA-kEAlTG EIlU
7 3 KTt VPCTFDFPLCRL
0398 PEklPIL ITbl ION
C405 INkPLATIPN THER
0418 CEDICAl IAIEKSI
' O43L PFCJfCT kP)rCCCK
   0+5& FIPILY PLALhILt
I* z2ooc 42 -
  mua 1G0174
.I 500R3 500s 1
I *- f co 0 c-500 9-10 0 0 9 2-
** 36579 35526 72lC5
* *--12 3 3 2 -10 5 1 1-1 338 3 d
341 1 'cECICLC-'IYTEhSl 211413
                                                   *e 1CCSOt llOS1l
                                                  ** (ciao 40010 IQQP~O
a72FTF1mTTB                                     -** --- 330CC- 363CC c93cc
7442-UP En? 1 ZOtuHE ALT
037C CSEb FEAtTk ED. 51210 51250 ** -
-
.
-C~~C-RE~.L~~CIT~TIC~
'
I+
460 r5-9 6 c 74
** Zifbi 24764
ir
..-
.I-
. .-
RREAKUUT OF REOUSr
06 PROGRAM PtPlOO
REGl#U - MAINE
RH 00054 10172 PAGE 2
I RHPS-OS+JTOGRc-L .
..
-9-
. _. .. -..-. . -
lity of Mine's becoming part of a New England RMP was dircussed,
interest regarding Regional Medical Program was generated.
ae chose autonomy and an appropriate grantee organization was formed,
ical Cure Development, lac.
ical Center were particularly active in pre-planning phases.
The Bingham Associates Fund and the Mlna,
6 first planning request wao submitted to the Division of Regional Medical
  amr in December.
cant orgaaieation; Bingham Associates Fund as the fiscal agent, and
ield Director of Bingham Aseociates (on 108n 100% to Mdical Care
opmnt) ar pl ning coordinator.
It designated Medical Care Development, Inc., as  the
the 01 planning grant the program's professional staff was assembled
r, Manu Chutterjee was appointed full-tiam program coordinator.
ngs with regional health and education agencies became establiehed
ice, horpital coordinatom (or acting coordinators) were appointed in
Periodic
nd held imetings, two feasibility studies were iaitiated, the
was completely divorced from the grantee organitation to eli-
e porrribility of legfiproblems and an overlap of membership, and
rational proposal wan developed.
fst operational requert was submitted in February.
as ratisfled as to the Region's readiness for an operational award.
notsd that, Initially, emphasis was given to development of the
1 mdical program rather than to establishment of priorities among
A Hey site visit
the 02 year the Region continued to fund program staff and the orlginal
The Region rebudgered and utilized unexpended funds to initiate new
the Pirectore of Medical Education activity and the Regional Library
~ts,
~
or which rupplemental funds were not available.
                             The Region re-
continued funding for program staff and six ongaing projects and
opmntal funding for the 03 operational year.
t
-10-
1970 -
-
The Region was site vieited in October to assess its readiness for a
developmsntal component.  Developmental funds were approved by the
November Council. The site visit team considered, the evolution of ,
Maine's Regional Medical Program was being co~utstent with that of
the program at the national level.  The RMP started with a categorical
emphasie &ut expanded to include a comnitment to the development of an
integrated system of medical care to provide access to medically
dcprassed populations, as well as Improvement of availability of care
to the comnunity at large.
emphasie, and are also geared to the unique needs of Maine itself.
The six program objectives reflect this
1971
The August Council recornended triennial status for the RMP and develop-
mental funding be approved.  The increase in program staff was a concern
of the Revlew Committee and Council.
I_
RAG decided that the three broad operational objectives should be given
prlority as far as the Maine Program.
1972
The RMP submitted an emergency medical services and health servicee/
education activities (MEHEIA) proposals for supplemental funding. The
EM proposal developed, which is regionwide in scope, as a result of
the Cl06e working relationship between CHP Ageneies and the program
staff.
the University of Maine.
-
The program staff stimulated the MEHElA project by working with
The June Council approved both of these Proposals for supplemental
funding.
The VA has supplemented partial funding for the MEHEIA Proposal.
During the verification review visit on Nay 2, the team found the Maine
RMP Review Process exceed8 the mi.nimum standards in some areas, but there
are others in which it does not meet them. The RMP's review process was
conditionally certified until the areas of concern have met the
requirements:
(1)
The bylaws of the RAG be revised to reflect the responsibility
of the Board of Directors of the Medical Care Development,  Inc.
in the review process as being limited to fiscal and admini-
strative affairs, and the RAG being fully responsible for
program policy and decisionmeking;
(2)
A more specific outline of the review process be developed and
made available to applicants, and 8 conflict of interest state-
ment be developed which coincides with Federal pblicy;
-12-
*
])rijicipal I'i-ohl~~~~: . I..
The RAG byhwe are to be revised to reflect the responsibility of the
Board of Director8 of the Madical Care Development, Inc, in the review
procaos ae being limited to fiscal and sdminiotrativa affaire; and the
RAG being fully repponaible for program policy and decioionmaking.
The grantee hae been requeetad to provide thca rationale or the projected
staff increase.
The RMP should establiah a priority ranking and funding system.
The RAG needs to aetabliah a conflict of interest policy.
I
Priiic i ])a 1 ,\ccoiitl> 1 i :;Iiw~~nts
-. . _..-
As a result of a cloee working relationship with VA, Model Cities, CHP
AgUnCi88 and the University of Maine; the RMP developed (1) MEHEIA,
(2) EM, (3) Kannebec Valley Regional Health Agency, (4) Lubec, (5) Com-
munity Action Program, and (6) The Sutnmer Student program or further
deoalopmcnt of primary care in urnnierserved areas.
The RMP was completely involved in the study of the College of Physicians
until March 1972.
The MRMP received $400,000 in funds from other sources to help develop these
activities.
The negotiated contract with Harold Keairnee, M.D. for evaluation supervision.
Jsst~cs ri'cl~i ring attcntj 011 of rcvi c\;(\rs
Maine's RKP should continue rystematic studicns of the interest, use, and adap-
tation of problem oriented medical records.
There art no minorities involved in the program in any capacity.
.
There ie no sptcffic policy in the application delimating a XRKF policy or
long- term euppor t .
~Iio\f . C ircctor, Regional M-.dical. Programs Service
_- I__--
--
Re j cc ted
(date)
Region Maine
Review Cycle 10/72
.B
r)
  COblPCINENT mTD FINIZNCIAL SUMMARY
AN'NIVE2SARY APPLICATION DURIKG TRIENNILDI
Current Counci 1 -
Component
PROG?AM STAFF
COXTRACTS
6
DEVE LOPXEXTAL COW . .
0 ?E ?,AT I CX4L PROJECTS
Kidney
EKS
-2
hs/ez
Pediatric Fulmonary
Cther
TOTAL DIRECT COSTS .
GCGN C 1 L - APPROVED
LEVEL
Annualized
Funding
TR Year 01
$ 462,492
2'; 000
'78,653
416,855
$ 960,000
- -~
$1,503,872
Appl-ovcd
IACVCl For
TR Year 02
$1,646,394
Rcgion s
Rcqucst For
TR Year 02
$ 785,720
(75,000)
96,000
794,376
-
$1,676,096
R c comcn de d
Funding For
TR Year 02
/s/ _. SARP
/-/ Review
-
C om,i t t e e
< 3
( 3
       3
(
( 3
c
$1,200,000 .
Rec.ommendations From
/-Tf Review Conimittee
'Ilic mtrrrbcrs of the 3Laf.i Anniversary Review Panel reconiwnded t1iat ffnine's
Rcgiondl Iledical Program be supported at the 1 cvel of $1,200,000 direct costs
for the seccnd year of tricnpiurn. Thcsc: funds will provj de support for program
staff, operatiopa: activities and a devcl-opmerital. component. This repr~sciits
an increase over the Region's current. annualtzcd J eve1 of funding. An increase
was considered justified by the SARP because of Llie Region's current stage of
development.
"he Staff Anniversary Review Panel was impressed with thc Regjon's  continuing
t-o refjne its objectives to:  (I) conduct ej.:perimeiits in new riicthods for deliv-
ering health services; (2) develop new health nianpowrcr; and (3) update level
of medical knowledge for health proiessional- and public e
The objectives are directed tor67ard solving $kine's uiiique problems, and yet
are still in IrceTiing k7j th national priorities.
realistic assessiiieni of needs and appeal- to be functional as guidelines Lor
operating the progrsin. These reflect input from providers, consumers, and
low-income members of the TUG. HRHP has continued to cstablish its leader-
ship role througliout the State.
services to undcirserved, urban and rural areas of the State.
A substantial anount ($1,666,465) was awarded during the latter part of  the
current year to support supplemental activi ties in erner3cnc.y iiiedi cal services
and health servicesleducation activiti cs over a three year period and
although this was a plus for the Region, reviewers were somewhat concerned
about the capability of program staff to adequately manage such a tremendous
increase in the Region's overall budget,  Although their fears '117ere sornerdw t
relieved by the information that one nicmber of the staf would bc responsible
For the administration of the hs/ea (l.IEIIEIk), stafF was urged to express this
concern to the Rcagion. Somewhat paradoxically, there vas concern about the
large projected starf increase fi-om 25 to 32 positions; arid rhe lack of
inforination supporting the rat ionaLe for the projccted increases The SARP
showed concern for the one to one ratio of proFessional and clerical positions;
and the Coordinator 's salary as being clispropor tiona tc to the remainder of
staff,  RMPS Xanagement Assessment Unit wjll work wi th the Region to resolve
The priori ties reElect a
The I'rogrm has been successful in providing
these issues.
e
c
EOU: 9/7/72
, . . .. . . .
.I
I
Ted Griffith --- ----
-
Collductcd: none
os
early' 1973
S ch e du 1 c (1.:
*. d
st Site Visit: .June 1971 (in response to triennial application)
Mrs. Florence R. Wyckoff [National Advisory Council)
Brudt? Evxz4.st, M.D.
kb$% p. Carpenter, M.D., Director, Western Pennsylvania RMP
Paul Dygert, M.D., private practitioner, Vancouver Washington
(National Advisory Council)
Staff Visits:
to clarify the geographic relationshi
, Mississippi anl Western Tennessee
ing the grbgrams
s W) is der
by ms. Silve&Et4tt, Lamptofl and cur
MID-SOUTII POl'ULh'l'TON CEN'I'BRS AND
  h4 ED 1 C A L ?' R A I N I ?.:G F' R OG R A Ms
Comprehensive Health Planning
     B Agencies
Comprehensive 1 leal th Planning
    B Agencies
The Bootheel Council (Missouri) :
as well as the funded CHP(b) agency.
program stafE subsidy, MItllp assisted with identification of needs
and development of priorities.
'I'his is MRW's Area Advisory Council
Through contract funds and
The Jackson Purchase Council (Kentucky):
as this council was forming.
MRMP provided data base
NW Tennessee Council: MRMP prepared portions of this council's
application; did the leg work to start the office; presently is
budgeting contract dollars to assist in identification of needs.
WCC:
Council has excellent overlap; products of joint efforts have been
outstanding and are expected to continue under new arrangement.
Formerly W's Regional Advisory Group; new Regional Advisory
District #I Council (Mississippi) :
WMP did leg work in establishing; budgeted $15,000 contract dollars
through A agency to catalyze.
Not yet funded for operations--
District 42 Council (Mississippi) :  Still in process of organization.
Activities under requested Developinental Component include completion
of work in this area.
District #3 Council (Mississippi) :
MRMP contributed $4,000 f or survey work; included in hW's EMS plans.
Funded through Appalachia- -
NE Arkansas Council:
of data base.
kRMP assisted riith planning funds and development
./
-- IO
Ak
IC C3
AlrARDEO bW4RCEC
E? c4
CCtPChFhT        c1--- 02 --.--
    '! ``E __       . - ._
09/70-08/71 04/_11-1217? _- TPIPL ** 01173-12/73 _____-__-_ 01/74-12/74 C1/75-12/75 TCTbL It
                                                                           la
**
I
NO
                39 1092 2
162700 325400
1CEz4C 21'17174 ** 20lC922 1900000
COCO FPCGFbY STCFF 5357CO s~e234 7) 162700
c
E1AL 592 100 L654tCC 15128
6 127980
**
b195964 32t7e23 zesais3
-
- 96 22 mar
c
Region: Memphis
Review Cycle: October 1972
Demographic Inforrnat ion
I. The Region's Coverage:
Consists of parts of five states traditionally known as the
Memphis trade area on the basis of hospital referral patterns.
Made up of 75 counties:
21 in West Tennessee
16 in Arkansas
27 in Mississippi
6 in Missouri
5 in Kentucky
IT. The Region's Population:
Contained 2,560,032 people in 1970
Most populous subregion is the Tri-County area containing Shelby
County, Tennessee (Memphis) ; Crittenden County, Arkansas ; DeSoto
County, Mississippi with 802,000 residents--nearly one-third of
the region' s population.
The other subregions contain the following population :
North Mississippi 662,559
West Tennessee 459,404
SE Missouri
Kentucb 329,626
East Arkansas 374,909
Although there is a shift from rural to urban areas, the region
remains essentially rural, characterized by an agricultural economy.
@%?%e exception of the city of Memphis, with a population of
624,000, the largest city has a population of less than 50,000
(Jackson, Tennessee).
The East Arkansas subregion has the lowest population density;
even Western Kentucky, the most densely populated subregion, falls
below the national average.
Only 13 of the 75 counties in this region have as much as half of
their population residing in towns of 2,500 or more persons.
Race
mof the region's population is Negro; there is a small American
Indian and Oriental population.
Black population within subregions and by county is significant.
However, the distribution of the
Blacks comprise 73% of the population in Tunica County, Mississippi
while the Ozark area makes a striking contrast to the rest of the
Arkansas subregion with a very high white and elderly population.
Nine of the 27 counties in the Mississippi subregion have populations
of more than half Black.
Ae dk subregion with the highest ratio of persons over 65 is Kentuchy;
the lowest is North Mississippi.
instance, has a 12.9% under age 5 average as compared to the
national average of 8 o 6%.
Tunica County, Mississippi, for
Infant Mortality
The infant mortality rate of the region is 28.9 compared with the
national average of 21.7.
subregion have rates at least twice the national average.
Seven counties in the Mississippi
Distribution of Physicians:
In tlus region there is one physician for every 1,206 people.  The
Benton County, Mississippi ratio is 1/7,505 and DeSoto County,
Mississippi has a total of 5 physicians--1 for every 7,177 people.
," - '
Income -
Thessissippi subregion has the lowest income level.
4 counties in the MHMP territory with a family income of under $4,000,
-- -.
0.
Of the
3 are in Mississippi.
0
I
Region : Memphis
Review Cycle: Oct. 1972
HISTORICAL PRCXXAM PROFILE
W's early years were spent under the watchful eyes of its parents--
The University of Tennessee Medical Units (the grantee) and the
Mid-South Medical Center Council (the board of which served as the
MEiMp Regional Advisory Group),  As the program developed, its relationship
to WCC evolved into an exceedingly fruitful partnership; UT has proven
to be an excellent grantee- -vigilant but without co-opting tendencies.
This region first received operational funding in 1968, activating 10
projects basically representing an extension of the medical center
rather than a deliberate pursuit of regionalization.  One of the 10,
however, was a linkage and sharing of resources between hospitals in
Paragould, Arkansas, and Kennet, Missouri.
Reviewers of the second operational year application kept in mind
that MRW had developed its operational plan under considerable
pressure from DRMP to assume operational status and realized it
had submitted readily available, attainable proposals for its debut.
Initially, the second year continued the ongoing activities with the
addition of an ICU project in Jonesboro, Arkansas.
Supplemental funding in the second year (June 1970) allowed the
region to activate 5 new projects and Memphis' regionalization was
underway.
was begun; cardiovascular clinics, operated by the Mississippi St.
Board of Health, received funding; a demonstration program in home
health care seated in Paragauld, Arkansas was started; and the expansion
of the geographic bases of West Tennessee activities beyond Memphis/
Shelby County lines began.
of events occurred that created a crisis for MRMP, its grantee, and
MC--a sanitation employees strike, a hospital employees strike
(both of which were of very long duration), and the assassination of
k.. Martin Luther King.  The majority of the Memphis medical center
manpower was devoted to keeping the complex operational under great
stress and RMP expansion temporarily took a back seat.
The question of other continuing sources of funds after W support
terminated arose in the review of Memphis'3rd year operational
  and MRMP went into its 3rd year with the message to start
building continuity for its successful activities elsewhere.
The triennial application submitted by the region the following year
was a combination of:
A mobile health screening activity in Northeast Mississippi
Also during this operational year, a series
cation.
Staff felt the region had not really addressed this
-
. A requested Developmental Component authority
. The continuation of 5 projects for their previously specified life
. 3 additional years of funding for Program Services 'and for 7
. The termination (at the specified time) of 3 projects
o 12 new proposals
projects beyond their previously specified life
The application requested $2.7 for the 04 year; site visitors recommended
$2.0 for each of the 3 years; Committee and Council recommended
$1.6 or each of the 3 years; the Uirector, WS allocated $1.3 or
the 04 year.
mental component authority .
The site visitors, Committee and Council assessed the following pluses
and minuses:
None of the reviewers recommended approval of the develop-
+The working relationships between MICC and RMP had indeed
created a unique interface between Comprehensive Health Planning
and Regional Medical Programs and both organizations were taking
full advantage of the opportunities.
-The organizational identification of the.EuiRMP Regional Advisory
Group as the board of bNCC has created an administrative (and
possibly legal) complication that needs to be clarified.
of several organizations but
ful activities it generated.
+Mnh.Tp staff had developed a good role as "broker" for joint efforts
-Paradoxically, did not have a good record of spinning off the success-
-The Coordinator appeared to be overextending himself and needed
RMP
a good #2 man.
and a replacement still has not been found.)
(Ur. Charles McCall had left for the Texas
+The region, nevertheless, has the potential of becoming one of
Total RWS budgetary restrictions pennitted funding only at the $1.3
level. True to form, Memphis allocated these dollars to the 7
activities seeking 3 year renewals, but promised that this would be
their terminal year; the 5 continuation activities were also supported;
2 of the 12 new proposals were activated.
Hospital Learning Center, had strong subregionalization potential.
In June of this year, Memphis received supplemental funds which brought
it up to the approved $1.6 level for an extended 16 month 04 year.
the better programs.
One of the two, the blodel
e
True to its promise, it did not allocatc: any extens ion t ime or
dollars to the projects schedulcd for tennination; it gave basical ly cxctcn-
sion time dollars only to the continuing components; and it acti.vatccl
3 previously approved but unfunded activities
a combination of 2 proposals.  Collcctively, these activities display
a good combination of training and service.  In developing its budget
for the extended current year, the region paid good attention to its
future year budget needs and has not boxed itself in by activating
projects that cannot reasonably be continued within the existing level.
Conversely, it has learned to project turn over dollars rather well,'
and it is this type of projection that will support the existing program's
continuation needs.
Memphis submitted an EVS proposal in April 1972, competing for $762,898
to fund for 18 months the first "year" of a 2 year activity.
Memphis role had been identified in both the Tennessee and Mississippi
state plans for a partnership of federal, state, community and
private framework, as the lead program charged with the involvement of
hospitals and medical schools to upgrade emergency room services,  An
award of $67,038 was granted for further planning and surveying needs.
one of which represcntcd
The region also competed in June, 1972 for supplemental funds for
health services/education activities but the applications were not
recommended for funding.
  COMPONENT AND FINA!!CIAL SUMMARY
ANNIVERSARY APPLICATION DURING TJUEKNIW
Annualized
Funding 1st
TR Year 04
-
Current '. . I Council-
Approved -
Level FOT 2nd
'IR Yezr 05
-
Component
PTtCiGPAN STAFF
b
COSTRACTS
DEVELOPMENTAL COMP . .
\ OPER4TIOSAL PROJECTS
p1
Kidney
ENS (contract)
' hs/ea (contract)
Pediatric Pulmonary
C ther
TOTAL DIRECT COSTS .
COUNCIL-APTROVED
LEVEL
. - :.'
. ..-.,
1 ,,....
,,.. .
i .. .I ;
..
,. .
1,627,000
1,627,000'
t
Region's
Reauest Forznd.
998,298
1,012,624
162,700
e. .. . .
1,094,205
i
( 506,000
( 400,000'
1
3,267,827
Region : Memphis
Reconmended .
Funding For 2nd
TR Year 05
-
/-/ - SARP
/-/ Review
-- .
Committee
/Z;IYes
1
i
1
1
1
e
Recommended -
Level For
Reminder
of Triennium
f
1
1,627,000
d
I
..,
Princip:~I I'rob1cn:s :
Please see attached staff ~neil~)r~i~dtiit~
Principal Accoinpl isluiicnt s
Please see attached staff memorandurn
?
Issues requiring attention of reviewers
Please see attached staff memorandum
.*
/3
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE
Dale:
Re$y lo
Atln 4:
Subjccf:
  TO:
From:
August 17, 1972
Staff Review of the Memphis Anniversary Application
Vr. Lee E. Van Winkle
Acting Chief, IMPS, South Central 0
anch
L/
3s. Lorraine 31. Kyttle`f'
Public Health Advis+ ,
-
On August 3rd the following staff met to review the ?!emphis anniversary
application for the purpose of identifying issues for the attention of
reviewers:
Mr. Larry Pullen, Grcints Management Branch
F4r. Gene Nelson, Planning and Evaluation
Mr. Ted Griffith, Region IV, HEW
M.S. Lorraine Kyttle, South Central (Clperations Branch
Remembering the concerns of previous reviewers of this region, staff
elected first to consider the effects of the recently created Memphis
Regional Advisory Council which is now organized as a body free-
standing of the Mid-South Medical Center Council.  As early as 1969,
site visitors questioned the complicated organizational arrangement
under which W3IP was operating vis a vis the >%KC.
was officially designated as the bIRlP Regional Advisory Group, and the
full membership me`; only twice a )-car.  The real decision-making authority
was vested in a 45-menber Board o!' Directors, which met 8-10 times a year.
bMCC was and is a po:.+er-fiil and berieficial influence on health care in the
Memphis inedical tr,-.de area.
area covering west Tennessee; Crit tendon County, Arkansas; and DeSoto
County, Mississippi, and as such i'epresents a valuable ally for RMP.  The
working relationships between RW md FNCC (0) are exquisite.
The 151-member MMCC
It is thc CHP(b) agency for the 14-county
However, the 14-couity zandate vested in ?NCC gave rise to questions of
the legality of that lmdy holding the decision-making authority for a
program serving 75 ccuities an3 actiirely supporting (both with professional
assistance and grani funds) activj tics beyond MMCC's geographic sphere.
Beyond the possible legal issue, revicizrers challenged the cumbersome
adniinistrativc structure such itn arrangement had spawned.  A Policy and
Review Committee within the RVP striicture had been created and was acting
like a RAG in most ways, hut \<as riot vested with the proper decision-
making authority; there was also cin WIP Planning Board which the Coor-
dinator had established to advise him and which usually met in joint
sessions with the Fcjli~y and Review Comqittee.
'kc complications of these arrmgenents led previous reviewers to with-
advantages of close ties to >MCC--Cffl' were important and that Memphis RhP
was utilizing these opportunities we1 1, but the Region was given the message
hold developmental component authority when according triennial status
to this region last year.  At that time it was acknowledged that the
(.
i<.
`L-
- *A- -----: ...,+;nnal at the decision-making level.
c
t
2
0 C)n June 28. 1972. the full membership of hMCC voted to accept a resolution
presented by the'Board of Directors which disenfranchised &self as the
RMP Regional Advisory Group.
Memphis Regional Medical Program composed of 36 persons and vested in that
body all of the powers formerly held by the Board of Directors of MCC with
regard to RMP matters.
It created a Regional Advisory Council for
The new body is not simply a selection of 36 MMCC members (although it is
difficult to assemble a group interested in health care delivery in the
Memphis area and not have them be WKC members),
made his first moves seeking a free-standing RAG, he proposed the establish-
ment of a committee within WCC to explore solutions, and he involved Dr.
Bland Cannon, a consultant to both MMCC and UT; Dr. Joseph Johnson, Chancel-
lor of UT and an WCC member, and Mr. Norman Casey, Executive Director of
MMCC and the CHP(b) agency.  MC did create such a committee and all of
the persons named above were included in the 7-member body.  The committee
reviewed the activities of W, considered nominations for a new RAG, and
developed a working paper for guides to bylaws.
When Dr. Culbertson
The new membership reflects a good geographic distribution of the territory
served; a 5-member overlap of WCC board members; and a Chairman, Dr.
Francis Cole, who certainly knows his way around MCC, UT, 0, RGD, and
the health needs and interests of the region.  Dr. Cole was the chairman of
the Policy 6 Review Cmittee and his confirmation by the grantee is assured.
Proposed bylaws developed by the 7-member Committee mentioned above are up
for discussion at the initial meeting of the new RAC on August 16.
opment of revised administrative and review procedures is also on the agenda.
Drafts of both documents have been reviewed by staff and the preliminary
work done by MRW and the new RAC is excellent.
Staff concluded that the region has satisfied the disqualifying factor
concerning developmental component authority and recommends its approval
for the last two years of the triennium.
Goals 6 Objectives:
Tn January 1972, MlMP sharpened and redefined its goals and objectives.
(This need was cited by 1971 site visitors).
broadly stated: (1) increasing the availability of care; (2) improving
accessibility to care; (3) enhancing its quality; and (4) moderating its
costs.
objectives, but among the four statements MRMP has attempted to cover
the full spectrum.
attempting to digest the several different treatments of them in this
application.  Staff concluded that the pursuit MRMP had described of
3 goals did little to accomplish the fourth, but this we felt
to most regions. The new goals are directly reflected in
The devel-
The 4 goals are still
It was difficult to distinguish strategies, priorities and
These are explicitly stated; our difficulty was in
ecisions recently made by MRMP.
AccomDlishments and Imlementation:
8
P
It is in the area of program staff services and cooperative relationships
with other organizations that this region probably excells in perfoimance
but does not report on well.
of them) there are references throughout other sections of the applica-
tion to MRMP's inputs to other regional health efforts.
it difficult to get a sense of the total contribution MRMP staff has
made in the role of catalyst as well as architect.  The expanded health
care offered by Wesley House (inner city Memphis--hnded by OEO)
stems from a proposal generated and partially written by MRMP staff; the
experimental health care delivery system funded by a NCHS R t?, D con-
tract originated from MRMP staff work; the recently awarded Sickle
Cell Anemia grant from NIH had a heavy component authored by this
staff; a family planning center proposal recently competed successfully
for f-EMi4 funds and had its genesis in bRW.  Planning groups and
institutions have become quite accustomed to looking to RMP for tech-
nical assistance and consultation, and MRMP has filled this role commendably.
In addition to the Forms 9 (20 pages
This has made
Con? inued Support :
This has been an area of concern for previous reviewers.
year, the region evidenced only a vague concept of spinning off
successful operational components.
lot in a hurry,
operational projects, which either have just terminated or will
terminate by April 1973 resulted in the following:
Until last
They appear to have learned a
Specific inquiry about the fate of the original 10
1 project terminated with no continuation of the activity
2 projects continued under other sponsoring but on a restricted
5 projects continued either at full range or nearly full range
2 projects (which will not terminate until April 1973) have
bas is
by other Cunding
tentative agreements for future support, 1 of which the Mississippi
State Board of Health plans to fully fund.
Minority Interests:
M the 36-member new Regional Advisory Council, 9 members are
Black and 6 are women,  Staff noted that one of the minority members
is the controversial Mr. Ollie Neal, Administrator of the Lee County
Cooperative Health Clinic in Marianna, Arkansas.  Mr. Neal is known
in the area as an outspoken proponent of the need for change in the
health care delivery system.
Since the submission of the Equal Opportunity Employment form 7
included in the application, the lone minority professional (a female)
has resigned.
for her replacement.
only minority proSessional on a program staff in a region where 31%
of the population it serves is Black.
bW is recruiting a black, female nutritionist
At this time, the replacement candidate is the
..
4
The activities MRMP supports reach the rural poor, which, in most of
the subregional areas includes large numbers of Negroes, to an extent
much greater than the complement of the program staff would indicate.
The cardiovascular clinics supported in North Mississippi cover counties
with high percentages of Blacks; the high risk infant component, which
is regional, will target the minority population (it is just starting
up): the proposal to expand the services of existing Memphis neighbor-
hood health centers to primary care (and is a good combination of train-
ing and service) primarily serves the indigent; the hypertension con-
trol component operating in 3 northern Mississippi counties operates
in an area where more than half the population is Black; and the
arrangements entered into with the Lee County Cooperative Clinic (Mari-
anna, Arkansas) for on-the-job training of nurse practitioners is
an activity targeted to minorities.
Grantee Oreanization:
There has been no problem of grantee interference with RAG'S
decision-making role in the past under the MMCC arrangement and
none is expected under the new arrangement,
Chancellor of UT Medical Units is an MnCC member, is a member of the
new RAC, and keeps himself well-infoned on MRMP affairs.
UT as the grantee is a proven partner without co-opting tendencies.
Dr. Joseph Johnson,
Process :
Staff believes the Coordinator is overextended and whereas he gives
good overall leadership, the need for specific mastership sometimes
makes MRMP miss the mark insofar as responding to specific signals
ram RMPS is concerned,  He needs, and has needed or some time, a
strong Program Director.
time but not filled.
The position has been budgeted for quite some
The Forms 6 and 7 regarding the Program Staff give information that
does not agree--the listing of personnel was updated later than the
Equal Iinployment Opportunity report.  As of August, 1972 there were
loyees on Program Staff.
            The entire Program Staff Services budget
(Salaries & Wages, Travel, Consultation, etc .) currently approximates
one-half of their total program budget.  When the last tally of RMP
percentages was made (FY 1971) two-thirds of the regions were budgeting
from 31 to 60 percent of their total funds on program staff and
staff activities.
to the health groups and institutions in its region--grant proposal
writing being only one.
The proposed Program Staff budget Vernphis submits for next year still
     Staff realizes that both the grantee and MMCC have
informally advised Dr. Culbertson to stay below 51%.  With the excep-
tion of the Program Director vacancy (the needed #2 slot) staff
unanamiously recommends that the region be advised no further
26 are classified professionals and 18
1 and secretarial.
MRMP provides a tremendous staff resource service
within the one-half mark if you delete the $1 million contract
ory.
expansion of program staff is deemed warranted.
?he personnel listing in the application reflects 13 vacancies and
36 filled positions, so some additions have already been effected
since the application was prepared.
a triennial status with certain budgetary prerogeratives, but a recommen-
dation regarding no further expansion of program staff included in an
advice.letter which reaches both R4C and the grantee would be potent.
We realize that this is a region in
Memphis KMP has assembled a staff of essentially full-time competent
people who move very well in the health community.
credentialed, but Dr. Cu1herl;on is the only full time M.D. on staff.
They are well-
Participation and Local Planning:
It is this area, staff believes, in which hW has excelled,
interests of the key health groups arc woven through MflW's activities
(particularily its staff services) and conversely MRW is a partner in
most undertakings of other organizations.  Its superb collaboration
with Health Systeins Management, Inc. (the organization developed to
administer the NCHS - R 6 D experimental systems contract); WCC;
W; UT and the Health Departments of most of the states involved in
its teritory, forms a productive coalition.
The
Assessment of Needs and Resources:
Staff resources are involved in almost a preoccupation with systematic
identification and analysis of needs and resources,  But this staff
has developed an eminence in this region as a resource for data and
analysis that has proven tio be the springboard for some excellent
joint ventures.
utilized by the state Department of Transportation and was one of
the reasons for IW'S identification as a component in the state's
emergency medical system.
of data) is reElected in the activities of other health interests
in the region as well as I\IRMp.
For example, staff's studies on emergency rooms was
Much of this type of activity (analysis
Management and Evaluation:
The order and scope of activities appear to be well-defined and under-
stood by staff. A management assessment visit is planned for this
region early next year which will provide more specific evaluation
on this point. This past year, the staff has increased its vigilance,
both fiscal and programmatic, over operational activities.
Like many regions, the results of MRflP's evaluation efforts are still
fragmented but they are aware of this and are attempting to get at
the whole thing,
application preparation, has been identified by staff as targets
This area, as well as improved reporting via
e
o
or working toward with the region in the upcoming year.
Since attaining triennial status, Memphis has instituted more
sophisticated budgeting mechanisms to identify projected funds so that
new activities may be initiated.  The administrative procedures cover-
ing the developmental component are in the process of revision and
the work staff has done in this regard for presentation to the new
R4C looks good.
Program Proposal :
There is a $1 million contract proposal under the Regional Staff
Services portion of this application which breaks out as follows:
. Inter-Regional Information Exchange Program $ 4,000
. Community Health Service Educational Activities  $400,000
o Tennessee Nursing Association Manpower
. ambulatory Health Care Centers
. Emergency Medical Services Program
$100,000
$500,000
Feas ib i 1 i ty Study $ 2,600
The ambulatory health care centers portion builds from keystone component
#36, Expansion of Neighborhood Health Centers, an approved but unfunded
activity of highest priority which is proposed for activation in
this application.
purpose of extending the Memphis/Shelby County concept of utilizing
a nurse in an expanded role to the rural areas of the subregions.
Endorsements of the concept have already been secured from local
physicians and early implementation is promised.
The community health services education component proposes the expan-
sion of the model hospital learning center recently funded at Jackson-
Madison County Hospital, Jackson, Tennessee (component #32) to a net-
work of eight such learning centers.  The expansion proposes a second
center in Tennessee (at Union City), one in Kentucky, one in Arkansas,
one in Missouri and 3 in Mississippi.
basically as the Jackson station is, the individual programs would be
determined by local conditions.
the proposal seeks to:
Basically, the $100,000 contract request is for the
  Although they would be patterned
Based in an active comity hospital,
. develop learning centers which provide instmctional materials,
trained personnel and organized channels of corramznication with
the UT Medical Center Library and the UT Audiovisual Department--
, create a MRMP regional development liaison office that can be a
focus for RMP activities in the area--
. train local in-service leaders to respond to regional requests
. encourage residency and intern training programs, working
for assistance--
collaboratively with university medical centers - -
-
. improve arrangements with local vocational and community
colleges to expand allied health manpower training- -
. encourage quality control systems such as FAS/hW--
. initiate consumer education programs.
The emergency medical services program is essentially a resubmission of
an activity Memphis proposed in the spring of this year competing for
supplemental funds.
to further survey and plan total EMS needs.
that by January 1, 1973 (the beginning of this region's next operational
year) this will have been accomplished and it again requests operational
monies.
into this proposal, preliminary consultation should be arranged with
the Division of Professional and Technical Development.
At that time, $67,038 was awarded to the region
The region tells us
Staff recommends that should MRMP budget operational dollars
Briefly, the new activities are:
#41, Patient Safety and Electrical Surveillance proposes education to
  promote awareness of electrical hazards and safety measures;
  a regional pacemaker referred clinic (at UT) and registry; a
  regional cardiovascular health delivery team to upgrade the
  knowledge of the general practitioner concerning his cardiac
  patients.
practitioners in two settings:
the Lee County Cooperative Clinic (Marianna, Arkansas) carried out
on a one-to-one basis with Clinic physicians; and (2) intensive
sessions at the Arkansas Medical Center or at UT, whichever
proves to be more expedient.  This proposal has encountered
some political controversy since the original clearances were
secured (a local health professional who ran unsuccessfully for
governor included the danger of this type of activity in his plat-
form).
is working with MRMP hopefully to implement the activity under the
auspices of the county medical society.
#43, Regional Blood Banking proposes to link the small community
  hospitals in the region to the Baptist Hospital Blood Bank in
  Memphis.
  2 years, after which the project should be self-supporting.
#42, The Satellite Clinic Program proposes the training of nurse
(1) on-the-job training at
However, the Marianna Community Hospital's new administrator
      The region estimates that RMP support will be needed for
The descriptors covering the 15 components proposed for funding reflect:
. 67% of the component dollars are in activities that combine
training with patient services
. 12 of the 15 offer multicategorical pursuits
. 9 activities (35% of component dollars) are subregionally based
, ..
..
. ..: .
! : ...
\. .I -3
-. -j.r
S
0
.
. 4 activities (56% of component dollars) are regional activities
with ties to central services
. 2 activities (8% of component dollars) are a network of central and
satellite units
, two-thirds of the activities are sponsored by other than the
The $1,381,870 requested for operational component funding is comple-
mented by $1,044,781 funds from other sources ($23,000 state funds,
$911,781 local funds and $110,000 other federal sources).
single medical school in the region.
STAFF RE-TIONS :
This application requests $3,267,827 direct costs for the second
triennial year (the region's 05 operational year).
annualized level of Eunding is $1,627,000,
Staff recommends an increase in the approved level to permit funding
at $2,252,000 based on the following rationale:
$1,627,000- -to support current program for the upcoming year which is
The current
~
rather tightly budgeted on projected turnover dollars to
continue activities initiated in the extension period.
$ 162,700- -for developmental component
$
237,30O--to support selected new activities including the
225,00O--to pursue selected activities under the contract request
keystone component #36
$
$2,252,000
a/
b~magcrilcnt Survcy (Date) :
-*
process Verification Vis it
cafeducted july 25, the Region
was certifiad.
i
#
dran M.D., Review Cmittee (Chairman)
                                .
Robert Brown, KD., Coordinator, Kansas R)pB
Jack Hall, M.D. , %+odist Hospital Indianapolis
George Hinkle, Grants Management Branch
Joseph Jewell, Grants Review Branch
Elsa Nelson, Continuing Education and Training .Branch
Jeabne Parks, Grants Review Branch
Eugene Piatek, Office of Planning and Evaluation
Maurice Ryan, Program Director, Region V
WS STAFF:
Attended two RAG Meetings and visited the MARMP Staff once(Pgm. Dir.)
ting (Program Director)
tend RAG Meeting-. met Dr. Tuner [Program Director 6 SCOB Staff Rep.)
/7-10/72
Attend RAC,' Retreat - Consult on preparation of anniversary
application (Program Director 6 South Central Operations Brand
Staff Representative.
Accompany Dr. Himm, Dm, on his visit to consult with
major health providers interested in developing a state
kidney plan (Program Director 6 Staff Representative)
-. , . ..,.-lL ---_ _- n;*ar+nr p C+aff Rpn.\ .-.-
-
-.
- 2-
<--,.
6:& 1-
&-&a
-.-* 7'
RECENT EVENTS OCCURRING IN GEOGRAPHIC AREA
OF REGION
2
Appointment by Governor Milliken of Irving A. Taylor as Director of
the Office of Comprehensive Health Planning.
I
Coverage of entire state by CHP areawide (b) agencies.
Beginning development of an emergency medical services state plan.
(A cooperative effort between MAW, CHP, Department of Public Health and
Office of Highway Safety Planning.)
Initial meeting (June, 1972) of all individuals and organizations '
interested in the development of a state plan for the prevention,
detechtion and treatment of kidney desease. (Co-sponsored by MARMP, the
State Office of CHP and &e Michigan Kidney Foundation.)
Development of a "State Plan for Nursing Education in Michigan, Phase 11:
Planning for Licensed Practiual Nurse Education"
(Provisional) .
Formal incorporation of Area Health Education Centers in Grand Rapids
and Flint.
Passage of certificate of need legislation for acute care general hospitals.
In May, 1972, Michigan became a member of the National Institutional
Television Consortium in order to promote health education for 8-10
year olds.
Selection of two DEtroit agencies (the Detroit Health Facilityssthe Detroit
Medical Foundation) for receipt of Health Maintenance Organization Planning
E unds.
Michigan receiving four assignees from the National Health Services Corps.
Wit3im tB4& Academic Sphere
Michigan State University:
1,
Formal insitution of on-campus headquarters of the College
Osteopathic Medicine; first on-campus classes held; an
increase from 36 to 64 students entering the 1972 class.
2. The School of Human Medicine graduated its first
class of medical students.
- 3-
Wayne State University:
1.
Entering into phase I1 in the development of a large scale
ambulatory facility to be located in the Detroit
Medical Center Complex where students will be able to rece
training in an ambulatory and multidisciplinary setting;
the opening of Scott Hall, the basic science unit for
the Medical School that permits admission of 256 medical
students; establishment of a Department of Family and
Community Medicine under Dr. Ruben Meyer (RAG member).
University of Michigan:
Redesign of the Post Graduate School of Medicine to
provide for community extension*
ng the most recent results stemming from the consortium of the Deans
the four medical schools is the capacity for a student in any of the
r SC~OO~S to take elective courses for credit in anycof the other
ive
8.9 MILLION PEOPLE CLUSTER MAINLY IN THE SOUTHERN ?ART OF THE STATE
ALMOST 80 PERCENT OF THE POPULATION LIVE IN THE 17 MOST POPmATED COUNTIES,
-
1
1. Population of Michigan Counties
(1970 Census)
400,000 or Over
1. See table, No. 67
e
... ....
. I'
_C.__
I
i .j;.;--:=.
...
....
...... ... ..
. :._
..... ....
. .:.
..
. ...............
  _I
..
. .*
..
-
...
- \I.
..
'
1~11 s i.n y s C~I C) o 1.5;
' ..
..
. ,-___IL---------
, ,i /.
..
-7-
.. . .AI 5% Lv.
. . .
,
.. .
f
,
i
Michigan RMP
' COMPONENT WD FINANCIAL SUiWRY Review Cycle October/72
ANTIVERSARY APPLICATION DURING TRIERNIUM
Conponent
PROGRAY STAFF
COSTRACTS
DEVELOPMENTAL COiW .
6
OPERnTIOXAL PROJECTS
Kidney
ENS
hs/ea
Pediatric Pulmonary
Other
TOTAL DIRECT COSTS
comer L-APPROVED .
LEVEL
Current . .
Annualized
04
Funding
TR Year
160,598
1,483,784
1,924,566
~~
2,100,000
Counci 1 -
Approved -
Level For
TR Year 05 .
-
2,100,000
2,100,000
?
Region s
Request For
.TR Year 05
-
425,940
-0-
` .192,'350
2,379,189
c -0- I
( . -0- 1
( -0- I
2,997,479
Reconmended -
Funding For
TR Year 05
-
/-/ Review
-.
Commit tee
I
1
( 1
I.
I
I
I
c
Recommended
Level For
Remindcr
of Trienniun
I
co
3 \
*The Region identifies two projects (#45 6 #46) as Health Service
Education Activities, when in fact they do not meet RJ4P.S'
definition of such an activity. ,The titles of these projects wil*'bT.?
                                         ,$.$ .* 1 '
                                                     9**y .I 8 I`
changed.
< ,.>
4AL
_.
-~ '4 -2 .
- _- AUGUSl--8~19?2 - -
8REAKC:UT OF AEQL1EST
--- ~I_ -- -- 05 PROZRAM PERIUD
- IS1 (21 (41 f
IDEf4rIFICATION OF COMPONENT I CONT. WITHINl COW. BEYOND! APPR. NOT I NEW
I
I' .
..
-12-
.
HISTORICAL PROGRAM PROFILE
OF THE MICHIGAN ASSOCIATION
FOR REGIONAL MEDICAL PROGRAMS
Nov. '65 - Governor's Council on Heart, Cancer, and Stroke met to discuss
PL 89-239; Albert Heustis, M.D.,  Chairman.
Dec. '65 - Dr. Marston, NIH, met with health providers to discuss a
RMP in mchigan.
June '66 - The Michigan Association for RMP was incorporated.
June '67 - The region's first planning award was granted.
Sept.'67 - Albert Haustis, M.D. was appointed full-time Coordinator.
June '68 - A pre-operational site visit was conducted.
The region was
considered to be viable, cooperative arrangements were being
fonhed'and.operationa1 projects were likely to lead to
desirable regionalization. (No negative findings were revealed.)
June '68 - The region became operational.
The first year operational program
consisted basically of the Central Planning Staff, subregional
planning projects (at Wayne State, Michigan Dept. of Health,
Michigan State Udiv. and Univ. of Michigan) and continuing
education activities, a large portion of which were sponsored
by the University of Michigan.
were almost entirely sponsored by major health institutions
(medical schools, Department of Public Health and the Heart
Association).
education project which was to become, in the 03 year, identified
as a subregional planning activity.
no emphasis on a particular disease category.
The ten operational type activities
Zieger/Botsford Hospitals sponsored a continuing
            The overall program placed
July '69 - The region was awarded 2nd year operational funding.
National
reviewers found the region had exhibitied growth and maturity
under excellent leadership.
superb.
The region's review system appeared
No negative findings were revealed.
The second year operational program continued along the lines
of the first, but with some exceptions.
Department of Public Health subregional planning project was
discontinued and stroke began to emerge as a major emphasis
with the funding of four related projects. Spons~rshfp of projects
remained with major health institutions.
Support of the
-13-
Aug.'7O - The region was awarded 3rd year operational funding.
The
reviewers believed MARMP was on target.
considered too small.
concern regarding the contributions and the relationship to the
Central office of the four subregional planning offices. Quantitative
project evaluation needed strengthening.
Program staff was
Both the region and the reviewers expressed
While the third year program remained basically the same as the
second, the region took more interest in the underserved and
funded a related project.
than the traditional institutions were funded. The continuing
education project at Zieger/Botsford was identified as a
subregional planning project under the central program.
Also, more projects sponsored by other
June '71+A pre-triennium site visit was conducted.
The region received a
favorable review by the site visit team, Committee and Council,
and was approved for triennfum and developmental component.
Issues raised by th&s review are elaborated on in the Staff
Observation Section of this document.
pt. '71- The region began its 04 year of operation with an award of
$1,923,509 for program staff, de$elopmental component,  three
subregional planning projects (University of Michigan is dis-
continued) and 11 operational projects, most of which were
initiated in 02 and 03 years.  Additional emphasis was placed
on delivery of services to the underserved with the funding
of three related projects. Also, the MSU planning office took
on the cew look of a project designed to improve services  to
a specific underserved population.
I, -Albert Heustis, M.D. resigned as Coordinator and Gaetane
Larocque,Ph.D., the Association Coordinator, became Acting
Coordinator.
, - Gaetane Larocque, Ph.D. resigned and Theodore Lopushinsky, Ph.D.,
a Program Representative, became Acting Coordinator.
y 1, - Robert Tupper, M.D., Director of Medical Education at Pontiac
3.972
General Hospita1,became permanent Director.(Title changed from
Coordinator to Director. )
2 - The region's 04 program period was extended 4 months(9/71-12/72)
     and with supplemental funds the region's award is increased to
      $2,566,087 for the 16 month period.
July 6, - Region submitted current application for RMPS review.
1972
STAFF OBSERVATIONS
- 14-
Principal Problems Previously Identified E Achievements toward
their Solution
The site visitors' concern of a year ago regarding the future of
the program upon Dr. Heustis' resignation was justified.
It took the Board of Directors eight months to recruit and hire
a new Director, during which time the program progressed at a
slow rate due to a lack of leadership, resignations of staff
(at one point there were only two professionals on staff) and
an accompanying morale problem.
and the hiring of additional staff,  'there is a new enthusiasm
and vitality throughout Michigan RMP. After being aboard only a
short time, Dr. Tupper became aware of how accurately the national
reviewers of a year ago identified the more significant problems
of the Region which demand immediate attention.
Following are concerns identified a year ago and relevant comments.
Since Dr. TUpper's appointment
Concern: Goals and objectives were not stated explicitly in
quantifiable terms nor were they related to
identifiable time-frames.
The retreat scheduled for a year ago to deal with this
problem never took place.  The new planner/evaluator
has worked out with Dr. Tupper a specific concept to
deal with the problem.
to and accepted by the RAG at a June '72 retreat.
The RAG has identified some general areas of possible
program direction. Based on these staff is presently developing
a specific program, with alternatives, to be presented
to the RAG for endorsement.
This concept was presented
Concern: A need was identified for a more systematic evaluation
system.
A new planner/evaluator has been hired who has an excellent
background in evaluation.
every roject and in cooperation with the Project Director
is wor ing out an agreeable evaluation mechanism.
concept for planning and the developnlent of goals and
objectives has program evaluation built into it.
in the areas of allied health.
He is currently site visiting
His
Concern: A lack of depth of program staff was noted particularly
Three people have been added to the professional
staff which now totals five.
the other three are genera1ists.h. Tupper tentatively
sees a total of about 13-15 professional staff most of
whom will be generalists.  Specialists and allied health
people will be considered in relation to the new program
look once it is developed.
Of these, two are. specialists,
_. -
I.
.. ...
-15-
Concern: The salary structure for central. program staff should be
more equitable to that of institutional program staff.
Concern:
Central program staff salaries have been increased
in an attempt to make them more equitable.
are for the most part now equitable with those of
institutional positions with the exce tions of the Director
at Wayne State ($32,000) his Deputy ( i 27,000) , and the
Director at Zieger/Botsford at ($30,000).
are comparable to those of other regions.
Salaries
Most salaries
The relationship of CHP to MARNP was unclear.
In June 1972, MARMP and CHP held a combined retreat
to improve dialogue and planning efforts.
time, Dr. Tupper and the CHP (a) Director have established
close working relationships as have ?Ae two staffs.
are working closely in the development of a state kidney
plan and a state emergency system plan which will be
jointly funded.
which appears to be the first step in continuous dialogue.
Plans include assigning staff members as liaison to
specific @) agencies.
The 'Iregion should refine its mechanism to insure more
realistic budgeting and financial control of funds.
Dr. Tupper is aware of the problem in this area, and
he expresses his awareness of the need to 9requent-
IY monitor program expenditures so as to use rebudgeting
more fully in promoting efficient program expansion.
Consideration should be given to haw MARMP might
improve its image and visability to both the
professional and lay constituency.
New organization plans include a Director of Cmunications.
Responsibilities of this position will include the
publication of periodic news letter and other, wrspecif ied
means of promoting NARMP and it5 mission.
Staff supported in the three subregional planning offices
be identified with MAfi"Mp and be identified with programs
and activities which are directly related to b!ARMP goals,
objectives and priorities.
The budgeting for subregional personnel and functions
be separate from other programs which may be carried
on in the institution.
A line of authority be established between the central
office and the staff of the subregional offices and be
so refl.ected in an organizational chart.
Since that
                   They
Dr. Tupper has attended CHP (b) meetings
-ID-
-
During the past year considerable change has occurred
with respect to the functions of the subregional
offices and their relationships to the central office.
"his change represents a phasing out of subregional
planning as it has been functioning in the past.
The Michigan State University planning component has been
altered so that it no longer serves as a subregional office
conducting many diffuse activities, which due to overlap,
confuses evaluation. While it maintains the same title
it in fact is a project having the specific mission of
developingt9in cooperation with 314 (e) grant; a family
health center,
underserved of a rural area, Cass County.
will serve as a model for the rest of the state.
staff includes personnel serving in the center.
project is consistent with the region5 goals and objectives
and will be considered as any other project including
the expectation that it will terminate by 8/74.
and continuing care models for the
Thisfin turn,
Project
The
With the submission of this year's application,
the Wayne State Planning Component now represents a
specific project designed to develop prototype family-
centered, hospitalrbased, primary health care organization
in Mt. Sinai Hospital, which has the potential
of becoming an I-Ml capable of serving a low-income
population of 10,000,  As with the MSU component, while
the title remains the same, the project will be subject
to the same conditions and evaluation as any other
operational project and will be expected to terminate by 8/
73.
The Zieger/Botsford Hospital participation activity has not
undergone much change.  It remains basically the same
emphasizing an effort to document the quality of care
being delivered to the underservecl,and through the use
of PAS and peer review improve services.  To date, no
progress has been made to incorporate this activity as
a part of program staff or completely isolate it as a separate
project with a limited period of support.  Dr. Tupper has
a strategy for terminating the project, but it will
necessitate a trade off for a smaller staffed osteopathic
subregional office which will be directly responsible
to him.
Problems Not Previously Identified but which are Recognized
and beine Resolved bv the Region.
Problem: The region's bylaws are in bad disarray and are
not consistent with the RNPS statement on
Grantee-RAG relationships.
-17-
Dr. Tupper, the board and RAG are wrking together
to develop bylaws which do comply with the RMPS
s tatment and incorporate other suggestions made
by WS staff.
e
Problem: Few minorities (1) and no women are employed on
program staff in professional positions.
Dr. Tupper is aware of the problem and intends to
make special efforts to recruit both minorities and women
to professional positions.
Problem: MARNP activities are limited to the southern and
   particularly the sourtheas tern part of the state.
Dr. Tupper is aware of the situation and will be
making special efforts to develop activities
relative to the needs of the northern mral cammunities.
Issues Requiring the Attention of Reviewers
e basic issue is whether or not the reviewers believe the Michigan
ogram is deserving of having its NAC approved level raised
 YO^ its current level of $2,100,000.
f the *gion is approved and awarded the amount requested, it
ill allow it to continue its basic program outlined for
already spoken to in this document,however, a staff review of
MAR@ is scheduled for August 29 and any issues resulting from
eview, not previously identified, will be the subject
eparate document.
e
, . . ,. _I .. . -. .. ~ _" - -. . .- . . .. .. . ,. .. ....... ... .~ ~. .. . . .. . , . .. . . ___ -. __ -. . .. ~r~
c:
,. ,
-'. .I
I 1?
I.
-
1,924,566
r\ -
c- 1.1
i '. -0-
,.
n
[ -/I-
_- -...-
_-"_._--_I-
-... .
04 Year
05 Year
06 Year 2,445,891 2,325,89 1
Re qu e s~~d-
$2,34 0 6 J 8
2,439,588
Recorm:lcnded*
-- -__-I----
$1,500,099
2,110,000
The Icidney project is gxcl-uded Iron. the 04 year level but is hcliG>:?
in the 05 and 06 year levels.
CRI'I'T(iLTE :
I^.
Ccimittcc accepted the reconw~ndations~ of the site visit team with the
exception of the funding level for the. first year of the trFeriniujn.
The 04 year undSng ].eve1 rcflects the CO~CET?S reviewers had aboiit
some of the projccts l>!lG~? has choscn to fund and tlie fact the first
year budgct period for the triennial i.s only for 10 .months.
Cominittee w2s aware that these projects werc deceloped i'rior to the
rethinkicg of the region and thc restructuriJl:, of MG and progrzm 5-taf f
and feel that th? rzgion should bc- restricted during the iiist year funding,
and they should ree~izluate the prcyosed activities and be very selsctive
in the ones they dacide to fur,c;.
direction of MRNP and coincide w:th the nbu goals and objcctives
The pi0irct.s should reflect the new
t
i
I
i
I
It was not.ed by the .reviewers that IlPNP has macle a sigiiificant turnaround
since the September 197 1 site visir., and have answered ~1.11 the criticisms
of tliat visit.
prograin arid the, new staff appear to be compe-tent ail! dedi.cated.
Tlie leaders11 i.p and niaiiagemm t of M3F has dramatically irriproved and it
was felt by the reviewers tilit the regiou has the maturity md ability
to move forvard and should be a:ia.;ded tricniiial status:
The RAG has becom~: actively involved iii ilirecting the
I
,
I
i
$411,097
----
Y
485,133
$896,230
.I_.-..-_IUIIII.
$1,095,428
Tsr. ycar
- 1,7;p,48(
( 183,634 J
3
( I-_.-
S 666,387
250,000 .
1,529,504.
(120,4G3)
( 150 3 4 1 )
I
$ 513,823 $ 633,842
        I
i
A Region requested a Tour month extension and wds a
$321,U53 for continuation.
year to 10/72.
This extended their 03 operational
** Ten month 1S'udget
       SITE VISIT REPORT
MISSISSIPPI REGIONAL MEDICAL PROGRAM
     JACKSON, MISS LSS IPPI
      JUNE 29-30, 1972
Site Visitors
Joseph W. Hess, M.D., Detroit, Michigan, Chairman, Site Visit
John P. Merrill, M.D., Boston, Massachusetts, Member of
Claude E. Nichols, Jr., M.D. Harrisburg, Pennsylvania, Practicing
Mr. Donald Trantow, Evaluation Consultant, Director of Assessment,
Team, Member of RMPS Review Committee
RMYS Hational Advisory Council
Physician, Member of Susquehanna Valley RAG
Georgia RMP
Regional Medical Programs Service
Lee Van Winkle, Acting Chief, South Central Operations Branch
William Torbert, Public Health Advisor, South Central Operations
Vernie Ashby, Public Health Advisor, South Central Operations
Eugene Nelson, Office of Planning and Evaluation
Earle Belue, Division of Professional and Technical Development
T. H. Griffith, SEW Region IV Representative for RMPS
Branch
Branch
Mississippi Regional Medical Program Staff
T. 1). Lampton, M.D., Coordinator
Pat L. Gilliland, Assistant Director for Administration
Guy T. Gillespie, M.D., Assistant Director for Planning
James B. Moore, Ed.D., Assistant Director for Community
Bob Cotten, Communications Specialist
Betty Zimmerman, Grants Management Officer
Jack Gordy, B.S., Planning and Evaluation Assistant
Tom Brooks, M.A., Health Planner
Nita Gunter, M.A., Sociologist - Demographer
A1 Betts, Program Specialist
Carlyle Baker, Program Specialist
and Evaluation
Liaison and Program Development
-2-
- Mississippi Regional Medical Program Regional Advisory Group
Lewis Nobles, Ph.D., President of I4ississippi College,
Guy I). Campbell, M.D., Member of RAG
David B. Wilson, M.D., M.P.H., Chairman of RAG Planning
Chairman of Regional Advisory Group
Committee
Participants
Robert E. Blount, M.D., Dean and Director, University Medical
Center
Charles W. Flynn, Mississippi Hospital Association
Cyril A. Walwyn, M.D., Mississippi Medical and Surgical
Association, Minority Group Representative
Richard E. Barba, Mississippi Division of American Cancer
Society
Miss Lucile Little, Mississippi Heart Association
Frank M. Wiygul, M.D., Mississippi State Board of Health
Pxthur A. Derrick, Jr., M.D., Mississippi State Medical
Mss Wynema McGrew, Mississippi Nurses' Association
Alton B. Cobb, M.D., M.P.H., Medicaid Commission Representative
Phil Laird, CHP "A" Agency
Association
-3-
Purpose of the Sire Visit
The site visit was to review the Mississippi Regional Medical
Program's Triennial. Application request and to ascertain the
progress made by the region since the previous staff assistance
site visit: of September 1971.
This site visit report is a compilation of observations and
conclusions from all members of the site visit team and
follows the outline of the RMPS Review Criteria.
A. Performance
Since the Staff Assistance Site Visit of September 1971, the Mississippi
Regional Medical Program has taken many positive steps in developing a
program that is now a major contributor and a very important  leader
in the rlolf77ery of health care to the people of Mississippi.
The goals and objectives were expanded and delineated during a
retreat of the Regional Advisory Group in December of 1971.
are the basis or the new direction MRMP is now moving. The RAG
arid program staff were also restructured during that
retreat which has resulted in a cohesive and dedicated working group.
MRME' has not only answered and dealt with all of  the criticism and
recommendations of the 1971 site vlsit team, but has moved forward
in the accomplishment of other goals.
These
The coordination between the University Medical Center and the MRMF'
appears extremely good. MRMP has been instrumental in setting up a
School of Allied Health at the University Medical Center for which a
Dean has just been appointed.
The number of midwives in the County Health Improvement Program has
increased, resulting in a reduction of neonatal deaths in Holmes
County. In 1968 the neonatal death rate was 28.0 per 1000 Live
births. This was reduced to 19.8 in 1970 and 7.0 in 1971. Previously,
the neonatal death rate was the highest in the country. Also in Holmes
County, a number of pediatric nurse assistants have been trained under
the auspices of MR?.? and medical care has reached out to the urban
community with the establishment of a satellite medical clinic
in a trailer.
Renal satellite units have been set up around the state which has
significantly reduced the cost of dialysis. In the University
Medical Center the approximate cost per patient is $19,500 per year.
In the trailer units (4 currently operational), the cost per patient
dialysis has been reduced to $3,500 for units with 3 or more patients.
- 4-
Similarly, heart clinics have been set up which have resulted in
care being given to patients outside of the hospital, again resulting
in cost moderation.
The initial establishment of a stroke care demonstration center
has been expanded and clinics outside the hospital have now been
set up where neurologists are available for consultation.  An
average of 100-150 patients per year are being treated.  Courses
have been developed for physicians and they have been invited to
spend 5 days on the ward with a neurologist in the stroke care
demonstration center. Some 20 physicians attended the course
last year.
been implemented by the development of courses for nurses.
15-20 nurses from various parts of the state attended courses last year.
In addition, nursing care for the stroke patient has
                                       Some
A pulmonary training program in inhalation therapy has been established
and a-number of inhalation therapy aides trained, who may now
function effectively nritside hospitals.
trained 38 aides and was designed for the disadvantaged unemployed
persons with 30 percent of the ones trained being minorities.
The 20-week program has
The original coronary care unit,funded by MRMP at ZMC, which
at the time was the only one in the state, hzs trained 120 nurses in
coronary care.
of other units in hospitals around the state staffed by individuals
trained at UMC.
cardiopulntonary resuscitation.
This has resulted in the establishment of a number
Some 4,000 individuals have been trained in emergency
h extremely important activity is the program for the training of
dental hygienists.
since there is no dental school in Mississippi.
that perhaps this prograq may contribute to the establishment of a
dental school.  In addition, real effort has been made at establish-
ing an adequate third party payment base to take over the cost of
patient care when RMF' monies are phased out.  There is a close rela-
tionship with medicaid since the present head of medicaid is a member
of RAG.
This program appears to be particularly effective
MRMP staff feel
Another example of continued support is with the Hollandale Midwifeq'
Project in which medicdd money is paid into a pool which is  to
help support service costs of the program;
One possible drawback has been the fact that much of  the effort of
MRMP has been undertaken by faculty members of UMC.  This has
been possible through MRMP support, but since other sources of
funding to support contributions to continuing education by these
individuals is slim, it seems unlikely that in the future they can
continue their efforts in this area.
-5-
There are specific goals, objectives and priorities dealing with
the improvement of health care delivery for underserved minorities.
MRMP activities have made primary health care services available
in heart clinics, neurology, and active stroke programs in which over
50 percent of the patients in attendance represent minority  and
underserved groups.  This type of care has improved services throughout
the state bringing the health care team to the patient in settings
dose to their home and only those patients who need the more extensive
work up in the medical centers are referred.  This has resulted in
the specialty clinics not being swamped with routine patients that
can be seen, diagnosed, and treated in the local area.
The training of inhalation therapy aides has attracted minority
groups and other project activities which have employed minority members.
Minority patients have talcen advantage of all patient activity
services funded by MIWE'.
Dr. Lampton and staff have assisted minority professionals in
obtaining hospital privileges in several instances.  When the Black
Hospital was closed in the Yazoo City area and patients were referred
to the previowly all white hospitals, they assisted in getting the
black professionals accepted on the staffs,  and have also worked with
the hospitals in becodng certified for medicaid and medicare
programs.
The program staff has one minority professional and one minority
secretary. Further efforts are being made to employ Competent
minorities in unfilled vacancies.
One outstanding program the MRMP staff are involved in is with
Black medica3. students that are attending school outside of Mississippi.
Seminars are being held in which these studento are brought back
to Mississippi in an effort  to interest them in returning to the
state upon completion of their studi.er;.
The RMP has been instrumental in assisting minority groups throughout
the state in obtaining access to health care services, and access
to schooling that is available.
B. Process
Coordinator
On the basis of previous visits by RMPS staff and the comments of
a number of MRMP program staff and RAG members, the Coordinator has
provided strong leadership and appears knowledgeable and exhibits
-6-
eiithuiiiasm. There was further evidence of this in the large
number of organizational changes that have occurred since the September
1371 site visit.  The program has developed a sense of direction and
cohesion, and the Coordinator has succeeded in gathering about him a
young,dedicated program staff who appear to have the potential for
functioning effectively. There is evidence that some further maturity
as Coordinator is yet to be developed, but there seems to be little
question that Dr. Lampton has made substantial progress  as a program
manager.
The working relationships with the RAG seem to be cordial and satis-
factory as determined from the formal and informal statements of
members of RAG.
but has not been filled. Dr. Lampton indicated that he is concerned
about finding a well-qualified pewson to fill this position.
A position of Deputy Coordinator has been created
Program' Staff
The program staff does reflect a relatively broad range of professional
and discipline competence although some of them are new and as yet
untested in an RHP setting.
improvement in this regard since the September 1971 site visit.  A
number of the older nembers of the staff have demonstrated effective
administrative management capability although there is substantial
room for improven?ant,particularly in the area of planning.
Assistant Director for Planning and Evaluztion is a physician who is
half time with W, the only half time-position on program staff, and
he does not eppear to be very sophisticated in the area of program
planning.
master degree in Urban end Rural planning and lacks the necessary
experience to provide strong support at this time.
Unquestionably,there has been substantial
The
His C'nief Planning Assistant is a recent. graduate with a
The program staff apFears to be adequate,except for the planning
section. There was concern on the part of the site visitors
regarding the salary level for several key members of the program
staff. It was felt that the level was too low to retain competent
staff for a long period of time. The new goals and objectives and
the general orientation of the program staff sppear to be appropriate,
but projects which have evolved out of the goals and objectives have yet
to be developed.
Regional Advisory Group
The site visitors felt that most of the key health interest in
institutions within tbe region zre represented on the RAG; and
RAG nembers appear to be geographically distributed on the planning
and executive cormnittees and the task forces.
Jjr. Nobles, Chairran of RAG, is the president of Mississippi College
and has a broad background in pharmacy.
site visitors exhibited intelligence, experience, and practicality.
He also has maintained contact with the State Legislature and has been
active in lobbying far legislation to increase SU~~OK~ for training
paramedical personnel.
His presentation to the
- 7-
Most impressive has been the resrructuring of RAG.
more involved in the activities of MRMP. The RAG is scheduled to
meet 3 times per year, but in the last 6 months more frequent meetings
have been held with a special  retreat in December 1971,  to reorient
the program based cn recommendations of the September 1971 site v.lsFt
and to develop the ciirrent set of goals and objectives.
They have become
Attendance at MG meetings have been running over 50 percent.
a bylaw's requirement tha,t if a member misses more than 3 meetings
he is dropped from RAG membership.
as consumers out or" a total of 37. The consumers actively participate
in the deliberation as shown by the RAG minutes.
                      There is
There are 11 RAG members classified
Since the 1971 site visit, there has been a marked change in the role
which RAG plays in the decisionmaking process.
more actjvely involved in planning committee and task force work, and
a system is being implemented that involves RAG members on monitoring
teams est~hlished for each project that is approved and funded.
The RAG is much
The Executive Committee meets between RAG meetings,  and the RAG has
delegated to it authority for approving small projects and grants
not over $2,000.
tative of the total RAG,
The Executive Cornnittee is geographically represen-
Grantee Organization
The grantee organization (University Medical Center) provides adequate
administrative support and there appears to be a good working relation-
ship with W. In general, it permits sufficient freedom and flexi-
biiity and does not appear to be interfering wlth RAG'S policy making
role. However, MRMP may need some special Consideration by the
University In  terms of personnel policy and the establishment of salary
levels for program staff in order to assure appropriate working conditions
to retain competent program staff.
Participation
The major health interests  in the state appear to be participating
and working well with MKMF'. Members of these health interests,
including the Nursing Association, Medical Association,  Black
Medical Community, Heart Association, Cancer Society, State Board
of Health, Veterans Administration and general practitioners from
the rural community, were unanimous and enthusuastic about the aims
and accomplishments of MU@ e
Local Planning I
MFMP has worked closely with CHP in developing "b" agencies.
are currently 3 operating "b" agencies in Mississippi and MRMP has
been involved In getting each of them operational.
stated objectives for the corning year is to assist in developing "b"
agencies in other local areas.
There
One of the program's
-8-
With the cooperation of MRMP, LO local planning areas throughout
the state have been identified.
these areas was supplied by MRMP.
concerning organizations in 9 of the 10 areas and 5 of these are
in the active planning stage at this  time.
There is an adequate mechanism for obtaining CHP review and comment,
and the existing "a" and "b" agencies have input and comment on
program proposals.
Much of the data used in defining
Active discussions are going on
Assessment of Needs and Resources
The MRMP has participated in and/or has available to it a rather
large data base documenting the health needs and resources of
Mississippi.
the expertise needed to mve from available data to program develop-
ment. *The needs of Mississippi are so extensive in the health
area, that almost alijl Lype of project could find some rationale or
justification.
that a careful review and analysis of the available data be made
to provide the context for an overall program plan of action which
will be most cost effective and efficient in addressing the unmet
health needs of the people as a whole.
activity remains a weak point in MRHP at this time.
                                                       ,
However, there has been, thus far, an apparent lack of
Tfiis situation would seem to meke it even more urgent
A systemtic planning
All of the projects in the current trlgnnial application were developed
concurrently with the rethinking of the goals and objectives and the
restructuring of the RAG and program staff. Consequently, the
current set of projects have not evolved as a result of the rethinking
which has gone on during the last 10 months, although several of
rhe projects are compatible with the directions expressed by the new
goals and objectives.
- Management
The coordination of program staff activities has improved substantially
since i" moved into its new quarters in which staff are in one location
and in close physical proximity to one another.
faction which characterized the progrsm in September 1971, and was
rather freely voiced by prograin staff at that time, was found on
this site visit.
concern of the site visitors in having a half time person as
Assistant Dlrector for Planning and Evaluation.
weak area of the progran, it was felt that this position should be
full-t.ime since new staff members working I.n this section will need
guidance and consultation in directing the activities of the program.
None of the dissatis-
However, an exception to this general rule was the
Since this is the one
I.
.. ..
,.
,
.. .
-. ..
, ..-, .
-9-
A plan has been developed for regular systematic monitoring of
individual projects by both written reports and by site visits of
project monitoring teamq, which include program staff, MG members,
and other consultants as necessary. Periodic progress and financial
reports are also required.
Evaluation
The program has a full-time evaluator who appears to have the potential
to improve the evaluation activities of MRMP. He had been with the
program only 4 months prior to the site visit.  The projects which
are currently ongoing, and the new projects in this application, did
not have the benefit of his expertise, and the site visit team did
not have R basis upon which to judge his performance, although their
prognosis was optimistic. His plans for evaluating and monitoring
projects, as well as for organizing total program evaluation, appears
well conceived and practical. The site visit team was impressed
with his presentation and felt that his input to the region will have
a positlve effect.
new projects, including those which are proposed in the triennial
application.
He plans  to build more effective evaluation into
A particular problem which was identified in the application is the
difference in evaluative criteria between the stated objectives,
project devezopment guidelines, technical review criteria, develop-
mental component priorities, the FUG rating form, and the program
evaluation statement form 14. This was called to the attention of
the region during the site visit.
C. Proposal
The priorities of MRMP have been established and complement the need
for health care in Mississippi.
during a retreat of the Regional Advisory Group in December of  1971.
The priorities are congruent with the national goals and objectives.
In general, the activities proposed for the triennial application
relate to the stated goals and objectives, although, for the most part,
they were initiated prior to the RAG retreat.
The priorities were established
The methodology for monitoring and evaluating the current list of
activities were olrtlined by the Program Evaluator during the site
visit.  The approach the region has chosen to pursue is both realistic
and practical and the site visit team has confidence that the intended
results proposed in the activities will be accomplished.
In view of the fact that the University Medical Center is the only
institution of higher medical training in the state, and with their
program of continuing education, it is felt that the knowledge
gleaned by MRNP will be adequately disseminated to the medical and
allied health fields throughout the state.
- 10-
The communications specialist of the program staff has developed
methods to keep RAG members, health care providers, and the general
public informe6 on the various activities and the mission of MRMP.
His input to the triennial application and his presentation to the
site visit team is evidence that his knowledge of the region and
of MRMP's mission will be a great asset to MRMP in the area of
information and commication.
The program staff feel that because of the paucity of manpower and
facilities,  the maternal and childcare facilities , which are the
spin off of other projects, vi11 help to improve the utilization of
manpower and facillties.
ship will be a very necessary prerequisite, since 37% of the population
in Mississippi is black, with 41 black physicians practicing in the
state.
which are not maintained on the surface but are, however, maintained
in the mores and customs of the people, programs of this nature have
an increasing beednp on the welfare of the entire state.
The project for black physicians preceptor-
In the view of the inherent problem of "separate but equal,"
With the Schocl af Allied Health at UMC and active recruitment of
both black medical students and allied health personnel,  there
can be marked improvement in the number: of physicians and allied
health personilel who will be serving the community.
MRMP has shown, through the midwifery progrem, that individuals can
be taken care of in outlying areas and that paramedical facilities
will be developed, as proposed in the-currect application to
increase the availability of care.
There are ten planning and development districts in the state.
MRMP recognizes the fact that health care generally follows trade
patterns in Mississippi and that these ten districts form the basis
of any approach to improving the health delivery systems, as well as
the care that people receive in the region,
with CHP to regionalize the health care in Mississippi.  The current
list of projects proposed in the triennial application is by no means
the utopia for regionalization, but the site visit team believes
that plans and uethods for doing this can be achieved by MRMP.
KRNP is actively involved
.
*- . ..
.. .
.. .
..I
..
. .:.
Although the performwe generally has been socrd,  there is a lack
of agreexent on the part of the program staff, with the precept
that: "evidence of support for continuation of successful activities
in program by community organization or other Federal or State agencies
after RMP funding has been phased out," should be provided.
instances, staff argued that even though no evidence for continuing
support is available and in all probability will not be available,
the project should be launched and supported in and of itself.
In many
-11-
A number of projects, particularly the kidney project, have been
partially funded by agencies other than MRMP, and it is felt that
each project will, in turn, be reviewed and evaluated with other
funding sources being investigated.
Re c omend a t ions
1. The site visit team recommends that the Mississippi Regional
  Medical Program be awarded triennial status, and that the
  triennial application be approved for funding as  follows:
04 Operational Year $1,926,984
05 Operational Year 2,200,000
06 Operational Year 2,445,891
The triennial application includes a request for developmental
component .
2. Strengthening of the Planning Staff:
a.
There should be a full-time director of the planning and
evaluation section.
b.
Extensive training is needed for the new planning staff,
including training visits to RMPs which have well organized
and operational planning.
Suggested RMPs are:
Florida
Georgia
Northlands
Ohio Valley
Tennessee Mid-South
3. Emphasis should be placed, in the immediate period ahead, on the
  development of written program statements for each of the goals,
  1 through 5, with priority and implementation schedules based
  on the goals and objectives agreed upon. Then these statements
  could be used as the basis for reevaluating currently developed
  projects and assessing the need for new project development
  appropriate to the goals and related program statements.
4.
Better documentation of need, based on need assessment studies
appropriate to local areas, which relate to program goals and
objectives, is necessary.
5.
Improved Technical Review input to the RAG and its  subcommittees
with greater emphasis on Technical Review in the decisionmaking
process is essential to the program.
-12-
. .-.
6.
The program staff and the planning committee of RAG should
coordinate the evaluative criteria with the stated objectives,
project development guidelines, technical review criteria,
developmental component priorities, the RAG rating form, and the
program evaluation statement form 14.
the statements that should be coordinated:
The following is a list of
a.
b.
d.
e.
f.
g*
h.
C.
Guidelines--page 83--1st paragraph, Items 1-7
Technical Review and Rating Form--features 1-5
Developmental Component Priorities--page 100,l-5
Goals and Objectives--page 72A & B, I-V
Criteria #2--page 146, "New Modalities. "
RAG rating form criteria
Application information for project applicants, 1-3
General Principles--page 82,l-5
7.
MU-& should work to obtain CHP and State funding of ongoing
health planning data collection and movement toward placing the
data collection project into the State Board of Health or the
CHP (a) agency.
-8.
MRMP program staff salaries should be reviewed with the UMC
administration to see if a mechanism can be developed fur
more adequate program staff compensation.
an.,
'William A. Torbert
-,
.. .. .'
-. . .. ..
-.
,
, . .. 1 ... -4.-
.
I_ __--_-_- ---
c-~I~I)~~,~~TJI:: Theodore `D. Lampton, M.D.
I,IiS`T IbY~IXG: . Eugene Nelson - P. & E.
Staff ,for RFW:
--- .-
William Torbert - PHA - SCOB
hwrence-i%Llen - Grants Mnmt .
- --
I
---- ---
1% I
.-.
11 1 1: 01: A1~1~1,lCA'I'ION:
3rd Ycar
Regj 0113 1 Officc I\cprcr;cnYaLi\*e:
-
TheokJL GrCffith
LI
/ x / Tyj.c]inj :i1 / / `l'~-icl~lli~l~
I-
L1
I\l~llrl~CliIC71t SUrirc)' (Date) :
-
2nd Ycar
-
/- / `j'rictit~ial / / Other
COl1 du c t c d :
Scheduled.:
May 22-25, 19?2
or
, I-
--
ast Site Visit:
- Staff Assistance
rj L&K--
Chairman - Dr. Joseph Hess, Committee
Dr . Anthony Komarof f , Council
Dr. McCall, Consultant .
Br. Levenson, Consultant .
Dr. Vaun, Consultant
w
Staff Visits in Last.12 Months:
Dec. 1-3, 1971 - .RAG Retreat and Staff Assistance
- DATE PURPOSE
Mar. 22-24, 1971 . - RAG Meeting of Project Review
April 1972      - . Staff Assistance
May 18-19, 1972   - Verificatiop of Review Process .
Recent events occurring in geographic area of Region that are affecting
RMP program:
Highlights of activities during the past year involving MRMP program stafif:
1. In June 1972, Govergor Waller appointed Dr. Risher as head of CHP(a) agency.
2.  An EMS saatewide planning council was established with 'all agencies involved
  in Emergency Medical Care participating.
Creation of the new School of Allied Health at the University Medical Center.
  A new Dean was appo*nted on July 1,. 1972.
L2,
3.
k
c
4 4.
The new Riverside Psychiatric Hospital opened -- only privately owned
Psychiatric Hospital in Mississippi. -..-J
@$@
'C'"J*,
--a -
5.
Maternal and Infant Care project in Holmes County under the County Health
Improvement Program has been expanded to 3 other counties - Warren,
Sharkey, Isaquena.
Applachian Project became operational and was funded at $2.4 million.
6.
7.
Three Regional Vocational Centers established in Mississippi that included
some training for health careers.
8.
A New School of Nursing established at the Mississippi State College
for Women in Columbus, Mississippi.
9.
Legislation has been passed and the Board of Trustees have approved a
new dental school for Mississippi.
10.
A'Nurse Anesthetist program was established at the University Medical Center.
11.
The Legislature passed a sickle cell screening program for the public
schools.
12. Moorehead Junior College, in the Delta, has initiated a new program
for upgrading WNs; to RNs.
Tri County Comprehensive Health Program (Yazoo, Madison and Leake Counties\-
funded at $416,000 under the Experimental Health Delivery Services.
13.
14.
Five National Health Corp personnel assigned to Mississippi.
15.
Full-time director of family planning appointed in the State Board of
Health.
16.
First class of dental hygenists graduated in June df 1972.
17.
New Helicopter ambulance service in Hattiesburg.
the state.
The only one in
18.
MRMP was the sponsor of Mississippi's first "Health Expo" held during
the first three days of October, 1971, which drew throngs of interested
people from all areas of the state.
DEMOGW PHI C I NFORMAT I ON
Tota I (2 1 393.5
  Biloxi-Gulfport 134.6
   Jackson 258.9
.
-
POPULATION: (1970 Census)
@a :&?$
Total Population: 2,216,912 $ Urban: 44.5 ..-Qx
' Population Density 46.9 per sq. mile $ Non-whi-I-c: 37
Age Group, 1970
Age Group State U.S.
                          34
Under 18 yrs. 38
18 - 65 yrs. 52 56
65 yrs. B over' IO IO
ETROPOLITAN AREAS
AGE D I STR I 8UT I ON
Source:
Bureau of The Census - PC(I)-AZG and PC(I)-B26 1970 -
1'970 Census of Population; .
State and Countv ,U26
INCOME - Average Income .. per Individual, 1969
State (of RMP) $2,192
United States - $3,680
Source: State data from Statistical Abstract of the U.S., 1970
. I,
(Dept. of Commerce)
HOSP 1 TALS
Non-Federal Short- and Lona-Term General HosDitals. 1971
Short-Te rm
Long-Term
Number of Beds
--I----
Number
I--
115, 9,262
0 0
V :A. Genera 1 tlosp i ta 1 s 2 I ,576
(One has long-term unit)
Source: Mississippi Hospi-tals With License Status and
Governing Bodies, February I, 1971, Mississippi
Commission on Hospital Care
h- ~
Component
PI\OGWV STAFF
CONTRACTS
4
DFIVE LOPMENTAL COMPONENT
-,
OTERAT I OSAL PROJECTS
Kidney
. EP!S
Iis/ea
Pediatric Pulnonary
. Other
TOTAL DIRECT COSTS
COWCIL RECOMMENDED LEVEL C. -
- .. . . __ a
COMPONENT AND FINANCIAL SUMMARY
  TRIENNIAL APPLICATION
Current Annualized
-~
Level 03 Year
7/71 - blTz*
411,097
. ----
.,
485,133
.
896,230
1,095,428
o
Rcquc
1st year
95,315
C,730,480
..
2,340,618
it for Tri
2nd year
633,842
---e
190,600
1,555,746
(161,915)
----
(137,743)
----
----
2,439,588
inial
3rd year.
9' 666,387
250,000
1,529,504
(120,403)
----
'I
(150,341)
Comii t t ee Recomentl n t ion fo
Counc
1st year
..
-.4pproved
2nd year
*Region requested a 4 month erttension and was awarded
1$321,053 for contingation.
operational year to 10j72.
This extendkd, their 03
RECIUV - Hi55
BRtAKO RE OUE ST RM 00057 1W72 PAGE 1
- RMPS-OSM-JTL -
04 PKt PE R1 OD - - - - __ - -
...
I~~E:ITIFICATI~~N CF Li;YP,kL>;T I CJXT. ~.LT.il:il CONT. DEYUNU
I A???.. PL&I231 APPII. PEKIUII] PHEVIOUSLY I PREVIOUSLY I DIRECT I INDIRtLT I . IUlAL 1
I L'F SbPPOHT I CF SUPPORT I FUhDEO I APPROVED I COSTS 1 COSTS 1 !
.
. ..
! .__ !
I I I I
JULY 17rlP72
l3REAKOUT OF  REQUEST
05 PKOSRAA  PERIOD
REGION - niss
an 00057 io172 PAGE 2
RMPS-OSM-JTOGRZ- 1
......... ................... _- .... - - ._ . - --
.-I .--:
.. __ .
'i-
.............
I
... .... -
- --
REGIONAL MEDICAL PROGRA~S SERVICE
RMPS-OSM-JTOFHL h6
I REGIO)(. 57'-iIss' ~~~P-jupp~.YR o.~--- -- FUNDING HISTORY LIST _-.___
m OPERATIONAL GRANT (DIRECT COSTS ONLY) AL'L AEQUEST-AND'-~NARDS~S-OF HAY 3ir 1972
,--
JUNE 811972
AWARDED AWARDED mmom AIWAROEO
01 - 02 L3
.- COHPONElllT --
NO TITLE 07/71-06/72 TOTAL
___-
COO0  PROGRAU STAFF         3C69QO       4C18CO       411097      1119797
001  conpa STPK DET         62600      1198CO       91627      274027
052  IRN OXRX CHR PU       20C30C       178000       93784       472084
MlSS PG INST IN 38500 57200 62790 158490
- 003
004
oc5
Ow6
OC 8
,-3
7GOCO
33592 __ 93792
           86000
52332 190832
          81000
25210 ____ 25210
1ooo'J lOCC0
54470       328370
31 11::       2a14io
3C218 3i12ia
RECUT HLTH RNPW 70000
CYA CLNCS INOIG 29000 -. 312CG
EST COORO SYS C 164605 lL932C
COHPR PRG CPR T 39000 47000
RAD RX TRN CONS 2L-900 454LU
REG COCPR NEURO 67503 7 1000
COUPR REN OIS T 46300 341cu
EUPGY N CRTCL I ____- _. - ___
RENAL OIS PROG
WP CONTL OEM A
tl!i
   011
' G12
-',,  e13
-,   018
617
**
**
**
- . . _- . . I
- TOTAL - 1229tOO 1095400 896230 3221230
I
** .... .~ . ...... ... __ ___
- .... ..... I -. ............. - ........ .- ..... . - . . __ - -
.. .. .. ................ __ .. - __ -
SI' -_-__~-----.- __ _--__ .. -...--._I ...... -I --- -
I
.. _. ..................... .....................................................
. ~- .. ..............
-
~ .- .- . . .. _. ......... ... - ... __._ .............. .- ___ ............. - ....... ..... .- ...
!f
...
.. .. ... -
.. ...
4
.. ........... - .. - --
4 ..... .. - ........ .- ... .... ..- . ...............
............. .......... - .......... ---~
,_ .............. -. ...... ....................
LJ
LII
__ -
,-
.... ... ~ -.__ . -- ---.
- - ..- .... .................... - - . .- . - . -
---.I .......... . . - . - - -
7
I ,-
.+ ..........
I _- ,a: -.I ...... -. .
-. . a. .............
Jlcgion: Mississippi RMP
Review Cycle: Sept/Oct. 1972
One Medical School located in Jackson serving the .entire state.
For the most part, medical care is avail&'lE to ah citizens,
but the. real problem is in educating the people to take.
advantage of medical services.
Upgrading and increasing health manpower is the major goal for
this region and positive steps are being takeh to alleviate this
problem.
for health services/educational activities.
The region was awarded supplemental funds to begin p-laming
Mississippi has only one physician per 1,350 people, which is
half the average for the U.S.  This figure includes all urban
areas. In many rural districts of Mississippi, the ratio
reaches almost astronomical proportions.
The region's emphasis in the past has been categorical in hear,t,
cancer, and stroke, and in continuing education with activities o
centering around the Medical School.
The new thrust is regionalizing the activities' with the major
emphasis on improving the health care delivery system access
and availability to all persons.
Projects being submitted by the Eegion have been designed for
outreach into all areas of the state.
%
The regipn is requesting funds for 2 continuation projects.
All other projects are new.
Ten old projects are being' terminated.
The developmental component is intended to provide MRMP with funds
to move rapidly and elipenditiously in responding to emerging or
unique program development activities.
The internal problems that plagued ihe, region a year ago no
longer exist. .
The program Gas moved to new quarters outside of the Midical School
complex.
The program staff has been reorganized and new st& have been
hired to fill needed vacancies.
-
-
The RAG has been restructured and is no longer a reactionary group
but now exert good leadership and strong influence on the program
and are actively involved in directing the activities of MRMP.
. . ~.
~- -. -.
-
. .
I
-. .
..
..
. .~
..
,'
.. ,
..
..
.. t
,.. . ..
-
The Mississippi RMP, a year ago was just beginning to turn the
corner in becoming a strong and important leader in the
0
development and delivery of health- services to all people of
Mississippi.
together" so to speak and are now a cohesive, dedicated and
enthusiastic group who are looked on by the health professionals
of Mississippi as strong and reliable leaders in developing
programs that are innovated and challenging, but are designed to
meet the health needs of the region.
During the past year they have "put it all
0-
Review Cycle: Sept/Oct.. 1972
STAFF OBSERVATIONS
Principal Problems :
Review of.the region during last year's review cycle revealed
the following problems :
1.
Goals and objectives were broad, giving the region little
direction.
2.
No Black professionals on program staff.
3.
Program staff needed further strengthening in both planning
and evaluation skills.
4.
RAG needed to be restructured and become more involved in
directing the program.
The region was relying quite heavily on the "bubbling up"
technique as opposed to a balance between this and a RAG
and program staff stimulated system of project development.
5.
6.
Evaluation had not consisted of more than progress reporting.
Principal Accomplishments:
1.
2.
3.
4.
5.
Program staff has moved to new facilities away from the
Medical Center, resulting in a new identity for MRMP throughout
the State.
RAG and program staff has been restructured and reorganized
and RAG ii now more involved and.is directing; the program
instead of being a reactionary group.
Goals and objectives have been refined and further delineated,
and RAG and program staff are developing programs to meet the
goals and objectives rather than waiting for activities to
bubble up.
Additional staff have been hired to fill vacancies in planning
and evaluation.
work in the program development area.
A Black professional bas also been hired to
Evaluation techniques have been developed for evaluating
projects and overall programs.
Issues Requiring Attention of Reviewers:
The region is requesting triennial status and developmental
component.
Much of the effort of MRMF' has been undertaken by faculty members
of the University Medical Center.  This has been possible through
MRMP support, but since other sources of funding to support
contributions to continuing education by these individuals is
slim, it seems unlikely that in the future they can continue
their efforts in this area.
MRMP may need some special consideration by the University in
terma of personnel policy and the establishment of salary levels
for program staff in order to assure appropriate working conditions
to retain competent program staff.
.
c
a SARP
L
Region New Mexico
Review Cycle Sept/Oct, 191
Type of Application - Trienc
Rating . 294
RECOMMENDATIONS FRO14
@ Review Committee
/7 Site Visit Council
RECOMMENDATION :  The Review Commi ttee concurred wi th the site vi si t team's
recommendati ons regarding :
1. The RMP's readiness for triennial status.
The approval of a developmental component.
mi ttee rejected the site vi si tors  recommendations- on the total amount
of funds to be recommended for each of the three years of the triennium as
      ding level of the developmental component. Committee
      uctions in both project and program staff funding requests.
           overall reduction are included in the critique section of
ort.  The following summar-izes the Committee's recommendation for
  tional year compared with'the Region's request and the site
    cornme nda t i o n :
Re comme nda t i on
% Program's Review
Request (05) Site Team Committee
$J,319,722* $ 830,000 $~,070,ooo
232,305 3 50,000" 1
138,228 120,000
$1,690,255 $1,300,000 $1 ,l5>0,
f
ancer registry funds were transferred from the program staff to the
perational project budget category.
mended totals of $1,200,000 and $1,250,000 for the sixth and
m years respectively, including a developmental component of
ch of these years,
ing $120,000 for the developmental component for each of the
Committee believed that the $120,000 recommended by the site viiit
The si te visi tors had recommended $1.3
:
velopmental component was too ambi tiotis for a Program that
undergone so many changes throughout the past year.
Even though Committ
ognized the significant progress made since Dr. Gay's appointment as
rdinator, which included a number of changes in program staff, the expansion
the RAG from 41 to 116 members, the establishment of 9 standing committees
         membership, the revision of the bylaws, the development
     puterized financial system ,and the involvement of both provider
d community groups in establishing the goals and objectives for the triennial
L e Region New Mexico
Review Cycle Sept/Oct, 19/
RECOMMENDATIONS FROM REVIEW COMMITTEE . Page 2
application request, they suggested that more time is needed to' concentrate
on initiating comprehensive activities and programmatic thrusts,
Review Committee noted that the Program has made excellent progress in
increasing minority involvement on the Executive Committee, RAG and its
comi ttees.  The Coordinator has already responded to the site vi si tors
concerns regarding the employment of mi nori ty members on program staff.
It was noted that the Coordinator has hi red three additional minority
staff members thus resulting in a total of six minority program staff
mitlee noted that the NMRMP's program objectives are commendable.  However,
e proposed use of funds appeared to be a continuation of old-line activities,
Concern was expressed regarding the proposed con ti nuati on of ongoing acti vi ties
for a fifth consecutive operational year.  In this connection, there was
extended discussion concerning the request for conttriued funding for the
cancer registry.
trongly urged the Program as well as the project director to- seek other
ources of support for this activity during the next year.  Reviewers agreed
4th site visitors that the $118,000 requested should be budgeted and
monitored as an operational project rather than as a program staff activity.
Reviewers were made aware of several of the outstanding qualities of this
particular program and were informed of the partial support being made
The site visit team had dealt with this issue and had
ailable from the National Cancer Institute.
iewers also r&ed the request for a substantial increase in the number of
personnel needed to implement project activities under program staff direction.
It was felt that this strategy should'be discouraged since it would probably
lead to further prolongation of activities beyond a maximum three-year time-
limit.
staff through the use of operational project funds rather than pursuing
continued assistance through its program staff budget.
eview Committee disagreed with the site visit report statement "if the
They recomnended that the Region should consider supporting additional
ram is interested and seriously intends to facilitate HMO planning, it
ld bring onto the program staff people with appropriate experience in t
gerial and financial aspects of HMO planning.  Commi ttee noted that two
organizations in Albuquerque have funded HMO activities and could be called
upon to offer consultation to other applicants upon demand.
omittee further discussed the overall staff complement and agreed that the
mmuni ty Health Services Response Sys tern was parti cul arly outstanding.
cognition was made of the number of demands from communities which were  .
ing responded to from this section.  In spite of this commendable effovrt?
viewers believed that this staff should concentrate more of its efforts in
imulating programmatic activities rather than responding solely to the
ming single, isolated project requests.
COMPONENT AND FINANCIAL SUMMARY
   TRIENNIAL APPLICATION
Current Annualized
ERATIUNAL PROJECTS
Pediatric Pulmonary _.
ECOMMENDED LEVEL
~a'st Site Visit:
(List Uatcs
June 8-9, 1971 - Sister Ann Josephine, Chairman, Review Committee
I
II_--.-
Chairinnn, Other Co:mittcc/(lounci 1 Rci!ibcrs, Consul tnilts)
Anthony J. Komeroff, M. D. - National Advisory CouncitE
George E. Schreiner, M. D, -
Morton C. Creditor, M. D. - Consultant
Arthur M. Rogers - Consultant I
John Gramlich, M. D. - Consultant
It I1 If
11---* Staff \'isits --_I____ in Last 12 Honths: --
I
(List I9ntc and 1)urpose) October 17-20, 1971 '- Frahk G. Zizlavsky-ln~rodurtore
I VlSl
January 21-22, 1972 - Harold Margulies, M.D. Director' -
April 19-22
ky 94-18
JufIy 25-28, 1972 - Frank Zizlavsky, Joan' Ensor, Kathy Scurlock-Verificati on of Revie17
Speech to State Medical
                                           Society
1972 - Frank G, Zizlavslcy,>Attend RAG me,eting and Technical Assistacce
I
-9 1912 - Edward Bloomquist - Kidne Technical pssistance
972 - Frank G. Zizlavsky - Atlend Chicano, Cultural Awareness Program
PKQceSS
I
Itcce~~t events occurririq in gcop?-:inliic area of Kcgioll that  a7.e nfri.ctilin
ILfli' pYogl-nlll:
..- '.L-l-..p-- - --d-
--I-_.--I ---_-
1.
2, Coordinator has completely reorganized program; hired new staff;
fe% Coordinator James R.,Gay, M.D. a6 of July, 1971
enlarged RAG; increased committees; changed Program from traditional
program staff and projects to Developmental Program Staff & Community
response.
3, June, 1972 - National Advisory Council approved $425,675 for. 01 year
and $139,046 for 02 year for project 818 - STATEWIDE EHS and $82,oOQ
for project li's 19-22 for 01 year hedlth service education activiries,
z
e
Nursing Schools
Unfv. 0: N.S.
Mcdi ca 1 t cchnology
___.__-I___ - I-
5 ( 1 at V.A, hospital)
__- -_- - . -
Numb e r
----
Rad i ci lop, i c Te chno logy
7
( 1 at PtlS Indian MC, Gallup)
Numb C' r ___-_______---__----- -..---
POTULAT IC:: :
Total Population ; 1,014,000 I, Urban - 69
Population Density; 8 per sq. mile
'
7, Non-white - 10
(large proportion
Indian and Sp. surname)
h!ETROPGLLTA'4 AUAS
i
L
AGE DISTREBUTLOX
*
Percent of Total by Spzcificd
Age Group, 1970
Source: Rriyccu ol thc Census- PC ( VI Ir VZ> 1370 - I370 Census
Of ~'OPLI 1 CI t i Qti ;
Stcte and County i: 33
Rurc.au of the Censtts - PC (P3) .. 3, U.S9 I'opulatlon
of St-aildsrd 3etro~:oliLan Statistical Axcns, 1970.
.
Kill 003 34 .
I
Medica). Greup!, in the'U.S., 1969 ; A.bl.A., Chicap,@, 1971
Sourccs: Distribution of Physiclans, `tospitals, and Hospital 'Jcds
in the U.S. 1969, .her. Kedical ASSOC., Chicago, 1970.
Health Manpower Soiircc Book,. Section 20, PHS-NIH-BEHT, 1969
The lkalth Professions Educatjonal Assistzncc Yrogram,
Report to the ?resident and the Congress, Sept.11970
I
(P9.S- RIII-REXT)
-6-
/
-
Fciion: . N:!,+
Review Cycle:
L
m MEXICO
C onp onen t
PROGW*l STAFF
CONTRACTS
DEVELOPMENTAL CO@OiNENT
OPEPATIOX4L PROJECTS
6
Kidney
* EMS
hs/ea
Pediatric Pulmonary
Other
TOTAL DIRECT COSTS
COWCIL RECOWEXDE'D LEVEL
COMPONENT AND FINANCIAL SUMMARY
   TRIEIQJIAL APPLICATION
o
Current Annualized
Level 04 Year
-
' 610,682
.
426,037*
1,036,7 19
Reqc
1st year
1,2 01,263--
118,459
1,319,722
138,228
232,305
1
L, 690,255
st for Tr.
2nd year
'. 06
1,381,452
84,825
1,466,277
158,968
135,906
,761,151
nnial
3rd year.
07
1,441,5 15
56,550
1,498,065
165 , 974
55 , 390
1,719,429
   Coun 1
1st year
Comi t t e e Re coxen5 ,'i t i c.2 for
I
*;Includes Project $6 Emergency Medical Services funded at $61,274.
L
I
cn
h
I'
dULt 18. 1972
. .. .
I_ _... -
Review Cycle: October IY/Z
HISTORICAL PR0GRh.M PiiOPILE OF REGION
The University of New Mexico School oE Medicine was designated by the
Governor to plan and operate a Regional Medical Program, and a planning
grant application was submitted to DRMP on July 1, 1966. Planning was to
be carried out by disease-oriented committees set up by the Regional
Advisory group.
Director, as well as chairman of the Executive Cormittee 01 the RAG.
The Dean of the School of Medicine was appointed RMP
Thc 2irst planning grant was awarded for the period October 1, 1966
to November 30, 1967. A seven month grant period was awarded for the
second year planning continuatiori because of disapproval by the National
Advisory Council of the Region's first operatiunal application. Reasons
tor disapproval wcre:
1) no justification for expenditures of 01 year funds;
2) over commitment of Dr. Fitz, the. Coordinator;
3) planning activities for the 02 year were vague and  seemed
operational in nature; and
4) no RAG involvement.
The Region resubmitted an improved operational application described
a$ "Phase I" program with five operational projects. The Review Committee
(January 11-12, 1968) recommended deferral and a site visit to deteriniile
t\e real needs of the region with appropriate translation into a unified
colnprehensive proposal with a truly regional  orientation.
Prior to the sire visit, the NM/W submitted a Phase I supplement -
which included a number of changes in the proposal.
Advisory Council of May 27-29, 1968 recornended approvi;  in a reduced
amount and a grant was made in the amount of $965,305  for Core and
seven projects.
The progress report for the first year indicated some organizational
improvements with a notable shift away from the medical school.  The
region identified $355,612 in unspent balances and was granted
S ,252,911 (D.C.) for a fourteen month period.
The Mational
*
The cuntinuation application for the 03 year requested Core and nine
;>rclj(-ct:, ($1 ,053,537) and carryover balances in the amount of $174,902.
'The continuation award for the third operational year was made
fectivc September I, 1770 for twelve mor,ths with a direct cc,st
;11I1OUIl
0 f $ 1 , 1 7 0 , 1 7 1 .
...
I .
.,
- -. ..
,.
:: '.
I' . i
.. . ,
,. -
-__-
On May 1, 1971 the New Mexico RMP submitted i.ts triennial application
(iricluding a developmental component) request for the @A year,
S1,003,503, for the 35 year $985,603 and for the L6 year $886,97?.
-12-
Region: New Mexico
Review Cycle: October 1972
0
0
0
On June 8-9, 1971 the NM/RMP was site visited. The site visit team
identified rhe major strengths to be the good relationships that exist
between the* NM/KMP and other professional groups, and the Dean of the
Medical Sclioo I supportive role in the RMP. However, majvr weaknesses
In the krl;lon still exifited. These were: I) an excess dependency ol
the Medica; Sctiool on the resources of NM/fWP; 2) lack of a good
coordinator; 3) need for strengthening of Program Staff; 4) better
representation of the Executive Committee of the R4G; and 5) lack of
progress in the kidney disease area. The program received $796,312
for its 04 year (only one additional year) with a follow-up site visit
in a year to evaluate a revised triennial application.
In July 1971, James R. Gay, M.D. became new Coordinator. During tile
past year, Dr. Gay has reorganized the New Mexico RMP, hired new
Program Staff, enlarged the New Mexico RAG from 41 to 116 members,
increased the number of its committees, revised by-laws, and revised
organizational structure from traditional mode (vertical hierarchial
pattern) to matrix system where everyone is in a co-equal position
on an organizational chart.
In April, 1972, the budget period for the program was extended an
additional four months to December 31, 1972. An amount of $1,382,288
was made available for the 16 month period (9/1/71-12/31/72).
The June, 1972 RMPS National Advisory Council approved Project #18-
Slatewide Emergency Medical Services for $425,675 for 01 year, and
$139,046 for 02 year. Also projects f's 19-22 were approved or
$82,000 $or only one year.
amount of $2,029,009 for the 04 year budget period.
The Program is presently supported in the
On July 1, 1972 the New Mexico RMP has submitted its revised triennial
application (including developmental component) request for its 5th,
6th and 7th years of financial support.
-1 3-
Region: NEW ElEXICO
Revieti Cycle 10/72
STAFF ORSEXVATIONS -
1.
,-i L. .
3.
li I
5,
7.
(i
'I .
principal Problems:
Program Staff budget request is large i .e, xcqticsting 3k additional
staff members.
Lsr,r:e proportion of Program S taf I: budget for equipment
Program Staff being project directors could become conflict of interests.
Other areas of contintied financial support after the withdrawal of
?2GP support .
'Tny docs NM/IQfP continue  to fund Project- i/lA- Ttrmor Registry when on
?;;e. 20, j tern 9 - it states. .. continues oi)jcctions CQ Twwr Registry. ..
Docs r? :hrec year plan really exist?
Program did not submit any new projects as part of its triennial application
P,plI'S policy prohibits more than 5 years of financtal support for projects
!% and $8.
.
principal Accomplishments:
1. AssLsted Hone Education Livelihood Program (H.E.L.P.) to assume
responstbility for the Migrant Health Program in New Mexico.
2.  ,!l/'tV.u? has reorganized total Program.
3. Provided assistance to small clinics throughout New Plexico.
4. Provided excellent assistance to comunitj.es for obtaining National
.5.
6. Excellent representation of minorities on Executive Board, MG, and
I!eaLth Service Corps placement of assignees.
Program Staff has responded to many community requests for assistance
Cornmi t tees.
Issues reqtriring nttentjon of reviewers:
J.
I+I?S pol icy, adopted in August 1969 by NlZC docs not permit support of
. nrl c ! raining; in "cstahli shed hcollh professions. Therciotc training
pro;:rnrns Tor dental assistants (p.45), mcd<cnl Inborntory techn:'cj 311s
(p.95) or inhnlntjon therapy technicians (p. 119) are inelj.;:ihle for
R'.iPS operational ;rant support.
-. 'Y/:WLp stztes on p. 42, item 10, that it plans prcgram disengagement
<-zd recycling of funds.
vs!. tians and activities of the Cmnnunity I?ch?lbi litation activity at
1 cost c.f $95,000 fit in wtth thCs plan?
How does the trsnsfer of some of the strlff
-14-
Rep, i on : NEIJ FIEXICO -
Review Cycle 10/72
e STAFF OBSERVATIONS (continued)
Port 5 - Regional Characteristics
Three outstanding features of these publications are the instructive
nature of the content, the easy readability of the style of writing
and the ingenuity in analysis of sociological factors. Part 5, Appendix I
and 11 provide a beautiful education on social factors, their relation to
of health are not available.
and educational level lay the foundation for their use as indicators of
hea 1 th.
.
disease, and their use as indices of health especially-where direct measiires
The discussion on infant mortality, longevit::,
Appendix XI1 and Appendix IV are based on a mathematical technique known
as Factor Analysis.
the assumption that the sociological concept of "Factors" is valid.
A more serious question can be raided about the "statistical significance"
of some of the findings. In Appendix 111, they use County Data which are
gross and in Appendix IV they use Enumeration District Data which are in-
adequate and the results in the two reports differ as a result.
The entire analysis and interpretation is based on
Part 10 - Manpower Development
The New Mexico RMP states that the State Senate Bill 71, which requires
M.D,'s and O.D.'s to participate in continuing education activities, has
given new impetus to WS's continuing education activities.  The stated
pupore of the Act is to "protect the health and well being of the citizens
of the State."  If continuing education is to have an effect on people's
health, continuing education needs should be determined by identified
deficits in patient care rather than on what the provider would like to
learn, and evaluation of continuing education activities should focus on
provider performance and changes in care rather than on provider satis-
faction with the program, New Mexico RMP mentions hospital medical
audit procedures as one kind of input into program planning. 'There
should be increased emphasis on this and similar kinds of need determination.
On page 8 of the Manpower Development section, Part 10, the applicant mentions
that a proposal to develop evaluation criteria and a controlled study of
outcomes has been submitted but does not elaborate any further.,
The Nursing component of the Manpower Development section state6  that the
New Mexico RMP is reinforcing efforts of health care organizations in
measuring quality of care provided. How are they doing this?
-
STAFF OR SERVATI OYS (c on ti nu ed )
The Alii ed Health Component OZ Mmpower Development mentions  team
ap?ronch to nzn.igerncnt of health problems 3s DEC of its functions,
Fie Sixsing Section does likewise.
of ducational lesrcls of nursing or allied health personnel or are they
' alkinz about teams rnade up of several different disciplines?  Elaboration
-3 nceZcd.
',%at arc the i.ntcrrelationships between the many educational activities
proposed in thio triennial. application? For example, how does the health
aide trainin8 descrihcd in the lime Hcalth Nezwork (page 40, triennial
npplicati.on)  fir: in Y; th the Comriunity RehaSilj.tatFon proposal on page 43?
'Jill thc planning for dental health training,  nt Easeern New ):cxico Uni-
versity (page 46) be coordinated with or incorporated into the plannin;:
{or a health education system for that section of the State,  a health
services/ediico tion activity wh j.ch was approved Jirne 1/72 for supplemental
fvndtng?
existing education activities to Lhe four consortiz Eor health services/
cll:cntion actj.vities bein2 planned f:hroughout the State?
de7ielopr;ent is to be considered as extending a?ung a conkinuuni of
recrci tnen:, production, distribution, titilization and continuing education,
5cn the rcgi.on shoutd be considering the Interrcls tionships and coordj-nation
cf all of its ongoing and projcctcd cdticaticnal activities.
coordination would also help fulfill onc of ].he Region's stated objcctives--
io manage program more efficiently and noderate costs.
Do the teams consist of mixtures
b
Indeed, how does the RMP plan to relate all. of its already
If manpower
This kind of
Parc 11 - Health Care Delivery System
StaSE was impressed vfth the comprehensiveness as well as  the direction
of the initiative.
i-ndeed, is very optimistic in scope.
This activity is entirely appropriate for an RMP and
Part 12 - Sclccceci ~'iarncter~stics nl: Ikri i.ic*xIco Clrl IsIirc
S~!ec tcd characteristics of New Mexico culture stresses the sociological
f;:ci-ors j 11 di.scussj.ng the Iicalth problems ?>ecause of  t.he  three different
cv11rcres wi tliin the. state, namely Anglo, Chicam an2 1 ndian.
P:3r t 14 - Cancer Programs
T!:esc: docments are descriptions of plans and activities.
evaluate their proposals 3s segments of a program one needs more information
In order to
-16-
STAFF OBSERVATIONS (continued)
about the problems they address, the alternative solutions to those
prohlerns from which these approaches were chosen and the reason For
the priori ties accorded these plans.
For example, the ratio of annual cancer deaths to annual incidence or
new diagnoses appears to be 1100 to 2500. Perhaps New Mexico already
i~ approaching the American Cancer Society goal of saving 50% of
cancer patients.
patients with multiple cancers is .0025% of the population, perhaps
smewhnt lower than the national average.
A total of 2500 cases,  even without correction for
The forthcoming development of new untlsual radiation therapy resources
and a related cancer center are calling attention to cancer in New Mexico.
It is clear that these facilities will require patients and that their
existence will change the patient referral patterns in the state and
adjacent areas.  The new centers will not reduce the State's medical
resources, and they wi.11 pick up only a small fraction of the workload
of the existing medical care system. For all of these reasons, one
must question the Rplp priority of projects whose principal beneficiaries
to date seem to be future Untvereity-related oncological activities,  and
drug testing.
The plans for both projects appear to have been designed along admirable
lines,
Both are thoughtfully detailed in procedure.
seems to be developing its own registry, which seems to suggest that the
Statewide registry cannot serve all the needs of therapists.
Both strive to involve practicing physicians and existing hospitals.
The leukemia-lymphoma program
The registry project seems to be rather costly, With a dozen accessions,
and fewer than half as many deaths per working day, and its basic, tabu-
lations and printouts designed, the organization seems over-staffed at
thirteen full-time and two part-time people.
program gives little information on its performance. The usability and
reliability of the data collected by its field workers, the performance
of hospitals in providing the records, the trends in accession and losses
to follow-up would be helpful parameters for assessment of the registry's
chances of success.
in stage at diagnosis or patient referral patterns have occurred in the
hospitals that have participated for two years or more.
The account of the registry
It would also be useful to know whether any changes
The leukemia-lipphoma project also is costly.
an unknown current annual expenditure for a patient load of 225 now
It would add $90,000 to
-17-
STAFF OBSERVATIONS (con ti nued ) -
rezisrered to an estiriated 400 or so.
benefit fmm this added cost, and much of the treatment would be experi-
'-:ental, with investigational new drugs. It appears that the project
wist rely heavily tipon its clinical triaL and research valves to justify
~LS costs. IT t-his is true, should it not be supported by research
i ntcrests, rather than by a Regional Medical Program?
Not all of these patients would
pari: 15 - Priority llealth Care
iJo information is presented regarding several critical areas:  Methods
to provide conrinuin; nupport following expiration of REIP grant;
Zffcclivencss of existint; model system in adclrcssine, thc tar;.,r?t IIcrtIth
problem; Local verification or the acceptobili ty of the proposed approach;
:.:-v~luation criteria.
Part 16 - llealth Information Center - provides general information.
?art 17 - Community Rchobilitation Program
T!.is program seeks to enlarge the awareness of rehabilitation among
existing social and nedical workers.
spectalist team whic5 seeks to impart both awareness and skills to ?oca1
mrk-forces, on a community-by-community basis. In one area the team
hes demonstrated to its own satisfaction that it can improve n community's
awareness and utilizaeton of consciously planned and administered rehabi-
1i;ative techniques.
sjtuation the :em found and the changes that allowed it to disengage with
con:*Sction that its mission was accomplisliccl.
The objective is admirable.  As an improvement of the performance of
cxistfn:: resources, ir appears to be a legitimate RMP objective.
!'s some dnubt :liar the approach employed in the experiment recounted
s'ioi:ld be continued, because it seems to this reviewer to Se one tZlat
'muld ~akc 2 .ton$ i:jnc to COVC~ the State.
To do this, it emnloys a five-
1
1
No before and after data are given to show t?ie
Tilere
TFe State-directed agencies should have bcen pcrforning chis Cunction
ni.l ;?ion:.
ic-7 zfFor~s cn ??lp!n~ thc State agencies tr: be more aggrassive,
Could not :he 9fp reach nore localities sooner by concc2tratfng
-18-
t
&
Mr. Spencer Colburn, Public Health Advisor, Eastern Operations Branch,
Division of Operations and Development
SITE VISIT REPORT
NORTHERN NEW ENGLAND REGIONAL MEDICAL PROGRAM
AUGUST 9-10, 1972
I . CONSULTANTS
William Thurman, M.D., Chairman; Review Committee Member; Professor
and Chairman, Department of Pediatrics, Univereity of Virginia
School of Medicine, Charlottsville, Virginia  22901
Ms. Florence Wpckoff, National Advisory Council Member, 243 Carralitos
Thomas Nicholae, M.D., Executive Director, Colorqdo-Wyoming RMP,
Mr. Roger Warner, Director of Planning & Evaluation, Arkansas
__^I.. University -- .- Little . Rock, _Arkar;Escae 12204..
Road, Watsonville, California 95076
2045 Franklin Street, Denver, Colorado
80205
Regional Medical Program, 500 University Tower Building, 12th at
RMPS STAFF
Mies Cecelia Conrath, Associate Director for Continuing Education
and Manpower, Divieion of Prof eaetmal end Technical Development
Miss Sandy Flythe, Public Health Analyst Trainee, Eastern Operations
_.- ---" __ . -,
Branch, Division of Operations and hvelopnknt
Mr. William McKenna, Jr., Program Director RMPS, Office of the
... -
Regional Health Director, Boston, Massachusetto
02203
Lyman Van Nostrand, Acting Chief, Planning Program, Dffice of
-_LI-- Plannitt a@ -@.alua$ion-
Mre. Evelyn Biddle, Administrative Assistant
Donald Danielson, Director NNERMP
Edgar Francisco, Ph.D., Director of Planning 6 Evaluation
Barbara Higgins, Community Health Reseurch Aesociate
Rayburn Lavigne, Aseistant Director for Program Development
Robert Liversidge, Aseistant Director or Continuing Educat
Mrs. Catherine Lloyd, Research Associate
Carl MBneri, Regional Bealth Development Project Manager-Respiratory
Michael Quadland, CorPwraity Haalte Development Activity
Anthony Robbins, M.D., Director, Community Health Development
Mrs. Mary Taylor, Manager, Cancer Proarm
ion
-2-
Consultant to NNERMP -
Milton Nadworny, Ph.D, , Chairman of Department of Economics,
University of Vermont
NNERMP Regional Advisory Group Members
Mrs. Priscilla Allen, M.D.;Aesistant Director Public Health Nursing
Richard Bushmore, M.D., Welfare Department,  State of Vermont
Gerald Errion, Director, N.E. Kingdom Mental Health Services
Reverend William Hollieter, Consumer *
Edgar Hyde, M.D., Private Practice, Northfield, Vermont *
William Luginbuhl, M.D., Dean of University of Vermont Medical School,
John Mazuzan, M.D., Private Physician, Chairman of RAG
Hilda Packard, R.N., Director, Nursing Service Brattleboro, VeTont *
Robert Richards, M.D., Private Practice, Springfield, Vermont
Lois Smith, R.N., Hospital In-Service Educator, St. Albans, Vermont
Barbara Taft, Housewife, Springfield, Vermont *
M. Dawson Tyson, M.D., Represented RAG Member, Yasinsiki, Director,
Joel Walker, Administrator, Central Vermont Hospital, Varre, Vermont
Keith Wulace, Consumer
for state
Burlington, Vermont *
JJA Hospital, White River Junction, Vermont
* Members of the Executive Committee
Others
Sinclair Allen, M.D., Co-Director, RMP Respiratory Disease Management
Joan Blankenship, R.N., Project Director, Ambulatory Pediatric Program;
Richard Bouchard, M.D., Director RMP Heart Management Committee
Stanley Burns, M.D., Director RMP Cancer Management Committee
Garath Green, M..D., Co-Director RMP Respiratory Disease Management
David Miller, Executive Director, Vermont VHSI
Jan Westervelt, Director Vermont Comprehensive Health Planning
Committee
Executive Director, St. Johnsburg Home Health Agency
Committee
i .
..
5'
2. .
\.
Northern Hew England W - 3- RM oooO3
The aite visit was in response to a triennial application from the
lolERllEp.
overall progress, its current quality, ita readiness for triennium
ststus and a developmental component, and to arrive at a funding
recormendation for considerat ion by the Stational Review Codttee
an8 the lOetional Advisory Council on Rw8.
The gurpoees of the site viait were to asaess the program's
Prior to January, thia program devoted 8 great majority of its time
and energy to developing a data base for health planning and also
in phnning 8 6lrrgl.e msnagement eryatem for RbfP and W.  With the
data base, problems of accreditation and utilization contlnulslly
occurred.  Wfth the mnagea~ent syetem cowlicated a8minietrative
etructureo were considered but no admlniatrative lstructwe could be
created that would allow linking the two organizations in s manner
which would preserve each proaram'e inteadad purpose, at least In
the oplnion of the Federal Government.  To complicate the organi-
zational problems even further, Vermont me the rocipient of an
Lbrperimntsl Bealth Services Delivery Syotem contract In excess of
~,OSO ror a two year pertad.
Rcal1zing that en acceptable management syetem could not be readily
&eveloped and that continued RWS euppost far such a massive data
collection effort wa~ unlikely, the program began formulating a more
utradlticmal" RlIp h Janusry under the new leaderehip of Mr. Danielson.
A reader of this document should keep in mind the infancy of $he new
program 8% the tiere of thie eite visit snd the influence this Stage
of maturity We on the fiadings, opinions, suggertlons, and recom-
mndstions contained within thio report.
1. Goale, abdectivse and Psioslties
Due to the infmcy of the liliaE Program as a "program", goalis, obJsctive8
and priorities have not yet been developed and explicitly atated.
bylaw8 of the RAO, and the application for triennial support refer to
program goals 8s being wee of Improving acceseibility to medical care,
enhanciag quality of care, end increasing efficiency and efficacy of
mdlcal care Belivery.  These are considered as area8 of concern stated
in a very broad and global genae th8t cemot be interpreted, or accepted,
ae atdlndcrrde against whiah to mke polioy and funding dealrioner.
The
llorthern Hew England RNP -4-
RH 00003
V
It ie coatridered, however, that the program Is now on the fringe
of making a cmrrtructive move in this area end 8 significant impact
within the next 90 to EO bye should occur.
which a problem list is presently being developed, the "beginningsf'
of what sppcars to be necessary for the establishment of an active
and effbctive RAb, and 8 program staff cognizant of the immediate
need for explicit but appropriate goals, objectives and priorities.
These are all positive factor8 which should lead to improvement
soon in this area.  This is not to say, though, that the eite team
I8 not without concern for in discussing this subject during the
vielt, it became apparent that RAQ, the technical committees as
well as etsff In the region, do not share a common concept of how
goals, obJectives and priorities ere to function.
staff seem to understand haw goals, objective6 and priorities ahould
be used In policymeking, decisionmeking, evaluation, etc., but some
(the Chairmn of the RAO In particular) did not appear to have this
6ame understcmdlng.
both during the formsland informal sessions and there Is reason to
believe that 8 unanimity of uaderstsndlng will soon develop.
T&ey have data from
The program
There was extensive diecussion about this point
Even though it is mentioned above that the RAG has the "beginnings"
As discuseed later in thie report under Regional Advisory Group and
Ninority Interest, there la concern that the present RAG membership
is not representative of all desired factions.
and community group8, and allied heslth personnel are Lacking
rtpresentetion.
of being an effective group, It also la not an area without concern.
--.
, ,1
Illotably, consumer
If the goals, objectives and priorities are to accurately reflect
the region's needs and problems, all desired factions should be
repreeented in their formulation.
2. Accompll8hmente and Implementation
The mJor accomplishments have been the developwnt of the Regional
Disease Management approach and the developmnt of a data b8Se for
health planning.  Regional Disease Managensent is a committee approach
to heart disease, cancer, and reeplratory dieease.  Of these three
committeee, heart is the most developed, data has been collected,
professionally enalyzed, and standards and guidelines have been
developed for treatment far coronary care.
When considering the effectiveness of the disease management commit-
tees, it is encourt@ng to note the acceptance of the committee's
recommcndstiona by providers as well as acceptance of "updating"
changes recommended by the cormnittees through their continuing evel-
uation and updating of eteadards proceas.
0
Eerch cornittee le free to oa;.,ipnize itself into subcommittees and
task forcw, but generally develop 8bng the lines of atanduds
asld guidelines for treatment, educational sequiremnts, and
Ion ayetelaa.
AdBitional cormaitteee in emergency medical service systems, kidney
disease, eat? other problem apeas of disecbae and health care delivery
are planned.
The ]RrgiomL Disease b(an&@m@nt approach ie Con6ider@d a aubstantlal
         lishnuent becsueo it ~trve~l at3 mechanism for stimubting
      fvftiea, provides 8 vehicle throqh which to replicate
eucceslerful. accoxplislmmts , and f uact ions 8s a msna for promoting
wM@r applfcatim of new kncrwleege and technique8 e  Hawever, these
codttees need a functional operating plan, bybwe, and a definite
       roaching their mission.  In %he paat
        e been the influential force in the
stsucture 80 it is anticipated that with their pr
estpbasfs &iPPiculties will develop as
aaaum itfa Leraderehilg role In formulati
ai "new" RB@ now begins to
a total progrsm desipcd
seheneive empbsie. In the semx of 8 fun@i;SoniW Rlbo,
$tees were the only way of obtalnbg "provider" bput in
is iPsportant that the management co&tte@6 understand
the strength and lilnitatloas of their sole in policy development
obna Beciaionmkiag.
0
besbse for health planning wquestiombly holds a poteptial
    ling Illare rational 8ecisimw as to how the health dare
system should be msged and what s%anWder and guidelines for
treatment are more efficacioae. me data Wee laas been the source
for nreny reports, paperm, mathe Like, published by the program
evidence that the
care problem such a8 COmggreh@n6l\l@ Health Planning "a" ana "b"
agencies, the Experimerrtal Xealth Senices Delivery system (1Bs&), 8
that e number of parties concerned with health care delivery pro-
blem are not u8erc1 of the bta and in fact fn BOW instance8 may
nut even be ware of ita existence.
The site vis%% team fs amre that the datca will ooon (Septemibar 1972)
be funded and minCeined by a separerte independent organization; but,
nevertheless, believe the RMP haa to assum some continuing; respcms-
fbility in solviag the problem of deveLoging a utilization strategy
for the data.
(a list of which
sppended to this report).
Also, there it3
bawbeen used by others concerned with health
, etc. Yet, in this 8am connection theye is evidence
fi many ways this program le considered to be one in which
Horthern Hew England RMP -6-
'&!CO~l~8hiEXlt6 have been fwj there has been little effect on
mnltorlng costs, and aside from the program emnating from the
management committeem, there has been little impsct on the improve-
ment of the quality of care.  Again, hawever, the site teem is
cornfortable with the lmpreesion that prugress Will be achieved in
the future.
%
3. Continued Support
There is not a firm policy on contfnued support.
continued support ie formally addressed in the tecbnical review
crlkeria and there is subatantial evidence that emphseis is given
to continued support during the planning, developing and reviewing
4. Minority Interests
Due to the fact that there is no signfflcant ethnic minority in
Vermont, the reviewers chose to use the term "minority", divested
of racial connotations, and to refer to the poor and medically
underserved sector of its population.
(Blacks, Indians, Japanese, Chinese, and others) constitutes 0.4
of l$ of the total population.  From census data it is estimated
that one-fourth of the population of the State have French a6 their
first and in may 68868, on3y language.  Regardless of the small
number of minorities, the site visit team feels that the RAG should
be more representative of the total population served by the program.
The issue of
Of ~rOpO6818 o
The total minority population
Xt was indicated by the FW that the membership of the RAG will
probably be increased by ten In the near future.
fop?, euggeeted that these additions should be chosen with the
Idea of sdequate representation of all aepecte of the population
a8 we11 a8 other local intoreeta in mind.
On the program staff there are no minorities anathere are no
womn In top-level decislmnaklng positions o
Probably mre survey8 have been done in this region than in any
other to assess the health needs, problems, and utilieation of
eervices of minority groups, but very few "true" consumers have
been consulted in formubitfag study deslgns of interpretation of
the data, or in action plans.
The team, there-
- 7-
RM 00003
1. Coordinst or
Considering the prbceee of transition through which the Northern
Hew Engfand RMP hs0 been going, the new Coorainator seem to have
done a commendable job.  Donald Danielson VBB appointed Mrector
of lU!fERbB in January of' 1972.
re8lgaed to become Mrector of Research and Development of Health
$yetems Incorporated, the recipient of HSNA ExperbntaL System's
contract o
!he prevaous Mrector, John Wennberg,
During the following months, Mr. Danielson has reorgsnizedthe
Regional Advisory koup to laake It a separate functianing body for
Rbop, ha~p revised the program staff structure and begun to hire
IOM new people, and gut together the current eppliaation.
He #@ems to have developed a good working relationship with the
Regional Advisory Oroyp md there mer generally goo8 interection
with the Chairman of the RAFI, B. John Wazuzan.
It did seem apparent to the site team that a deputy director was
needed.
for tluch, and that he woula b@ a health professior~al rather than
a maasgement-type, SB thie seemed to be where the staff structure
needed retrengthening .
MI?. Danielson said he WBI in the process of' recruiting
2. Program Staff
The program staff has been reorgsrnizad to reflect the movement of
the large data (Iffort to Health Syeteme, Ine.  The data base staff
of 11 people plue recretrarlce ha8 been dissolved, with eomc moving
Into ofher pouitiona in W snd oome going to E8I.
'phe reorganized structure now includes two mJor ataff fanetione
end two major line functions.
and evaluetion, -king u6e of the data base built by the m, and
e~ucationel activities support, which will help in educatioaal
dcslgn and evaluation in eupport of local project efforts.
The two mjm line dlvialogrll are:
Staff fwnctions include plaming
(a) Health
to gut
System Development and Demonatration Staff - Designed
together 0 comaunity heslth devslopmht support
Northern New England RMP -8-
RM-00003
5
capability which can work with local areas in developing coordin,?ted
health services.
head this division.
A young M.D., Anthony Robbins, has been hired to
(b)
Regional Program Development Staff - Responsible for staffing. the
disease management committees and task forces, which currently
include heart disease, cancer, and respiratory disease. Others
proposed are in emergency medical systems and kidney disease.
staff is also responsible for the program management of the projects
in this area.
This
The site team felt that the program staff at present is heavily manage-
ment-oriented, and that there is a significant need for nursing and
allied health personnel on the staff, to provide a broader range of
professional and discipline competence.
The team also thought that staff was needed in the areas of health system
development and community organization, to provide a stronger alternate
focus to the categorical interests.  Efforts at keeping the medical com-
munity and public informed of RMP activities might also be strengthened.
The program staff currently employed was essentially full time.
3. Regional Advisory Group -- -
The process of reshaping the Regional Advisory Group seems to be moving
along well.
Planning Board in December 1970, to form a single planning and manage-
ment decision group for the state,  This proved to be unacceptable to
RMPS at the national level, so that in the latter half of 1971, WS
and HSMHA specifically indicated that functions assigned to RMP, CHI?,
and the Experimental Delivery System (HSI) must be separated so that
each could be given appropriate attention.  An RMP Study Committee then
went to work to re-establish a'separate RMP Advisory Group, and adopted
by;Faws for the new RAG in February 1972.
The new RAG currently has a membership of about 30, with the expectation
that it will be expanded to 40 in the near future,
The RAG was merged with the State Comprehensive Health
The site team noted that specific areas of representation that need
strengthening are nursing and allied health personnel, consumers,VA Hospital
and possibly 8ome of the economic and local political interests,  and
representation of the areawide CHP agencies.
In this connection, the site team also brought up the question of the
status of the three New York counties around Plattsburgh which the
Vermont RMP sometimes claims responsibility for.
The team stated that
Northern New England RMP
e
-9 - RM 00003
if this area wa~ to be considered part of the NNERMP, then they should
be represented on the RAG,  On the other hand, if it was determined
that they really related more to the Albany RMP, it might be better
to make that clear, so the situation did not remain in limbo,
team made it clear that from a:RMPS standpoint, there was no objection
to the NNERMP releasing its partial claim to that New York area.
The
The RAG is structured to meet four times annually and to-date the
meetings are very well attended.
role in setting program policy.
that both the RAG and the staff needed to initiate a much more defin-
itive process of setting specific objectives and priorities.
the objectives are tending to be set by the Regional Disease Management
Committees, which are strictly categorically-oriented, rather than
looking at the problems across-the-board,
The new RAG has played a very active
The site team made it clear, however,
Otherwise,
The RAG does have an Executive Committee which has been meeting
frequently and which has a wide base of representation.
4. Grantee Organization
The University of Vermont is the Grantee Institution for the NNERMP.
Relationships seem to be generally good with the grantee permitting
sufficient freedom and flexibility to the RMP,  There was some question
raieed about the policy of submitting the names of proposed RAG members
to the President of the University for concurrence, especially in light
of the new RMPS policy statement on RAG/Grantse relationships.
The RMP, concerned about the overhead charged the program (currently
70.2% of salaries and wages), is moving its offices to an off-campus
site to achieve a lower rate (46.73 of salaries and wages).
supports this move.
The aite team also noted errors in the method of filling out Form 15
(Operational Activity Summary) and Form 16 (Financial Data Record) of
the RMPS application form.  On most of these forms,  the NNERMP listed
the University of Vermont as the sponsor institution, and on many
listed a program staff person as project director.  This gives the
distorted picture that most funds are flowing to the University of
Vermont, which is not the case.
form to show who was actually running the project.
An additional question was brought up on the advisability of asking for
specific medical school review and comment on project applications.
This seemed to duplicate in some ways the work of the technical review
committee structure.
The grantee
The R,MP was requested to correct these
Northern New England RMP
-10-
RM 00003
-
5. Participation.
There seemed to be evidence of close interaction with some health
groups and interests, but a lack of involvement with others,
was noted that particularly on the Regional Disease Management
Committees, physician Influence was dominant,
that these groups in particular needed a broader range of repre-
sentation, including nursing and allied health interests, and
possibly some public or consumer involvement,  Although the volun-
tary health agencies are participating, it was felt that this aspect
could be'strengthened, as well as greater involvement of the State
Health Department,
political elements could be more significdntly involved.
It
It was suggested
It was also felt that the economic and local
6. Local Planning
The NNEW seems to have developed good working relationships with
the two areawide CHP agencies that exist in Vermont:  the Northern
Counties Health Council (Northeast Kingdom), and the Connecticut
Valley Health Compact.
will be developed in the future.
The large data base which RMP developed proved to be a helpful rationale
in the definition of medical trade areas.
patterns and utilization of services was particularly useful in defining
appropriate sub-regions for planning purposes.
It is expected that three more planning areas
The data on patient flow
There seems to be an adequate mechanism for obtaining CHP review and
comment on RMP proposals.
wide agencies provided comments.  It is not quite certain the extent
to which the RAG took these comments into account in making their
final priority rankings.
7. Assessment of Needs and Resources
The data base developed by NNERMP is probably one of the best in the
country.  The general analytical approach was the development of the
following indices: population needs and characteristics; community
characteristics; resource investments (manpow&, facilities, expen-
ditures); utilization of services; and end regults.
Both the State CHP agency and the two area-
,
Titis base has provided a good source for identification of problem
areas and resources available. It has been particularly useful in
development of categorical programs by disease management committees,
particularly so in the area of heart disease.
Northern New England RMP -11-
BM 00003
The major concern is now that the data effort is being moved into
Health Systems Incorporated, will the RMP develop a working linkage
80 that the data continues to be available for a more action-oriented
approach to using it,  The site team mentioned that some mechanism
should be established to make certain that the data continued to
prove useful to the XHE' in its planning and development activities.
8. Management
A REP staff member is assigned management responsibility for each
project.  Each manager must work with the project director and the
Director of Planning and Evaluation to develop a work schedule and
the points at which project acitivity may be measured and evaluated.
Periodic progress and expenditure reports are required at least
quarterly for all projects.
of the project, the Director of Planning and Evaluation and other
staff are to provide assistance to get these solved.
expenditure is low for a project, funds will be diverted to other uses.
If difficulties are noted in development
If the rate of
It is difficult to tell at this point how well the program staff
activities are coordinated.
analyzed more easily after the RAG sets some more specific objectives
and priorities, and after existing staff vacancies aze filled.
This component of the program may be
0
9, Evaluation
In addition to the management reporting process, an evaluation process
has also been designed.
ever, 60 it is rather early to judge it.
full-time staff person for planning and evaluation, and will probably
be hiring an assistant in this area.
Two mechanisms are used to provade feedback on progress ta RAG and
clther appropriate committees.
submits a quarterly report to the RAG stating progress made concerning
project ovjectives for that period,
site visits which may be called for by:  (a) the Director of Planning
and Evaluation; (b) a disease management committee; (c) the Executive
Committee; or (d) the RAG.
It has not really been teated to date, how-
The program does have a
The first is that a project director
The second involves peer review
There is also an annual evaluation of each project, whether or not
the project is subject to renewal during the following year.
basis of the proposer's annual report and materials provided by staff,
evaluations will be made by the appropriate disease management
On the
I
Northern New England RMP
"12-
RM 0_00003
committee and the Executive Committee.
characteristics of the project which contributed to its success or
failure, will be asked to recommend whether or not such activities
should be replicated in the region, and whether similar projects
should be considered for future funding.
These groups, after examining
3
There appears to be no line of direct responsibility from those con-
ducting the overall ongoing evaluation to the Director of Evaluation.
Such an organizational arrangement would clarify the responsibility
for the continuing evaluation activity.
Considering the reorganization of the NNERMP review process and RAG,
it is too early to determine whether this mechanism will convert
unsatisfactory results into program decisions and modifications,.
The RMP needs to develop for both its own benefit and for that of
project directors, a specific procedure relating to the phasing out
of unsuccessful or ineffective activities.
V. PROGRAM PROPOSAL
1. Action Plan
-~
-.
.~
.-
The NNERMP has not, as yet, established goals, objectives and pri-
orities.  However, they recognize the need and understand the
importance of developing a framework of goals, objectives and
priorities.
program related to the RMP's mission statement.
Director of NNERMP, stated that ranking of priorities will occur in
the very near future and that these priorities will be congruent witii
The site visit team stressed the need to convert fo a
Mr. Donald Danielson,
national goals and objectives. +.
The activities now being proposed by the region do relate to their
approach toward new priorities, objectives and needs.  However, the
team is concerned that though the 20 proposed projects have sevetal
common objectives, there is need to tie these related efforts together
so that the resources have a greater potential for changing the health
care system than if they are left as isolated activities.
all seven cancer proposals have a high proportion of effort devoted to
cancer education of the health professions and the public, but they
are proposed as seven separate independent activities.  Likewise, the
five heart proposals have a high proportion of effort to education of
health manpower and the public, but they are also independent of each
other as well as of other RMP proposed activities.  Infant and Mother
Care which carries the top priority ranking by the region does not
relate to other RMP activities.
For example,
Northern New England RMP -13- RM 00003
Seven discrete categorical areas are to be used as part of a coqsumer
education program using the extension serivce network, but there is
no consolidated approach or strategy by the health providers to use
this resource to achieve maximum benefit.
In four categorical areas, i.e., respiratory disease, cancer, heart,
and cerebrovascular rehabilitation plans are proposed to establish
and adopt procedures to improve patient care management within com-
munity hospital. No interface, exchange, or strategy is suggested
or considered.
staff effort and its resources by its heavy concentration on cate-
gorical approaches and thereby loosing the promise of a program change
to improve the system of health care delivery.  Attention to the whole
instead of individual bits and pieces is essential if the change
promised in the reorganization is going to be fulfilled.  The Regional
Management Committees on a categorical base must interface and inter-
lock with RMP goals and objectives or there is danger of a traditional
5Ld-LinC ahraaic dimawe pugma bein$ developed.  me program might
welZ ewmriUer consoli8sttan of some or its propoeed sctivltiee when the
actus1 program to be Implemented is deterptineb.
IR summary, this RMP is in danger of fragmenting its
?ne. planned and proposed activities are realistic in view of the
resources available and past performance.
Abundant data exists on
the region's health problems and resources so that criteria for setting
priorities becomes all the more important in this region*
The team was told that methods for reporting accomplishments and assess-
ments have been proposed.
commitment to the reporting process so that accomplishments and results
can be easily measured,
priorities had not previously been viewed and updated periodically, it
will be done in the future.
Evaluation teams plus managers have a
The Director also indicated that though
2. Dissemination of Knowledge,
In regard to including other groups or institutions that will benefit
from data, the team finds that these groups have been targeted and
that they will be further involved in the future.
Knowledge, skills, and techniques to be disseminated have been identi-
fied in some areas, but not yet developed in relationship to community
affairs with the exception of the ambulatory pediatric program.  Once
implemented and developed, there is little doubt that they be dissent-
inated in the region.
The site visit team is concerned that the RMP seems to be operating
singularly and not in conjunction with other organizations and research
e
Northern New England RMP -14- RM 00003
institutions in the area excepting the University of Vermont and
those hospitals with coronary care units.  Other health and edu-
cation providers have not-ye: -become -involyed and there -is evidence
that they had not really @$ep Interested in becoming 80,
likely is because the past RMP strategy has been preoccupied with
data gathering and not action, Improvement is expected in this area
under the new program thrust.
4
'Ihis, most
The team is in concordance in thinking  that while the RMP has not
shown any evidence of improving quality of care other  than in coronary
care or moderating costs, this will be a by-product as the program
moves on.
practical techniques is very significant at this point in time. For
example,  the use of referral centers has been well established and
help by RMP should continue in the future.
The approach to dissemination of knowledge about applicable,
3. Utilization Manpower and Facilities
Utilization programs are not yet far enough along withln the regjon
to comment on except to say that there are a limited number of pro-
grams in a limited number of community health facilities.'
are all well utilized and will most likely improve in the future.
Thest'
I ._
.-
We saw no evidence that there has been increased produc tivity of
health manpower other than physicians and possibly the utilization
of nurse practitioners, The region, however, urider&tariris u tiliza tiori
problems and is beginning to move in this area, although, implemen-
tation has not actually occurred.
._
4. Improvement of Care
'Ihe RMP has identified the problems of expansion of ambulatory care and
the geographic areas requiring attention,
ities will expand ambulatory care and other needs.
In reference to communication, transportation services, and others,
the RMP is doing well as can be expected.  They are available but
often are not well used nor do people understand how to use them.
The EMS is an excellent example of what can be done.
Problems of access have been identified and solutions are in project
form.  Current and proposed activities will strengthen primary care.
Underserved areas are beginning  to receive attention in one or  two
projects. As the RMP moves more fully.into a sesvices, more
involvement of the underserved areas will occur.
Current and proposed activ-
There are some health maintenance and disease prevention components,
but these are not yet a major emphasis in this particular RMP.
We
.-
I.
%.
1-
i
Northern New England RMP -15-
RM 00003
can see that they will be in the very near future.
ance and disease prevention components andiplam are considered
realistic in reference to the present state of the knowledge,
Health mainten-
5. Short-T~erm Payoff
Operational activities will increase the availability and access to
services over the next two to three years.
to measure payoff is understood, is documented, and is well estab-
lished in the new evaluation mechanism.
The need for feedback
It is reasonable to expect that RMP support can be withdrawn over
the next three years in most instances.
6. Reaionalization
With respect to regionalization, the team found that plans  and
activities are aimed at aasisting provider groups and institutions.
Greater sharing of facilities, manpower and other resources  is
definitely envisioned in their planning and projects at this point
in time.
available to other areas.
health practitioners and institutions.
is also a definite part of their planning and has already'been
demonstrated with coronary patients.
Existing resources and services will be extended and made
New linkages will be established among
Progressive patient care
0
7. Other Funding
There is little question but that the region has already attracted
funds other than RMP and will continue to do so. Most of those
have been state and federal, but some local and private funds have
been involved. The region has, it was iadicated, definite plans
for bringing in others.
to other federally funded health program8 and have furnished the
base for much of their activity to date.  This is particularily
evident with Comprehensive Health Planning, Experimental Health
Servlce Delivery Systems, Health Maintenance Organizations, and the
Federal-State-Local Health Statistic Center.
RMP activities have been definitely related
..
..I
...
Northern NeQ En'gland RMP -16- 101 00003
-
SUMMARY '
-
Taking into consideration the history of this program with' its
preoccupation on data gathering and efforts to organizationally
merge RMP and CHP, the site visitors were favorably pleased with
developments since January when the RMP decided to devote its
energy to developing a viable RMP.
The site team recognized the infancy of the program reviewed, the
fact that many elements of the program are untested, and that for
the most part the NNERMP is a "paper" organization.
the quality of the materials assembled and with an insight tu the
management capabilities of the program staff, the visitors were
impressed with the progress to date and believed prospects for
continued development are good.
Yet, based IJn
In light of the above remarks, however, the site team has the
following suggestions:
I
.
The gods and priorities need to be further defined and mort
accomplishment in the next 90-120 days.
The Regional Advisory Group needs to expand its membership to
, include better representation of youth, minorjties (as
' interpreted under Minority Interests of this report), the
medically underserved, areawide planning agencies , allied
health, and representatives from the bordering areas of
, New Hampshire and New York if it is establishd that these
areas are indeed appropriate territories of the NNERMP.
i sideration should also be given to the appropriateness of
the economic and local political interest having representation.
' emlicitly stated.
Ideally, the time frame on this is for
.
Con-
. ' The RAG should consider establishing a subcommittee structure
i aligned with goals, once goals have been developed.
. I The cbmposition of the disease management committees, ad hoc
; groups, and technical review committee6 should be examined
                            At this time,
' there is concern for over representation of physicians, thus
i limiting constructive input from other providers or I persons  ,
, knowledgeable on health care problems.
I
closely to insure appropriate repreeent'ation.
. !Also, measures should be taken to assure that these groups
are supportive of the program's evaluation plan.
The disease management comittees should have bylaws, or another
similar management tool, to align their functional operation
plans with the total program.
I
.
1 *
I
Northern New England RMP
0
RM 00003
, Consideration should be given to developing management com-
mittees for non-disease areas of interest to RMP such as
community health,
. The approval and disapproval mechanisms for projects should
be more clearly delineated.
.
The evaluation scheme should be re-examined to give further
assurance that the RAG and program staff each understands its
respective roles in review, evaluation, and feedback.  This
should minimize potential conflicts.
changes should be made coordinating all program staff performing
my evaluation with the Director for Evaluation.
Also, organizational
.
The vacant program staff positions should be filled with persons
that will provide the program with a broader range of professional
and discipline competence,
system development, and community organization are specific
suggestions.
Nursing, allied health, health
.
The program should look at all their proposed projects and
relate common objectives so that the resources have a greater
potential for effecting constructive change of the health care
system.
.
The RMP still needs to assume some continued responsibilities
for making the region aware
in the development of a data utilization strategy.
A foml policy on continued support should be established.
of available data, and to
assist
.
.
The surveillance and monitoring devices of projects should
include a method for prematurely phasing out unsuccessful
or ineffective projects.
Each of the above points were discussed at the feedback session at
which: the Program Staff, the Dean of the Medical School,  the Chairman
of the RAG and several other RAG members were in attendance.
In addition to presenting the above points at the feedback session,
the following advice was given with the belief that it may serve to
improve the program's presentation in future applications:
, The forma 15 and 16 should each reflect the same project
sponsor, and this should not necessarily be the grantee
institution but the  institution or agency at which the
project is being coordinated and actually implemented.
.
Program staffs' discipline, professional competency, speciality,
or area of
fnteresr be identified.
Northern New England RMP -18-
RM 00003 -
,
A problem-solution chart be include$ in the program report.
$
.
The role
clearly identified so that potential areas of conflict :or
decisionmaking are handled in advance.
of the project managers and the project directors 'Je
RECOMMENDATION
It is the site visit team's recommendation that triennial status
not be granted at  this time, but that the program receive two-year
approval, with developmental component rights, at the level of
$850,000 each year,  It is further recommended that there be a site
visit next year to determine progress, se-evaluate the second year
funding level, and again determine the program's readiness for tri-
ennial status if in fact triennial status is again requested.
.
With this recommendation there is one restriction and it is with
the continuation request for Project #6, A Program in Kidney
Disease.
and third years are $37,900 ana a $25,400 respectfully; the requested
levels are $78,740 and $70,000 respectfully.
change of scope of the activity and there has been no re-evaluation
by a technical review group that would satisfy review-of-lcidney-
proposal-requirements as set forth in the May 3, 1972 NID, it is the
recommendation of the site visit team that the present level of approval
remain.  If RMPS wishes to investigate this situation further :ind it
is decided further evaluat3.m of this situation is merited,  thP site
visit team has no objection.
The presently approved levels for this project's second
                         Because there is ;le
Morthern New EngtOdd RnP
-19-
APPENDIX I
RM 00003
Northern New Englhdd RMP - 20- Kn UVVUJ
NORTHERN NEW ENGLAND RllGIONAL MEDICAt PROGRAM PUBLLCATIONS LIST
A. Published by the Program
"A Comparison of Utilization of Selected Health Services
by Various Age, Income and Education Groups in the CVHC
Area." January 1971. A Connecticut Valley Health Compact
Report.
-
"A Layman's Look at the Working Paper of Health and Medical
Care Resources, Spring 1970.
"A Report on Cancer in the Vermont Region." February 1971.
"A Report on Kidney Disease insthe Vermont Region." May
. 1971.
1.
2.
3. 4. A Report on Vermont Hospitals 7/71
A Report on Prepayment in Vermont
A Report on Respiratory Disease in the Vermont
Region 12/71
A Report on Stroke in the Vermont Region
"A Report to the State Health Planning Advisory Council."
April 1971. Basic demographic data.
"A Working Paper of Health and Medical Care Resources.
November 1969.
Connecticut Valley Health Compact Report.
1.
2.
An Inventory of Health Manpower in the State
of Vermont 6/72
An Inventory of Health Related Educational Programs
in The State of Vermont
6/72
"Background and Methodology of the CVHC Area.
1971.
"Children's Immunizations in the CVHC Area."
A Connecticut Valley Health Compact Report.
"CVHC Results: Mental Retardation." July 1971. A
Connecticut Valley Health Compact Report.
"Coronary Care Network Newsletter.
first issue: October 1970.
August
A Connecticut Valley Health Compact Report.
August 1971.
Published bimonthly;
"Demographic Characteristics of the CVHC Area. 'I
1971.
"Family Planxling Patterns in the CVHC Area."
1971.
January
A Connecticut Valley Health Compact Report.
A Connecticut Valley Health Compact Report,
August
1.
2, 3. Eighteen Individual Hospital Reports
Identification of Major Health Problems and
Needs in Vermont 5/72
Thirteen Individual Home Health Agency Reports'
9/71
Northern New England RMP -21-
RM 00003
"Infant Mortality in the CVHC Area." August 1971. A
Connecticut Valley Health Compact Report.
0
1. Inventory of Health Care Services and
Facilities in Vermont
llKnowledge, Need and Use of Home, Health, Mental Health
and Related Services." January 1971. A Connecticut Valley
Health Compact Report.
"NNE/RMP Health Planning Data Base." Winter 1970. a
"Northern New England Regional Medical Program"  (newsletter) .
Published bimonthly; first issue: February 1967.
"Patterns & Utilization of Health Services and their
Economic Implications in the CVHC Area.''
A Connecticut Valley Health Compact Report.
"Patterns of Use of Hospitals & Preferences for Hospitaliza-
tion. April 1971. A Connecituct Valley Health Compact
Report.
August 1971.
1. Physician Manpower in Vermont 10/71
"Projected Impact of Health Maintenance Legislation in
0 Vermont." May 1971.
1. Report on Health Care in Vermont (Layman's Version
2. Report on Vermont Home Health Agencies 9/71
of "Status Report. . ''1 8/72 Revised
"Setting of Health Goals in Vermont: Problem in Political
Science and Technology of Planning ,I1 presented at the 11th
Annugl Institute of Management Sciences, Los Arrgeles.
October 1970.
"Smo&ing History and Behavior of the CVHC Population.
August 1971. A Connecticut Valley Health Compact Report.
1. Standards & Guidelines: Vermont Coronary Care
Network
"State Health Planning Advisory Council By-Laws .
1970.
Cornptehensive Health Program Boards.
"Statcus Report of the Community Health Systems of
(Technical Version) August 1971.
"The Consumer's View of the Health Care System and Health
Insurance." April 1971. A Connecticut Valley Health
Compact Report.
January
For the combined Regional Medical Program and
0
Worthcan Hew Englhdd RMP , ;ZL- RM 00003
.+.3
"The Northern New England Regional Medical Program
Health Planning Data Base."
Northern New England Regional Medical Program Conference
and Workshop on Evaluation, Chicago; .September 1970 .
"Utilization of Dental Services in the CVHC. 'I January
1971. A Connecticut Valley Health Compact Report.
"Variations in Patterns of Medical Care in the Vermont ,
Region for the American College of Surgeons, Regional
Meeting." September 10, 1971. Burlington, Vermont.
Paper presented at the
B. Publi'bhed Nationally and Locally
"HMO Hearings Begin ,I' Legislative Roundup. July
23, 1971.
"HMO Strategy Would Increase Cost of Care in Vermont,
Study Shows ,It NHT Newsletter. June 7, 1971.
"How One Regional Program Looks ,'I Modern Medicine.
March 1966.
Review Cycle: 10172
RMF'S STAFF BRIEFING DOCUMENT
,
k
P
REGION: Northern New England OPERATIONS BRANCH: Eastern
NUMBER: 00003
Chief: Frank Nash
COORDINATOR: Mr. Don Danielson Staff for RMP: Spencer Colburn
TYPE OF APPLICATION:
3rd Year
Lm Triennial f 7 Triennial Regional Office Representative:
William McKenna
2nd Year
L-7 Triennial c] Other Management Survey (Date):
Conducted:
Scheduled: October 1972
or
Last Site Visit:
(List Dates, Chairman, Other Committee/Council Members, Consultants)
October 1968 - (Program Site Visit) Dr. Proger, Chairman, Dr. Storey,
Robert Lawton
December 1970 - (Technical Assistance Visit) Dr. Mark, Chairman, Drs. DeLon,
Keller, and Komeroff
Staff Visits in Last 12 Months:
(List Date and Purpose)
February 1972 - To establish a channel of  communication with the new
coordinator, discuss regional development plans as well as coming site
visit.
June 1972 - To attend first meet:ing of new RAG, and to clarify question:;.
regarding the scheduled August site visit, review verification visit
and management assessment visit.
Recent events occurring in geographic area of Region that are affecting
RMP program:
MSDS Contract
F-S-L Statistic Grant (presently under consideration)
-3-
Region: Northern New Ihgland
Review Cvcle: 10/72
POLITICAL INFORMATION
Governor : Deane C. Davis (R)
Senators :
George D. Aiken (R)
Robert T. Stafford(R)
Representative: Richard Mallory (R)
DEMOGRAPHIC INFORMATION
Population characteristics :
Total: 444,732
X Urban: 32
% Non-white: 0.4 of one percent
Age Distribution (%)
Under 18 yrs.
18-65 yrs.
65 yrs and over
Average Income per
  Individual
Mortality Rstes (CY 1967)
Heart Diseases
Cam er
Vasc. Lesions
All Causes, all ages
Facilities and Resources:
Schools
Medlcine (UVM)
Ikrsing
Practical Nursing
Cy t o techno 1 og y
Medica 1 Techndlogy
Radiologic Technology
* * * *
Hospitals
Nonfederal Short Term
Nonfederal Long Term
V.A. General Hospital
e
VT. U.S.
35 35
54 55
11 10
$3,267 $3,680
435.5      364.5
173.9      157.2
117.5      102.2
. 1085.4 1143.5
Ember Enrollment (71/72) Graduates (72)
--
1 288 66
4 523 108
2 106 94
1 (Med. Center Hospital, Burlington)
1 (rn)
2
* * * * * * *
Number of Beds
   2,244
Number
18
3 2,325*
1 200
*Plus 42 beds in respiratory disease unit at the Med. Center
Hospital, Burlington.
* * * * * * * * 1 * *
- 4 ..
\I
,/
Special Hospital Facilities Number
Intensive CCV I1 1
Cobalt Therapy 3
Isotope Facility 3
Radium Therapy 1
Renal Dialysis, in patient 3
Rehabilitation, in patient
* * *
* * *
* * *
Nursing and Personal Care Homes (1972)
Number of Beds
22I.E 8 69
Skilled Nursing Home
Personal Care Homes with
Nursing Care 1311
Long Term Care Units 1043
* * *
* * *
* * *
Manpower
Profession -
Physician - Active
Inactive
General Practice
Medical Specialties
Surgical Specialties
0 ther
Osreopa th
Nurses - Active
LPN - Active
Inactive
Inactive
Number
644
32
218
150
69
20 7
33
--
2373
955
1067
316
*
*
.. .
.-.,
..
.- . ..:
... . .
____ --.\
, ., -r.,
y.-.: . . ..
... . ;E
. .. .
. L_.
e
COMPOSEST AX9 FINA.YCXL S!J>Pi%RY
   TRI EKX IXL APPLICATION
Coqocent
Pedi at r i c7ulnonazy
Gthc-r .
-\
)TAL DIRECT COSTS
ltn*CIL' RECO.WSNDED *LEVEL
c-
Current Annuzlized
Level 03 Year
$ 397,578
725,967
o
*
Region Northern New
Review Cycle 10/77
V
I I
462,368 $ 480,000 $ 500,000
I* I
ii4 , 617
683,804
78; 740
1
1
1
114 , 6x7 114,617
'( 70,000
.
1442368
46236t 48OCCC sccccc
            659978 1645878 **
                           47C823 **
,-lTRT-- 9c;261-- 70 17 61' *
*,?617 11 46 1-3 857"
CCCO PROGRAM STAFF        5567CC 389200
OC2 PFCCPESflbE CCP     194400 120000 156423
TOOG-CEV E CTA EhiTf6. C
-UOI-PaOJECT-lY CnNTV
-0C7--Eb'Z IkCEECSlhC
009 PIGH RISK INFAN
-DITTECIE~sLfTEO Cf
7127PBu 1 ATPCY -FEn
- 014-- PEGICNLL 12EC-R F
015 PAP lPfAC FEbSl
                                                     148740
   72060 ** 5535c 4t402 172050
- 7200---
10000
C06 KIChFY FFCJECT t52SC 5 5 2 s c -** 78?40_ ---
** 70298
** 57260 3e527 38440 1fOSbl I-
.* n5752 85216 5341C 22431e
o *- 47616 41616
** ll0CJ 11 CSS
                                     88558
    197 14772 8531554
.+-
                                           ** 2522e 29238
                               -7 3 C C2 -- C C-1 t E 5 i?
                                                                           10.355
                                         o *- 24364 29725 31452 85595
-'tie -PLFLrc FCLCbTlC ** 31797 - 31797
019 ELCTPICIL SAFE - 4*-72t4Ev2-5f6 . b 7 13'2 f32306
021 PRCFCSSIONAL 0 +* 2c030 39515. . 22959 82504
  023 hEh TEChhICCES
z--O 24--EGrUGk IC h f i 0% 5
- -02 6
011 REClCNALILEO RE -
013 CbhCEP PROTOCOL -
I
472C4 28199 29952
21'GCCI;RhTlTt OF C +*
017 RECICPAL CAPCEF - -
-O~C-EPRL~-IC-CF-C~P o 502?9 40522 4 341 b 13457_1
                                                          50920  i
                                                                           1750 i
Z 025-S1Rf6TCCCCCAL C ' ** 30'50 4ccc lC50 i
** 22082 29654 317FO 83556 f
-- -... _-
. +*      sosic
. **      17 50
   **       368C
722-GPGC FCf'K+-EFPE
3630
--_----- -
   C AP 0 I LC-l-FX6R
021 rEoLTr CCUCbTIO
+8
2545812 ** 126Clt9 lllb3?1 IC31253 34ce379.
- TOThL - 41560c 59_420().- 1040012 ~ ___- ___ .___ __
-L- .----
JULY 17*1972
KtblLW -  N NtW
RM 00003  10172
i I
I TOTAL I
1 I
I 1
1 1
a
*
a
I
02U EAPLY IO CA2L;IACS
I
J
I
1
.--
.I_--
1 I I I I I
   )70r000 1 L480rOOO I I S566.337 I S1.116.337 I
ICTAL 1
- 10 -
Region : norwaii LVCW L1116-Lo11.L
Review Cycle: 10/72 --
HISTORICAL PROGRAM PROFILE OF REGION
8
July , 1967
riscal Year 1968
June, 1968
- John E. Wennberg, M. D . became PrOgriIill
Coordinator (100% time).
Site Visit:
The role of systems analysis activities in
RMP is discussed.
systems had helped them organize the
planning process
in other than planning activities.
Visitors felt that
but questioned its use
-
During Ey 68 the RMP accomplishments were:
1)
Participated in development of the
Connecticut Valley Health Compact whose
overall goal is to examine the possi-
bilities for the provision of total
health care in the Connecticut Valley
Healkh Compact region.
2) A physician attitude study is initiated :>
' -1
,<..: .!
3) Heart inventory is completed. ~ . ~ _.- ,I---
4)
A survey was made of existing medical
records to evaluate time involved in
history taking and recording of data
from the viewpoint of completeness
and retrievability .
5)
A state-wide education program is con-
ducted in external cardiopulmonary
resuscitation.
6)
Possibilities of a cervical cancer
screening program are explored.
7)
Involvement with three projects related
to information sys terns.
-
First Operational grant request receivL2d
requesting support of four projects as
follows :
Project U1 - RMP office
Project #3 - Emergency Health Care
Project #4 - Continuing Fducation for Ilealtlt
In early September a project #5 - Evaluation
Protocol for Coronary Care System Inclusivt!
Emergency Health Services was submitted and
Project 82 - Progressive Coronary Care
., ..
,- ,-*
..
&>
k .-./
Professionals
* 11 -
October, 1968
November, 1968
December, 1968
0
February, 1969
May, 1970
- Site Visit to discuss 01 operational. request: .-
Major concerns of the visitors:
1) Slow rate of maturity;
2) Lack of involvement of RAG - especially
  in the decisionmaking process;
3) Degree of influence of Executive Committe
  or RAG;
4)  Lack of Medical Society involvement in
  generating program ideas;
5) Lack of a clearly defined conceptual
  strategy for the region.
All projects were reviewed and visitors  felt
this had merit but additional planning was
needed.
- Council concurs with site visit team and
Review Committee and 01 operational grant
  is deferred for additional information
  and clarification.
- Dr. Wennberg request (granted) permission
  to meet with DRMP to discuss November
  Council's recommendation. He asked for
permission to revise the operational
application and be allowed to submit it
  for the January-February 1969 review cycle.
His justification for requesting this was
that a delay to the April-May cycle would
be extremely detrimental to NNERMP.
- Council approved operational request and
authorized funding of Projects Nos.  2--
Progressive Coronary Care, and 4--Continuing
Education for Health Professionals.
The WS staff review of the 02 year
operational request found the progress
reporting so sketchy, the future plans
so nebulous and the financial reporting
so unjustified, that the application was
deemed unreviewable. There was also
considerable discussion about the region's
first year of operational experience
resembling its planning its planning
experience, i.e., concentrating on problem
identification, epidemiology studies, data
analysis, etc., without a clear-cut
operational plan of action.
- 12 -
August, 1970
December, 1970
RMPS staff reviewed a revised 02 operational
request, approved it, and recommended a
site visit to investigate:
1
1)
Whether the region actually has systems
analysis capabilities.
2)
Whether the region's strategy and its
incorporation into the CHP planning
structure was consistent with RMP goals
and also evolving a Regional Medical
Program.
3)
Whether there has been any major
reallocation of regional resources.
Site Visit:
The findings and recommendations were
generally as the following:
The major emphasis on data acquisition
and analysis strategies was reasonable,
however, some of the region's resources
should now be allocated to RMI? activities
which would give the RMP some visibility
in the region.
been used effectively in some instances,
but some plans for utilization, including
a systematic data utilization strategy,
should now be developed. Particular
attention should be paid to problems
encountered in preparing or "marketing"
the data for specific organizations.
addition, the region should broaden the base
of understanding of the data system among
regional groups and perhaps add someone
not integrally involved with the program
and with expertise in preventive medicine
and public health to the Study Committee
of the RAG.  Although in the early plan-
ning days, there was evidence of support
from the Medical School and the State
Health Department, these visitors reported
problems in communication with members of
these institutions. The relationship with
the practicing community was also a qiiesticbn.
The data techniques had
In
- 13 -
e May, 1971
--
August, 1971
October, 1971
- RMPS staff was unable to grasp accom-
plishments of the region and requested
that the National Review Committee and
Council be requested to assess  its
program approach before the region
begins preparation of its three year
application.
- National Advisory Council expressed
concern over the program of the region
and requested a staff assistance visit
to the region.
- Dr. Margulies, Director RMPS, sent a
letter to Dr. Luginbuhl, Dean, College
of Medicine, UVM, expressing concern
over the status of RMP in Vermont, the
portion of RMP resources going for
support of the Experimental Delivery
System and conversely the portion going
toward program development consonant
  with the Mission Statement.
- Mr. Don Danielson is appointed Program
  Coordinator and the effort to rebuild
NNERMP along "traditional" lines is
  started .
- 14 -
Region: Norther New England
Review Cycle: 10/72
-
STAFF OBSERVATIONS
Principal Problems:
The priniciple problems have been this program's failure to:
1)
establish a RAG active in decisionmaking,
2)
develop a clear-cut operational plan of action,
3) coordinate RMP, CHP and MSDS into one management system
acceptable to both Vermont and the Federal Government, and
4)
develop a systematic data utilization strategy for W or
other potential data users.
Principal Accomplishments:
The principal accomplishments have been:
1)
2)
3)
development of the Regional Disease Management approach
development of a data base for health planning, and
publishing of reports in heart, cancer, kidney and
respiratory diseases.
Issues requiring attention of reviewers:
1.
2.
3;
4.
5.
6.
7.
Present and future organizational relationships between RMP,
CHP and EUSDS?
Relationships with the medical school with particular attention
to the Medical Review and Comment provision in the review
process?
Correlation between the activities and the stated program's goals,
objectives and priorities, and determination of which is the
product of what?
Composition of the RAG (CHP a and b?) and its Executive Committee?  j
The RMP plans for future support and/or utilization of the data
base?
Compliance with the CHP review and comment regulations?
The plans for involvement and development of the three counties
in New York State considered a part of this region?
I
-- 1-1 SARP
ReZion: Northern New England RM 00003
RevJcm Cycle: Qctobex 1972
Type of bppl icntion: Trieniijnl
Rat.in,l; : --- 2 82
__-_ ____- ----____--I__
I__---
Re comnien dat ions From
. /fl Review Committee
.- -
Site Visit
/7 Council
I-
-
RECOMi'lENDATLON
The National Review Committee concurred with the reconmendati on of
the August 9-10 site visit teaill. That is, it reconiinended: (a) The
request for triennial status be denied and that the program be
approved for its 04 and 05 years at the level of $850,000 each year;
(b) W5 thin the $850,000 a devel.opmenta1 component in the amount of
10% of the program's previous annualized  direct cost level be awarded;
(c) k site visit be conducted prior to the 05 year to completely
reassess the program.
With continuation request for Project #6, A Program in Kidr,ey Disease,
it is recommended that the presently approved levels of $37,900 and
$25,400 for this project's second arid third years remain. The requested
support levels of $78,740 and $70,000 or these two years should not
be approved.
The Total Request (d.c. )
Request
-_I_.
Year
04
05
06
CRITIQUE
$1,260,789
$1,116,337
$1,031,25 3
Review Coninittee
Re cornmen dation
$850,000
$850,000
  -0 -
Taking into consideration the history of this program with its pre-
occupation on data gathering and efforts to organizationally merge
E4P and CHP, the Committee was favorably pleased with developments
since January when the RMP decided to devote its energy to developing
a viable RPP.
-2 -
The Coininittee recogqized the infancy of- the Ijrograrn reviewed,  the
fact that many elements of the progrr;nl arc> untested, and that or
the most part the MNISPJ-IP is a "paper" organizntjon.
the quality of the materials assenrl~lcd and with an insight to the
management capobi lities o tlie pr:~gra~~i staff, particularily the
new Director, IiIr. Danielson, it is believcd prospects for continued
development are good .
Yet, based on
The following suggestions emanat ecl from tlie review:
.
The goals and priorities need to be further defined and more
explicitly stated.
, The MG needs to expmd its membership to include better
rep res en?. at i on o f you L h , the me d i.ca1I.y under sc rve d ,  ar eawi de
planning agencies, allied health, and represciitativcs from
the ;ordering areas of New Hairip2;l)ire and New Yorlr if it is
established that these areas are indeed appropriate territories
of the XNlXIP. Consideration should also be given to the
appropriateness of the economi c and local political iiiterest
having representation. -
. The RAG should considcr establishing a subcomrnittee structure
aligned with goals, once goals have been developed,
, The composition of the disease management comrnittees, ad hoc
groups, and technical review committees should be examined
closely to insure appropriate representation. Also, iiieasures
should be taken to aysurc that these groups are suppo~-l:ive of
the program's evaluation plan.
.
The disease management coirimi ttees should have bylaws, or another
similar management tool, to a1 ign their functional operation
plans with the total program,
I Consideration should be given to developing management committees
for non-disease areas of interest t-o Pdzl) such as cominunity health.
. The evaluation scheme should be reexamined to give further
assurance that the RAG and program staff each understands its
respective roles in review, evaluation, and feedback.
should minimize potential conflicts. Also, organizational changes
should be made coordinating all prograrr, staff performing any
evaluation with the Director for Evaluation.
The vacant program staff positions should be filled with persons
that will provide the program with a broader range of professional
Th-is
t
.
c
-3-
and discfpline competence. Nursing, all.%c?cl health, hea1t:h system
developnicnt, and comunity' organ:i.zati.on are specific suggestions .
The 1)ro~r,rni!i.5~1ould 100k at a1 1 tlicir proposed projects and relate
coimon o1,jcctivcs so that the rclsocirces Ilrive a greatcr potential
for effecting constructive change of the Iicalt-11 care system.
a The PXFj still needs to assume some continued responsililities for
rnakjng the rsgion aiware of avaiidb3e data, and to assist in the
developnicnt of a data uti lizatiori strategy.
A formal policy OR continued sul)port shoulrl be established.
. The survci lla-~ce and monitoring devices or Frojecls should iiiclude
a liicthnd Lor preniaturely phas ing out unsuccessful 01: inef Fective
projects.
It was emphasjzed that tlte transitior the MNEK?P i!; presently going
through is not the tradi tional projcct-to-progLnrs trznsition most
RXPs experier:ce, but one of changiiip from an orgaii zation priiiiarily
Inierestcd in data collection to one rrow in concert with the presci>t
SPS mission sta~ement ID fact, tl-rc fer7 categor-ical activities of
the program have a comprehensive flair with clefini_te considerations
for broader problems.
Dr, Luginbuhl of the University of: Ve?-mont was riot presznt during these
deliberations.
Component
___.-
hslea
Pediatric Pulmonary
Other
TOTAL DIRECT COSTS
Current Annualized
Level 03 Year
$ 397,578
328,389
725,967
$ 462,368
114, G17
683 304
( 78,740
( 1
c 1
     I
     1
_--
(
1,260,783
nrn i fl1
w--~- I---
ynar
__.
$ 500,000
114,617
416,636
i
I
i
I
10%
~
(37,900) (25,400)
850,000 j s50,000
Region Rochester
. Review Cvcle 10/72
- f7 SARP
Type.of Application:
Anniversary before
Triennium
Rating 269
Recommendations From
-
./ X/ Review Comniittee
-
- -
/ 1 Council
-
/ / Site Visit
-
e
RECOMMENDATION: The Committee agreed with the site visitors in
recommending an approved level of $935,000  for the Rochester RMP's
05 operational year. In arriving at this level it was necessary to
balance the numerous and promising changes made during the year
against the considerable work yet to be done.
$900,000, plus $35,000 earmarked for the kidney program, was considered
appropriate because it would represent an increase over the current
approved level and a moral encouragement to the RegTon and would
permit the RRFP a sufficient allocation for program staffing, develop-
mental and planning activities, as well as an increase in project
activities beyond those initiated during the 04 extension period.
The base level of
Requested Recommended
$1,035,000 $935,000
Critique - The Committee agreed with the site visit team that over
the last year the Rochester Regional Medical Program has seen dramatic
organizational, functional, and programmatic changes, particularly:
1.
The resignation of the previous Coordinator and the hiring of
Dr. Peter Mott.
2,
The dissolution of the previous large program staff in terms
of functions and people and the beginnings of the new.
3.
The change in the character of the program with the termination
of sixteen ongoing projects and the initiation of new directions
in concert with newly-established goals.
4. The change in RAG composition, interest, and responsibility.
-2-
5. The closer working arrangements with the CIlP (b) agency. '
Time has not yet permitted the Region to complete the change process,
however, and many areas still need a substantial amount of work;
especially:
1. The further development of goals, short-term objectives, and
priority setting mechanisms,
2. Completion of the organization of RAG committees and delineation
  of their functions, with an awareness of the need for minority
  representation. There is a necessity too, which the Region
  recognizes, to diminish the power of the Executive Committee and
  increase the responsibilities of the UG. '
3. Development of program staff as a high program priority. There
  was the suggestion that the Region may wish to increase program
  staff over that now projected.
4. The immediate development of by-laws and procedures, with the
proviso that these documents-must he furnished to RMPS staff
for review,  and that the January 1st award be contingent on their
completion. It was stressed that there must be a clear definition
of the differing roles of program staff and RAG.
The Committee agreed, too, that the numerous other points of advice
the site visitors relayed to the Region (which are contained in the
site visit report) be formalized and relayed to the Region after
Council consideration.
EOB / DOD
9/26/72
..
COMI'OKENT A!! @ INANCIAL SUAWIARY
1 Current Annualized Level
ANNIVERSARY APPLICATION ' BEF0.M TRIENNIUM
" Request For
Con;! one n t
Year
I
PROGRQl STAFF
COXTPuKTS
IjEVELOP3:ENTAL COMPONENT
.
' OPEtL'ITIONAL PROJECTS
PIsdiatric Pulmonary
Other
o TOTAL DIRECT COSTS
COUhrCIL-UPROVED LEVEL
$ 259,855
--
e-
598,951
I
I.
$ 8581806 .
I
$ 871,308
05 Year
$ 415,000
   -0- .
-0-
620 , 000
( 35,000 )
( -0- 1
( ( -0- 1
      1
(, . -0-
( -0- .. )
..
$1,035,000
Requesti5Funding For
Year
/-/ SARP /x/ Review Comnit?
..
._
,.
-
$935 , 000 combined
..
' . (35,000 3
(
I
i
I I'
$935,000
$35,000 for the Regional Kidney Program.
REGION: Rochester OPERATIONS BRANCH:
NUMBER: RPI 00025 Chief: Frank Nash
COORDINATOR: Peter Mott, M.D. Staff for RMP: Eileen Faatz
LAST RATING: WC':
h I_
TYPE OF APPLICATION:
3rd Year Regional Office Representative:
/I Triennial /I Triennial Robert Shaw
2nd Year Management Survey (Date) :
Triennial &m Other
Anniversary prior   Conducted: November 1970
to Triennial-05          or
Operational year    Scheduled :
Last Site Visit: June 1971
(List Dates, Chairman, Other CommiUeelCouncil Members, Consultants)
Alexander M. Schmidt, M.D., Dean, Abraham Lincoln School of Medicine,
Robert Lawton, Deputy Director, Tri-State RMP - Consultant
Richard Cross, M.D., Chairplan of NJRMP RAG - Consultant
Richard Haglund, Associate Coordinator for Administration,  Intermountain RMP -
Staff Visits in Last 12 Months:
University of Illinois - Review Committee Member
e
Consultant
(List Date and Purpose)
October 1971 - Dr. Orbison (Dean, Med. Sch.) and Dr. Saward (Assoc. Dean Extra-
February 1972 - Dr. Pahl, Mr. Peterson, Mr, Simonds, Mr. Shaw, Ms. Faatz -
mural Affairs) visit Rockville to discuss RRMP problems with Dr. Margulies.
to review the changes/progress made since the June 1971 site visit, discuss
the Rochester situation with all key people involved,  and recommend
necessary changes for the Region in the future.
and site visit .
June 1972 - Ms. Faatz - review recent progress and,discuss upcoming application
Recent events occurring in geographic area of Region that are affecting
RMP program:
All year. Continuing conflict between Blue-Cross sponsored pre-paid group
practice plan and many area physicians who oppose the idea - with Blue
  Cross the victor.
a Rochester health authority.
and concomitant increase in close working relationships between CHP and
Fall 1971, Unsuccessful attempt by CHP (b) agency and others to establish
ng 1972.
BDplopment of Assistant Director of CHP (b) agency
RMP.
June 1972,  Tropical Storm Agnes wreaks havoc on the Corning-Elmira area -
both cities inundated - possibly two of Cour community hospitals beyond
repair and many private physicians' offices wiped out.  Since this area
has been rife with duplication and gaps in health delivery system, there
-~JQ+= +ha nnaaihllitv for some restructuring of the system in the
In New'York State And Detail of
Rochester RMP
.._, . ,.
-3-
Region: RnrhPatPr
Review Cycle: 10/72
DEMOGRAPHIC INFORMATION
o
t
The Rochester Regional Medical Program is composed of ten counties
in the western portion of New York State.
by the Lakes Area RMP (Buffalo) and on the east by the Central New
York REP (Syracuse), on the north by Lake Ontario, and the south by
Pennsylvania.
It is bordered on the west
The city of Rochester is the third largest in New York and is  the
industrial, commercial, educational, and cultural center of the area
covered by the RRMP.  More than half the city's people earn their
livings in manufacturing industries.  Eastman Kodak and the Xerox
Corporation employ large numbers.  The second largest city in the RRMP
area is Elmira, a manufacturing center in the south-central part  of
the State. The remainder of the Region can be characterized as small
townjrural, including the beautiful Finger Lakes area, and has fruit
growing, truck gardens, dairy farms, and vineyards.
The approximate population served by the Region is 1.2 million.
statistically the population of the ten-county area is 66 percent urban,
this is a result of the large urban population in the two most populous
counties of the area: Monroe County (Rochester) and Chemung County
(Elmira). The other eight counties in the Rochester Region are over-
whelmingly rural. The non-white population of the area comprises 5.5
percent of the total, with the largest concentration in the city of
Rochester where 17.5 percent of the population (52,115) is non-white.
Many Blacks and Puerto Ricans in Rochester, though, feel that the
census figures are considerably lower than the actual population figures.
The RRMP area contains 271 registered migrant camps - one-third of the
New York State total - and during the peak season there are somewhere
between 12-15,000 migrants in these camps, mostly Blacks.  The median
age of the area is approximetely 28 years with eleven percent of the
population over 65.  There is a generalized out-migration in the age
ranges 20-35 and an in-migration at ages under 20 and over 65.
average family income in the area is somewhat lower than that of  the
rest of New York State and the percentage of people eligible for public
assistance is higher.
There are 27 general acute care hospitals4 in the Region with a total of
4,153 beds. Of these, seven hospitals and 50 percent of the total beds
are in the Monroe County (Rochester) area. Elmira has two hospitals
of about 250 beds each.
one community hospital each.
registered MDs and 10,435 RNs, with 70 percent of the physicians and
50 percent of the nurses in Monroe County.
shows, though,  that in the ten counties there are only 800 active, non-
institutional primary care physicians (GP, internal medicine, pediatricians,
and OB/GYN) under 65 years of age.
The health education institutions in the area include the University of
Rochester School of Medicine and Dentistry, eight professional nursing
schools and three for practical nurse training, one cytotechnology and
six radiologic technology programs,  as well as two hospital-based programs
for medical technology.
Although
The
The remaining eight counties contain at least
The Region houses 1,798 licensed and
Appendix A to the RAG Report
Current. Annualized Level
' Rcqucst For
Kidney
--- __L
Rcqucst Funding Foi.
?1S/C3
Pediatric Pull7!023ry
u-
I
1iCTAL DIRECT COSTS
C3iiXCI i -X??R3VE3 LEVEL
* Only Coun
' Year
$ 259,855
598,951
c
$ 858,806
$ 871,308
1 approval for the 05 year j:
$ 415',000
-0-
-0 -
620,000
' ( 35,000
( 201,500
I
( I -0-
(. .
-0-
1
$1,035,000
*
Yc3r
I
I
I'
$35,000 for the Regional Kidney Program.
-.
.
-7-
Region: Rochest er
Review Cycle: 10/72
HISTORICAL PROGRAM PROFILE OF ReGION
The initial planning period for the Rochester Regional Medical Program
began in October 1966.  By that time Dr. Ralph Parker, the former Medical
Director of the Rochester Regional Hospital Council, had been appointed
Coordinator and Mr. Frank Hamlin, past President of the Hospital Council,
had been appointed Chairman of the Regional Advisory Group.  These
appointments were considered particularly auspicious since the Hospital
Council is an organization which practiced regionalization well in
advance of the concept's embodiment in PL 89-239.
Council were impressed with the history of cooperation among the components
of the medical community in the Region.
When the RRMP applied for operational status in early 1968, staff and
national reviewers emphasized Dr. Parker's difficulty in recruiting
full-time staff (haiwas the only full-time person for the first nine
months) and the lack of administrative personnel involved in the program.
Despite this problem, site visitors and CoPrmittee/Council reviewers
thought the Region to be well-established with good university and
community support, and ready to inaugurate an operational program.
Since each of the five project proposals in the original operational
application, however, addressed some aspect of heart disease, the
reviewers indicated that the Region needed to give attention to the
development of a balanced program.
The Committee and
Over the next couple years as project proposals were reviewed by
Committee and Council and as continuation requests were assessed by
RMPS staff, the initial optimism about this Region began to wane.
fact, uneven progress in the BRMP prompted a staff reduction of the 02
year commitment.  There appeared to be a growing concentration of
activities in Rochester (and the University Medical Center in particular)
at the expense of peripheral involvement.  The laissez-faire administra-
tion of the Coordinator, the low rate of expenditures, and the continued
dearth of full-time professional staff were seen as problems as well.
The Rochester RMP appeared to lack influence on the health care system.
These growing concerns spurred numerous visits to the Region.
The first was a site'visit in April 1970.  In general, the site team
found that many of the individual projects were strong and many were
promoting regionalization.
was beset by the suspected difficulties.
administrative deficits of the Coordinator and the passive character of
the Regional Advisory Group which had relegated problems regarding program
and priorities to others.  This visit and a subsequent management assess-
ment visit in November 1970 resulted in recommendations to the Region .
that the RAG assume its responsibilities for direction and that the
program hire a strong Deputy for the Coordinator and provide administrative
assistance to the program.
The Spring of 1971 saw the submission by the RRMP of a Triennial
Application which exhibited the same chronic problem areas, and another
site visit was scheduled for June.
was merely a replay of that in 1970, the site visitors were optimistic
about the recent creation of an interested and active Executive Committee
of the RAG, and in this Committee the visitors saw a possible hope for
In
The Regional Medical Program itself, however,
Of prime importance were the
Although in many ways the 1971 visit
bringing the RRMP out of the doldrums.  The program still remained, though,
a conglomeration of individual projects, and the primary problems identi-
fied continued to be:
1.
Problems in program staffing and lack of administrative leadership.
2.
Lack of integration of goals and objectives into a coordinated
program approach with attendant priorities for determining
program activities.
3. The inadequate review and decisionmaking process and the failure
of the RAG to assume its responsibilities.
The many concerns of the site visitors were relayed clearly to the Region
and emphasized by a recommendation to fund RRMP for only one additional
year, and at a reduced level.  The Region was told that there would be
a follow-up site visit in a year to check progress.
Within a few months of the site visit Dr. Orbison (Dean of the Medical
School) and Dr. Saward (Associate Dean for Extramural Affairs) visited
Dr. Margulies in Rockville for a frank disaussion of the Region's problems.
For some time after this, the Region appeared to continue business as
usual, stretching its 04 year award to cover all approved projects, which
by this time numbered 17, primarily categorical and dominated by nurses'  ,
and physicians' continuing education activities. Then, on January 1, 1972,
Dr. Parker's resignation was announced and interim direction was assumed
by Mr. Jonathan Rudolph, a young man who had come with the program only
a few months before as assistant to the Coordinator.
.-
-. ,
-.e- .
. I. . ,.
. .!
.-
.....
..
' -.s.. "
A rather large team of RMPS staff members (five) visited Rochester in late
February 1972 and were rather disappointed to find that other than Dr.
Parker's resignation and the search for a new Coordinator,  the situation
was as stagnant as it had been for the last two years,
spent discussing necessary changes with the numerous people involved with
the program.  Although the messages delivered by RMPS staff at that time
were not new, perhaps the degree of receptivity was, because after the
February visit, a number of things happened in rather quick succession
(including the appointment of a new Coordinator).  These are described
briefly on the next page under Principal Accomplishments.
Meanwhile, an RMF'S administrative decision to implement a three-cycle review
year, caused Rochester's 04 year to be extended four months from 8/31 to
12/31/72.  RRMP was asked to justify an award of $266,672 (a pro-ration
of the present level of funding) with the understanding that during the
four-month extension new activities could be implemented with RMPS staff
approval,
without approval of the National Advisory Council.
submitted an application for $266,672 for the four-month extension.
for program staff activities and thirteen projects was requested.
thirteen projects, ten were completely new and evidenced a new trend in
Rochester, away from continuing education and categorical activities.
the strength of the major programmatic, functional, and organizational.
changes which had occurred in the Region in the last months, and on the
basis of the new look represented by these projects, Dr. Margulies and
RMPS staff gave Rochester the authority and funds to implement these
activities for four months,
Two days were
These activities, though, could not be continued beyond 12/31/72
In June, the RRMP
Support
Of the
   On
-9-
Region: Rochester RMP
Review Cycle: 10/72
STAFF OBSERVATIONS
Principal Problems:
Main problem is the insufficient time since Dr. Mott became Director,
for all the necessary restructuring:
a. Essentially, at this point, the Director and the Assistant
Director are running the program by themselves, a rather
difficult task.
b.
The RAG bylaws and other procedures need revision.
c. The RAG committee membership (selected before the new RAG
members were appointed) needs to include minorities and
other new members.
d. In filling future RAG vacancies, the program should consider
whether the present composition of seven women on the 36-
member group represents adequate sexual parity.
e.
The RAG must continue to take on increasing responsibility
and relieve the Executive Cornittee.
Principal Accomplishments:
In this last year there have been considerable organizational, func-
tional, and programmatic changes:
a. New Director - Dr. Peter Mott
b.
Changed composition of RAG to increase minority and consumer
representation, and election of a new RAG Chairman (the second
in the Region's history).
6. Establishment of goals, termination of old program, and
initiation of new directions.
d.
Closer working arrangements with CHP and development of
relationships with groups not formerly involved,  such as
inner-city and migrant organizations.
Plans for complete reorganization and reorientation of program
staff.
e.
Issues requiring attention of reviewers:
a.
Goals - Does regional experience since the formulation of
goals suggest that they should be modified?
0
b. Is the review process adequate?
-IO-
STAFF OBSERVATIONS (Con t hued)
Issues requiring attention of reviewers (continued).
c.
Are the Region's ideas about the organization and functions of
the new program staff reasonable, and are recruitment activities
meeting with success? !
d.
Is the proposed evaluation process for individual projects going
to be handled in a coordinated fashion?
position for evaluator of program staff.)
(There is no proposed
e.
With the change in program direction, is the previous base of
community support being maintained, or is a new constituency
being developed, or both?
f.
How has the University/RRMP relationship withstood the recent
program changes?
.. ,
..
. 1!
.... ...
Page 2 - Review Committee - Texas RM 00007 '
advisory groups appeared practical at this time. The visitors also
believed the proposed activities reflect peripheral involvement.
Expansion of more allied health representation in the decisionmaking
groups has been limited, but sincere beginning efforts were noted.
Of major concern to the visitorss progress in minority involvement
on the program staff and in the decisionmaking process has been slow.
However, attention was drawn to RMPT's written plan for recruiting
minority program staff.  The site visit team believed the application
request to be modest for what RMPT proposed doing and recommended
approval for the period of time and in the amount reauested. The
<'
visitors also went on record recommending a continued rating of "A"
for RMPT.
he Review.
       Committee expressed concern that the RAG is still
dominated by providers of health services, and noted only minimal
change in minority involvement.
the projects seemed to be self-serving to producers of services.
It was also believed that many of
was expressed that a program which has to deal with the kindJof
sues in Texas, particularly Blacks, Mexican-Americans, migrants, etc. ,
n only do so with the kind of experience they can get from people
are involved with these problems.
The Committee noted the relatively modest request submitted by the
RMPT and wondered Ljhy the program wasn't bigger in view of the size
                         On the other hand,
e reviewers were not impressed by many of the proposed projects
and questioned hcw much impact they would have on the health care
del i very sys tem .
The Committee recognized some progress in Texas and the keen ability
         However, it was believed that the Region should
the state and the magnitude of the problems.
the Coordinator.
minorities and consumers, and sharpen its focus
rs. Flood were not'present at the discussion of this
.I
B:DOD 9/ 291 72
Region:
COMPONENT AND FINANCIAL SUMMARY
   TRIENNIAL APPLICATION
R
Committee Recommendation for
Current Annualized
Level 04 Year
L -Approve<
2nd year
  Counc
1st year
nnial
3rd year
;t for Tri
2nd year
Requ
t
Is t year
Component
$ , 877,970
--
$ 754,129
$ 579,999
138,280
90,000
[ $1 58,000
$190,000)
$21 0,000;
225,000
1,297,538
160,000
200,001
EVELOPMENTAL COMPONENT
PERATIONAL PROJECTS
1 ,264,341
1,317,47;
771,761
($309,640:
( 337,15j'
  --- 1
: $337 I1 57:
(294,640)
m,
hs/ea
Pediatric Pulmonary
Other
$2,400,508
~1,900,00
$2 $1 00,oo
$2,300,0(
$2,178,470
$2,34023
$1,580,040
TAL DIRECT COSTS
UNCIL RECOMMENDED LEVEL
..
         REPORT
           OF
Rl3GIONAL MEDICAL PROGRAM OF TEXAS
        SITE VISIT
August 1-2, 1972, Austin, Texas
BY
REGIONAL MEDICAL PROGRAMS SERVICE
CONJXNTS
Pa;?
I . SITEVISIT"4 .................... 1
  A . Consultants .................... 1
  B . RMPSStaff .................... 1
C . DHEW VI Regional Staff .............. 2
I1 . REGIONAL MEDIC& F'RCXBAM REPRESENTATrvEs AND OTHERS . . 2
A . Executive Corrmittee and Regional Advisory Group . . 2
B . Grantee ...................... 4
c . Pro@;ramStaff ................... 4
D . Others ...................... 5
I11 . BACKGROUND INEKlRMATION ................ 7
A . Purpose of the Visit ............... 7
B . Pre-Site Visit Meeting .............. 9
IV . CONCWSIONS. GESJERAL IMPFESSIONS AND RECOIvlMENDATlON . . 10
V . WIEW DETAIL3 .................... 11
  A . Performance .................... l!
B . Process ...................... 15
c . ProgramPro~sal ................. 21
ATI'ACHMENTS
I . Supplemental Coments ................. 25
Recruiting Plan 1973-74 ................ 23
11 .
I11 . Non-RMpTF'unding ................... 33
-1-
I. SITE VlSIT TEN!
A. Consultants
Miss Elizabeth E. Kerr (Chairman)
Review Cormnittee Member
Director, Program in Health Occupations Education
Division of Health Affairs
University of Iowa
Iowa City, Iowa
Ws. Mariel S. Morgan
National Advisory Council Member
Chief Medical Technologist
Presbyterian Hospital
Albuquerque, New Mexico
- 1/ George E. Miller, M.D.
(fomner member of Review Cormittee)
Director of Research in Medical Education
College of Medicine
University of Illinois
Chicago, Illinois
- 1/ Alf'red Popma, M.D.
(former Ember of National Advisory Couricil and past
Director of the Mountain States RMP)
Boise, Idaho
John A. Lowe, M.D.
Director
South Dakota Regional Medical Program
Vermillion, South Dakota
B. RMPS Staff
p-
- l/Miehael J. Posta
Acting Chief
Mid-Continent Operations Eranch
Division of Operations and Development
Joseph de la Puente
Acting Deputy Director
Office of Planning and Evaluation
JirrnTy L. Roberts, M.D.
Health Consultant
Division of Professional and Technical Development
- l/Participated in the previous site visit June 1971 - chaired by Dr. Ifiiller
Luther J. Says, Jr.
Operations Officer
Mid-Continent Operations Branch
Division of Operations and Developmnt
C.
DHEW VI Regional Office Staff
David Eubanks
Program Representative
Dallas, Teras
A.
Executive Committee and Regional Advisory Group
- 2/ Richard T. Eastwood, Ph.D., Cham
Director, Houston Medical Center
  Houston
- 2/ Arthur H. Dilly
University of Texas System
(Chairman of Capital Area Planning Council - CHP(b)
Austin
R0bert.K. Bing, Ed.D.
President, Occupational Therapy Association
University of Texas Medical Branch
Galveston
Levi V. Perry, M.D.
(Coronary Care Project)
Private Practice
Houston
N. C. Hightower, M.D.
Past Chairman, RAG
Chairman of Nominating Comittee
Scott and White Clinic
Temple
George J. Race, M.D.
Chairman, Technical Advisory Committees
Baylor University Medical Center
Dallas
- 2/ Elizabeth Jones, R.N.
Chairman, Continuing Education Committee
Associate Dean, University of Texas School of Nursing
Houston
!-
i- ;;
t.
tt
- 2/Executive Committee Members
I
-3-
Edward L. Baker
Texas Pharmaceutical Association
Dallas
- 2/ S. R. Greenwood
Chairman, Availability Cormittee
Member, Program Development Codttee
Temple National Bank
Temple
- 2/ Jams. E. Bauerle, D.D.S.
Texas Dental Associafiion
  san Antonio
Martha N. Bobbitt, R.N..
Texas Nurses Association
Amarillo
Wlrton G. Hackney
Executive Director, CHP (a>
Austin
Billye Brown, R.N.
Member, Evaluation Cormittee
Associate Dean, University of Texas School of Nursing
Austin
Vance Terrell, M.D.
Program Developmnt Cormittee
Private Practice
Stephenville
V. J. Bel& (ex officio)
Director, V.A.
Temple
Charles Corley
President, Texas Society of Medical Technologists
Abilene
John M. Smith, Jr., M.D.
Texas Medical Association
Private Practice
san Antonio
- 2/ Grover Bynum, M.D.
Vice Chairman, Evaluation Coattee
  Private Practice
  Austin
- 2/ Executive Corranittee Members
-4-
- 2/ J. G. Cigarroa, M.D.
Private Practice
Laredo
B. Grantee
Charles A, LeMaistre, M.D.
.Chancellor
University of Texas System
Austin
C.
R. L. Anderson
Comptroller
University of Texas System
Austin
Charles B. McCall, M.D.
coordinator
Stanley Burnham, D.Ed.
Director, Professional and Cornunity Programs
Louise Miller, B.A.
Chief, Administrative Services
David K. Ferguson, M.S.-
Deputy Coordinator
Robert 0. Humble, M.A.
Deputy Director for Cornunity Programs
kverly Drawe, M.J.
Chief, Information Service
Thomas V. Sander, B.B.A.
Accountant '
Hubert Reese
Data Management Specidlist
John Donbroski'
Program Development
Linda Johnson
Technical. Information Specidlist
- 2/ Executive Cormittee Member
Program Staff
.. .
.... .
'_. I. ,
, :, .., .
. .l .- .
, .-_
. ._ .
.. .
'<..i;'
-5-
John G. Dailey
Director of Education Prograros (effective 9/1/72)
Central'Office Based Operations Officers
Robert L. Anderson, M.B.A.
Gerald Mussey, M.Ed. (ENS Specialist)
Billy D. Gwartney, M.B.A.
Subregional Representatives
Sumel D. Richards, Ph.D.             #2 Lubbock
Maria Elena Flood                 #3 El Paso
Jarnes C. Karsch, M.S.              #4 Abilene
Grady Faulk, Jr., M.Ed.            #7 Tyler
N. Don Macon #8 Houston
Sister Marion Strohmeyer, R.N., M.P.H.
#10 Harlingen
D. Others
Floyd Norman, M.D.
Assistant Regional Director for Health and Scientific Affairs
DHEW Reeon VI
Dallas
Garabed Eknoyan, M.D.
Ehylor College of Medicine
(Renal. Disease Project, Director)
Forrest Ward, Ph.D.
coordinating Board
Texas College and University System
Austin
Lincoln Williston
Executive Director
Texas Medical Association
Austin
Ray Hurst
Texas Hospital Association
(TRMP Health Careers and Electrical Safety Projects)
Austin
Lewls A. Leavitt, M.D.
Wlor College of Medicine
(TRMP Rehabilitation Projects)
-6-
Robert Mickey
Office of Medical Health Manpower
Texas Medical Association
Frederick Fleming
Executive Director
Houston-Galveston Planning Conmission - CHP (a)
Houston
Velma T. Faulk, Ph.D.
Project DFrector
GRO Projects 54 A-E
Jo Ann Hinson
GRO
Verma Hancock
GRO
-7-
111. BACKGROUND INFORMATION
A.
Purp ose of the Site Visit
1.  To assess program progress, processes and proposed
  Triennial Application.
constituted mor factors taken into account by the
  site visit team.
The RMPS Review Criteria
2.
As recomnded by the August 1971 National Advisory
Council the site visit team was charged to provide
specific infomtion on progress in the following
areas which were enumerated in RMPS' Advice Letter of
August 11, 1971 to RMPT.
a.
"The RMP of Texas needs to establish priorities
under its new program direction.  Although the
review system appears to be satisfactory at the
present time, reviewers felt that it cannot be    .
f'ully tested until priorities itre established.
Only then can the Region expect to concentrate on
funding patterns which relate to the real health
needs of the Region.
b.
"The subregional staff members need more assistance
and support from the central staff and RAG members
in the development of specific programatic activities.
Ucal advisory groups, either in cor@mction with
CHP(b) agencies or under the auspices of RMP of Texas,
would also further the enhancement of progressive
action in the subregional areas.
"The approval of the developmental component request
should also assist the Region in the further development
of mom peripheral involvemnt.
e.
"More representation from allied health groups is
needed on the major policy making bodies, especially
the Executive Cormittee and the Regional Advisory
Group.  Reviewers felt that those who are now
serving on task forces and conanittees could/should
be considered for election into policy making positions
and continue to use the subcommittee structure as a
"training ground" for additional nonphysician health
professionals and consuITy?'I?s.
-8-
d.
"Similarly, additional minority group mrnbers shr,ul,l
be included on the RAG and Executive Cormittee.
Reviewers noted the cormitmnt of FOP of Texas to
the health care needs of Dhe Blacks and Mexfcar-
American populations which together comprise 30%
of the population of the Region.  Althou& there
is representation f'rom professional members on these
groups, reviewers urge the Program to consider the
nonprofessional's involvement in proposed activities
soon enough for them to be constructive in their
participation.
in the subregions where activities will be planned
for ghetto residents and migrant workers.  By
utilizing minority groups, especially those with
bilingual talents, at the local level, a mre
extended RW orientation could be offered whicii
could provide a source for better selection or those
who could be considered for election into the
Regional Advisory Group o
"It was noted that there were no minority representatives
on four of the mJor subcommittees of the RAG or any
serving in professiowl positions of Core staff.
Program should strive to improve these weaknesses.
Perhaps employment opportunity on the Core stzff
might be improved by inserting a recruitment swestion
into the operational objectives of the Administrative
Service Division (note page 68 of the Triennial
Application) .
"In giving attention to the assessment of regional
needs and problems, some reviewers felt that the
process seemed to be more of a central office academic
review rather than peripheral involvement and inp7-A--
a theoretical rather than przgnEtic approach.
agreed that the Core staff theoreticians are most
capable but mly need to have increased input r'rcm tt!e
emerging subregional organizations. These statements
might be considered as a corollary to item #2 found
above.
This would seem appropriate, especially
The
e.
iievlcders
f.
"Reviewers felt that overall Program accomplishments
to date have been relatively modest.
that some projects, such as the Cancer Registry,
have not progressed as rapidly as others.
It was ncted
   The
-9-
relatively high f'unding priority given to the
Registry activities was most perplexing to the
reviewers.
care program was cited as having had a real impact on
the health delivery system.
per se, were not discussed by the reviewers other
than how they were ranked for funding consideration.
It is assumed that this apparent short-coming will
be rectified when short-term objectives and program
priorities become finalized by the Regional Advisory
Group. ''
On the mare positive side, the corcmuy
Other project activities,
B. Fre-Site Visit Meeting
1.
As part of the verification of' RMPT's review process,
Messrs. Posta and Says visited and interviewed
representatives of the CHPb) , two CHP(b)  Planning
Comnissions and sponsors of four projects (2 approved and
2 disapproved) July 28 & 31, 1971 in Houston and Austin.
On this phase of the verification, they found RMET in
compliance with the RMF'S' Review Process Requirements and
Standards.
2.  The site visit team met the evening of August 31, 1972
  to review the purpose of the site visit as outlined
  above.  At the suggestion of Dr. Miller (chairman of the
June, 1971 site visit), it was weed that most of the
  discussions should be directed toward the concerns of
  the August, 1971 Council; and that little would be gained
  in rediscovering most of what was learned during the
  previous site visit.  For these reasons RMFT agreed to
  last minute changes in the agenda to allow adequate time
  to get at the major issues during the first day.  Also,
  for this reason som RAG and Cormittee members originally
  scheduled to attend during the second day were not present.
However, RAG and Cormittee representatives present were
  satisfactory to the conduct of the visit.
Other issues to be explored as presented by RMPS staff were:
-UtiUz&ion of consmr groups in establishing
Objectives and priorities.
--Relationships with CHFCa)
              and Cb) agencies in
planning and project development; particularly since
only 5 of 21 (b) agencies have been funded and
TRMP local advisory groups have not be activated.
- 10 -
---Why are no planning and/or feasibility studies
included in the application?
---What is the current status of emergency mdical
services and what is ?rRMP's role?
-4f those projects whei-e ?RMp support is to be
phased out in the 04 year, how many Will continue?
--Proposed budgets indicate only minimal support
f'rm other sources.  If successful, what are the
assurances of their continuation after cessation
of 'I" support?
---In the long range planning, what will the relation-
ships be between GRO projects and Area Health Rep source
Information Centers?
---With regad to GRO projects, what are the cost-sharing
services other than education?
---Explore rationale of f'unding of the many new projects
                                                       &' -'<
for one year only, as well as unspecified growth funding~,'*..;~ - -;
in the 06 & 07 years.
\-
IV.
CONCLUSIONS, GENEXG 7MpRESSIONS AND RECOMMENDATION
The Regional Medical Program of Texas has developed priorities
which were the basis for the development of the proposed three
year program. Objectives and priorities should be further developed
in measurable terms; hence the critical need for rapid employment of
a qualified evaluator,
support and assistance to the subregions.  Progress and projected
staffing of subregions is good.
and being, responsive to local CHP b) planning groups rather than
formation of local RMPT advisory &roups appears practical at "vis
time.  The proposed programs reflect peripheral irivolvemnt.
Expansion of more allied health representation in the decision-
making grou~s has been Umited, but sincere beginning efforts were
noted, however.
also been slow in the transition md this issue must be addressed mcire
rapidly.
shoultl now be tested,
do and approval is recmnded for the period of tine and in the
amounts requested.
record recommending a continued rating of A for RMPT.
There was new evidence of central off-lce
Their plan of cooperation with
Progress in minority interest involvement has
Evidence of overall progress is clear and proposed action
The request is modest for what they wmt to
The site visitors also strongly wished to go on
- 11 -
Supplemental docwnts requested from RMPT (appended to this
report) are as follows:  1) a discussion of program elemnts
relative to 1974 and 1975 plans for new activities; 2) Recruitment
Plan 1973-74; and 3) Non-WPT Project Funding.
At the request of RMPS staff RMPT also provided supplement;_il
information on the renal disease project with a cover letter
dated August 14, 1972.
A. Performance
1. Goals, Objectives and Priorities
This was one of the major concerns of the previous site
visitors as stated in the advice letter.
and short-term objectives have since been established.
Priorities have been delineated and coincide with both
RMPT and national objectives.
The objectives ils evidenced by testimony during the site
visit are understood by all those participating in the
process.  The paucity of measurable objectives inherent in
the priority statements, however, was noted.  The Chairman
of the RAG, the Coordinator and his Deputy shared this
concern and intend to develop measures of effectiveness.
A Chief of Program Development and Evaluation is to be
employed and more expert consultation will be sought in
strengthening the E3aluation Cormittee.
It is clew that the subreglonal offices axe now providing
more input into the system.
subregional office representatives.
advisability of developing local advisory groups was
discussed and the concensus was that CHP(b)
oriented planning councils are being developed and that
potential activities of local RPIP  advisory bodies would
constitute wasteful dupllcation of effort.  This would
also be detr-ntal to codty efforts, particularly
in Texas, because not all of the potentially effective,
articulate, and well-infomd consuITIE3rs have been introduced
to the system.  Perhaps RMPT could assist in developing
more expertise in council consumer participation, as
suggested by om of the subregional representatives.
Specific long-term
This was supported by all
The issue of the
       consmr
- 12 -
A joint effort to train consumers in council participation
is presently being supported by Migrant Health and RMPS.
In addition, five contracts for developing an environment
for Chicano Health Consmr Participation are being supported
by RMPS in Texas, Arizona, Colorado, and California in the
hope to alleviate this need for effective council
participation.  Mrs. Maria Elena Flood, subregional
representative in the El Paso area has been appointed by
RMPT to spearhead the latter in Texas.
The site visitors believe some real progress has been made
toward establlshing priorities under the EW program
directions.  The stated priorities, when appropriate, have
been followed in the funding of operational activities.
Priorities are addressed to regional needs and reflect the
possibility and lnstmntality for continuous development
and improvement.  While their objectives and priorities
reflect the result of a study process, there is little
evidence that other than "studied opinions" entered into
the priority determination mechanism.
2. Accomplishments and Implementation
There is evidence of continued accomplishnent stimulated
by Program Staf'f and RAG Committees.
support of a planning effort towards a comprehensive
proposaL addressed to renal disease has resulted in a promising
activity.  If this program is successfUlly funded and
implemented, it will bring to Texas one of the first
efforts addressed to comprehensive care of a particular patient
group on a regional basis.
Health Education Resource Programs (AHEFP) are other
examples of likely successrul activities.
For example, the
Project GRO and their Area
While "traditional" projects had been supported in previous
years, these are now being terminated.
of projects, as presented, promise to deliver improved
accessibility.
wider application of howledge is not yet visible.
A new generation
The thrust of these activities 'coward the
Quality of care has not yet been addressed with emphasis,
particularly in terms of providing opportunities to measure
these objectives.
. -.
...
. -.
..
1 . .:.
,.
.. , ..
,. .
. . .,.
.-..-:.,
- 13 -
aepresentatives of various multi-disciplined professional
organizations testified favorably on behalf of RMM'.
Salient mng these was the Texas Medical Associatlon,
the Texas Wsing Association, and the Texas Pharmaceutical
Association.
It was recognized that the Region is serving an effective
role towards the delivery of health services by being a
bridge between the institutional physician, the practicing
specialist, ard the general practiuoner.
is serving as a catalytic agent toward progress addressed
to implementation of FiI" priorities.
Here tne program
The visitors saw positive potential reflected in present
and scheduled accomplislmnts.
3. Continued Support
In response to questioning by the visitors, the Regional
representatives reviewed the continuing support status of'
activities funded during 1970-72.  Of twenty-two projects
supported only two will continue after the close of the
current period; eight will be supported by self and/or
other support; seven will be discontinued; and continuance
of three is questionable.
It is evident that the issue of continued project support
may well become an irnportant component in RMpT's decision-
making progress.  While FtMFT feels that past performance
in this area could well be improved, the future will bring
early consideration of this issue at the proposal development
stage.  For exarriple, an integral. part of the total
perfomce plan for an integrated kidney disease program
for Texas willbe identification of continued sources of
support other than RMPT with particular attentior, to fee
for ~ervice.
4. Minority Interests
The lack of adequate minority involvement being a historical
problem in FMFT, this revlew criterion was explored in
depth by the site Visitors, as will be recognized throughout
this report.
on the F'rogram Staff, one professional and two clerical
(Spanish summed), one of whom was added during the past
Wre are only three minority representatlves
- 14 -
year.  A recruitment effort has been underway for somethe
for a qualified Mexican-American to head the San Antonio
subregion.  Employment of Black subregional representative
in Dallas is also a consideration.
out that Sister Strohmyer, subregional representative
in the Rio Grande Valley, though of German ancestry,
identifies extremely well with the Mexican-American in
that area.
is expressed in the following table:
It was also pointed
Minority and female representation on the RAG
MINORITY AND FEMALE IXPIESmAflON ON RMPT RAG
1968 1969 1970 1.971
--__I-
SPANISH SURNAME       - 1     1 2
BLACK              1 2    3 3
            1 3 5 6
FEMALE
                               11
                            50
----
TOTAL OF RAG 32 33
% OF RAG immmsrn~ -6.3 18.2
Although there is clear evidence
'ICTAL OF ABOVE 2 6 9
                        44
                      20.5
f min
cons&r mum through the subregions,
1972
3
3
5
11
51
22.0 21.6
rity input by
the visitors
expressed-dissatisfaciion with the small number of
minority members on RAG and its sub-structure.
for the Reglon is the significant number of mlnority
personnel on project staffs.
A plus
The present goals and objectives coincide with areas of
minority concern, particularly those addressed to "making
quality of care available in those areas where little if
any is now available."  Planned activities are addressed
to the training of Embers of minority groups in health
occupations,  RbPT is not satisfied with its performance
in minority involvenlent.
of Texas System, Charles A. LeMaistre, M.D., advised that
as the grantee institution, the University of Texas
indicated awareness of their responsibility to assure
compliance by the FWT.
The Chancellor of the University
2.
A proposed "Recruiting Plan" for 1973-74 was pt,, eEt4
to the visitors.  The plan includes the hiring of Elacks
ard Spanish Sunanw3d/Spanish Spealsing Americans.  It wa;
emphasized that the Recruitment Effort Document includes
plans for constructing a talent roster.  This docmntation
was submitted to RMPS as a supplement to the application
prior to the Review Committee meeting.
Dr. Cigma, a RAG meniber and a private physician from
El Paso, who identified himself as a Mexican-American,
advised that all the tokenism in the world would not
help without true concern for the needs of minorities.
In the RMPT RAG he has clearly seen concern for the needs
of the urderserved.
B. Process
1. Coordinator
Dr. McCall, the Coordinator, has provided strong leadership
to the Texas Regional Medical Propyam during his three-year
tenure.  He has assembled a viable Regional. Advisory Group
and has utilized the diversified talents of its membership
in establishing the threeyear plan as presented in the
Triennial Application.
Group has been actively involved in responding to the
concerns of the August, 1971 National Advisory Council as
enumerated in the advice letter August 11, 1971.
Dr. McCall's excellent rapport with the members of the
Regional Advisory Group and with the mmy health agency
representatives was overtly apparent to the visiting team.
In addition to tMs task, this
The Program Staff is outstarding as evidenced by their
individual presentations throughout the two-day site visit
meeting.
major responsibilities and receives the same degree of
loyalty from other members of the staff as does the
Coordinator.
The Deputy Coordinator, Mr. David Ferguson has
Program Staff
w Current FU%T staff' consists of 19 professionals.
but two of them serve 100% time, and there has been very
little turnover during the past two years.
professional staff members are requested in next year's budget.
All
Six additiorlal
- 16 -
They include a Director of Educational Programs, a Chief
of Program Developnt and Evaluation, a Nursing Eikcatcr,
and three subregional representatives.
believe that the additional positions budgeted (approximately
$100,000 annually) in the Triennial are justified.
Chief of the Program Development and Evaluation position
is considered essential since Mr. Humble, who had filled
this position until recently, has been appointed Deputy
Director of Cormunity Programs and will now be more
involved in working with the subregional representatives.
The site visitors suggested that consultant services also
be considered to assure that effective program evaluation
plans materialhe by the RAG Cormittee assigned to this
function.  Aside fican program evaluation responsibilities,
this Cormittee will also be expected to assess Frogam
Staff activities.
The site visitors
The
The Program Staff reflect a high quality and broad range of
professional discipline competence. Particularly impressive
was the quality of the subregional representatives who
demonstrated thorough knowledge about their responsibilities
described their active involvement with the local Council
_- r
I.
and respective geographical assigned areas. They also -: i
.. ~ 3
.-
us
of Govements and CHP 314(b)  agencies who give additional
input frm the consumer interests in the respective
subregional areas.
3. Regional Advisory Group
The 51 member RAG met three times during the past year.
The average rate of attendance was 70%.  The site visit
team noted that most of the key health interests were
represented on the RAG.
membership was considered to be satisfactory.
with many Regional. Medical Programs, physician representation
is proportionately high while consumer interests remain rel-
atively low.
attention since the sm problem was evident when the Regj.on
was assessed in 1971.  "he RAG Chairman and the Coordinator
responded to this concern by stating that progress had been
made in the selection of one-third of the members who were
replaced during the past year.
clear that the progress was not as good as it should be and
strongly urged that this problem be addressed as soon as
possible.  Dr, Eastwood, RAG Chm, responded by stating
Geographical distribution of its
However, as
Tbe site visitors gave this deficit considerable
The site visitors Fade it
- 17 -
that the present &ers of the Advisory Group are
outstanding personalities.  He also expressed his belief
that there is a distinct difference in institutional and
practicing physicians; and considering Texas" large
population, geography and nuher of medical institutions,
the nmber of physician RAG members may be minimal.
this premise expanding the RAG me&ership may be the solution
to involving more non-physicians.
On
The 16 mber Executive Cornrdttee met 4 times during the
pat year and provided ample guidance to the Coordinator
and staff.  This Committee was particularly effective in
providing leadership in the total review process and in
utilizing the Regional Advisory Group.'s many (51) cormittees
and task forces.  Membership composition of all comittees
was found to have the sam weakness as the RAG.
The Program Development Conanittee assumed an active role
by establishing short-term objectives and program priorities.
As a result of its work, seven Program Cormittees have been
fomd to identif'y general program activities relating to
the seven priorities identfied.  The Chairman of each Program
Cornnittee is a RAQ member and serves on the Executive
Cornnittee.
each of the seven priority statements and funding allocations
projected for use of growth funds in the second and third
year of the proposed Triennial Grant Application.
the Program Staff has a fairly good concept of what kinds
of activities should be generated in subsequent years.
The Staff will also be able to better employ developmental
funds in stimulating activities which have a direct
relationship to the short range objectives identified.
General program activities are described for
                       Thus,
4. Grantee Organization
Dr, Charles LeMaistre, Chancellor, University of Texas
System, Mr. R. L. Anderson, Comptroller, and Mr. Arthur
Dilly, Executive of the UT System assured the site visit
team that the grantee does provide fkeedom and flexibility
to the RAG and does not interfere with the programmatic
endeavors and the decisionmking functions of the RAG.
The site visitors wished to be assured that compliance was
being Et in equal employment practicies for minority groups
and womn.  When the response to this inquiry indicated
that progress had not been as good as it should be, the
visitors suggested the need for an affirmative action
- 18 -
plan which would include a recruitment practice callirsg
for the advertisemnt of the job, its description, the
credentials needed, records of interviews conducted and
the results of them, upward mobility intents, and the
implementation of an applicant file.  The visitors were then
presented with a recruitment plan which had been prepared by
the Program Coordinator which was considered to be a
"forthright" response.
concern that intent should be encampassed far beyond the
sole responsibility of the Coordinator and urged that
the above mentioned affirmative action plan be considered
for draft by the RMPT and ratified by its membership.
It was apparent that the grantee also recognized its
responsibility in seeing to it that the minority interest
problems are resolved.
However, the team expresEed the
5. Participation
Many health interests, institutions and groups are actively
participating in Rl"T as evidenced by the number of persons
NIO attended the two-day visit.
captured the controlling interests of the program.  In
comparing the budget request with that of last year,
there is a complete turnaround with respect to funding
the major universities and institutions.
ment has provided more corramcnity resources but has not
brought about less cooperation from the major health
institutions.  Although there remains a high degree of
mdical society influence on program activity corsiderations,
much progress has been noted.  For example, an HdQ activity
is being funded by HSMHA to the Bexar County Nedical Society
as a direct result of RMPT involvement and staff asslstance
in drafting the application.  Also, the first three program
priorities indicate a marked change in the philosophy of
the Texas program in that access, availability md
utilization of manpower have replaced the categorical
emphasis of yesteryear.  There remains strong Tesentrnent
in implemnting new physician extender manpower programs
(i.e., physician assistants) on the part of the Texas
Medical Association ('IMA).  This was aga.in eniphaized
by a ?MA Official and progress in this area may be slow
unless the four proposed AHERP's (health services/educal;ion
activities) generate additional strength through the
County Medical Societies.
No major group has
This accomplish-
- 1g -
The political and economic power is involved in th? 3EY
program. Aside from active RMPT physician prominence on
the state and national scene (i.e., cancer and heart),
the CHP agencies and local Councils of Governments have
given endorsements to the Region.
6. bcal Planning
CW(b) planning has developed slowly. There are 21 CHP
(b) state planning reglons encompassing the entire state
(254 counties).
almost all of the others have received state fbds
($10,000 to $20,000 each) for staffing.  Nineteen (19)
of these agencies now have councils.  In Texas, each CHP
(b) agency is associated with a Council of Govermnt.
The latter are voluntary associations of local governments
of which two-thirds of voting members are elected officials.
All health proposals for state and/or federal support me
reviewed first by the CHP Planning Agency and then by the
Council of Government. All proposals applicable to the
City of Houston also require review and comnt by the
Mayor's Office of Planned Variation, one of approximately
twenty federally supported proparm.
RMpI'has defined 10 subregions covering the entire state
and six of these have now been staffed.
four will be staffed by the end of the current period
with priority given to the San Antonio and Dallas areas.
Most of the subregions relate to two or more CHP planning
agencies.
the central office staff.
interface with local planners and consumer groups.
During the last RMPT review cycle, there was ample evidence
that RMPS' Minimum Review Process Requirements and Standards
for local review have been carried out in a most
satisfactory mer, particularly b the CHI?(%> agencies.
As reported by FWS staff the CHPd agency has participated
in the review of RMPT applications but only through limited
staff involvemnt. The Council has not been involved because
it meets only twice annually. CHP(a) staff reported and
described their review and comnt workload as voluminous
(49 agencies have health components); yet they believe they
too should have technical review prerogatives.  Its staff
is limited and the lack of a complete state plan is
probably because most of its $500,000 budget is used in
Five have received federal funding and
The remaining
Unstaffed subregions are currently served by
The Region has an excellent
- 20 -
enhancing the local (b) agency growth.
by one of their officials they are more inteirsced i!i
developing the players before the script.
As eh?~iu3sst2Z
7.
Assessment of Needs and R, Psources
There was ample evidence that RMPT has conscientiously
accumulated a great deal of data as evidenced by its
being selected along with 6-7 other RMps to participate
in the WashingtodAlaska Management Ii-Lfomtion Sys tern
program.  The data is utilized, but probably not to its
fullest extent in identioing specific and measurable
needs,  The priorities, as stated, reflect the general
mission statements of the national program and are not
based necessarily on specific needs as docwnted by
hard data obtained by the FiiWT.
8. Management
The mnagement capability of RMTT continues to be
excellent.
well coordinated, including mnitoring by RAG members,
a Program Staff person and other selected ad hoc members.
Progress and financial reports are required on a quarterly
and monthly basis respectively and shared services are
being actively pursued by satellite hospitals participating
in the five project GRO activities.
Association is participating actively through its
diversified activities especially in the electrical
hazard project and in the shared services program being
implemented in 18 hospitals.  The latter propam has
demonstrated a 10% savings in services provided bjj
utilizing the concepts employed by better miagement
techniques.
Program Staff and project activities are
The Texas Hospital
9. Evaluation
At the present time, there is no full-time Evaluation
Dlrector on the Program Staff even thoupa there is
evidence of some management assessment in this specjalty.
Several activities have been rightly terminated due LO
evaluation and monitoring assessments by staff arid tkte
RAG.  Sane project activities have been evaluated fa.ii>ly
extensively while others have not due to the shortage of
statf expertise. Very little consultant services have .
been procured to more f'ully provide evaluation to progarn
development and Progran Staff activities.
The site
.j . .
- .-. . .
-,-....
' ..I,
i-. .. I
':, . .>
_1-. ,?
__. .:.
- 21 -
visitors were assured that employment of a qualifiL4
evaluator would be given hi& priority and that the RAG
Evaluation Conanittee and consultants would be more highly
geared to this effort during the ensuing year.  More
effective evaluation is critical to the Region's further
program development and effectiveness.
C. Program Proposal
1. Action Plan
A comprehensive effort, the priorities have been
thoughtfully prepared with much debate and review, and
are clearly congruent with national goals and objectives.
The proposed activities relate to stated priorities and
objectives, wlth increasing attention to needs.  Though
modest in terms of identification of areas of highest
need, the proposal is much more realistic in light of
available resources and past performance.  The goals
are amable, but are stated in such a general way, it
will be difficult to quantio; and is one of the weakest
parts of the program proposal.  Methods of reporting
accomplishmnts and assessing results are proposed, but
address individual activities more than program
achievement.
are planned,
Periodic review and updating of priorities
2. Dissemination of Knowledge
Most programs have a focus on appropriate provider groups
and/or institutions that will benefit. Knowledge, skills
and techniques to be disseminated have been identified
to varying degrees in some projects,
degree of imolvemnt of health education and medical
institutions as evidenced in their widespread support of
program proposals.  Better care to more people is the
goal to which mst projects are directed; but some solid
masurement of results remains to be seen. Moderation of
costs of care is addressed.
address management of most f'requent health problems, those
to which attention is given are significant and not rare.
There is a remarkable
While RMPT does not necessarily
3.
Utilization of Manpmer and Facilities
The Region's intent to utilize cornunity health facilities
is apparent in most projects.  At this stage increased
productivity of health manporsrer does appear to be an
- 22 -
objective in most of the projects.
allied health personnel has improved.
types of health manpower is a sensitive issue, further
attention is being given.  Utilization of manpaver ad
facilities is an identified priority and it is receivin&
appropriate program focus.  Underserved areas and
populations is a concern of RMPT as reflected in their
proposal.
Utilization of
Although new
4. Improvement of Care
There seems to be a very limited degree of studies of
ambulatory care, but this data may emerge in next year's
program staff activities.
other groups in attempts to improve Dnergency Medical
Systems.  Access to health care is their first priority
and projects are addressed to this issue.  Prirr-ary care
and its access will probably be strengthened since this
is an important element in several projects.
attention is given to health maintenance md disease
prevention in the proposed activities.
Program staff are involved with
Less
5. Short-term Payoff
The proposal in part is directed more toward the
availability of an access to services, than swly
gathering more information about health problem; whether
this goal will be achieved remains to be seen.  The need
for feedback to document actual payoffs is projected but
not specificdlly planned.
planned beyond three years and plans for transition to
other  sources of support are generally incluexi.
Support of projects is not
6. Regionalization
Support of multiple groups and institutions is a mior
goal of the program as reflected in many of the activities.
Sharing existing resources, and services and  ne^ Linkages
among provlders are indicated in the three year plan.  "he
concept of progressive patient care (e.g., OF clinics,
hospitals, extended cpse facilities, home health services)
are only minimdlly reflected in the application.
'. '
-.
- 23 -
'1. Other Funding
Contrary to the irSomtion in the application, there
is ample evidence that the Region has and will attract
runds from sources other than RMPT.
in detail during the site visit, the RMET accountant
provided RMPS staff with a document which indicates
non-FD" flm3ir-g as follows:
$882,372 and terminating projects - $150,380.
Though not discussed
new and continuing projects -
4
August 15, 1972
Harold f.larcJulies, M.D., .Director
Regional Medical Proyranis Service
Parklawn l$uilding, Room 11-05
5600 Fishers Lane
Hockvi 11 e, Mary1 and  20852
Dear Dr. Margulies:
The attached materials are forwarded in response to discussion  with the
site visit team on August 1 and 2, 1972.
During that visit we outlined the Regional Advisory Group's work toward
definitive program developxent.  The reviewers asked that we reduce to
writing, RI4PT's 1974 and 1975 plans regarding new activity in each short-;-.'- '.
                 discusses each program element as it  ..: ._ '
. -.
range prograin area.
bas been identified by the conimit3ecs of the Regional Advisory Group and
as presented at the site visit.
Attachment I.
.
Another area of discussion was the minority composition of the staff of
the Regional Medical Prograni of Texas.  The discussion centered around the
recruiting plan presented to the tean as additional  information.
suggested we forward the plan as -inforination suppl enental to our appl ication.
It is enclosed herein as Attachment 11.
Under separate cover and letter we have sent you (August 14, 1972) additional
documents in support of the Texas statewide renal proposal.
was requested by J. 1. Roberts, M.D. of your staff.
It idas
This material
We hope this information will be useful..in the prcscntatiotb of tflc RMPT
Triennial Application to the review committee and council.
clarification is needed or information required please let us know.
If additi6nal
7
hirles B. kCall, M.D.
Coordinator
,' c
.. 1
. .*
C BM/m j
XC: Miss Elizabeth Kerr-
I.
Enclosure ..__.-
-s. Elariel S. Morgan
r. Luther Says
&* n n-3 - n-I __._
( 3)  i d c 11 1' i f i cat j 011  and  tl i s cu s s i. o 11  o P 11 iir t i c u 1 a r  c 1 crii c n I- c;  o f
(;;1c1i pi-o~rant arcn or ciiip11:~:;is 1)y tlic I{cgioi~:iI. Medical  1'ruOgr:l.n
or '~'csas. 'flit coniinittees , tl~roiigli tlic lat,tcr xssi~nlnen~-,
spccificd scver;il arciis of particular concern as a point of
tlcpai-turc for Purtlicr program d~:vcl opi~cnt and iiiimcdi atc oci
for. stnlf cffort. Tlic timing of tlic c1cvel.opincnt process was
such that thc stalf did not: have this information availnlJlc
to thcin wlieii proposals and ideas iroin the coinriiunity were
being solicited and evaluated in December, 1971 arid Janrrary,
972. I'liereore, the f irr; t opportunity to explore community
interest in depth in these areas will come in the 1973 rcview
Y
cycle.
  The staff of the Regional !.IedicaI. Program of Texas  is
seeking cominunity interest and jnvolveinent in those elements
sct out hj thc program coin~~ittecs. The nits of this search
will bc forthcoming in the 1973 review cycle. In anticipation
of new activity in these specific arcas, a ~nini.muin mount of ~
funds in the 1974 and 1975 budgct have been idcntificcl. Some
of tlicsc funds arc avai~ab.Ie Irom tcrminating projects. Othcrs
b
JI~IVC been incIudcd 011 thc basis of an cstimatcd nuiulicr and
size or activity antici.pntec1,
'c
TI~C a'ctual spccific activity to
1 .: F. . .
.e
- 26 -
I
ACcc!is -
Public (paticnt) cd cation '- idcas for tho rcduction of
bnri-icrs to health arising Crom lack of knotqlcdgc ahout ill-
ness, thc licalth care system, or financing mecl~;lnis~ns.
T 'r
Cultural barrier reduction - tes.t methods for overco!~iin~:
health barriers relating to culture from both the paticnt and
pro f e s s i ona 1 v i eivp o in t s .
Quality consistcl~cy - try mcchanisms to assure that the
quality of care provided is consis tent. without regard to
economic or social status.
Coordination of reierrals - exp.7 ore ideas for coordi.naij ng
paticnt referrals to reduce the conlusion and allpearancc of
fragmentation in the health care system.
Simplification of the entry - proccss - aside 1~0111 cost
and information, seek idcas concerning the simplification of
the acquisition of care.
Availability -
Emergency service coordination - seek activities whose
purposc is tlic dcveiopmcnt of linkages and/or coordinatj 011 of
scrviccs of commt~nitics involved in the delivcr)r o emcrgc~ncy b
nicdicnl trcatnlcnt .
iacilities not IION avai1:iblc.
IJtili z;ition -
.' ,d .
,
Utilization studies - encourage studies of facility and
nurscs not working as nurses.
Rural rcsource coordinatjon - support activitics that
aiiri for cooperative interaction among rural coiiiinunj tj es in
the efficicnt and ef Cectivc use of health carc resources.
Health Manpower -
Curriculum coordination - explorc means by which arti-
culat i on and coordination can bc expanded in the region' s
manpower program.
C en t r a 1  r c f e r en c e  s our c e d c! v e 1 o pme n t  -  s u pp o r t  fur t 11 e r
activities that will improve and expand this valuable program.
Continuing Education -
Professional self-asscssmcnt - seck methods for re-
designing the conventional approach to self-assessmrnt.
Community leadership development - encourage health
professionals to becgme involved in coniinunity plannirlg and
seek ways to provide some training for the assumption of that'
role.
Audio-visual techiiiqucs - analyze new electronj c tecliniques
for potential use in refresher education. '
Rc-instruction,in disease management - test idcas for
selecting the appropriate subject ar.eas' for re-instruction
pi- e s cn t ;z t ions .
0
-25- *
L
h
cncournge attcmpts to closc tlie co~iiinuni cations gap betwccn
tlic ~'town'' professionals and the "go\vn" professionals .
Tnvolvcn~cnt of state education agency - try idea:; whi.cli
involve thc state education agency stiff in RIW~ activity.
Extension -
. Successful project screciiing - 'seck successPu1 idcns
froin this and other RZ4P's that might bc applicable in Texas.
, ~ ..
, . -1
Publication of successiul effort - support the sprcncl of *=- -.!
..,
information regarding activitres that have successfully con-
tributed to improved patient cqre.
Publicize proj cct progress regularly - en'couragc eE:Eoi-ts
at publicizing the progress of project effort in a11 attcirlpt
to involve the intcrcst of others.
Audio-visual information - maintain a kiiowlcdgc of
I.
, -+.
,
.I .
' . .. .. .
,. ..
  ...
... . '
.. , ..
.; , '
.*
At the time of the devc:lopiiicnt of this plan tile Regional  I4cdical Pt-Ctljrdi;
of Texas eitiployed 30.6 full time equivalent staff in seven offices tfi,-ouliirL'
out the state.
prczyt-diii ciiiploys no Elacks and three I~lcr,ican-Ar;rericaiis.  This pldri is dc-
signed to I)ring the staff of the Regional illedical Program of Texas iiito
rcssanal)le parity with the 1970 censlls tabulation of rnajor iiiinori ty groups
in Texas.  The census identifies 12.7 percent of the Texas population as
Black and 17 percent as Spanish surnamed.
That staff is 44 percent male and 56 perccnt female.
Tile
Recruiting -- Goa7
Tne goal of the prograin regardi ny i,iiriority staffing is .presented it) the
attached table. To meet this goal recruiting efforts will be organized to
seek, in the next two years, five Blticks, three Mexicat7-flinericans, and two
females.
professional and other criteria for ci;iployiiient in this program.
anticipated that this goal can be achieved by the end of 1974.
Every effort will be made to find individuals who can meet the
It is
The following vacancies exist in the present. organizational structure of
the Regional Medical Program of Texas:
Available Positions
---
Current Vacancies:
0
Chi eP , Program Devel opment and Eva1 uati on
Nurse Education Coordinator
Regional Representative - San Antonio
Administrative Assistant - Houston
Future Vacancies (1973):
Regional Representative - Dal las-Fort l!orth
Regional Representative - Aniari 1 lo
Clerical positions will be created in each of the regional offices as th;)
professionals are employed.  This will add three half-tiilic secrct;lrics tu
the staff by the end of 1374.  One secretary is proyi-ai:iined for the Austin
office staff in 7974.
In additioti to the planned additional positions shown above there wi'11 be
vacancies that occur froiii noriiial attrition.
this rate will -be ayp$oxiinately two clerical and one professional per year.
Recent experience itidiccitcs
- 30 -
b
cooperation of Regional Advisory Group liK!iii!J(!r7>,
i's, tire ttai:iw of sevrjral minority rccruitit,*j cutit tict:
acli will ~JC tliorouyhly cxplor'cd in ttic coiaii II~J
eads io
.i 5 w:trc 01-
quali I'icd
tiionths.  At1 Pxfstitl cirp'Ioyr.ient aycncy also is supplying good
po te 11 ti a 1 1 y ci uil1 i fi ed i t~di vi dua 1 s .  The en ti re pro9 ri:m s la ff
ttic vhcancics that exist arid is alert. to the availability of
p ro f c s s i on i\ 1 s. .
Proqress -...I-____- atid Evaluation
lhi s rcciwi ti ng plan wi 11 be eval uatcd in two areas.  (1 ) fkcords w-i 11 be
developed and maintained on cacti rcci-uiting contact.  A file will bo c1o;c:d
only when a final advice letter is written or the individual  rcrx)vr-: hiw,ei f
from consideration.
each three montlls as a part of the quarterly adininistratS ve revi cw procc-sc..
(2) Progrcsr, toi.!drd tlic coniposi tc goal will be reci~rc~cd
,
Current:
iilack
     PROGRAM STAFF
MIWORITY REPRESEXTATION PLAN (1 )
ilexi can/Arr,eri can
Fen!a? e
Total Staff
---,
G5al:
Black
&xi cm/Amri can
Fen2 1 s
Total Staff
  Profess i ona?
itisber Fercen t
0' 0
1 5
6 31
19.6
3 13
4 17
6 26
24.6
Clerical
iii ti r.ib e r
.Percent
0 0
2 18
11 7 00
11
2 13
2 17
13.5 100
13.5
  Compos i te
ilumber Percent
0 0
I
w
P
3 o 10
17 56 I
30.6
5 13.
'6 ' 17
79 50
38. 1
,. , . . . '.
. .. .. ,
FROM :
SUBJECT:
Operations Officer
Mid-Continent Operations Branch
<
_-
~~&mal ~cal Progrsrm of ~xas 'a Supplemental Information to the
Triennial Applicatlon
<
_-
wg~onal ~cal Progrsrm of ~xas 'a Supplemental Information to the
W-emlal Applicatlon
mng the site visit to FWEC tie subject of support; fro~n other
sources vim discussed. contrary to the lnf'omtion In tk Triennial
dtmdon is being met. AlthougsI not discussed specifically duriw
fhe hit, RMPT provided this reporter wlth a list- of r10n-M
euppart of both new an8 continuing activities $882,372, as well as
prqjects to be tenrdnated this period 8150,380.     .
. Application under review, them vias anple eadence that this
T.
_- \
pK RegLcn has subsequently clarified that their figures are for
the figures include sennces of 0- ldrd.
c-.
., -
t:
clne year and gre expected to increase In subseqwnt years. Also
AHRIC - qricr . 2,400
T y 1 c r .- Sin i 1: h C o u n t y
5,090
I'r o j cc t  IIliAClI
7,000
Family Mcdj cal. Resource 4,000
C e n t e r P 1 ann i II g
I
!
AIIERP - Central Tcxas 2,750
Electrical Safety Services 100,000
Cont inuiiig Medical
Education
Project HEARD
0
22,230
55 , 990
37,400
--
-- --
Standard Tcchniqucs for --
Home Health Care
Rehab Nursing Tcchni.qties    20,500
Demo' Unit Continuing     70,415 33,137
For Small Iiospi tals
Education in Medical Rehab
Project GRO . 25,000
.*
Proj ec t MAN0 72,800
Chi 1 d r CII s lie ar t Pr ogr aiii 43,000
W. Texas - S.E. New blcxico 6,250
-- --
AliERP - Kio Grande Valley --
8- - --
' 4.
AIIERP - South Texas - -.
372,000
Strltcwide Cancer Registry ..$
.-
itcducc C011ipl.j cat ions
I:o 1 1. owing llad io 1: 11 e r apy
Maxi 11 ofaci;il
1Ie;il th Cnrccys
Dial. Acccss
Strokc Demo Program
Medical l'hysics
I 1111 a 1 a t i on T 11 c r a p y
Electrical IIazards
o
2,400
13,500
14,500
49,832
3,500
2,000
--
5,000
-..
-. -
-
Eradication 05 Cervical 14,548
Cancer
PASTBX 4,000
Inter-regional Serial
Contr o 1
1,100
Re 11 a b Man a g e ni e n t
-
6,000
St. Elizabeth's
--
--
--
--
Regional Rehab - IVharton
Regioiial Rchab - Nctf
)3 r ii uii f e 1 s
27,000
7.,000
7/28/72
Review Cycle: October i972
3
REGIomr Texas OPERATIONS BRANClI: Mid-Continent
?. , -., -
o NUbER: 00007 Chief: Michael J. Posta
C0ORDINATOR:Charles B, McCall, M.D.
Staff for RMP: Luther J. Says, Jr.
Operations Officer, MCOB; Jim
LAST RATING: A **, de la.
..
TYPE OF APPLICATION:
- 3rd Year Regional Off ice Representative :
e/ Triennial / / Triennial VI. Dallas. Texas)
-
- 2nd Year Management Survey (Date):
/ / Triennial /-/ Other
71
-
Conducted:
Scheduled;
or
Last Site Visit:
(List Dates, Chairman, Other Committee/Council Members, Consultants)
July 29-30, 1971 - George E. Milla?, M.D., Chainnan;'Alfred M. Papma, * M.D.;
Joseph J.'Smith, M.D. and I. J. Brightman, M.D.
.. . -
9 %e VM
to TElMp Central Headqwters,
Assistance to Safety and
93 _rnl@zgn
and to attend RAG *
Recent events occurring in geographic area of Region that are affecting
RMP program:
meeting,
-_
1.
Seven priorities established with an ad hoc ccanmittee for each to develop
appropriate programs.
In addition to the folk existing subregional offices (El Paso, Houston,
Harllngen, and Tyler), two me were implemented (Abuene and Wbbbck) o
San Antonio and/or Dallas will soon begin.
2.
3.
Five representatives. of TRMF' participated 'in t& RMPS sponsored conference on
wamness of the Mexican American culture May 14-17, 1972, Abiquiu, N. M.
W
SP
14
15
4
TEXAS POPULATION 1970: 11,196,720
TEXAS CITI.ES with 100,000 or more population
(1970) and % change since 1960
CITY       POP. (1 970) % CHANGE
a Amarillo 127,010 - 7.9
b Lubbock 149,101 +15.9
         322,261 +16.5
c El Paso
d Fort Worth 393,476 +10.4
e Dallas t
I
844,401 +24.2 c;
f Austin 251,808 +35.0
g Houston 1,232,802 +31 .4
h Beaumont 115,919 - 2.7
i San Antonio 654,153 +11.3
j Corpus Christi 204,525 +22.0
NUMBER OF OTHER CITIES OR'TOWNS BY SIZE
POP. RANGE NUMBER
2,500- 9,999 249 .,
10,000-49,999 100 I
17
50,000-99,999
........
._ -
./
# 07 REGION: TEXAS
- Geography and Demography
Encompasses entire State; several subareas-
Counties: 254     Congressional Districts: 23
populas (1970 Census) - 11,197,000
Urban: 80%
Density: 43 per sq. mile
Texas u. s.
37%  ' 35%
54%           55%
9%           10%
Age Distribution: .-c-
Under 18 years
18 - 64 years
65 and over
Metropolitan Areas: 17 SMSA'S
Total Population 6&&&lfl.'
Dallas Galveston Odessa
El Paso Laredo
San Angelo
Skm=%
Wac0
Abilene
Brownsville
Corpus Christi Fort Worth Lubbock
Wichita Falls gouston
. Denison- Sherman Texarkana Tyler
Race: 87% White; 13% non-white
                           364.5
Heart bisease 157.2
Vascular lesions
275.3
130.2
Malignant neOp1.     92.2 102.2
(aff.CNS - stroke)               935.7
All causes 798.6
b
".
....
_. .
.....
.....
_-_ ..
, .. ,. 8
, ..... !
_.. ..
-. . -.
:.-- :
._ .
Age specific
death rates
(all causes)
45-64 yrs .-1081.4
65 & over -5518.8
0
,
-5
107 Region: Texas
Resources and Facilities
Medical Schools -
Baylor U. College of Med., Houston
U. of Texas, Med. Br., Galveston
U. of Texas Southwest Med. School
U. of Texas So. Texas Med. School
Medical School, U. of Houston
Dallas
San Antonio
(developing )
1969/70 Graduates
Enrollment
362 88
598 147 .
426 107
2 16 33
Dental School
3 - Baylor, U. of Texas, Houston and U. of Texas, San Antonio
Pharmacy
3 - U. of Texas, Austin; Texas So. U:-& U.' oi? Houston, Houston
Professional Nursing Schools
Practical Nurse Training
51-32 are college or University
                   153- majority at college or
based special vocational and
                            technical schools
Allied Health School -- University based:
University of Texae, Med. Br, at Galveston
'School of Allied Health Sciences, Galveston
Public Health
university of Texas, Houston - School of Public Health
Accredited Schools
Cytotechnology - 9 (five affiliated with University or Med. Sch,
Medical Technology - 57 (one at VA Hospital and one at Broake Army)
Radiologic Technology - 60 (one at Brooke Army Med. Center)
including one at Brooke Army Med. Center)
..
Physical Therapy - 4
(one at Brooke Amy Medical Center)
I
-6-
- 5/71.,
-
#07 Region: Texas
Hospitals - Community General and V.A. General-
490 44,587
7 2,532
14 2,857
Short term
Long term (special)
v. A. (general) -
Skilled nursing homes 441 31,587
# Hospitals with
selected spec!-a1
facilities '
Intensive Care -
X-ray therapy -
Cobalttherapy -
Isotope
Renal dial
(in pt.1
Rehab. (in pt.1-
-
Active       11,279
Inactive          481
Osteopaths @.O.'s) 721
Ratio of active M.D.'s (per 1O0,OOO POP.): 106
*percent byspecialty: General practice - 31%.
     Surgical spec. - 33%
Medical spec. - 21%
Ratio per
Graduate Nurses, 1966
# 100,000
Actively employed in nursing 20,167 . ' . 188
Not employed in nursing 9,955
-
139
78
33
84
48
24
Licensed Practical Nurses (1967)
Total employed in nursing (adj o )
Not employed in nursing
13,386
---
,
._
5/71
RDB
Component
1st year 2nd year
I.
PROGRAM STAFF
COrnRACTs .
L
. DEVELOPMENTAL COMbYENT
  CPERATXOXAL PROJECTS
Kidney
. Ex6
hs/ea
Pediatric Pulmonary
3rd year. 1st year
. Other
TUTAL DIRECT COSTS
-
CO~CIL RECON!E?;D~D LEVEL
..
~oMPoNENT AND-TINANCIAL SUMMARY
TRIENNIAL' APPLICATION
Current Annualized
Level _ok Year
I
$ 579,999
138,280
Rcgion: Texas
Review Cyclc: .q-+/nct 7973
I Comnittc
Recornendation for
1-Approvec
2nd year
Level
--
Jrd yeor
--
o 7.
.-
JULY 17~1972
-
I
BREAKOUT OF REQUEST
-- 05 PROGRAM PERIOD
REGXI3 - TEXAS
Rn OOQO~ lam PAGE 1
RIPS-OS-JTOCRZ-1
_-
.. .
JULY 17.1972
BREAKOUT OF REUUEST
- 05 PROGRAM PERIOD
--.- .
REGIOY - TEXAS
-_ BREAKOUT OF REQUEST RM 00007 10172 PAGE 3
JULY 17~1972
RhPS-OUCJfOCRZ-&-,
- -. . . - - . - 06 PROGRAM PERIOD - -
-__ - I - .
-,
JULY 17,lf72
BREAKOUT OF  REQUEST
Ob PHUGRAH  PERIOD
JULY 18.1972
-- __ -
BREAKOUT OF  REPUEST
P7 PROGRAM  PERIOD
REGION '-  TEXAS
RH OO'l97  1(3/72 PAGE 5
RMPS-OSH-JTOCRZ-1
_-
I
JULY 18'1972
BREAKOT OF  REQUEST
27 PROGRAM  PERIOD
, REGION -  TEXAS
    R9 o??fl7  11/72
P4GE 6
RMPS-OSM-JTOGRZ-1
component
Title
No
Disease
COO2 Feasibility of pastex
c2m ~I-annimRenal
C21Z FeasibiUty Stud3r
~220 planning So. Texas Med.   60,135
~230 y- So. West Med.   62,596
C240 plannj.~ Calveston U. T   95,194
c250 ~3mnirx Dental Inv. 42,194
c260 planning Multi. *de 45,386
e270 planning Reg. Ca. WOga  37,622
~290 pmmim Baylor Fea. ,180.117-
C2U Programstaff
Subtotal 755,630
$ 721,219 $
15,000
. 3,260
4,349
11,500
  9;500
27,725
792,553
596,883
26,748 12,570
DOOO Developmental Component I
001 IViecEcal Genetics 25,149
003 East Texas Hosp. Teachi%  40,164     50,000
005 Re@onalConsultation in  47,500
   Radiotherapy
006 Medical Physics 28,500
007 Cancer Incidence and    76,446
  Resources in Texas
008 Statewide Cancer Registry 38,000
014 Stroke Demonstration
  Progressive Program
014A Stroke Demonstration
Chain
004 Cw. Hospital lY&B.Ution 47,500
60,000 30,000
       45,000
49,584
80,000 91,123
     141,045
$ 527,617
20,000
4,000
551,617
87,334
20,000
108,000
63,419
Total
9/7 2-12/72
$1,481,222
20,000
  4,000
.:580,140
15,000
  1,743
' 75,135
65,856
99,543
42,194
56,886
47,122
,207_.842
2,696,683
87,334
64,467
40,164
97,500
137 , 500
' 143,084
141,045
63,419
page 2 - Funding History List
Component 01
NO Title 7/68-9/69
014B Stroke Dmnstration $
015 ha-wide Respiratory 174,388
016 Regional Rehabilitation 107,007
017 Regional Rehabilitation
    san Antonio 60,709
017A Regional Rehabilitation
017B Regional Rehabilitation
018 Univ. of Texas Dallas Co. 40,873
019 Rehabilitation Cardiac
   Work 41,181
020 Wadication of Cervical
    Cancer 80 083
030 Planning for Allied
    Health R-aining 51,870
031 Long Mstance Consultations
033 Extended Coronary Care
    Nursing Training
035 Reduce Complications j J' J
036 Serial Control System
037 Health Careers
038 Dial Access
039 Amual'IbmrClinic
042 Continuing Education for
    Occupational Therapists
043 Instructional Program for
     Allied Health Educators
045 Comnunity Action
046 Ivbxillofacial Prosthetic
046A Maxillofacial Prosthetic
046B Maxillofacial Prosthetic
046C Maxillofacial Prosthetic
  02         03
10/6!3-9/70   10/70-8/71
242,915
127,063
80,000
67,708
67,607 46,185
74 , 620
g0,ooo
13,000
35 , 000
84,000
37,006
16,500
28,000
29,801
15 .) 000
24,000
17,500
160,000
100,000
45,049
86,700
19,395
62,550
38,566
28,001
65,762
19,963
11,520
22,826
90,977
106,217
04"
9/71;8/7 2
$ 36,581-
  20,000
5,444
14,556
20,000
55,000
34,878
30,062
35 , 060
Total
9/72-12/72
$ 36,581
497 , 303
321,778
174 , 501
5,444
14,556
160,542
41,181
276,783
64,870
54,395
146,550
110,566
65,002
172,563
53,463
26,520
46,826
17,500
206,217
34 , 878
30,062
35,060
305,977
    component
No Title
Total
  01
7/68-9/69
$
  02
10/69-9/70
$
__c__
$2,220,891
04%
9/71-8/72
$ 26,900
  75,000
  68,583
$1,3909435
$ 26,900
75 Jooo
68,583
$6,934,366
I
-17-
Regional Medical Program of Texas
04 Yr. Extended 16 Months (9/71-12/72)
Direct Costs
Program Staff
Planning Renal Disease
$ 926,818
  26,500
Sub total
Developmental 120,000
06 Medical Physics 20,000
14 Stroke Demonstration 100,000
16 Demnstration Unit 20,000
17A Demonstration Unit-Registry Rehabilitation      5 3 444
l7B Demonstration Unit-Registry Rehabilitation 8,556
20 Cervical Cancer 20,000
35 Radiotherapy Complications 35,000
36 Serial Control System                   9 , 001
37 Health Careers 77,000
38 Dial Access 24,555
45 C-ty Action 55,000
46 Maxillofacial Prosthetic 100,000
08 Cancer Registry Bexar Co.
131 939
51 Inhalation Therapy 48,100
54A OR0 - Tarleton State College            22,247
54B GRO - Sam Houston State University         22,247
54C GRO - Tyler Junior College             22,847
54D GRO - Del Mar College
543 GRO - Graduate School of Bicanedical Sciences
55 Electrical Safety Services
58 Area Health Education Resources Program        15,000
                               21,000
60 S. Texas Area Health Education Resources        15,000
                               Ij0,OOO
61 MAN0 - Family Health Service Program          30,000
62 Children's Heart Program
63 Area Health Resources Infonration Center        8,000
64 Standard Tech. for Hme Health Care          12 , 000
65 REACH 8,000
66 Dqonstration Unit in Medical Rehabilitation     22,270
                              9,009
68 Dey. Auto Area Health Resources Infmnation Center  17,712
4,992
g$i;
59 S. E. New Mexico Health Resources Program
67 Basic Rehabilitation Nursing Technician
Total
$ 953,318
$2,106,720
- 18-
MIONAL MEDICAL PROCRAM OF WS
        HISTORY
FUNDING (DmT COSTS):
Planning
Grant Period Period Amount Funded
01
02
01
02
03
04
7/66-6/67 (12 mos . ) $ 969,541
7/67-6/68 (12 mos o )
1,0393295
Operatioral
7/68-9/69 (15 mos o 1
1,615,000
1,708,040 T/ - 5/
10/69-9/'/0 (12  OS. 2,220,891 i/
10/70-8/71 2/ (11 mos o )
9/71-8/72 r16 mos. )
2,106,720 Ti/
Included $444,178 Carryover from 01 year.
Award for 11months at request of RMPS to accommodate anniversary
Included $549,344 Carryover f'mn 02 year; also, includes 12% budget
04 periods extended from 9/71-8/72 $1,390,435 to 9/71-12/72 $2,106,720
Reflects a 12% budget - reduction imposed in April 1971.
review scheduling.
reduction placed on Texas E71 1971 appropriation.
to accmodate Three Cycle Review.
REGIONAL DEXELDFMJWT:
In December, 1965, various academic, State and private health representatives
met to discuss the potentials of the then newly enacted legislation calling
for Regional Medical Programs.
which later became the Regional. Advisory Group.  After first attempting to
establish three separate Regions, the applicants comprhised on three
subregions in North Texas, South Texas, and the Gulf Coast.  Seven schools
in the Houston area represented the Gulf' Coast subregion, while the UTSW
in Dallas represented the Northern subregion  and UT San Antonio represented
the Southern subregion,  The University of Texas at Austin was designated
the applicant organization, while the Texas Medical Center in Houston was
designated the fiscal agent,  In June 1970, the fiscal agency was transferred
to the Office of the Compbmller of the University of Texas System in Austin.
The initial planning grant was awarded in July 1966, but progress, including
staff recnuitment was relatively slow.
in planning for an Allied Health Waining Program and in starting a Cancer
Registry; San Antonio reported resistance problems with private practitioners;
A State Coordinating Comittee was formed
Baylor (Houston) rewted some progress
-19-
Regional Medical Propam of Texas
RM 00007 10172
0
while Southwestern (Dallas) reported good progress in surveying resources
and personnel needs in the categorical diseases.  Dr. C. LeMaistre was
serving as Program Coordinator in Austin, and Dr. Spencer Thompson was
appointed Associate Coordinator and was stationed in Galveston.
the second planning grant year, staffs from the various institutions
began joint planning meetings, task forces were created in the categorical
diseases, the RAG began to develop its Review Process and the Texas Council
of' Health Science Libraries was created.
its initial operation applicatio&which led to a site visit conducted in
June 1968.
During
"his planning group submitted
The major concern of the site visitors was the apparent lack of central
direction and coordination of the program,  This was illustrated by the
uneven progress made in the developnent of the nine subregional planning
units and by the fact that operational proposals appeared to be "based on
institutional interests and strengths with very little regard Eor
comrmXnity needs and goals - either regionwide or local - and only a few
demonstrated evidence of true cooperative arrangements or unilateral
peripheral involvement .I'  The site team observed that the Regional
Advisory Group, though under strong leadership, had not been active in
the identification of program goals and the development of program plans.
The RAG was weak in its representation of minority groups, consumers, allied
health professions, and the practicing cmty,  Because of these apparent
shortcomings, Council recommended a one-year approval of the Texas
operational application, including continued planning support, with future
funding contingent upon demonstrated improvement in the areas mentioned
by the site visit reviewers.  Accordingly, a one-year operational award
was issued.
planning activities.
A subsequent site visit ms held in April 1969 to access the progress
made in fulfilling the conditians laid down the year before as necessary
for further f'urding; that is, strengthening central administration and
exparding the RAG.  The revfewers were satisfied that these reqQirernents
were being met; a new coordinator, Dr. Charles McCall, had been appointed
and had presented his plans for tightening up the organization.  The RAG
was expanded to include nine new interested @;roups.  On that basis, the
Region received an 02 award including carryover, as well as cormitrrients
for the 03 and 04 years.
The 03 continuation application, reviewed by RMPS staff, indica&&- that
Dr. McCall's plan appeared to be working:
out by January 1970 (except for development of a subregional office in
Houston) and for the first time the Region had a multidisciplinary program
staff in Austin. Functional differentiations between the RAG and the program
staff had been delineated.  The RAG had adopted a set of *@ylaws and
seemd to be involved in program development,
primayy review responsibilities, had. been made agents of the RAG rather
than of the Coordinator.  Financial rmnagement procedures had been altered
with RMPS assistance.
These fbr-ds were divided evenly between operational and
The planning bases were phased
Five task faces, with
Planning and evalution functions had heen
-20-
.Regional Medical Program of Texas
consolidated in the Coordinator's office.  Close relationships between
'I" and the Texas Hospital Association and a formal working arrangement
with CHP had been initiated.
On receipt of the Region's Triennial Application for the 04, 05, 06 years,
another site visit was conducted during June 1971.  The visitors were
convinced that TRMP had mde considerable progress during the pa5t two
yews, but in the absence of specific proposed activities for flmding
for the second and third years of the request, three year f'unding was not
recommended.  The Region was complimented on its concerted efforts to
develop program activities outside the confines of the medical institutions
without losing the support and conmitment of these necessary resources.
It was recognized that there itre still strong proponents for the categorical
medical center approach in Texas, but in the opinion of the site visitors,
these interests had been neutralized by the support for a program
emphasizing the needs of communfty hospitals and practicing physicians.
The focus on subregionalization was also commended.
inciigenous workers with firsthand knowledge of their respective worMng
.
Subregionalization was being pursued.
The decision to employ
areas indicated that action oriented planning and implementation of
program activities can be initiated more quickly and be mox concentrated
on the real health needs in the respective geographical areas.
office staff of the RMP of Texas was acknowledged to be highly qualified,
enthusiastic and well directed by its Coordinator and Regional Advisory
Group, Also noteworthy was the involvement and participation of practicing
physicians at both the decisiormddng level and in the area of ongoing
projects, especially those which have assisted the physician with upgrading
patient care.
the State Health Department, the nursing association, the hospital
association and voluntary health agencies are supportive of the RMP of
Texas.  As recommended by the site visitors, the August 1971 Council
approved the Region for two years support, including a developnsental
component.
The central
It was noted that other key health groups, including CKP,
.
.:-
...
. .. i
. __
.. ,
. ..
-.
: * ,
. . . :.
.~
. ..
, ..
..
.. ..
. --
-21-
DEPARTMENT OF HEALTH, EDUCATION, ANI) WELFARE
HEALTH SERVICES AND MENT'AI, HEACI`H A1)MINIS'I'Ith`l'IC)N
MEMORANDUM PUBIJC HEALTH SERVICE
e
TO : THERECORD
DATE: July 24, 1972
STAFF OBSEKVATIONS
: Operations Officer
Mid-Contlnent Operations Branch
Carrpnts agreed upon at RMPS Staff Meeting July 18, 1972, regwding
the Triennial Application from the Regional Medical Program of Texas
and the Site Visit scheduled August 1-2, 1972.
SUBJECT:
Participants :
* Michael J. Posta, Chief, Mid-Continent Operations Branch
* Luther J. Says, Jr., Mid-Continent Operations Branch
* Joseph L. de la mente, Office of Planrdng and Evdluation
* Jirmly Roberts, M.D., Dlvision of Professional and Technical
Development
Harold White, Grants Management Branch
* Denotes staff mmbers of the proposed site visit team.
SWrmary:
The meeting began with a brief review of the references prepared for
the site visitors with particular attention to the history of TRMP,
previous site visit, advice letter, Management Information System
printouts on previous ftmding, breakout of tb proposed three year
sperding, and descriptor sunanary.
Staff noted the funding of current 04 year to be as follows:
Date of Awasd Period Amount (dace) Activities
9/3/71
$1 , 274,565
Program Staff $523,081
15 Projects $751,484
9/1/71-8/31$72
9/lf71-12/31/72 $2,106,720 mtFa Staff $953 818
              Developmental $120,000
              31 Projects $1,032,902
6/.'W!T 2
(!mended - 4 mo. ext.)
- 22-
Page 2 - THE RECORD
The proposed triennial funding (d.c.) plan is as follows:
05 - 06 - 07
-
Program Staff Activities $ 754,129 $ 862,762 $ 877,970
Developmental Component 160,000 200 , 000 225,000
Projects (27) 1,264,341 (16) 796,960 (9) 537,538
Unspecified Growth Funding -0- 480,000 760,OdO
Total $2,178,470 $2,339,722 $2,400,508
The renal disease and GRO components consists of five projects each.
It was interesting to note that support of 13 projects will be phased out
during the current 04 period.  Continuing support for two more years is
requested for the five GRO projects which began at the beginning of the
current 04 period.  Continuing support for one more year is requested for
the Electrical Hazards project now completing its fbt year.  Continuing
support is requested for eleven new projects which began during the Last
quarter of the current extended 04 period.  Ten new activities are proposed,
five of which represent the renal disease component.  Of the 21new
activities (11 began in the current period), ten are currently budgeted for
one year only, two for two years and nine for three years.
Staff was favorably impressed that most of the project sponsors are other
than mdical schools and most of the activities are subregional.
activities are continuing education, training new and existing health
manpower, patient care and coordination of health services.  Only two
projects are categorical disease oriented.  Mexican-Americans are the
primary target population of five projects (four in the Rio Grande Valley
and one in the San Antonio area).  Blacks are the secondary target population
of two projects.  Other special target groups include:
poor, 14 for rural areas, and 2 for other poor.
delivery methods represented by the projects:
care, home health care, in hospital care, and mobile units.
include access, area health education (4), medical consultation, health
team approach, joint services, patient and public education, and safety.
The health professional target groups include physicians, nurses and almost
all categories of allied health personnel.
The primary
1 for the inner city
Primary health care
ambulatory care, extended
primary elements
Issue Requiring Attention of the Site Visitors
The site visitors should specifically explore "@'s progress relative to
the six constructive criticisms enumerated in the RMPS advice letter of
August 11, 1971.
-.
,- . ..
.. .
.. .
.. .
~I
..
e
4
-23-
Page 3 - THE RECORD
Other issues should include:
Utilization of consmr g??oups in establishing objectives
aM3. priorities.
Relationships with CHP "a" and "b" agencies in planning and
project develapment; particularly since only 5 of 21 'lb" agencies
have been f'unded and TRMI? local advisory pups have not been
activated .
Why are no planning and/or feasibility studies included in the
application?
What is the current status of erergency mdical services and
what is 9RMF"s role?
Of those projects where TRMP support is to be phased out in
the 04 year, haw    will continue?
Proposed budgets indicate only minimal support from other
sources. If successfU, what are the assurances of their
continuation af'ter cessation of TRMP support?
In the long range planning, what will the relationships be
between GRO projects and Area Health Resource Infomation
Centers?
With regard to GRO projects, what are the cost-swing
services other than education?
Explore rationale of f'unding of the many new projects for one
year only, as well as unspecified growth flxnding in the 06 and
07 years.
I
Regkon Virginia RM 00049
r Review Cycle 10/72
'%I
.' Type of Application:
Triennium
Rating 287
Recommendations From
-
/ X/ Review Committee
-
-
_-
-
/ / Council
- / / site Visit -
RECOMMENDATION:
The R9view Committee accepted the recommendation of
-the site visitors that the Virginia Regional Medical Program be approved
three years.
A developmental component in the requested amount to be funded
within the total $1.8 million level,
2.
Critique - The Chairman of the site visit team presented the findings
of the team to the Review Committee. Progress of the Program since
the last site visit was illustrated both by reference to the Region's
change in attihde and the favorable response by the Regional Advisory
Group, the Coordinator, and Program Staff in regard to past concerns
and recommendations of review groups.  The site visitors' evaluation
of programmatic achievements, current concerns and recommendations
emanating from the August 1972 visit were presented,
Committee discussion focused upon the recommended funding level for
the Program.
Staff budget for central staff services was provided.
The Program's capability to effectively allocate and utilize the
recommended funds was discussed. The Chairman of the site visit team
reported that the Program had attained a maturity of judgment and a
demonstration of competency (in the way it had moved and.in the way
it anticipated it was going) that qualified it for triennial status
at this point in time.
Clarification of the requested amount within the Program
'Dr, William G. Thurman was not present during the discussion.
EOB/DOD 10/2/72
Region: Virginia RMQ004
Review C-eT
COMPONENT AND FINANCIAL SUMMARY
TRIENNIAL APPLICATION
Component
Current Annualized
      03 Year
' Level -
RQGRAM STAFF
ONTRACTS *
LOPMENTAL COMPONENT
PERATIONAL PROJECTS
hs/ea **
Pediatric'Pulmonary
AL DIRECT COSTS
WCIL RECOMMENDED LEVEL
$
501,225
(41,802)
-0-
536,566
$1,037,791
I
$1,010,000
. * Program Staff Total
Included in Operation
__
._
Requ
1s t year
1,016 , 407
(376 , 769)
80 , 000
1 , 893,136
: 136,996
:128,045 1
[ 45,660
r
c 1
r j)
2 , 989,543
;t for Triennial
2nd year 3rd year
I
$1,054,02
$1 , 159 , 429
`I
        80 , 000
1,574,98 1,169,137
(142,675)
( 52,094)
-
i
80,OO
Committee Recommendation for
  Counc
1st year
;1 , 800 , 00
1-Approved Level
2nd year 3rd yea:!
I
-+- $1,800,000 $1,800,0~
rejects - Total
d
     SITE VISIT REPORT
VIRGINIA REGIONAL MEDICAL PROGRAM
    August 3-'., 1972
I. SITE VISIT PARTICIPANTS
Consultants
Sister Ann Josephine, Chairman, Administrator Holy Cross Hospital,
Salt Lake City, Utah
Benjamin W. Watkine, D.P.M., 470 Lenox Avenue, New York, New York
Morton C. Creditor, M.D., Coordinator, Illinois Regional Medical
Program, 122 South Michigan Avenue, Suitk 939, Chicago, Illinois
William Vaun, M.D., Director of Medical Education, Monmouth Medical
Center, 300 2nd Avenue, Long Branch, New Jersey
Staff, Regional Medical Programs Service
Mr. Frank Nash, Acting Chief, Eastern Operations Branch
Mr. Clyde Couchman, Program Director, RMPS - DHEN Region 111
Ms. Joan Ensor, Program Analyst, Office of Planning & Evaluation
Ms. Marjorie L. Morrill, Health Consultant, Division of Professional
Mr. George Hinkle, Public Health Advisor, Eastern Operations Brar-h
Staff, Virginia Regional Medical Program
& Technical Development
Eugene R. Perez, M.D., Executive Director
Jack L. Mason, Ph.D., Asst. to Executive Director for Evaluation
Ms. Ann S. Cann, Communications & Community Affairs
Ms. Tandy Shields, Assistant to Communicatipns 6 Community Affairs Officer
Mr. Freeman H. Vaughn, Program Development & Operations Officer
Mr. Sam Kalman, Planning C Technical Services Officer
Mrs. Barbara Peace, Records and Registries Administrator
Mr. Archie Nelson, Jr., Assistant Allied Health Officer
General W. C. Haneke, Business Administrator
Mr. Arthur L. Burton, Assistant Business Administrator
Mrs. Mildred Brown, Community Liaison Officer
Mr. Fred Beamer, Community Liaison Officer
Mr. Henry Kauffelt, Community Liaison Officer
Mrs. Wilma Schmidt, Community Liaison Officer
Mrs. Norma L. Doeppe, Executive and Administrative Secretary
Representatives of the Virginia Region
A.
Regional Adviaory Group - Members
Anthony J. Munoz, M.D., Medical Society of Virginia, Private Practice,
Farmville, Virginia, Chairman of the RAG and Executive Committee
Virginia RMP -2- RM 00049
-
Representatives of the Virginia RMP (continued)
%,
8
A. Regional Advisory Group - Members (continued)
Mack I. Shanholtz, M.D., Commissioner, Virginia State Health
Department, Richmond, Virginia, Executive Committee of RAG,
Bylaws Committee
Mr. Hunter A. Grumbles, Hospital Administrator, Memorial'Hospital,
Danville, Virginia, Executive Committee of RAG, Program Committee
Mr. Bernard W. Woodahl, Executive Vice President, Virginia Division
American C&ncef Society, "Richmond, Virginia, Cancer Commit tee,
Btecutive Committee of RAG
Comonwealth University, Richmond, Virginia, Ex'ecutive Committee
of RAG.
Frank A. Wade, M.D., Chairman, Medical Society of Virginia,
Private Practice, Roanoke, Virginia, Review & Evaluation Committee
R. A. Mackintosh, M.D., Private Practice, President-Virginia
Academy of General Practice, Review & Evaluation Committee
Thomas C. Barker, Ph.D., Dean, School of Allied Health Professions,
Virginia Commonwealth University, Review & Evaluation Committee
Mr. James B. Stone, Executive Director, Virginia Heart Association,
Richmond, Virginia, Heart Disease Committee
Robert T. Manning, M.D., Dean, Eastern Virginia Medical School,
Norfolk, Virginia
Mr. D. Joseph Moore, Executive Director, Tidewater Regional Health
Planning Council, Norfolk, Virginia
Mrs. Jane B. Nida, Director, Department of Libraries, Arlington
County, Arlington, Virginia
L. A. Woods, M.D., Vice President for Health Sciences, Virginia
B. Board of Directors - Members
Daniel Mohler, M.D., Associate Dean, University of Virginia,  School
Charles Tomes, M.D., Ph.D., Medical Director, Memorial Hospital,
Kinloch Nelson, M.D., Assistant Chief Staff for Education, Veterans
of Medicine, Charlottesville, Virginia
Virginia State College, Petersburg, Virginia
Administration Hospital, Richmond, Virginia
C. Ad Hoc and Standing Committees
John C. Hortenstine, M.D., Director of Medical Education, Winchester
Memorial Hospital, Winchester, Virginia, Chairman, Heart Committee
Walter Lawrence, Jr., Division of Oncology, Medical College of
Virginia, Virginia Commonwealth University, Richmond, Virginia,
Chairman, Cancer Committee
Department, Richmond, Virginia, Committee on Kidney Disease
James C. Pierce, M.D., Medical College of Virginia, Surgery
Virginia RMP -3-
RM 00049
D.
E.
o
OrganizationslInstitutions
Daniel Mohlet, M.D., University of Virginia*
Warren H. Pearse, Virginia Commonwealth University (VCU)
L. A. Woods, M.D.; Vice President of Health Sciences, VCU *
Robert T. Manning, M.D., Eastern Virginia Medical School*
Raymond P. White, D.D.S., School of Dentistry, VCU
Mr. James Moore, Medical Society of Virginia
Frank A. Wade, M.D.; Chairman, Medical School of Virginia *
Charles Tomes, M.D., Ph,D. , Old Dominion Medical Society*
R. A. Mackintosh, M.D. , Virginia Acadmy of General Practice*
Mrs. Barbara Walker, Virginia Nurses Aesociation
Hr. Earl Willir, Virginia Hospital Association
Mr. Herbert Seal, Virginia Nursing Home Association
F. B. Wiebusch, D.D.S., Virginia Dental Association
Mayer Levy, D.D.B., Virginia Dental Association
Mr. Keith Kellum, Virginia Pharmaceutical Association
Ms. Barbara Gibson, Virginia Pharmaceutical Association
Mr. James H. Stone, Virginia Heart Aesociation*
Mr . Bernard Woodahl, American Cancer Society, Virginia Division*
Mr. Edgar J, Fisher, Jr., Va. Council on Health & Medical Care
Mies Ann McMeill, Tuberculosis 61 Respiratory Dieease Aseociation
Mr. Henry.Harmon, Model Neighborhood
Mrs. Poe, Model Neighborhood
Mr . David Benson, R$AF' (0 .E .O . )
Mr. W. H. Brower, CHP (A)
Mr. D. Joseph Moore, CHP (B)*
Kinloch Nelson, M.D., Veteretrans Administration*
Mack L. Shanholtz, M.D., Virginia State Health Department*
Others
Mr. Beverly Orndorff, Science Writer, Richmond Times Dispatch
Ms.
Mr .
Mr.
Mr .
Alberte Clayborn, Richmond News Leader
Gene A, Pierae, MCV, Renal Dieease
Robert Youngeman, Southeastern Inter-regional Exchange Prdgram
John Taylor, Congressman Satterfield'e Aesistaat
*Dual Listing
Virginia RMF'
-4-
RM 00049
INTRODUCTION: -
11.                   The Virginia Regional Medical Prograx
                   will have completed its first three
years as an operational program on December 31,  1972.
of the August 3-4, 1972 site visit was to assess the region's
overall progress, the quality of the current program and its prospects
for the next three years.
PURPOSES OF THE SITE VISIT
The purpose
The site visitors reviewed the Virginia RMP's decisionmaking and
review processes, administrative and evaluation capabilities, and
the current planning, involvement and accomplishments with respect
to program directions of the Regional Medical Programs Service.
The new review criteria and Mission Statement were used by the site
visit team as a guide in evaluating the overall program and arriving
at programmatic recommendation.
111. SITE VISIT OBSERVATIONS
Goals and Objectives
The Virginia RMP goals and objectives were developed after the newly
established Program Committee had reviewed national, state, and
local health priorities and received input from state and local
health planning councils,  the various health societies and associations,
other RAG members, and the Virginia RMP staff.
ives reflect the latest mission statement of the RMPS and are
explicitly stated even to the extent that activities to be directed
toward implementation and accomplishment of the stated objectives
are delineated, They are considered to reflect regional-needs and
problems to the extent that the activities identified with the goals
and objectives evolved from need identifying conferences and feasibility
and planning studies. It is considered that they have been accepted
by the health providers and institutions of the region as signified
by formal endorsement of the Program health provider groups,  and
membership of health providers and consumers on the RAG,  the Board
of Directors and various RAG committees. However, it does appear
that community and consumer group participation in the development
of the goals and objectives has been limited to their representation
on VRMP review and decisionmaking groups.
- __
These goals and object-
The region has endeavored to prioritize the goals and objectives as
well as proposed program activities.
system has been devised for establishing relative priorities of
individual projects/activities at the time they are reviewed by the
RAG.  Rating sheets are utilized that measure ten positive elements
(need-intensity need-extent, potential benefit success probability,
resource use and generation, scientifidtechnical characteristics,
A very thorough numerical rating
Virginia RMP -5- RM 00049
evaluation, educational strength, budget analysis, and program balance)
and one negative element (adveree reaction or effects).  These elements
are rated on a scale ranging from 0 to 5 and adjusted by as6igned
"weighing factors" that reflect the relative importance of each of the
elements evaluated.
objectives and prioritias established appear to  be adequate, evidence
was found that there is no clear plan for utilizing the ranking system
in establishing funding priorities.
visit team that confusion exists as to the purpose and potential
benefit of priority ranking as a mechanism for funding determinations
and decisionmaking,
need to more fully discuss and understand the intended purpose and
method envisioned for utilization of the goals, objectives and project
ranking system in future funding and policy determinations.
Although the procedures followed, and the goals,
It is the consensus of the site
It ie suggested that members of the Program
Accomplishments and Implementation
The VRMP is in its third year of operational activity, having been
awarded operational status effective January 1970.
that provider groups are looking to VRMP for consultation and assistance
and that the involvement of physiciana, nurses, allied health
professionals, hospitals, universities and other agencies in efforts
to improve health care throughout the region is making a difference in
the total health care system.
Evidence of significant program staff activities was manifested by
involvement directed toward improved care for stroke patients in
underserved areas, development of skills in utilizing medical audit
a8 an educational inetrmnt to improve quality of patient care, and
activities related to rehabilitation consulting teams for nursing homes, pro-
em in sickle cell anemia and many other areas.  Program staff has
assisted in the establishment of the Virginia Medical Information System
as a Statewide Biomedical Library service which is currently planned for
expansion to a subregional level.  The coronary care evraUatlon project
that originally began with five participating hospitals was expanded to
eleven; now that RMP funding is to be discontinued, it is anticipated
that the effort begun by the VRMP will continue at 8me hospitals and
be discontinued at others where the original objectives have been
accomplished o
of successful effort8 aseociated with consultations in discharge
planning, community hospital baaed physician education, and improved
care for stroke patients in underserved areas.  Program staff activities
have stimulated or directly resulted in greater involvement of dentists,
pharmacists, and allied health personnel.
better utilization of manpower through the continuing &cotion efforts
and dissemination of new knowledge and techniques through training
programs for myocardial fnfarction, cardiopulmonary reewcitation,
There is evidence
0
Current plaus provide for continuation and/or expansion
Activiti@o We resulted in
0
Virginia RMP -6- RM 00049
emergency coronary care, and continuing education training for nursing
--
personnel..
relationships in the five subregional districts staffed by the Community
Liaison Officers.  This process has been continuously evolving thrnugh-
out the development of the VRMP.
There is a measure of accomplishment in the building of
*
Areas of planned development that should have a direct effect on the
quality  of care and better utilization of manpower include proposed
project activities associated with family nurse practitioners,  career
opportunities for hospital personnel, obstetric training for nurse
practitioners, automatic patient history development and translation.
Progress toward cost moderation is anticipated by program staff's
discharge planning effort and the proposed project for development of
shared services, facilities and personnel for rural health care
institution of Virginia.
Minority Interest
It is not clear to what extent the Region has identified and analyzed
existing data that could permit the RMP to assess its role in meeting
health care needs of the underserved areas.  However, the response in
supporting sickle cell anemia education and screening activities and
the measurable model cities involvement by program staff would
positive action in meeting the needs of minority groups.
visitors were apprised of other endeavors to stimulate a greater response
for serving minority needs that were unsuccessful primarily due to this
group's preoccupation with employment and housing deficiencies.
was suggested that the VRMe should seek a more positive input in this
area from minority members of the RAG and Board of Directors.
believed that this input could result in stimulation of ideas that
could then be more fully developed by program staff with continued
consultation provided by these members.
indicate
The site
It
It is
Minority groups are represented on the Board of Directors (2 of 12),
the RAG (4 of 34) md professionally on the program staff (3 of 19).
However, the representation on standing committees and on other
committees of the VRMP was not viewed as favorable.
Increased minority group representation should be considered, not to
arrive at an equitable percentage relationship, but to reflect the
magnitude of the problem and to better serve the minority group
population in the VRMP area.
.it.
,.
. . .:
.. - ,
*
: I. .;
\ :.....
_. .
,
.. ..
- _.
Virginia RMP -7-
1 Continued Support
RM 00049
There is an established policy for withdrawing RMP financial support
at the end of the initial three year support period.
reported that it is actively seeking other sources of funding upon
termination of RMP aupporf, past efforts do not appear to have been
very successful - a situation that is not uncomanon to the VRMP.
Currently, ten projects are ongoing:
year of support and without any positive indication of a future source
of funding and two are being discontinued; one is being expanded on
a subregional level with two of the three medical schools providing
continued support for the ongoing portion, and two others are being
continued either partially  or completely by other funding sources;
the two remaining ongoing activities are to be continued as central
staff activities, only one of which has a positive commitment for
continuation by other sources.  The 15 proposed new projects in the
triennial application relate more positively to this iearue: The
VRMP is currently seeking support from the National Center for Family
Planning Services for two proposes sickle cell anemia activities and
addressee the issue in a positive manner for ten of the rematning 13
project proposals.  Of the remaining three, one is a short-term
assistance type activity without any long-term qualities, one is
reported as positively selected for continuation although the source
of funding is not mentioned, and the issue is not addressed in the
final one.
The Program is strongly advised to continue devoting this accelerated
attention to all program elements (including program staff continuing
activities) and to consider incrementally decreasing funding of
activities over the approved support period to facilitate the use of
RMP dollars for initiation of new activities directed toward
accomplishment of goals and objectives.
Although it was
three are still in the initial
0
Coordinator
Dr. Eugene Perez, the Program Coordinator, although he has a tendency
to overreact must be described  as a strong, competent leader that
relates well with the RAG, the Board of Directors, members of his
staff and other professional organizations.  He has orgmized an
effective and functioning etaff that appears to be well qualified and
highly motivated.  Even though the dminirrtrative naechanSem8 are
present for effective communication with the RAG, the presence of
ideal communication was questioned by the eite visitors and refinement
of these processes ie considered necessary,
It is strongly recomended that the Region be advised to accelerate
its current ongoing effort to locate and hire an effective deputy
iirector. Mot only is a deputy coordinetor considered essential to
Virginia RMP -8- RM 00049
insure continuity of the program, it would relieve Dr. Perez of
many of the daily time consuming routines thus permitting an even
-
greater involvement in overall program management and an intensif i-
cation and improvement of daily communications both within and without
the VRMP organizational structure.
Program Staff
The program staff is all full time, impressive, competent personnel
with an adequate range of professional disciplines and management
capabilities.
with respect to duties and responsibilities and very involved in
activities to strengthen relationships and foster involvement of
communities throughout the area. Site visitors, although not concerned
with the flexibility and dedication of members of the staff, were
apprehensive about the capability of the staff to adequately absorb
the increased work load with respect to monitoring,  evaluation and
RAG liaison that is inherent in the proposed expanded program.  (It
is noted that the current application
positions and five other positions for a planner, assistant plri: ier,
statistician, health educator and a registrar.)
The site visitors were especially cognizant of substantive program
activities placed under the management of program staff and encouraged
the region to secure a firm commitment of the RAG for developing
mechanisms for control and provision of necessary support for the
management and program monitoring rcqujred of these activities.
Individual employees appear to be highly knowledgeable
provides for seven secretarial
The VRMP plans include the opening of subregional offices ir, each of
the five areas of the State delineated by the Virginia Hospital
Association. Each office is to be staffed by an area coordinat-or
(currently employed and designated as a Community Liaisor. Officcr)
and a secretary.  The responsibility of the area coordin-~',~ will
be to work and plan -5th health care institutions, educatiw,il
institutions, health professionals and subprofessionals and othcr
interested personnel and programs 201- the improvement  of  the ' pa ttrh
delivery system through manpower development.  It is also planned
to establish Local Advisory Groups within each of the five  arcas
to more adequately determine local health needs and methods  fcr
successful attainment.
_i ..
.. . .*..
. .;.: : .
, .: . ..::
. . -
l,. ,
.. .,,,
:. - .
- 2: _-
, .:..:
... . .
___ .
~ - ~~- ~
Regional Advisory Group
The RAG is considered to be adequately representative of alL key
health interests, institutions and groups within the region aid C>&IE
that is actively participating in setting program policies,  estab-
...
Virginia RMP -9- RM 00049
lishing objectives and priorities, and providing overall guidance and
direction to the program activities although the site visitors sensed
that a greater degree of guidance and direction may be needed with
respect to program staff activities.
and the meetings are considered to be well attended, especially when
one views the wide geographical diotribution of the maberehip.
The RAG meets at least quarterly
An Executive Committee of the RAG has been established to act for
the RAG between meetings, subject to subsequant approval of the entire
group, but the visitors considered this six-member group small
comparison to the proposed expanded program and too provider dominated.
It is recommended that the group be enlarged, preferably by the
addition of consumer-non-provider type representation.
in
The Virginia RAG ha8 made extremely significant progresa in regard
to orientation, indoctrination and active participation of its members
since the last site visit.
appear to be very capable and dedicated with the common goal of
making the VRMP a viable and recognized health care source in Virginia.
During the past year, the group's bylaws have been rewritten to (1)
mre effectively state its responsibilities and the responsibflities
of the Executive Director eo the group, (2) provide for more frequent
meetings and (3) establieh a new Program Cornamittee, Bylaws Committee,
an Ad Hoc Committee on Allied Health and an expanded role for the
Review and Evaluation (NE) Committee.  The RAG membership in line
with the expanded role of the R & E Committee, has participated in
local site visits to ongoing projects and an increase in this type
of effort is planned.
heading of "Management", it was the consensus of the team that the
workload envisioned is too great for this five member R 6 E Committee.
Improvement in this area, more effective channels for communication
between the RAG and program staff as previously stated, and minor
changes in the RAG composition and cormnittees (such as lay consumer
interests on the Executive Comrmittee and more adequate (b) agency
representation) are recommended to complement the already significantly
improved RAG.
Members interviewed during the visit
However, as more fully discussed under the
Grantee Organization
The Virginia RMP is an incorporated entity governed by a 12-member
Board of Directors.
of 18 former RAG members who were very active and knqwledgeable
concerning the purposes and working mechanisms of a Regional Medical
Program.  Since incorporation, three of the original Directors have
once again accepted membership on the RAG, thus assuring knowledge
and understanding of the eeparate functions of each of the two groups.
The grantee organization was originally composed
Virginia RMP -10- RM 00049
The grantee organization provides adequate administrative support,
the needed freedom and flexibility, and recognizes the RAG'S policy-
making role as set forth in the RAG bylaws.  To further facilitate
efforts to expand daily communications between the Board of Directors,
the Executive Director, his staff, and the RAG, it is strongly
recommended that ex-officio Board of Director membership on the RAG
be provided, and vice-versa.
-
Participation
The Virginia RMP has established close interrelationships with
major health oriented organizations within the State,  it is in
communication with Model Cities programs in Norfolk and Richmond,
Virginia, and it has demonstrated effort toward developing relation-
ships with CHP (b) agencies. Although the relationships with-CHP
(b) agencies have not been sufficiently accomplished, the Program
appears to be
to continue efforts in this direction.
for adequate representation from all (b) agencies on the RAG was
stressed by the site visitors,
cognizant of this need and has expressed its  intent
In this connection, the need
'-.<-
Cooperative efforts and liaison with health oriented organizations are
the RAG'S various standing and ad hoc review committees, and program
staff.
objectives of the VRMP and has once again endorsed the program.  The
Region has established a working relationship with the newly emerged
Eastern Virginia Medical School and has continued its involvement '
and mutual cooperative arrangement with the other two existing medical
schools,
is actively involved with the participation of all three medical
schools, CHP (a) and (b) agencies, the state and local health
departments, both the Medical Society of Virginia and the Old
Dominion Medical Society, Virginia Academy of General Practice,  and
others.
exemplified by interlocking memberships on the VRMP Board of Directors, f ,- *
-_
The State medical society has reviewed the new goals and
It would appear that the political and economic power complex
In view of the Program's interest in continuing education activities,
it is encouraged to continue to improve relationships with the medical
schools and the community colleges, but cautioned not to ignore
hospitals in its continuing education efforts.
Local Planning
The VRMP has demonstrated achievement toward developing relationships
with CHP (b) agencies. Although, the relationships have not been
sufficiently developed, the Region appears to be cognizant of this
Virginia RMP -11- RM 00049
need and has expressed its intent to continue its efforts in this
direction. In this connection, the degree of success varies in
each of the five subregional areas of the VRMP.
ticipation by the Tidewater CHP (b) agency and memberghip
Executive Director on the RAG tends to be indicative of opportunities
of early planning input from this area, although the actual quality
of the input could not be determined.  Of the remaining five CHP (b)
agencies in the region that are considered operational, positive
relationships were reported by only  one of the program staff Community
Liaison Officers.
Active project par-
of its
The Program has established a mechanism for obtaining CHP review and
comment, but it would appear that the action is not completed with
sufficient lead-time for the comments to be considered by the RAG.
It was suggested to the site visitors that the "stepped-up" (one
month) submission date for the current application did not provide
sufficient time for receipt and consideration of comment during this
submission cycle.
The VRMP's plans for Subarea Coordinator Officers and the establishment
of Local Advisory Groups (LAG) are envisioned as providing a workable
mechanism for greater local involvement in the development of program
proposals and program direction.  It is recommended that the Region
be advised to consider representation from these LAG'S (e.8. Chairman)
ae active members of the Regional Advisory Group to enaure local input
into the decisionmaking and policy determining proceas.   ,
Assessment of Needs and Resources
At the present time there is no systemmatic continuing method of
identifying needs, problems and resources that has resulted in program
decisions based on an analyeis of data, but representatives of the
Program have stated their intent to assess needs as identified by
the emerging CHP process,  Goals, objectives and priorities are largely
designed to be consistent with national priorities and are in agreement
with the RMPS mission statement for regional medical programs.  The
RMP has utilized group discussions, staff visits into the area, and
the activities of the Community Liaison Officers in the five subareas
of the VRMP to determine the immediate needs of the population.
The Virginia Council on higher education has been given the respon-
sibility of compiling a complete inventory of all health care personnel
and facilities within the region.  The VRMP will cooperate with the
Council in the survey activities and the publication of the results,
and is actively collecting a data base (Central Tumor Registry) with
the ultimate goal of providing better care for precaent and future
cancer victims in Virgiuicr.
Virginia RMP
-
-12- RM 00049
An improved health data base is stated as one of the goals of the
VRMP.  Congruent with this goal is a planned survey to determine
educational needs of health professionals and health care institutions
to facilitate effective planning for continuing education of health
care personnel.
,-
Management
The management "blueprint" followed by the Virginia RMP appears to
be conceptually adequate in that periodic progress and financial
reports are required, provisions have been made for monitoring of
projects and other activities by program staff and members of the
RAG, and personnel are considered professionally qualified and
competent. However, as stated elsewhere in this report and repeated
here for both emphasis and quick reference,  this is the area in which
the site visitors believed a greater refinement and strengthening of
procedures would most significantly improve the Program.
a. The Review and Evaluation Committee (R 6 E) in its expanded role
  reviews and reports to the total RAG as to the efficiency of the
  various program activities, in addition to its primary responsi-
  bilities for (1) performing or causing to be performed all required
  technical reviews of new applications and (2) establishing a
  recommended priority for funding when reporting to the RAG.
  this regard, especially with escalation of R i E Codttee members'
  participation on site visits, it is the consensus of the team that
  the work load and responsibilities should be delegated to a larger
base of technical and scientific expertise.
In
b. Communications should be improved both within the VRMP organi-
zational structure and with other health interests throughout
the region.
organization is placed upon the need for,more timely and complete
involvement of the RAG in the day-to-day activities with possibly
the program staff preparing briefs to facilitate absorption of
the data by the RAG Chairman and other committees and members.
In regard to other health agencies, improved communications and
working relationships with the existing and emerging CHP (b)
agencies are recognized for primary emphasis, especially with
respect to determination of health needs in underserved rural and
urban areas and for improved coordination with resultant mini-
mization of duplication and dilution of health improvement efforts
within the region.
Emphasis for improved communications within the
'
c.
The Executive Committee should be enlarged and be truly repre-
sentative of the RAG composition. In this connection, non-provider
representation should be included.
'L
Virginia RMP
-13-
RM 00049
Evaluation
The VRMP is experiencing problems common to many RMP's in the
development of an effective evaluation process.
evaluation staff member, but the site visitors have concluded that it
is too early to judge the evaluation progrram under way
state that the techniques and evaluation data being obtained need to
be improved.  The evaluative syetem provides for progress reporting
and review by project directors, site visits and routine monitoring
by program staff and members of the RAG with provisions for feedback
to appropriate groups.  However, there is no indication that these
evaluation efforts have resulted in program modifications or that
ineffective activities have been discontinued or scaled down.
Discussions with the Region in  regard to it8 evsluativs efforts and
among members of the eite visit team durSng executive mssions, high-
lighted the urgent need for all regional medical programs to improve
evaluation methods and techniques.  It was the consensue of the team
that a greater effort needs to be directed toward facilitating
exchange of ideas, methods and even "peer" review of evaluative
techniques utilized by all regional medical programs in assessing
both project and program effectiveness.
It ha8 a full-time
except to
Action Plan
Since the last site visit, the VRMP has established a RAG Program
Committee whose responsibility is to review and update goals,
objectives, strategies and concepts for the VRMP along with the
primary responsibility of providing guidance to the Executive
Director for program activity and project development.  The RAG
has recently accepted new goah and objectives formulated by this
Committee which enables them to move from a heretofore categorical
emphasis.  These are considered to be congruent with the national
objectives and in agreement with the new REIPS mieelon statamat.
Administrative procedure8 for reporting accompliehmante, monitoring
the progress and aseessing and evaluating results have been
established, but a greater refinement of these efforts is considered
essential.
0
Dimemination of Knowledge
VIRMP has been actively participating on the Coordinated Health Survey
Committee with CHP and the Virginia Council on Health and Medical
Care in surveying health manpower, facilities and services in the
State and has assisted in the dissemination of the results.  This
survey will become an mpual activity to establish a ool~lpon data base
e
Virgfnia.RMP -14- RM 00049
eventually to be transferred to a State Ceater for Health Statistics,
A Health Data Library, established in the VRMP office, provides
services primarily utilized in program staff operations.
these library resource materials are available to other agencies and
other individuals upon request,
The Virginia Medical Information System project has provided ready
access to medical information obtainable from regional and national
sources. It is currently planned to establish two information
sub-centers at community hospital libraries that will cooperate
with the ongoing system that is to be continued by the two medical
school participants.  It is proposed that this endeavor will be
supplemented by a Virginia Drug Information and Consultative Service
project during the next triennium.
Provider groups and lnetitutions that will benefit from the proposed
activities have been determined to some extent, although, knowledge,
skills and techniques to be disseminated, in most instances, are
yet to be determined and are
Many of the proposed activities are to be based in health education
and research institutions of the region and are designed to provide
better care to more people by
and dentists and by providing for the assumption of time consuming
routine procedures by specially trained allied health personnel.
These efforts, if successful, could result in improved availability
and accessibility of health care accompanied by a moderation of
health care costs.
3
4
However',
included as objectives of the activity.
improving the skills of physicians
\
_-
--
Virginia RMP -15- REI 00049
Utilization of Manpower and Facilities
Improvement of the quality of health manpower and the efficiency
and economy of health care services in Virginia are identified
priority areas for the VIW. Activities directed tow8rd the develop-
ment of shared services, facilities and personnel in rural areas,
the provision for new types of allied health personnel such as the
proposed obstetric and family nurse proctitimar traSning programs,
and efforts toward the expanded role for pharmacists and new career
opportunities for hoapital personnel will reault in increased pro-
ductivity of phyeiciarce and other allied health promuel.
many of the octivitiee are directed toward greater ufillzation of
manpower and facilitiar in rural areaa and will undoubtedly benefit
the areas in which the activity is to be conducted, the immediate
overall regional benefit is viewed as me that wdd be relatively
insignificant,
Although
Improvement of Care
By intensified utilization of local workshops, group discussions,
activities of the Cormamity Liaison Officers, staff visits throughout
the area, and planning and feasibility studies the RMP has msde
progrees in identifying problem areas and developed methode by which
ambulatory care might be improved.
and project activities should measurably expand ambulatory and emer-
gency medical service care.
components realistically based on present knowledge are included
in the application.  However, tin the opinion of the site vicsitors,
the proposed objectives appear to be overly .rnbr5emeb
pated that the activities could lead to improved ~CCQCIS to primry
care and health sarvlces in underesrved rural areae, but that the
improvement in undareerved urban and ghetto area# will be minimal.
As stated before, repreeantativas of the VW were encouraged to
increase staff efforts In the latter areas.
Many of the program staff activities
                                            '
Realth maintenance and disease prevention
tt a arptid-
Short-term Payoff
Short-term payoff is inherently a part of the continuing educational
and training proposals and will be realized if these activities
are successful in accomplishing their stated objectives.  In addi-
tion, program staff activities directed toward discharge planning,
Virginia RMP -16- RM 00049
the quality of medical care assurance based on chart audit and-con-
tinuing education, rehabilitation consulting teams, and improved
care for stroke patients all have the quality and potential for
immediate benefit to recipients of the services.  If one can assume
that manpower savings realized by more efficient techniques,  the use
of less highly skilled personnel for routine services, and improved
productivity of hospital and allied health personnel by providing
greater career opportunities and incentives could lead to moderation
of health costs, then the proposed activities will moderate health
costs. However, short-term payoff does not appear to be the primary
goal of the proposed program.  The VRMP did not demonstrate to the
site visit team that sufficient time had been devoted to the develop-
ment of short-term goals, although the policy for withdrawing support
after three years is well established and indications are that it
can be done successfully.
4
.
Regionalization
The program plan should assist in creating new linkages among health
providers and institutions, and it is aimed at assisting multiple
provider groups and institutions.
the Drug and Medical Information network projects,  the Radiation
Therapy Consultant Service activity, and the proposal for Development
of Shared Services in Rural Health Care Institutions are specific
examples of items included in the plan that have this underlying
quality.
and manpower and extending the capabilities to a larger area of
the population.
geted and varied project activity is proposed,  the site visit team
was greatly concerned about the seeming absence of coordination
between similar and related activities.  It was suggested by members
of the site visit team that consideration be given to combining some
of the education and training activities proposed.
The Kidney Disease proposal,
Each of these is capable of insuring sharing of facilities
While a wide range of health providers are tar-
..
_.i
. I
I ."
, > .
:.- .
-.
I.._
Other Funding
The Region has been reasonably successful in attracting funds for
ongoing activities from local and State sources.
application indicates other sources of funds totaling $198,172 or
6.6% of the total requested direct cost  amount.  Furthermore, the
VRMP has indicated that it is actively seeking other federal funds
for support of the two sickle cell anemia activities included in
The current
Virginia RMP -17- RM 00049
the current application.
been made and more positive results are anticipated toward obtaining
commitments assuring activity continuation from other funding sources
once RMP funding is withdrawn.  Please refer to the section Continued
Support for a more detailed analyeis of this area.
It is also noted that great strides have
Conclueions
The site visit team was generally
the VRKP since the last site visit. Indoctrination of the compara-
tivelynew RAG appears to have been successful in that the members
are actively participating in the decision and policymaking processes.
The development of this group has been further enhanced by the
reappointment of three former RAG members who had resigned to accept
appointment on the Board of Directorr for the VRMP.
impressed with the progress of
The VRMP has refined its organizational and managerial structure
to provide for more frequent RAG meetings for execution of its
responsibilities and greater involvement of RAG members in the
evaluative and monitoring aspects of the program.
The concept of using RWiew and Evaluation Committee (R&E) members
for monitoring of operational activities by reviewing progress
reports and participating in site visits for evaluation (with the
assistance of program staff and RAG members who live in the vicinity
of the project) should be &ore workable if the RbE Committee is
expanded to lessen the work load on individual members.
The VRMP bylaws have been rewritten to more positively state the
functions of the RAG and the responsibilities of the Executive
Director and his staff to the RAG.
been established for regular review and modification of the goals,
objectives, and priorities of the VRMP $0 that they may effectively
reflect the needs of the region and still remain congruent with the
mission of Regional Medical Programe a8 reflected by national needs
and priori ties o
The planned establishment of Subregional Area Coordinator offices
of Local Advisory Groups (LAGS) to more positively determine local
needs and priorities should provide an even firmer foundation for
the program expaneion envisioned in this application.
A new Program Committee has
,
in the five geographical eubdivlsions of the region and the formation
While focusing on the improvements and latent potential of the VRMP,
one must also consider the need for further refinement (as noted
Virginia RMP
-18-
RM. 00049
-
throughout this report) of the areas in which progress is so note-
worthy __. with special consideration being given to the need for
improved communications between the primary managerial components
of the region:
staff (including the subarea coordinators) and the Board ofgrectors.
The Region needs to develop improved coordination of fragmented
efforts in similar and related type activities such as those directed
toward pharmacists, dentists, and other allied health personnel.
need to be coordinated and developed on a regional basis with greater
participation from interested groups. In this regard, since the
August 3-4 site visit, word has been received from Dr. Perez, the
Program Coordinator, that a meeting of representatives of health
organizations and groups interested in emergency medical services
was convened on August 9, preliminary to development of a Coordinated
EMS System for the State of Virginia,
follow-up meeting is planned. )
the RAG, Executive Director, members of the program
w
. bolated activities proposed in the area of emergency care systems
(Progress was made and a
Recommendations
The proposal, as submitted, is viewed as an ambitioMundertaking
administratively efficient program staff and place too great a
monitoring and evaluative load on the maturing RAG and its Committee
structure.
._
,
that might very well overburden the small though well qualified and
'_
Accordingly, the site visit team recommends that the VRMP be approved
for:
(1)
(2)
Triennial status at a $1,800,000 direct cost level for each
of three years ;
A developmental component in the requested amount to be funded
within the total $1.8 million level.
In the opinion of the site visit team, while permitting expansion
and gtowth to a viable region, funding support at the reduced level
will make necessary greater program coordination among the various
activities (program staff ad projects) and closer monitoring of
daily progress to obtain the most effective utilization of avail-able
funds.
.I .
,.. .
. -.
,.. .
i ..
7 ..
.. ;.
1. , ., f
.I
I . ..
.-'.."'
Review Cycle: 10/72
RMPS STAFF BRIEFING DOCUMENT
Vfl 8- fl qwq .-
REGION: Virginia            OPERATIONS BRANCH: East ern
NUMBER: RM 00049              Chief: Mr. Frank Nash
e L
I COORDINATOR: Eugene R. Perez, M.D. Staff for RMP: George F. Hinkle
                                        Marjorie Morrill
                                             Charles Barnes
LAST RATING: 246 Joan Ensor
TYPE OF APPLICATION:
- I' X/ Triennial - I' / Triennial Mr. Clyde Couchman
- - 3rd Year Regional Office Representative:
-
2nd Year
I_
1 1 Triennial - I' I' Other
__.
Management Survey (Date):
Conducted: July 1971
Scheduled :
or
Last Site Visit: September 14-15, 1971
Sister Ann Josephine, Review Committee, Chairman
Bruce W. Everiet, Council Hember
Louis K. Collins, M.D., Conmltant, Private Physician
William C. Fowkes, Jr., M.D., Consultant, California W, Region 111
Fred Shapiro, M.D., Consultant, Renal Disease
Staff Visits in Last 12 Months:
April 6, 1972 - Attend RAG meeting and discuss recent developments at
the National VRMP level.
(subsequently approvedlfunded) Emergency Medical Services
Pro3 ec t .
Application.
April 17, 1972 - Provide staff assistance in resolution of a proposed
June 7, 1972 - Attend RAG meeting for review and approval of Triennal
Recent events occurring in geograph:Lc area of Region that are affecting
RM! program:
(a) In 1972 the General Assembly of Virginia amended and re-enacted
legislation relating to exemption from tort liability of persons
rendering emergency medical services in Virginia. After July 1, 1972,
paramedics who are properly trained may perform more advanced emergency
procedures such as initiating intravenous fluid therapy, administering
medications to relieve pain and prevent cardiac arrest, and perform
cardiac defibrillation.
(b) Legislation has been passed that permits dental students entering
their senior year  to accept summer employment in state supported and
government institutions in the community when supervision is provided
by a Medical College of Virginia (School of Dentistry) faculty appointee.
I. .
,,
VIRGINIA REGIONAL MEL,' A PROGRAM
SUB REGIONS. (FIVE) + PERFORMANCE SITE DATA **
TRIENNIAL APPLICATION, .
I
,
P
-I-
DEMOGRAPHIC INFORMATION
Population (1970 Census): 4,648,500; Approx. 63% urban, 19% non-white
and a median age of 25.9.
U.S.
-
State
35% 35%
Under 18 years
18-65 years         57% 55%
6 5 -over            8% 10%
Land area: 39,838 square miles Population Density: 117/square miles
Major SMS Areas:
Health Statis tics:
Facilities:
Population RMF
(000) Sub-Region
Lyn chbu 1: g            121.8 IT
Newport News-Hampton    289.3 V
Norfolk-Portsmouth     633.1 V
Richmond             515.6 IV
Roanoke             179.4 I1
(Metro DC Area)      (350 .O) (111)
Mortality rate per 100,000 population for Heart
Disease is 312, 128 for cancer and 85 for CNS
Vascular Lesions all of which are from 15-19%
below the National average.
for all causes is 820.9 whereas the U.S. average
for all causes is 935.7.
Deaths per 100,000
The State has two major medical facilities, the Virginia Commonwealth
University (Medical College of Virginia) and the University of Virginia
School of Medicine.  Within the State are 34 nursing schools that offer
Registered Nurse programs and 44 nursing schools which offer L.P.N.
programs.
cytotechnology facilities and 23 Radiologic technology facilities
within the State.  One school each in the disciplines of Dentistry,
Pharmacy, and Allied Health and Physical Therapy are located within
the State at the Virginia Commonwealth University, Richmond.
The American Hospital Association (1970 Guide Issue) reports 102 short
term hospitals and two long term general hospitals with 16,385 and 434
beds, respectively plus two V.A. General hospitals with total bed capacity
of 1,493.
with nursing care and 20 long term care units with respective bed
capacities of 6,862, 2,873 and 925.
The State of Virginia has 4,900 physicians (106/100,000) and 28 osteopaths.
There are 16,487 professional nurses of which 4,975  are inactive and
5,843 licensed practical nurses of which 959 are inactive.
region has approximately 949 radiologic technoligists, 2,611 pharmacists,
2,552 dentists, and 433 dieticians.
There are eleven schools of medical technology,  four
There are 82 skilled nursing homes, 59 personal care homes
The Virginia
E
S
1 \,..
'\
Current hnuzlized\
CO2p"Clt Level 03 Year
t for Tri
2nd year
-
-
c0ur.c
.st year
nial
3rd year.
sequc
1st year
(376,769
,)
1,893 ~136
t ,150,429
.,054,027
S 501,225
(41,802)
89,000
-I)-
1,169,137
L,574,982
536,566
(142,675
( 136,996)
( 128,045)
( 48,669
--
I
( 52,094
--
--
I
c
COEXIL RECO?-MEXDED LEVEL
* Included in Pro
,,+* Earmarked - Inc
f
$2, P89,54 3
1
$1,037,791
TOTAL DIRECT COSTS
I
$1,010,000
'am Staff total
d
d
lded in Operational Pro ects - +,?tal
i J:,
*a
..
-I
I
,l
!
I
8
-c1
I
c
JULY lee 1972
B
..
..
' 'i
, ?...
, , ,'
I.:
.. .
..
.. .
....
KtlilON -  VllrClNIA
RM 00049 10/72 PAGE 4 I
wrps-csr-Jrrr.a?- 1
JULY 18,1972
P.REIKOUT OF RFPUEST
05 PPLGRAM YLRIUI;
I
I
JULY lEs1972
,.
.. . '
..
PEGION -  VIRGIhIA
RR 00049  1U/72 PACC 5
,I,.* It.. ,*I.*.*- ,
(51 (2 i (4 1 (1 I
LUNI. Ultl~lNI WN1. ULYUkJ]  AI'JJH. hU1   I hl kr hL1   I 311D VfhR I
APFR. PEPlCCl  PPPR. PFRlCOl  PREVIOUSLY  I PRLVILUSLY  1 CIRFCT I
CF SUPPCWl I  1F SUPPORT I  FUhCEO     I APPHUVID    1 COSTS I
I I I I I
I TrTN 1
I ALL YEAPS I
IDlFECT CCSTS I
i I
BREAKOUT OF REOWEST
06 PRnGRAM PEPIWl
WCGIUN - YIHGINIA
'PAGE 5
Rn 00049 :0/7z
RCPS-C Sr- Jl CCP? -1
                              ( 51
IOENlIFICATICN CF CCI(PChEN1 I CGNT. kITFINl
                     I APPR. YERICOI
                     I I
036 CBSlCTR1# IRAINING PROGR I 1
1 CF SUYPCRl I
(21 (4) (1 1
CCNT. BEYOND1  APPR. NOT   I NEhv NOT    I 3R0 YEAR I
APPR. PERICCI  PREVIOUSLY  I PFtVlLUSLV  I CiRCCT I
Lt SUPPCRT I  FUkOEO      I APYHUUtl)    I COSlS I
I I I I
I TCTAL 1
I I
I I
I ALL YEARS 1
II)IRECl CCSIS 1
I I i I
A* I I S6L9fZ I UMuLi-ines,elr_r
                   1-
037 SHAREC SEW RURAL hEAlTk( I 1 I I I I
                                                          I
                       I
       <l 1 AZrAQh
030 SYSTLY FCP ILhITCPIhG CUI I 1 I I I I I
                   I sw2q I $2-9 1
039 FARILY fCUCATlON PROGRAM1 I I I I I I I
                                                              s12.ZOa I
ullX_EZ-uu
04a COWWLAITY HLALTM ECb CChl I I I t I I
I ?t
Lp+suLL,
I
TOTAL
..
Region: Virginia -
Review Cycle: Sept./Oct.
HISTORICAL PROGRAM PROFILE OF REGION --
The Virginia Regional Medical Program received its initial planning grant
award in January 1967 with the University of Virginia School of Medicine
in Charlottesville, Virginia as the Grantee, Congruent with awarding the \
02 year continuation grant for planning activities in March 1968,  the
grantee was changed to the Medical College of Virginia in Richmond,
Virginia (now the Virginia Commonwealth University).
The first two years of planning activity were marked with concerns relative
to the absence of representation cf paramedical personnel and minority
groups on the Regional Advisory Group and inadequate Program Staff.   In
addition, evidence of a cooperative medical school commitment to the .
Program was not present, planning efforts continued to remain at a minimum
level, and sub-regionalization was considered to be at an elementary stage.
,
In July 1968, the Region's operational grant application was disapproved
with the awarding of continuation support for an 03 year of planning
activities.  The Region was advised that core activities be strengthened,
that a regional approach be used in project development,  and that the
Advisory Group be increased in nuuber and that it include representation
from paramedical professions and minority groups.
The Region resubmitted its operational grant application to the December
1969 Council and a site visit was made to the Region on October 1-2,  1969.
The December 1969 Council concurred with the recommendations of the site
visitors and the Review Committee that the Region be awarded operational
status.  Of the seven projects in the application, Council approved five
projects for the initial operational status award and then subsequently
(March NAC) approved two new projects, one of which was funded during
the 01 operational year with additional funds and the other through the
rebudgeting mechanism.
the grantee organization for the Virginia RMP.  Nine additional members
had been appointed to the Regional Advisory Group, which brought the
total membership to twenty (20) members (current membership is 36).
Four outstanding committees on heart disease, cancer, stroke and related
diseases were created to replace Task Force members and these were
broadened to include dentists, nurses, hospital administrators and
minority representation.
consideration in the formation of these committees, An Executive
Committee, consisting of six members and exercising all of the authority
of the Advisory Group relevant to its functions at interim between
meetings of the RAG, was activated.
established an RMP Committee for heart disease, cancer, stroke and
related diseases. Each medical school Committee chairman acted in
liaison capaclty between the schools and the RMP Central Office and
also as an official member of the Coordinating Planning and Evaluation
Committee (Medical School Liaison officers have been eliminated in new
VRMP, Inc. organization).
The Medical College of Virginia remained
Regional representation was also taken into
At this time, each medical school
During the February 1971 review cycle the Region's request for a
developmental component was denied because the plan of action was thought
to be too general and a sufficient degree of maturity had not been attained.
Concern was also expressed over the reduction of medical representation
on program staff by the deletion of three consultant positions although
there was indication that active recruitment for a physician to fill
the deputy coordinator position was underway (recruitment for this posi-
tion is not included in the current application).  The inability to
detect a satisfactory plan of action remained a growing concern although
it was encouraging to note that steps had been taken to strengthen the
program evaluation and administrative sections.
Effective March 1, 1971, the Grantee was changed from the Virginia
Commonwealth University to a corporate body, the Virginia Regional
Medical Program, Inc. The motivating reason for this change in grantee
evolved frola what was considered to be inadequate fringe benefits. The
Virginia Commnwealth University is a state supported institution,  its
employees are regulated by the State Merit System and given State  retire-
ment benefits. However, since the VRMP employees are paid by a Federal
grant they were not considered to be State employees and were not eligible
for State employee fringe benefits.
A Regional Medical Programs Service Management Survey was conducted
on July 26-28, 1971 during which the administrative systems, policies
and practices were reviewed. Although some areas were considered to
need greater administrative and fiscal controls, major deficiencies
were not uncovered.
istration and Grants Management (Business Administrator) was considered
to be the key to prodding the necessary controls.  In a relatively
short time four different individuals had occupied this position.
The incumbent during the Management Survey still serves in this capacity.
The last review cycle (October/November 1971) included a September 13-14
site vlsit initiated at the request of the Coordinator.
issues of discussion focused upon the newly established Regional Advisory
Group the difficulties encountered by the Region in changing its program
direction from one of a strictly categorical nature, and the request
for a developmental component.
I
The supervisory position for the Division of Admin-
The paramount
Concomitant with the March 1, incorporation all but two of the existing
members of the Regional Adviaory Group were organized into an eighteen
(18) member Board of Directors.  The RAG membership was increased to
thirty-six that included two former RAG members and ten members who had
functioned in various committee capacities. Reviewers were concerned
about the relative newness of the RAG and recommended that extensive
orientation measures be taken, the RAG meet at least on a quarterly basis,
and a mechanism be developed to enable the RAG to participate in a more
meaningful project/program review and evaluation.
Region's goals were Considered to be quite diffused, the categorical
emphasis of the projects was not favorably reviewed and the developmental
Furthermore, the
- 14 -
-
request was disapproved.  It was sugl;ested that another year was needed
for the Region to indoctrinate and dcwelop the RAG into an effective
decis ionmaking group and present a program application along the guide-
lines of the new Regional Medical Program mission.
The newly established RAG had met only once prior to the last review
cycle, but has had four meetings since December, including a two-day
retreat for orientation of new members. RMPS staff has attended two
of the recent RAG meetings during wh:ich project activities, program goals
and objectives were review.
100% participation from the members.
visited projects for evaluative purposes and indoctrination.
The discussions were lively with almost
RAG members have reportedly site
The RAG bylaws and VRMP Guidelines for Project Applications have been
re-written since the last review cycle and the goals and objectives
have been revised from a strict categorical emphasis (heart, cancer,
etc,) in an effort to implement the new mission of.Regiona1 Medical Programs
in a manner designed to be harmonious with national needs and priorities
- and the needs of the people of the State of Virginia.
- 15 -
Region:, Virginia
Review Cycle: Sept/Oct 72
1.
2.
3.
4.
5.
6.
7.
STAFF OBSERVATIONS
Principal Problems:
The absence of a deputy coordinator and the diminishing physician
input to Program Staff.
Program Staff turn-over since last review.
Apparent fragmentation of project and continuing education efforts.
Over-reaction of the VRMP to areas of concern and funding decisions
made at the National level.
Degree and actual extent of cooperative relationships with other
organizations.
Principal problems during last review:
(CHP Agencies and Medical Schools)
Little accomplishment toward establishment of new goals
and objectives.
Medical school involvement other than through project activity.
Need for indoctrination of new Regional Advisory Group - more
frequent meetings .
Inadequacy of meaningful mechanism for RAG to participate in
project/program review and evaluation.
Need for refinement of role definition and role dikstinction
of the Board of Directors and the Regional Advisory Group.
Greater emphasis needed for coordination of the Region's
efforts in responding to consumer needs and in programming
these activities into the overall goals and plans.
Categorical emphasis of projects.
Principal Accomplishments
Location of nursing coordinators in five educational institutions
throughout the State. (Project 119).
Establishment of Virginia medical information system as a statewide
biomedical library service. (Project 117)
Efforts to improve management of stroke patients in rural areas by
involvement of medical center with the physicians and other health
professionals in the community. (Project 64)
Emergency medical service training activities associated with CPR
and emergency coronary care procedures for volunteer rescue squads,
(Projects P3 & 14)
Reported success of a discharge planning feasibility study and its
plan for expansion to VRMP subre~$.ons.
- 26 -
Initiation of Sickle Cell Anemia (SCA) education program in public
schools and provision of assistance in coordinating SCA efforts
throughout Virginia.
-
Involvement of closer working relationships between the three medical
schools, the State Health Department and the Virginia Medical Society.
The VRMP and the School of Allied Health of Medical College of Virginia
conducted the first State conference of allied health in the State of
Virginia.
Efforts of Program Staff associated with development of skills in
utilizing medical audit as an educational instrument to improve quality
of patient care.
Impressive program of continuing education for nurses and the movement
toward expansion to other allied health professions.
The establishment of new goals and objectives and its movement in a
new direction to improve health care delivery professions.
Important steps toward improving the basic organization:
accelerated efforts to indoctrinate the new Regional Advisory Group,
assignment of Review and Evaluation Committee members to projects for
review of progress reports, site visits and evaluation, and updating
of the RAG By-Laws and Virginia RMP Guidelines for Project Application.
incorporation,
Issues requiring attention of reviewers
1.
as determined by last review.
Evaluation of progress toward resolving principal problems
2.
Capability (qualifications and potential) of new Program staff.
3. Policy issues with respect to:
(a) Tumor Registry Activity.
(b) Sickle Cell Anemia activities (Projects and Central Regional
  Services Activities).
(c) Nature of some activities classifi.ed as Central Regional
  Services Activities.
SITE VISIT REPORT
o
I*
WEST VBGINIA REGIONAL MEDICAL PROGRAM
AUGUST 7 & 8, 1972
SITE VISIT PARTICIPANTS
Consultants
Henry Lemon, M.D., Professor of Medicine, University of Nebraska, Omaha,
Gladys Ancrm, Ph.D., Community Health Board of Seattle, Seattle,
Bland Cannon, M.D., Memphis, Tennessee, National Advisory Council member
Winston R. Miller, M.D., Director, Northlands Regional Medical Program,
Richard Haglund, Acting Director, Intermountain Regional Medical Program
Nebraska, Chairman
Washington, Review Committee member
Inc., St. Paul, Minnesota
Salt Lake City, Utah
RMPS Staff
Clyde Couchman, Program Director, RMP, Office of the Regional Health
Joan Ensor, Program Analyst, Office of Planning & Gvaluation, Division
Martin Greenfield, M.D., Health Consultant, Division of Professional &
Frank S. Nash, Acting Chief, Eastern Operations Branch, Division of
Norman Anderson, Public Health Advisor, Eastern Operations Branch,
Director, DHEW Region I1
of Operations & Development, RMPS
Technical Development, RMPS
Operations 5r 3evelopment, RMPS
Division of Operations & Development, WS
West Virginia RMP
Charles I). Holland, Director
William A. Ternent, Associate Director
Norene M. Thieme, Program Analyst
Sheila D. Baquet, Office Assistant I
David S. Hall, Ph.D., Director, Office of Research & Evaluation
Edward M. Bosanac, Data Analyst
Peter P. Gallina, Coordinator Field Operations
William G. Cooper, Area Liaison Officer
Gerard R. Hummel, Area Liaison Officer
Larry E. Yost, Ph.D., Program Specialist, Health Manpower
William D. Wyant, Program Specialist, Emergency Medical Service
Robert 3. Williams, Program Specialist, Health Care Delivery Demonstration
West Virginia RMP -2-
RM 00045 -
SITE.VISIT PARTICIPANTS (continued)
RAG Members
Jimmie L. Mangus, M.D., Chairman
Frank W. McKee, M.D., Dean West Virginia University of Medicine
Charles E. Andrews, M.D., Provost for Health Science, West Virginia
Harry S. Week, M.D., President, State Medical Association, Planning
Haynard Pride, M.D., Private Physician, Health Manpower Committee member
A. Thomas McCoy, M.D., West Virginia State Medical Association, Health
Manpower Committee member
Fay P. Greene, M.D., West Virginia State Medical Association, Health Care
Delivery Demonstrations Cornittee member
Patricia Brown, Consumer Member, Planning and Evaluation Committee,
Consultant Representative, State Comprehensive Health Planning Council
School of Kedicine
and Evaluation Cornittee member
Committee Yembers
Dr. Ralph Nelson, Planning and Evalution Committee member, Provost-off-
Dr. Harry Stansbury, Planning and Evaluation Committee member, Director,
Charles Lewis, Member, Health Manpower Committee, Staff member, State
Daniel Hamaty, M.D., Chairman, Health Manpower Committee
Mrs. Geariean Slack, Member, Health Manpower Cornittee, Associate Professor,
West Virginia University School of Nursing, Director, Continuing Uucation
-Robert Eakin, Member, 'Bealth Care Delivery Demonstration Committee,
Administrator, Menlorial General Hospital Association
Mrs. Carol Cutlip, R.N., Kember, Health Care Delivery Demonstration Corn.,
Assistant Administrator, Fairmont Clinic
Leon H. Kingsolver, Member, Health Care Delivery Demonstration Cornittee,
Director, Comprehensive Council of ,Region VI1
Fred Parker, Member, Emergency Medical Services Committee, Southern West
Virginia Regional Health Council
Samuel W. Channell, Member, EZnergency Medical Services Committee,
Executive Director, West Virginia Pharmaceutical Association, Osteopathic
Associa tion
Campus Education, West Virginia UniverSity
Comprehensive Health Planning
Medical Association
Other Resource Persons and Visitors
Edward Perrine, hmediate Past Director, Health Planning Association of
North Central West 'Jirginia, Region V
Walter H. Moran, M.D., Professor, Department of Surgery West Virginia
University Schooi of Medicine
West Virginia RMP -3- RM 00045
Other Resource Persons and Visitors (continued) -
e
Patrick Hamilton, Attorney for the HYGEIA Foundation
James Hart, Consultant for the HYGEIA Foundation, Reprenentutive
Charleston Area Medical Office United Mine Workers Welfare and
Fund
Mrs. Joanne ROSS, Director, Southwest Community Action Council
Joseph T. Skaggs, M.D., Former RAG member, Leadet of a developing group
Barbara Jones, M.D., Professor and Assistant Chairman, Department of
Allen Strum, Project Director, Upshur County School Health Program
Larry Thompson, Director, Health Incorporated, Parkersburg, West Virginia
Robert Youngerman, Inter-Regional Informational Exchange Program Representative
Allen Graham, M.D., National Health Service Corps Assignee to the Crum-
practice in Charleston, West Virginia
Pediatrics, West Virginia University
Kermit Medical Center
West Virginia RMP
-4- RM 00045
INTRODUCTION:
The primary objectives of this site visit were to review progress
made by the West Virginia RMP since the last visit and  to determine
their overall readiness for implementation of a three year program
plan.
Based upon the evidence and information gained through this site
visit, it is concluded that progress has been made and that the
West Virginia WP is truly developing a regionalized program.
strong points of this program are well chosen and clearly recognized
objectives around which planning revolves.
Delivery; Emergency Medical Service; and Healrh Manpower. The site
visit agenda was organized primzrily around the program objectives.
The
They are: Health Care
The West Virginia W has been guided by ah effective combination
of the West Virginia Medical Center and the State Medical Association
who provide medical direction to the Ccordinator.  The site visit
team rated the Coordinator very high for his administrative abilities,
energy, and understanding of the needs and practicalities of program
achievernent in this area.
with the Regional Advisory Groilp, reacting appropriately to the
health needs of the region.
workingwith other organizations in the State to get matching funds
and in particular, to develop structures for comprehensive health
care planning ("b" agencies), although these agencies have experi-
enced delay in getting under way.  The West Virginia R4P has approached
the improvement in health care delivery by multiple routes  and has
developed six subregional offices staffed by regional liaison officers.
The regional liaison officers closely coordinate their activities
with the "b" agencies and the University's county extension programs
and this approach has proven effective in gaining entree to  interested
consumers and providers in the area.
The program staff functions very well
Staff has been very effective in
The site visitors reviewed the West Virginia RMP's decisionmaking
and review processes,  administrative and evaluation capabilities
and current planning, involvement and accomplishment with respect
to the program directions of the Regional Medical Programs Service.
The review criteria and Mission Statement were used by the site
visic team as a guide in the evaluation of the overall program.
-5-
RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72
1. GOALS, OBJECTIVES, AND PRIORITIES (8)
For the most part the program has been characterized by exceptional
performance in this area.
lies in a well conceived and developed planning process built around
clearly defined program goals and objectives.
to refine and redefine these objectives,  and has arrived at three
primary goals toward which it will direct its efforts;  these address
the State's most critical health needs: health care delivery,  emergency
medical services, and health manpower. The priority concern for all
of these goals is creating and improving access to care in the unserved
and underserved portions of the region.
In fact, one of WRMP's major strengths
The program has continued
The question of the degree of provider acceptance of the program's
goals and priorities is one that is difficult to answer.
that key provider institutions (e.g., medical school and state medical
society) accept and understand the basic tenets of the RMP, but it
appears doubtful that the word has been adequately spread to some of
the more rural areas, particularly to community physicians and foreign
medical graduates practicing in remote locations.
question that
that their formulation was based on perceptive recognition of
consumer needs: this program can certainly be described as one
whose prime focus is to meet the desparate health needs of the
medically indigent,
It is clear
There is little
the stated objectives respond to community needs and
2. ACCOMPLISHMENTS AND IMPLEMENTATION (15)
Program staff activities have resulted in substantial achievements,
including in particular the development of a number of programs
directed toward improving the distribution of medical services in the
region. These programs. primarily dealing with the establishment of
outpatient clinics and group practices in underserved areas of the
State, are baaed upon a thirty-year background of community efforts
to increase and maintain physician coverage of the State's population.
Although the clinics will probably neither lead to wider application
of knowledge and techniques nor to any reduction of medical  care costs,
there is no question that they are the sorts of program which will
meet a critical need in West Virginia, that of providing access for
those who now enjoy only limited or no entry into West Virginia's
health care system.
-6-
RMP : WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10L72
,
2.
ACCOMPLISHMENTS AM) IMPLEMENTATION (15) Continued
Particularly encouraging is the development of group practice
affiliations in two major medical centers remote from the University.
It is anticipated that these will be sites for expanded residency
training programs at some point in the future, and that they will
become subcenters of excellence for the care of categorical diseases.
Their establishment should be recognized as one of the outstanding
achievements made through the coordinated efforts of the medical
school and the RMP, both by virtue of their intrinsic value and
because they have resulted in a broader base for physician and other
provider acceptance of the Regional Me'dical Program,
4
3. CONTINUED SUPPORT (10)
The policy of actively searching out other sources of funding for
activities begun under RMP auspices has been one of the program's
major strengths. One must note, however, that West Virginia RME'
may encounter difficulty in pursuing this policy in the future
because of the State's limited resources.
-7-
RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72
4. MINORITY INTERESTS (7)
West Virginia's black minority makes up approximately four per cent
of the State's population.  Ethnic pockets exist only in the larger
cities, notably Charleston (5.6% black) and southern McDowell county
(25%).  Questioning of the program staff and RAG members brought  out
the fact that the major focal point of the program has been the
poverty level and medically indigent population in general, without
attention to specific mihority groups.
relationship with the Appalachia Regional Commission and has been
successful in obtaining funds to support projects directed to the
poverty level and medically indigent population.
has apparently given so& thought to the development of activities in
the McDowell area, there have been some problems with the project
director of the five million dollar health care program, supported
by the Appalachian Regional Commission, in the entire nine-county
southern portion of the State, including McDowell. Due to these
conflicts, this has been the last area to be considered in the W'S
subregionalization plan.
The program has a good working
Although the program
While the Coordinator was emphatic about his efforts to recruit
minority employees for the program staff,,it was the feeling of the
visitors that minority groups were under-represented (currently
minority employment consists of only on& black secretary) and that
efforts should be continued to recruit both blacks and women to the
staff.
policy in recruiting students for medical training;  it is one of
accepting only "high achievers,'' that is,  those students with records
of outstasding accomplishment in their undergraduate studies.
was brought out in the discussion that the level of educational
services in many of the poverty districts was such that little
achievement could be demonstrated, thus creating somewhat of an
artificial barrier for minority students wishlng to further  their
education.
might be modified; until that time, however,  the RMP should continue
efforts to recruit qualified minority staff members from outside
the State.
Another matter of concern mentioned was that of the University's
It
It is hoped that the University's admission policy
.-.
-a-
PREPARED BY: Norman Anderson
DATE: lo/,,$$- >+..
RMP: WEST VIRGINIA
5. * COORDINATOR (10)
The Coordinator has obviously provided strong leadership in the
development of the West Virginia RMP.
and managerial abilities to deal with the problems with which he is
faced. He relates and works well with the RAG and in the last four
months has recruited an individual as associate coordinator who
appears likely to provide the necessary planning and administrative'
assistance needed in a larger program.
coordinator the RMP has hired three program specialists,  a data
analyst and a field representative.)
it is advantageous to have a non-medical man in this particular
position since he has to relate equally diplomatically to the
University and to the leadership of the State Medical Association
in a manner which will generate a minimal amount of  friction and
a maximal amount of cooperation.
1
He has adequate administrative
(In addition to the associate
The site visitors feel that
This has obviously been achieved.
6. PROGRAM STAFF (3)
The program staff are all full-time and represent a broad range of
competence with the exception of the key disciplines of medicine
and nursing.
established in the program staff at least as half-time positions
with authority and responsibility in the areas of planning and
evaluation.
A physician and nurse staff position should be
r.
..
-9-
DATE: 10/72
_-
RMP: WEST VIRGINIA PREPARED BY: N0rma.n Anderson
7. REGIONAL ADVISORY GROUP (5)
The RAG and its subcommittees have more than adequate representation
from providers and other health interests throughout the State.  The
RAG itself is heavily provider oriented: including alternates, its
total membership of 38 (+12 alternates) consists of 24 physicians,
four hospital administrators, and five other health professionals,
all together accounting for over 90% of the membership.
four non-provider members, only one might be considered a "real"
consumer, in the sense that she represents the poor and medically
underserved population of the region.
site visit team that the Regional Advisory Group composition
should be modified to be more representative of consumer groups
(induding racial minorities which currently have only minimal
representation), the nursing and allied health professions, and
community colleges.
This modification may well necessitate amending the RAG bylaws,
which now call for representation from a specific list of health
organizations and ipterests  in the State.
impressed by the testimony of one of the RAG members, Ms. Brown
describing her "living room" approach for stimulating consumer
interest both in the West Virginia RMP and in health care in
general.  It is hoped that this approach will do much to  foster
consumer participation in the program.
It was felt that the RAG has an excellent attendance and partici-
pation record. Meeting of RAG subcommittees, likewise, seem to
be well attended and to have garnered enthusiastic support.
Of the
It was the consensus of the
The team was especially
e
While the RAG does play a role in determination of policy and
overall program direction, it was the site team's impression
that this role is one more of reaction than action. It seems
that program staff are responsible for most of the actual
planning and program implementation, although the RAG is kept
informed of developments. From information presented, it appears
also that RAG does not monitor or evaluate program staff activities.
The RAG'S Executive Committee, like the larger body, is not
broadly representative of the health and consumer interests in the
State. This particular group, in fact, numbers no racial minorities
or women among its members.
group also needs to be expanded to provide for more input from
nurses, allied health personnel, and consumer groups.
It was the visitors' feeling that this
7. REGIONAL ADVISORY CROUP (5) Continued
Since staff is non-medical and under great influence from the Univeristy
it seems appropriate that specific mechanisms be developed to insure
that: RAG expertise and perspective are utilized in monitoring and
evaluating program development.
conceptual. framework for revising or discontinuing specific activities.
4
This will help provide a broad
8. GRANTEE ORGANSZATION (2)
The Dean of the tledical Center stated that he is the budget officer
for West Virginia RMP and that he periodically meets with Mr.
Holland (although there is no regular schedule for such consultation).
The Dean attends most of the Executive Committee meetings.
further stated that it is Mr. Holland's responsibility to keep him
informed of West Virginia RMP's activities.
nications are maintained between the University and the W..
There is a Hedical Advisory 'Committee to the Coordinator, composed
of the Dean, the Provost for Health Sciences and a Professor of
Surgery.  Again, no meetings of this group are scheduled.
of contractual procedures the RMP must use the University system,
and as a state institution, the University must use state procedures
and meet state requirements.
approved through the President's office of the University.
system is complex but the University is wholly committed to the
RMP and its success and has made several significant efforts to
eliminate procedural delays that the RMP has encountered.
He
Open lines of commu-
In terms
All contracts are processed and
This
Responding to site visit team questions about the informality of
staff, RAG and grantee relationships, the Dean stated that "it
seems to bother you people that we get along so well together."
He said "we have a compatible marriage and that if the RMP did
not have the support of the University it would be a disaster
because they could not stand alone."
other reports such as the Management Assessment Report that the
Vest Virginia RW is strongly supported by the University.  The
site visit team was convinced that the grantee organization
does provide adequate administrative support within the constraints
of the state government system and permits sufficient freedom for
This further substantiates
- 11 -
RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72
8. GRANTEE ORGANIZATION (2) Continued
program development. The University does not swm to be interfering
with RAG'S policy making role.
nication and liaison between the RAG, the program staff and the
University through the crucial presence of Dr. Andrews who has
exerted a very strong directional influence in the past. He claims
currently not to be directly involved in programs, although his
influence is probably still significant in less direct ways.
There is obviously very good commu-
However, West Virginia RMP may need special consideration by the
University in terms of personnel policy and the establishment of
salary levels far program staff in order to be competitive with
other IMP'S to recruit and retain competent program staff.
.
9. PARTICIPATION (3)
Almost all key health interests are actively participating in the
West Virginia RMP and it does not seem to have been captured or
co-opted by any major interest.
economic power complexes are involved but the HYGEIA Foundat ion
which provides a significant portion of health care in the State
has not yet been brought into active RAG participation. As an
example of participation Mrs. Joanne Ross, Director, Southwest
Community Action Council stated that the RMP regional liaison
officer has provided a great deal of assistance and that "RMP
is a mover and a doer."
The region's political and
- 12 -
-
RMP: WEST VIXGINIA PREPARED BY: Norman Anderson DATE: 10/72
io. LOCAL PLANNING (3)
The State Comprehensive Health Planning Agency is in the Governor's
office staffed with a full-time director and a secretary.
are six established (b) agencies and West Virginia RMP has been
instrumental in getting each of them operational. As a result of
a recent CHP study a total of eleven (11) regions have been certi-
fied for planning.  This means five (5) more (b) agencies are to
be developed. West Virginia RMP will provide assistance in the
development of h (b) agencies.  The State Agency Director says
he has no problems with matching funds, but the (b) agencies have a
lot of problems with matching funds. The State agency provides
assistance to WP staff in developing data. The comprehensive
health care agencies have been slow in developing, but we might
anticipate a faster growth in the future.
There
West Virginia ZiXT has recently developed .and. published a report
entitled, Guidelines for Proposal, Review and Operations of
Activities which adequately describes the review process of  the
region: The Guidelines specify that the proposal is sent to the
appropriate Comprehensive health planning agency for its review
and comment at the same time the proposal is submitted to the
West Virginia RMP Technical Review Cormnittee for its assessment.
From all indications very good working relationships exist between
West Virginia RMP and CHP.
meet the stated review requirements of applications by CHP.
The Guidelines as written more than
Recomxrmded Action:
11. ASSFSSMENT OF NEEDS AND RESOURCES (3)
lIhe West Virginia RMP has participated with the University and CHP
in data collection to identify health needs, health manpower and
health resources in the State. Bealth needs in the State are many
and are characterized by the State being  the third most rural in
the nation, by having the second highest ratio of proprietary
hospitals, and by having a very high percentage of physicians
who were trained in other ccuntries. The State has approximately
400 unlicensed foreign named physicians working in the State.  A
method should be developed to provide full accreditation for those
physicians and equal participation in the affairs of  the medical
community.  The need to establish residency training programs in
- 13 -
RMP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10172
the State is well documented.
has increased nursing manpower by approximately 30 lpercent and a
corresponding decrease in physician manpower by approximately 30
percent.  Many of the remaining physicians will be of retirement
age in the next few years.
developed concurrently with the goals and objectives and the
restructuring of the technical committee and program staff,
the past the area liaison officers have functioned somewhat
pendently in assessing the health needs in their area.
Over the past few years West Virginia
The current triennial application was
In
inde-
12. MANAGEMENT (3)
The central office program staff was reorganized and expanded  to
support the work of the field staff.
together with the field operations coordinator make up an organizational
unit which is one of only two activities that report directly to the
program coordinator.  The other organizational unit is the Office of
Program and Grants Management which is a standard administrative
service organization.  In view of the p-ojected program growth
this office may need to develop additional strength to provide the
coordinator with adequate financial monitoring and control.
All three of the other program staff organizationalitunits report
to the coordinator through the recently established position of
associate coordinator. These three organizational components are:
Office of Program Research and Evaluation, Office of Program
Planning and Development, and Office of Information and Comuni-
cations. The Office of Program Planning and Development is a new
activity that was initiated to assist the field staff. This office
is comprised of four staff specialists'in the area of Health Care
Delivery Systems, Emergency Health Services, and Health Manpower
and Medicine.
The area liaison officers
_-
---------
- 14 -
RYP: WEST VIRGINIA PREPARED BY: Norman Anderson DATE: M/72
12. MANAGEMENT (3) Continued
Changes made following the Management Assessment visit in June,
are apparently seen as satisfying personnel and organization
structure needs for the future.
if the projected program expansion is approved.  Position
descriptions are not yet available and fiscal procedures have
not been written out. With the Management Assessment and
site visit accomplished, staff plans to take up these tasks.
This may need further review,
llecomended Act ion
-
13. EVALUATION (3)
The Office of Program Research and Evaluation is staffed by a
program evaluator, a data analyst-and a research assistant.
Evaluation is in the process of transition and change  and
upgrading cannot be adequately evaluated in all phases as yet.
West Virginia RMP does require quarterly progress and financial
reporting on all operational activities.
periodically meet with project directors in their areas to
discuss progress of a given activity as it relates to the
objectives.
i
I
Field staff members
- 15 -
P: WEST VIRGINIA PREPARED By: Norman Anderson DATE: 10/7
Program Proposal
The priorities of the proposed program by the region are well established
and understood in terms of objectives, but their use in the selection of
proposals to be funded, and in preparation of the developmental component
are not spelled out in detail.  The activities are highly congruent with
national objectives and needs.  The proposals appear soundly based and
realistic in view of resources.
ated, although we are not sure that enough
in the review and evaluation process to insure this.  The reporting
methods proposed for three month monitoring of projects seem fairly
subjective at present.
when necessary.
The results can be quantitatively evalu-
sophistication has developed
The region has been quick to modify its objectives
A decision was made early,  in view of their major objectives, to improve
health care delivery but to leave to the University the major responsibility
for continuing education. Some limited self-evaluation demonstration
projects hairs hen developed for physicians, and a visiting physician program
was instituted which was not very successful and is no longer operational.
Linkages are being developed for closer cooperation in postgraduate medical
education at the residency level. The emphasis is upon delivery of
the common rather than rarely required facets of health care, such as
emergency medical services.
The program generally should have an impact on improvement of facilities
for delivery of health care and utilization of present personnel (midwife
and pediatric nurse physicians assistants). The planning for this began
early in the program.
Improvement of clinic care is a major prospect for several portions of
West Virginia through the development of new clinics.
emphasis deals with the development of improved access to patient care
under difficult local conditions. These activities are strongly sub-
regionalized and can be expected to have immediate payoffs  in better
patient care, with increased availability of and access to services,
and improved quality of care.  However, total medical care costs will
probably increase rather than decrease as services are made available
to areas where medical care has previously been
short supply.
The total program
nonexistent or in very
Important developments to improve categorical types of health care in the
long run appear through:
1. Supporting care linkages between the general group practices in
outlying communities (such as Hygeia supported clinics) and multi-
specialty groups in urban areas, as in Charleston and Huntington.
2. Development of residency programs in the latter areas, which can
  increase physician retention in the state from a 40% level at the
0
I
- 16 -
RMP: WEST VIRGINIA PREPARED BY: No- DATE: 10/7 5.;
-
end of medical school, to a 7077, level at the end of residency training.
There are no residency training programs now, although one is being
started,
These two factors will strengthen relations between general and specialty
care and should lead to improvement in the quality of care.
d
The region has been outstanding in obtaining outside funding for its pro-
grams.
value and viability of the program plans.
believe that an official letter from the State Medical Society, endorsing
the program as stated in the triennial application, would be helpful.
It is the site visitors' opinion that an action pattern has been established
which, barring unforeseen complications, can i.mprbve the quantity 200-30(X
within the next decade,  This impression was substantiated by a visit
to the Fairnont Clinic to determine what has been accomplished through
strictly local means.
This fact alone serves as the most.concrete demonstration of the
The site visitors, however,
Site Visit to Fairmont Clinic, Fairmont, W. Va.; August 8,  1972
'fhe site visitors terminated their work with a visit to a nonprofit
clinic organized 15-20 years ago by the Monongehela Valley Health
Associatian (a lay group).which now offers a full range of health
services, including home care, clinic care, and hospital care. The
clinic averages 500 patient visits daily from 8 a.m. to 10 p.m.,
with a staff of 13-14 full-time physicians, and with its own integral
pharmacy, X-ray, lab, emergemy room, record room, and podiatry service.
It accepts
.persona? ffndnces, and operates two satellite clinics in the hills
six and 31 miles distant.
$20-25.
embracing hospital, clinic, and home care.
story building downtown housing their home health service.  This is
split into care grol;ps by age (over 56 and under 65), with two separate
nursing staffs, and covers the surrounding rural area as well.  The
Fairmont clink has one of the new Family Health Center Grants thus
far awarded by HSWl.A.
patients, including 50% not covered by third party or
      The average patient visit cost runs from
Records are all typed and of high standard, with a unit system
There is a separate five-
This clinic, and an even more extensively developed clinic at Elkins,
which fnclzdes transportation facilities for patients, should at some
time recei.ve careful evaluation with respect to actual costs and
benefits of operating an areawide health system embracing the home and
clinic (but not hospital costs, these being handled by an independent
agency).
At present there is little linkage between this clinic and WVU
Medical Center, since third and fourth year clinical clerks have been with-
drawn in favor of hospital assignments.
REfP assisted materially in
\ L .'!
\.___I.
- 17 -
-
WEST VIRGINIA PREPARED BY: Norman Anderson DATE: 10/72
obtaining the Family Health Center Grant, and has established an
excellent working arrangement with this clinic.
a tremendous demonstation project and local resource
The clinic represents
SUMMARY
The site visit team was very impressed with the energetic program staff,
the cooperation and assistance provided to other agencies, the coordinated
team approach to health care, the excellent subregionalization and their
resourcefulness in garnering funds from other sources. The WVW was
described as a well oiled machine that is responsive to the health needs
of the region.
and published report entitled: Guidelines for Proposal, Review and
Operations of Activities which ad-equately describes the review process
of the region.  Everyone agreed that this is a well prepared report
and a definite asset to program development.
The site visitors were pleasdwith the recently developed
The grantee organization has been responsive to  the needs of the WVRMP
as was descri'ueci in the Management Assessment Report in April when
the grantee obtained authorization from the West Wnia  State Auditor
to make operating capital advances to institutions that collaborate
with the Regional Medical Program and do not have the capital  to
implement the agreed upon program activity, During the course of this
site visit this continued commitment was restated.
It was felt that there has been adequate flexibility established with
RMP under the university structure, however, some problems still exist
concerning the fiscal system, salaries, personnel qualification, and
acceptance by the university personnel system which are slowly being
aired.
The team was a little concerned with the informality of the administrative
procedure, but observed that excellent rapport has been established with
the key health industry in the state.  We did suggest that the administra-
tive procedures be adequately described in writing.
It is the opinion of the site visitors that the West Virginia Regional
Medical Program has made an impact on the Health Care System.
is a mature region that has performed well and has acquired the necessary
skills and organization to continue to improve and influence the health
care system in the wild and wonderful State of West Virginia.
This
RECOMMENDATIONS
1.
That the West Virginia Regional Medical Program be approved for triennial
status with the follming funding levels:
04 operational year      $1,500,000
05 operational year      $1,600,000
06 operational year      $1,700,000
- 18 -
WEST VIRGINIA PREPARED BY: Norinan Andersorr. DATE: 10/72
The recommended funding levels include the developmental component
request.
following:
ment in program staff support, even though the visitors felt that the
voiced concern with regard to two of the proposed operational
activities:  the first, V6luntary Office Self-Audit Services, because
it reaches only a limited number of physicians in the state and its
cost benefit relationship seem very high; and the second, the Camden-
on-Gauley Medical Center, because the team felt that the Pd4P should
make efforts to obtain matching funds from the Hygeia Foundation,
which is sponsoring the program.
-
The site team made these recomendations based upon the
(a) that the program is not requesting any major incre-
program is slightly understafedxb) the visitors in particular I
2.
That nursing, medicine, 2nd social service disciplines be added to program
staff as at least half-time positions with major responsibility and
authority in the areas of planning and evaluation.
3.
That written policies and procedures delineating the respective admin-
istrative responsi3i:iiies of the WVRMP and the grantee institution
be developed.
4.
That the bylaws of the Regional Advisory Group be revised to allow
broader representation anu specific responsibilities of the grantee,
the RAG and the program staff.
allied health, nursing professions, and consumer interests should be
represented on the RAG.
types of representation desired, rather than specific organizations.
Currently, any change requires revision of the bylaws,
that addition of representatives from the rural provider insitutions
(especially the UMW-affiliated Hygeia and Ephraim McDowell Foundations)
was especially important, since these organizations have contributed
heavily in carrying out the RMP goals for broader health care coverage.
The RAG could easily reduce its representation among the categorical
voluntary health agencies to a single representative member for all of the
agencies currently represented.
from community colleges, nursing, social service, allied health, and consumer
groups o
That RAG develop a procedure for applying established program priorities
and criteria in project funding determinations.
of a comprehensive review and funding process.
Rural health care provider institutions!,
Flexibility should be increased by specifying
It was felt
Further, RAG should increase membership
5.
This should be part
6.
That efforts to recruit additional female and minority personnel on
program staff be continued, and that actlvities be initiated which
will, impact cjn specific minority pockets.
That a portion of the developmental component be used to carry out
the additional planning and research necessary to develop a
residency trainicg program for primary and secondary physician training
7.
- 19 -
PREPARED BY: Norman Anderson DATE: 10/72
* W: WEST VIRGINIA
in several of the major hospitals in the State.
the State Medical Society has obtained $300,000 from the State
legislature to assist in the improvement of the residency training
program.
component was to be used for anything other than the general objectives
and patterns of activfties that were described.  The site visit team
felt it would be appropriate for the West Virginia RMP to utilize
portions of this developmental component to obtain maximal physician
retention estimated at 70% through assisting in the establishement of
the residency training programs outside of the medical center, particularly
in Charleston, Wheeling, and other major communities in the region.
It is to be noted that
The site visitors did not perceive that the developmental
Review Cycle: 10/72
-
c
REGION:
NUHBER:
RMPS STAFF BRIEFING DOCUMENT
West Virginia
RM 00045
COORDINATOR: Mr. Charles Holland
LAST RATING: 358,
OPERATIONS BRANCH: Eastern
--.-
Chief: Frank Nash
Staff for RMP: Norman Anderson -
I__-
Eileen Faatz
TYPE OF APPLICATION:
/--IT/ Triennial LIJ Triennia1
3rd Year
2nd Year
L-. 7 Triennial LJ Other
Regional Office Representative:
Clyde Couchman
Management Survey (Date) :
Conducted: April 24-27, 197 2
Scheduled :
or
Last Site Visit:
(List Dates, Chairman, Other ComitteelCouncil Members, Consultants)
July 8, 1969 - Anne Pascaeio, Ph.D. - RMP Review Committee
Bruoe Everist, M.D. - RMP National Advisory Council
Desmand O'Doherty, M.D. - Consultant
Staff Visits in Last 12 Months:
(List Date and Purpose)
September 28, 1971 - Alan 8. Kaplan, M.D. (Staff Assistance)
April 24-27, 1972 - Management Assessment (Tom Simonds, Rod Merhker,N. Anderson)
April 26, 1972 - Verification of Review Process (N, Anderson, Clyde Couchman)
June 23, 1972 - Staff Visit (N. Anderson)
Recent events in geographic area of Region that are af f ec tin&
RMP program:
1.
2.
3.
4.
WVRMP has recently redefined and restated their objectives to be more
responsive to the needs of theiRWon.
'Ihe Technical %vim Committee structure has been reorganized. A
Technical Review Committee has been established for each of  the three
objectives.
WVRMP has developed and published a report entitled, Guidelines for
P$cuiYoral, Review and Operations of Activities which describes the
review process of the Region.
Management Survey team report and verification of the review process
report .
-_
Mr
Robert Whit lex
.-
Mr . Gerald Humme 1
258 Stewart Street
Morgantown, West Va.
, I
Mr. Garvey Gilaore
Eishop Hill Building
203 Randolph Avenue
Elkins, West Virginia
-- / /-
-3-
DEMOGRAPHIC INFORMATION
1.
2.
3.
e 4*
5.
Geography
Region: West Virginia
Review Cycle: 10/72
-
The region conforms to the political boundaries of West Virginia,
For planning purposes the region has been divided into nine sub-
regional areas.  The boundaries of these sub-regional areas  are
the same as those of CHP "B" and the State Economic Development
Department. Land area: 24,079 square miles.
Papulation:
1970 Census
a. Total: 1,744,200
b. Urban: 39%
C. Rural: 61%
d. Minority: 4%
Income:
State of West Virginia - 1969 ($2,610) - 1970 ($2,929)
United States - 1969 ($3,680) - 1970 ($3,910)
West Virginia ranks 46th in the U.S. per capita income
Average income per individual - 1969-1970
Age distribution:
Age group
under 18 years
18-65 years
65 years and over
Facilities and Resources:
West Virginia
33
56
11
a.
b, Sixteen Schools of Professional Nursing, seven of them
c,
West Virginia University School of Medicine
college or university based.
Sixteen School of Practical Nursing
U.S.
35
55
10
-
Allied Health Schook
a. Two schools of cytotechnology
b, Sevem*sehaole of Medical technology
c.
Twenty-four schools of radiologic technology
-4-
Ho s pi t als
a.  Short term - 74 - 9,286 beds
b. Long term - 2 - 460 beds
C. V,A.Gerfral Hosp. -4-1,257 beds
6. Manpower: Active
* a. Physicians - 1,596
b. Osteopath - 100
c. Professional Nurses - 4,704 (260 per 100,000)
d. Lic. Pract, Nurses - 2,317 (136 per 100,000)
Total - 1,696 (94 per 100,000)
-
*
From a study conducted last year, utilizing the West Virginia
Medical Association Journal  of new members of the West Virginia
State Medical Association from 1961-1971, the following data was
collected.  A preliminary analysis of the data shows that, of
all new members of the Stare Medical Association, a significantly
high and growing proportion are foreign medical graduates (9%
of these joining in 1961 vs. 65% in 1971),
_-
COMPOSENT iWD FXNAYCIAL SU4WWIY
TRI EKN I AL APPLIC.4TION
2nd year
_-
3rd ye=.
Kidney
E.3 *
(2f , 556)
hs/ea
PediatricTulEonary
Gther -
.
(24,105)
TAL OIREcf COSTS**
* $63,'375
**$863,375
- ._
CurreRt hnuzlized
      04 Year
Level
-
$ 57.7,086
148,466
-_
--
222,914 .. .
800,000
' $ 929,810
cified Growth Funds
Ileac1
1st year
$ 584,725
95,222
  80,000
' 1, i35 ; 15 3
25,000]
41,506
[ 49,830)
$1,799,878
..
Co:!!?c
1st year
I.
I
c
d
d
!
. 1'
i
!
I
I
I
I2
..
I
co
I
JULY I 7, I.* r,!
      EM I            I                                    I            I I    r41JPP 1
022 PARKEkSUUcb AhtA HdRt t-tl            1 1            I I           I I            I
021 SAILLLITE HtALIH LtNltiiSl I - I I I i
-
#.?nu L-LLLrlo&QQe-lrso.oooJ 12~W I
' flLUrLl;r'Y
- 10 "
Region: West Virginja --
Review Cycle: 10/72
History. - In December 1965, Dr. Clark K. Sleeth, then Dean of the
     West Virginia University School of Medicine,  convened a
meeting to discuss the State's participatfon In RMB.  The meeting
was attended by representatives of the State Departments of Health
and Welfare, the West Virginia Heart Association, the Wesr Virginia
Division of the American Cancer Society, the West Virginia Hospital
Association, the West Virginia University Medical Center and the
general public. Upon unanimous agreement to participate, the Medical
Center was selected to initiate and coordinate planning co establish
the WVRMP.  A 28-member RAG was appointed and Dr.  Sleeth was elected
chairman. The RAG appointed 8 12-member staff committee to prepare
the planning grant application.
This region received a planning grant for three years beginning
January 1, 1967.  The amount awarded the second year included a
supplement of $141,807 for four geasibility studies; (1) Suivey of
a Rural Area (Blacksville); (2) Mechanical Morbidity Reporting by
Physicians; (3) Coronary Care Unit; md (4) Physicians Self-Audit.
The latter three also were supported in the third year. The third
year was extended seven months to August 31, 1970, and the Self-
Audit to September 30, 1970, with no additional funds.
A site visit was made in July 1969 to assess the region's capability
to become operational.
had many obstactles to overcome.
economic crises, leaving most areas without adequate health care.
Small towns, rural and mountain areas, so predominant in West Virginia,
lacked health personnel.
and there was little evidence of effective continuing education into
the hospitals and medical profession.  Add-lng to these problems, Dr.
Wilbar, the Regional Coordinator, died in January 1969. Mr. James
G, Holland, Associate Coordinator, was sPrving as Acting Program
Coordinator,
coordinator poeition, the site visitors believed the region was ready
for operational status.
has taken an active role in the WW 2nd good physician and nurse
participation was evident.
cooperative arrangements.  As pointed out to the region,  there was a
need for better minority representation on the RAG.
KAG only recently had organized its comittee structure, and it was
too early to determine how well it was working.
on joint planning with Comprehensive Health Planning were projected
for the near future. Council recommended approval for operational
status for three years for core and four projects.  Mr. Charles D.
Holland was appointed Regional Coordinator and to provide appropriate
supervision of the medical aspects, a special Medical Advisory Committee
was constituted to assist the Coordinator.
It was-noted that when the GNRMP began, it
      The Stare suffered from critical
The aedlcal school was only 11 years old
Despite the dearth of resources and the unfilled
The West Virginia Univeristy Medical School
.The region also has established appropriate
  The 35-member
Subarea offices based
History (continued)
When Committee and Council took a brief look at the region early  in
1971 when supplemental support for new projects was requested,  it was
observed that although the region had been operational for only one
year, the program seemed to be moving forward under effective
leadersfiip. Subsequently, however, the across-the-board twelve
percent reduction for all RMps reduced West Virginia's 02 year grant
from $516,567 to $454,579. But later on in the year the region
received an additional $126,299 from unexpended 1971 appropriations
to provide supplemental support for core and an ongoing project and
to initiate an approved/unfunded project.
supplement only, and the commitment for the 03 year remained at the
reduced level of $454,579.
This was a one-year
- f2 -
Region: West Vir.ginia
Review Cycle: 10/72
HISTORY OF REGION
Principal Problems since Region received first planning grant in
1
January 1, 1967.
Review and Council Concerns
a)
The degree to which the regional activity would be expanded into
peripheral areas.
b) Lack of information on resources of the Medical Center.
c) Relationships with other existing programs. (Appalachian Health
Studies and Development.)
Site Visit:
July 1969 (Preoperational) - Recommended operational status 1/1/69 - 12/31/70.
Concerns of Site Visitors
     The need for increased representation from the poor on the RAG.
a)
b) Recruit an educator to program staff for bringing in consultants with II -
a.
.-
expertise in education. Review and Council recommended operational __
status .
October 1971 Review Committee and Council
a)
WVRMP was penalized because they had not had a site visit since
1968 and very few staff visits.
b) Questions concerning the reorganization of the committee structure.
c) Questions concerning the review process of the Region, Recommended
staff assistance be provided to the Region to clear any problems
  in advance of submittal of the Triennial Application.
Principal Accomplishments:
1. Reorganization of the committee structure.
2. The recruitment of an Associate Director, three Program Specialists,
a data analyst and a field representative.
3.
Revision and simplification of the review process as spelled out in
the WVRMP Guidelines which also outlines program objectives and
priorities.
- 13 -
Region: West Virginia
Review Cycle: 10/72
e
Principal Problems (Based on application, since last review)
1.
Relationship between WVRMP and the grantee (University of West
Virginia Medical School) which was dealt with through the management
assessment visit.
3
2.
The Sack of poor white representation on the RAG, Committees, and
few allied health representatives.
Principal Accomplishments
(Based on applications, since last review)
1.
Reorganization of the technical review committee's structure which
has been conformed to the programs new objectives.
2.
The development of "Guidelines for Proposal, Review, and Operation
of Activities" which describes the review process,
3. Redefined and restated their objectives, The objectives are Health
Care Delivery, Health Manpower and Bnergency Medical Care and each
objective has a number of sub-objectives.
4. WVRMP has filled the following positions: an associate coordinator,
three program specialists, a data analysist and a field representative.
Through cooperative efforts and joint funding with a variety of
public and private nonprofit organizations, five rural health care
centers are being established.  WVRMP staff play a cruclal role in
obtaining other funding, i.e., $120,000 was."matched" by other one
mllllion dollars- fromisther  source^.
5.
e
Issues requiring attention of reviewers
Same as principal problem. (WVRMP bylaws are very restrictive governing
RAG composdtion.
the bylaws be rewritten.)
Site visit team may want to consider suggesting that
Recommendations From
/1
Region West. Virginia $Y 00045
Review Cycle October 10172
Type of Application: Triennium
Rating 336
.Review Committee
Council
The Review Committee accepted the recommendations of the site visitors that
the West Virginia Regional Medical Program be approved for triennial status
with the following funding levels:
04 Operational Year          $1,500,000
05 Operational Year           1,600,000
06 Operational Year           1,700,000
The recommended funding levels include
the developmental component request.
Committee viewed West Virginia RMP as a viable program with a well conceived
d developed planning process built around clearly defined program goals
and objectives.  Each proposal is directed to one of the three objectives--
health care delivery, emergency medical services, and health manpower. The
goals and priorities are directed to improving access to care in the
unserved and underserved portion of the region.
e concerns expressed by Committee have been adequately described in the
te Visit Report listed under recommendations,
Committee recommended that
he concerns be strongly emphasized  in
oncern expressed by Committee is  that
representation on the RAG.
the advice letter. One major
"poor" people should have adequate
Conxp onen t
PROGRAM STAFF
ONTRACTS
DEVELOPMENTAL COMPONEfiT
PERATIONAL PROJECTS
Kidney
Epls
hs/ea
Pediatric. Pulmonary
Other
TAL DIRECT COSTS
WCIL RECOMMENDED LEVEL
COMPONENT AND FINANCIAL SUMMARY
TRIENNIAL APPLICATION
Current Annualized
          Year
Level
-
$ 557,086
148,466
--
222,914
$ 800,000
$ 929,810
Region: West Vi;;a *
Review Cycle:
&
Re*
1st ,year
$ 584,725
  95,222
  80 , 000
1,135,153
9-
: 41,506)
: 49,830)
1
1,799,878
$ 619,19
--
80,OO
1,280,80
(27,556)
1,980,000
nnial
3rd year
$ 656,279
--
80,000
1,343 , 7 21
( 24,105)
2,080,000
$1,980,000 $2,080,000
Committee Recommendation fox
Counc
1s t year
L, 500 , 000
1-Approved Level
2nd year 1 3rd yea
-+--
1,600,000 $1,700,01
I
C001~111N,11'012: John S. Hirschboeck, M.D.
staff fol. I~~~~~:  Jeanne L. Parks, SCOB
-
William (I1Billt*) Reist, SCOB
Last Sitc Visit:
December 1970; Chairman Dr. Russel B, Roth, Gouncil
9
Ih.. Edmund Lewis, Review Committee
Staff Visits b8`last 12 Months!
June 8-9, 1972:
To attend RAG meeting to get overview of review process;
to see RAG in action in preparation for verification of
review process visit.
,June 13, 1972:
Recent Events Occurring in Geographic Area of Region that are Affecting RMP
Program:
Verification of review process visit
I
In Yay 1971, the Governor of Wisconsin created a Health. Planning and Policy
Task Force to (1) study the state's health needs;TZ) d esign a comprehensive
system whTch would provide the health services consumers require; (3)
compile a health plan and designate health priorities; (4) reamend a
legislative program; (5) suggest any necessary administrative reorganization;
(6) identify the responsibility for government, the providers, the educational
system and the consumer; and (7) make recmendations,on the financing of
system ad the consumer; and (8) make recommendations on the financing of
health care, utilizing both public and private capital, with a request
for early identification of those areas demanding priority attention.
~,
To accomplish this far-reaching and significant undertaking, the following
Task Force work groups were established;
(1) Health Service Research E Development
(2) Health Financing
(3) Education of Health Workers
(4) Transportation (EMS)
-
~
~
~ ____
-2-
Health Planning
Environmental Health
Health Education of the Public
Personal Health Services
Evaluation of Health Services
Each of the work groups have projects or studies underway which will be
finalized ,within the next six months and will provide the basis for final
recommendations to the Governor.
171e Governor also appointed a Health Policy and Program Council which carries,
along with other duties, the responsibility for Comprehensive Health
Planning under the Bureau of Comprehensive Health Planning, the state (a)
agency.  This Council will continue its work after the Task Force has completed
its assignment and will be in a position to take action on program areas
identified by the Task Force,  WRMP has both staff and committee representatives
on both groups, As policy develops for the State of Wisconsin, WRMP may
have a significant role in the implementation of new programs which might arise
out of the two bodies.
'I'hree new CHP (b) agencies have become operational; one in North Central
Wisconsin, one in North Western Wisconsin and one in the Lake Winnebago
District. There are now 8 operational CHP (b) agencies in the State of
Wisconsin,
30 *
32*
- 5-
IXXXAPHIC, FACILITIES AND RESOURCES STATISTIC4L WY
REGION: WISCONSIN
:
The region encompasses the entire State.
Counties: 71 Congressional Districts: 10
Population: (1970 Census) 4,417,900
Urban: 66% Density: 81 per square mile
Rural: 34%
A e Distribution: Wisc .
            36%-
65 years and over 11%
t?knFzT 18-64 years 53 %
U.S.
33T-
55%
10%
6- -total population:
2,388,000 (over 50% of State total)
nn-Wisc)--262.0 Madison- -287.5
Milwaukee- -1393.3
Racine- -171.2
% (large proportion Indians); White--96%
ources and Facilities Enrollment
Graduates
-F1s
  92
Medical Schools- -M&. College of Wisc . ,Milwaukee
University of Wisc . Med. Sch. ,Madison
409
Pharmacy- -1 at University of Wisc. Hospitals, Madison
Dental School--Marquette University, Milwaukee
PrOfe5SiOnal Nursing Schools
Practical Nurse Trainin
32--all at Technical Inftitutes
are based at colleges and
Universities 1
Cytot.echol0gy- - 3
Medical Technology--35 incl. 1 at V.A. Hosp.
Radiologic Technology--30 incl. 1 at V,A, Hosp.
Physical Therapy--2 (Univ. of Wisc. Med. Sch. and Marquette U.)
Medical Record Librarian- -1
(Wood)
(Wood)
-6-
Ilospitals- -Comity General and V.A. General
Beds
-
#
LI
Short term 158 21,866
Long term (special)       8 1,198
V .A. (general)         2 1,342
Skilled Nursing Homes    353 27,205
-
# Hospitals with selected
special faciligies
Cobalt therapy- -24
Radium therapy- -41
Renal dial (inpt) - -18
Rehab (inpt) - -27
* q,
Intensive Cardiac Care- -52 'i
Isotope--42
,.
c
Long term care units 65 3,667 I
component
XGNAL PROJECTS
hs/ea
Pediatric Pulmonary
DIRECT COSTS .
I L-APPROVED
EL
September/tktober/fS
CONPONENT AND
ANWERSARY APPLICATION DURING TRIENNIUM
Current . . Counci 1 -
Annualized
Funding
TR Year lst
(OS year)
529,955
64:792
117,822
1,066,503
x
1,779,072
1,779,072
Approved -
Level For
TR Year 21b4
(06 year)
1,779,072
Region's
Request For
..TR Year 2nd
625,607 *
.. . .
200,898
1,350,110
( 312,881 1
(1,265,896 1
c 3
( 1
c 3
2,176,615
Recormended
Funding For
TR Year 2nd
/-J
' /x Review
Committee
1
1,779,072
cReconmndcd -
Level For
Remainder
of Triemiunl
4
I
I
I I I 1 I
015 COPPREPEhSIVE RFhAL PRCCl I I
ROY I I I I s3-$ I El
I I I I I I
1'
023
.-
I
I
cc
,. . .
,. .,...
,'
I I I 1 *-
I I f 1 I t I I
TETAL
.-
- TOTAL - 548900 llC25CS lCtlFtCC lC23@15- 32425t2 7CC727E * ZLltttS 1654731 62016 393??C2
1: r
-11-
Mi s tosical Profile
`%e Wisconsin W's initial planning year began September 1, 1966,
was designated as an operational program on September 1, 1967, and.
received Triennial States on September 1, 1971.
The Wisconsin W Inc. was formed as a collaborative venture by the
Flarquette School of Medicine and the University of Wisconsin.
emompasses the entire state of Wisconsin, with the largest concen-
tration of its population in the seven Southeastern counties of
Wisconsin, which serve as one of the area-wide health planning agencies--
the CHPA for Southeastern Wisconsin (WASEW).
nationally in the mount of money spent for higher education.
Health Sciences Unit of the University Extension, University of Wisconsin
in Madison has been a pioneer in the development of continuing education
for resources for physicians, registered nurses, and allied health
professionals, and has achieved national reputation for the excellence
of its work. The W has Over the years collaborated with these
resources which have resulted in the development of a number of
operational program designed for nurses and physicians and other
health professions in the region.
It
The Region ranks high
The
During its early years of operation the WRMP has concentrated basically
on quality of care in categorical disease areas and post-graduate
education programs for physicians and nurses, with principal operational
foci in the Marshfield, Milwaukee, La Crosse and Madison areas, and to
a much lesser extent in the Central Northeast and Northwestern portions
of the state. The northern portion of Wisconsin is characterized
mostly by large rural areas sparsely populated with small rural hospitals
and for the most part inadequate facilities,  Operational programs have
recently been developed which do provide some outreach to some of these.
rural areas, The region through its newly appointed field representative
for Northern Wisconsin has been working with hospital administrations in
this area and has assisted these hospitals in the development of
collaboration and service sharing arrangements.  The current application
requess funds (Project #36A) for support of such an activity.  Project
d 30, brth Central Wisconsin, illustrates another example of an outreach
program in the Northern and Central area for the small rural hospitals.
These projects among others in the current application illustrate
the region's emphasis on finding ways to extend services to areas out-
side the Metropolitan and University centers and the large group clinic
settings, and on developing methods for monitoring the quality of care
and moderating the costs of quality health care.
far B statewide EMS project for the State of Wisconsin also represents
a program which would aid people in the Northern areas and will tie
together a number of extremely scattered, smaller services.
working in close collaboration with a broad spectrum of the health
groups in the region and has developed a network of communication and
functional activity among medical centers, hospitals, and health agencies
in the region,
The awarding of $1,265,810
                       '
WRAP is
me region has successfully terminated a number of its original three
year projects by either receiving support from other sources, or
because of unsatisfactory results. Appendix D of the current application
describes the accomplishments and sources of funding of these terminated
projects.
in Detection and Management of Gp ecologic Malignancy,are projects
Project #16,Medical Library,& Project #20,Action Program
W has improved the extent ad quality of its evaluation pyocedures
responsibility for and has been actively involved in conducting project
site visits and developing methods to produce "outcome" data rather
than theoretical information.  Evaluation is now built into projects
during the initial stages of their development.  The region's review
process was the subject of a June 13, 1972 visit.  It was found that
the mechanics of the WVP review process generally meet the minimum
standards ; however, it was recommended that provisional certification
be given pending implementation of staff's recommendations and suggestions
which relate to: (1) conflict of interest; (2) feedback letters; (3) provi-
sion of review criteria to potential applican$s;
of the r gionIs byelaws; and (5) provision of written review criteria to
technicaf reviewers.
by the establishment of a Review and Evaluation Committee which has the
(7
'.-.-- .;:-;y
1
(4) re-examination
The region has expanded the membership of the Corporation from its
original three to a total of nine members.
tW reassessed its utilization of developmental component funds in
light of its present objectives, and have defined in greater detail
its intent and purpose in developing program meas for developmental
component funding.
funded; five of these have been approved by the RAG for extended
support and appaar in the project section of the current application.
Areas of activity include delivery of primary health care, and
monitoring the quality of health care.
During the past year, seven activities were
During the past year, increased efforts have been made in furthering
effective comications and collaborative efforts in program
plming and development with the state areawide CHP agencies.  WRJP
provided assistance to the Northeastern HFC in preparation of an
application for a project with the Menminee Indians and has consulted
with this HPC about cardiovascular surgery needs and neighborhood clinics.
Consultation ad assistance has also been provided at the request of the
0 agency of Southeastern Wisconsin, on matters relating to require-
ments of Cardiovascular Surgery.
Foundation of Wisconsin, the WRW convened a conference to identify the
components of an effect-ive community action program to ,deal with the
problems of sickle cell disease, established guidelines for such a
program, and have since provided consultation to the Medical Society
of Milwaukee County and the United Cormunity Services of greater
Milwaukee about sickle cell comity action programs.
In collaboration with the Johnson
Issues bquiring Attention of Reviewers:
The basic issue is whether the WRMP shorrld be approved and funded
at the level requested in the current application.
for $2,176,615 including $200,898 for devel-o@eatal component funds.
The region-is currently funded at its NAC approved level of $1,779,072.
Recornended funding for the developnent component should be based on this level.
The request is
If the region is approved and funded in the amount requested, it will be
able to continue its basic prograa-as oG-t5i8 -iii''%e- ccfrenf
application, provide salary increases for program staff &nd initiate
eight new activities which for the most part will provide services
and health care needs to areas of the state which have in the past
been neglected.
A staff review will be scheduled arid if additional issues are raised
'-- *L- -th;nrt nf a SeDarate document.
-13-
Staff Observations
Principal Problems :
Prior to the submission of the W's Triennial application, a site
visit was conducted which revealed problems related to:
(1) the lack of objective methods of evaluation
(2) the.inadequate representation of racial minorities on the RAG
and a lack of minority representation on  rogram staff
minority program members, and only one minority (black)
representative on the RAG)
(3) lack of sufficient depth of the program ~taff
(4) the extent of subregionalization efforts, especially in the    .
rural northern part of the State
(5) developmental component request too broad and all encompassing,
lacking specificity as to how the funds would relate to
priority needs
(6) The three-member corporation is not large or broad enough to
govern such a large program as the WRMP, Inc,
(This still remains to be a problem, as t fi ere are still no racial
Principal Accomplishments:
wRI4p's Triennial Application reflected a definite response to the
specific problems , concern and recommendations of the reviewers.
The region has added depth and strength to the program staff by the
addition uf a Physician Associate Coordinator for Program Development
and Evaluation (Madison WRMP office) , a Deputy Coordinator for
Regional Liaison (Milwaukee WRMP office) , and a field representative
who serves W as liaison in the North Central area of Wisconsin.
His efforts have been directed towards promoting and providing
assistance in the development o'f collaboration and service sharing
irmong the rural hospitals, particularity in the rural areas of
Northern Wisconsin,  He has worked successfully with the hospital
administrations in the area and has identified opportunities for improved
cooperation among these hospitals,  As a result of these efforts,
seven participating hospitals, working through a non-prof it corporation
are in the process of merging to share services and to combine health
care services in an effort to provide more comprehensive services and
to improve the quality of services that is so urgently needed in this
has improved its subregional efforts by establishing cooperative
relationships with some of the large proprietary clinics, namely,
Marshfield and Gunderson.
the Marshfi-eld Clinic have designed a proposal to establish the
concept of regionalization by providing a variety of medical and
laboratory senrices to the small rural hospitals in the North-Central
area of Wisconsin.  It is anticipated that other health care delivery
systems within the central Wisconsin region will also participate in
the provision of outreach services to these rural areas.
As an example, WRMP and staff members of
,.
..
             ,_ - .-. .-,~. i.^ .-
................... ... .... ......... ... ... .......
-_ ............ ..... ...... -, ....................
529,955
63,732
117,822
1,066,5C3
1,779,072
S25,SC7
I
2,1?6-, 615
1 7.7 2,572