up *EO I .le I t I t t z m m@ A F I L . VP The theme of this year's Annual Report is best reflected by the word CHANGE. By nature, Regional Medical Programs are con- stantly changing to meet the challenges of new goals, directions and new ideas. The year of 1972 has seen some of the most dramatic changes in the history of the Lakes Area Regional Medical Program, Inc. The CHANGES have strengthened the structure and operation of the program. It has meant "quick response" in dealing with recommendations suggested by a federal site visit team as well as changing the emphasis from heart disease, cancer and stroke activities to a more inclusive area of activity and interests as they relate to improving the quality and availability of health care to all residents in the region. The ability and attitude toward meeting the responsibilities of these changes is a fine example of the dedication and efforts put forth by the volunteers and staff who make up the Lakes Area Regional Medical Program, Inc. Among the many letters of protest sent to legislators and the President by those associated with the egional Medical Program, Inc. concerning the Administrations order to phase out Regional Lakes Area R Medical Programs, is a communication from Dr. Irwin Felsen, President of the Lakes Area Regional Advisory Group, Inc. Part of the letter follows: Dear Mr. President: Unfortunately the results of the endeavors of health programs cannot simply or clearly be evaluated in terms of "output" measurements. In regard to Regional Medical Programs, much confusion has surrounded its evaluated success. Unfortunately, the old metaphor of "comparing apples and oranges" emerges. It would be impossible to evaluate each R.M.P. program and its projects through a rigid field study design. The fact remains that R.M.P.'s have focused on changing "process". Few would disagree that the health advances of the "ivory tower" were not finding their way to remote communities. Few would disagree that health care delivery was duplicative, fragmented, and inefficient. Few would disagree that most health providers jealously protected their domains. Few would disagree that many communities were without many basic health services. Health power figures had no political force to serve as an /.ncentive for communl.- cation, cooperation, and action. R.M.P. provided this force. With its meager budget, it could not singlehandedly erase a generation of inefficient and ineffective health delivery. It could not simply provide direct services for those communities without them. It no authority to force "power figure" to do anything. However, it was an incentive, a monetary-social force that stirred health political figures into action. The medical schools listened to the consumer from the remote commu- nity. The practicing surgeon listened to the social scientist from the university. "Ivory tower" virologists instructed practical nurses in the rural areas. Top internists consulted with generalists. It was a force for social change. It was not the ultimate answer, but certainly a force more responsive than the hackneyed state and local political institutions that have proven their impotence in regard to bringing about social change in the health field. To dismantle this force appears unconscionable. What will take its place? Traditional political institutions? Doubtful, such institutions have proven their ineptness in bringing about such change. They are plagued with more pressing problems-housing, welfare, schooling. Even with new revenues, the basic political structures and institutions do not change. There is no way to "prove" that R.M.P.'s efforts in promoting coordination, coopera- tion and actions by health power forces has resulted in any "output gains" One can show progress in reducing fragmentation, duplication and inefficiency. One can show input by consumers in the decision-making progress. Do these actions result in "output gains'. e-g-, has health status been improved? However, it appears that such actions and coopera- tion is organizationally logical. Perhaps, we should be compelled to use the least used of all senses to answer this question-common sense. Sincerely yours, Presiden t Lakes Area Regional Advisory Group, Inc. a word from the ... EXECUTIVE DIRECTOR The future of the Lakes Area Regional Medical Program, Inc. is threatened by the current crisis in health care legislation. Caught in a struggle between the Legislative and Executive branches of our government, regional medical programs have come under scrutiny by our lawmakers. This scrutiny has revealed what we have known all along-that regional medical programs have created an effective process which enables those mandated and professionally competent to develop and implement health care services-to do this and disseminate their product to the profit of the public. John R. F. lngall, M.D. Executive Director Lakes Area Regional Medical Program, Inc. iv A Page THEME ......................................................................... Dr. Felsen's Letter to the President ................................................. A Word f rom th e E xecu tive D i rector ................................................ iv HISTORY OF RMP'S ...................................... - ........................ 1 The Grantee Institution ........................................................... 1 The Enabling Role ............................................................... 2 REGIONAL ADVISORY GROUP ..................................................... 2 Board of Directors List ........................................................... 4 CANCER RELATED ACTIVITIES .................................................... 9 Tumor Registry ................ ; ................................................ 9 Cancer Teaching Days ............................................................. 9 LAKES AREA REGIONAL MEDICAL PROGRAM, INC. GOALS AND OBJECTIVES ............ 10 LAKES AREA REGIONAL MEDICAL PROGRAM, INC. STATEMENT OF REVENUES, EXPENDITURES, ENCUMBRANCES AND FUND BALANCES ................... 12,13 PROGRAM COMMITTEE ........................................................... 14 OPERATIONAL PROJECTS ......................................................... 15 DEVELOPING A GRANT PROPOSAL ................................................. 23 Proposal Review Process .......................................................... 24 EVALUATION ........................... I ........................................ 25 Evaluation Workshop ............................. ............................... 25 STATUS OF PROPOSALS .......................................................... 27 Proposals Submitted to Washington ................................................. 28 PROGRAMS IN CONTINUING EDUCATION - 1972 ...................................... 29 EMERGENCY MEDICAL SERVICES SYSTEM .......................................... 31 Emergency Medical Services Workshop ............................................... 31 INNER CITY HEALTH PROBLEMS .................................................. 31 LAKE AREA HEALTH EDUCATION CENTER ......................................... 32 ALLEGANY COUNTY MOBILE HEALTH UNIT ......................................... 33 RURAL EXTERNSHIP PROGRAM ................................................... 34 35 LIBRARY PROGRAM ............................................................. 35 Hospital Library Consultation Service .............................................. COMMUNICATIONS ............................................................... 35 VOLUNTEER'S CONTRIBUTION .................................................... 36 LAKES AREA REGIONAL MEDICAL PROGRAM, INC ................................... 37 Professional and Support Staff ..................................................... 37 38 Project Personnel .............................................................. v Figure Page 1 Counties That Make Up the Map of The Lakes Area Regional Medical Program, Inc ........ vii 2 Composition of the Board of Directors of the Lakes Area Regional Advisory Group, Inc. 3 3 List of Board of Directors - Lakes Area Regional Advisory Group, Inc . ................. 4 4 Lakes Area Regional Medical Program, lnc.'s Goals and Objectives .................... 10 5 Lakes Area Regional Medical Program, Inc. Statement of Revenues, Expenditures, Encumbrances and Fund Balances .............................................. 12, 13 6 Proposal Review Process ..................................................... 24 7 Status of Proposals ......................................................... 27 8 Proposals Submitted to Washington ............................................ 28 9 Programs in Continuing Education - 1972 ........................................ 29 10 Volunteer's Contribution .................................................... 36 vi FIGURE 1 The Lakes Area Regional Medical Program, Inc. Area The LARMP is one of 56 federally funded, locally controlled programs in the United States. The Lakes Area Regional Medical Program, Inc. is made up of nine counties: Niagara, Genesee, Erie, Wyoming, Chautauqua, Cattaraugus, and Allegany in Western New York, and Erie and McKean counties in Northwestern Pennsylvania. It covers an area of 7100 square miles with a population of approximately 2,020,000 According to the 1.970 census. vii HISTORY OF RMP'S Focus Changes During 1972 the emphasis of RMP's has expanded from projects dealing with specific diseases Legislation to regional programs benefiting entire health systems. Regional Medical Programs began in October Noting the importance of close coordination of 1965 under Public Law 89-239. Originally the activities with other groups, RMP's have worked in legislation was concerned almost entirely with concert with areawide Comprehensive Health specific diseases - heart disease, cancer and stroke. Planning agencies as well as other local, state, and Kidney disease was later added by legislation in regional groups in planning activities that achieve October, 1970 under Public Law 91-515. RMP's were RMP goals and avoid duplication of efforts. urged to speed application of research to the patient's bedside. The Grantee Institution Since signing of the law, 56 Regional Medical The Board of Directors of the Lakes Area Programs have emerged as autonomous regions Regional Medical P rogram, Inc. was established in covering the United States, Puerto Rico and the Trust February, 1972 to assume functions previously Territories. The 56 programs vary in population and performed by the Research Foundation of the State size - 33 programs cover entire states, four encompass University of New York. two or more states, 1 1 are parts of single states, and eight are parts of two or more states. As the grantee institution, the LARMP Board of Directors receives, administers, and accounts for Regional Medical Program.Purposes Federal grant funds in a manner which implements the program established by the Lakes Area Regional Regional Medical Programs seek to strengthen Advisory Group V and in accordance with Federal and improve the nations health care system and regulations and policies. making quality health care more easily accessible to all persons. Under the able leadership of Chairman Allan Korn, Professor, State University College at Buffalo Unlike many federal programs, the RMP's and the valuable efforts of his four colleagues: operate primarily under local direction. Their Herbert Bellamy, Inner City Businessman an strength lies in the "grassroots" participation by the Community leader; Norman Slawinski, Branch many devoted volunteers who make up their regional Manager, Marine Midland Bank; Irwin Felsen, M.D., advisory groups. Each Regional Medical Program President, Lakes Area Regional Advisory Group, Inc.; works locally to stimulate cooperation and and Richard A. DiVita, Certified Public Accountant, innovation among health service providers. the Board of Directors stimulated significant reductions in the administrative (overhead) costs of The parent organization is the Regional Medical managing the multi-million dollar LARMP Grant Programs Service, which is part of the Health Services Award. Administrative costs dropped to less than and Mental Health Administration, a unit of the U.S. 10%, in 1972 as compared to over 25% in previous Department of Health, Education and Welfare. Each years. This figure is well below prevailing indirect cost RMP is funded by HEW to help meet regional health rates experienced locally and nationally by needs. institutions performing similar functions. With regret, Mr. DiVita announced his LARMP has been successful in attracting resignation from the Board of Directors at the close additional monies to RMP - supported activities: of the 1972 fiscal year. Mr. Maynard Parker, recently voluntary agencies and other groups have committed retired executive with the Hooker Chemical monetary investment to what otherwise would have Corporation of Niagara Falls, New York was selected been exclusively RMP operations; county medical as Mr. DiVitA s successor. societies and hospitals contribute funds to the LARMP advisory group to meet expenses that cannot be paid by federal funds; RMP's investment in the Lake Area Health Education Center led investment in the center by the Boards of Trustees of two Erie, Pennsylvania hospitals and the Veteran's Administration; and the Rural Externship project, which attracted private contributions from hospitals, physicians and local governments. A Name Change Lakes Area Regional Medical Program, Inc. Regional Advisory Group On March 1, 1972 the new name Lakes Area Regional Medical Program, In . came into being. This The Regional Advisory Group, Inc. consists of a change reflects the programs intent to clarify the group of over 350 persons from throughout the relationship of the two Pennsylvania counties of Erie nine-county Lakes Area Regional Medical Program and McKean, that are part of the region. These region. This includes all those who serve on each counties have become quite active in the program and of the county committees, usually meeting on a the new name was chosen, in part, to acknowledge monthly basis. their membership. The Regional Advisory Group's Board of Directors is a group of 43 members who meet monthly to The Enabling Role direct the program's operation and development. Within the past year, the RAG revised its by-laws Over the years the Lakes Area Regional Medical and made some changes in provisions for both Program has taken particular pride in its designation delegate and at-large membership. as an "enabler." The Upstate Medical Alliance, a group of black The LARMP staff emphasizes its brokerage role health professionals including physicians, dentists, whereby help is given where it is required. If LARMP and others was added to the list of institutions and cannot help, other appropriate organizations are groups with permanent representation on the RAG. contacted. The LARMP staff continues to keep up to Also added was the Comprehensive Health Planning date on other funding sources and agencies that can "b" agency in Pennsylvania, increasing the member- be of help in solving a particular health problem. ship in this area of representation to two. Another aspect of the enabling role has been An expanded number of public health members- insistence that projects have a viable marketing at-large have been appointed to form a RAG which strategy. LARMP resources are invested as seed will represent all elements of the provider and monies for activities that can be integrated into the general population with attention given to involving health-care pattern of the region. minority group members, labor leaders, businessmen and women. 2 FIGURE 2 Composition of the Board of Directors of the Lakes Area Regional Advisory Group, Inc. 100- a- -r 35 - U) cc LU m uj 30- iC) 25 - U- 0 Z 20 - LU C) cc LU 15 - 10- 5- A B c D E F G H I K L m COMPOSITION OF THE BOARD A. 9 M.D.'s representing the nine county medical societies B. 9 members representing the nine county committees C. 2 members representing the Faculty of Health Sciences, State University of New York at Buffalo D. 1 member representing Roswell Park Memorial Institute E. 1 member representing Western New York Hospital Association F. 2 members representing Comprehensive Health Planning Council of Western New York, Inc.; Comprehensive Health Planning Council of Northwestern Pennsylvania, Inc. G. 1member representing the Upstate Medical Alliance H. 1member representing the Regional Health Director, New York State Health Department 1. 1member representing Erie County, New York, Health Commissioner J. 1member representing the Veterans Administration K. 13 community members - at large L. 1 legal counsel M. 1 to be named 43 TOTAL MEMBERSHIP 3 FIGURE 3 LIST OF MEMBERS OF THE REGIONAL ADVISORY GROUP AND STEERING OR EXECUTIVE COMMITTEE Name and Address Institution and/or Categories of Occupation Representation CHAI RMAN: **Irwin Felsen, M.D. private practice private physician/ Wellsville, New York Allegany County Medical Society VICE-CHAIRMAN: **Father Cosmas Girard, OFM, Ph.D. Sociologist-Anthropologist member of the public/ St. Bonaventure, New York St. Bonaventure University Cattaraugus County Committee SECRETARY: **Theodore T. Bronk, M.D. physician Niagara County Medical Mt. St. Mary's Hospital Director of Laboratories Society Lewiston, New York TREASURER: **John C. Patterson, M.D. Roswell Park Memorial Roswell Park Memorial Buffalo, New York Institute Institute OTHER MEMBERS: *Hugh Allen, M.D. physician Erie County County Medical Erie, Pennsylvania Hamot Medical Center Society *Sister Bernadette Armiger, R.N., Ph.D. Dean, School of Nursing Niagara County Committee Niagara University Niagara University Niagara Falls, New York *Virginia Barker, R.N., Ed.D. Dean, School of Nursing member of the public/ Alfred University Alfred University Allegany County Committee Alfred, New York Lester H. Block Attorney legal counsel Buffalo, New York LaVerne Campbell, M.D. New York State Health official health agency Buffalo, New York Department - Regional New York State Health Health Director Department Indicates new member since May 1, 1972 submission Indicates member of Executive Committee 4 Name and Address Institution and/or Categories of Occupation Representation Max Cheplove, M.D. physician Erie County, New York Medical Buffalo, New York Society *Mrs. Ramona Charles Tonawanda Indian Tonawanda Seneca Indian Basom, New York Reservation Reservation and Community House *Mrs. Carolyn Daughtry Erie County Department Erie County, N.Y. Health Buffalo, New York of Mental Health Department *Wiliam H. Ennis Hamot Medical Center Erie County, Pa. Committee Erie, Pennsylvania Executive Director *Dominic Falsetti, M.D. physician Niagara County Medical Niagara Falls, New York Society *John Foster Family Planning Director Erie County, Pa. Committee Erie, Pennsylvania Martin Luther King Center Erie, Pennsylvania William Gaiter Director member of the public Buffalo, New York BUILD Organization Buffalo, New York *Larry J. Green, D.D.S. State University of New Upstate Medical Alliance Buffalo, New York York at Buffalo, School of Dentistry *Robert Haith, Jr. Director Veterans Administration Erie, Pennsylvania Veterans Administration Hospital, Erie, Pennsylvania *William Hilger United Auto Workers member of the public Lockport, New York Herbert Joyce, M.D. physician member-at-large Buffalo, New York Past President, RAG Bert Klein, D.P.M. podiatrist Chautauqua County Committee Jamestown, New York *Ed,@iard F. Marra, M.D., MPH physician State University of New York Buffalo, New York at Buffalo, School of Medicine *Murray S. Marsh W.C.A. Hospital Chautauqua County Committee Jamestown, New York Administrator Indicates new member since May 1, 1972 submission Indicates member of Executive Committee 5 Name and Address Institution and/or Categories of Occupation Representation *C. Conrad Monroe Banker member of the public/ Corry, Pennsylvania Vice-President, Marine C.H.P./N.W.Pa. Midland Bank 'Elizabeth Moore Director, American Red Cross member of the public Batavia, New York Chapter Genesee Unit William E. Mosher, M.D. Commissioner, Erie County Erie County Health Buffalo, New York Health Department Department F. James Murphy Administrator - Genesee President - Batavia, New York Memorial Hospital Western New York Hospital Association Gerald P. Murphy, M.D., D.Sc. Director, Roswell Park Chairman - LARMP Buffalo, New York Memorial Institute Cancer Committee *Robert Harris Director, Western New York Western New York Kenmore, New York Hospital Association Hospital Association *Joseph Paris Director, Veterans Administration Veterans Administration Buffalo, New York Hospital, Buffalo, New York *J. Warren Perry, Ph.D. Dean, School of Health Related Faculty of Health Buffalo, New York Professions, State University Sciences, State University of New York at Buffalo of New York at Buffalo Edward Roche, Jr., M.D. physician McKean County Medical Bradford, Pennsylvania Society Harry A. Sultz, D.D.S. Professor, School of Medicine Erie County, N.Y. Buffalo, New York State University of New York Committee at Buffalo Patricia Stopen, R.N. Wyoming County Health Wyoming County Committee Warsaw, New York Department George E. Taylor, Jr., M.D. physician Allegany County Medical Cuba, New York Society Paul Welsh, M.D. physician Genesee County Medical LeRoy, New York Society Richard T. Williams, M.D. physician Wyoming County Medical Warsaw, New York Wyoming County Society Community Hospital Indicates new member since May 1, 1972 submission Indicates member of Executive Committee 6 Name and Address Institution and/or Categories of Occupation Representation *Gene Wilczewsky Director, Comprehensive C.H.P./W.N.Y. Buffalo, New York Health Planning Council of Western New York, Inc. Duncan C. Wormer, M.D. physician Cattaraugus County Portville, New York Health Organization Professor Earl N. Stopfel and Mr. Norman C. Berg were elected as at-large members to the RAG in March, 1973. Indicates new member since May 1, 1972 submission Indicates member of Executive Committee 7 REGIONAL ADVISORY GROUP ALTERNATES Mr. Gerald Farmer, Director (Representing Mr. Conrad Monroe) Comprehensive Health Planning Erie, Pennsylvania Craig Fisher, M.D. (Representing Dr. Dominic Falsetti) Niagara Falls, New York Mrs. Fleeta Hill (Representing Mr. William Gaiter) BU I LD Organization Buffalo, New York Robert A. Jackson (Representing Mr. Robert Haith, Jr.) Chief of Prof. Services Veterans Administration Hospital Erie, Pennsylvania Dana Lundquist, Associate Director (Representing Mr. William Ennis) Hamot Medical Center Erie, Pennsylvania Roland Miller M.D. (Representing Dr. Hugh Allen) Chief of Am@'Ulatory Care Hamot Medical Center Erie, Pennsylvania Ms. Marguerite Nolan (Representing Dr. Edward Roche) N.W. Pa. TB and Respiratory Disease Society Bradford, Pennsylvania Rev. David Pettit (Representing Mr. John Foster) Associate Director Martin Luther King Center Erie, Pennsylvania Mr. Gerald Schofield (Representing Dr. Gerald Murphy) Deputy Director for Administration Roswell Park Memorial Institute Buffalo, New York 8 Cancer Related Activities Cancer Teaching Days During the twenty-four month period of Seven Cancer Teaching Days were conducted January 1, 1971 to December 31, 1972, the Lakes during 1972. These were usually co-sponsored with a Area Regional Medical Program, Inc. expanded local American Cancer Society unit and held in $1 18,250 for cancer activities. Of this total approx- conjunction with Roswell Park Memorial Institute. imately 90% represents project activities and 10% core staff activities. Program topics included "Current Advances in Lakes Area Regional Medical Program is the Treatment of Leukemia," "Cancer and the directly involved in education, training and service Psychology of Adolescent Smoking," "Diagnosis and programs (demonstration projects). The primary Management of Head and Neck Cancer," "Oral thrust of cancer related activities has featured support Pathology - Detection, Diagnosis and Treatment," for efforts in prevention, manpower training and "Cancer of the Colon," "Cancer of the Uterus" and specific research activities. During 1972 13,120 "Carcinoma of the Colon, Changes and Status in persons were served by individuals trained in projects 1972." sponsored by the Lakes Area Regional Medical Program. This shows an increase over the 1971 total A total of 1,054 registrants including nurses, of 1 1,860 persons served. physicians, therapists and other health professionals attended these programs. Tumor Registry The Tumor Services Registry project which began in 1971 continued operation throughout 1972. Its primary objective is to improve cancer control by promoting improved patient care through regular periodic follow-up. This aids physicians in determining the efficiency of treatment modalities, and provides a valuable resource for continuing cancer education. The Tumor Registry presently has twenty participating hospitals. In 1972 there were 2,819 cancer cases diagnosed by the service as compared to 1,293 in 1971. Registry activity within the central office and member hospitals has resulted in specific training of fifty-five registry personnel. This has been accomplished through workshops, hospital visits, telephone conferences, and direct supervision. In addition the LARMP previously provided initial funding and support for "Topical Chemotherapy for Precancerous Lesions and Cancer of the Skin." This project introduced practicing physicians in the Western New York region to 5-FU (5-Fluorouracil), a highly effective topical anti-cancer agent. 9 FIGURE 4 LAKES AREA REGIONAL MEDICAL PROGRAM, INC.'S GOALS AND OBJECTIVES Goal No. 1. To stimulate and promote preventive services in health maintenance. OBJECTIVES 1. To continue defining the need for additional or new preventive services in each sub-regional area, based on a data profile of resources and services, an assessment of the community's characteristics and health problems, and on the acceptability of the service to the community. 2. To encourage delivery of preventive services through sources of primary care with emphasis on the role of allied health personnel. 3. To encourage coordination among government, voluntary, and private agencies to (a) maximize the impact of preventive services and lb) assist public health agencies in responding to community needs. 4. To encourage expanded programs in health education. Goal No. 2. To develop and improve primary care services. OBJECTIVES 1. To continue defining the need for additional altered or new primary care services in each sub-regional area, based on a data profile of resources and services, an assessment of community characteristics and health problems, and on the receptability of the pattern of services to the community. 2. To maximize the role of existing health personnel in delivering primary health care by (a) improving distribution of health personnel, (b) encouraging the expansion of ambulatory care within or associated with community hospitals, (c) using inter-disciplinary approach to the delivery of primary care, (d) encouraging the development and evaluation of innovative methods of health care delivery, and (e) promoting improved referral patterns to assure continuity of care. 3. To encourage general and family practice and other forms of primary health care. 4. To stimulate development of already defined new roles of health personnel. 5. To seek feasible solutions to the problems of distance and lack of transportation as barriers to utilization of primary care, preventive and rehabilitation services. 6. To promote consumer education regarding availability and utilization of existing health services. Goal No. 3. To encourage the development, expansion and integration of rehabilitation services to the continuum of medical services. OBJECTIVES 1. To continue defining the need for additional altered or new rehabilitation services in each sub-regional area, based on a data profile of resources and services, an assessment of the community's characteristics and health problems, and on the acceptability of the patterns of service to the community. 2. To promote the continued development of a variety of facilities and programs to assure placement of patients at the appropriate level of care. 10 FIGURE 5 LAKES AREA REGIONAL MEDICAL PROGRAM, INC. STATEMENT OF REVENUES, EXPENDITURES ENCUMBRANCES AND FUND BALANCES FOR THE YEAR ENDED FEBRUARY 28,1973 (unaudited) Federal TLN Special Total Funds Funds Funds All Funds Fund Balances at March 1, 1972 s -- $ -- $ $ -- Revenues: Grants Awarded 2,435,567 2,435,567 Service Fees -- 87,084 87,084 Contributions -- -- 12,106 12,106 Miscellaneous 1,148 335 7 1,490 Total Revenues 2,436,715 87,419 12,113 2,536,247 Expenditures 1,303,843 14,614 3,682 1,322,139 Encumbrances 22,565 --- 22,565 Total Expenditures, Encumbrances 1,326,408 14,614 3,682 1,344,704 Excess of Revenues over Expenditures and Encumbrances and Fund Balances at February 28,1973 $1 110 307 - $72 805 $ 8 431 $1,191,543 GRANTSAWARDED Grants from the Department of Health Education and Welfare for the period March 1, 1972 through April 30, 1973 amounted to $2,435,567 allocated by components as follows: Core Program $ 906 452 Rural Extern 30:950 Comprehensive Health Information Profile 133,126 Telephone Lecture Network 132,384 Chronic Respiratory Disease Program 69,709 Tumor Service Registry 85,783 Information Dissemination Service 58,848 Model Program for Comprehensive Family Health 63,747 Allegany County Mobile Health Clinic 88,007 Master Plan for Planning & Articulation of 18,857 Allied Health Education Comprehensive Continuing Care for Chronic Illness 217,704 Emergency Medical Services System 275,000 Lake Area Health Education Center 355,000 $2,435,567 At February 28, 1973, $1,434,900 of the grant funds had been received. In April 1973 a revised grant of $3,156,103 was awarded to LA.R.M.P., Inc. for the period March 1, 1972 through February 14, 1974 in connection with the phase-out of the Regional Medical Program as directed by the Executive Branch of the United States Government. 1 2 LAKES AREA REGIONAL MEDICAL PROGRAM, INC. BALANCESHEET AT FEBRUARY 28,1973 (unaudited) ASSETS Federal TLN Special Total Funds Funds Funds All Funds Cash $ 131,132 $45,777 $8,431 $ 185,340 Federal Grants Receivable 1,000,667 -- 1,000,667 Accounts Receivable 527 27,028 27,555 Deferred Charges 1,066 -- 1,066 TOTAL ASSETS $1,133,392 $72,805 18,431 $1,214,628 LIABILITIES, RESERVES, AND SURPLUS Withholding Taxes & Insurance $ 520 $ $ $ 520 Reserves for Encumbrances 22,565 22,565 Unappropriated Surplus 1,110,307 (1) 72,805 8,431 1,191,543 TOTAL LIABILITIES, RESERVES AND SURPLUS $1,133,392 $72,805 $8,431 $1,214,628 (1) Unused grant awards allocated to projects listed on page 12 of this report. Regional Medical Program Services has advised that these funds will remain available through August 31, 1973. 13 Program Committee A program committee composed of Regional Advisory Group (RAG) members was organized in 1972 for the purpose of providing continuous assessment of all operational projects and program staff activities. The committee examines these efforts in terms of their relationship to present goals, objectives, and priorities of LARMP. The group usually meets each month, prior to the regular RAG meeting. The formal charge to the committee is: (a) assesses goals, objectives, and priorities of LAR P and make recommendations regarding these matters to the RAG, (b) in the context of objectives and priorities, review and evaluate on-going projects and activities to determine effectiveness and make recommendations to the RAG. It is expected that this group will be the principal RAG sub-committee for short-term, intermediate, and long-range program planning. 14 OPERATIONAL PROJECTS During the period of March 1, 1972 to February 28, 1973, eleven projects were supported by the LARMP. Project No. 1 - Telephone Lecture Network (TLN) Primary Purpose: General Continuing Education Health Care Focus: All types of health care Target Groups: All health professionals, special groups, i.e. parents of diabetic children, asthma chapter, other chronic illness groups, health educators (ASHET) Area Served: Western New York and Northwestern Pennsylvania Objectives: To meet the educational and training needs of health care personnel and enable them to provide better patient management in the hospital as well as in the home PROGRESS REPORT: There are currently 35 hospitals on the network. During the past year, project activities have been expanded to include general continuing education for anesthetists, medical librarians and mental health therapists. A monthly Family Practice Conference and a Pediatric Journal Club, as well as a Pharmacy Journal Club were also introduced during this period. The network offered a total of 20 different lecture series in cooperation with 29 educational institutions, government health agencies and professional associations. Attendance exceeded 20,000 and certification of 8,042 continuing education hours provided. Three college level courses for students preparing for entry into health related professions were offered. On April 18, 1972, the network was instrumental in helping a Meadville City, Pennsylvania physician save the life and restore complete physical and mental health of a moribund patient with herpes encephalitis. Well over one-third of patients with herpes encephalitis die. Fortunately, a week earlier, the network had tied into the Drug Information Center operated by the School of Pharmacy (SUNY) and was vigorously promoting the service. With the information obtained over the network the physician was able to obtain an antiviral drug that was undergoing clinical tests in California. The lapsed time from the initial call for help and when the drug was received from California by the physician - 12 hours. This project, designed to foster information exchange by providing an easily accessible communication system, was cited in the September 19, 1972 issue of the Congressional Record for its role in providing communications for the Veterans Administration Hospital in Bath, New York during the tropical storm "Agnes" which struck on June 21, 1972. The subsequent flooding disrupted local telephone service and the network was pressed into service, thereby supplying the only means of communication for that hospital until June 29, 1972. 15 The system provided direct access to such services as the Drug Information Service, Information Dissemination Service and Laboratory Information Service. These average 2 to 3 calls a day via the network when scheduled programs are not in progress. Six programs for those who live with and care for relatives with a chronic disease were presented. These programs not only dealt with the medical programs associated with chronic disease, but also the psychological impact it has on the family. Approximately $75,000 in non-federal funds have been generated to help support this project during the past 12 months. Project No. 2 - Information Dissemination Service Primary Purpose: Provide library service to health professionals and health institutions Health Care Focus: All types of health care Target Groups: Health Institutions, health professionals Area Served: Western New York and Northwestern Pennsylvania Objectives: Provide library services to health professionals; encourage hospital libraries to develop their own services; provide consultation service to hospital library personnel PROGRESS REPORT: The Information Dissemination Service began providing service in June 1970. During the first year of operation a total of 12,393 requests were received and processed. During the period of December 1, 1971 to November 30, 1972 the IDS provided health professionals with the following library services. Photocopy requests for Journal Articles - 27,800 Loan of bound journals - 495 Books loaned - 2,557 Bibliographic searches - 769 Reference requests - 245 Consultation services in relation to library management included responses via telephone, Telephone Lecture Network, and personal visits by the component director to the hospital libraries. Workshop Held A workshop was held on August 31, 1972 whi ch included discussions on acquisitions, cataloging, reference, periodicals and inter-library loans. The discussions emphasized basic procedures and problems involved in library management. A librarian was appointed to the program staff of LARMP. One of her functions is to acquaint people in the region with the services available and assist them in the operation and development of their libraries. 1 6 Project No. 3. - Chronic Respiratory Disease Program Primary Purpose: Education and health care facilities development Disease Category: Pulmonary Health Care Focus: Treatment, rehabilitation, comprehensive care Target Groups: nurses, allied health professionals, physicians, families of patients Area Served: Western New York and Northwestern Pennsylvania Objectives: Provide home care and rehabilitation programs for patients; provide educational programs for nurses, patients and families of patients in chronic respiratory disease. The following components of the program were previously instituted: (not necessarily in 1972) Screening Program Pulmonary Function Laboratory School of Respiratory Therapy Respiratory Therapy Service Pulmonary Physical Therapy Home Care Program Continuing Education for Nurses Rehabilitation Program Continuing Education for Physicians Model Pulmonary Care Facility Respiratory Intensive Care Unit PROGRESS REPORT: In 1972, 50 new patients were enrolled in the rehabilitation program, 34 of whom were able to complete the 8-week program. All but two of these patients experienced substantial symtomatic improvement as well as objective evidence of improvement of exercise capability. Thirty-eight patients completed the rehabilitation program and were invited to enroll in a rehabilitation clinic in 1972. These patients are seen every three months and are encouraged to continue their activities following the formal program. Nine hundred sixty-two nurses participated in 35 teaching programs during 1972. The educational programs were an important aspect of the program. A pamphlet that deals with chronic respiratory disease was developed and published for the purpose of assisting in teaching patients and families more about the disease and how to handle it on a day to day basis. Over 3,000 of these pamphlets have been distributed and have received enthusiastic acceptance. Project No. 4 - Emergency Medical Services System Primary Purpose: Part Training and Part Patient Services Disease Category: Multicategorical Health Care Focus: Diagnosis and Treatment Target Groups: Multiprofessional; Patients 1 7 Area Served: Erie County Objectives: To document emergency medical needs and to develop an appropriate emergency medical services system throughout the nine county region. PROGRESS REPORT: Researchers have surveyed 18 Erie County Hospitals and 4 in Niagara and Cattaraugus Counties; 53 volunteer fire ambulance/rescue and 3 emergency first aid squads. Survey data on commercial and hospital based ambulances has been obtained from the New York State Department of Health. Based on data collected, recommendations were made to the Communications Sub-committee as to placement of radio equipment. This sub-committee, comprised of several communications experts, designed and developed bid specifications for the Emergency Medical Communication Network. Training Courses Held Medical En-ergency Technician training began in October with two courses completed, thirteen in process, three beginning in March, 1973, and five more beginning in April, 1973. Educational materials, equipment, supplies and training aids are secured. The Erie County Medical Society has assisted in recruiting physician instructors. Several area hospitals are providing the emergency room observation sessions. In depth research on emergency cardiac care projects was completed. Based on the accrued data, a cardiac care project was developed with a Buffalo hospital and ambulance service. Emergency Medical Care Committees have been formed in Niagara, Cattaraugus, and Chautauqua counties. Committees are anticipated in the remaining five counties of the Lakes Area Regional Medical Program, Inc. Project No. 5 - Tumor Service Registry Primary Purpose: Part Training and Part Patient Services Disease Category: Cancer Health Care Focus: Comprehensive Care Target Groups: Medical Records personnel, physicians, cancer patients Area Served: Western New York and Northwestern Pennsylvania Objectives: To provide better care to cancer patients by improving (1) quality of care by hospital and physician and (2) access to care through follow-up procedures. PROGRESS REPORT: Continuous operation of the registry was maintained with processing of input data, publication and distribution of periodic reports and further expansion of the follow-up program. 18 Hospitals participating increased from 18 to 20, with a hospital bed increase from 3,017 to 3,817. Five workshops were held for continued training of hospital registry secretaries. All participating hospitals were visited during this period for purposes of individualized instruction and actual assistance in abstracting hospital records. The basic abstract, the hospital follow-up and the physician follow-up forms were revised with several improvements; adequate supplies of each were obtained. New computer programs have been written to retrieve stored data in a well organized and meaningful form. Project No. 6 - Lake Area Health Education Center Primary Purpose: Coordinate area-wide health care education Target Groups: Health care providers, consumer groups with emphasis on Spanish-speaking and Black migrant workers. Area Served: Pennsylvania Counties of Erie, Crawford and Warren; Chautauqua in New York and Ashtabula in Ohio. Objectives: To provide area-wide education and training programs for providers and consumers. PROGRESS REPORT: Programs are being conducted in the areas of - continuing education in medicine, pharmacy, dentistry, clinical pharmacy, clinical pastoral education, medical program development and medical education coordination, therapeutic drug information service, training of nursing personnel in geriatric care, training of activity leaders for long-term care facilities, basic health care education for underserved migrants, Sickle Cell disease education program, planning, evaluation and analyses of health manpower needs. Other programs under consideration deal with: nursing institute (coordination and development of all area programs in nursing, at all training and academic levels); nutrition education (a similar program for dietitians, nutritionists and most food workers with perhaps an out-reach touching the education of specific lay groups in nutrition and career opportunities through health education for regional employment - COHERE, a program designed to recruit, education and place manpower in health services.) Project No. 7 - Allegany County Mobile Health Unit Primary Purpose: Part Training and Part Patient Services Disease Category: Multi-categorical Health Care Focus: Prevention and Screening Target Groups: Rural Population; Health Professionals Area Served: Rural Allegany County Objectives: To make health education classes available to citizens of Allegany County; and to provide health assessment programs for all ages. 19 PROGRESS REPORT: A custom designed self-contained multi-purpose mobile health unit was purchased in June 1972. During the summer months an extensive orientation program was conducted for both health professionals and consumers concerning the purpose of the unit. A driver-secretary was employed as of May 1, 1972. The unit has been operating on a three-day, two-day alternate week operation covering five sites. A total of 54 individuals have received health assessments as of November 30, 1972. So far, 24 persons, or 44% have been referred to a physician for follow-up of a suspected deviation from health. Two of these people have been hospitalized. The age of clients has ranged from 15 to 78 years. The list of problems has reflected the health problems of the general public (cancer warning signals, circulatory disturbances, elevated blood pressure, etc.). As of March, 1973 over 145 persons have visited the unit for service. Project No. 8 - Comprehensive Continuing Care for Chronic Illness Primary Purpose: Research and Development Disease Category: All Chronic Diseases Health Care Focus: Prevention, screening, diagnosis, treatment, rehabilitation Target Groups: Health Care Team, Inner-city Poor Area Served: Buffalo Inner-city Area Objectives: To develop a model demonstration program which would implement and evaluate a comprehensive continuing approach to the care of patients with chronic illness. PROGRESS REPORT: 1. Recruitment of full staff 2. Completion of research instrument 3. Development of research instrument 4. Creation of problem oriented clinic charts for experimental patients 5. Graduation of Home Health Aides from training course. 6. Several site visits made to locations at which programs similar to ours are being developed 7. Development and implemation of pilot study 8. Completion of data collection for retrospective chart review of 100 chronically ill E. J. Meyer Hospital patients Data from the pilot and retrospective studies are being analyzed to achieve a good estimate of patient behavior to pretest methodology and data gathering instruments, and to refine clinical practices. 20 Project No. 9 - Model Program for Comprehensive Family Health Primary Purpose: Part Training and Part Patient Services Disease Category: Multicategorical Health Care Focus: Prevention, screening, diagnosis, treatment and rehabilitation Target Groups: Multi-professional Area Served: Buffalo Metropolitan Area Objectives: To identify community health needs and meet these needs through the team approach; to develop a model to demonstrate the effectiveness of family physicians. PROGRESS REPORT: A computer terminal facility has been developed and is now in operation. Record systems have been modified to provide the basis for adequate data. Encounter forms have been created to provide a reasonable basis for making this data computer adaptable. The necessary personnel to achieve this have been engaged. Alternate sources of support for the program at the Family Practice Center have been generated to support the educational aspects. These funds are being derived from the federal government under the Health Manpower Act of 1971 and from the development of a new Department of Family Medicine at the School of Medicine, State University of New York at Buffalo. The project, in its entirety, was initiated and is being subsidized by Deaconess Hospital. Project No. 10 - Master Plan for Planning and Articulation of Allied Health Education Primary Purpose: Coordination of Health (training) Services Disease Category: Multicategorical Health Care Focus: Comprehensive Care Target Groups: Allied Health Professions Area Served: Western New York and Northwestern Pennsylvania Objectives: To identify manpower needs, training programs presently in operation, roles and responsibility of RMP-CHP; to develop advantages of and mechanisms for cooperative regional planning; and to construct a master-plan PROGRESS REPORT: An Advisory Committee was appointed to provide necessary leadership. The initial meeting of the Council was called to discuss coordinated regional planning. An analysis of the region with respect to current manpower needs and educational programs was accomplished. 21 It was determined that the region is currenti oversubscribed with allied health programs y eds. Coordinated regional planning should prevent with respect to health manpower ne unnecessary duplication of educational programs and overproduction of manpower. Project No. 1 1 - Community Health I nf ormation Prof ite Primary Purpose: To identify problem areas for the Lakes Area Regional Medical Program, Inc. and other health agencies. Disease Category: Multi-categorical Health Care Focus: Data Collection and analysis Target Groups: Allied Health Professions Area Served: Western New York and Northwestern Pennsylvania Objectives: To provide a data base covering the health care systems of Western New York and Northwestern Pennsylvania. PROGRESS REPORT: Profiles have been completed for Cattaraugus and Allegany counties, New York; for the aging in Erie County, New York; and ambulatory care services for the inner city of Buffalo. A profile of Family Planning in the seven counties of Western New York will be completed in February, 1973. Data collection has begun on the profile of Chautauqua County. These reports have had wide distribution nationally and have become the model for similar studies elsewhere. 22 DEVELOPING A GRANT PROPOSAL Letter of Intent Regional Advisory Group Review A letter of intent is the first step in develop- Comments of the county committees, the ing a proposal for submission to LARMP, Inc. It is a Proposal Committee, and the Comprehensive Health brief summary of the project concept. R MP program Planning Councils are forwarded to the Lakes Area staff and county committee chairmen use the letter Regional Medical Program Regional Advisory Group of intent to determine if the idea is pertinent to the (RAG). The RAG is the final review and the decision- ,goals and objectives of LARMP, Inc. Results of this making body. It considers the recommendations review are communicated to the author. He then provided by all other review groups, and makes the decides if the proposal warrants further development. final decision on approval of projects. The author The letter of intent should be a one or two- is specifically requested to attend the RAG meeting page, single-spaced, typed letter addressed to: at which his proposal is being considered. Executive Director The actual funding is dependent upon RAG's Lakes Area Regional Medical Program, Inc. priority ranking of approved projects within LARMP, 2929 Main Street Inc. goals and objectives, subject to the availability Buffalo, New York 14214 of funds. It must include: o a brief statement of what is proposed The LARMP review mechanism promotes and by whom involvement of the sub-regional groups o documentation of the need education of author and reviewers m what is to be accomplished-the objectives equity of review. 0 how it is to be accomplished-the methodology The proposal author is in personal contact with the N anticipated cost over requested funding period series of groups who review his proposal. In 0 plans for measuring the effect of the project- particular, he must be prepared to explain to the evaluation component. county committees his concept and its applicability to their particular situation. The Regional Advisory Review Criteria Group has final authority for both approval and The letter of intent is reviewed by the county funding decisions. committee chairmen to determine if an idea is pertinent to the goals and objectives of the Lakes Area RMP, Inc. The Comprehensive Health Planning Councils are provided copies of the letters of intent for their staff's review and comment. Special forms are used by the county committee chairmen, LARMP, Inc. staff, and CHP-staff, to review letters of intent. 23 FIGURE 6 PROPOSAL REVIEW PROCESS Author 1 LETTER 0 LARMP CHP Staff Headquarters Review and Comment Staff Assessment COUNTY COMMITTEE CHAIRMEN ASSESSMENT I Author develops PROPOSAL DRAFT LARMP Staff Review & Comment Technical Review Evaluation Committee Author develops FINAL PROPOSAL FINAL PROPOSAL DISTRIBUTED CHP Council County To Review Bodies Committees Review and Comment Proposal Committee 24 EVALUATION Evaluation tools have been developed to assure All proposals submitted to LARMP for possible that health activities goals and objectives remain funding, are screened to insure the presence of an flexible and respond to the documented needs of the effective evaluation component. All operational region. These tools also measure the contributions of projects are monitored by a newly developed activities to the programs goals and objectives and the quarterly reporting system which includes site visits activities themselves to see if they are well-conceived and informal visits by LARMP staff members. and well carried out. Information derived from measures of program effectiveness is used periodically to reassess goals and objectives, determine the level of support for ongoing activities, and seek out projects and activities which address themselves to as yet unmet objectives. During 1972 an attitudinal survey of a sample of consumers in Allegany County was conducted to determine attitudes towards health, health care and perceived health needs as reported by residents of this rural county. Interviews of the same sample population will be conducted this summer to determine any changes in attitudes and whether or not the recently installed Allegany County Mobile Health Unit has had any effect on these changes. An Evaluation was conducted on the Rural Externship project to determine changes in attitudes of health science students towards rural health care delivery systems. Revision of the Telephone Lecture Network evaluation methods resulted in a change of programming more suited to the needs of the participants. A study is currently underway to determine the EVALUATION WORKSHOP usage patterns of the Information Dissemination Service. A site visit of the Tumor Registry took place Process of Program Evaluation in April, 1972. An evaluation workshop sponsored by the A survey of the LARMP's official newsletter, Lakes Area Regional Medical Program, Inc. and Forum, was carried out to determine the visibility of featuring talks by Dr. John Cassel, Chairman, Depart- the program throughout the region as well as ment of Epidemiology, School of Public Health, attitudes toward the newsletter. A number of University of North Carolina and the Honorable LARMP sponsored workshops and continuing Elliot Richardson, Secretary of U.S. Department education programs for health professionals were of Health, Education and Welfare, was held Novem- evaluated to determine their effect on participants ber 2, 1972 at the Treadway Inn, Niagara Falls, and to assist in planning for future programs. New or 25 The purpose of the workshop was to acquaint evaluation. Those who participated realized the those persons associated with the Lakes Area importance of evaluation, and demonstrated an Regional Medical Program, Inc. with the evaluation increased appreciation of its relevance to program mechanism, its complexity, and the need for overt goals and objectives. The workshop produced commitment to its implementation. Evaluation is rationales for 'why' evaluation is necessary in terms considered to be an essential component in all of the of planning and outcome. It forced people to ask Lakes Area Regional Medical Program's projects and basic and direct questions about the need, motive, program activities. It is a mechanism that promotes and direction behind projects. It lead to the sound planning, productive operation, and innovative clarification of individual goals, demonstrating the replanning. Evaluation efforts depend upon the need for relevant, workable, and specific objectives. cooperation of project sponsors and administrators; and cooperation depends upon understanding. The In an attempt to evaluate particular projects of workshop proved to be a workable way to accomplish LARMP, participants were confronted with that understanding, for both project and program evaluation problems. They found that as they shaped people. evaluation, they reshaped the project. Evaluation began as an idea and emerged as a functional process It was generally agreed that the workshop that required work, understanding, and unqualified brought about a positive attitudinal change toward commitment from every facet of every program. -7, 26 FIGURE 7 STATUS OF PROPOSALS Thefollowingproposals wentthrough thelakes Area Regional Medical Program review process during 1972. Results of Title Author RAG Review Period A Public Health Nutrition Ruth E. Kocher Approved 3 years Program for Chautauqua and Cattaraugus Counties Continuation Proposal for Phyllis F. Higley, Ph.D. Not Approved 2 years Development of a Master Plan for the Planning and Articulation of Allied Health Education in the Western New York Region Improving Medical Laboratory Sara Marie Cicarelli Approved 2 years Services in Rural and Small Hospitals Development of a Homemaker Health Association of Not Approved 3 years Service in Niagara County Niagara County, Inc. Dial Access for Cancer Edwin A. Mirand, Ph.D., D.Sc. Tabled 3 years Information Service Emergency Medical Erie County Department Approved 1 year Services System of Health 27 FIGURE 8 Proposals Submitted to Washington as part of Lakes Area Regional Medical Program, Inc. Triennial Grant Application for September 1, 1973-August 31, 1974. Title Coordinator Telephone Lecture Network Joseph Reynolds Chronic Respiratory Disease Program John Vance, M.D. Tumor Service Registry John Patterson, M.D. Model Program for Comprehensive Family Health Ernest Haynes, M.D. Allegany County Mobile Health Unit Virginia Barker, R.N., Ed.D. Comprehensive Continuing Care for Chronic Evan Calkins, M.D. Illness Improving Medical Laboratory Services in Sara Marie Cicarelli Rural and Small Hospitals Public Health Nutrition Program for Cattaraugus Ruth E. Kocher and Chautauqua Counties Emergency Medical Services System James H. Cosgriff, Jr., M.D. Lake Area Health Education Center Michael Carey 28 FIGURE 9 PROGRAMS IN CONTINUING EDUCATION, 1972 DATE PROGRAM LOCATI ON REGISTRANTS CO-SPONSORS February 24 Cancer Teaching Day Wyoming County Community 110 American Cancer Society "Current Advances in the Hospital Wyoming County Unit Treatment of Leukemia" Warsaw, New York March 1 1 Cancer Teaching Day Niagara Falls Memorial 152 American Cancer Society "Cancer and the Psychology Center Niagara County Unit of Adolescent Smoking" Lakeside Laboratories April 6 Cancer Teaching Day David A. Howe Memorial 90 American Cancer Society "Diagnosis and Management Library Allegany County Unit of Head and Neck Cancer" Wellsville, New York May 3 Cancer Teaching Day Holiday Inn Downtown 175 American Cancer Society "Oral Pathology - Detection, Erie, Pennsylvania Pennsylvania Division, Inc. Diagnosis and Treatment" Erie County, Pa. Unit Pennsylvania Department of Health Cancer Control Division June 1 Cancer Teaching Day Castle Restaurant 210 American Cancer Society "Cancer of the Colon" Olean, New York Cattaraugus County Unit June 15 Aging Seminar Jamestown Community 300 Study Commission, Problems of "Understanding the Aging College the Aging Process" Jamestown, New York October 1 1 Health Guides Workshop Parkway Ramada Inn 70 Lakes Area Regional "Communication - Process Niagara Falls, New York Medical Program, Inc. and Problems" (continued) DATE PROGRAM LOCATION REGISTRANTS CO-SPONSORS October 19 Cancer Teaching Day Holiday Inn 213 American Cancer Society "Cancer of the Uterus" Batavia, New York Genesee County Unit November 2 Evaluation Workshop Treadway Inn 120 Lakes Area Regional "A Workshop - The Process Niagara Falls, New York Medical Program, Inc. of Evaluation" November 8 Heart Teaching Day Holiday Inn 335 Heart Association of Western "Live Longer Electrically, Batavia, New York New York with a Pacemaker" Genesee and Wyoming Counties Units November 15 Aging Seminar Hotel Jamestown 366 Study Commission, Problems of "Understanding the Aging Jamestown, New York the Aging Process - Part I I" Jamestown, New York November 16 Cancer Teaching Day Cameo Restaurant 104 American Cancer Society "Carcinoma of the Colon, Wellsville, New York Allegany County Unit Changes and Status in 1972" November 29 Sickle Cel I Seminar 1490 Jefferson Avenue 70 Niagara Frontier Association "Community Involvement in 585 Michigan Avenue for Sickle Cell Disease Combating Sickle Cell Buffalo, New York Lakes Area Regional Disease" Medical Program, Inc. 1,054 Emergency Medical Services System nurses, public health personnel, volunteer firemen, Civil Defense, Red Cross, ambulance and emergency Emergency Medical Services on the Niagara squad members, hospital administrators and others. Frontier got a big boost in 1972 when the Lakes Area Regional Medical Program, Inc. working with the Erie One thing the participants had in common was County Emergency Medical Care "Blue Ribbon their interest in solving the problems associated with Committee" (this group serves as the advisory body the delivery of safe, efficient and effective emergency to the Erie County (N.Y.) Health Commissioner) health services. developed an Emergency Medical Services project for the area. Inner City Health Problems The project received $250,000 from the Lakes Inner city problems in Niagara Falls, and Area Regional Medical Program, Inc. on June 28, Buffalo, Ne@v York as well as Erie, Pennsylvania have 1972. The EMS system provides a radio communica- received continued attention and surveillance by tions network that links all police and fire depart- LARMP. ments, fire base stations, hospitals and transit author- ities for emergency services in the county. The project During 1972 a LARMP staff member worked also includes a Medical Emergency Technician Training closely with many action agencies such as Model program for 5,000 ambulance and rescue squad Cities, Community Action Organization, Niagara attendants over a 3-year period. Community Action Program (NIA-CAP), Family Service Reach Out, etc. In addition he provided Emergency Medical Services Workshop consultation, technical writing and information gathering skills to small groups and government The First Annual Regional Conference on agencies operating in these areas. The community Emergency Medical Services held February 1 - 3, groups include the Family Life Consortium, Niagara 1973 in cooperation with the Emergency Medical Frontier Association for Sickle Cell Disease, Perry Care Committee, Erie County Health Department, Valley Community Health Center, Lackawanna was highly successful and brought together a number Health Center and the Erie, Pennsylvania Sickle Cell of persons interested in EMS such as physicians, Society. I= ft@ @ @-M U74vl&j 31 The LARMP's continued emphasis on LAHECisanon-profitcommunitycorporation, combating the categorical disease, Heart, Cancer and whose goal is to serve as a community-based and Stroke resulted in further cooperative efforts with operated regional system of education and training medical and lay groups in a community-wide effort to for health manpower, providing them with "basic," develop a program for screening, education, referral "continuing," and "innovative" programs. LAHEC and treatment of persons with hypertension. Involved coordinates and develops area resources and potential in this effort were representatives of the Upstate in order to meet area needs in health-care manpower. Medical Alliance, an organization of black physicians, The area served is primarily Erie County, dentists and podiatrists; as well as members of the Pennsylvania, with its quarter-million population National Medical Association, a similar national black along with a second quarter-million from four group. contiguous counties in a tri-state distribution: Crawford and Warren in Pennsylvania; Chautauqua in Community leaders representing the Bayfront New York; and Ashtabula in Ohio. Additionally, as Community Center, Booker T. Washington - Erie I specific need arises, other counties may and do Center, and the John F. Kennedy Center, all of Erie, participate. Pennsylvania have participated and provided their support in dealing with problems related to their LAHEC's board of directors, their panel of areas. consultants, and their numerous program committees, who represent a comprehensive cross-section of the The BUILD organization (BUILD, Unity, area's health-care manpower and their clinical and Independence, Liberty and Dignity) has sought educational settings are currently directing a wide assistance from the LARMP in developing a.proposal range of activities that not only maintain the for hospitals to use community health aides/patient competence of but also introduce breakthroughs in advocates as a means of changing existing utilization knowledge and new techniques to the area's patterns of hospital facilities within the community. health-care professionals; furthermore, they offer certain groups of lay persons the opportunity to become more pragmatically informed about health Lake Area Health Education Center - and health care. Erie, Pennsylvania The Lakes Area Regional Medical Program, Inc. This fiscal year, LAHEC's activities are funded has pioneered a precedent-setting activity supporting it (cash) 61% by the Lakes Area Regional Medical fiscally and philosophically along with the Erie (Pa.) Program, Inc. 37% by the Veterans Administration, Veterans Administration Hospital. Some 60 hea t or and 2% by local contributions. If in-kind services are health-related organizations in the LAHEC area also translated into dollars, then the proportions are as supported the LAHEC concept and have contributed follows: 54% LARMP, 32% VA, and 14% local. funds and in-kind service. Twelve programs are the core of LAHEC's activities The concept of the "area health education since July 1, 1972. The programs are: center" was introduced nationally in October 1970 in 1 .Continuing Education in Pharmacy the Carnegie Commission report on "Higher 2. Clinical Pharmacy Education & The Nation's Health: Policies for 3. Drug Information Service Medical & Dental Education" (McGraw Hill). 4. Continuing Education in Medicine LAHEC, however, is a pioneering "community" 5. Medical Program Development & Medical variant of the "university" model proposed by the Education Coordination Carnegie report. 6. Continuing Education in Dentistry 32 7. Clinical-Pastoral Education Allegany County Mobile Health Unit 8. Training of Nursing Personnel in Geriatric Care A mobile health unit, designed to provide 9. Training of Activity Leaders for Long- health assessments and health education to Allegany Term-Care Facilities County residents, was purchased with LARMP funds 10. Basic Health-Care Education for Under- in mid 1972. It was fully equipped and put into served Migrants service on October 4, 1972. 11. Sickle Cell Disease Education Program 12. Planning' Evaluation, & Analysis of Health- During the first five months of operation the Care-Manpower Needs unit made regular weekly stops at Angetica, Alfred Station, Caneadea, Richburg and Whitesville seeing Three other programs are under consideration: 141 persons at an average visit of one each hour. The 13. Nursing Institute (coordination and devel- maximum number of persons that can be seen in one opment of all area programs in nursing - at all training day, ten, has been achieved. Of the 141 persons seen, and academic levels). who range between the ages of 15 - 85, 55 are males 14. Nutrition Education (a similar program for and 86 are females. Seventy-nine of the 141 persons dietitians, nutritionists, and most food-workers - with seen were referred to family physicians or to the two perhaps an outreach touching the education of hospitals in the county for further examination. Five specific laygroups in nutrition). were hospitalized including one person who 15. COHERE--Career Opportunities through underwent surgery for a precancerous condition. Health Education for Regional Employment - an Of the 141 persons seen, 19 had no family ambitious program to recruit, educate, and place physician. Twelve of these were referred to a manpower in health services within the LAHEC area. physician of their choice. The total cash budget for this year's twelve Types of referrals included persistent sore programs was well over half a million dollars (and tongue, chest discomfort, shortness of breath, edema close to two-thirds of a million if in-k inds are added). of extremities, flaking mole, long period of hoarseness, frequent indigestion, abnormal blood pressure and increase in blood glucose. RSIT OEALTfl UNIT 33 Rural Externship Program Nursing 4 Dentistry 2 First hand living experience and exposure to Hospital Administration 1 rural health delivery services in small communities are Medical Technology 1 the essence of the Rural Externship Program. This Podiatry 1 project has begun to demonstrate its effectiveness in Social Work 1 directing more health manpower toward underserved Total 34 rural areas. Besides the participation of thirty-four While each student was assigned to one health science students in the 1972 summer, program, principal preceptor, in actual practice he received the working in thirteen small communities in the region, benefit of working with a number of other health the project has resulted in a substantial change in professionals, so that over sixty preceptors were attitude among these participants. Before beginning involved in the program. Since there were several sites their externship, the students indicated that 20.8% of where students representing a variety of health them were planning a rural health career following disciplines were located, they had the opportunity to graduation. At the end of their 1972 experience, the share experiences with on another and participate in a number planning such a career increased to 38.1%, or "team" approach. almost double the earlier figure. The 1972 program lasted for eight weeks. It is Direct exposure to primary care and to health expected that the 1973 operation will also be eight care settings not currently a part of their formal weeks and will include forty students. Externs receive clinical curriculum occurred for students in the a stipend of $1 00.00 per week. The Rural Externship following disciplines and number in each: Program has been sponsored by the Lakes Area Regional Medical Program, Inc. since 1970 and funded Medicine 1 2 by the Appalachian Regional Commission and volun- Physicial Therapy 7 tary contributions from the various communities as Pharmacy 5 well as by the Lakes Area Regional Medical Program, Inc. itself. 34 Library Program applications. A series of four Telephone Lecture Network programs for hospital library personnel is The total Lakes Area Regional Medical Program now underway and have been well received. A packet Library program since September, 1972, has operated of library management reprints has been sent to ten in two phases: the in.house informational system and institutions. Plans are being made for a one-day the hospital library consultation service. workshop for librarians late in 1973. Local consultation efforts are coordinated with A newly appointed librarian for the LARMP the educational programs of the Medical Library began her duties by developing a collection of Association and the Regional Medical Library. monographs, journals and pamphlets for program staff use. The monographs are being cataloged with Communications the National Library of Medicine scheme. Current The variety of activities conducted by the awareness needs of program staff are served by Lakes Area Regional Medical Program, Inc. are circulation of journal title pages and lists of new brought to the attention of special target groups and library materials. the general public through effective use of the news media,exhibits displayedat conferencesand meetings, Photocopy and bibliographic service of the brochures for special programs and published articles LARMP funded Information Dissemination Service in the many health-related journals. have been used extensively. Television and radio have been used often to Basically the hospital library consultation cover program activities. The "Forum," the LARMP service is designed to help health care facilities newsletter, brings news of important LARMP events, establish and manage a library for professional health to over 13,500 on the LARMP mailing list. personnel. Maintaining a flow of reliable information to Among the services provided are: assist the news media has resulted in extended coverage of hospitals in building and maintaining an effective our activities. Feature stories about some of our library service for a viable collection; consultations operational projects have appeared in almost all of with hospital administrators concerning the the daily newspapers in the region. establishment of a library service in their hospital; use of the Telephone Lecture Network to communicate The media has provided good local coverage to with library personnel for training program purposes; our continuing education programs for health conduct workshops for the library personnel; provide professionals in the various communities where the assistance in completing forms to obtain federal funds programs were held. (resource grants) for library collections. The LARMP subscribes to almost every daily Hospital Library Consultation Service and weekly newspaper in the region. Eighteen institutions have requested News clippings from these newspapers are consultation services. Many community hospitals clipped, and copies circulated to area legislators, were found to have minimal collections and expressed RMPS, and appropriate LARMP staff for interest in submitting NLM improvement grant informational exchange. 35 FIGURE 10. Volunteer's Contribution In 1968, community time volunteered to A study was conducted in 1968 by the Lakes LARMP showed that for every federal dollar received, Area Regional Medical Program, Inc. to find out what 23 cents was provided by the volunteer's was being contributed to the LARMP operation in contributions of time, efforts and other resources. In terms of money by the many dedicated volunteers 1971 this figure rose to 40 cents for every federal who take part in its activities. dollar. This included the use of such resources as In 1973 the figure is 66 cents for every federal meeting rooms, services, workshops, and time spent dollar. By 1974, it is projected that local in meetings on RMP business along with other such participation will increase to about 68 cents/federal f actors. dollar. 7(V - cc 6(9 - 0 50i - cc ui 0 Lu 40@ - U- o: LU 30e- z Z) 0 20@ - L 1968 1970 1972 1974 YEAR PROJECTED M COOPERATIVE CONTRIBUTIONSTO LARMP PER FEDERAL DOLLAR EXPENDITURE 1968-1974 36 LAKES AREA REGIONAL MEDICAL PROGRAM, INC. PROGRAM STAFF: Professional - John R.F. lngall, M.D. - Executive Director James J. McCormack, Ph.D. - Associate Director Robert J. Miller, M.B.A. - Executive Assistant to Director Patricia Shine Hoff, R.N., M.A. - Assistant Director - Nursing & Allied Health Benjamin Morgan, B.S. - Comptroller Marion Sumner, M.B.A. - Consultant Anthony Zerbo, B.A. - Assistant Director - Communications Robert Beebee, M.B.A. - Staff Associate Helen Brown, M.A. - Staff Associate David Buck, M.R.P. - Staff Associate William D. Crage, M.S.W. - Staff Associate Janet Gelsinger, B.A. - Staff Associate Jean Hanna, M.P.H. - Staff Associate Michael Miller, B.A. - Staff Associate Diane Pinchoff, M.A. - Staff Associate Joan Philipps, B.S. - Staff Assistant Gary Smith, B.A. - Staff Assistant Teresa Wang, B.A. - Accountant Support - Julianna Bednarz Alice Bragg Carol Butcher Hazel Cunningham Elizabeth Eberl Karen Harper Charlene Kane Mary King Bonnie Kirisits Marcia Moule Rosemary Meyers Rosetta Parker Diane Williams Urban Batt Richard Raeihie 37 PROJECT PERSONNEL TELEPHONE LECTURE NETWORK MOBILE HEALTH UNIT Joseph Reynolds - Director Dean Virginia Barker - Director Bob Mathiebe Ray Meacham Doris Unger Marge Witkop ALLIED HEALTH Robyn Atkinson Phyllis Higley - Director Monica Stenson COMMUNITY HEALTH INFORMATION PROFILE Robert Barak Janet Love Harry Sultz, D.D.S. - Director Frank Rens CHRONIC ILLNESS Ruth Grabenstetter Lynn Goris Evan Calkins, M.D. - Director John Nelson, Donald Snyder Lorraine Heh Andrea McKown Donald McGreevy Sandra Kennuth Julia Varnish Mary Brogan Subhash Narula TUMOR REGISTRY Howard Strong John Patterson, M.D. - Director Charlene Norman Freda Honig Sally Rollek Dolores Gamble Dominica Limburg Joy Greenwood Lavada Davis Alice Pfonner Lola Bishop Angelika Saxer Minnie Brown Mary Penkacik Lillian Peeples Jacqueline Levitt INFORMATION DISSEMINATION SERVICE Mary Lou Olson Sharon Dittmar Jean Miller - Director Joanne Nichter RESPIRATORY Ruth Hyman Thomas Garvin John Vance, M.D. - Director Geoffrey Stearns Frances Cirbus Barbara Edelman FAMILY PRACTICE Ruth Frederick Ernest Haynes, M.D. - Director LAKE AREA HEALTH EDUCATION CENTER Joyce Fais Suzanne Manson Michael Carey - Director Timothy Kittle Robert Corrigan Norma Montagnino Mary Ann Henry Brenda Willson Anthony Silvagni Margaret Bennett Edward Taylor Nancy Harti Victor Vidal 38 EMERGENCY MEDICAL SERVICES James Cosgriff, M.D. - Director Roger Fenlon Thomas Allen George Ball Sandra Bogdanowicz David Clowes Sandra Colligan Mary Beth Cosgriff Samuel Drago Robert Enggist Glen Fosdick Sam Fried Geoffrey Gibson Susan Haber Jeffery Lacey Cooper Lansing Cathy Rohrer Lucia Shealy Nancy Sobierajski Dorothy Stone Allen Stone Nicholas Vastola Michael Walters William Wutz Gregory Photiadis 39 Director of the Regional Medical Programs Service Harold Margulies, M.D. Executive Director for the Lakes Area Regional Medical Program, Inc. John R. F. Ingall, M.D. Lakes Area Regional Medical Program, Inc. 2929 Main Street Buffalo, New York 14214 Telephone: (716) 835-0728 40