0 dt, 0 0 Telephone 725-0680 Area Code 901 MEMPHIS REGIONAL MEDICAL PROGR'AM FOR-HEART DISEASE, CANCER AND STROKE 1300 MEDICAL CENTER TOWERS 969 MADISON AVENUE AES W. CULBERTSON, M.D., MEMPHIS, TENNESSEE 38104 rogr,am Coordinator ,AES W. PATE, M.D., :hoirmon, Central Committee April 21, 1971 Harold Margulies, M. D., Director Regional Medical Programs Service Parkl-awn Building- Room 11-05 5600 Fishers Lane Rockville, Maryland 20852 Deat Dr. Margulies: On February 24 I sent to you a memorandum including eleven vignettes on programs or activities which we have that relate to the new national directions ftr Regional Medical Programs as stated in the narrative portion of the FY-1972 Presidential Budget. After I returned from the recent meeting of RNP Coordinators in Atlanta, I asked our information officer to 6xamine our program with respect to activities that appear to relate to items in the President's recent health message. For your information I am enclosing his report in a memorandum dated April 7 in which he summarizes fourteen activities of the,Memphis Regional Medical Program which we believe are perti- nent in this regard. We have been working on new directions and new emphases in the Memphis Regional Medical Program since the second Airlie House Conference in May of 1970. I believe that we are now in a position to demonstrate some substantial results of .these ef forts. This brings very best regards to you. Yours sincerely, W. Culbertson, M. D. JWC:hm Encl. telephone 725-0680 'Area Code 901 MEMPHIS REGIONAL ML'--DICAL PROGRAM FOR HEART DISEASE, CANCER, STROKE AND KIDNEY DISEASE 1300 MEDICAL CENTER TOWERS 969 MADISON AV@@NUE W. CULBERTSON, M.D. MEMPHIS, TENNESSEE 38104 irom Coordinator & Director 5 W. PATF, M.D. irmon, Planning Board MEMORANDUM TO: Dr. James W. Culbertson, Pro-ram Coordinator .PROM: Clayton Braddock Information Officer SUBJECT: New Directions for Memphis RMP DATE: April 7, 1971 This should be considered a supplement to my memorandum of February 17. To indicate the increase in the tempo of activity in our program, I should point out that most of the following either developed or came to the fore since that memorandum was written. 0 The new information presented here is divided into simple groups under the following headings: Innovative health-care delivery systems, the accessibility of hea_ 1 care, the manpower crisis, and new project proposals. The last group,of course, have not completed the review process, but have substantial merit and are described as indicators of significant ferment among Memphis RMP's constituency. INNOVATIVE HEALTH-CARE DELIVERY SYSTEMS Model Health Service System-- L-i the past few days, the mayor and other officials of the City Of Corinth, iMiss. , have invited Memphis RMP to coordinate and assist in the development of a model health service system in a 10-county area around that city, participatin- in the venture with other federal a-encies such as Housing and Urban Development 0 t3 and the Appalachian Regional Commission. No opportunity and challenge has elicited such enthusiasm and excitement from members of the core staff. Health Maintenance -- To continue its deep interest in Health Maintenance Organizations, Memphis RMP is completing plans to provide special training in the HMO program to selected members of the core staff. These persons will provide consultation to interested groups in the region, including a number of physicians who have requested information. We have invited an HMO specialist from the re,-lonal office in Atlanta to speak to the Memphis RMP staff and some staff members will attend a conference on HMOs in oxi, Miss., on April 21 and 22. Health Delivery Management -- Although our involvement in the proposal to create Health Systems Mana-ement, Inc., was sketched briefly in the February 17 memorandum, catalytic role Nvliich included stimulti@ for the o'ricdnal idea, major assistance in research nd formal writin.- of the proposal. This pro.-ram now has a deep commitment to the *concept of IISM, Nvliich is a local version of the Experimental Health Services Plannino, and Development System. Memphis RMP is mal@- firm plans for the eventual fruition of HS.LNI, includin- a substantial role as the evaluative arm of the proposed agency. HSM as proposed, would achieve "an integrated health care system (for the three-county, area of Metropolitan Mempliis)-xvhich will provide access to and equity of health services, the containment of unit and a(T(Tre,,Tate costs, and the maintenance of quality services. The application has been submitted by this pro-ram's Reaional Advisory Group and an initial site visit has been completed. Health Advisory GrouDs -- Memphis RMP is actively engaged in oro-anizin- such aroups in areas where they do not now exist. A major interest of this pro-ram is to make such groups advisory bodies to as many health a-encies as possible in any -iven area, municipal, ,county, state and federal. One outstanding example is the North Mississippi District No. 1 Health Advisory Group, which is in the process of bein- formed now in a six-count-y area. This -roup Nvill serve as advisors to Memphis RMP, the Mississippi Reoional Medical @,ouram, the Mississippi Comprehensive Health Planning Acr t> ency, and possibly the Appalachian Regional Commission. Memphis RMP staff again, was the catalyst in obtaining the a-,reement from both Mississippi RMP and Mississippi CHP to use the 0 services of the new health advisory group. ACCESSIBILITY OF HEALTH CARE enc Health Personnel Act -- Coincidin- with the aims and -oals of this Act, 0 ZD the Memphis RMP is movin- in several directions to make health care more available C> to the inner city sick poor. The pro,-,ram has received requests from agencies in our region, including the Memphis and Shelby County Health Department and Wesley House (a stru- ' g but effective neighborhood health center) for information about the EHP "glin Act. Wesley House has asked for assistance in findin- and recruitin- personnel to t> t> work at the health center. This program has developed and made available to the community highly qualified staff resource personnel iA this field who are already at work in the community. Consumer Educa tion A. Because of the serious need in this area, a consultant has been retained to identify the regional needs in consumer education and the techniques which will be required to meet those needs. B. Community and health leaders in Paraaould, Ark., have requested Memphis RMP in recent days to help them develop a consumer education project to meet the needs of 12 Northeast Arkansas counties. The Sick Poor -- Since late February, Memphis RMP has been servin- as advisor 0 y &ncy to a new organization established to help persons in poor Memphis neighborhoods rrparticipate more fully in the creation and direction of health and welfare efforts designed to help them. Leadin- the new organization are the Memphis chapter of the C) @Tational Wplfnrt- 'Ri(y'ht.,z Oranni7nfiny, -n-nrl fkn lXt^-I, T----4-,,,- /IIYT'KT\ -3- *HE MANPOWER CRISIS The Memphis RMP, in cooperation with health providers at the University of Tennessee Medical Units and leaders of the consumer community, has requested Secretary John A. Volpe of the Department of Transportation to include the Memphis Mid-South rea,.on in the MAST air-ambulance pro-ram. Although the present MAST proaram has been limited to five sites, the proposal to include Memphis will be considered when expansion studies are completed. iN'E, W PROJE C TS The following new proposals, now in the early phases of the review cycle, are described here, not only because of their own merits as potential demonstrations of effective health care techniques but because they also touch on many aspeP-ts of the new catalytic ferment described above. Leari,iin!,y Center -- As an additional component in the development of a regional medical information networl,., it has been proposed that a satellite learning center be established at Jackson, Tenn. The center would serve as a branch of Memphis RMP's Reaional Information System operatin-, out of the University of Tennessee Medical Units Library. This existing information pro-ram has been one of the richest contributors to Memphis P's growing number of supporters and friends. C6ntinu@@ - Education (Physicians) -- The proponents, the Tennessee Medical Association, seek the coordination by some centralized office of all continuing medical education in Tennessee. This central office would not be directly involvedin education, but it would serve as a catalyst, identifyin- needs and resources. It,would encourage continuing education in general, especially "self education", and would assist in the evaluation of existing and proposed programs in the state. Improvement of Nursing Care -- This proposed projectis designed to "identify expectations for current and projected functions of nurses" in the reoion and to "assist nurses in gaining competencies to meet.these expectations. 11 Procrram approach 'mcludes collab- oration vv ith administrators and physicians and preparation of nurses to assume expanded' roles in health care delivery. Nursing In-Service Education-- Central to this proposal are facts -leaned from a regionwide survey by Memphis RMP staff showin- (1) the -reat desire of nurses for such in-service education (2) that no formal mechanism- exists for development of in-service education of this nature and (3) while most institutions have someone assigned to this task, few have formal preparation for the job. Decentralized Health Services--This proposal would supplement existin- preventive Z> &vices by installing primary care operations in certain existing neighborhood clinics. Terrsons served would be ambulatory patients with minor complaints, relyino, primarily on clinical nurses and other paramedical personnel. Such a project would also serve a@-, A nnrl rp-f,-.rrnl fnt-.Illif-v rplioiri-no- than n"@ocii"a f"n@ 0;@r nf 'N/Tn@nk4o T-T^,-n4+,31,, SUBCOMMITTEE ON LABOR AND HEALTH, EDUCATION AND WELFARE, AND RELATED AGENCIES COMMITTEE ON APPROPRIATIONS 92YI) CONGRESS Democrats Daniel J. Flood (Pennsylvania) - Chairman William H. Natcher (Kentucky) Neal Smith (Iowa) W. R. Hull, Jr. (Missouri) Robert (Bob) Randolph Casey (Texas) Edward J. Patten (New Jersey) ReRublicans Robert H. Michel (Illinois) Garner E. Shriver (Kansas) Charlotte T. Reid (Illinois) Silvio 0. Conte (Massachusetts) Robert M. Moyer, Clerk Henry A. Neil, Clerk LABOR-WELFARE SUBCOMMITTEE OF THE HOUSE APPROPRIATIONS CO M TTEE 92ND CONGRESS DANIEL J. FLOOD (Democrat) of Wilkes-Barre Pennsylvania. Born in Hazleton, Pennsylvania, November 26, 1903. Received early education in public schools of Wilkes-Barre, Pennsylvania, and St. Augustine, Florida. Graduate of Syracuse University, A.B. and M.A. degrees, and later attended Harvard Law School and Dickinson Schoo o aw, Carlisle, PehsylvaniA, graduating in 1929 with L.L.B. degrees. Admitted to the bar of various State and Federal Courts in 1930. Attorney for Home Owners' Loan Corpor- ation 1934-35 Deputy Attorney General for Pennsylvania and Counsel for Pennsylvania Liquor Control Board, 1935-39; Director, Bureau of Public Assistance Disbursements, State Treasury, and Executive Assistant to State Treasurer, Pennsylvania, 1941-44; married Catherine H. Dini6i J. Flood Swank on September 24, 1949; member of many o-,P Plilke.9-Barre (lith Dist.) local civic, fraternal, beneficial, and social D,--mo(,.rat - l@lth term societies. Elected to 79th, 81st, 82nd, 84th Congress and re-elected to succeeding Congresses. Former Vice Chairman of Special Committee to investigate Katyn Massacre (murder of Polish officers by Russians). Also member of Subcom- mittee on Defense, Committee on Appropriations. 2 WILLIAM H, NATCHER (Democrat) of Bowling Green, Warren County, Kentucky; born in Bowling Green, Kentucky, educated in the public schools of Bowling Green, Kentucky, and high school at Ogden Preparatory Department; A.B. degree, Western Kentucky State College, Bowling Green, Kentucky; L.L.B. degree, Ohio State University, Columbus, Ohio; married to Miss Virginia Reardon, of Bowling Green, Kentucky, on June 17, 1937; two daughters: Celeste White, 26, and Louise Lewter, 22; practicing attorney, Bowling Green, Kentucky, since March 18, 1934; Federal concili- ation commissioner 1936-37 for Western District of Kentucky; elected county attorney of Warren County in 1937 and served three four-year terms, Iv@il.liam H. Natcher elected Commonwealth attorney of the 8th Judicial rr(,,en (.9d Dist.) District, composed of Allen and Warren Countries, 10ti! term in 1951 and served until August 15, 1953, having been elected to Congress; Baptist; member of Kiwanis club, Odd Fellows, Americal Legion Post 23, and 40 and 8 Mammoth Cave Voiture 1146; past president of the Bowling Green Bar Association; past president of the Young Democratic Clubs of Kentucky ' 1941-46; during World War II served in the United States Navy from October 1942 to December 1945; elected to the 83d and succeeding Congresses, Also member of Subcommittee on Agriculture, and Subcommittee on District of Columbia (Chairman), Committee on Appropriations. NEAL SMITH (Democrat) of Altoona, Iowa; born March 23, 1920, at Hedrick, Iowa; married Beatrix Havens, two children, Douglas and Sharon; farmer and lives on farm near Altoona, Iowa; engaged in the practice of law in Des Moines, Iowa; graduated Drake University Law School; attended @'ssouri University College of Liberal Arts and Syracuse University Schools of Public and Business Adminis- tration; 4-H Club member and leader for ten years, farm operator since 1937 except for time and armed services and some of the time in college; spent four years in World War II, citations include ?4eal Smith nine battle stars, Air Medal, 4 Oak Leaf Of )47,to6)na (Iltk D@@@t.11 Clusters, and Order of the Purple Heart; elected National President Young Demo- cratic Clubs of America 1953--served usual two-year term 1953 to 1955; former chairman, Polk County Board of Social Welfare (a nonpaying civic board which distributed several million dollars per year to needy families and elder citizens); former assistant county attorney for Polk County, Iowa; member of Disabled American Veterans, Masonic Order, and various farm, school, and service organizations; elected to 86th and succeed- ing Congresses. Also member of Subcommittee on State, Justice, Commerce, and the Judiciary, Committee on Appropriations; and Select Committee on Small Business. 0 W. R. HULL, JR. (Democrat) of Weston, Missouri; born in Weston, Platte County, Missouri, April 17, 1906; widower; children, Mrs. Susan Hudson and W. R. Hull 3d; elected to the 84th Congress and succeeding Congresses. Also member of Subcommittee on Agriculture, Com- mittee on Appropriations. W, R. Hull, Jr. oF Weston (6t7i Dist., 9t7,z term ROBERT (BOB) RANDOLPH CASEY (Democrat) of Houston, Texas; born in JoDlin, Missouri, July 27, 1915, son of Sam R. and Mabel E. Casey; moved to Houston, Texas, in 1930, and graduated from San Jacinto High School; attended the University of Houston and the South Texas School of Law at night; was admitted to the State bar of Texas in 1940; opened law office in Alvin, Texas, and served as city attorney and also a member of the school board; returned to Houston as an assistant district attorney in Harris County, in charge of the civil department; in 1948 was elected to the State house of representatives and served in the regular and special sessions of the 51st Bob Casey Legislature; elected county judge of Harris of Houston (22d Diet.) County in 1950 for a two-year term; re-elected Do,-qoo.rat - 7th term in 1952 and again in 1954 for a four-year term; member, First Christian Church; married Hazel Marian Brann on August 13, 1935, and have ten children--Hazel Mary, Robert, Jr., Catherine, Bonnie, Mike, Shawn, Bridget, Eileen, Timothy, and Kevin; elected from the newly created 22d district to the 86th Congress and succeeding Congresses. Also member of Subcommittee on Legislation, Committee on Appropriations. 4 N EDWARD JAMES PATTE (Democrat),of Perth mboy, Nj.; born in Perth Amboy, August 22, 1905; graduated from Newark State College, Rutgers Law School, L.L.B., and Rutgers University, B.S. ED.; member of Eagles, Moose, Elks, Kiwanis, Knights of Columbus, National Conference of Christians and Jews, Chamber of Commerce, and NAACP; lawyer, 1927; teacher public schools, 1927-34; mayor of the city of Perth Amboy, 1934-40; county clerk of Middlesex County, 1940-54; campaign manager for Robert B. Meyner, 1953 and 1957; secretary of state of the State of New Jersey, 1954-62; ILI president, Salvation Army Board; past president of the Middlesex Bar Association; chairman of the Middlesex County Democratic Committee, Edward J. Patten 1934-36; member of the Democratic State of Perth Amboy (15th Digt.) Committee and member of American Judicature Democrat - 5th term Society; recipient of "Outstanding Citizenship" award from American Heritage Foundation and Blnai B'rith's "Brotherhood" award; married February 22, 1936, to Anna Quigg of South Amboy, N.J.; one daughter, Catherine M.; elected to the 88th Congress November 6, 1962; reelected to the 89th, and succeeding Congresses. Also member of Subcommittee on Military Construction 5 ROBERT H. MICHEL (Republican) of Peoria, Illinois. Born March 2, 1923, in Peoria, Illinois. Graduate of Peoria Public Schools and Bradley University, B -S. 1948, business administration. Served in the enlisted ranks during World War II; awarded the Bronze Star, Purple Heart, and four battle stars. Married, foux children. Elected to the 85th and succeeding Congresses. Also member of Subcommittee on Agriculture, Committee on Appropriations. Robp-rt !I. Michel of !,(Peoria (1 8th Dist.) Republican - 8th te- GARNER E. SHRIVER (Republican) of Wichita, Kansas. Born July 6, 1912, in Towanda, Kansas; married in 1941, three children. Attended public schools of Towanda and Wichita; graduate of University of Wichita in 1934 (post-graduate study at University of Southern California in 1936) and Washburn Law School, L.L.B. degree, in 1940. Engaged in law practice since 1940; served for three years in the U.S. Navy as an enlisted man and officer during World War II; State representative 1947-51 and State Senator 1953-60; member of American, Kansas and Wichita bar associations, Veterans of Foreign Wars, American Legion, National Sojourners, Albert Garner E. Shriver Pike Masonic Lodge, Wichita Consistory, of Wichita (4th Dist.) De Molay Legion of Honor, and College -!?P-pubLican - 6th tem Hill Methodist Church; elected to the 87th Congress November 8, 1960 and succeeding Congresses. Also member of Subcommittee on Foreign Operations, Committee on Appropriations. CHARLOTTE T. REID (Republican) of Aurora, Illinois; attended public schools of Aurora and Illinois College at Jacksonville, Illinois; under the name of Annette King, served as staff vocalist on NBC and appeared as a vocalist for three years on Don McNeill's radio program; active in civic and political affairs; married to Frank R. Reid, Jr. (now deceased), in 1938; two sons, Frank R. Reid III and Edward Tompson Reid; and two daughters, Patricia (Mrs. George Lindner) and Susan Reid; elected to the 88th and succeeding Congresses. Also member of Subcommittee on Foreign Operations, Committee on Appropriations. Charlotte T. Reid of Aurora (15th Dist.) RepubZican - 5th term SILVIO 0. CONTE (Republican) of Pittsfield, Mass.; born in Pittsfield November 9, 1921, son of Mr. and Mrs. Ottavio Conte; attended public schools in Pittsfield and the Pittsfield Vocational High School, graduating in 1940; machinist at General Electric Co. in Pittsfield before joining the Seabees in World War II; served in Southwest Pacific; attended Boston College and Boston College Law School, graduating in 1949; admitted to the bar. same year; in November 1950 elected to the Massa- chusetts State Senate; served as Senator from Berkshire District 1951-58; served as chairman of Senate committees on Constitutional Law, Insurance, Judiciary, and as chairman of Legislative Research Council, Specia Commission Investigating Health and Welfare Trust Funds, Commission on Fish and Game, Commission Investi- gating Accident and Health Insurance, Commission Investigating the Increase in Tank-Wagon Prices of Gasoline and Fuel Oil, Commission Studying Blue Cross-Blue Shield, Commission Investigating Discriminatory Practices in Fraternities and Societies in Massachusetts Colleges and Universities; selected by Massachusetts Junior Chamber of Commerce as outstanding young man Silvio 0. Conte of the year in 1954; member of platform of P-,"ttsfir,-ld (Ist -T)ist.) committee at the Republican National Convention ReT,ub'@ican ?th tem in 1960 and 1964; director of the Pittsfield Girls' Club; director of Hillcrest Hospital; member of Berkshire Bar Association, Massachusetts Bar Association, Federal Bar Association; maintains congressional office at 7 North Street, Pittsfield, Massachusetts; married to the former Corinne Duval, four children, elected to the 86th and succeeding Congresses; delegate to Republican National Convention; 1968, member of Platform Committee; member of Appro- priations Committee; Subcommittees on easury- Post Office; Foreign Operations and Transpor- tation; Select Committee on Small Business; Joint Commission on the Coinage; Migratory Bird Conservation Commission. 7 APP,'L30P@@TIOI"iS Hous e Labor-Health, E@@@Uca-t@,ion, and ',,4'elfa.,re Der.iocrp4-S Daniel J. Flood (Pennsylv@-nd-a) Chaix7aan Williani 11. llatclier (Ker-tucky) Neal S.T-i,,ith (Iowa) W. R. liull, Jr. (Missouri) Robe@,, (Boo) Randolph Casey (Texas) -L'Ien (lie-,, Jersey) Edward J. Pat Republicans Robert H. I-,Ijchel (Illinois) Garner E. Shr4.ver (r,,ansas) Charlotte T. Re@d (Illinois) t Sil,,r4Lo 0. Conte (I,!assachusetts) 0 0 0 CREATER DELAII-@'Al@J,7@ VALLEY: Dani.el John Flood (D), es-Barre, Pennsylvania (Distri@ct 11) I. BACT,GROUND A. Grantee or Si-)oi7isor: tJniversi.ty City Science Center B. Coordinator: George 1,. Clai7,ijfler, l@,I.D. C. Boundaries: eastern Pennsylvania, southern New Jersey, a,-id state of c@ D IliFtorv 1 Initial plaiini,n@, rate 1,@p i--:L I 1 9 6 7 2 Operational st@itu!-,' April 1.969 A. Support t@l-@roi-ioh FY 70: $7,303,000 B. FY 71 level of si-@,ppol-t:: $.2,-I-G-. (projected) C. Total support to date: $9,4i2,357 III. OR@t,IZATIO@l A. Regiollal@ Advisory Group 1. Chai.rrian: 1%7il.lia;R F. KelloiT, TI.D. 2. Co:@i-position (51 members) a. 12 practicing I)Iiysicians b. 10 medical center officiD.I.,,@ C. 8 hospital administrators d. 3 voluntary health agency representatives e. 2 other health workers f. 10 public health officials g. 6 members of the public B. Core staff: 53.51 FIE IV. OPI@-V-,T-i-O@IAL ACTIVITIES The Region currently has ni-7-ie.ongoiii,@, operational activities with total funding lc,,7el- of in direct costs. nurses -In coi-onar,,7 care unit operation accounts for 30% of these fui@ds; most of the balance ($IJI4,000) is in two projects which concern the establishment of 3. Ira @o di-sea@L@.,_cen.ter,@;, on.e for pediatric pulmonary disease. The remaining four activities include the school for -il dise radiotlierapeutic technology, ren, -ase retraining and reactiva tion of women physicians, and general intensive care training for nurses. V. SEI,ECTED PEGIO@'@Y@L Clij',Pl@CTFRISTS A. Populat@toii: 8.5 mil.1-ic)n -- 92% white B. Ilea]-th resqurccs 1. 5 r@,edical schools 2. 165 silort-terin, non-federil. hospitals with 40,000 beds; 47/'. (76) of these involved in the P\Ml 3. 13, 'JOO prac tici-,,I(,, plays icii,@ -, (,@l. 1). 's and D. 0. 's) 28,500 registered iiursc@s VI. ILLUSTI@ATIC)@',ITS OF ACTIVITY The basic purpose of the Intensive Care Training Program was to provide instruction i-n nursing of patients with acute conditions, such as those arisi-Tic., from diseases of the heart, luii,,s, kidneys, central. nervous systeir,. A totci-l- of 32 Registered Nurses were trained in two el-even-week Gener-@il. Intensive Care Nursing Courses. At the completion of both eleven-week courses, written evaluations of the entire course were completed by all. trainees. It was the consensus that the course was richly successful and that the objectives were niet to a high degree. v KENTUCKY (01410 @IAJLEY l@IP). William 1-1. N@i.tcher. (D), BACKGROUND A. Grantee or Spon.sor: University of Kentucky Research Fotmdatioii B. Coordinator: 1,Villian, @IcBeatli, M.D. C. Boundaries: Most of Kentucky's 101 counties, 21 Indiana counties, 16 Ohio counties, and 2 latest Virginia counties. D. History 1. Initial planning award: January 1967 2. Operational status: Januar)r 1969 II. @,TING A. Support through FY70: $2,660,000 B. -n'71 leirel. of support: @3i.@ C. Total support to date: $4,00@,188 III. A. Regional i@dvisory Group- 1. Chairman: Donald 1. Lo@rry, Cincinnati, Ohio 2. Composition (38 members) a. 10 practi.ci-no physicians b. 8 medical center officials c. 7 hospital administrators d. 1 other health worker e. 3 public health officials f. 9 members of the public B. Core staff: 16.23 F-TE IV. Pl@OGRANl PRIORITIES A. Health manpower B. AmbulatorN, care I V. OPEPATIO.'QAL ACTIVITIES: The region currently has seven funded activities in the amount of $81.7,100 direct costs. Patient care demonstrations comprise 35% )@ tried funds; more the S(Y-,6 is directed toward continui@) education and training. On@p-i,oject is concerned with stroke rehabilitation. 'I'h@@ia@nder are not related to specific diseases but deal in such areas as multiphasic screening, rural home health care demonstrations, drug information services, and directors of medical education. Both the multiphasic screening and the home health care activities are directed toward disease control in the indigent population. VI. SELI,"C'I'L-D l@,'GIONAL CH,"vPACI'EPISI'ICS A. Populati.on.: 6 million -- 71% urban B. Ilealtl-i resources 1. 3 medical schools 2. lS7 short-term, iioii-Federfil, hospitals with 22,679 beds; 12% (19) of these i-iwol-iTed in the R@,IP 3. 5900 physicians (i@ff) I s @id D. 0. Is) 17 0 .,188 reai-stoi-ed iatirses, vii. ILLUSTRATIO,\'S OF ACTIVIFY A full spectrum of home health services is i-,o,,v available to a rural. population of 75,000. The ac,-c@cl, the cliron.ici.1-1), i.11, the disabl.ed, aiid the poor ire iiu,,i receiving the f-ul-1. rall('e of nursin,(,Y, ph,@sibt]-ieral.)@T, laboratory, and social services. As one local physician expressed the impact of this project: "The patients are now aett iiag better care than I alone could give them. The), really see us all interested in their @,,:olfqre -irid for the first time since I have been practicing medicine, I am really functioning as part of a team. This home ciro program has made iTie practice better n,@edicii-ie." The Thrust Col-r@@giittec gives top priority to iiiiiipoa,or in the ambulatory care area. The development and efj.octi-ve utilization of q@il.liiry ,,-)ersonn,-l brought about better accessibility to people in 4 solatod, areas. 'I'J-lroti(7]a this iric@chaiii,s)Ti, a. series of '@ocal meetings were held Keith the benefit of joint sponsorship by area-wide CoiliT)rohensiire flea-Ith Planning bodies throughout t e IZogion. These @,@,Tc-re special, local discussion meetings in which those, individuals and institution--, interested and i.nvol.ved ii-i ambulatory care manpower concerns provided substantial input to further develop the program Thrust. The meetin(Ts served to inform local interests of the O@,R%,IP priority and to stimulate interest and secure response from local participants concerned about the manpower problems of ambulatory care delivery. 2 Neal ]@.di,,Ta,i-d Siiitli (1)) , Al-tooiia (Fifth 1.):Istrict) I B@NCKGI,!P)tJIND A. Grantee or SI)onsoi-: Iowa Ui-iivers:i.ty Col'Leo,e of Nledici-ne B. Coordinator: I-larry IVcinber(,-, @I.D. C. Boundaries: Cote-rntinous state D. Ilistoi-)r: 1. Initial. planning grant: Decei-ftl)or 19@')6 2. Operational status: July 1-968 A. Supoort tlirouoli 1--@70: 82,247,000 B. FY71 level of support: (projected) C. Total support to date: $2)94.7,888 III. OR@C@IZY@TI'O'@\, A. Regional Advisor),, Group 1. Chairman: Kenneth Barroiqs, Des @loi.i-ios 2. Composition.: (47 members total) TSIC@LCUIS a. 20 practicing pl-i-N b. 4 medical center official,,; C. 2 hospital administrators d. 4 voluntary health .i,geiic-@, representatives e. 9 other bcal-tli workers f. 1 public lioa,'Lth official g. 7 members of the public B. Core staff: 16.00 F-TE IV. OPER@FIONAL A(,-TIVITIES Iowa F@%,nl has a total of eight ongoing activities with a funding level of @@441,000 in direct costs. Of that amount, over half is directed to five programs concerned with training personnel in the treatment of heart disease. StroRe activities account for most of the remaining fluids; tTi&-Fr major purpose is train.i.ncT personnel in the comprehensive iiiii-i.acement of the stroke patient. V. SELEC'I'L-D PEGIOlq.AJ, CI-IAW@CFERISTI.CS A. Population: 2.8 Diillion -- 53% urban, 99% white B. I-lealth resources 1. Iowa Uni@rersity College of Medicine 2. Coll.ege of Osteopathic @,ledi.ciiie and Surgery 3. 130 sliort-teriEl non-Feder@il hospitals with 14,562 beds; 62% (81) of these involved with the R@,111 4. 2 ,800 practicing physicians (I,,I. 1). 's and D. 0. I s) 10,000 active registered nurses OF ACTIVITY To achieve the fullest impact, the Iowa Regional- @ledical- Progrwi (IR%T) is liel.l-)ii-i- local plain. oivn health services program. To this end, they have foi-ir Consultants ij]-io travel. around the state and with local institutions, organizations, and individuals to help assess c-,,,@isti.ii.g Health resources, identify needs, and develop proarais to iricet those needs. Approxii,i@,tely eiohtN (80) perce,.it of the 143 pejioral hospitals in Ioi%ra have in a training T)roc3Ir(fc I n )mi Congress. her- 30, 19,71, a report thereon which shall plan so developed in terms of- @i) the number of people -ivho woulo nder the i))'an; / "(ii) the kind and type, of health care covered under the I)Iin; C((iii) the cost involved in carrying out i a costs would be financed; 0 0 I 0 Regional Medical Programs Budget Estimate House Senate Year to Congress Allowance Allowance Appropriation 1966 $25,000,000 N.C. 1/ $25,000,000 $25,000,000 1967 45,024,000 $45,004,000 45,004,000 45,004,000 1968 64,314,000 54,314,000 64,314,000 58,814,000 1969 68,922,000 N.C. 1/ 68 922,000 61,907,000 1970 2/ 100,000,000 76 000 000 100,000,000 ioo,0002000 1971 2/ 96)502,000 96,5022000 ll5iOOO,OOO 1062502,000 1972 2/ 52, 771,000 1/ Not considered. .2/ Includes programs previously supported under the appropriation '@Chronic diseases," for comparability. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Health Services and Mental Health Administration History of 1972 Estimate 1972 Department OMB reduction Estimate Department reduction from 1971 to Estimate President's from agency Department Appropriation Department to OMB Budget request, Submission Posi- e-:) ro riation (a) (b) (c) e (f) tions Amount @gio-.ial Medical Pro-rams $106,502,000 $91,697,000 $91,617,000 $52,771,000 $80,000 $38,846,000 Department reductions: a. Program direction & management services ....... $80,000 Total, Department reductions ..... $80,000 OMB reductions: a. Grants ........... $39,000,000 b. Direct operations + 57,000 c. Kidney ........... + 17,000 d. Smoking & health. + 13,000 e. Regionalizatio@ activities ..... + 43,000. f. Program direction & management services ....... + 24,000 Total, O,4B reductions ..... $38,846,000 February 9, 1971 Budget History - Grants (In thousands) FY 1966 FY 1967 FY 1968 FY 1969 FY 1970 FY 1971 FY 1972 Authorization ....................... $50,000 $90,000 $200,000 $65,000 $120,000 $1251POOO $150,000 Appropriation: Grants ............................ 24,000 43,000 53,900 56,200 73,500 89,500 40,500 a, Add: Balance brought forward from previous year ..................... --- 21,934 b/ 25,900 36,1.65 20,000 15,298 34,500 Less: Amounts held in reserve by BOB .... --- 21,000 - 30,900 20,000 15,000 34,500 Amount available for obligation ..... 24,000 43,934 48,900 72,365 78,500 70,298 75,000 Less. Amount obligated - Grants .......... 2,066 27,052 43,635 72,365 78,@ 70,298 75,OOG Lapse: Grants ............................ --- 11,982 c/ --- --- --- --- --- Balance carried forward ............. 21,934 4,900 5,265 --- --- --- a/ Appropriation request. b/ Available through December 31, 1966. C/ These funds were appropriated for fiscal year 1966, available for obligation until December 31, 1966. They lapsed on that date.