16 arml* ALABAMA CONTINUING EDUCATION IN BLINDNESS PREVENTION In the State of Alabama, optometrists provide services to 51 counties while ophthalmic services are offered lin 12 counties. It is, therefore, imperative that sts be trained to detect potentially blinding conditions. With this in mind, the Alabama Regional Medical Program gave partial funding to a project at the University of Alabama in Birmingham's School of Optometry. This is the first optometric ok6iect ever supported,by a regional medical program, the firstf@ @@.-.k-ind in the nation. The objective of this project, to upgrade the knowledge and skills of the optometrist in the detection and identification of potentially blinding conditions, is being obtained through 40-hour residencies. These residencies entail training in the following causes of blindness and related diseases: epidemiology, social consequences, specific clinical entities leading to blindness and the relation to hypertension, glaucoma, diabetes, stroke, cancer, arteriosclerosis, cataract, neurological diseases, and other related problems. two seminars held thus far, involving 40 Alabama Optometrists. In an evaluation of the first seminar held, it was reported that for five weeks prior to the courset nine of the twelve optometrists reported a total of 63 potentially blinding conditions. During the five weeks following the course, all twelve optometrists detected and referred 235 potentially blinding conditions. These were examined and verified by ophthalmologists,, internists or other specialists. his of optometrists was compar t @,@@8 tome ists whe during rive weexs prior to the course, report:@-7-a"'@6tal of 98 potentially blinding conditions. During the five weeks following the course, 26 of the 28 reported a total of only 94 potentially blinding conditions. 2'a-@ 'owed %AT! 5@ The program utilizes the most sophisticated methods and machinery known for detection of such blinding conditions as vascular disease, cancer, diabetes, myopia, affections of the cornea and sdlera, and optic nerve atrophy. It is projected that seminars of this type will be held for small groups of optometrists until all Alabama optometrists have had an opportunity to take advantage of this unique project. Status: Partial funding beginning July 1971 of $7,488. Funding as Project #38 - 4/l/72 -- 4/30/73 - $18,600. AlabamaRegionatMedicalProgram * P.O.Box3256 o 1108South2OthSt. o Birmingham,Alabama35205 * (205)934-5394 NSAS YTEGIONAIL MEDICAIL PROGRAM ["NIVIIII@Sili'l' ll'ON@'l@j@ BLI)G. 1,N]VI@RSITY IZO('II -,2201 110 4-52,):@@ AFF)I@f,@k'I'ED 'flfl@ Ol,' ('EN'FER September 18, 1972 Dorothy M. Bailey Writer Office of Communications and Public Information Regional Medical Programs Service Rockville, Maryland 20852 Dear Dorothy: I do hope that the enclosed sheets will provide the information you need for the cardiovascular project. Dr. Douglas just happened to be in my office when the mail arrived with your request for specifics. About the discrepancy in the first paragraph on Regional Laboratory Quality Control, the correct figure is 13. Participating hospitals include: St. Bernard's, Jonesboro; Cross County, Wynn; Cleburne County, Heber Springs; Newport Hospital, Newport; North Arkansas Hospital and Clinic, Batesville; Medical Center, Calico Rock; Fulton County, Sa em; Randolph County, Pocohontas; Lawrence Memorial Hospital, Walnut Ridge; Piggott Hospital, Piggott; Van Buren County Hospital, Clinton; England Hospital, England; and Rison Hospital, Rison. Should you need further information, please let me know; but before closing let me thank you for the nice comments in your letter. Sincepely, Director of Information Arkansas Regional Medical Program ARKANSAS Cardiovascular Rehabilitation Facility and work Evaluation Unit The need for combating heart disease is apparent from this statistic: between 1964 and 1968 persons died of heart disease in Arkansas. The Arkansas Regional Medical Program is meeting the need. They have supported numerous coronary care units designed to provide training for physicians and nurses in modern concepts of care for the acute coronary patient. Another heart disease statistic has prompted further ARMP involvement: the 21,613 persons in Arkansas whose activi- ties are limited because of heart disease. No state facilities exist for cardiac rehabilitation or work evaluation. Thus, the "Cardio- vascular Rehabilitation Facility and Work Evaluation Unit" project, initiated by the University of Arkansas Medical Center, and supported by ARMP, is meeting an important health need. John Douglas, M.D., assistant professor of medicine at the Univer- sity of Arkansas and director of heart disease at ARMP, is director of the new project. The project supports the staffing of a central cardiac rehabilitation facility, located at the Arkansas State Hospital. The center provides training in the concepts and techniques of cardiac re- habilitation for medical and paramedical personnel from the larger sub- regional hospitals in the State and to any others who might be inter" ested. Incorporated in this training are concepts of cardiovascular conditioning, exercise tolerance testing, cardiovascular monitoring during simulation of the patient's particular employment activity and adapting these results to a prescription of his cardiovascular potential. The cardiology divisions of the UAMC and the Little Rock Veterans Administration Hospitals are contributing to the effort. Three staff members from these hospitals are concerned primarily with training. Teams of personnel from the sub-regional hospitals are invited to the center to observe testing and training sessions. These personnel undergo on-the-job training until they have acquired the proficiency necessary to operate on their own. Consultation is provided to assist these personnel to establish work evaluation and rehabilitation units in their own hospitals. Through support of the work evaluation unit, ARMP will further assist in development and continuation of coronary care through evaluation of results of such programs. ARKANSAS Cardiovascular Reliabilitati,on l,acil-ity and l@ork- Evaluation Unit The need for combating heart disease is apparent from this statistic: between 1964 and 1968, 6,884 persons died of heart disease in Arkansas. The Arkansas Regional Medical Program is meeting the need. They have supported numerous coronary care units designed to provide training for physicians and nurses in modern concepts of care for the acute coronary patient. Another heart disease statistic has prompted further ARMP involvement: the 21,613 persons in Arkansas whose activities are limited because of heart disease. No State facilities exist for cardiac rehabilitation or work evaluation. Thus, the "Cardiovascular Rehabilitation Facility and Work Evaluation Unit" project, initiated by the University of Arkansas Medical Center, and supported by A%MP, is meeting an important health need. @@ouglas, M.D., assistant professor of medicine at the University of Arkansas and director of heart disease at ARMP, is director of the new project. The project supports the staffing of a central cardiac rehabilitation facility,__Iocated at the MM. The center provides training in the concepts and techniques of cardiac rehabilitation for medical and paramedical, personnel from the larger sub-r@ional. hospitals in the SI e @,.,to any others who might be interested. LThe cardiology a-@iv@is"lo@n@s 'of th@'@e UAM nd Vhe Li,ttl v Admini Hospitals are contributing to the effor@ Thre members from these hospitals are concerned primarily with training. Teams of personnel from the sub-regional hospitals are invited to the center to observe testing and training sessions. These personnel undergo on-the-job training until they have acquired the proficiency necessary to operate on their own. Consultation is provided to assist these personnel to establish work e@a .,--and rehabilitation '@inits in their own I-lospital-s' @tion 'Unit page 2'- Cardiovapcul- tation Faci@@,,.- rough support of the work evaluation unit, AR'I\T will further assist lopment and continuation of coronary care through evaluation of results of such programs. Alli@@SAS Ile, Car(lio-,Tic-cular FacilitY l@iid Work -re are 21,613 I)e -tei-r itc@ of .6x', ap@as the rsoris Iiiiiitcd in tl LI](! St 4 per- li,Zijor clisei,-c-. Bet@.7een 1.964 a-lid 1968, 6,88 sotis d.'Lcd of heart disease in i@rkansas. In recent years, numerous coro- ll"!ry care units have I)c@(--n activated and -nir)dc@rn concepts of care for the acute coronary patient have been propoaated through A.@MP-siipportcd train- ini@ courses for physicians and v.,arsc,.s. Hc)-,.7cver, there have been no facilities in the state for worl, evaluation or cardiac rehabilitation. John Dc)ti(,,las, @I.D., -assistant professor of- Medicine at the University of I,.rlh-- a to come to PAcific Medical Center (PMC) for-PrActical training and experience in the skills of intensive care. ual-i-ied truction at PMC. A three-week, RMP-spons6red course for ICU/@CU nursing was conducted concurrently with the physician training sessions Special emphasis was placed on the assessment and evaluation of crucial problems encountered in intensive care. In December 1971, after'@ ?a-r@ phys.@n&4-had..,.,completed th@training program@I e,@in-residence instruction was established At the Colusa facility for *EOkaton is a non-profit, charitable corporation related to the Christian Church of Christ) of Northern California-Nevada. -It is comprised of three divisions: health care, housing, and education. The Eskaton Colus4 Healthcare Center is a satellite facility of the Eskdton American River Healthcare Center. appraise k@. @Tfiis in-residence training was conducted by cardiologists @4ately-two.wee Robert Popper, William Armstrong, and Rodger Shepherd; and Mildred Czar, R.N., M.S. e purpose of follow-up in-residence training at the Colusa Healthcare Center wa to supervise the physicians and nurses as they applied their new skil o patients in their own intensive care uni and to identify and remedy problems ountered,-) with the new equipment and procedures. The Eskatbn Colusa Healthcare Center opened in October, 19@i as an 84-bed health care facility(designed to serve the 12,400 residents of Colusa Count @). On October 28, 190, A modern fully equipped, six-bed intensive/coronary care unit in the new facility was opened. Physicians and nurses from the RMP 'training program went out to Coluoa and i ity. (Acc provided follow-up training in the now fac 1 oHIng to the doctors and nurses at the hospital the follow-up instruction served to reinforce the previous training programs in San Francisco All nurses, and two additional staff'physic'ians have subs quently been involved in the in-servide training that continues at the hospital. 'Ead level of nursing care receives instruction to facilitate continuity of care between general nursing, coronary care nursing, and intensive care. Consultation is Conti nuousl available rom Dr. Rodger Shepherd, Dr. Robert Popper, and Mildred y If Czar, R.N., M.S. (Clinical Specialist in Cardiovascular Nursing) @-so a 24- ur telephone consultation servi lth6dih the Colusa Hospital training experience is too recent to afford statistical ev4 n in terms of morbidity and mortality, the staff is convinced that the increase i the duality of care over the past few months has been "fantastic." Physicians i@@and nurses are now able to make immodiatO and accurate diagnosis. Although outside @c t tion from larger ho!t pitals continues, the physicians, because of increased on ide e,in performing new skills and expanding medical awareness, are taking on more responsibilities in managing complex patient problems. The use of the phbno-trace @ysteiR has diminished, indicating that'physicians are becoming more confident that .,,,,,their EKG interpretations are consistently correct. An interesting development resulting from concurrent training in intensive/coronary care skills for physicians and nurses is that communication between these two specialties has increased considerably. Physicians now feel confident that nurses are well qualified to interpret accurately the patient's condition and provide relevant and necessary feedback. Nursing standing orders have been re-written and ate far more comprehensive. The introduction of comprehensive routine standing coronary care orders., carried out skillfully by the n urses, combined with a cooperative nurse-physician team, has resulted in more efficient and improved care. 'Some direct results of the RMP iCU/CCO training course for physicians and nurses at the Eskaton Colusa Healthcare Center are as follows-. -A crash cart" was established for the first time. This cart contains all the necessary equipment for emergency treatment of cardiac arrest. -A "Code 9911 (Cardiac Arrest) procedure can be performed skillfully with complete cooperation, coordination and efficiency. Each member of the team is sure of his function. -Ctitital care patients are placed on a heart monitor. -Nurses and physicians can immediately recognize critical changes in the heart monitor patterns. -All staff nurses are able to: 1) assist in monitoring arterial gases 2) maintain arterial and venous lines; 3) assist in the insertion of these lines; and 4) measure and evaluate central venous pressure readings. -Nurses at this facility are now able to evaluate the general status of the patient And contact the physician only if he is actually needed. Physicians Are confident that nurses can -perform these skills accurately. -continuing Education is "ongoing." Joint physician-nutse conferences Are held weekly for EKG reviews, and monthly for review of IeU/CCu cases. -Other members of the health care team such as inhalation therapist , physical therapist'. occupational therapists, dietician,.etc. are now being involved in the total care of the patient on a regular basis. The best testimonial for this program's success can be summed up in a quote r Cheryl Adams, R.N., Inservice Nursing Director, "The new system has been worki so well that it seems like it has always been this way." Back-Up Sheet REGION: Area I Regional Medical Programs (California Committee on Regiona Medical Programs LOCUS OF ACTIVITY: Intensive/Coronary Care PROJECT TITLE: Intensive Care Program: An integrated and problem solving approach. I iversity of California, SPONSORING INSTITUTION, Area I Regional Medical Programs' Un San Francisco; pacific Medical Cdfiter, San Francisco. PROJECT DIRECTOR, TITLE ADDRESS: Elliot Rapaport, M.D. Acting Coordinator and Associate Dean for Regional Medical Programs 745 Parnassus Avenue San Francisco$ California 94122 (415) 666-4221 DATES: Colusa Project: June, 1970 through December, 1971 FUNDING: Core Consultants And Travel Budgets--$6,000, OMR FUNDS: Fees paid by physicians and the Eskaton Corporation COOPERAT NG-AGENCIES AND INSTITUTIONS: Pacific Medical Center, San Francisco; ChildrenO Hospital, San Francisco; University of California, San Francisco; Eskaton Corporation, Medical Staff of ColusA Healthcare Center; San Francisco General Hospital. AREA SERVED: Colusa County TARGET OPULATION: 12,400 CONGRESSIONAL DISTRICT: New districts not available yet. CONTINUATION AFTER RMP SUPPORT WITHDRAWN: In-hospitAl program for continuing education in intensive care will be sponsored by the medical staff and hospital administration on a monthly basis. CORE STAFF CONTACT: Rodger Shepherd, M.D., Pacific Medical Center,(415y 931-8000, E t. 334 DATE PREPARED: 2-11-72 DRAFTED BY: Naheed R. Aly California, Area IV PERIIqATAli CRISIS CARE PROGRAM AND SERVICE DEVELOPMENT A three-year Area IV operational project is making available to I community hospitals in Southern Cali-fornia modern perinatal concepts and technology used primarily by major medical centers in diagnosing and treating critically-i.11 newborns. This effort, based at Harbor General Hospital, Southern campus of the UCLA lledical School, will prepare physicians and nurses in the prerequisite specialized skills and provide consultation and assis- tance to their hospitals to encourage establishment of perinatal units. It is financed the first year by a $72,000 grant awarded September, 19 . A major target of the program is the life-threatening complications which occur during the perinatal period--from the onset of labor through the first four weeks of infant life. These conditions which often affect the respiratory system, the heart and other vital functions of the newborn accounted for 4,522 infant deaths in Cali- fornia last year. Training is being conducted in the intensive perinatal unit at Harbor General, among the few facilities in the state combining the care of the fetus and the newborn. It is fully equipped with bassinettes, incubators, isolettes and special monitoring.eouipmoht to record breathing and heart beat patterns of the newborn. Dur-i-ri"this firs-L year, focusing exclusively on nurses, three weeks 9 of int truction isbelp 0 ensive ins g offered to f ur enroirees at a tirue, @ outreach services@ participating hospitals to facilitate application of acquired knowledge. Fifty percent of the training time is devoted to clinical experience emphasizing nursing assess- ment of the infant's clinical condition and nursing management of the silk neonate. Highlights of the course curriculum include detection and management of high risk mothers and infants, manage- ment of infants with respiratory disease, infant resuscitation, use of monitoring equipment, transportation of infants, control of nursery infections and oxygen therapy. Twenty-four physicians will be the focus of the second year's efforts with the final year spent in team training. The program was initiated by Dr. Joseph St. Geme, Jr., UCLA profes- sot of pediatrics and chairman of the Department of Pediatrics at Harbor General in response to what he termed need" for community hospitals to develop these @nits because tta- ditional academic teaching hospitals can not assimilate all the infants who need intensive care. Problems of transporting the critically ill infant from one hospital to another also are inten- sified.@ Directing the program is Dr. Williaii oli, associate professor of pediatrics and neonatology at UCLA and head of the Division of Neonatology at Harbor General. Also represented on the program faculty are the other specialties concerned with perinatal care, including fetology, gynecology, obstetrics, pediatric neurology, California, Area !V -2- microbiology, surgery and cardiology. The application of perinatal concepts makes it possible to deter- mine genetic defects, such as mongolism, in the fetus and certain congenital disorders which can be reversed if treated immediately after delivery. California, Area IV ion: California Locus of Activ@: Operational Project Project Title: Perinatal Crisis Care Program and Service Development Status: Ongoing Sponsoring Institution: Harbor General Hospital Project Director, Title,, Address: Joseph W. St. Geme, Jr.p M.Do William Oh, M.D. Department of Pediatrics Harbor Gerieral Hospital 1000 West Carson Street Torrance., California 90505 Dates: September 1, 1971 to August 31, 1974 Funding: $72,000 Other Funds: -0- Cooperating Agencies and Institutions: None TapLet Population: Nurses and physicians working in newborn units of community hospitals throughout Southern California. Congressional Districts: Senators Alan Cranston and John Tunney Continuation after RMP Support Withdrawn: Integration into inservice education programs and perinatal units in community hospitals. Core Staff Contact: Lee Horovitz, Associate Area Coordinator, California Regional Medical Programs, Area IV (UCLA) Date Prepared: February 12., 1972 Drafte@b Jackie Reinhardt 6AI, (@v) - California, Area IV (UCLA) Central Indian Health Project Home for approximately 1,000 Indians in rural Central California is four isolated rancherias located in@ rough, heavily-wooded terrain in Fresno and Madera counties. Medical care is a low priority among this population who lack transportation, telephones and other communications to link them with the closest urban com- munity, 50 miles away. Most of the residents receive public assistance. They live in makeshift dwellings with no plumbing. Jobs are scarce and those that do exist are seasonal, primarily associated with the timber industry. Day-to-day existence is frequently a struggle, Preclud- ing any major concern with good health or nutrition. To improve access to and utilization of health services among this minority group the Central Indian Health Project was initiated in j4ll September' , with $12,290 in core funds. A major impetus for this project@ as the findings of serious dental problems among 200 Indians screened in June, 1971. Seve@@-@r6sno dentists recruited by the Central San Joaquin RMP District Committee volunteered their time and facilities for this effort. over a six-month period four indigenous residents have been recruited and trained as health advisors and as advocates for their peer group. They'lea'rned adva@ced'fi;s-t aid, how to recognize symptoms for common illnesses, nutrition and sanitation information. Returning to their 'respective rancherias in February, the health advisors, all women, are helping to identify unmet health problems and to act as "medica ombudsmen." Mobile tw s -wave radios are installed in cars owned and -opekated by these Indian women, linking them to the project head- quarters whom they alert in cases of injured and lost'hunters, fire, civil disturbance and law enforcement problems. A base station at Valley Medical Center, expected to be fully operative in Marc@, will enable them to contact physicians directly for consultation regarding a medical problem and, when advised to do so, transport patients to the hospital for treatment. In addition to the four weeks of training they have already received .through the Fresno and Madera County Health Departments, the health advisors will complete another four weeks of instruction beginning in March, 1972. This will enable them to take on their responsibil- ities with more confidence, although at no time are they instructed to provide medical treatment as paramedics db4 Medical and related resou@@s -ipthe two counties have been high y supportive of this effort,'w@i'e'@h can expect to be continued at the conclusion of the initial funding period with additional RMP money or with funds from other Federal sources. California, Area IV Region: California Locus of Activity: Developmental Component Project Title: Extending Health Care Services to Remote Indian C-om-munities Status: Ongoing nsoring Institution: Central Valley Indian Health Board Project Director, Title, Address: Mr Richard Johnson Fi;cal Officer Central Valley Indian Health Board 541 Fifth Street Clovis, California Dates: September 1, 1971 to August 31, 1972 : $14,978 Other Funds: -0- Cooperating Agencies and Institutions: Fresno County Comprehensive A-ealth Planning, the Fresno County Health Department, and the Valley Medical Center oubpatient department. Area Served: Four rancherias in the eastern, mountainous parts of Madera and Fresno Counties. Target Population-. Approximately 1,000 Indians Congressional Districts: #16, B.F. Sisk (R) Continuation after RMP Support Withdrawn: The Central Valley ndian Health Project will include the project in their subsequent funding applications, as well as examine other possible funding sources to maintain this service, if it proves successful. Core Staff Contact: James Ricketts, District Coordinator, Central San Joaquin District of Area IV RMP Date Prepared: February 12, 1972 Drafted by: Jackie Reinhardt California, Area IV SA14 FERNANDO VALLEY HEALTH CONSORTIUM The San Fernando Valley Health Consortium evolved out of an Area IV operational activity concerned with improving health care to a target population of 250,000 residents in the northeast section of the Valley. Although part of Los Angeles County, the 144-square mile area comprising the Valley has its own character deriving in part from the mountains surrounding it and the two million people of all economic levels who reside there. The RMP project surveyed existing health resources prerequisite to the pre-paid comprehensive health system it is now in the process of establishing with OBO funds. Findings showed that health care was not only poorly coordinated but a serious manpower shortage exists, especially in the Northeast Valley. Few opportunities are ,,,'available for recruiting and training minorities in health careers. From early grass roots discussions initiated by San Fernando Valley State College in 1969, a consortium of health care providersk- hospital private physicians, extended care facilities and public agencies educational institutions and health care consumers was deveh'ped. Eight Task Forces were formed and assigned respon- sibility for the following areas of concern: medical legislation, legislative liaison and funding, review of consortia models and determination of program priorities, survey of existing educational institutions, programs, facilities and personnel, survey of health manpower needs, survey of existing community health facilities, pro- grams and personnel and accreditation and certification. ...Included in the accomplished documents of these Task Forces are a compilation of the many accreditation certification and licon- sure bodies involved in the allied heal@h professions; a compila- tion ofexisting curricula in the consortium;educational institu- tions,'@questionhaires to survey health manpower needs. The San Fernando Valley Health Consortium achieved corporate status September 16, 1971 and a 25-member Board of Directors representing all community elements was elected. Its major activities are directed toward organization and coordination of existing and new health manpower training programs within various member institutions. This work is be ng carried out with Area IV and V core and develop- mental component funds, $50,000 from the Northeast Vallev Project and $5,000 contributed by participating hospitals. xpansion of the effort as an Area Health Education Center is pro(posed as part of an Area IV operational proposal submitted February, 1972@ California, Area IV Region: California Locus of Activity: Core, Developmental Component, and proposed Project Title: San Fernando Valley Health Consortium Status: Ongoing Sponsorinq Institution: California Regional Medical Programs, Area I'v nd San Fernando Valley State College Project Director, Title, Address: Addie Klotz, M.D., Director San Fernando Valley Health Consortium, Inc. 10401 Balboa Avenue Granada Hills, California 91344 Dates: June, 1970 to August, 1972 Lundi@: $22,500, 1970; $3,000, 6/71; $25,000,.9/71; $50,000, approved 1/72. other Funds: $22,500 from San Fernando Valley State College, T5,-Ooo from participating hospitals and other institutions. Cooperating Agencies and Institutions: Five major hospitals, two valley colleges, the Welfare and Planning Council, Comprehensive Health Planning and representatives from Areas IV and V of RMP. Area Served: San Fernando Valley Consortium Area: San Fernan o Valley, Ant elope Valley, Simi Valley, Santa Monica, West Los Angeles and Ventura County. Target oLulation: Entire Consortium area population--approxim.ately 0 000 people. Congressional Districts: #13, Charles M. Teague (R); #20, H. Allen Tmi-th (R); lt22, James C. corman (D); #26, Thomas M. Rees, (D): 427, Barry M. Goldwater, Jr. (R); #28, Alphonzo Bell (R). Continuation after RMP Support Withdrawn: Project results will be used in SFV Health Consortium 0 erational Project to develop core curricula for allied health personnel, which is presently seeking Pd4P funding. Core Staff Contact: Nat Feder, ACSW, Assistant Coordinator, San Fernando Valley District, California Regional Medical Programs. Date Pr pared: February 12, 1972 Drafted By: Jackie Reinhardt z- v) f California, Area IV CONTINUED EDUCATION AND SER'@,TIC',-, DEVELOPMENT PROJECT FOR EXTENDED CARE D'ACILITIES California which leads the nation in the number of licensed nursing homeb--an estimated 1,271--does nor-, now require its administrators to meet continuing education requirements or to be licensed. That ,will change in July, 1972, the effective date of a Federal direc- tive requiring all states to give li.censure examinations or forfeit matching payments un,@-er Medicare and Medicaid (Medi-Cal). This requirement and the interest expressed by nursing home pro- fessionals in increasing their knowledge and their skills led to a three-day planning conference convened by CRDIP Areas IV and V in July, 1969. Several priority concerns emerged., among them the need for better interprofessional understanding toward the goal of improved patient care. The Continuing Educati,-n and Service Development Project for Exten- ded Care Facilities is one outgrowth of the planning session.. It is financed by a $62,280 operational grant awarded in September, 1971, more than two-and-a-half years after the planning conference. Despite the long time lag, the project has been able to generate much support from the nursing home profession. Thirty-five professionals serve on an ECF steering committee and three subcommittees Cun,@er the direction of Hoyt Crider, who also --.-s@e0 chaired the planning s.%i n v evelbped the curricula for a series of patient odre'and management courses which admiiii..s- trator d rectors.bf--riursing services participate in toge- ther, sponsibilities for coordinator and faculty, orientation, public relations and enrollment, reporting an evaluation procedures. More than.300 nursing home administrators and directors of nursing services, @:many---of-, th-em---from,.the are expected to have completed one of the six courses by August, 1972. Instruc- tion is being offered in four counties--Los Angeles, Orange., Santa Barbard and Fresno. The course is recognized as an important educational tool not only for meeting the lic@nsure requirements, but for extending continu- ing education Opportunities to the nursing home professions. Its focus on the development of an administrative-management team is unique since most educational programs segregate administrators and nurses, preventing them from benefiting from each other's experience. It is expected that the refined curricula will be incorporated into extension-type courses by various colleges and universities in the Californiq region. California, Area IV Region: California Locus of Activity: Operational Project Project Title: Continuing Education and Service Development Pro- ject for Extended Care Facilities Status: Ongoing Sponsoring Institution: Western Center for Continuing Education for Health Care Facilities, UCLA Extension Project Director, Title, Address: Kelly Swaryck Project Coordinator Western Center University of California, Extension Statewide Programs Los Angeles, California 90024 Dates: September 1, 1971 to August 31, 1974 Funding: $62,280. Other Funds: -0- Cooperating Agencies and Institutions: American Cancer Society, Los Angeles County Branch; California Association of Nursing Homes,-, California Association of Nursing Homes for the Aged; California Regional Medical Programs, Areas IV, V and VII; California State Board of Nursing Education and Nursing Regis- tration,i California State Department of Public Health; Geriatric/ Extended Care Conference Group of the California Nurses' Associa- tion, Los Angeles County Chapter; Hospital Council of Southern California; Los Angeles County Health Department; Los Angeles County Medical Association; Los Angeles County Heart Association; Tuberculosis and Respiratory Disease Association of Los Angeles County. Target Population: Nursing Home Administrators and Directors of Nursing Services ressional Districts: Senators Alan Cranston and John Tunney i Continuation after RMP Support Withdrawn: At the end of the @67nt period it is expected that the refined curricula would be incorporated into regular extension type course offerings by ,-various colleges and universities in the Region. Core Staff Contact: Al Torribio, MSW, Associate Coordinator, CRMP Area IV tU-L@A) Date Prepared: February 12, 1972 Drafted by: Jackie Reinhardt L, I V,) California, Area iv kuu@) ORGAN PROCUREMENT AND TRANSPLANTATION PROJECT Since Harbor General Hospitalts participation in the California Regional Kidney Disease Program in September., 1971, the number of cadaver kidneys it has procured has tripled. This increase is attributed to both a $40,000 RMP grant and the formation of the Greater Los Angeles Belzer Preservation Service, a cooperative community effort affiliated with four medical schools., including UCLA. Harbor's Department of Renal Transplantation used to work in ttcrisis" atmosphere associated largely with the maximum six hours in which a kidney could be safely preserved by freezing methods, With the acquisition of two Belzer Preservation units.* one of them financed by RMP., that time has been extended to 48 and sometimes as long as 72 hours. It has also relieved much of the stress connected with harvesting the organ., finding'. a suitable recipient and successfully transplanting the ki neY at Harbor.or one of the other nine kidney transplant centersf@ which@' uppiies cadaver kidneys. The.RMP funds, subcontracted through Area IV, also have enabled the Harbor effort to add a second technician, special monitoring equipment and purchase a mobile unit which speeds the harvested organs to waiting redip4@ents.as far away as San Francisco. This support has resulted in real strides in meeting the needs of end-stage kidney patients, according to Project Director Thomas Moore, M.D. Monitoring can be done with more precision because of the newly-acquired equipment which measures the osmolity, Ph, electrolytes oxygen and carbon dioxide composition of the fluid used in perfuming the organ. There also is more time for tissue typing to match the,,donor and the recipient and for the first time more thah.@Onor can be serviced at once. 'Additionally., Harbor is getting more kidneys of better quality. Another $30.,OOO approved by CRMP in Dedemb@r@ 1971, wil 1 provide for a nurse or technician coordinator, relieving Dr. Moore of the record keeping and data,accumulation duties, and a transplant burgeon trainee,3boosting Harborls transplantation capability from 12 organs a year to ab many@as'loo by the end of 1972. California, Area IV o@n: California Locus of Activity: CCRMP Core Activity Project Title: Organ Procurement and Transplantation, California Regional Kidney Disease Program Status: Ongoing Sponsoring Institution: Harbor General Hospital Project Director, Title, Address: Thomas Moore, M.D., Chief Dept. of Renal Transplantation Harbor General Hospital 1000 West Carson Street Torrance, California 90509 Dates: September 1., 1971 to August 31, 1974 Funding_: $40,000 CCRMP Core Support (Awarded September, 1971) $30,000 CCRMP Core Support (Awarded February, 1972) Other Funds: In-kind contributions of the Greater Los Angeles Belzer Preservation Service and the Southern California Kidney Foundation Cooperating Agencies and Institutions: The Greater Los Angeles IFelzer-preservation Service and the southern California Kidney Foundation Congressional Districts: #17, Glenn M. Anderson (D) Area Served: Southern California TarGet Population: End-stage kidney patients in Southern California Continiiation after RMP Support Withdrawn: S61f-supporting Core.Staff Contact: Wadie Elaimy., Dr.P.H., Director of Research and 15evelopment@alifornia Regional Medical Programs, Area IV (UCLA) Date Prepared: February 12,, 1972 Drafted by: Jackie Reinhardt t V) California, Area IV NURSING CAREER LADDER SERIES In May, 1971, a special task force of the San Luis Obispo District Committee, California Regional Medical Programs, was appointed to delineate the health problems in the District. One of the problems noted was the lack of opportunity for upward mobility in the nursing field, especially from nursing or hospital attendant to licensed vocational nurse to R.N.-- A.A. degree to R.N.--B.S. degree. In August, 1971, the San Luis Obispo District Committee received a core grant of $937.00 to carry out a feasibility study of such a ladder series system centered around Cuesta Community College, San Luis Obispo, a junior college. The study was to determine interest in building a nurses ladder series including junior colleges, state colleges, and various nursing licensing agencies. The feasibility of such a career ladder series has been estab- lished with Cuesta Community College and Fresno State College providing the major ingredients. Cuesta Community College has agreed to offer courses in nurse aides, licensed vocational nurse and registered nursei A.A. degree. It is planned that the student could then transfer to Fresno State College without loss of credit to completed R.N. degree program. The program will provide the student with opportunity for gainful employment at each level with the right to return for upward career mobility at a later date with no loss of academic credit. The program will eliminate "dead-end" jobs for those individuals with capabilities for advancement. Nursing career candidates from low income, disadvantaged minority groups will be provided with a program that will afford them an opportunity to be gainfully employed and the opportunity to continue training for better careers it the nursing field. To date, there has been superb response from the educational institutions and the various licensing agencies. miss Juanita Booth, R.N., M.S., Director of Nursing Program, Cuesta College, San Luis Obispo, is the Project Director. A Nursing Career Ladder Series Committee has been responsible for the study. This small core grant of $937.00 coupled with a determined volunteer Regional Medical Programs committee membership generates considerable optimism for a ladder series in nursing that is unique in the nursing education field and one that may be a national model. California, Area IV Region: California Locus of Activi@y: Core Activity Project_Title: Feasibility Study of a Nursing Career Ladder Series Status: Ongoing Sponsoring Institution: Nursing Career Ladder Series Committee, @h Luis Obispo District Committee Project Director, Title, Address: Miss Juanita Booth, Director Nursing Department Cuesta College P.O. Box J San Luis Obispo, California 93401 (805) 544-2943 Dates: September 1, 1971 to March 1, 1972 Funding: $937 Other Funds: In-kind contribution of $2,780 Cooperating Agencies and Institutions: Cuesta College, Fresno State Co@i:&ge, 1 censin'g agencies, UCLA ffchool of Nursing Mt. St. Mary's School of Nursing, Bakersfield State College Area Served: San Luis Obispo and Fresno Counties, California Target Population: 400,000 population Congressional District: #12, Burt Talcott (R) Continuation after RMP Support Withdrawn: To implement the curric- ulum, a developmental component grant proposal is being written. Core Staff Contact: Victor Farrell, Assistant Coordinator, San Luis Obispo Distxl@ct, California Regional Medical Programs. Date Prepared: February 12, 1972 Drafted By: Jackie Reinhardt (I VI) ANEMIA SCREENING PROJECT In November, 1971, Guadalupe, a small. migrant farming community with no hospital facilities and only one physician, screened 592 children for anemia. This ambitious effort was made possible by the pooling of health and other community resources with its neighbor, Santa Maria, also in northern Santa Barbara County. With the help of the Santa Maria @IP Community Committee and $940 in Area IV core funds, a two-day clinic was set up in Guadalupe's two elementary schools. In-kind contributions totalled more than $5iOOO, representing services from the Santa Maria Hospital Out- patient Clinic and private physicians acting as referrals; Blood Bank Volunteers, Visiting Nurse Association of Northern Santa Barbara County and the Santa Barbara County Welfare and Health Department. Extensive outreach services attributed to the response of Guadalupe residents. Families of preschoolers were contacted personally by outreach workers from the Guadalupe Center who went from door to door in this Spanish-speaking area. Local school children channeled information to school children and obtained consent forms from their parents. Although only preliminary results of the tests are available, they support the concern of Santa Maria pediatricians who stimulated the Project. Using the copper sulfate method, 63 percent of the pro- schoolers' and 33 percent of the school children's tests indicated an anemi6 condition (less than 12mg. hemoglobin). More than 125 of these youngsters have been referred to physicians and.the Santa Maria clinic for follow-up testing and treatment, with ut charger" 'as of January, 1972. Outreach workers currently are contacting parents of another 70 children whom records show have not seen a physician. Many families indicated lack of trans- portation, financing and inability to leave their work as reasons why they had not responded. It is anticipated that these efforts 'Will be continued as part of the Nutrition and Health Project of the Guadalupe Community Council. RMP sponsors also sought to accomplish several other objectives. One of them--the establishment of new links between physicians in Santa Maria and Guadalupe children--is already measurable. Physicians report many of the children referred from the Anemia Screening Project are new atient8 or patients who not made p a visit for an extended period. Other objectives still being evaluated include determining the motivational patterns of rural farm workers, their responses to free cas6-finding services and the potential for anemia screen- ing in other areas. California, Area IV egi In@. California Locus of ActiviLZ: Core Activity Project Title: Guadalupe Anemia Screening Project status: Ongoing Sponsoring Institution: Santa Maria Community Committee Project Director, Title, Address: James Handley, M.D. P.O. Box 1232 Santa Maria, California 93454 Dates: September 1, 1971 to August 31, 1972 Funding: $940 Other Funds: $5,000 ih-kind contributions from the Santa Maria @s-pital Outpatient Pediatrics Clinic and private physicians. Cooperatinq Aqehcies and Institutions: Santa Maria Hospital Out- @at-i-e-nt Pedial id, Guadalupe Community Council, loca physicians. 'Area Served: Guadalupe Target Population: 592 children Cohgressional Districts: #13, Charles M. Teague (R) Continuation after RMP Support Withdrawn: Will be continued as art of the Nutrition and Health ProjecT of the Guadalupe Connun- ity Council. Core Staff Contact: Victor Farrell, Assistant Coordinator, CaIifornid Regional Medical Programs, Area IV (UCLA) Date Prepared: February 12, 1972 Drafted@: Jackie Reinhardt Californias Area IV (UCLA) MOBILE DENTAL CLINIC PROGRAM When school nurses in Ventura County were asked by the RMP District Committee what they saw as the most pressing health problem among school children, their response came back loud and clear: Bad Teeth! It also triggered in June,$,@@1971,, a mobile dental clinic program spea@neaded by a"Joint RMP-CIIP Task Force in cooperation with UCLA and USC Dental Schools. More than 300 low-income elementary school children were screened and follow-up services provided by the student dental team as of Februaiyj 1972, The program, which expects to reach between 700 and 1,000 youngsters the first year, has been financed totally by in-kind con- tributions from the RIIP i- , CI-IP., UCLA and USC Dental Schools., local school districts, Ventura County Health Department, Ventura County Community Council., Ventura Dental School and other civic organiza- tions. Santa Paula, t@ first of five communities to be visited, demonstrates the cooperation which has characterized this effort. Arrangements for the five visits during June and July, 1971, were handled by-a local community planning committee under the direction of Joe Bravo, Santa Paula School Superintendent. This group provided the follow- Ing: --Lodging for the student dental team at Fillmore nursery school and St. Sebastian Church in Santa Paula --Preparation of meals for children and workers by the Mexican American Civic Organization and several other local organizations --Transportation for parents and children by policemen who volunteered to man school buses during off-duty hours --Follow-up services offered without charge by several local dentists. In return 196 children from Santa Paula and neighboring commun es of Fillmore, Piru, Ojai and Saticoy received dental services valued at more than $8,000, although it cost the communities involved $2..750 or $13 a child. Several significant spin-offs also have occurred as a result of the mobile dental clinic program. Sixteen Ojai dentists screened 47 children and treated some of them. They offered the use of their offices to the USC-UCLA team to treat 27 others. Similar efforts are just beginning among Ventura dentists and school children. Although only midway through the first year, the mobile dental clinic program anticipates continuing support. Already 16 dentists have committed their services for another 12 months. Calif ornia, Area IV ion: California Locus of ActivJ.ty: Core Project Title: Mobile Dental Clinic Program Status: Ongoing Sponsoring Institution: Joint Pd-4P-CIIP Task Force, Ventura District Project Director: Norman H. Fortier, D.M.D., Ventura Dates: June, 1971 to June, 1972 Funding: Core RMP staff, in-kind contributions Other Funds: -0- Cooperating Agencies and Institutions: UCLA and USC Dental Schools, local school districts, Ventura Uounty Health Department, Ventura County Community Council, Ventura Dental Society and other civic organizations. Area Served: Ventura County, including communities of Ventura, anta Paula, Oxnard., Simi Valley. Target Population: 1,000 low income elementary school children. Congressional Districts: #13, Charles M. Teague (R) Continuation after RMP Support Withdraiin: Although stimulated and coordinated by an RMP-CHP Joint Ta@k Force., this project is not dependent on financing from RMP. UCLA and USC Dental Schools and Ventura County dentists have pledged their support for continued operation during a second year. Core Staff Contact: Dan Sullivan, District Coordinator, Ventura District of Area IV, CILNIP. Date Prepared: February 12, 1972 Drafted by-. Jackie Reinhardt California, Area IV SANTA MARIA CONTINUITY OF CARE.PROGRAM A comprehensive Continuity of Care Program for a rural-urban community with a population of 58,000 was initiated in September@ 1971, at Santa Maria, California. This prograiefunded by a .,,from Cal $9,476 Developmental Component.Gra@ ifornia Committee Regional Medical Programs Services,provides a coordinating body in the community to furnish consultative services to physicians or health institutions in order to foster good discharge planning, continuity of care and referral services. The program will help to reduce health care costs by better utilization of health services in the community and at the same time assur@@ the patient of continuous, adequate, approp- riate and efficient care. Quality of care will be improved by placement of the patient in a care plan tailored for him as an individual. As a result of this grant all three acute general hospitals now have full-time continuity of care coordinators. The project furnishes a community coordinator) and secretarial hel p to coordinate the entire program and to work directly with patients in the physicians' offices and after discharge, from the acute units. The Santa Maria Community Committee has'assurance from the Visiting Nu ice o@,Vg rse Fthern Santa Barbara County, Inc. that support the program after the project funds are used., ipecific need for among a large population i@ group of farmwbrkers' families with Spanish surnames) re It@,l@ld@ren and the elderly,we. Most Continuity of Care programs h.ave been primarily concerned with acute hospital discharge planning. Although this is a feature of this program, emphasis is placed on continuity from the home situation, the physicians office, acute hospital care, E.C.F. care, follow-up care and back to home care. The referral for assistance may occur anywhere in the chain. The project is officed with the Visiting Nurse Service of Northern Santa Barbara County, Inc. Other agencies involved are Santa Barbara County Welfare Department, Community Action Committee, O.E.O., in Guadalupe and Santa Maria, the Santa Maria Academy of Medicine, a local physicians group, throe acute general hospitals, a representative from the local E.C.F.'s and the Santa Barbara County Health Department. California, Area IV Region: California Locus of Activity: Developmental Component Project Title: Proposal to Develop a Continuity of Care System, Santa Maria-Gaudalupe Area Status: Ongoing Sponsoring Institution: Visiting Nurse Service of Northern Santa Bar ara County, Inc. Project Director, Title, Address: Mrs. Catherine Carey, Director Visiting Nurse Service of Northern Santa Barbara County, Inc. 1035 W. Main Street Santa Maria, California 93454 80 5) 9 22-1 4 4 8 Dates: October 1, 1971 to March 31, 1972 Funding: $9,476 Other Funds: IN-kind contributions of $13,800 Cooperating Agencies and Institutions: Marian Hospital; Santa War-ia Hospital; Valley Community Hospital; Visiting Nurse Service of Northern Santa Barbara County, Inc., Santa Maria office of the Santa Barbara County Department of Welfare Services; Mr. Charles Rivas, Director, Guadalupe Service Center, Community Action Com- mission; Santa Maria Academy of Medicine; Santa Barbara County Health Department. Area Served: Santa Maria-Guadalupe, California Target Population: 57,842 people, 15% with Spanish surnames Congressional District: #13, Charles M. Teague (R) Continuation after RMP SuP2ort Withdrawn: Visiting Nurse Service of Northern Santa Barbara County, Inc. Cote Staff Contact: Victor Farrell, Assistant Coord3nator,.San Luis Obispo District, California Regional Medical Programs. Date Prepared: February 12, 1972 Drafted@: Jackie Reinhardt AL California, Area IV CANCER CHEMOTHEIRAPY FORUM Late in 1970 and early in 1971 the Continuing Education Sub- committee of the San Luis Obispo District finalized plans to present a series of educational sessions for physicians concerning cancer, diagnosis and treatment, especially in the area of chemotherapeutic agents. A survey revealed that 75 - 100 physicians would be interested in such a series. Interest in physicians' on-going education in the local area is unusually high since the closest medical center is over 200 miles distant. it was the intent of the Cancer Forum to reduce the morbidity and mortality of cancer in the area by providing the area physicians with additional education and training in the cancer area. The Regional Medical Programs committee felt that the cost and inconvenience to patients could be reduced if the patient was treated locally and not referred 100 to 200 miles away. A $1,000 core grant was received from Area IV@early in 1971 to help finance the series. A close,cooperative arrangement between the local American Cancer Society and the District Regional Medical Programs resulted in the California Division, American Cancer Society, granting an additional $1,250 to the program. These funds and a required registration fee for each physician has already funded four sessions, two-mo@e are scheduled and funds available for at least six more )sessions. Sessions are held on Saturdays and each session is led by an authority in a particular area of cancer. Subjects have ranged from a general overview of cancer treatment to a scheduled session on the problems a physician encounters with the dying patient, their family and friends. Each session enrolls 25 to 30 physicians. @-f irrer- The cancer p @is district will receive direct benefits acaltional expertise being acquired by approximately 50 to 75 physicians in the diagnosis and treat- ment of cancer. California, Area IV Region: California Locus of ActiviLy: Core Activity Project Title: Cancer Chemotherapy Forum Status: Ongoing Sponsoring Institution: Continuing Education Subcommittee, San @ui-s Obispo D-i-stiF!ct-, W.IP Area IV; local and California division, American Cancer Chemotherapy Forum. ect Director, Title, Address: Eugene Juel, M.D. 148 Casa Street San Luis Obispo, California 93401 (805) 543-8310 Dates: May 1, 1971 to September 1, 1972 $ 1, 0 00 Other Funds: $1,250 from the California Division, American Cancer @ociety. ns: Continuing Education Sub- alifornia Division, San Luis Obispo Branch, American Cancer So iety, Sierra Vista Hospital, San Luis Obispo, Consultant: Justin J. Stein, M.D., Professor of Radiology, UCLA Center for the Health Sciences, Department of Radiology, Los Angeles. Area Served: Northern Santa Barbara County and County of San Luis Obispo, California 'Target Population: 300 physicians ressional District: #12, Burt Talcott (R) Continuation after RMP Support Withdrawn: Cancer Forums will not ontinue, however, this series has already created interest in other physician educational programs by Regional Medical Programs, San Luis Obispo County Medical Society and interested private physicians. Core Staff Contact: Victor Farrell, Assistant Coordinator, San Luis Obispo Distr@ict of California Regional Medical Programs. Date Prepared: February 12, 1972 Drafted Bv: Jackie Reinhardt L California, Area IV PEBIATRIC NURSE PRACTI'PIONER PitOT PROGRAM Since 1953 @.7he-ri the first child health conferences were developed in California, interest in and recognition of the expan- ded role of the nurse in pediatrics has continued to grow. Today nurses from many different sett.ings--child health clinics, hospital outpatient departments and private i.)Iiysician's offices--are ideal candidates for pediatric nurse practitioners. Opportunities for training in this extended role, however, have not kept up with the desire or ability of nurses to function in this capacity or with the need for their services in pediatric practices. Most preparation has been through inservice education primarily associated with public agencies. only recently have academic insti- tuti-ons begun to realize a continuing responsibility in nurse education. Three universities in California currently offer or will soon be initiating training for R.N.s wanting to expand t eir ro es. To enroll in these courses, nurses must either take a leave of absence from their jobs or resign altogether. The need for other alternatives led in October, 1970, to the for- mation of the Southern California Pediatric Nurse Practitioner Advisory Committee composed of representatives, including PNPS, from 35 agencies, hospitals and other institutions. Through subcommittees and task forces, they investigated current course offerings, developed a curriculum for a short-term course and methods of evaluation. Area IV provided staff assistance, classroom space and core funds, although the effo.rt was carried out largely on a volunteer basis. sixteen enrollees were accepted for the seven month course which started May@1971, in cooperation with UCLA Extension and the School of Ifursing. It included one month of intensive training and a six"month preceptorship in the nurses' own agencies. Each enrollee was,employed in ambulatory child care settings and recom- mended by employer who @ agreed to allow her to utilize her new skills during and upon completion of the preceptorship. Some tentative conclusions have been drawn from the testing, oval- uation and observations to date: 1. The format of the curriculum, one month of intensive training followed by a six month internship is workable. However, the first month should be extended to six weeks for inclusion of mote clinical and didactic instruction and more time for independent study. 2. Students found the instruction by so many volunteer teachers and proctors fragmented, therefore full and part-time faculty are needed. 3. Even the student who is still in training worth for she is able to take on new tasks formerly carried ou b t y physicians. C;i tp -L-,o eing incorpora c @both a developmental modifications":are b component and operational grant proposed)40P tinuati'on of this program. ea IV (UCLA) California, Ar Region: California Locus of Activity: Area IV core funds Project Title: Pediatric Nurse Practitioner Pilot Program Status: Ongoing Sponsoring Institution: Southern California Pediatric Nurse Practitioner Advisory Committee Project Director, Title, Address: Joseph St. Geme., Jr.., M.D. chief Department of Pediatrics Harbor General Hospital 1000 West Carson St. Torrance, California Bonnie Bulloughp R.N., Ph.D. Assistant Professor UCLA School of Nursing Los Angeles, California Dates: February, 1971 to December, 1971 Fundin : $1.,OOO Area IV core funds 9 In-kind contributions of more than $ii,ooo Other Funding: none Cooperating Agencies and Institutions: UCLA.Extension, UCLA School of Nursing, USC Medical Center, California Pediatric Center., Children and Youth Project, California State Department of Public Health, Southern California Permanente Medical Group, Read Start Program, Orthopaedic Hospitalo California Nurses, Association, Pediatrics Outpatient Department, UCLA Medical Center-, South Central Multipurpose Health Services Center, Children's 'Hospital, Charles Drew Postgraduate Medical School, Martin Luther King Jr. General Hospital, Los Angeles City Schools, Los Angeles County Health Department, East Los Angeles Child and Youth Clinic, Harbor General Hospital, and Regional Medical Programs., Area IV. Congressional Districts: Honorable Alan Cranston D) Honorable John Tunney @D) Continuation after RMP Support Withdrawn: Incorporation into nursing curriculum offered by UCLA Fxtension or School of Nursing Core Staff Contact: Sheila Cadman, R.N., assistant coordinator for nursing and allied health,, California Regional Medical Programs,, Area IV ('UdLA). Date Prepared: February 14, 1972 Drafted by Jackie Reinhardt CALIFORNIA REGIONAL MEDICAL PROGRAMS AREA V 1 WEST BAY STATE STREET 0 ALHAMBRA, CALIFORNIA 0 91801 (213) 576-1626 P. 0. BOX 1390 o ALHAMBRA, CAUFORNIA gItM- UNIVERSITY OF SOUTHERN CALIFORNIA 9 SCHOOL OF MEDICINE PI September 6, 1972 Ms. Dorothy M4 Bailey Writer Office of Communications and Public Information Department of Health, Education, and Welfare Public Health Service Health Services and Mental Health Administration Rockville, Maryland 20852 Dear Ms. Bailey: I am enclosing vignettes, as requested in your letter of August 3, for the Pacemaker Registry and Information Center, SEARCH: A Link to Services, Comprehensive Stroke Care and The American Indian Free Clinic in Compton, as we as some information on The Coordination of Free Clinics. We think the publication of selected vignettes is a great idea and hope that at least one of our programs might be represented in the next revision. Please contact me if any additional material is needed. Si (Mrs.) Elsie M. McGuff Communications Coordinator McG:cc Enclosures HEALTH CARE FOR OLDER RESIDENTS OF A BMIO Older citizens of an inner-city barrio are the particular target of an exploratory one-year program funded by Area V of California Regional Medical Programs. The goal of the project is to investigate the feasibility of an ambulatory,,total follow-up health care clinic for senior citizens. Data is being collected and solutions sought to such needs as specific health problems, transportation, special problems that influence or affect the health of the aging, and the nee an utilization of different types of hme care services. To qualify, the patient must be-over 50 years of age, ambulatory, a resident of East Los Angeles or Northeast Public Health Districts, willing to return for specialty clinics for a period of one year, and cooperative about completing questionnaires. A thousand cases, selected randomly, have been screened and are being followed by a case-manager-total-follow-up approach. The citizens who were not selected after screening are referred to appropriate agencies. The test project is conducted from two trailers parked on a vacant lot near the local public health department building. Community interest is such that the senior citizens volunteered to care for the grounds and landscaping on which the trailers are situated. The project is carried on by contract with the Los Angeles County Health Department. Rii:(;I.ON: CALIFORNIA REGIONAL MEDICAL AREA V NAtff,,' OF PROJECT: older Residents Integrated Health Care Program LOCUS OF ACTIVITY: (circle one) :.C-,o,re_AP-tiyity Operational Project Developinental Component Project STATUS: (circle one) Ongoing @'t-ompleted'-') Just beginning SPONSORING INSTITUTION; Contract with Los Angeles County Health Department PROJECT DIRECTOR, TITLE, Jane Shields, M.D. Al)ljlcESS: District Health Officer East Los Angeles Health District 670 South Ferris Avenue Los Angeles, California 90022 DATES: (indicate beginning date and date of completion, if finished) August, 1970 (did not actually get underway until June,1971-June, 1972) FUNDING PERIODS AND AMOUNTS: (01 $402000 OTHER FUNDS, if any: COOPERATING AGENCIES AND INSTITUTIONS: Los Angeles County Heart Association and East Los Angeles Health Task Force AREA SERVED: East Los Angeles Health District and Northeast Los Angeles Health District. 'rARGET POPULATION: Residents of area over 50 years of age (ambulatory). CONGRESSIONAL DISTRICTS: #19 (Chet Holifield (D) and #30 (Edward R. Roybal (D) Covering part of Los Angeles County CONTINUATION AFTER RMP SUPPORT CONCLUDES: Los Angeles County Health Department CORE STAFF CONTACT: Miss Teresita Moreno, M.S.W. Assistant Coordinator DATE PREPARED: August 29, 1972 Pro ect Information Sheet l@ii@(.I()N: (;A],[.FoIMIA REGIONAL MEDICAL PROGRAMS, AREA V NAME OF PROJECT:Stroke Rehabilitation Liaison Nurse Program LOCUS OF ACTIVITYI (circle one)( Core Activity) Operational Project Developmental Component Project STATUSO. (circle one)( ongoing) Completed Just beginning .@Po@i,<;ORIN('y INSTITUTION: California Regional Medical Programs, Area V PROJECT DIRECTOR, TITLE, Robert H. Pudenz, M.D. ADDRESS: Special Advisor, Stroke and Related Diseases 1 West Bay State Street P. 0. Box 1390 Alhambra, California 91802 DATES: (indicate beginning date and date of completion$ if finished) January 1970 FUNDING PERIODS AND AMOUNTS: (01 OTHER FUNDS, if 6ny:Short-term traineeship for two nurses for a Rehabilitation Workshop Services in kind from L. A. County - USC medical & nursing staff & Huntington Memorial Hospital medical & nursing staff ('O()TIERATING AGENCIES AND INSTITUTIONS: L. A. County - USC Medical Center, Huntington Memorial Hospital, Rancho Los Amigos Hospital., Casa Colina Rehabilitation Hospital, Community Hospital of San Gabriel, Midway Hospital, Intercormnunity Hospital iLli Covinl, Presbyterian Inter-Community Hospital, St. Joseph Hospital, St. Francis of Lynwood Alit@A: SERVI@D: Area V 'i.@AR(ir,,i, POPULATION: Stroke victims in acute care hospitals (,()NGR.I@'SSIONAL DISTRICTS: 13-17-19-20-21-22-23-24-25-26-27-2 -2 -30-3 -32-34 (@ONI',INUATTON AFTER RNP SUPPORT CONCLUDES: Major support presently provided by community. Regional Medical Programs acts primarily as organizer and conve er o existing resources STAFF CONTACT: Kay D. Fuller, R.N. DATE PREPARED: August 28, 1972 STROKE REHABILITATION LIAISON NURSE PROGRAM Over three years ago, the Area V Stroke Committee identified ear y r,(@llabi'iitation and continuity of care following acute hospitalization as primary problems involving the management of stroke patients. To improve direct patient care in these two problem areas, a Stroke Rehabilitation Liaison Nurse Program was developed by Area V staff, based on a similar and very successful program at Memorial Hospital,and Medical Center of Long Beach. The concept involves training a Stroke Liaison Nurse to initiate a specific stroke management program in the acute hospital, This nurse, after evaluating the newly admitted stroke patient, works closely with the Attending physician and nursing staff developing the overall patient care plan for that particular patient. This patient care plan subsequently involves others on the multi-disciplinary "stroke team" such as physical and occupational therapy, social service, etc. Another phase of the program has the Stroke Liaison Nurse working closely with the patient's family and agency-institutions outside the hospital, in anticipation of discharge from the acute hospital. Training, consultation and coordination of services for extended care facilities and home health agencies fill out the role of the stroke nurse. Totally.through an Area V core effort (no operational funding was involved), and working with and utilizing community resources, six Stroke Rehabi itat on Liaison Nurae,s(representing a total of 1700 acute beds) have now completed A comprehensive seven-week didactic and clinical course. This stroke program has since been well established in each of the participating hospitals and Page I of 2 Pages the Area V.1'stroke team," composed of core staff members, is presently developing strategy for expanding the program into six more acute hospitals during the remaining months of 1972. Qu@irterly "Stroke Seminars" have been initiated providing an oppor- tunity for the Liaison Nurses and Area V Stroke Team to meet for the purpose of information and program exchange. Page 2 of 2 Pages Project Information Sheet REGION: CALIFORNIA REGIONAL MEDICAL PROGRAMS, AREA V NAME OF PROJECT: SEARCH: A LINK TO SERVICES LOCUS-OF ACTIVITY: (circle one) (Core Activity Operational Project Developmental Component Project STATUS: (circle one)( ng) Completed Just beginning SPOINSORING INSTITUTION: USC School of Medicine PROJECT DIRECTOR, TITLE, joy G. Cauffman, Ph.D., Principal Investigator ADDRESS: University of Southern California School of Medicine 2025 Zonal Avenue Los Angeles, California 90033 DATES: (indicate beginning date and date of completion, if finished) FUNDING PERIODS AND AMOUNTS: (01 - $ Area V participated in the planning and contributed a small amount of funding in the 01 year and continues OTHER FUNDS, if any: to contribute staff expertise. Department of Health, Education,and Welfare, Public Health S6rvice, National Center for Health Services Research and Development COOPERATING AGENCIES AND INSTITUTIONS: See enclosed brochure AREA SERVED: Los Angeles County TARGET POPULATION: People seeking health and related services in Los Angeles County CONGRESSIONAL DISTRICTS: 13-17-19-20-21-22-23-24-25-26-27-28-29-30-31-32-34 CONTINUATION AFTER RMP SUPPORT CONCLUDES: CORE STAFF CONTACT: Mrs. Kay D. Fuller, R.N.' (.213) 576-1626 DATE PREPARED: August 30, 1972 SEARCH: A LINK TO SERVICES As one of the largest metropolitan areas within the United States, Los Angeles County is in serious need of a comprehensive and efficient system for providing @heal,th information and referral services. In an effort to alleviate this situation, SEARCH: A Link to Services, at the University of Southern California School of Medicine, has been developing a computerized information and referral system. Assisted by Area V since its developmental phase, and funded by a grant from the US Public Health Service, the SEARCH system is designed to match persons seeking medical and/or social assistance with individuals or agencies providing such services. A study of referral patterns in the County was carried out with several objec- tives: To implement a system for classification of consumer health problems and services; to develop an effective method for tracking customers referred for health care; to construct a feasible model for measuring the outcome for referral; to evaluate the significance of variables associated with the.outcome of referral. After surveying all health information and referral services within Los Angeles County, the project has specifically identified the characteristics of existing services, has determined their compatibility, and has explored the feasibility of linking these services into one computerized health services data system for- the County. In the period from 1972 to 1975, the project will endeavor to establish health counselling and referral centers, sponsored by SEARCH, and located within existing facilities of cooperating organizations. Within these centers, computer terminal devices will be provided as a tool for health workers to use in linking consumers with providers of care. These terminal devices will be connected to a central time-sharing computer facility via telephone lines,. At the central computer facility, a data bank will be maintained which contains a comprehensive description of medical and social services within the County. When center personnel counsel consumers, they will query the bank for information to assist them in directing consumers to services tailored to meet their indi- vidual needs. It is expected that such a system will enhance the referral process, thereby enabling more consumers who have health problems and need help to reach appropriate sources of health care. L Project Information Sheet Rl,,(;ION: (,ALIFORNIA REGIONAL MEDICAL PROGRAMS, AREA V NAME OF PROJECT: PACEMAKER I,OCUS OF ACTIVITY: (circle one) Core Activity (.Operational Project) Developmental Component Project S'J'Al.'US: (circle one) (Ongoing) Completed Just beginning INSTITUTION: USC School of Medicine lll@O,fECT DIRECTOR, TITLE, Michael Bilitch, M.D., Project Director ADDRESS: Los Angeles County - USC Medical Center 1200 North State Street, Room 6131 Los Angeles, Cal,@f.forn@i.n 90033 I)A'I'I',S: (indicate beginning date and date of completion, if finished) May 1, 1970 J,'tTNI)ING PERIODS AND AMOUNTS: (01 - $ 48,530 (02 - $ 67,458 ) (03 - $ 88,676 ) OTIIT;,',R FUNDS, if any: -0- ('O()Ill-i,RATING AGENCIES AND INSTITUTIONS: Hospitals in California Regional Medical Programs Arbas IV, V, VIII, Pacemaker Clinics, ftiiieral. ltoiyie directors, County Coroner's off@i.c(, Alll,',A SERVED: Los Angeles County, San Bernardino County, Orange County, Ventura County, Kern County, Santa Barbara County 'I'Ai?(;P','r POPULATION., Patients with Pacemakers ('t)N(;]@l;',.r)S@l'ONAL DISTRICTS: 13-17-19-20-21-22-23-24"25-26-28-29-30-31-32-34...24-33- 38... 25-32-34-35... 13...18-27... 13 ('()],i'[']'NIJA'I'ION AFTER RMP SUPPORT CONCLUDES: integration into the Los Angeles County automated data bank. Available on a subscription basis to physicians and pacemaker manufacturers. CONTACT: Kay D. Fuller, R.N. I)A@l,'E PREPARED: August 28, 1972 THE PACEMAKER RE@GISTRY AliD INFORMATIOli CEIITER This project, which became operational in May, 1970, has four major objectives. The first of these is to register patients with pacemakers, @ as of August 31, 1972, 970 patients with pacemakers have been identified. Of these, 280 are fully registered and are actively followed by the Registry. The remainder ate patients who are actively followed by various pacemaker clinics or whose physi- cians, for one reason or another, do not wish full registry services. In preparation for an on-line computerized pacemaker status and clinical data system linked with the Los Angeles County/University of Southern California Medical Center computer service, the Registry's data collection forms are now being used by an additional pacemaker clinic serving 120 patients in the area. The Registry is currently exploring alternatives for following patients' progress, utilizing a remote data collection device. Several devices have been developed making it possible to receive and record pacemaker interval data via telephone lines. Follow-up transmission has proven effective and demonstrates economy of time and money for the patient, physician, and medical facility. evices and--by- t-@.-mean,&" ntly t@ three such d are curre follow@ 96 patients. The recovery of pacemakers is another ob ective of the project. To date, some 850 pacemakers have been recovered, of which over half are recovered on replacement, the remainder being acquired post mortem. The recovery program is proving a valuable asset in determination of the reliability and validity of pacemaker function. The project also acts as an information center concerning the use and functions of pacemakers. This aspect of the project became fully operational in February, Pacemaker - Area V California RMP Page I of 2 pages 1971 and since then, more than 80 consultations have been provided. The Registry format for patient follow-up is being used as a model by physicians And others in establishing pacemaker clinics both nationally and internationally. Professional education in the use and functions of pacemakers is a fourth 6bjec- tiv(i of the.projecto A special exhibit displays the various kinds of pacemakers And describes their uses and parameters. An easily read, quick reference chart, which can be displayed on the walls in emergency and critical care rooms, is distributed to health care facilities in Southern California to aid the clinician to correctly identify pacemaker function.and malfunction in light of pertinent clinical evidence. over-100 physicians responsible for the care of patients from whom pacemakers have been recovered have been interviewed to assist in correlating clinical information with that acquired from the recovered units. Records are also maintained concerning how physicians feel about pacemakers, And about the care of those patients who have permanent pacemakers. A survey of 315 hospitals disclosed 130 where permanent pacemakers ate implanted, and a record is kept on which physicians are involved. Other educational efforts have been the presentation of lectures and seminars throughout the country, and several papers presented at local and international meetings by the Project Director. A one-day pacemaker course held in June, 1971 is to be repeated in June, 1073. Pacemaker Area V California RMP Page 2 of 2 pages FKUJEUT iNFU @ TION SHEET REGION: CALIFORNIA REGIONAL MEDICAL PROGRAMS, AREA V NAME OF PROJECT: Coordination of Free Clinics LOCUS OF ACTIVITY: (circle one) Core Activity ional.-Px@t., pmental Component Projec STATUS: (circle one) Completed Just beginning SPONSORING INSTITUTION: Southern California Council of Free Clinics PROJECT DIRECTOR, TITLE, Michael Wood, Director ADDRESS: 3493 Cahuenga Boulevard, #3 Los Angeles, California 90028 DATES: (indicate beginning date and date of completion, if finished) December 15, 1971 FUNDING PERIODS AND AMOUNTS: (01 - $27,400 OTHER FUNDS, if any: COOPERATING AGENCIES AND INSTITUTIONS: Los Angeles County Health Department, Los Angeles Regional Family Council Childrens Hospital of Los Angeles AREA.SERVED: Southern California TARGET POPULATION: Aliented youth and families who for geographic, ethnic, or financial reasons have failed to connect with established health facilities. CONGRESSIONAL DISTRICTS: 11-19-20-21-22-23-24-25-26-27-28-29-30-31-32-34 ... 25-32-34- 35...35-36-37... 24-33-38... 38...13 CONTINUATION AFTER RMP SUPPORT CONCLUDES: CORE STAFF CONTACT: Mrs. Jane Z. Cohen Assistant Coordinator DATE PREPARED: August 23, 1972 SOUTHERN CALIFORNIA COUNCIL OF FREE CLINICS The success of the free clinic movement in serving alienated youth, and families.who for geographic, ethnic or financial reasons have failed to connect with established health facilities has been attributed to their approach -'Wlv@ combines an atmosphere which lends itself to treating the patient instead of the symptom, a lack of intensive screening personal, financial or residentia and as non-judgmental a climate As is humanly possible; total community involvement on all levels of operation'. with both professional and paraprofessional staff composed entirely of volunteers. Although initial programs dealt largely with crisis intervention, the services of the clinics have been expanded to meet the health care needs of their communitIies more comprehensively and now offer medical and 8ental treatment, family planning and prenatal classes, legal and draft counseling, psychiatric counseling, and pregnancy and abortion counseling. The Southern California Council of Free Clinics was established in August, 1970 with representation from each free clinic in Southern California. Ideas discussed by Council members Are directed back to each clinics' Board of Diredtors, composed of representatives from the community, thus, a direct line is created between the users and the providers of free clinic services. The Council meets regularly once a month; the Executive Committee once a week, and committees as necessary. An Advisory Board has been formed and began meeting in October, 1971. Bi-month clinic schedules arepublished and a small central office is maintained. A developmental component grant to the Southern California Council,i . Its activities Page 1 of 2 Pages in defining, evaluating and improving the quality of care delivered by free clinics have, thus far, proved very successful. The Council now has a standing committee on Quality Standards as one result of progress on the developmental component. A grant proposal submitted by Area V has been approved, but remains unfunded at the present time. It proposes: To develop the ability of Southern California Council of Free Clinics to maintain itself; to protect the individuality of each free clinic; to be sure the Southern California Council reflects the clinical needs; to help each free clinic maximize its range of services and use of resources; to enhance the maintenance of free clinics financially and through support of volunteers and voluntary health agencies. --all There are now over 50 Free Clinics throughout Southern California private, non-profit corporations directed and operated by the people who use them. The free clinics in Los Angeles County alone recorded 450,006 patient visits in 1971. Page 2 of 2 Pages. . -,Barlow/ joimson Advertising and Public Re!-ations Syracuse Albany June 15, 1972 Ms. Patricia Q. Schoeni Dept. of Health, Education and Welfare Health Services and Mental Health Administration Rockville, Maryland 20852 Dear Pat: At long last -- some Central New York vignettes'. And there's more to come. As you know, this has been a chaotic time for CNYRMP and it has taken this long to get some of the specifics from the projects for use in the vignettes. I look forward to seeing you in Boston. Sincerely, 'O (Mrs .) S ra M, Anglund Vice Pre den t or Public Relations SMA/nam Enclosures P.S.: Here's an advance of the Utica Sunday supplement with a good RMP story. 117 Highbridge Street, Fayetteville, N.Y. 13066 315/637-9895 GENERALIST NURSE PRACTITIONER TRAINING PROGRAM Twenty-seven area nurses are currently being trained as generalist nurse practitioners in a program representing a new concept in health delivery, sponsored by the Central New York Regional Medical Program. Of the nurses in the programr 25 are from agencies serving the rural and urban medically disadvantaged. Under this project, nurses from hospitals, health agencies and doctors'offices participate in an intensive seven-month educational program,., learning to provide primary medical care. Nurse practitioners work under a phy8ician's direction, but on their own, handling common health services and thereby expanding the care delivery po ent3al of the physician. It i6 estimated that if, nurse practit- ioner can save a physician from seeing 16-20 patient.q,,,,,with common medical problems each week- day, physicia@ would have one,t,,,,r al..half more weekdays available for-Palcou'@6le-anq@-0 lems,@%@continuinq education, etc. Many of the people currently being treated by the nurse practitioners are elderly individ- uals and others who would otherwise not receive continuing medical care. REGION: Central New York Regional Medical Program FOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Nurse-Clinician Training Program (Generalist Nurse P r a c t i t i o n e r s STATUS: Ongoing SPONSORING INSTITUTION: Community-General Hospital, Syracuse, N.Y. PROJECT DIRECTOR, TITLE, ADDRESS: Miss Gertrude Chorescavich, R.N. Director of Nursing Services Community-General Hospital Broad Road Syracuse, New York 13215 3 1 5 - 4 6 9 - 5 DATES: 10/l/71-12/31/72 FUNDING: $42,850 OTHER FUNDS: Space COOPERATING AGENCIES AND INSTITUTIONS: Nurses from any agency in 17-county area are eligible to attend. AREA SERVED: 17-county Central New York RMP area. TARGET P 40 nurses per year. OPULATION. CONGRESSIONAL DISTRICTS: NY #31, Robert McEwen; NY #32, Alexander Pirnie; NY #33, Howard Robison; NY #34, John Terry; NY #35, James Hanley; Pa #1@0, Joseph,,,McDa e. CONTINUATION AFTER RMP SUPPORT WITHDRAWN: Program will become self- supporting through tuition charges. MEDICAL LIBRARY ASSISTANCE PROGRAM The Medical Library Assistance Program, including a medical bookmobile sponsored by the Central New York Regional Medical Program, was designed to fulfill the need in many area hospitals for a better developed library facility. In one year, the bookmobile visited 43 hospitals and five subacute facilities in Central New York and Northern Pennsylvania, training the person who serves as hospital librarian and stimulating interest in develop- ment of a hospital library. A total of 1,201 health personnel visited the unit. The renovated motor home carries a set of journals and medical books which form an integrated health science core library for physicians, nurses and allied health personnel. These 90 books and 74 journals represent what experts have selected as the minimal amount of literature which even the smallest hospital should provide in its staff library. As a result of RMP assistance, a total of three hospitals have received National Library Medicine improvement grants; two have received notice of approval and five are currently submitting applications. Through the bookmobile and RMP, health people through- out the region can borrow books or photocopies of journal articles from the library at Upstate Medical Center in Syracuse. The hospitals visited are encouraged to have the basic indices so that they may make full use of Upstate's lending facilities. Requests for inter-library loans to the Upstate Medical Center from area hospitals increased to 5,127 or 56.5% over the previous year. The Biomedical Communications Network handled 343 computer searches or 64.9% more than last year on behalf of the area's health agencies. Of special interest is the fact that two paraplegic patients in area hospitals became interested in serving as hospital librarians as a result of the mobile's visits. One has been trained by the RMP staff librarian and is now handling the job in a hospital which also recently received a National Library of Medicine improvement grant as a result of RMP assistance. The second paraplegic is currently in training. REGION: Central New York Regional Medical Program FOCUS OF ACTIVITY: Core Activity (Stated as Feasibility Study) PROJECT TITLE: Medical Library Assistance Program STATUS: Ongoing SPONSORING INSTITUTION: CNY RMP Core Service PROJECT DIRECTOR, TITLE, ADDRESI.: Miss Suzanne Murray Library Coordinator Central New York Regional Medical Program DATES: 711171 - 9/30/71 (officially), but activity has continued under Core FUNDING: Initially shared $19,437 with health mobile project. OTHER FUNDS: Now - Core. COOPERATING AGENCIES AND INSTITUTIONS: Upstate Medical Center, all facilities in region. AREA SERVED: 17 counties served by CNYRMP. TARGET POPULATION: 55 hospitals, selected nursing homes. CONGRESSIONAL DISTRICTS: NY #3 1, Robert McEwen; NY #32, Alexander Pirnie; NY #33 Howard Robison; NY #34, John Terry; NY #35 James Hanley; Pa #10, Joseph McDade. CONTINUATION AFTER RMP SUPPORT WITHDRAWN: STROKE REHABILITATION MOBILE CONSULTING SERVICE The stroke mobile sponsored by the Central New York Regional Medical Program, 1969-1971, served both a patient service and health professional education role. The unit, staffed by a team of rehabilitation specialists visited hospitals and nursing homes; conducted extensive patient evaluations and taught local people how to carry out treat- ment. Perhaps its greatest effect was in showing health people that there were things which could be done for stroke patients,:( that they should not,just let them,,lie in @d During its 2@-1/2 years of operation, the service conducted 136 programs ranging from one to six days. These included institutes, demonstrations, patient consultations,@,",@ nursing inservice program development. Personnel from 148 different facilities f -ell 17 counties participated in the unit's programs. Following is A list of the types and number of facilities from which personnel participated: Hospitals--45 Extended care, nursing homes--62 Public health agencies--16 BOCES and manpower development and training--6 Schools (nursing, health education,.social work,. physical thekapy)--10 Heart associations--2 Nursing home district associatidns--2 Department of social sekviceg--l RMP nursing subregional programs--4 Altogether, 4,896 contactswere made by the mobile unit. Of the 370 physicians who took part in unit programs in some way, 126 referred patients. Other contacts made were 3,751 nurses; 225 occupational, physical and speech therapists and social workers; 482 other personnel; 547 family and interested people from the community. A total of 241 patients were evaluated. REGION: Central New York Regional Medical Program FOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Mobile Rehabilitation Service STATUS: Term 31/71 SPONSORING INSTITUTION:,,SUNY - Upstate Medical Center PROJECT DIRECTOR$, TITLE, ADDRESS: Leo Jivoff, M.D., Prof. & Chm, Dept. of Rehab. Medicine SUNY Upstate Medical Center 750 E. Adams Street Syracuse, N.Y. 13210 315-473-5820 DATES: 7/l/68 - 3/31/71 FUNDING: $308,724 OTHER FUNDS: COOPERATING AGENCIES AND INSTITUTIONS: Personnel from 148 different facilities participated in strokemobile activities. AREA SERVED: 17 counties served by CNYRMP TARGET POPULATION: stroke patients health p6rs,onnel CONGRESSIONAL DISTRICTS. NY #31, Robert McEw6n; NY #32, Alexander Pirnio; NY #33, Howard R-bbisoh; NY #34, John Terry; NY #35, James Hanley; Pa #10, Joseph McDade. CONTINUATION AFTER RMP SUPPORT WITHDRAWN: HOME DIALYSIS TRAINING PROGRAM The Home Dialysis Training Program funded by the Central New York Regional Medical Program annually trains 15-20 patients and their families to conduct he@"O'dialysis in a home setting. It also serves as a training center for physicians, nurses, allied health professionals and technicians from hospitals and public health agencies throughout a 17-county area. 8emodialysis is the treatment in which an artificial kidney "cleans" a patient's blood when his own kidneys have failed. A major impact of the program is to moderate the cost of care and-'-iree hospital beds. While a hemodialysis machine re- presents a substantial investment -- about $3,000 -- it proves less costly to use at home than in the hospital. Figured into the cost of in-hospital use must be the services of nurses, technicians, and other health personnel, plus linens, supplies, and normal overhead. These costs may add up to over $15,000 annually. Home dialysis expenses are less than one-third this amount. In addition, when dialysis can be done at home on a flexible time schedule, kidney disease victims may be able to hold down a job, go to school,.e-tc-. Prior to the RMP-sponsored uniti several Central New York kidney patients had gone to New York City for similar training. While the patient and his family ate being trained, health, care personnel from his area are train6d,also. These people are then able to serve this particular patient in the home environment. But, perhaps more important, by updating the knowledge of health people throughout the region, the basis for a coordinated regional dialysis program is being developed. There are approximately 75 patients in the 17-county area on hemodialysis. REGION: Central New York Regional Medical I-Irogram FOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Home Dialysis 'I'-t,aining Program STATUS: Ongoing SPONSORING INSTITUTION: SUNY, Upstate Medical Center PROJECT DIRECTOR.- TITLE, ADDRESS: E. T. Schroeder, M.D.,, Assoc Prof.'Med. SUNY, Upstate Medical Center 750 E. Adams Street Syracuse, New York 132 10 315-473-4456 DATES:. 6/26/70 12/31/72 FUNDING: (1) $43, 219 allocated, $9, 786 spent (2) $30, 028 allocated, $22., 010 spent (3) $18, 329 allocated OTHER FUNDS: Hospital space and full time nurse by Onondaga County Health Dept. COOPERATING AGENCIES AND INSTITUTIONS: Upstate Medical Center Onon.. Co. Health Dept@. AREA SERVED: 17 counties served by CN-Y RMP TARGET POPULATION- 76 patients currently on hem odialysis, 80-100 new patients per year; health professionals serving them in their homes. CONGRESSIONAL DISTRICTS: NY #31, llol)ert'McEwen; NY #32, Alexander Pirnie,- NY #33 Howard Robipfson; NY #34, John Terry; NY #35 James Hanley; Pa #10, Joseph McDade CONTINUATION AFTER RMP SUPPORT WITTIDR..,IIWN- PULASKI MODEL RURAL AMBULATORY CENTER Residents of a 21,000 population rural area near the eastern shore of Lake Ontario are receiving medical care from the Pulaski Model Rural Ambulatory Care Center, located 40 miles north of Syracuse. The center, which is funded by the Central New York Regional Medical Program, treats 150-200 patients every week; (,4--.days.). Prior to the opening of the Pulaski Center, the area was served by only two physicians in spite of the fact that community leaders had worked to attract doctors for five years. Their efforts included offering facilities. The problem was solved with the help of St. Joseph's Hospital Health Center of Syracuse which offered to staff the facility under its Family Practice program. Liaison is maintained presently through the exchange of staff members. When a proposed new clinic building is completed, communications will be effected through the use of closed circuit television, Xerox telecopier and data phone. The center provides a model which other areas with physician shortages might copy. It is based on the idea that physicians may be more willing to pra-ctice in rural areas if they have continuing education opportunities, modern facilities, a team of doctors and allied personnel to work with and a strong liaison with a medical center. Residents from St. Joseph's and students from Upstate Medical Center rotate through the clinic in two-month intervals. The goal of these rotations is to encourage young doctors to undertake rural practices. The Pulaski facility is owned by Northern Oswego County Health Building, Inc. (NOCHBI), which was created f i ive years ago to help attract physicians to the Pulaski- Sandy Creek area. It is through NOCHBI's efforts that the center, presently located in a ranch house, was purchased, maintained and equipped. Every week 5-10 patients are treated for previously undiagnosed conditions. Patients in whom a known con4dition was not receiving adequate care prior to the project'n@mber 5-10 per week. REGION: Central New York Regional Medical Program FOCUS OF ACTIVITY: Operational Froject PROJECT TITLE: Model Rural Ar,,-@tlatory Care Center STATUS: Ongoing SPONSORING INSTITUTION: St. Joseph's Hospital, Syracuse, N.Y. PROJECT DIRECTOR, TITLE, ADDRESS: Francis S. Caliva, M.D., Prof. & C,hm. Dept. of Family Practice Upstate Medical 'Center/and Director of Medical Education St. josep@h's Hospital Syracusei New York 13203 DATES: 10/l/71-12/31/72 PUNDING- $53,433 OTHER FUNDS: St. Joseph's Hospital NOCHB Inc. Patient @eceipts COOPERATING AGENCIES AND INSTITUTIONS Northern Oswego County Health 'Bldg., Inc., Upstate Medical Center AR A SERVED: Northern" Oswego County TARGET POPULATION: 21 000 - patient service area in a rural setting; coht. education for Family Practice residents. CONGRESSIONAL DISTRICTS: NY#31 Robert'MtEweo CONTINUATION AFTER RMP SUPPORT WITHDRAWN: MEDICAL LIBRARY ASSISTANCE PROGRAM The Medical Library Assistance Program, including a medical bookmobile sponsored by the Central New York Regional Medical Program, was designed to fulfill the need in many area hospitals for a better developed library facility. In one year, @he bookmobile visited 43 hospitals and five subacute facilities in Central New York and Northern Pennsylvania, training the person who serves as hospital librarian and stimulating interest in develop- ment of a hospital library. A total of 1, 201 health personnel visited the unit. The renovated motor home carries a set of journals and medical books which form an integrated health science core library for physicians, nurses and allied health personnel. These 90 books and 74 journals represent what experts have selected as the minimal amount of literature which even the smallest hospital should provide in its staff library. As a result of RMP assistance, a total of three hospitals have received National Library Medicine improvement grants; two have received notice of approval and five are currently submitting applications. Through the bookmobile and RMP, health people through- out the region can borrow books or photocopies of journal articles from the library at Upstate Medical Center in Syracuse. The hospitals visited are encouraged to have the basic indices so that they may make full use of Upstate's lending facilities. Requests for inter-library loans to the Upstate Medical Center from area hospitals increased to 5,127 or 56.5% over the previous year. The Biomedical Communications Network handled 343 computer searches or 64.9% more than last year on.behalf of the areals health agencies. Of special interest is the fact that two paraplegic patients in area hospitals became interested in serving as hospital librarians as a result of the mobile's visits' One has been trained by the RMP staff librarian and is now handling the job in a hospital which also recently received a National Library of Medicine improvement grant as a result of RMP assistance. The second paraplegic is curren@-ly in training. REGION: Central New York Regional Medical Program FOCUS, OF ACTIVITY: Core Activity (Stated as Feasibility Study) PROJECT TITLE: Medical Library Assistance Program STATUS: Ongoing SPONSORING INSTITUTION: CNY RMP Core Service PROJECT DIRECTOR, TITLE, ADDRES-": Miss Suzanne Murray Library Coordinator Central New York 1 Medical Program Regiotia DATES: 7/l/71 - 9/30/71 (officially), but activity has continued, under Core FUNDING: Initially shared $19,437 with health mobile project. OTHER FUNDS: Now - Core. COOPERATING AGENCIES AND INSTITUTIONS: Upstate Medical Center, all facilities in region. AREA SERVED: 17 coun ties served by CNYRMP. TARGET POPULATION: 55 hospitals, selected nursing homes. CONGRESSIONAL DISTRICTS: NY #31 , Robert McEwen- NY 132, Alexander Pirnie; NY #33 Howard Robison; NY #34, John Terry; NY #35 James Hanley; Pa #10, Joseph McDade. CONTINUATION AFTER RMP SUPPORT WITHDRAWN: HOME DIALYSIS TRAINING PROGRAM The Home Dialysis Training Program funded by the Central New York Regional Medical Program annually trains 15-20 patients and their families to conduct hemodialysis in a home setting. It also serves as a,training center for physicians, nurses, : allied health professionals and technicians from hospitals an public health agencies throughout a 17-county area. Hemodialysis is the treatment in which an artificial kidney "cleans" a patient's blood when his own kidneys have failed. k A major impact of the program is to moderate the cost of care and free hospital beds. While a hemodialysis machine re- presents a substantial investment -- about $3,000 -- it proves less costly to use at home than in the hospital. Figured into the cost of in-hospital use must be the services of nurses, technicians, and other health personnel, plus linens, supplies, and normal overhead. These costs may add up to over $15,000 annually. Home dialysis expenses are less than one-third this amount. In addition, when dialysis can be done at home on a flexible time schedule, kidney disease victims may be able to hold down a job, go to school, etc. Prior to the RMP-sponsored unit, several Central New York kidney patients had gone to New York City for similar training. While the patient an d his family are being trained, health care personnel from his area are trained also. These people are then able to serve this particular patient in the home environment. But, perhaps more important, by updating the knowledge of health people throughout the region, the basis for a coordinated regional dialysis program is being developed. There are approximately 75 patients in the 17-county area on hemodialysis. REGION: Central. New York Regioiiil. I')-orfrani FOCUS OF ACTIVITY: Operatioii,,i.1 Ilroiect PROJECT TIT.T.,E: Ilon-ic, Dialysis 'I't-.,itiing P,,-o-,t-,i.ni STATUS: Or),goillg SPONSORING INSTITUTION: SU@,-, 1)'I)statc, Medical Center PROJECT DIIIECTOR, TITLE, ADDRESS: E. T. Schro(-,-clcr,, M.D., Assoc Prof. 1\@led. SUNY, Upstate Medical Center 750 E. Adams Street Syracuse, New York 13210 315-473-4456 DATES: 6/26/70 - 12/31/72 FUNDING: (1) $43,219 allocated, $9, 786 spent (2) $30, 028 .illocate(l, $22, 010 spent (3) $18, 329 allocated OTHER FIJ-NDS: Hospital space and full nine nurse bv Onoii(,',,i.ga County Health Dept. COOPERATING AGENCIES AND INSTITUTIONS: LTp@,tit(-, Medical Center Oiioii.. Co. Ilealtli Dept. AIZEA SERVED: 17 counties served I)v CN-Y RAII' TAIIGET POPUI,@ATION: 76 patients currently on liemoclialysis, 80-100 new patient per v(@@tr; health-professionals serving them in tlic@ii@ homes. -Y #31, ltol)crt I\IcE@%7c@ii; NY #32, Alexancle Pirni CONGRESSIONAL DISTRICTS: N r e NY #33 HoNvarci Robi)(son; NY #34, John Tr-@i-ry; NY #35 James Hanley; Pa #10, Joseph McDade CONTI@7\'-UATION Al,TL;'I->, R-AIP SUPI'301'LT YORK CENTRAL NEW PULASKI !,IDDEL RURAL AMBULATORY CENTER Residents of a 21,000 population rural area near the eas-@-ern shore of Lake Ontario are receiving medical care- from the Pulaski- Model Rural Ambulatory Care Center, located 40 miles north of Syracuse.. The center, which is funded by the Central New York Regional Medical Program, treats 150-200 patients every week (4 days). Prior to the opening of the Pulaski Center, the area was served by only two physicians in spite of the fact that community leaders had worked to -attract doctors for five years. Their efforts included offering facilities. The problem was solved with the help of St. Joseph's Hospital Health Center of Syracuse which offered to staff the facility under its Family Practice program. Liaison is maintained presently through the exchange of staff members. When a proposed new clinic building is :completed, communications will be effected through the use of closed circuit television, Xerox telecopier and data phone. the center provides a model which other areas with physician shortages might copy. It is based on the idea that physicians may be more willing to practice in rural areas if they have continuing education opportunities, modern facilities, a team of doctors and allied personnel to work with and a strong liaison with a medical center. Residents from St. Joseph's and students from Upstate Medical Center rotate through the clinic in two-month intervals. The goal of these rotations is to encourage young doctors to undertake rural practices. The Pulaski facility is owned by Northern Oswego County Health Building, Inc. (NOCHBI), which,was created five years ago to help attract physician's to the Pulaski- Sandy Creek area. it is through NOCHBI's efforts that the center, presently located in a ranch house, was purchased, maintained and equipped. Every week 5-10 patients are treated for previously undiagnosed conditions. Patients in whom a known condition was not receiving adequate care prior to the project number 5-10 per week. Central New York Re,@o a illro gv, a ni REGION FOCUS OF ACTIVITY: Operatio@ial ri-o,ject PROJECT TITLE: t@'@,odel Rural Ai@,@@ Care Center STATUS: 0 n g o i n g SPO NSORING INSTITUTION: St. Josepfi's Hosp.ital, Syracuse, N.Y. PROJECT DIRECTOR, TITCE, ADDRESS: Fran-cis S. Caliva, M.D., Prof. Chm. Dept. of Family Practice Upstate Medical Center/and Director of Medical Education St. Josenii's Hospital Syracuse, New York 13203 DATES: 10/l/71-12/31/72 FUNDING: $53,433 OTHER FUNDS: St. Joseph's Hospital NOCHB Inc. Patient receipts COOPERATING AGENCIES AND INSTITUTIONS: Northern Oswego County Health B-Idg., I-nc., Upstate Medical Center 'Oswego County AREA SERVED: NorthL'rn TARGET POPULATION: 21,000 - patient service area in a rural setting; cont education for Family Practice residents. CONGRESSIONAL DISTRICTS: NY#31 Robert'McEwen CONTINUATION AFTER RMP SUPPORT WITHDRAWN: STROKE REHABILITATION MOBILE CONSULTING SERVICE The stroke mobile sponsored by the Central New York Reaional Medical Program, 1969-1971, served both a patient service and health professional education role. The unit, staffed by a team of rehabilitation specialists visited homes'; conducted extensive patient hospitals and nursing evaluations and taught local people how to carry out treat- ment. Perhaps its greatest effect was in showing health people that there were things which could be done for stroke patients: that they should not just let them lie in bed. During its 2 1/2 years of operation, the service conducted 136 programs ranging from one to six days. These included institutes, demonstrations, patient consultations, nursing inservice program development. Personnel from 148 different facilities from all 17 counties participated in the unit's programs. Following is a list of the types and number of facilities from which personnel participated: Hospitals--45 Extended care, nursing homes--62 Public health agencies--16 BOCES and manpower development and training--6 Schools (nursing, health education, social work, physical therapy)--10 Heart associations--2 Nursing home district associations--2 Department of social services--l RMP nursing subregional progtams--4 Altogether, 4,896 cbntactswere made by the mobile unit. Of the 37 physicians who took part in unit programs in some way, 126 referred patients. Other contacts made were 3,751 nurses; 225 occupational, physical and speech,therapists and social workers; 482 other personnel, 547 family and interested people from the community. A total of 241 patients were evaluated. '@ll E G I I Medical Program Central Believe York Regi ona FOCUS OF ACTIVITY Operational Project PROJECT TITLE: Mobile Rehabilitation S e r v i c e .STATUS. Term. 3/31/71 SPONSORING INSTITUTION:-SUNY Unstate Medical Center PROJECT DIRECTOR, TITLE, ADDRESS: Leo Jivoff, M.D., Prof. & Chm. Dept. of Rehab. Medicine SUNY Upstate Medical Center 750 E. Adams Street Syracuse, N.Y. 1 3 21 0 3 1 5 - 4 7 3 - 5 8 2 0 DATES: 7/l/68 3/31/71 FUNDING: $308,724 OTHER FUNDS: COOPERATING AGENCIES AND INSTITUTIONS:. Personnel from 148 different facilities participatedin strokemobile activities. AREA SERVED: 17 counties served by CNYRMP TARGET POPULATION: stroke patients -.health personnel CONGRESSIONAL DISTRICTS: NY #31, Robert McEwen; NY #32, Alexander Pirnie; NY #33, Howard Robison; NY #34, John Terry; NY #35, James Hanley; Pa #10, Joseph McDade. CONTINUATION AFTER RMP SUPPORT WIT@IDRAWN: GENERALIST NURSE PRACTITIONER TRAINING PRCIIJ'RAM Twenty-seven area nurse.s are currently being. trained as generalist nurse practitioners in a program representing a new concept in health delivery, sponsored by the Central New York Regional-. Medical Program. of the nurses in the program,, 25 are from agencies serving the rural and urban medically disadvantaged. Under this project, nurses from hospitals, health agencies and doctorsloffices participate in an intensive seven-month educational program learning to provide primary medical care. Nurse practitioners work under a physician's direction but on their own, handling common health services and thereby expanding the care delivery potential of the physician. it i6 estimated that if each nurse practit- ioner can save a physician from seeing 16-20 patients with common medical problems each week- day, that physicians would have one or one and a half more weekdays available for acute prob- lems, continuing education, etc. Many of the people currently being treated by the nurse practitioners are elderly individ- uals and-others who would otherwise not receive continuing medical care. REGION: Ciyntral New York Regional Medical Program FOCUS- OF ACTIVITY: Operational Project PROJECT TITLE: t@urse-Clinician Training Program (Generalist Nurse Practitioners) STATUS: Ongoing Community-Ceneral HOSDital, Syracuse, N.Y. SPONSORING INSTITUTION: PROJECT DIRECTOR, TITI:E, ADDRESS. Miss Gertrude Cherescavich R.N. Director of Nursing Services COMMLInity-General Hospital Broad Road Syracuse, New York 1 3 21 5 31 5 - 4 6 9 - 5 5 1 1 DATES: 10/l/71-12/31/72 FUNDING: $42,850 OTHER FUNDS: Space COOPERATING AGENCIES AND INSTITUTIONS: Nurses from any agency in 17-county area are eligible to attend. AREA SERVED: 17-county Central New York RMP area. TARGET POPULATION: 40 nurses per year. CONGRESSIONAL DISTRICTS: NY #31@, Robert McEwen; NY #32, Alexander Pirnie; NY #33, Howard Robison, NY #34, John Terry; NY #35, James Hanley; Pa #10, Joseph .,@IcDade. Program will become self- CONTINUATION AFTER RMP SUPPORT WITHDRAWN: supporting through tuition charges. 0 c, ',Jay Rulo, l@. il@f. ID i @L --a! a-@ Arcadia, -@h,-, fir @:ary nurse training cc),@--se by th@ and a-,- 4 C) -4 the F-'Lor-Lda Heart Assoc-L L-.L @l In -LI-i@ Summer of ic)(@j9. -- - -i @.h ,ac returned home Wi@@ L@ii@, desire to r writir-,-T nor of one nurse a n @o ano@.aer, Miss Rule has prcpar@,-,d a practica.-i- de O', h, -,,'i7 to re uni-L-- 1 hosr L--.L open a coronary ca In SrLaa- will requ-@rc @n@-@nt of wo--rl,-, a.L-,Ll. ,@over@-@@@ce," she warns ncr Then she proceeds to t-at will enable in a small hospital --c avoid a of wasted iro'--'-on ai-d accomplish the rL@@s-dlts dc@s.-,L:ced. ','he paper, "Tips for C,--:,@nin(-.r -- Corona--y Care Ui-ii-@ fo-- the N,urse in a Small Hospi@a'-," expected" to be pub-'@-.shc;L, "-his L)aSoto's fi-ve-bed was opened Deceimh,,..-, I-, 1969. i-r-,@--lU(Les thlzee beds that az@ mc----'-@--ored and beds -Lcor re- cover,,,7 @,@--nd ICU patients. a s-lk-- @L -.L@ --F consists c-.@ @- ful,L-ti:-:@@ 1.@is, 4 part-time RNs, 2 full-@LircLe LPNs , 1 par--@-time '-he special Care Unit her hospital, Dc-Soto served "LO9 cardiac patieni--E; cLur'Lllg 1970 and 140 during 197'". There were 29 cardiac death @- the first year and 24 the L--@cond year. @Lhc-:fe- was a total of @ -")a-'k--ienL-s in the unit di:,--ring 1970 o-- a,-,i av@-,,,@--age stay of 3.7 days. The Unit served 374 oat'@L.e-rts @--.e reyt year for an average s't--a,7 of 2.5 days. ci L -a-tion CCKJ da lfc, .1'.. (I -Lc) ct-@@:)le nurses -'Cc) in the ii-12;1-:CUCLion of ot'.-.@'ier @'CU personnel, particular-LV valuable to '@hose from si.,,aller hospitals. More than 300 nurses co::Li-,olc@ted the course cLurinq the Fr@viP support period. Community support arragne- ments will continue to provide -L"-his training. REGION: Florida Regional -@cal @lrogram LOCUS OF ACTIVITY: Opcra-tio--ia-L I?ro-jec@L' PROJECT TITLE: Florida Co@,,c)r@a::v Care Nurses Tra4 riinc@; STATUS: Concluded SPONSORING ORGALNIZATION: i d a T:lo--art Association PROJECT DIRECTOR: LouLs j%I.D. Mia@iii, :'Ic)ri.cli 3'-'@) 1 4 5 ,"'@'ES: llarch 1, '@969 - FcL-i-i-iar,/ '972 FUNDING: 01 - $110,261; 02 - $-125,517; 03 - @,82,975 FUNDS: None Hosp.-Ltals COOPERATING LGE'@,TCIES AND I' Community and CoL@aun-' 'Zy Junior Co!'L@-c.,@s @,-@A SERVED: State of Florida T@-RGET POPULATION: Nurses from hospital staffs CO'@@TINUT-r 2TON AFTER Pd@P SU2@2O@- ContinuF,,@-on of t-@@ training activities will be provided by varying local coopera- -2. 1e tive arrangements. In so--c- -,@r-s-L--E,.nces , tuition fees w-- -'-l b cnarged students with a portion of the cost being absc---bed "@-Y the sponsoring institution. -L.,i other locales,, the local co-@--Ci- ..unity junior college will provide didactic instruction with +-I-@ training hospital providing necessary clinical experiences. CORE ST@--7F CONTACT: Gordon R. Engebretson, Ph.D., Deputy Director DATE PREPARED: February 1, 7L972 DRAFTED BY: Harold A. Tyler, Assistant Director for Coramunications Vignette: GRMP Activity A KIDNEY DISEASES PROGRAM FOR GEORGIA A plan to develop and integrate health care resources for kidney disease throughout the state of Georgia was instituted - with the support of GRMP- through the joint efforts of the Regional Nephrology Centers at the two medical schools of the region, Emory University School of Medicine and the Medical College of Georgia, and the two hospitals that have been designated as Kidney Area Facilities in Georgia. I strides being made in kidney research, e aqspite of the tremendous G orgi lags behind in its preparation to translate these research accomplishments into improved patient care for its citizens. In Georgia approximately 100,000 cases of genitourinary tract disease occur each.year, 200 of which enter the category of terminal renal failure susceptible to radical therapy by dialysis or transplantation. Neither the facilities nor the trained personnel are available to provide new forms of therap to all \\those who would benefit from them. y Improvement in the quantity and the quality of care for patients with kidney disease is the main focus of. activity at this time., GRMP is playing a major supportive role 4n the achievement of progress @n the following projects: tThe support of,'-the Regional Nephrology Centers based at the two medical schools which will expand referral services to the entire region. Complete utilization of medical school resources will permit trans- plant surgery, organ retrieval, and tissue typing. With the proposed expansion of atient care services in the region and area facilities, p development of new skills for physicians, nurses and allied pro" fessionals is essential. The educational facilities available at the medical schools will make the logical sites for specialized training. In order to begin o assure,@'thorough regionwide coverage, two area facilities have b@tn designated, one at Columbus and one at Augusta. Each area facility will be headed by a regional,,,centertr ane nephrologist. Specialized diagnosis and treatment of patients with kidney disease will be offered. There are future plans for the establishment of limited-care low- cost dialysis facilities throughout the state. This type of facility wil be designed to provide long-term dialysis for patients who, for one reason or another, are unable to g@ on home dialysis, but who require only limited assistance(to be carried out in an accessible center. BACK-UP SHEET Region: Georgia Regional Medical Program Locus of Activity: Operational Project Project Title: A Kidney Disease Program for Georgia (Regional Nephrology Centers and Kidney Area Facilities) Status: Ongoing Sponsoring Institution: GRMP Project Director, Title, Address: Regional Nephrology Centers Kidney Area Facilities Elbert P. Tuttle, Jr., M.D. George E. Van Giessen,, Jr., M.D. Advisory Director 1021 15th Street Atlanta Artificial Kidney Center Suite 11 69 Butler Street, 8.E. Augusta, Georgia Atlanta, Georgia 30303 C. Daniel Cabanisst M.D. James B. Hudson, M.D. Chairman School of Medicine Department of Internal Medicine Medical College of Georgia The Medical Center Augusta, Georgia 30902 Columbus, Georgia Dates: 2-1"72 through 8-31-74 Funding: $103,028 (Current Year) Other Funds6. Collection of fees, medical schools and hospitals, training grants from National Institutes of Healthi Georgia Heart Association, private foundations, facilities grants from Division of Vocational Rehabilitation of Georgia, contracts with the U.S. Department of Health Education and Welfare Cooperating-A4encies: Emory University School of Medicine, Medical College of Georgia, designated Area Facilities.- National Institutes of Health,, Georgia Division of Vocational Rehabilitation, National and Georgia Kidney Foundations, State of Georgia: Board of Regents of the University System Area Served: State of Georgia Target Population: Patients throughout the state stricken with renal disease BACK-UP SHEET Page 2 Congressional Districts: (1) G. Elliot Hagan, Sylvania (2) Dawson Mathis, Albany (3) Jack Brinkley, Columbus (4) Ben B. Blackburn, Atlanta (5) Fletcher Thompson, East Point (6) John J. Flynt, Jr., Griffin (7) John W. Davis, Summerville (8) W.S. Stuckey, Jr., Eastman (9) Phil M. Landrum, Jasper (10) Robert G. Stephens, Jr., Athens Continuation After RMP Support Withdrawn: Fee scale and continued grants Core Staff Contact: Mr. William Wilkins Date Prepared: February 15, 1972 Drafted by: Ms. Patricia Harris Vignette: GRMP Activities CARDIOPULMONARY RESUSCITATION PROGRAM The Georgia Heart Association, with financial support from GRMP for a three-year period, set up and achieved the following objectives in.the field of cardiopulmonary resuscitation, throughout the state.of Georgia: A cardiopulmonary resuscitation training program was es- tablished as of August 1971 in almost all major hospitals throughout Georgia; 117 of the 220 licensed hospitals 2 VA hospitals, 9 military hospitals. DeVelop@,a cadre of trained instructors. Throughout the --State and to- a structure' @@r@bugn wnicfi an instructor could function in his respective community# yithin the period of time from June 1, 1968 through Au t 31, 1971, the 2520 instructors who were trained in CPR care indludedt- 215 Physicians 1028 Nurses 1277 Others (paramedical, personnel in high risk occu- pations, police, fire, utilities, industry) The 2520 instructors who were trained,cover 120 of the Georgia counties, a total geographic'/area in which 93% of the state's population lives. In addition, 38 countywide committees on CPR wore formed to enable instructors to carry on activities within their own counties. Courses are being conducted statewide for instructors nd other persons who have the need for a continued pro- ficiency in CPR procedure. ;n addition, assistance in the development of CPR in-servi training programs ls I is being offered and encouraged on a continuing basis by the Georgia Heart Association. The CPR program is remaining an ongoing program of the Georgia Heart Association. The skills of the four CPR Field Reps who have been with the program are continuing to be utilized in their new assignments as GHA Field Reps. A recent increase in budget has allowed the,hiring of additional field staff (expansion from 6-10 members).I'-'@he geographic territory to be covered by each rep has been reduced from 24 counties to 18 counties. BACK-UP SHEET: CARDIOPULMONARY RESUSCITATION PROGRAM Region: Georgia Regional Medical Program Locus of Activity: Operational Project Project Title: Cardiopulmonary Resuscitation Program Status: Terminated; continuing on own funds Sponsoring Institution: Georgia Heart Association, Inc. Project Director, Title, Address: Joseph A. Wilber, M. Chairman CPR Committee, Ga. Assn. 2581 Piedmont Road, N.E. Atlanta, Georgia 30324 Dates: July 1, 1968 - August 31, 1971 Funding: 01,02,03: $265,916 Other Funds: Georgia Heart Association Cooperating Agencies and Institutions: Georgia Heart Association, hospitals throughout tFie state, fire departments, police departments, public utilities, business and industry, ambulance and rescue personnel, military base. Area Served: State of Georgia Target Population: Entire Region Congressional Districts: 1. G. Elliot Hagan, Sylvania 2. Dawson Mathis, Albany 3. Jack Brinkley, Columbus 4. Ben B. Blackburn, Atlanta 5. Fletcher Thompson, East Point 6. John J. Flynt, Jr., Griffin 7. John W. Davis, Summerville 8. W.S. Stuckey, Jr., Eastman 9. Phil M. Landrum, Jasper 10. Robert G. Stephens, Jr., Athens Continuation After RMP-Support Withdrawn: The CPR program has remained an ongoing program ot the Georgia Heart Association. Core Staff Contact: Mr. William Wilkins Date PreDared: February 10 1972 .1 Drafted by: Ms. Patricia Harris Vignette: G,%@@',P Act-ivitY CO,@l@MUNITY HIGH BLOOD PRESSURE PROGRAM IN METROPOLITAN ATLANTA A concentrated effort to detect and control hypertension is being conduc@ed in a predominantly black,middle class urban community of 23,000 a 9 e residing in S.W. Atlanta. The majority of dults indivii a, 4 15 old r uals with elevated blood pressure are either undetected, untreated or inadequately treated. This demonstration program will identify those existing conditions which deter indigent patients from medical care of -@'@ncoura ge indigent hypertension and will discover procedures wħħt patients to seek and @ accept care. If the majority of hypertensives in the country could be adequately controlled through the use o proper medication, a maDor reduction in morbidity and mortality, especially in stroke among men, would be achieved. GRMP funding of the project began September 1, 1970. Various methods of screening for elevated blood pressure were tried and evaluated for effectiveness. The most successful methods found were mobile van screening (shopping centers, apartment complexes, etc.) and door to door screening throughout neighborhoods. Prime testing times were pinpointed: week-days between the hours of 3:00 p.m. to 8:00 p.m. During the first year of operation) 6012 adults were screened; 1,713 sive. 7i% bf"@hese@(1224) were either (28.5%) were classified as hyperten undiagnosed, untreated, or inadequately treated. Letters referring the identified hypertensive patient for diagnosis and treatment were more suc- cessful (59.3%) and efficient than phone calls made to individuals (50.9%). Presently the program provides services including screening, refer- ral, education and follow-up. Without availability and accessibility of diagnostic and treatment facilities, results from the use of the services will not be recognizable. During the first operational year, a follow-up system was established and 1000 patients were followe ve@ipnly 25% r of these hypertensives are presently under treatments, @@a@ e @ t under adequate controllfor a number of reasons-,, including lack of knowledge about hypertension, limited transportation to centers administering caret and the high cost of medical care,.,- v A target date of February set for the openincT of a,low cost or f ree Community Resource Center Cin.. the target-,are4) whic@ @" of f er. care to 100 patients who will be randomly selected from the 75% untreated follow-up cases.' Trained volunteers will play a vital role in operating this center After the initial two or three months of implementation. BACK-UP SHEET Region: Georgia Regional Medical Program Locus of Activity: Operational Project . Project Title: Community High Blood Pressure Program in Metropolitan Atlanta Status: Ongoing Sponsoring Institttion: Georgia State Department of Public Health Project Director, Title,'Addre,ss: Joseph A. Wilber, M.D. Director, Cardiovascular Disease Control Georgia Department of Public Health 47 Trinity Avenue, S.E. Atlanta, Georgia 30334 Dates: 9-1-70 through 8-31-74 FundLng: $181POO '00 (for first two operational years with GRMP support) A other Funds: Georgia Department of Public Health, Health Services and Mental Health Administration, Department of Health, Education and Welfare Cooperating Agencies and Institutions: Georgia Department of Public Healthi Georgia Heart Association, Atlanta Medical Society, Fulton County Medical Association, Fulton County Health Department, Community Council of Metropolitan Atlanta. Area Served: Urban community in S.W. Atlanta; approximately 23,000 middle class predominantly black adults Target Population: Adults ages 15 years of age and older in this urban indigent area of Atlanta Congressional Districts: Fletcher Thompson, Ea'st Point Continuation After RMP Support Withdrawn: Sources t o help continue activi- ties are actively being sought. Core Staff Contact: Mr. William B. Wilkins Date Prepared: February 15, 1972 Drafted by: Ms. Patricia Harris G,@,viP Activities HEALTH OCCUPATIONS COUNSELING one hundred rural,,G predominantly black,disadvantaged high school students are -oarticiz)atinq in a unacrvle e lth occupations counseling project""@46A '@6hstrate the feasibility of this approach @solving of the current health manpower problems. G@viP selected ten high.school counselors from rural middle Georgiap p4xet-ully in-@erview@-@Aem and-we-@@ their principals to assure'that, the counselors have the capabilitv'cnebded to work with students in this intensified health occupations Counseling approac special orientation in health careers and educational opportunities was provided the -oarticinating counselors at the beginning of the program, through a workshop that included sessions with experts from governmental and educational intti- tutions in the state, as well as practicing members of the health professions. Most students pres,,en@@ Pursuing a health career are from L. 'han rural areas. In turn, these indivi- urban rather r_ p r.,:thi s duals will robably practice in the urban sett reason, e9 ia this proDect@)On the rural set- ting and @ schools with large numbers of disadvantaged students. Tfihen high school students think of health professions thev generally think of physicians, dentists, nurses, or phat- macists. Because o- their background, many students from the lower socioeconomic sector will not pursue these health pro- Lessions because they seem unattainable. Through this disadvantaged high school students will be made aware of behind the scene workers in the health field, such as nurses aides, orderlies, laboratory technicians, medical records specialists, Each counselor selected tez'students, ng,,ba@.-i.-s throughout the ual counseling with qro activities deki@ e to @erstanding of th @ed portuni-L.ies ava 1 suit6d. .---et.-h@-cally,ox,economicall-y dis dvantalged students someLthing,@.-in-@ -L-i there'Ore,, if goa.1s,,,are to be met, these per@son@s,@@ tanq@ i-ftust..have models,.-with,,.,,whom-.t-hey can identify. T@ --f@orl'students I ht to the Atlanta metropolitan area on a group trip e-@f vi n each of the health fields s@L.Udiedr?@o@t- "O@ly ptp@r@ eir or--ice, hbsoital, or laboratory R- t also in the in- zor,,nal set-,.-ng o-9 eir homes. th -proDect plans call for the oftehd -oarti- c zL 4-nc., s-.uaents to maintain active involvement during the summer vacn-"@i-on months, wherever nossible,@hrough actual employment as aides, clerks, etc. working on a daily basis with health pro- -essiol-als. BACK-UP SHEET: HEALTH OCCUPATIONS COUNSELING Region: Georgia Regional Medical Program Locus of Activity: Operational Project Project Title: Health Occupations Counseling Status: Ongoing Sponsoring Institution.- Georgia Regional Medical Program Project Director,'Title, Address: Mr. Algie Jordan, M.P.H. Associate Coordinator Facilities and Services Georgia Regional Medical Program 938 Peachtree Street, N.E. Atlanta, Georgia 30309 Dates: September 1, 1971 through August 31, 1972 Funding: $13,810 Other Funds: Cooperating Agencies: N. E. High School (Macon), Peach County High Schooi (Ft. Valley), R.E. Lee Institute Guidance Center (Thomaston), Willingham B. (Macon), Lamar County School (Barnesville), Baldwin High School (Milledgeville), Warner Robins Senior High (Warner Robins), McEvoy B. (Macon) Mary Persons High School (Forsyth), N.E. Complex (Macon). Area Served: Six county area in Georgia: Monroe, Jones Baldwin, Putnam, Peach, Houston. 'Target Population-. Predominantly black disadvantaged ri;ral high school students with a potential interest in a health career. Congressional Districts-. #3 Jack Brinkley, #6 John J. Flynt, Jr., 410 Robert G. Stephens, Jr. Continuation After RMP support withdrawn: Possibilities for other sources ot continuing support-are actively being pursued. Core Staff,Contact: Mr. Algie Jordan Date Prepared: February 10, 1972 Drafted By: Ms. Patricia Harris Greater Delaware Valley COMMUNITY AID AND REFERRAL EXCHANGE SYSTEM "CARES'L The need for a central information and referral service to simplify, facilitate and fol irect referral of individuals to appropriate health agenc he Health and lqelfare Council of Chester County, ies @@reco' 'g'@Oi Penns3 ta-t-i u@ - -8 e @Va-s cc that persons needing health services vices and that available services are used efficiently and fully. 11 of Chester County and part of Delaware County, @s- Cover@ a uccess of this project can establish a design for other Areas in the region and iw the states a@,a@t-@a to develop simi ar serve ces., The pr ivi 0 help him ogram guides the ind dua@ an tries to provide @ other@a-s-s-ts6@tice -as he receives-@ help, the program acts as a communication link between the agencies. The.central information and referral service useful --to identif@hat provider services currently exist, whether they are @essibie, available and accept verlap and what new provider services may be needed. it identify@ improved ways for agencies to work together in providing health care. Adcli:t-i,ma-i--,st@e @pplonma-l- @n-ed collect@- pertinent data on how agen referrals, an computer"d@i..@ "retrieve ineormatio agencies their servicesiv/as well as to reach out through development of Community Centers and by utilization of trained volunteers supervised by professional staff to extend substantially the health services to people otherwise unable to obtain such service. BACK-UP SHEET REGION: Greater Delaware Valley Regional Medical Program LOCUS OF ACTIVITY: Planning Project PROJECT TITLE: CARES STATUS- In second And final year SPONSORING INSTITUTION: Health and Welfare Council of Chester County PROJECT DIRECTOR: Mrs-Brent W. Roehrs, Director Chester County CARES 14 East Biddle Street West Chester, Pennsylvania 19380 DATES: October, 1970 - October, 1972 FUNDING: 1971 - $5,000; 1972 - $5,000 OTHER FUNDS: various for cooperating agencies COOPERATING -AGENCIES AND INSTITUTIONS: Pennsylvania Department of Community Affairs; Pennsylvania Department of Welfare; Mental Health/Mental Retardation Board of Chester County; West Chester Rotary Club; Dolfinger McMahon Foundation and interested individuals AREA SERVED: Chester County and part of Delaware County, Pennsylvania TARGET POPULATION: All individuals and families needing health services CONGRESSIONTAL DISTRICTS: Various CONTINUATION AFTER RMP SUPPORT WITHDRAWN: Governmental, state and local, and participating agency, funding CORE STAFF CONTACT: Stephen B. Langfeld, M.D. Associate Director, Program Development and Operations DATE PREPARED: 2/i4/72 DRAFTED tY: Ronald E. Miller IV Greater Delaware Valley FIGHTING RESPIRATORY DISEASES Respiratory failure, like heart or kidney failure, can often be reversed if the victim gets proper treatment in time. Establishing regional centers to provide advanced treatment for people with acute respiratory failure is one of GDVRMP's current objectives. Dr. Robert F.lj"ntn, coordinator, Head, Chest Section, Hahnemann Medical College and Hospita , a @ining program for physicians and allied health personnel in the treatment of respiratory failure, A total of 87 professionals have been trained. Surgical problems, neurological diseases, poisoning ,)or overwhelming pneumonias can cause respiratory failure. Most cases, however) are caused by chronic obstructive lung diseases such as chronic bronchitis, pulmonary emphysem@ and bronchial astluna., n recent years, cases of emphysema and bronchitis have increased sharply. In 1955, they caused 4,946 deaths. In 1966, the figure jumped to 22,686. Some experts predict these deseases may cause an many as 6,000 deaths in the Greater Delaware Valley this year. Diseases like emphysema can also cripple. In 1963, 14,897 people with emphysema received disability allowances because they could not work. Only heart disease disables more people. .@@Adding to the problem is the growing number of older cit zens. Respiratory illness is greatest and mortality highest among people over 40. As this segment of the population has increased, the problem has grown faster than treatment facilities. GDVRMP's respiratory project is aimed at helping close the gap. When trained personnel and proper facilities are available to treat respiratory patients, results are impressive. In one instance, a special respiratory care unit treating over 400 patients a year achieved a survival rate three times'higher than the rate prior to the opening of the unit. Another special unit boasts an 80% survival rate among patients suffering from acute respiratory failure. Designed to give participants intensive experience in the latest methods of treating respiratory failure, GDVRMPis training program is divided between classroom work and bedside care of the critically ill. The faculty is made up of staff from three hospitals. Guest lecturers from Temple University Health Sciences Center, Children's Hospital, University of Pennsylvania Medical. School and Geisinger Medical Center have also participated. FIGHTING RESPIRATORY DISEASES Page Two The respiratory care unit athahnemann is under the direction of Dr. Leon A. Kauffman, The five bed unit serving as the training and demonstration center for personnel from Philadelphia and nearby Ne w Jersey hospitals. The four bed unit at Allentg @ospital,' the general intensive care unit, is under the Dr. John P.' Galgon. It serves Lehigh, Northampton, Berks, Schuylkill, Carbon and Monroe counties and parts of Warren County in New Jersey. The Wilkes-Barre General unit, under the direction of Dr. Charles E4 Myers, is also in the intensive care unit. It servos as the training and demonstation center for the northern part of the region. cated in Pennsylvania's coal mining region,,,Wilkes-Barre General has had parti@u@Olar interest in respiratory probl@§,-i Under Dr. Myers direction, a clinic to treat anthradosilicosis or miners disease has been established. Some 400 patients visit the clinic regularly. BACK-UP SHEET REGION: Greater Delaware Valley LOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Centers for Respiratory Care STATUS: Ongoing SPONSORING INSTITUTI@N: Combination of hospitals PROJECT DIRECTOR: Robert F. Johnson, M.D. Coordinator, Head Chest Division Hahnemann Medical College and Hospital Philadelphia, Pennsylvania DATES: Started October, 19 9. FUNDING: $47,953 currently OTHER FUNDS: None @OOPERATING AGENCIES AND INSTITUTIONS: Hahnemann Hospital, Allentown Hospital, and Wilkes-Barre General Hospital AREA SERVED: Major part of Greater Delaware Valley Region, TARGET POPULATIO_IN: Adults with respiratory diseases. CONGRESSIONAL DISTRICTS: Several CONRINUATION AFTER @IP SUPPORT WITITDRA14N: To be financed by participants or by solicitation from other sources CORE STAFF COWACT: Stephen B. Lan-feld, M.D. Associate Director for Program Development and Operations DATE PREPARED: February 14, 1972 DRAFTED ZY_: Ronald E. Miller @v Greater Delaware Valley HOSPITAL PROGRAM TO IMPROVE PATIENT CARE THROUGH SELF-EVALUATION Ten area hospitals are participating in a program to improve patient tare through self-evaluation in the Greater Delaware Valley Region. The project is funded by a grant approved by the GDVRMP Regional Advisory Group in the amount of $59,963 for the first year of operation. Co-directoisof the program are: Dr.Daniel S. Fleisher, Director, Center for Health Education Studies, Temple University Health Sciences Center, and Dr. Gerald Escovitz, RMP Unit Chief, Medical College of Pennsylvania, who replaced Dr. Clement R. Brown, Jr., formerly Director of Medical Education at Chestnut Hill Hospital. The improvement via self evaluation program is divided into three phases. Phase One, completed by the cooperating hospitals, involves a work- shop at which physicians, hospital administrators, hospital Board members and medical record librarians develop approaches for drawing up explicit criteria for patient care. A form is designed so the medical record librarian can gather data concerning the hospital's performance. the kind of data needed is determined by the hospital's own physicians. The information collected by each hospital is then compared with the criteria for patient care set forth by the medical staff of the hospital. Phase One of the program has proven completely successful and each of the cooperating hospitals is committed to the two-year program. In Phase Two of the program, each of the hospitals will select three diseases, conditions, operations, or other problem areas in patient care. The selections may vAry from hospital to hospital. Once the choices are made, each hospital will set its own optimal and minimal criteria or patient care in the chosen areas. Data on patients in each area will then be collected.from hospital records. Phase Three calls for careful study by each hospital of its own data and narrowing the selected problem areas from three or two. Which two are selected will depend on the discovery of deficits in patient care - some area of perfomancebelowthe hospital's own minimal criteria. After analyzing P.0 ssible reasons for the deficits, the hospital, with the assistance of the project directors, will design educational programs aimed at overcoming them. One year after the educational programs have been launched patient records will be re-examined to measure changes in hospital performance. BACK-UP SHEET REGION: Greater Delaware Valley Regional Medical Program LOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Improving Patient Care Through Self-Evaluation T S- In second year of thirty-month program approval. SPONSORING INSTITUTION: Combined community hospitals. PROJECT CO-DIRECTORS: Daniel S. Fleisher, M.D. and Gerald Escovitz, M.D. Director, Center for Healtb Chief, RNP Unit Education Studies Medical College of Temple University Health Pennsylvania Sciences Center Philadelphia, PAi Philadelphia, Pa. DATES: Operational - August, 1970 FUNDING: $59,963 first year; $57,276 second year. OTHER FUNDS: None. COOPERATING AGENCIES AND INSTITUTIONS: Ten community hospitals. AREA SERVED: Major portion of Greater Delaware Valley including Philadelphia. TARGET POPULATI i@TS: Hospital patients generally. CONGRESSIONAL DISTRICTS: Not applicable. CONTINUATION AFTER RMP SUPPORT WITIIDRAI@N: Individual hospitals to assume continuation costs. CORE STAFF CONTACT: Stephen B. Langfeld, M.D. Associate Director for Program Development and Operations DATE PREPARED: February 14, 1972 DRAFTED BY: Ronald E. Miller Greater Delaware Valley KIDNEY PROGRAM A grant to launch a regional program for patients with kidney disease has been approved by GDVRMP and funded by Regional Medical Programs Service. The Regional Kidney Program is working for increased use of home dialysis and the expansion of existing dialysis units. It will also estab is a central information service including a registry of kidney patients, dialysis capability, tissue typing, transplant candidates and the availability of kidney donors. About 250 cases-of renal disease needing dialysis are diagnosed each year in the Greater Delaware Valley. Some authorities feel that people between the ages of 15 and 54 are the most suitable candidates for diaylsis. The cost of treatment is a major problem. Dialysis in a' hospital costs about-$14,000 per year. Home dialysis costs about the same the irst year but is reduced to slightly over $3,000 in following years. Estimates are that at the end of five years costs for dialysis patients in the Greater Delaware Valley will total an average of $3.5 million per year. Three states recently acted to help patients pay the high cost of treat ent. Pennsylvania has enacted legislation providing $1 million a year for patient support. New Jersey has allocated $250,000 and Delaware, $581,000. The Regional Kidney Program will encourage additional projects to aid kidney patients. One project now being drawn up calls for training nurses in dialysis. Another is for training technologists. The kidney program is sponsored by the University City Science Center. William C. Ellenbogen is project director. BACK-UP SHEET REGION: Greater Delaware Valley LOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Renal Disease Patient Support Program STATUS: Ongoing SPONSORING INSTITUTION: University City Science Center PROJECT DIRECTOR: William C. Ellenbogen University City Science Center Philadelphia, Pennsylvania DATES: Started April, 1971 FUNDING: Current year $23,360 OTHER FUNDS: None COOPERATING AGENCIES AND IN TITUTIONS: Medical schools, hospitals, health departments, voluntary agencies, and practicing physicians in Regioni AREA SERVED: Entire area covered by GDVRMP TARGET POPNATION: All persons in Region affected by renal disease CONGRESSIONAL DISTRICTS: Various CONTINUATION AFTER RMP SUPPORT WITHDRAWN: Participating hospitals, official and voluntary agencies expected to be sources of funding together with government. CORE STAFF CONTACT: Stephen B. Langfeld, M.D. Associate Director for Program Development and Operations DATE PREPARED: February 14, 1972 DRAFTED BY: Ronald E. Miller l@ v- Greater Delaware Valley CORONARY AND INTENSIVE CARE TRAINING Three hundred sixty-one nurses from 44 hospitals in the Greater Delaware Valley have received training in coronary intensive care in programs sponsored by GDVRMP. They were trained in 22 sessions at four hospitals. Sixty-two of the.nurses received training in general intensive care, including respiratory failure, head trauma, kidney failure and other acute conditions inaidition to basic instruction in coronary care. The coronary care courses were given at Wilkes-Barre General Hospital, Reading Hospital and Wilmington Medical Center. The general intensive care course was given at Allentown Hospital. All Pour programs are continuing and will train additional nurses. GDVRMPis program stresses cooperation among@S",N)'3.'tals for high quality training.-@iaculty are recruited from several institutions and the trainees come from a number of hospitals. The 44 hospitals that have sent nurses represent more than a quarter of the 165 voluntary short-term general hospitals in the region. most of the nurses who received training, r came from nearby hospitals, one came from 170 miles and another came from Jerome, Idaho, a distance of 2,400 miles. About 68 percent of the nurses taking the training courses are currently employed in CCU/ICU's, and an additional 10 percent have been so employed at some time since completion of their training. While many of the nurses came from hospitals that already had CCU'S, some hospitals sent nurses with the idea of establishing units when t e trainees returned. Other hospitals had CCU's that were running below capacity because of staff shortages. The training the nurses rece ?,n, "GDVRMP 'permitted ived( --,Programs) the hospitals to increase their service. A survey conducted among all trainees at the end of the courses showed most nurses enthusiastic about the program. Comments ranged from "an excellent learning experience" to "I feel more adequate to go back and work in the unit of my own hospital." BACK-UP SHEET REGION: Greater Delaware Valley LOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Coronary Care Training; Intensive Care Training STATUS: Ongoing SPONSORING INSTITUTIOR: Various hospitals 7ROJECT DIRECTORS: One for each of four programs DATES: Late T5-6-9 to present FUNDING: Current year - Coronary Care - $44,428; $43,461; $44,227, and Intensive Care - $48,887. OT'HER FUNDS: None COOPERATING AGENCIES AND INSTITUTIONS: Medical Schools, hospitals, official and voluntary agencies, practicing physicians and nurses AR VED: Major part of area contained in GEVRMP TARGET POPULATION: All prospective patients in Region CONORE8S!ONAt-I-BTRICTS: Various CONTINUATION AFTER PKIP'SUPPORT WITHDRAIQN_: It is anticipated that participating hospitals, schoo s and agencies will develop sources of funding for continuation of programs CORE STAFF CONTACT: Stephen B. Langfeld, M.D. Associate Director for Program Development and Operations DATE PREPARED: February 14, 1972 DRAFTED BY: Ronald E. Miller Greater Delaware Valley VNA-HOMEMKER CONSOLIDATION PROJECT The Visiting Nurse Association, with three offices in Luzerne County, Pennsylvania, and the Homemaker Service Agency of Luzerne County, have 'Consolidated into a single organization which is working with the cooperation of other health planning and provider organizations to reduce duplication and pb improve home health service to residents of the county. The consolidated agency is known as Home Health Services of Luzerne County. The consolidation developed from the recognition that a large y@-of persons eligible for discharge from hospitals could not be discharged due to their inability to obtain adequate home health services @ou7g6- @ho-l@ds while convalescing, and that there were many other persons who require more complete health care than they were obtaining. Health services provided by this consolidated agency include nursing care, homemaker service, home health aide service, medical social work, speech therapy, physical therapy and occupational therapy. In effect, the development of this consolidated agency has provided this community with a "hospital without walls". Additional health services are being added as the new agency becomes more involved in the total health care problems of the area. A recent service added is that of providing home care for respiratory disease patients. Other health providers in the area have endorsed this concept of consolidated services, and third-party payment agencies have expresse interest. The GDVIOIP participated in the consolidation in the planning process and provided partial financing. BACK-UP SHEET REGION Greater Delaware Valley Regional Medical Program LOCUS OF ACTIVITY: Planning Project PROJECT TITLE: VNA-Homemaker Consolidation STATUS: Completed SPONSORING INSTITUTION: Homemaker Services of Luzerne County PROJECT DIRECTOR: Robert V. Stevens United Penn Bank Wilkes-Barre, Pennsylvania 18701 DATES: Fall, 1971 FUNDING- $5,000 OTHER FUNDS: various COOPERATING AGENCIES AND INSTITUTIONS: Wyoming Valley United Fund; Blue Cto6s of Northeastern Pennsylvania; Welfare Planning Council, Wilkes-Barre, Penna.; Model Cities Agency, Wilkes-Barre; Rural Health Corporation of Luzerne County, Health & Hospital Planning Council of Northeastern Pennsylvania AREA SERVED: Luzerne County, Pennsylvania TARGET POPULATION: Hospital Patients being discharged CONGRESSIONAL DISTRICT: Honorable Daniel J. Flood #11 CONTINUATION AFTER RMP SUPPORT WITHDRAWN: Self-sustaining CORF, STAFF CONTACT: Stephen B. tangfeld, M.D. Associate Director, Program Development and Operations DATE PREPARED: 2/14/72 DRAFTED BY: Ronald E. Miller Program staff members are utilizing their talents in working with physicians who a-re specialists in drug abuse to produce a Drug Abuse Manua'-, titled "Guide to the Perplexed." Individuals and organizations in the community have shown interest in the project. For example, the State Department of Fducation has -requested 400 copies. The target group for the manual is primarily physicians, but will be of value to anyone working with those abusing drugs. The booklet will assist workers through the frustrating maze of fact and fantasy which so often dominates the area of drug abuse and addiction. Sections of the manual, separated into different colors, cover the following subjects: 1) the current drug scene in Hawaii; 2) street names of drugs; 3) diagnosis and treatment; 4) chemistry, physiology and complications of drugs; 5) bibliography; 6) signs and symptoms; 7) comunity services and programs; and, 8) legislation. To combat obsolescence, a covering current newslettervin addendLn fonn will be mailed periodically" drug information) to those requesting such material. The manual will be a quick aid to assist health workers to communicate easily and knowledgeably with drug users, thereby enabling them to give timely aid and assistance. Back-up Sheet Region: Regional medical Program of Hawaii Locus of Activity: Core Activity Project Title: Desk Reference on Drug Abuse Status: Coinpleted Sponsoring Institution: Regional Medical Program of Hawaii Project Director, Title, Address: Masato Hasegawa, M.D. Executive Director Regional Medical Program of Hawaii 1301 Punchbowl Street 14onolulu, Hawaii 96813 (808)-S31-6525 Dates: October 1971-March 1912 unding: Initial cost $3,595.for 1,000 copies. Manual will be sold at an appropriate cost to defray expenses of printing and binding. other Funds: None Cooperat@ Agencies & Institutions: State Department of Health, Division of Mental Health, Alcohol and Drug Abuse Clinic; University of Hawaii, Medical School, Department of Pharmacology; and private physicians Area Served: All of Hawaii Target Po7pulation: 500 Physicians, 400 Teachers and Counselors, and 100 Allied Health Workers Continuation After RV §mort withdrawn: This is a one-time proj ect. Follow-UP newsletter will be published by program staff. Core Staff Contact: Masato Hasegawa, M.D., Executive Director, REH Date Prga-red: February 15, 1972 AIR MAIL SPECIAL DELIVERY Regional Medical ProgTam of Hawaii/ H@,k,@ss Pavilion, 1301 Punchbowl Street, Honolulu, Hawaii 96813 Phone 531-6525 Cable RMPHawaii February 15, 1972 TO: Patricia Q. Schoeni Acting Director office of Communications and Public Information-@ FROM: Masato Hasegawa, Executive Director SUBJECT: Vignettes on RMP Activities j In accordance with your memo of January 6, 1972 we are enclosing a vignette from this Region. I hope you are able to use this even though we have missed the deadline. fk Encl. - "Desk Reference on Drug Abuse" TT T IT, OIC @',i(dne-; Di.sease P@og@am More thEii).350 I_]_-'I-104S ViCti@CIS of end-stage renal failure are waiting for transplants. Their alternatives to transplanta@L-ion are a lifetime of hemodialysis(using the artificial kil@l,ney riachi,-,,c) or death. Chronic kidney disease kills more AyiLericans yearly than automobile accidents. But enough kidneys are not being donated to meet the present demand for transplants. The Illinois Kidney Disease Program(IKDP) is a joint project of the Illinois Regional Medical Program and the Illinois Department of Public Health. Since it began in August, 1971, IKDP has worked to formalize the network of renal care providers to ensure quality care for all chronic renal patients. IKDP is involved in educating the medical and lay populations about the needs of the chronic kidney patient, and in providing the expertise to meet those needs. IKDP transplant surgeons are on call 24 hours a day to perform nephrectomies and give advice on potential donor suitability. One central number connects all physicians in the state with Program personnel and the various facets of transplant procedure can be begun from one location. When a physician obtains permission for an organ donation, he contacts the IKDP surgeon who advises him on donor suitability. The IKDP man then calls a central tissue typing laboratory at the University of Illinois Hospital in Chicago. This lab identifies and locates the renal patients most closely matched in blood and tissue type to the potential donor. A strict best match policy is enforced. If no appropriate match is found, the kidney is sent where there is a good match. Organs have gone as far as Omaha, and have been received from Vancouver and New Orleans. .Police and fire departments, the Illinois Emergency Services System, and private citizens all cooperate with IKDP by providing cars, small planes and helicopters for the Program's donor retrieval teams. IKDP surgical teams get to a potential donor as quickly as possible. Most nephrectomies are performed within an hour of death. Last winter, Illinois and Wisconsin State troopers joined with City of Chicago police to form a relay that delivered a kidney from Milwaukee to a Chicago transplant center in about two hours. more add one ELLINOIS Illinois Ki Disease Progr_anl After removal, kidneys are brought to Ch.il@reii's Memorial Hospital in Chicago, where they are evaluated on a Belzer apparatus. The Belzer, funded by IKDP, preserves kidneys for up to 72 hours, allowing ample time to observe the organs, and often preventing useless transplants. Training physicians, nurses and technicians in nephrology is another major concern of IKDP. Visits to participating medical centers are encouraged and geared to the expertise of individual groups. IKDP and'the Kidney-Foundation of Illinois sponsor a symposia series for practicing internists and general practitioners to focus on specific clinical and practical problems related to renal disease. These one day conferences are periodically convened in different cities around the state. IKDP also has a traveling representative who meets with hospital administrators, nurses and medical personnel to discuss the Program and its needs. Physician awareness is a vital part of the kidney shortage solution, and these talks emphasize the assistance physicians and hospital personnel can provide to the renal victim. !KDP's central procedure number, posted in every hospital and emergency room in the state, serves as a continual reminder that kidney donations are desperately needed. in only one year of operation, more than 100 cadaver kidneys have been donated through the IKDP. Seventy of these have been transplanted in Illinois.. The public and professional awareness of the need for kidneys is increasing. Donor retrieval and transplant procedures have been sophisticated and streamlined.'Further refinement of the Illinois kidney i-,,etwork through the IKDP will continue to help transform unavoidable death into the extension of life.for other peo@16-@ BACK UP SHEET egion: Illinois Regional Medical Program Locus of activ@: operational project Prolect Title: Illinois Kidney Disease Program Status: ongoing itution: Northwestern University Project Director: Frank A. Krumlovsky,M.D. Ass,ociate in Medicine Northwestern University Med-ical--School 303 E. Chicago Avenue Chicago, Illinois 60611 (312) 9 44-42 0 0 Dates: April 1972- March 31, 1975 Fundin : 01 year $364,000 Other funds: Illinois Department of Public Health in- kind contributions by participating institutions Cooperating agencies & institutions: Illinois Department of Public Health, Kidney Foundation of Illinois, University of. Illinois Medical School, Northwestern Memorial Hospital (Passavant Memorial Hospital and Wesley Memorial Hospital merger), University of Chicago-Pritzker School of Medicine, Veteran's Administration Research Hospital, Evanston Hospital (Evanston), Childrenis Memorial Hospital, Memorial Hospital(Springfield), St. Francis Hospital(Peoria), City Colleges of Chicago, Chicago Heart Association, Illinois Academy of General Practice, Chicago Medical Society, Chicago -Pediatric Society, North Suburban Association for Health Resources, Illinois Masonic Hospital Association, Southern Illinois Hospita Corporation(Carbondale),Christ Community Hospital(Oak Lawn), Rockford Clinic(Rockford), Christie Clinic(Champaign), Kishwaukee Valley Medical Group(Woodstock), Blessing Hospital (Quincy), Mercy Hospital(Urbana), Moline Public Hospital(Moline), Illinois Heart Association, West Suburban Hospital(Oak Park) Area served: state of Illinois Tarqet population: all Illinois end-stage renal victims Congressional districts:entire state more add one BACI@, T,'..-, @"--)"@lh'ET Continuation auto,-,. support for this withdrawn: planning through anc'. oi--I,ior resoti.-i-ces is a part of the project's activity, since this relatively new field is not currently a routinely supported part of the health care system. Date Prepared: 8/30/72 Drafted by: Cynthia B. Brilliant add one ILLINOIS Illinois Kidney Disease Program After removal, kidneys are brought to Children's Memorial Hospital in Chicago, where they are evaluated on a Belzer apparatus. The Belzer, funded by IKDP, preserves kidneys for up to 72 hours, allowing ample time to observe the organs, and often preventing useless transplants. Training physicians, nurses and technicians in nephrology is another major concern of IKDP. Visits to participating medical centers are encouraged and geared to the expertise of individual groups. IKDP and the Kidney Foundation of Illinois sponsor a symposia series for practicing internists and general practitioners to focus on specific clinical and practical problems related to renal disease. These one day conferences are periodically convened in different cities around the state. IRDP also has a traveling representative who meets with hospital administrators, nurses and medical personnel to discuss the Program and its needs. Physician awareness is a vital part of the kidney shortage solution, and these talks emphasize the assistance physicians and hospital personnel can provide to the renal victim. IKDP's central procedure number, posted in every hospital and emergency room 'n the state, serves as a continual reminder that kidney donations are desperately needed. In only one year of operation, more than 100 cadaver kidneys have been donated through the IKDP. Seventy of these have been transplanted in Illinois. The public and professional awareness of the need for kidneys is increasing. Donor retrieval and transplant procedures have been sophisticated and streamlined. Further refinement of the Illinois kidney network through the IKDP will continue to help transform unavoidable death into the extension of life.for other peo@ld-@ BACK UP SHEET Region: Illinois Regional Medical Program Locus of activ@: operational project Project Title: Illinois Kidney Disease Program Status: ongoing Sponsoringlinstitution: Northwestern University Project Director: Frank A. Krumlovsky,M.D. Associate in Medicine Northwestern University Medical-School 303 E. Chicago Avenue Chicago, Illinois 60611 (312) 944-4200 Dates: April 1972- March 31, 1975 Fundihg: 01 year $364,000 Other funds: Illinois Department of Public Health in- kind contributions by participating institutions Cooperating agencies & institutions: Illinois Department of Public Health, Kidney Foundation of Illinois, University of Illinois Medical School, Northwestern Memorial Hospital (Passavant Memorial Hospital and Wesley Memorial Hospital merger), University of Chicago-Pritzker School of Medicine, Veteran's Administration Research Hospital, Evanston Hospital (Evanston), Children's Memorial Hospital, Memorial H6spital(Springfield), St. Francis Hospital(Peoria), City Colleges of Chicago, Chicago Heart Association, Illinois Academy of Gendral Practice, Chicago Medical Society, Chicago Pediatric Society, North Suburban Association for Health Resources, Illinois Masonic Hospital Association, Southern Illinois Hospital Corporation(Carbondale),Christ Community Hospital(Oak Lawn), Rockford Clinic(Rockford), Christie Clinic(Champaigh), Kishwaukee Valley Medical Group(Woodstock), Blessing Hospital (Quincy), Mercy Hospital(Urbana), Moline Public Hospital(Moline), Illinois Heart Association, West Suburban Hospital(Oak Park) Area served: state of Illinois Target population: all Illinois end-stage renal victims Congressional districts:entire state more add one BACK UP SHEET Continuation after RMP support withdrawn: planning for this through fees and other resources is a part of the project's activity, since this relatively new field is not currently a routinely supported part of the health care system. Date Prepared: 8/30/72 Drafted by: Cynthia B. Brilliant ILLINOIS IMPROVING THE MEDICAL RECORD Physicians today are faced with great demands on their time and energy. It makes sense that improving the traditional, often chaotic medical record would help physicians provide better patient care. The Illinois Regional Medical Program (IRk4P), recognizing this need, has committed itself to implementing the Problem Oriented Medical Information System (PPOMIS) in Illinois. This method, originated by Dr. Lawrence L. Weed of the Univer- sity of Vermont Medical Center, establishes a logical framework for keeping patient records. Using the PROMIS concept, the physician sets down data relating to specific patient problems in a structured manner. Key elements of PROMIS are: 1) establishing a data base; 2) formulating all patient problems; 3) set- ting up treatment plans for each problem and 4) follow- ing up each problem with progress notes. A problem- oriented medical record allows a physician unfamiliar with a patient to see at a glance the patient's problems and what steps have already been taken to alleviate them. The IRMP is promoting PROMIS by several methods. A problem- oriented strategy group of interested health professionals from all over the state has been formed and has adopted a three-level plan for PROMIS. The clinical component is dealing with how to implement the concept; the technologi- cal component is developing manual and computerized tech- nology for those desiring it and the pedagogical component is investigating teaching methods for PROMIS. Subcommittees are currently concentrating on developing format, data base and educational guidelines and examples. IRMP is also circulating copies of Dr. Weed's film, "The Problem-Oriented Medical Record," to interested individuals and institutions around the state. There are p ans to develop a PROMIS training film. A bibliography of articles. relating to the PROMIS concept has been compiled. Several institutions in Illinois have begun using the Iproblem-oriented medical record in Various departments, including Michael-Reese Hospital, Chicago; Hines, Downey and Westside Veterans Administration Hospitals, and Rush- Presbyterian-St. Luke's Medical Center, Chicago. Medical students at the Peoria School of Medicine, Abraham Lincoln School of Medicine and Northwestern University are being introduced to PROMIS. By bringing together all the institutions and individuals in Illinois working with the problem-.,.oriented medical record, IR-MP is hopeful that a unified system of medical record keeping can be developed for the entire state. Back- li e et ion: Illinois Regional Medical Program, Inc. Locus-of Core Activity Project Title: Problem Oriented Medical Information System (PROMIS) Status: Ongoing Sponsorinq Institution: Illinois Ri4P Project Director: Marvin A. Schilder Associate Executive Director Illinois Regional Medical Program 122 South Michigan Avenue, Suite 939 Chicag@, Illinois 60603 Dates: March 1972 - PROMIS Strategy Group met for the first time. $90,000 for 01 year Other Funds: None Cooperating Agencies and Institutions: Michael Reese Hospital and Medical Cenfer, Chicago; [,It. Sinai Hospital and Medical Center, Chicago; Northwestern University Medical School, Chicago; Rush-Presbyterian-St. Luke's Medical Center, Chicago; University of Illinois, School of Basic Medical Sciences, Champaign-Urbana; University of Illinois, Abraham Lincoln School of Medicine, Chicago; University of Illinois, Rockford School of Medicine, Rockford; Chicago College of Osteopathic Medicine; Educational Support Resource, University of Illinois College of Medicine, Chicago; Hines VA Hospital; Illinois Institute of Technology - Research Institute, Chicago; Mercy Hospital, Urbana-, University of Chicago; Southern Illinois Univer- sity, Carbondale. Efforts are underway to involve as many hospitals and medical schools in the PROMIS strategy as possible. Area Served: entire state of Illinois Target Population: 16,000 Illinois physicians, as well as other health professionals Congressional Districts: entire state Continuation after RMP Support withdrawn: If the PROMIS effort is successful, it will be carried On in the everday workings of the doctor's office, the hospital and medical school. PROMIS seeks to change the physician's working behavior. IRMP funds are currently being used to facilitate the development of a uniform problem-oriented medical record system in Illinois. Core Staff Contact: Marvin A. Schilder, Associate Executive Director Date Pr red: 8/30/72 Drafted by: Ellen Soo Hoo ILLINOIS Illinois Kidney Disease Program More than 350 Illinois victims of end-stage renal failure are waiting for kidney transplants. Their alternatives to transplantation are a lifetime of hemodialysis(using the artificial kidney machine) or death. Chronic kidney disease kills more Americans yearly than automobile accidents. But enough kidneys are not being donated to meet the present demand for transplants. The Illinois Kidney Disease Program(IKDP) is a joint project of the Illinois Regional Medical Program and the Illinois Department of Public Health. Since it began in August, 1971, IKDP has worked to formalize the network of renal care providers to ensure quality care for all chronic renal patients. IKDP is involved in educating the medical and lay populations about the needs of the chronic kidney patient, and in providing the expertise to meet those needs. IKDP transplant surgeons are on call 24--hours,a-day to perform nephtectomies and give advice on potential donor suitability. One central number connects all physicians in the state with Program personnel and the various facets of transplant procedure can be begun from one location. when a physician obtains permission for an organ donation, he contacts the IKDP surgeon who advises him on donor suitability. The IKDP man then calls a central tissue typing laboratory at the University of Illinois Hospital in Chicago. This lab identifies and locates the renal patients most closely matched in blood and tissue type to the potential donor. A strict best match policy is enforced. If no appropriate match is found, the kidney is sent where there is a good match. organs have gone as far as Omaha, and have been received from Vancouver and New Orleans. Police and fire departments, the Illinois Emergency Services System, and private citizens all cooperate with IKDP by providing cars, small planes and helicopters for the Program's donor retrieval teams. IKDP surgical teams get to a potential donor as quickly as possible. Most nephrectomies are performed within an hour of death. Last winter, Illinois and Wisconsin State troopers joined with City of Chicago police to form a relay that delivered a kidney from Milwaukee to a Chicago transplant center in about two hours. more ........... ................. I N F 0 R M A T 0 N D A T A PROMOTING COOPERATIVE EFFORT IN THE ORGANIZATION AND DELIVERY OF QUALITY PATIENT CARE (Heart Disease, Cancer, Stroke, Kidney Disease, Chronic Pufn)onary Disease. Diabetes) CLARK COUNRIY @rrH STUDY GROUI' 1300 WEST MICHIGAN STREET, INDIANAPOLIS, INDIANA 46202 317/264-8492 .A -R@ An Indiana comurity and eight neighboring townships being assisted in their determination of health needs by the Indiana Regional Medical ProSran. The effect may ultimately lead to constriction of a new health clinic and to a wide range of health services for resiiE!nl:s of thp- ccnmunity. The project was triggered when public announcement of highway construc-- tion plans signalled the displacement of a medical clinic owned and operated by a physician in Charlestown, F, southeastern Indiana comruniLy o-@' 5,726 residents. The physician requested I@ assistance in dete@-,ing the range of services that should be offered by the replacement clinic he planned to build. IRT's first act was to help fonn an ad hoc state advisory co@t-tee to guide the project's initial stage. NaTned to this cam-Littee were represe-Titati\7es from the Indiana State Board of Health, Indiana Heart Association, Indiana Tuber- culosis and Respiratory Disease Association, and IRT. Ea&, c@ttee member shared a con=n talent: skill in L-ommunity development and organization. After a series of mee-@gs, the ad hoc c@ttee began the task of compil- ing necessary preliminary dat-a--demaraphic'@ormation, leadership profiles, and lists identifying interested health providers and citizens. The c@ttee's work led to the @Lorrat2-or. ol' @,e @,Torth Clark County Fe,,@t@ Study C.-o,.ip, - rised of local leaders, interested citizens, and health providers From the ranks of Page Two North Clark County Fealth Study Group A Vignette, Indiana P@ the Heart Association &-id IRT, two resource people were named to support the study group Is v7orl,,. InitiAl target of the study group was to determine health needs in Charles- town and the eight northern townships of Clark County. Twelve pressing needs were later identified via face-to-face surveying of 1,124 of the @als 5,617 families. The top priority survey indicated, was that of estab- lishing a full-time e,-ner,-,ency medical service, transportation system for coirmun- itv residents. Even before the survey documented this need, physicians in the c=nunity, as a result of the interest beirZ shown by residents, had organized seven-day-a-w6e]-,, round-the-clock emergency coverage. Analysis of data from the Charlest@-Northern Cl@ County project still co@,inues with IRIP playing an active, interested role. Today, the study group operates on a broader, more comprehensive scale. @other organizations have indicated a willingness in helping the study group meet its objectives The project stands as a model of how IRMP and its many resources can bring improve- ments in medical care delivery to the people of Indiana. Prepared by: Joe McCammon Field Representative Al k@, A significant effort has been made by the Intermountain Regional Medical Program to promote co.mmunity-based programs which stress continuing education concepts through Visiting Teaching Clinics in Heart Disease, Cancer, Stroke, Renal and Respiratory Disease and also through the subregional Cardio- vascular and Coronary Care Training Programs for Physicians and Nurses. Several other seminar type training programs and "in house" traineeship programs are also offered at the University of Utah Medical Center. Many of the above clinics have been conducted through the Subregional Learning Centers. and @@have proven to be beneficial in stimulating medical personnel to seek further training as well as to provide on-site training opportunities since it is often difficult for professionals to participate in training programs outside their own communities. Regional networks are being established to provide coordinate resources at graduated levels of care to form a linkage between the primary physician an resources of the subregional centers and the major medical centers of the region. When fully developed, these centers will make previously non-existent specialty training and care available at the local level. The Carnegie Commission on Higher Education identified five cities encompassed by the Intermountain Regional Medical Program which should become Area Health Education Centers. These cities are: Grand junction, Colorado; Pocatello, Idaho; Billings and Butte, Montana; Cedar City, Utah. In three of these areas IRMP has already stimulated significant activity through the establishment of Community Health Learning Centers. On-site medical education coordinators working with local advisory groups assess educational needs and draw upon IRMP and other resources to meet those needs. The health learning centers will also become quick reliable sources of medical information and gradually develop resource retrieval systems. Hospitals in each learning center subregion will have access to a pool of AV equipment - "hardware" (projectors and recorders) and "soft- ware" (filmstrips,, slides and audio and video tapes). In addition, centers will serve as a vehicle for planning educational programs and assisting with the over-all health planning activities of the area. Funding for the Centers has been a cooperative effort of the IRMP, hospital associations, hospitals, and other local groups. Workshops and seminars in such fields as trustee orientations, infection control, emergency room service, neonatal care, and burn therapy have been presented based upon identified needs. The estimated 44, 000 diabetics in the Intermountain Region will receive assistance in understanding and dealing with their illness through the Diabetes Education Program of the Intermountain Regional Medical Program. The project is establishing a Diabetes Education Center at Holy Cross Hospital in Salt Lake City, Utah. The Center is designed to provide the diabetic patient and a selected family member with a "live-in" educational experience for five days. During that period of time, patients are given self-care training skills for self-management and to recognize the warning signals related to complica- tions. Several hundred diabetics per year will participate in the educational programs. The Center will also serve as a research and educational facility for physicians, nurses and dietitians. Traveling programs to acquaint health care professionals with new developments in diabetes care will be arranged for the rural areas of the Intermountain Region. KANSAS model Cities Manpower Recruitment Program A grant of $20,415 to Model Cities Health Manpower and Recruitment by the Kansas Regional Medical Program provides or a coordinator and training of nine neighborhood health aides in Kansas City, Kansas. After an initial orientation course lasti@g three weeks, each of the aides was a.ssigned, time in varying sequence to get first hand knowledge of the operations of six offices of the City-county Health Department and the five other community health care and social service agencies. They also received a three week course in clinical counseling and casework at the local mental health clinic and were separately enrolled in six hours of course work at the Kansa.s City Kansas Junior College. In addition, the aides participate actively in preventive medicine educational programs conducted at public schools, day care centers and homes for the elderly in this area.. The project director, Miss Francine Carter, of the City-County Health Department, consults with the aides on future vocational possibilities, supervises their training activities and counsels them in their performance. Hopefully the aides will further their education or be hired by local agencies after one year with the program. A major function of the program is communication between the residents of the Model Cities area and the aides. Concen- tration with the model neighborhood residents ha.s been in home interviews. From this contact stems most of the services rendered. From May 1, 1970 through December 31, 1971, the aides performed a total of 2,004 initial household interviews and 550 follow-up visits. Between July 1 and September 30, 1971, the aides made 708 home visits with public health nurses; made 25 referrals to clinics in model neighborhood areas; developed three educational seminars - on venereal disease, immunization and beginning case work - and distri- buted health literature. In December, with the coordinatot's assistance, each health aide chose a multi-problem family for concentrated visits. The purpose of the visits was to change the family attitude to one of good health practices by helping the family understand their problems and guiding them to the proper Two Model Cities community agencies for assistance. Follow-up was made to determine whether appointments were kept and whether other problem areas developed. Future plans include recruitment of health aides to enter into the program in August, 1972; a. continued search for educational resources and employment for the aides who have not entered into an educational program; finding means of transportation to Model neighborhood residents; and working closely with other community agencies in the area to coordinate services and hopefully provide better services to residents. Region: Kansas Regional Medical Program Locus of Activity: Kansas City, Kansas Project Title: Model Cities Manpower Recruitment Program Status: Ongoing Sponsoring institution: Model Cities, K. C. Wyandotte County Health Department Project Director: Francine Carter Wyandotte County Health Department Kansa,s City, Kansas Dates: 9/l/71 to 6/30/72 Funding: $20,415 other Funds: Cooperating Agencies and Institutions: Ka.nsa.s City-County Hea. t Department, Kansas City Jr. College and Kansa.s City community health care and social service agencies. Area Served: Model Neighborhood area Target Population: 18,000 households in Model Neighborhood Congressional Districts: Larry Winn, Jr., Third District Continuation after RMP Support Withdrawn. Core Staff Contact: Mary Ann Blakeney Date Prepared: 7/2/72 Dra.fted by: Mary Ann Bla.keney KANSAS Nurse Clinician Program To determine the demand for physicia,n's assistants, the Ka.nsa.s Regional Medical Program mailed out a survey questionnaire to all members of the Kansa,s Medical Society. The 72% who responded indicated a wide variety of assistants would be hired. The "general'' physicians assistants seem- ed to be in most demand and the preference to hire nurses retrained for expanded assistant roles rather than ex- corpsmen or newly trained personnel was apparent. As a result of the survey a. nurse clinician program began in January, 1972. The purpose of the program is to further develop nursing skills to a.ssist e -Phvsicia.n. Under the supervision of the physician, the nurses will be able to do many of the necessary things required in pro- viding primary patient care. Approximately 40 nurse clinicians will be trained in the program. According to Jea.n Tomich, Ph.D., project director, "The eight week formalized courses wil focus on medical biological, psychosocia.1 and health care services. When the nurse completes the formalized course, she will study under the tutelage of the physician with whom she will be working. Each enrollee will be sponsored by an indivi- dual physician or an institution with the full guarantee of employment at the completion of tra,ining.@' Candidates must be licensed professional registered nurses educated in diploma, baccalaureate, or higher degree programs in nursing. Through experience and job performance, the nurse should have demonstrated a. concern for people, above average learning abilities, independent thought and judgment,a.nd the ability to give or manage nursing care for a. group of patients. The major responsibility of selection lies with the sponsor of the candidate who evaluates whether or no the candidate meets the criteria. In general, the physicians who answered the questionnaire felt that physician's assistants could both qua,nta.tively and qualitatively increase their practice. Region: Kansas Regional Medical Program Locus of Activity: State of Kansas - Didactic training in Kansa.s City Project Title: Nurse Clinician Program Status: Ongoing sponsoring Institution; KRMP and individual physicians or institutions. Project Cirector, Title, Address: Jean Tomich, Ph.D. Nurse Clinician KRMP 3909 Eaton Kansa@s City, Ka.nsa.s 66103 Dates: 7/l/71 to 6/30/72 Funding: $80,000 Other Funds: None Cooperating Agencies and Institutions: Individual physicians and institutions in Kansas. Area Served: State of Ka.nsa.s Target Population: Kansa@s patients of physicians and institutions. Congressional District: Larry Winn, Jr., Third District Continuation after,RMP Support Withdrawn: Coro Staff Contact: Project Director or Mary Ann Blakeney D@)te Prepared: 2/2/72 Drafted by: KANSAS Model Rehabilitation Project In April, 1971 the St. Joseph Hospital and Rehabilitation Center,, a 450-bed facility located in Wichita, received a. contract for $63,428 from the Kansas Regional Medical Program for a model rehabilitation pilot project. Collaborating in the project are St. Luke's Hospital in Wellington and Kingman Community Hospital in Kingman. Both hospitals are approximately 50 miles from Wichita. The program involves training of nurse rehabilitation specialists from Kingman and Wellington at St. Joseph's in Wichita. After training, the nurses return to their respec- tive hospitals to train others in rehabilitation techniques. A "circuit" team, which includes both a physical and occupational therapist, a clinical psychologist, speech therapist, home health supervisor, medical social worker, and nutritionist a.ssist in the complete range of rehabili- tation services provided to stroke patients in Kingman and Wellington hospitals. The goal of the pilot project is to duplicate in the local community, rehabilitation experience of a ma.jor re- habilitation center so that this program can be shared with other communities in Kansas. During the period from July 1 to December 1, 1971, 40 inter-institutional patient referrals for rehabilitation resulted from the program. so far 46 registered nurseso 10 licensed practical nurses and 182 aides have received training. Kingman County is currently seeking to establish a con- tract with Kingman Community Hospital to have the project- trained rehabilitation nurses provide home health care services to county residents. BACK-UP SHEET Region: Kansas Regional Medical Program Locus of Activity: Wichita, Wellington and Kingman (Kansas) Project Title: Model Rehabilitation Program Status: ongoing sponsoring institution: St. Joseph Hospit'al and Rehabilitation Center, St. Luke Hospital and Kingman Cty Hosp. Project Director, Title, Address: Alfred Hinshaw, M.D. Garvey Laboratory 3241 Victor Wichita, Kansas 67208 Dates.- 5/l/71 to 4/30/72 Funding: $63,428 Other Funds none cooperating Agencies and Institutions: The sponsoring three institutions. Area Served: South Central Kansas area. Target Population-. Stroke victims or rehabilitation ca.ses in two towns within a.radius of 50 miles from Wichita. Congressional Districts: Garner E. Shriver, Fourth District Continua'[-ion a-fter RMP Support Withdrawn: None known at this time Core Staff Contact: Dr. Alfred Hinshaw Date Prepared 2/l/72 Drafted by: Mary Ann Bla,keney KANSAS Ottawa, County Health Survey Recognition of the lack of public health nursing and environ- mental control services by citizens of Ottawa. County, located in north central Kansas, resulted in a. cooperative program by t e State Department of Health, the Ka.n-,as Regional Medical Program and the Ma,rymount College Department of Nursing. In June, 1971 with a. grant of $1,650 from Ka,nsa.s Regional Medical Program, an environmental survey studied health con- ditions and the gathered information was presented at public meetings of the concerned citizens. The second part of the survey involved personal interviews with 250 heads of households selected during the environmental survey. Information was gathered from each respondent re- ga.rding the occupation of the head of the household, the family size, their length of county residence, size of house, home sanitation facilities and family assessibility to health services. The interviews also gathered data regarding the personal utilization of health services and the status of respondents. Conducting the interviews were 20 nursing students from Marymount College, dressed in uniform, carrying college identifi- cation cards. The students were equipped with 1-hour long ques- tionna.ires plus the familiar instrument for taking blood pressure readings, "the cuff." By November, the confidential information collected from the questionnaires was coded for computer and re@lts were analyzed by the Kansas Regional Medical Program. Ottawa County has 6,1183 citizens of which 1,479 are 5-17 @@'years o f age and 1,263 are over 65 years of age. According to Sister Mary Savoie, R.N., the student's faculty advisor and director of the survey, results indicated the exis- tende of health problems which might be aided by a public health nurse. Since Ottawa County has no such service, Sister Savoie and Mrs. Mary Wright, are @,th nurse for the Kansas State Health Department, have @on"@a short term basis, nursing clinics and health information programs. The nursing clinic is a new type of health service which provides health screening checks of individuals who are well in an effort to identify health problems before they become obvious. Page two Ottawa County If a problem is found in the clinic, the individual is referred to his physician for medical diagnosis and treatment. !@Early identification and treatment of health problems," said Sister Mary Savoie, "often saves the person huge medical bills and hospitalization for a condition which, if found earlier, could have been treated on an out-patient basis." Four county physicians are cooperating, with the two nurses and the senior nursing @t@ p from Marymount. When i-t ein the survey'that 34% of the county women between the ages of 18 and 60 had never had a pap smear, an April date wa.s set for a clinic. The physicians agreed to give the test to detect early cancer of the cervix. At the first three clinics, out of the 33 persons who attended, 8 were found to need additional evaluation of their blood pressure. The survey showed that 90/c of the county ouse- holds interviewed suffered from high blood pressure. T e second series of clinics had double the number of participants. The nursing clinics are held in seven locations, Delphos, Wells, Bennington, Minneapolis, Ada, Tescott and Culver. Two adjacent counties are exploring their possible participation in an expanded nursing clinics network. The Ottawa County Commissioners are contemplating putting the question of County Health Service on the ballot at the primary election in August, 1972, for a vote of county residents. BACI@UP SI-IEET I,'OR VIGNETTE ON OTTAWA COUNTY SURVEY TO GO TO DRIMP COMMUNICATIONS Region: ',315tOOO T@ihich includes a federally-desigmted de-Dressed area. Coii @:r. Gerald Ford Eressioiial Districts; ir' 5 'Iutchinson Guy VanderJa-t ;ill 0 -@lf ord Cederberg r a ,,oii'uin,j.D,Iuion a-@'u-- I of Su-i-oort: Part or full self-su-pl)ort ol@ the educational visits (out not the central staff functions) has been voted by 8 oi@ the 11 target hospitals, Coii-,Lact: David Re-,,)reseiixtive Date -7"re@ired: 2/14/72 7)r,i--'tca 7@% @"cLllace -3. Doraiii, @oject '-'oo2:dire4..02? MISSISSIPPI REGIONAL MEDICAL PROGRAM P 880 LAKELAND DRIVE JACKSON, MISSISSIPPI 392i6 (6oi) 362-73II September 14, 1972 Patricia Q. Schoeni Director cations and Public Information Regional @dical Programs Service Parklawn Building 5600 Fishers Lane Rockville, Maryland 20852 Dear Pat: Here, in answer to your request, is another vignette on an activity of our program. Perhaps you will find it interesting. Bob Chambliss and James Daugherty attended the workshop, and I think Chmbliss was suitably impressed with the effort we made. I'll try to get you some more dope before long, meanwhile keep the faith. Yours,, Roberf-C. Cotten Director of Corflmunication and Information Wssiss' i Regional @dical Program ipp RCC/jec attachment Working J'or better health in Mississippi through Training, Education, and Demonstration Mississippians suffering terminal renal failure now are receiving life-saving hemodialysis treatments in a unique, MRMP-supported program that features the use of house trailers, converted to artificial kidney units, and installed on the grounds of community hospitals. The concept allows patients who have inadequate family support and/or housing facilities to obtain treatment without having to be hospitalized, at a cost they can afford. Three trailer units'are now in operation in various communities, serving a total of seven patients. Each patient received initial treatment and training in how to operate artificial kidney machines at the University of Mississippi Medical Center in Jackson, home-base IV for the state's artificial kidney program, which also supports three additional satlelite kidney units in. 4-s-. Each trailer is designed to serve a capacity of eight patients per week. Plans call for a total of ten trailer units eventually to be operational, serving an expected twenty-five new patients each year. The trailers are comfortably furnished in a pleasant, home-like atmosphere. Patients may have visitors any time and have the use of a telephone and kitchennette. A liaison with the community hospital is maintained through nursing and technical personnel, although they are called upon only in emergency situations, which so far have occurred infrequently. The Mississippi Regional Medical Program supports the training of these nurses and technicians and provides backing for the coordination of various state and community agencies, such as Vocational Rehabilitation, the Kidney Foundation of Mississippi, and civic clubs. Community pride is an important ingredient in the trailer unit concept, and has greatly cut the costs to individual patients. When the last unit becomes operational, there will be a hemodialysis treatment center within thFrty minutes of the front door of every citizen in Mississippi. Back-up Sheet Region --- Mississippi Regional Medical Program (the State of Mississippi) Locus of Activity --- Operational Project Project Title --- Decentralized Home Dialysis Centers Sponsoring Institution --- University of Mississippi Medical Center, Vocational Rehabilitation, Kidney Foundation of Mississippi Project Director, title, address --- John Bower, M.D. Assistant Professor of Medicine Director, UMC Artificial Kidney Unit 2500 North State Street Jackson, Mississippi 39216 601-362-4411 Date Operational --- July, 1970 Funding --- $76,327.19 Area --- Trailer Units in Greenville, West Point, Columbia; additional satellites in Tupelo, Pascagoula, McComb. Program serves entire state. Target --- 25 new patients per year Other funds --- Community agencies purchase trailer units through coordinated effort Continuation of Support --- Most likely continuation of support will be from state and local governments combined with support of community civic organizations. VIGNETTE Thirty-seven per cent of Mississippi's 2,216,912 people (or just over 820,000) are black, but of that number only 44 are practicing YU o compound the prob em, the average age of the black doctor in the state is 55. The Mississippi Regional Medical Program in July, 1972 provided a grant of $ 8,000 to support a workshop for the 60 black medical students now attending school in other states. The theme of the workshop was "Come Back and Get Involved", and stressed that health care delivery in the region was "still a challenge". The results of the three-day event were much better than those of a similar workshop which MRMP sponsored the previous year. Turnout was above what had been expected, and the students' responses indicated a growing interest in and awareness of the needs of people in their home state. MRMP also sponsored a black medical student preceptorship program, with a grant of $ 7,300, in the state during the summer in which 5 students had the opportunity of working directly with physicians in practice. The Program is steadily increasing its committment to improve the region's health manpower shortages by such activities as these. Status --- Contractual/Professional Staff Activity The Mississippi RMP covers the entire State of Mississippi, and has been operational since July 1, 1969. Its committment level for FY 1972 was $ 1,408,225. These funds were used during FY 1972 to support a total of 12 projects, of which one was in the area of general continuing education, one for training existing health personnel in new skills, 2 for training new health personnel, 7 for patient services and demonstration, and 2 for providing manpower development centers. ;A MISSISSlf'Pl REGIOI\IAI, NIEDICAL I)ROGRAM 2500 NORTH STATE SI-REE.--F JACKSON, M SS SS PP 39216 (601 362-7311 A'-7T viGNETri" IVidespread ignorance of health and health practices is one of the factors contributing to i@!LississippiIIs high incidence of morbidity and mortality from such "treatable" diseases as cervical cancer hypertension and diabetes. Lack of public health awareness undoubtedly plays a role in givina Mississippi the highest maternal and infant death rate in America. In the Fall of 1971, the Mississippi Reaional Medical Program sponsored a massive health exposition in the capitol. city of Jackson, as a means of educating the public to better health practices and to new developments in treatment and tie delivery of health care. Over sixty thousand. people, from all ivalks of life and from all parts of the state, came to see exhibits, demonstrations, and films provided by more than SO state health organizations and volunteer groups during the three-day event. large evenina crowds attended to hear such renowned medical authorities as Dr. Paul Dudley l@'hite, world famous heart specialist and former personal physician to President Eisenlioiier, and Ih,. lbbert Q. Marston, Director of the National Institutes of Health. 'nae decree of public involvement and participation was much greater than initially expected. People waited in line, often for as long as an hour, to have their blood tested, their hearing and eyesialit checked, and to participate in screening procedures for a multiplicity of health problems, including diabetes, hypertension, cervical cancer and emphysema. Thousands of young people were introduced, for the first time, to a wide range of health careers. Ihe $10,000 grant provided by DRIP made it possible for a non-profit group to establish the Ifealth Expo as an event that will continue, on its own steam., to educate a,-id inform @ilississippians about health and the availability of care. Status --- Contractual/Professional Staff Activity The Mississippi MIP covers the eitire State-of P4ississippi, and has been operational since July l-, 1969. Its committment level- for FY 1972 was $1,408,225, 'These funds were used during, @ 1972 to support a total of 12 projects of which one was in the area of general continuing education, one for training existing health personnel in new skills, 2 for training neiv health personnel, 7 for patient services and demonstration, and 2 for providing manpoiver'developmeiit centers. P? 7 1 )t] I) t-, t-)@) (III,: i r,l fin t'i MISSISSIPPI REGIONAL MEDICAL PROGRAM P 2500NORTHSTATESTREET JACKSON, MISSISSIPPI 39216 (601) 362-7311 VIGNE'FTE Widespread ignorance of health and health practices is one of the factors contributing to @lississippils high incidence of morbidity and mortality from such "treatable" diseases as cervical cancer, hypertension and diabetes. Lack of public health awareness undoubtedly plays a role in giving Mississippi the highest maternal and infant death rate in America. In the Fall of 1971, the Mississ' i Regional Medical Program sponsored ipp a massive health exposition in the capitol city of Jackson, as a means of educating the public to better health practices and to new developments in treatment and the delivery of health care. Over sixty thousand people, from all walks of life and from all parts of the state, came to see exhibits,, demonstrations,, and films provided by more than 50 state health organizations and volunteer groups during the three-day event. Large evening crowds attended to hear such renowned medical authorities as Dr. Paul Dudley White, world famous heart specialist and former personal physician to President Eisenhower, and Dr. Robert Q. Marston.% Director of the National Institutes of Health. The degree of public involvement and participation was much greater than initially expected. People waited in line, often for as long as an hour, to have their blood tested,, their hearing and eyesight checked, and to participate in screening procedures for a multiplicity of health problems, including diabetes, hypertension, cervical cancer and emphysema. Thousands of young people were introduced, for the first time, to a wide range of health careers. The $10,000 grant provided by HW made it possible for a non-profit Qroup to establish the Health Expo as an event that will continue,, on its own steanl to educate and inform Ndssissippians about health and the availability of care. Status --- Contractual/Professional Staff Activity The Mississippi @IP covers the entire State of Ndssissippi, and has been operational since July 1, 1969. Its camittment level for FY 1972 was $1.,408,1225. These funds were used during FY 1972 to support a total of 12 projects, of which one was in the area of general continuing education, one for training existing health personnel in new skills, 2 for training new health personnel,, 7 for patient services and demonstration, and 2 for providing manpower development centers. Working J'or better health in Mississippi through Training, Education, and Demonstration MISSOURI Plantfor Improvement of Pharmaceutical Services in Missouri's Rural Health Care Institutions (Hospitals and Nursing Homes) In the first year of this three-year project, t.@ approximately 50 hospitals of 100-bed size or less and 70 nursing homes will be @e to determine: 1. Current status of pharmaceutical services,,., 2. Facilities available for providing these services@, 3. Local pharmacists available. Cooperation of the hospitals and nursing homes was requested @-e -@-.,Ietters.,-,Thirty-eight hospitals and 60 nursing homes h-av@,agreed-to participate. By using questionnaires developed by Project Director Wayne M. Brown for hospitals and nursing homes, an interview is conducted with the administrator, director of nurses, and pharmacist, if available. @At-go the nursing stations and pharmacy or drug room are visitedil@@@t@@j,,, ave been visited. Five have the As of 21 7@.3i hospitals li services of a full-time pharmacist, 16 have a part-time pharmacist, and 12 have the services of a consultant. Various drug distribution systems have been seen.@many hospitals are concerned and indicated they need help in improving their systems. It is believed that the services provided by the full-time pharmacist will, of course, be better than that provided by a part-time or consultant. It is hoped that a program can be developed and implemented to improve what the pharmacist is doing in these institutions. This is the ultimate objective of this project. Thirty-nine nursing homes have been visited. Eleven have pharmacy consultants and the remaining 28 have no pharmacy service except for the actual providing of the drugs. Of the 11 consultants, 7 were spending some time in the nursing home. This time varied from a half-hour a week to one hour per month. In the other four, the pharmacist did not go to the nursing ho s. In nursing homes there is not a great deal of pharmacy input.' In the next two years of the project, programs will be developed to help the pharmacist i@ in the institutions provide better service. Back- heet Region: Missouri Regional Medical Program Locus of Activity: Operational Project Project Title: Plan for Improvement of Pharmaceutical Services in Missouri's Rural Health Care Institutions (Hospitals and Nursing Homes) Status: Ongoing Sponsoring Institution: University of Missouri - Kansas City School of Pharmacy and Division for Continuing Education Project Director, Title, Address: Wayne M. Brown Assistant Professor School of Pharmacy University of Missouri - Kansas City Kansas City, Missouri 64110 816-276-1614 Dates: July 1 - June 30, 1971-72 (First year - evaluation) July 1 - June 30, 1972-73 (Second year - program development) July 1 - June 30, 1973-74 (Third year - reevaluation) Funding: 1971-72 $25,000 ($3,000 added for Green Hills Project) 1972-73 $26,500 1973-74 No funding Cooperating Agencies and Institutions: Missouri Hospital @ss@iation, Missouri 0 t@eopathic Hospital Association, Missouri Nursing Home Association, Missouri State Medical Association, Missouri Association of Osteopathic Physicians and Surgeons, Missouri Pharmaceutical Association, Missouri Nurses' Association, and the Division of Health of Missouri. Area Served: The State of Missouri - excluding St. Louis County Target Population: 50 hospitals of less than 100 beds and 70 nursing homes. Congressional Districts: William J. Randall (D), Richard Bolling (D), @ (,Wm. (Bill) Hull,-Jr. (D)@IDurwood G. Hall (R), Richard jigichord (D), Wm. L. (Bill) Hungate, Bill D. Burlison (D). Continuation after RMP SUP2or:o- ithdrawn: t W . 1, I I&% Page 2 Core Staff Contact: Dr. Warren P. Sights Date Pre2ared: 3/l/72 Drafted By: Wayne M. Brown MISSOURI School Heart-Sounds Screening Program Approximately two-,-and-one-half years ago the PhonoCardioScan Project began in Missouri, sponsored jointly by the Missouri Regional Medical Program and the Missouri Heart Association. Since that time, 45,000 young people in six major communities and numerous smaller communities throughout the state have been evaluated for unsuspected heart disease. The program has tested first, fifth and ninth graders, and more recently, fourth graders, for the presence of heart murmurs or abnormal heart sounds. More than 700 students have been referred to their physicians for follow-up evaluation because of unsuspected heart murmurs. Many of these turned out to be of no major importance. However/ many significant abnormalities have been detected. Some of these have required referral to a medical center for a more complete evaluation. Some to have a heart disease which required some restric.- tioh of physical activity; others-have had to be placed on prophylactic antibiotics to prevent infection from developing diseased portions of the heart. Two cases detected in the course of the screening indicate how iT@ ,,the despot on,,@@ unsuspected heart murmurs can be. six-year-old@ ir om St. Joseph, Missotri# who @-was_ activ-e.-,.:an A 6d,to be healthy-was found to have an abnormal heart murmu@;,an(I was referred to the University of Missouri Medical Center, where s,he,,,-wa-s----f-ound---t-o -have -a "very serious restriction of flow through'th6 pulmonary valve.@," Immediate open heart surgery was necessary recovered rapidly,,,'@'@ has now returned to normal activities with no abnormal cardiac findings. A 12-year-old boy from Centralia, Missouri, was found to have a complicated inborn heart defect called Tetralogy of Fallot which is usually detected much earlier in life. -Ro'Veve@r, -.because of certain unusual features it had,not been detected.@ This patient recently underwent total surgical correction for the abnormality and is now progressing very well. An important by-product of this program has been public education. Many parents have learned something about heart disease in children. Thousands of volunteers have helped with the program and, through the assistance of all forms of news media, hundreds of thousands throughout the state have learned more about the importance of evaluation for the presence of heart disease in children. We have also been able to predict 2- the incidence of unsuspected heart disease in children -ilt, and have determined the best ages for'@"6Afi@ren t-e.-@ to@4ain the best cooperation and the maximum yield. At the present time the ninth grade has been found to be less satisfactory than the first, fourth and fifth grades. Back-up Sheet Region: Missouri Regional medical Program Locus of Activity: Operational Project Project Title: School Heart-Sounds Screening Program Status: Ongoing Sponsoring Institution: Missouri Heart Association Project Director, Title, Address: Dr. Jack S. Sanders Project Director 515 East High Street Jefferson City, Missouri 65101 Dates: 1969 - present Funding: 01 73,600 02 34,800 03 18,000 Other Funds: Cooperating Agencies and Institutions: Missouri Heart Association, PTA'S, Local school administration staff. Area Served: Statewide Target Population: Grades 1, 5 and 9 Congressional Districts: 2 prtz@t- sites L"@ma Continuation after RMP Support Withdrawn: Within the next six months the screening part of the program will end. However, compilation of important statistics and follow-up of children found to have abnormal findings will continue for some time. In most of the communities involved the program will be carried on through local purchase of the testing apparatus and through use of volunteers, who are now experienced in the use of the equipment. Core Staff Contact: Dr. Warren P. Sights Date Prepared: 3/7/72 Drafted By: Dr. Jack S. Sanders MISSOURI A Cooperative Prevention and Management Program for Cardiovascular Pulmonary Problems This cooperative program among physicians, hospitals and MORMP staff in the northeast area of Missouri is tackling cardiovascular-pulmonary problems. Each physician in the northeast district has received a booklet listing available speakers, topics and audiovisual materials on cardiovascular-pulmonary problems. When physicians and hospitals request speakers or materials listed in the booklet, the MORMP staff arranges to bring the seminar to the physician This eliminates hours of travel, and lets the physician himself determine what his educational needs are. Also involved in the continuing education programs are health and physical educators and leaders in school systems, and students at Northeast Missouri State College. The staff tries to improve public understanding about cardiovascular-pulmonary disease, with special emphasis on prevention., speakers bureau is being planned; radio and TV programs and news releases will stress. Back-up Sheet Region: Missouri Regional Medical Program Locus of Acti@: operational Project Project Title-. A Cooperative Prevention and Progressive Management Program for Cardiovascular-Pulmonary Problems Status: Ongoing. Sponsoring Institution: Kirksville College of Osteopathic Medicine Project Director, Title, Address: Dr. Richard H. Beck KCOS - 704 W. Jefferson Kirksville, Missouri 63501 Dates: 1971-72 Fundiln $40,000 Other Funds: Cooj2erating Agencies and Institutions: Kirksville College of Osteopathic Medicine Area Served: Northeast Missouri Tar!let Po ulation: Health professionals, especially physicians, p for continuing education. The entire population for ConS[ressional Districts: public information. Continuation after RMP Support Withdrawn: -2- Core Staff Contact: Drt. Warren P. Sights Date Prepared: 3/20/72 Drafted by: Elaine Selcraig. MISSOURI Southeast Missouri Radioisoto@Cancer Program This radioisotope program has brought a new type of medical facility to the rural area around Cape Girardeau, Mo. During the past three years, a completely equipped nuclear medicine department has been established at St. Francis Hospital, Cape Girardeau. O'M@@Le t% &0,441-@ne tJF SUAIA -k The nuclear scanning process is simple, but yields much information. Technicians inject radioactive material into the patient's veins. It accumulates and outlines the internal structure of the organ. This movement is traced with the persistence scope, which records areas of material accumulation by tumors, unhealthy tissues and cardiovascular lesions. Areas of increased activity show a greater accumulation of the isotopes. The radioisotope project gives people an opportunity to have an examination they would have to go to St. Louis or Memphis to get otherwise. The scans conserve physician time in making diagnoses and eliminate many cases of exploratory surgery. For example, one man came to the hospital for prostate surgery. In a routine work-up, including an intravenous pyelogram, the physician found something wrong with the patient's left kidney. Before going ahead with surgery, the physician needed to know how serious this defect was. The patient had a scan taken. Movies recorded the blood flow through his kidneys and the camera also provided Polaroid pictures showing different stages in the scanning process. His physician looked at this information and concluded it was safe to go ahead with the surgery. In June, 1969, eight months after the Project started, the first satellite laboratory was set up at Southeast Missouri Hospital with a complete well-counting system and a rectilinear scanner. Close correlation between the two labs has been valuable in developing techniques and maintaining quality control. The satellite at Southeast is self-supporting. Several nearby community hospitals also are considering development of nuclear medicine departments. Another important offshoot of the project is training professional assistants in the nuclear technician program. Back-up Sheet Region: Missouri Regional Medical Program Locus of Activity: Operational Project Project Title: Southeast Missouri Radioisotope Cancer Program Status: Ongoing Sponsoring Institution: St. Francis Hospital Cape Girardeau, Missouri Project Director, Title, Address: Dr. Milton Shoss 937 Broadway Cape Girardeau, Missouri 63701 Dates: 1968-72 Fundinq: 1969 75,200 1970 77,500 1911 43,000 Other Fun s: Cooperating Agencies and Institutions: St. Francis Hospital Cape Girardeau, Missouri Area Served: Southeast Missouri, southeast Illinois Target Population: Resident of southeast Missouri and southeast Illinois Congressional Districts: Pilit 1). btttlisoV'% Continuation after RMP Support Withdrawn: Will continue a gradual transition to fee-for-service basis, with cost of scans being borne by patients. Increase in number of scans performed will also lower cost. Satellite facility at Southeast Missouri is already self-supporting. Core Staff Contact: Dr. Warren P. Sights Date Prepared: March 14, 1972 Drafted By: Elaine Selcraig MISSOURI Homemaker-Home Health Aide ect Homemaker-Home Health Aide Project/h"@s trained a core of workers to do simple nursing procedures and "personal care" services such as grocery shopping, preparing meals, light laundry and housekeeping. T14-i ,.-pn,-.theildocto,gis referral to the chronically ill patient in the home, Home4m@ r-Home Health Aides have al,*6'served families during a perloa of acute illness, emergency, or stress that threatened the family's ability to remain together. Homemaker-Home Health Aides have worked under the supervision and direction of registered professional nurses to keep the chronically ill patient in the home, thereby releasing a hospital bed for the more acutely ill patients. Nine-hundred fifty days of nursing home care and almost 10,000 days of hospital- ization have been prevented during the two and one-half years the project has been funded. "Can Charley Brown keep coming back here?" the 4 year old towheaded boy asked. The Homemaker-Home Health Aide supervisor was making a routine visit to a home where a Homemaker had been assigned three days earlier. "Charley" Brown was really Mrs. Edna Brown, a motherly, good natured Homemaker-Home Health Aide. The home was shabby, with bare floors, but there was a warm fire in a wood-burning heating stove in the corner of the living room. The house was clean, the four children were warm, happy, and anticipating a good hot lunch. I'Charley" Brown and Homemaker Project.had made it all possible. Government issued commodity foods- dry powdered eggs, powdered milk, canned meat, cornmeal, lard, potatoes, oleomargarine, and raisins. ey@l-BTowrr-@a-d-, r.QaLly- On the old wood range in the kitchei scrambled eggs with small chunks of the canned meat mixed in, --vktit-d@@ fried potatoes, crusty cornbread @-r-e@,@-th-e @ri@ and i golden rice pudding with plump raisins. The towhead went to call Mamma'fro ]died just come home from the hospital.bhe day befu.Le. She came out smiling and sat down with the four children. "Charley" Brown beamed. 2- The apartment was neat, clean, and well furnished. There was a piano, but it hadn't been played in several months. Mrs. D. was too busy taking care of her 70-year-old husband@ who had had a stroke. Mrs. D. was not well herself. She needed to go to the doctor regularly, when it was possible to get a neighbor to stay with John. She was not making the improvement her doctor wanted her to make. Taking care of was an exh for a 69-year-old woman.@ N needed to be bathed and dressed daily. His meals ,t,(5@d repared, groceries must be shopped for, the laundry must ut, the house made presentable. It was just too (much ieveryone agreed on that.\) A housekeeper was found, but she didn't stay long. She didn't know how to bathe a stroke patient, prepare a low-sodium diet, give range-of-motion exercises, or use a Hoyer lift to I I- - -- move the patient to a wheelchair,. L. -fter What could be done? Put them-' in a nursing home? What shame. They could both I appy in the pretty little .1@@@apartment ,i;f there' was one to help a few hours aday @-@Then the doctor remembered Homemaker-Home Health Aide Project and called to request service for the couple. Thd next day t@ -t-cr---h-appem,@@ -,The Homemaker Aide bed bath, a front sunny window to look outside, The ishes, dusted, shopped for groceries and prepared the noon meal. @th-iTigs@,we-re-,-@,tter alreadyi@ Back-up Sheet Region: Missouri Regional Medical Program Locus of Activity: operational Prc),ject Project Title: Homemaker-Home Health Aide Status: Ongoing Sponsoring Institution: @Visiting Nurse Association of Greene County Project Director, Title, Address: Maude Lee Tillman, R.N. Executive Director, V.N.A. 2003 South Stewart Springfield, Missouri Dates: Project initiated September 1, 1969 Project terminates March 31, 1972 Fundia%: First year - $36,250.00 Second year - $82,843.00 Third year - $39,000.00 Other Funds: Cooperating Agencies and Institutions: Missouri Division of Health Missouri Heart Association Mo. Chapter American Cancer Society University of Mo. Extension Center Four local hospitals., practicing physicians, newspapers,, S radi-oil and television stations Area ervea: Greene County, Missouri Population 153,000 Target Population: All families with an ill member in or out of the home -thAt would b-en-efit bv a Homemaker to hold the family together. congressional D-Tstrfdts: #7 - Durwara G. Hall-7R) Continuation after RMP Support Withdrawn: It is believed that the project can be continued on a fee-for- service basis paid b the family receiving service. Donations y and bequests are being requested to provide service for people who cannot afford to pay. -2- Core Staff Contact: Warren Sights, M.D. Director of Operations, Date Prepared: 02-21-72 Drafted PI: Maude Lee Tillman, R.N. MISSOURI Early Diagnosis and Treatment of Children with Diabetes Mellitus A Research, Education and Detection (RED) Project in the field of diabetes mellitus has been in progress since January 1, 1970. This disease, primarily hereditary in nature, is on the increase. RED is the only way @n- to prevent or possibly delay the progression of this disease. detection and research program is aimed specifically at children under 16 years. In the past two years more than 2,108 glucose tolerance tests have been performed in area detection clinic@in,-8 central Missouri town I 16.9%@wer@e found to be abnormal. Pollow-up testing, nutrition and medical counseling were an,integral part of this project. Research is in progress to determine whether good nutrition and restricted concentrated sweets can prevent or delay the progression of the disease, especially in children with mildly abnormal tests. @@we are/further studying I)the relationship of insulin values, growth hormone and chromium i,e7 how these parallel the glucose level different ages Haiti Education is a must to be able to detect patients in earlier stages of the disease and to have patients follow through correctly on medical management. Physicians and allied health personnel need to be aware of the intricacies of the disease and its management to present it to the patient on a more understandable level. Information in this field is sent to personnel in a bimonthly bulletin after the allied health personnel have completed the eight-hour course of instruction (which has been held in eight communities,@,,. Physician instruction is held in conjunction --w:tth coii medical society meetings. The public health service and the Bureau of Maternal and Child Health have acted as community coordinators in follow-up instruction and detection in certain counties. Environmental surveys of the family help determine the immediate needs of the community or the home. Patients with specific dietary or insulin management problems often may be helped by relating to the specific problems found only in,,the home. Educational material has become a growing concern. V5 ha*e p-r -a Manual for Parents and @'Manual for@'@A2[ultsi4-,For the Fhysician and allied health personnel are the Manual for Physicians and Medical Students, Monograph for Nurses concerning diabetes mellitus in children and an Instruction Manual for personnel responsible for teaching patients of all age levels. As funds are available, a bright pictured colored book for children will become part of their instruction. -2- communities involved in this program," n, Princeton, Sedalia, Washington, St. Clair, Mexico, Jefferson City and Columbia, Missouri. The Green Hills Area in nort'hwest Missouri is now being included in the educational projec L.P.N.'s, 37 R.N.'s, five registered dieticians, five dietary aides and two nursing technicians or nursing home aides Nurs ,.,,,have completed the course. ing students and medical students at the University of Missouri have also been reached through scheduled classes specific to the needs, management and education of children. ,/Ongoing patient education pro]ects are now being carried on ix of the eight involved towns. D-iabetic detection programs now present in three of the eight towns. Diabetes Associations now organized in Rolla, Mexico, Columbia, Jefferson City and Joplin-Springfield area through contacts made with our pro3ect. "Camp experience has also been available over the last two years in the central Missouri area by the Robert L. Jackson Camp (or Camp Banting), held for two weeks at Holt Summit, Missouri. It is hoped that this will develop into a state-wide camp, including @,,the St. Louis and Kansas City camps. Children from 7-15 years I'@of age are able to increase in independence and knowledge about ,@their disease by participating in camping activities in a erly supervised atmosphere. pro Children with diabetes can have an active and productive life with vascular and neurological changes prevented or delayed. This is the goal of the RED Project. .4r Back-Up Sheet Region: Missouri Regional Medical Program Focus of Activity: Operational Project Project Title: Early Diagnosis and Treatment of Children with Diabetes Mellitus - To Delay or Prevent Vascular Changes of the Disease Status: Ongoing Sponsoring Institute: Department of Pediatrics University of Missouri Medical Center Columbia, Missouri Project Co-directors: Titles and Address: Calvin C. Woodruff, M.D. Professor Richard A. Guthrie, M.D. Associate Professor Department of Pediatrics University of Missouri Medical School Columbia, Missouri 65201 Area Code 314 442-5111, Extension 647 Date: January 1, 1970 - January 1, 1972 (completion date of project January 1, 1973) Funding: other Funds: Department of Pediatrics University of Missouri Medical Center Columbia, Missouri Cooperating Agencies: Division of Health Department of Public Health Bureau of Maternal and Child Health Area: Central Missouri area Target Population: Children from birth to 16 years of age Physicians and allied health personnel Continuation after RMP support withdrawn: Area hospitals to continue ongoing patient education. Continued communications through bimonthly bulletin available by yearly subscription or other Medical Center money. - 2- Core Staff Contact: Dr. Warren Sights Date: 3/7/72 Drafted By: Richard A. Guthrie, M.D. MISSOURI Mobile Rehabilitation Service Project A mobile rehabilitation team travels from Springfield to outlying hospitals and nursing homes. Th@ providescare which otherwise would not be available to rural residents. Vocational rehabilitation services are offered through Springfield Baptist Hospital Rehabilitation Center. The staff has given 161 treatments to 80 patients since December@1119The staff now visits the following units one day each week: Skaggs Community Hospital, Branson, Missouri; Barton County Memorial Hospital, Lamar, Missouri; West Plains Memorial Hospital, West Plains, Missouri; Ash Grove Nursing Home, Ash Grove, Missouri; Thayer Nursing Home, Thayer, Missouri; Kabul Nursing Home, Cabool, Missouri, and West Vue Nursing Home, West Plains, Missouri. The three hospitals have bed capacity of 163 beds and the four nursing homes have a bed capacity of 322. In addition to rendering actual treatment to patients, instruc ie,&- designated hospital personnel c '@he work-- @t-wee-n. Back-up Sheet Region: Missouri RegionAl Medical Program Locts of Activity: Operational Project Project Title: Mobile Rehabilitation Service Project Status: Ongoing Sponsoring institution: @Springfield Baptist Hospital Rehabilitation Center Project Director, Title, Address: Dr. Daniel L. Yancey Project Director 1211 South Glenstone Sprin field Missouri 9 I Dates: @ 1971-74 Fundi-n-a.: 01 - $20,000 02 @undecided 03 other Funds: Hospital Support (Space, Equipment, etc.) Coo ating A nd Institutions: .Rer gencies a Springfield Baptist-Hospital Rehabilitation Center Area Served: Southwest Area Target Population: Health.Facilities, etc. in Southwest Area n RahdAll (D), 1 CongreSsio al Districts: William J. Durwood G. Ha 1 (R) Bill D. Burlison (D) +IID Continuation after RMP Support Withdrawn: Not now known. 2- Core Staff Contact: Dr. Warren P. Sights Date Prepared: 3/7/72 Drafted by: Elaine Sblcraig MISSOURI COMPACT (Cooperative Ongoing Medical-Health Participation and Continuous Teaching) Practing physicians in the Greater Kansas City area are becoming actively involved in continuing medical education programs and seminars through the efforts of COMPACT. The one-year demonstration program, supported by coordinating activities of the Kansas City Southwest Clinical Society and the School of Medicine of the University of Missouri - Kansas City (UMKC), improves the quality of community hospital specialty department meetings through planned sessions of joint clinical review and combined resource medical audit on predetermined topics (arrhythmia, hypertension, etc.). Evaluation of the sessions is through questionnaires to participants. Self assessment exams are administered to bolster the learning experience. COMPACT also coordinates visiting lecturers, or "docents", of the UMKC Medical School with the continuing education programs of physicians in private practice. On October 26-30, 1971i two inter- nationally known cardiologists from London, England, Drs. Jane and Walter Somerville, appeared extensively in the community, appearing at five of the local hospitals, UMKC, the University of Kansas Medical Center, Kansas City General Hospital, Wayne Miner Neighborhood Health Center, as well as at dinner meetings of the Greater Kansas City Society of Internists and the Kansas City South- west Clinical Society. It is estimated they appeared before 436 physicians in private practice, 13 academic physicians, 134 residents and interns, 40 medical students and 123 nurses. A similar visit on December 16-18 by "Docent" Reginald Hudson, M.D., internationally prominent in cardiac pathology, resulted in appearances before 163 physicians in private practice, 5 academic physicians, 88 residents and interns, 110 medical students and 95 nurses. COMPACT also serves as a clearinghouse by providing a quarterly calendar of the continuing medical education programs in the Greater Kansas City area. The calendar is designed to inform the practicing physician of medical education programs and to help prevent duplication of efforts by planners of such sessions. A card file of all guest speakers is being established to provide the highest quality speakers for future programs. COMPACT wants to involve as many of the private physicians as possible in the Greater Kansas City area in improved specialty department meetings and special programs of the UMKC School of Medicine. Through involvement in continuing medical education.. and improved medical audit, the physicians of this metropolitan area will have increased the quality and level of patient care. COMPACT Back-Up Sheet Region: Missouri Regional Medical Program Locus of Activity: Operational Project Project Title: COMPACT (Cooperative Ongoing Medical-Health Participation and Continuous Teaching) Sponsoring Agency: Kansas City Southwest Clinical Society Project Director: J.H. Morris, Jr., M.D. 2220 Holmes Kansas City, Missouri AC 816 471-3999 Effective Dates: July 1, 1972 -June 30, 1973 Funding: $45,000 Cooperating Agencies and Institutions: University of Missouri - Kansas City; Kansas City Southwest Clinical Society; Kansas City Heart Association; Community Hospitals Area Served: Greater Kansas City Target Population: 1,500 physicians Congressional Districts: #4 William J. Randal #5 Richard Bolling Continuation after RMP Support Withdrawn: MORMP anticipates the activities generated by COMPACT will be continued by the Kansas City Southwest Clinical Society and the University of Missouri - Kansas City with support of community hospitals and area specialty societies. Core Staff Contact: Dr. Warren Sights Date Prepared: 1/25/72 Drafted by: J.H. Morris, Jr., M.D. MISSOURI Cardiac Care Missouri Cardiac Care Missouri began in octobe@ 1971. ,@t@'s overall goal is to lower the death rate from cardiovascular disease in southeast Missouri. There are 25 counties, including 25 ho'spitals, in the southeast region of the state. --,@--th-at- h -the first phase of the project@we,4.,@-@.@017@g nly 13 hospital@. Each of these hospitals has been personally contacted several times in an attempt to gain a greater knowledge of the present status, needs, and desires in coronary care in each of these hospitals. hospital administrators, chiefs of staff, and nursing service directors, i@ was.,Iea@fted- the greatest need apparently lies in ursing and physician education. To n this need, coronary care@ L@o@ V" CAPE GIRARDEAU COUNTY: coronary care training courses for nurses began at Southeast Missouri Hospital and St. Francis Hospital in Cape Girardeau. The ROCOM System iq used as a teaching aid. A- bei: @ulance, rescue, fire and police personnel;/in cardiopulmonary resuscitation)in'J cooperation with the Cape County Ambulance Service. "Earlv Warning Signs of Heari Attack,"' are @ng v staff and volunteers ons, ,,@,@'adio, television and newspaper,$ BUTLER COUNTY A coronary care course has been started in Poplar Bluff, with 28 students. We have had 3 all day sessions. Seven more sessions are scheduled. We have been asked to follow with a repeat course for those unable to attend this time, due to limited enrollment. The four Poplar Bluff hospitals are cooperating in this effort to improve coronary care. The medical ,,\,,,"staffs of these hospitals have met jointly to plan on a Community wide basis. ..,-MADISON COUNTY In Fredricktown.37 persons participated in two 4ecture/ return demonstrate classes on CPR. O@ Another class was presented on first aid and CPR. Twelve persons including police, industrial and ambulance personnel Back-up Sheet Region: Missouri Regional Medical Program Locus of Activity: Operational Project Project Title.- Cardiac Care Missouri Status: Ongoing- Sponsoring Institution: Missouri Heart Association Project Director, Title, Address: Clifford R. Talbert, Jr., M.D. Cardiologist #14 Doctors' Park Cape Girardeau, Missouri 63701 Phone: 314-334-4444 Dates: October 1. 1971 (Fqnds.have been approved until July 1, 1972) Fundipl: $50,000 other FuncTs: Cooperating Aaeacies and Institu'tions: Area Served: 13 counties in southeast Missouri Target Population: 25 counties in southeast Missouri Congressional Districts: 3,ltk @.. 't@kltovs (b) *t% Continuation after RMP Support Withdrawn: Core Staff Contact: Dk. Warren P. Sights Date. Prepared:. 3/3/72 Drafted by: Karen Hendrickson, R.N. MISSOURI SIKESTON INTENSIVE CARE UNIT Intensive care, especially intensive coronary care is becoming a necessity in small community hospitals"with limited medical staff,@ few or no cardiolocrists,,dn-. and limited nure(e specialists. The nearest',@hospital to Sikeston i - 4--t-an--area is 150 miles away.@ @ transportation of the critically ill person to this center would be extremely hazardous. The Sikeston Missouri Delta Community Hospital, with approximately 200 beds serving a rural area of approximately 150,000 people, proposed to set up a model intensive care unit in the belief that a small community hospital can maintain a well-functioning intensive care unit. The beneficial effects are shown in these results: 1. Patient care. The mortality in acute myocardial ihfarcts, which prior to the opening of the unit was 36%, dropped to 11.6% (well in line with the national average). Since the opening of the unit,, only one patient below the age of 60 has died from an acute myocardial infarct while in the unit. Intensive respiratory care resulted in dramatic im ement in patients with acute respiratory prov problems such as crushed chests, acute respiratory failure due to chronic pulmonary disease, respiratory arrest, and etc. Major vascular surgery can be performed now in the hospital with good post-operative care in the intensive care unit. A number of aortic aneurysms have been operated upon successfully. 2. Two-week courses (forty hours) of intensive coronary care and intensive care are being given at six to eight week intervals. These courses consist of lectures by the project director, a vascular surgeon, a chest surgeon and the pathologist. There are also lectures and demonstrations by the inhalation therapist. The course is implemented with the Multi-Media Rocom System. The trainees are given practical demonstrations in cardiopulmonary resuscitation, are called to the unit to observe any procedures such as defibrillations or cardioversions, and are shown autopsies. At present, 22 nurses have been trained from the staff of the hospital and 19 nurses from other hospitals. -2- 3. The opening of the unit has generated interest among the practitioners in the hospital. Several courses in basis electrocardiography have been well attended. The acceptance of the ICU by the medical staff was prompt and immediate. The treatment of the patients in the unit is under the supervision of the attending physician who, with the help of the intensive care nurse, is well able to handle most of the emergency situations. Cardiology consults are available on request. 4. The interest generated in the community and adjacent areas using our hospital is obvious in donations which helped buy the Rocom System for continuing coronary care nurse training. A resuscianne, an electronic heart and other teaching aids have also been purchased for continuing nursing education. 5. Several nurses from small hospitals in the area attended our training program, and with the basic knowledge obtained through our course, they will eventually be able to be used in their own intensive care unit. The Coronary Care Training Program has catalyzed other activities in the hospital. Emergency Room nursing personnel are being trained in cardiopulmonary resuscitation and monitoring of cardiac patients. This training program will be extended to other areas of the hospital such as X-ray technicians and laboratory technicians so that, ultimately, any person being with or around the patients knows the basics of cardiopulmonary resuscitation. Back-up Sheet Region: Missouri Regional Medical Program Locus of Activity: Operational Project Project Title: Sikeston Intensive Care Unit Status:@ Ongoinq S]2onsoring Institution: (Atslmvf-, Project Director, Title, Address: Carl G. Popp,- M.D. Project Director 1012 North Main @Sikeston, Missouri 63801 Dates: Approved July, 1970. Unit opened, September, 1970. rundiEE: July 11 1970 - June 30, 1971 - $1121318 July 1, 1971 - June 30, 1972 - $ 40,000 Other Funds: None Cooj2erating Agencies and Institutions: Area Served: 'Sikeston and surrounding area. @Targpt Population: Approximately 150,000 Congressional Districts: #10 Mr. Bill ]3urli!3on (D) Continuation after-RMP Support Withdrawn: The Intensive Care Unit will function as-a division of the Missouri Delta Community Hospital, Sikeston, Missouri, after termination of the,project. The Coronary Care Nur@e Training Program will be continued-as an in-s@ervice training program indefinitely by hospital and some of the nurse s eci&lists. thomedid4l staff of the p -2- Core Staff Contact: Warren P. Sights, M.D. Date@ Pre2ared: March 8, 1972 Dtafted by: Carl G. Popp, n.D. MISSOURI 10 Automated Physician's Assistant Residents of the small rural town of Salem can benefit from a Missouri Regional Medical Program project, the Automated -Physician's Assistant.- This group of computerized aids is installed in the clinic of Dr. B.J. Bass. Even though 'iles from the University of Missouri-Columbia Salem is 130 m medical Center, Dr. Bass uses the automated equipment to gain access to the'newest technology and information. The automated deviceer free Dr. Bass and his nurses to use their technical skills more effectively and to devote more time to patient care. The automated equipment is linked by telephone lines to a computer in the College of Engineering, University of Missouri- Columbia. With the computer's help, Dr. Bass and his staff can run tests that normally would require a patient to spend up to three days in the hospital, requiring much more time and expense. AX1 patients are weighed and have blood pressure and urinaiysis taken every time they come in, to get a cumulative bulk of information over a period of time. Examples of the automated tests are EKG interpretations, automated patient history interpretations, vision and hearing tests. An automated pro ram does 14 tests on each two-milliliter 9 blood sample. Standards have been set for the normal ranges for any one blood test, given an individual's age, sex, diet and background. The computer compares new information with the established ranges; Dr. Bass can quickly assess what is normal for each patient. A spirometer tests the patient's lung capacity as he blows through a device which measures flow and volume. Mathematical analysis of the speed and amount of exhalation aids diagnosis of respiratory ailments. The computer comp3'.les a list of key symptoms the patient has identified in his automated patient history procedure. With a thorough., computer-printed patient report of symptoms and test findings, Dr. Bass conducts a physical examination. All patient data is recorded in the computet's memory. Any of the information can be recalled instantly by'simply punching the patient's number into the system. I t1.I. I . -. I I. I t 3 'I . I .I I . I Back-up Sheet Region: Missouri Regional Medical Program Locus of Activ@: Operational Project Project Title: Automated Physician's Assistant Status: Ongoing S2onsoring Institution: University of Missouri - Columbia School of Medicine and College of Engineering Project Director, Title, Address: Dr. Earl M. Simmons University of Missouri Medical Center N307 Columbia, Missouri 65201 Dates: 1971 Funding: 153,500 Other Funds: Cooperating Agencies and Institutions: University of Missouri Medical Center University of Missouri College of Engineering Area Served: Southeastern Missouri Target Population: Residents in southeastern Missouri, around the Salem, Missouri, area Congressional Districts: RitAikrd It,6(A (t)) -t I Continuation after RMP Support Withdrawn: Core Staff Contact: Dr. Warren P. Sights Date Prepared: 3/15/72 Drafted By: Elaine Selcraig MISSOURI Biomedical Information Service. Btal.%) Missouri health professionals can take advantage o BMIS, a system that provides quick access to extensive medical information. BMIS relies on the comprehensive facilities of the University of Missourils Medical School library, and on sources such as the Poison Control Center of Childrents Mercy Hospital, Kansas City; and the,Drug Information Center of the University of Missouri - Kansas City School of Pharmacy. The heart of the system is a Mosler information system which stores more than a million pages from medical journals and monographs. These are indexed by content and the index is placed in the computer. The system can retrieve any single page in seconds. If a physician needs specific information on a particular topic, for instance, he can telephone BMIS from anywhere in Missouri. The computer searches through its memory and identifies all the articles about this specific subject. The articles are retrieved and a printer converts the microfiche to standard pages. The BMI8 staff checks the library and other sources for additional information . These items are either mailed or transmitted by photo facsimile. If a physician needs an answer it a hurry, the information can be relayed to him by telephone, and hard copy is sent later as a follow-up. Back-up Sheet Region: Missouri Regional Medical Program Locus of Activity: Operational Project Project Title: Biomedical Information Service Status: Ongoing Sponsoring Institution: University of Missouri Columbia School of Medicine Project Director, Title, Address: Dr. Warren P. Sights 112 Lewis Hall Columbia, Missouri 65201 Dates: 1971-72 Funding: 30,000 Other Funds: Cooperating Agencies and Institutions: University of Missouri Columbia - School of Medicine; University of Missouri - Kansas City - School of Pharmacy; Poison Control Center, Children's Mercy Hospital, Kansas City Area Served: All of Missouri Target Population: Missouri health professionals Congressional Districts: All Missouri districts Continuation after RMP Support Withdrawn: Fee-for-service from users Core Staff Contact: Dr. Warren P. Sights Date Prepared: March 20, 1972 Drafted By: Elaine Selcraig MISSOURI Plan for Improvement of Pharmaceutical Services in Missouri's Rural Health Care Institutions (Hospitals and Nursing Homes) In the first year of this three-year-project, approximately 50 hospitals of 100-bed size or less and 70 nursing homes will be evaluated to determine: current status of pharmaceutical services in the institution; facilities available for providing these services; and, local pharmacists available. Cooperation of the hospitals and nursing homes was requested and thirty-eight hospitals and sixty nursing homes agreed to participate. By using questionnaires developed by Project Director Wayne M. Brown for hospitals and nursing homes, an interview is conducted with the administrator, director of nurses, and pharmacist, if available. The nursing stations and pharmacy or drug room are visited also. As of February 1, 1972, 33 hospitals had been visited. Five have the services of a full-time pharmacist, 16 have a part-time pharmacist, and 12 have the .services of a consultant. Various drug distribution systems have been seen. Many hospitals are concerned and indicate they need help in improving their systems. It is believed that the services provided by the full"time pharmacist will, of course, be better than that provided by a part-time or consultant. It is hoped that a program can be developed and implemented to improve what the pharmacist is doing in these institutions. This is the ultimate objective of this project. Thirty-nine nursing homes have been visited. Eleven have pharmacy consultants and the remaining 28 have no pharmacy service except for the actual providing of the drugs. Of the 11 consultants, 7 were spending some time in the nursing home. This time varied from a half-hour A week to one hour per month. In the other four, the pharmacist did not go to the nursing homes. There is not a great deal of pharmacy input in nursing homes. In the next two years of the project, programs will be developed to help the pharmacist in the institutions provide better service. Back-up Sheet i-on: Missouri Regional Medical Program Locus of Activity: Operational Project ent of Pharmaceutical Project Title: Plan for Improvem Services in Missouri's Rural Health Care Institutions (Hospitals and Nursing Homes) Status: Ongoing Sponsoring Institution: University of Missouri - Kansas City scnool of Pharmacy and Division for Continuing Education Project Director, Title, Address: Wayne M. Brown Assistant Professor School of Pharmacy University of Missouri - Kansas,i Kansas City, Missouri 64110 816-276-1614 Dates: July 1 - June 30, 1971-72 (First year - evaluation) July I - June 30, 1972-73 (Second year - program developmen July 1 - June 30, 1973-74 (Third year - re-evaluation) Funding: 1971- 72 $25,000 ($3,000 added for Green Hills Project) 1972-73 $26,500 1973-74 No funding Cooperatinq Aaencies and Institutions: Missouri Hospital Associatior i Osteopathic Hospital Association, Missouri Nursing Home Association, Missouri State Medical Assotiation, Missouri Association Of Osteooathic Physicians and Surgeons, Missouri Pharmaceutical Association, Missouri Nurses' Association, and the Division of Health of Missouri. Area Served: The State of Missouri - excluding St. Louis County Target Population: 50 hospitals of less than 100 beds and 70 nursing homes. Conqressional Districts: W'l illiam J. Randall (D), Richard Bolling I @(oWm. (Bill) Hull, Jr . (D)@IDurwood G. Hall (R), Richard iteichord (D), Wm. L. (Bill) Hungate, Bill D. Burlison (D). Continuation after RMP Support W@thdrawn: C6re Staff Contact: Dr. Warren P. Sights Date Prepared: 3/l/72 Draf ted By: Wayne M. Brown MISSOURI Green Hills Cooperative Health Care Project Twelve small community hospitals are pooling resources to improve the quality of service in the Green Hills area. The effort involves a communications network, training"!Iambulance attendants, continuing education for health professions, and improvement of emergency care for coronary and stroke patients. Just one example of this cooperation: The Executive Committee of the Green Hills Cooperative Health Care Project requested that the School of Pharmacy at the University of Missouri - Kansas City provide a program of continuing education in pharmacology to nursing personnel now employed. It was their hope that, as a result of this instruction, patient safety would be improved and hospital costs reduced. The programs were conducted by four professors from the School of Pharmacy. They divided into two teams consisting of a pharmacologist and a clinical pharmacist. The teams went to different hospitals and held conferences from 9 - 12 and 1 - 4. it was believed that the pharmacist and nurse should be made more aware of drug administration problems and how to solve them. It was also thought that helpful suggestions could be given to decrease common drug errors in hospitals. Handouts were given out on intravenous solutions - their contamination and incompatibilities, adverse drug reactions and drug interactions. These were discussed in an informal manner to allow the participants to get answers to any problems they were having. Following the corAp,16@ion of these programs an evaluation with the Green Hills,@@-and the two teams will determine the effects of the program and,,x4hat type or types of programs can follow. I Back-up Sheet Region: MoRmp Locus of Activity: Operational Project Project Title: Green Hills Cooperative Health Care Project Status: Ongoing. Sponsoring Institution: Chillicothe Municipal Hospital Project Director, Title, Address: Dr. Joseph Conrad Project Director Chillicothe Hospital Chillicothe, Missouri Dates: 1971-74 Funding: 01 -$30,194 Other Funds: Contributing Hospitals Cooperating Agencies and Institutions: Gentry County Memorial Hospital Sullivan County Memorial Hospiti Noll Memorial Hospital Axtell Osteopathic Hospital Gen4 John J. Pershing Memorial Hospital Ray County Memorial Hospital Carroll County Memorial Hospital Wright Memorial Hospital Chillicothe Municipal Hospital Putnam County Memorial;Hospital St. Francis Hospital Cameron Community Hospital Area Served: Northwest Missouri' Tar@et Population: Population in area of 12 hospitals. saional Districts: W.R. (Bill) Hull, Jr. (D) Congre Continuation after RMP Support Withdra@qn: Common Bond of Hospitals in a cooperative effort. -2- Core Staff Contact: Dr Warren P. Sights Date Prepared: 3/7/72 Drafted by: Elaine Selcraig DRAFT VICUTTE - MW OWIXTAIM STATES) THE IMSE PIRACTITIONER AS A PRYSIC'LAY"S ASSISTANT A Certain areas of rugged land and low population density in Idaho face the amw obim as many rur.&I areas of America - few or no resident physicians. Pr (,U,5tqm P) Rowe"r.@ tho'kountain states Regional Medical Progra"ft, the'state of '14&bo has a program to@ extend @oo4icjil wW to many who otherwise have had to travel alias for basic medical attention. This program, known as the Nurse Practitioner as a Physician's Assistant Progrant is involved in training highly.qualifie4 *ad Motivated nurses to Act as physician's Assistants. The success of the program is directly related to the cooperation of the medical &&4 professional bodies in the State. From the start, the Idaho Medical Association# the Idaho Nurses Association$ and the Boar4o of Nursing, Xe4icine and pharmcy as well as the 'Idaho Rospital Association$ nursing educators *ad the c sities involved were included in the development of the project and kept /Ly the 'Who acted as a. @inf"m4l of its progres@ u IIAJ#on between participants. TWO fmily practitioners living in a c nity of $09 people and serving a papule ion of wre than 6,000 dispersed over a 100 mile radius, @ ogredd to **ploy the nurses as nurse practitioners upon their return from training. Since Idaho has so radical school and currently so physician assistant training prosraa,, the two selected nurses were entered at the Stanford University Medical Conter,which was offering its first pilot program for "pneralists.11 The States as -1 ProgLo@unded the training of the two aurgdo. At Stanford,, the nurses underwent-three months of intensive training, followed by a ww mouth clinical experience with a family practitioner. They a\f/e now @wo tug on an internship basis with the employing Idaho physicians. The aura* practitioner works under the supervision of the physician at all times though this supervision my be through telephone contact. The nurse practitioner duties include: detailed system review and history taking; examinations; pro-natal and volt child care; u~64-S chronic and geriatric aore; normal deliveries; ig @nization and prevention progr Commas'ptat iab pzu,6cuu7' emrgency care, including suturing minor lacerations;@- necessary house calls. The practicing nurse may write proic riptionsi but these most be counttr- signed by one of the physicians within 24 hours. Physicians also review records of all patients teen by the nurse practitioner. During the 1971 legislative session, a change in the Nurse Practice Act of 'Idaho made it possible for the specifically trained nurse to perform those acts of medical diagnosis or prescription of therapeutic or corrective measures which *@ be authorized by rules and regulations jontly promulgated by the Idaho State Board of Medicine and the Idaho Board of Nursing which shall be idiplementod by the lds"o Board of Nursing. This revision to the Idaho law allows the trained physt,cisa's assistant to function effectively without the constraints which could be introduced by licessure of physician atiistants or by us* of rigid definitions in the Medical or Nursing Practice Acts. Back-up Sheet Region: Mountain States Regional Medical Prograin/Idaho Office Locus of Activity: Core Activity Project Title: Nu@e Practitioners Pilot Project for Rural Idaho Areas Status: On going Sponsoring Institution: MSW -- see cooperating agencies, below Project Director, Title, Address: Dates: October 1, 1970 to present Fund@: MSRMP; training made possible by California RMP, Area III Other Funds: Cooperating Agencies and @itutions: Council physician and other health pro- fessionals, State Boards of Medicine, Nursing, Pharmacy, Idaho State Medical Association, State Nurses Association State Hospital Association. Area Served: 2 counties in south central Idaho Target Pbpulation: 6,000+ nwal residents Conmessional Districts: #1 Continuation after IM Support Withdrawn: MSRMP funded tra3-ning and has provided program coordination and continuity. Core Staff Contact: Mrs. Eileen M ll,, R.N. Date Pi-epared: February 14, 1972 fLIleS arici re@!@@ititioris j(liiit@v by tfie Idaho State Boird of Medicine and [lie Idaho Board of' Nui@siiig which sliall be iijipleri-@ented by the Ictifit.) Board of' Nursing." This revision to CA IDAHO'S fdalio"s Ntirsiri@, I)ractice Act has b(,c.T@i ji,icigecl by n health legislation experts to 1)@, the i-nost C.)I 16"4'U rmN S E PRACTITIONER pi@ogressive in ti-ie nation. ](Ia)i(@) law @illo%vs the trained pliysiciiii's assistant to effectively witlioL@l@ the restilt@ing @vhicli could be r-) ijitr(.)dLiced by licetisure of'pli)7siciayi assistants or by the LISE ol' i-i.gid def'iiiiti(@i-is in t@'ie Medical ot- Nursing I)ractice Acts. J.'Iie rules ,tiicl fegijlatiol'is ire @i.pl)roacliing a final draft. l@i ad(lit ion, guidclii-@.es f'or cii@l)loyers or agei@cies @itilizifig tiuj-ses in @@ll @oles will be iii@ide @ivail,-tl)le upon reclti@-,,st f'rc)rii !fie lci@ilio Board of iNu@-sjiig. III a(lditior@@ to the lial.)ilitv @ns@,ti-ance that the 11 LI FSOS carr@, I'@)i t@lieiiiselv@s, (1-ir. l(@@tho p)iysicia[is pay a i-iiiii f'ee i'(@)r aciclit@iori,,il iii@;uj-atite to c @over the iiiii-s(@ practitioner. TI@e i@iui,se p ,ictitioner mi.i@L have o@)portliriities f@@r CO@-itil)Lljl'@g eCILIcatic) jiist @@@ ITIY other l@iealtli r.@rof'e.@si@)Tial does, DLiriiic, tf@e first ycai's intei-ii- ship, the TIL@L@SO [)ractitioiier @viIJ have a great de@il of on-the-job leari-iing expei@ieti(-,@,, As she becomes even TYI(@i-c I)roficient, p@-eceptor@@tiil)s wit@i speci@il- ists will be aT-i-aric,ed to nie(,( lier iriclivi(.].tial needs. A PI]IOI'Pl@OJP'('7' 7'0 Iyl@f]'R 0 R t,R,4 L 111@ @A L 771 R I,,' -'[ie VVICHE Mountain I.;tatps i@egiotial M;.@dical PrcigrarT) encc)rrir)@iss(.@@@ Ida@io, Montana, Nevada and VVvofi-iir,g. I t " one of 56 Regional Medicat Prcjgrarris throughout the nation @@tittiorizfd b,@ Coii@jresS Lin(Jer Pt-. 89 239. of, CIIC, ii-icILI(filig t7 of l'ol- fliol-C iiie(licl] I)Ilt i-@@ flotise calls witli (@oulcl l@ol t)c the I'lill-S,@ I)ra@ti @s (leii@ of l@y I)Y @@)II to i-c@llocl(de(,] @iii ol(I ili@l:) @i @i,avc@l lo@ ii@;@i@-itii,,@@,@. Iiiis I)ioclii-i)e @)e 1)@' [II(' IlLirSC' {call] lab tests viltLi@l@v li@l fol- LI n's l@o lii@ve ill(@ sl.!I.Vi@@!@@s @@f LI ii,ipe"-V II (:)r tile litiTse caii \vlij@.@li sli@, was ti-Liiii(@t@l iii a llos[)@t@ll SCrtill"@ Pl@@@i(IiII2 of- S]I@@ 11)0 IL:ItIIO@i C)t' tile lio@LI)it@ll @io iii ati@] ci. i@illit@l)/ fluxes c,,@ flild tile Lll-iysici@iii", I c@ vie@N, tile r@ic@,)r(ls @ii@ f@roiTi ilic [lie Iii-st itic,j)ts sLeii b@@ tli ri,,irse t)iactiti(.)t-tei. 'f'li,e N@@ell iitirse pil@ici@itioller kil(@)",s [IC]- lililit@iti@),T.ls, I)ita slid i@' she II-,is @ill@ of. colistilis @@@l]@)w @(I by @i iiiot@tl-i tile tile III the o@" [lie [@(@@v wci-lciii@4 oil I'll] I'l-c@ iaiiiI l@ @l' @l tile I '.I i II ol 1 St I Iiiiv i- I INJ cli @t ii Ii a I @e -@7c (I t @i -@IC ](I' 110 TIL]F i2 PI-@[Ctiti(@)IlCfS Ir@ @),iid a i'xed lllolitlit@, 13illiril is the ai@d tli@T,,2 is Tio dit'f'eretitiatioii in cthal@@,@,s t@ @l@Nreci@ Serv@LCeS pk:rf'Orlll(',(i the IC Laid tile iittrEe pi@ IV 1)(@) is l@i- I @@d ,)v I @l 10@@ iaclitis si@@ I @'I 0 i@i w LI Liii,l lit)ii@)i [ier fc)r the I'@)@ f@r) the @l@ @;ysl @ll I view to eti DLI] itl@' ttIO 11) 7 1 soss the @@@ii-s Pi-@icticc @@i iTtide it I)c)ssil)le fbi- the I'l t] v ii I I i c@e \Ni ii,l I I I,, cli IC II @(I I i@@ I I i(@I ti-aii-icLi iiiiise tc) tliosc@ ,icts of' l@osis or or Co@'re@,ltive iiieast)i The Nurse Practitioner as a Lhy@ cian's Assistant Certain areas of rugged land and low population density in Idaho face the same probl-em as many rural areas of America - few or no resident physicians. 1-1c)-,,.,ever, with the help of the Mountain States Regional Medical Program (@ISRI%T) the State of Idaho has designed a proar@tm to extend medical tare to many who otherwise have had to travel miles for basic medical attention. This program, known as the Nurse Pracctitioner as a Physician's Assistant Program, is involved in training highly qualif4ed and motivated nurses to act as physician's assistants. The success of the program is directly related to the cooperation of the medical- and professional bodies in the State. From the start, the Idaho Medical Association, the Idaho-Nurses Association, and the Boards of Nursing, Medicine and Pharmacy as well as the Idaho Hospital. Association, nursing educators and the communities involved we.re included in the development of the project and kept informed of its progress by the MSPMP who acted as a liaison between participants. Two family practitioners living in a community of 899 people and se rving a population of more than 6,000 dispersed over a 100-mile-radius, agreed to employ the nurses as nurse practitioners upon their return from training. Since Idaho has no medical school and currently no physician assistant training program, the two selected nurses were entered at the Stanford University Medical Center which was offering '+-I =.t pilot program for 11 generalists." The MS@IP funded the training of the two nurses. At Stanford,+ the nurses underwent three months of intensive training, followed by a one-month clinical experience with a family practitioner. The @urse ?ractitioner works under the supervision of the physician a all times, though this supervision may be through telephone contact. Thetiurse actitioner duties include: detail.ed syste@ review and history @aking; @irlysical examinations; pre-natal and well-child care; chronic and geriatric care, normal deliveries; immunization and Drevention programs; emergency care, including suturing minor lacerations; necessary house calls. The practicing nurse may write prescriptions, but these must be countersigned by one of the physicians within 24 hours. Physicians also review 'records of all- Datients seen b-@ the nurse practitioner. During the 1971 legislative session, a change in the Nurse Practice Act of Idaho made it possible for the specifically trained nurse to perform those acts of medical diagnosis or T)re@cription of therapeutic or corrective measures which "may be authorized by rules and regulations jointly promul- gated by the Idaho State Board of Medicine and the Idaho Board@@jof Nursin- which shall be implemented by the Idaho Board of Nursing." This revision to the Idaho law allows the trained physician's assistant to function effectively without the constraints which could be introduced by licensure of physician assistants or by use of rigid definitions in the Medical or Nursing Practice Acts. Mountain States Regional Medical Program Idaho Office CORONARY CARE NG FOR SO@ST IDAHO AND EASTERN OREG A unique consortium has developed to meet the need for trained coronary care nurses for southwest Idaho and eastern Oregon. . area hospitals, St. Alphonsus and St. Lukets Hospitals in Boise, Caldwell Meinorial Hospital in Caldwell and Mercy Medical Center in Nampa have formed a consortium to provide training to area nurses. The Idaho Heart Association provides monies for this training and coordinates the project. /Idaho also provides sane funds for the project and furnishes office space and secretarial assistance to the Nurse Coordinator. Four six-week programs in coronary care-intensive care are held at alternating hospitals. N@es from outside the hospital consortium may take the training for a $100 tuition fee. More than 160 nurses have been trained in coronary care- intensive care in the two-and-one-half years the program has been in operation. Back-up Sheet Region: Mountain States RIP/Idaho Office Locus of Activity: operational Project Project Title: coronary Care Training in Southwest Idaho Eastern Oregon Status: on going sponsoring Institution: Idaho Heart Association Pr,ojer-t Director, Title, Address: Ray Willy Executive Director Idaho Heart Association 2309 Mountain View Drive- Boise, Idaho Dates: August, 1969 to present Funding: Idaho Heart Association; MS@/Idaho; St. Alphonsus Hospital in Boise; St. Luke's Hospital, Boise; Mercy Medical Center, Nampa; Caldwell Memorial Hospital, Caldwell. Other Funds: Cooperating Agencies and Tnstitutions: Same as above. Area health professionals assist in the teachirg through the coordination of a nurse Coordinator. Area Served: Southwest Idaho - Eastern Oregon (300,000 population) Target Pbpulation: All coronary patients in target area Congressional Districts: #1 Contirumt'ion after W Support Withdrawn: Hospital consortium, Idaho Heart Association, possibly other sources Oore Staff Contact: Mrs. Wilma Secor, R.N.,, Nurse Coordinator Date Prepared: February 14 1972 5 Mountain States Regional Medical Program Idaho Office TREASUP,E VALLEY EXPERIMENTAL BEALTH SERVICES DELIVERY SYSTEM In Ju-1y@ 1971, the Director of the Idaho office of,@' Fred 0. Graeber, M.D., was asked to also serve as temporary director for the Treas@ Valley Experimental Health Services Delivery Systerno a HSMHA contract with Boise State College for the development of an experimental model system of health care, combining existing compo- nents in innovative arrangements. Thxough January 31, 1972, when a permanent director was appointed, Dr. Graeber served in this new capacity. An advisory camnittee and several ad hoc c@ttees were formed. A work plan was formulated and articles of incorporation and by-laws were drafted. I.I.-MS-RMP/Idaho is presently providing office space to the permanent director and will continue to assist in the development of the project wherever possible. Back-up Sheet_ Region: Mountain States Regional Medical Program / Idaho Office Locus of Ar-ti@ity: Core Activity Pr,oject Title, Treasure Valley Exper@ntal Health Services Delivery System Status: On going Sponsoring Institution: Boise State College Project Dir-ector, Title, Address: Douglas M. Mitchell Project Director Treasure Valley EHSDS P.O. Box 957 Boise, Idaho 83701, Dates: A@t 4, 1971 to present (d@ con@mc+ was ti@n" by Boise S@ coiteqe) @ing: HSHM contract Other Funds: none at present NSRT/Idaho contributing office space Cooperating @encies and Institutions: Area Served: Treasure Valley - lo counties in Southwest Idaho and one county in Eastern Oregon Target POPulatic)n: 300,000 u-rban and rur@ including large ChicanO POPulatlon Congressional Districts: #1 Continuation after RMP Support Withdr-awn: Oore Staff Contact: Fred 0. Graeber, M.D. Date Pmpared: February 14, 1972 Mountain States Regional Medical Program Idaho Office OONSUMER EDUCATION IN ATHEROSCLEROSIS Too many people are ignoring the relationship of diet, exercise, and smoking to heart disease., In an effort to call these things to the attention of the general public, /Idaho and the Idaho Heart Association prepared an attractive information leaflet which was distributed to those who attended the Southwest Idaho State Fair in Boise during the last @eek in August,@ 1971. A booth at the fair demonstrated coronary care monitors and other equip- ment. Additional information on heart and related diseases was available for those interested. The Idaho Heart Association has made this leaflet available in their own information racks in various locations such as hospitals and physicians' offices. Back-up Sheet ReL',iOn: Mountain States Regional Medical Program/Idaho Office Locus of Activity: Core Activity Project Title: Consumr Education in Atherosclerosis Status: On goang sponsoring Institution- MS@/Idaho and Idaho Heart Association Project Director, Title, Address: Williain J. Coffman - Coordinator for Planning Operations MSRMP/Idaho P.O. Box 957 Boise, Idaho 83701 Dates: August, 1971 to present Funding: MSRMP/Idaho and Idaho Hospital Association Other Funds: COO@@ing @ies and Tnstitutions: Area Served: Southwest Idaho and Eastern Oregon Target Pbpulation: All persons in area Congressional Districts- #1 Continuation after @ Support Withdrawn: Oor,e Staff Oontact: William J. Coffman Date Prepared: February 14, 1972 FRED 0. GRAEBER, M.D., Director IDAHO DIVISION P.O. BOX 957, BOISE, IDAHO 93701 TELEPHONE: (208) 343-4817 ACTIVITY BRIEF NLIW 36 AWLJS7 2, 1971 tZT PROGRAM UWLD AT MOUNTAIN [WE AIR FORCE BASE The Military Assistance for Safety in Traffic (MAST) program operated at Mountain Home Air Force Base has been expanded to include inter-hospital transfer of patients and pick up and delivery of blood, medicine and human organs for transplant, ac T-@re ative's-,,,@ - The MAST program, whic7n utilizes military equipment and medical personnel inproviding emergency medical assistance and evacuation, particularly in accident casesl has been in operation as a pilot project on five military bases for n a year @n Home Air Force Base,, seven rescue missions flown 14, 4-@, including the July 3rd air lift from an isolated area of a @'L boy who had broken his leg. The important feature of this service is -Cne attendance of a medical corpamnduring all missions flown by MAST. Tne Idaho office of MSRMP has worked closely with MAST officials in Washington, D. C. and at Mountain Home Air Force Base, and with Idaho State Police and others involved in developing this Helicopter medical service. MSRMP/Idaho m s have attended all local and regional Kk3T meetings and assisted in organizing site visits and briefings. A committee to coordinate MAST activities for this area and to educate professional and consumer groups about the availability of this additional emergency medical service is being organized# Everett P@, Director of the an@ency Medical Service Division of the Idaho De t of Health has been selected as tor, an@ fcoL WEI,,rFitN INI'ER'ITATE COMMISSION l,'Olt HIGHE[T EDUCATION Back-up Sheet Region: Mountain States Regional Medical Program/Idaho Office Locus of Activity: core Activity Pi,oject Title: Military Assistance to Safety and Traffic (MAST) Status: On going a2nsoring Institut'10n: Mountain Hcme Air Force Base, Idaho Pr,oject Dir-ector$ Title@ Address: Major Charles W. Bradley Chief, Safety Division Mountain Home AFB Hq. 347th Tactical Fighter Wing/Tac Dates: July 1970 to present Funding: De nts of Defense, Transportation and Health, Education and Welfare Other Funds: Cooperating Mencies and Institutions: Mountain Home Air Force Base, Idaho State Police and other law enforcement agencies, Idaho Dep@ent of Health (Emergency Medical Services division), MSRNP/Idaho Area Served: Southwest Idaho Target Population: Accident and inju-ry victims Con-wessional Districts: #1, possibly parts of #2 Continuation after RMP Withdrawn: MSRMP/Idaho support has been in C( meetings, facilitating comunications, etc. Core Staff Contact: William J. Coffman Date Prepared: February 141, 1972 FREO V. UMALStm. M.U., IDAHO DIVISION i" 'N P.O. BOX 957, BOISE, IDAHO 83701 TELEPHONE: (208) 343-4817 ACTIVITY BRIEF NLfiBER 48 FEBRJARY 2, 1972 'EDICAL SERVICES PLMIED FOR STNILEY BASIN AREA The town of Stanley is located in the Sawtooth Mountains near Idahols primitive area. The population in winter is only 47, but from June to mid-October, the population is swelled by numerous loggers, summer msi- dnets, tourists and hunters. During this period, automobile accidents and injuries as well as hunting and gunshot accidents take their toll. The nearest hospital and physicians are 61 miles away, over an 8700 foot sLumiit via a twisting road, which is 2--2 1/2 hours driving time. The closest source of assistance is the forest ranger station in Stanley. Boise Mrs. Marie Osborn, a registered nurse,'@ivi is a summer resident of Stanley, approached both MSRMP/Idaho and the Idaho Hospital Association@er concern over major accidents and emergencies that have occurred. MSRMP/Idaho and IHA, working with the'coirmunity of Stanley, physicians in nearby Hailey and St. Alphonsus and St. Luke s Hospitals in Bo-,se, @ developed a refresher and in-depth training program in eimr- gency and trauma situations for Mrs. Osborn which fit the requirements of lations for expanded roles in nursing State Boards of Medicine and Nursing. Co@ty initiative and involvement have been key factors in the development a- this program. Stanley raised the funds to secure an aTrbulance and 25 of the town's 47 residents volunteered to take the first aid training @offered by Idaho Falls technicians. Two physicians in Hailey am interested in Droviding back-up and consultative services via phone and standing orders pertinent to anticipated situations. Wis. Osbom@ completed a six-week ional practice experience cit St. Luke's Hospital, and she riod of time in the trauma L,-U-r in the new St. Alphonsus Hospital., She ly 'E.tte,ndi% the first two-weeks of the Southwest Idaho Eastern Oregon k,or,onary Care Tr course in coronary-intensive care. Febru@ @ she , Harborview Hospital in Seattle for a One-MOA'LWA pr,eceptoiship in emergency medical s the cooperation o Wash@on/Alaska RW. Finally'r"@i@ sane clinical experience with the two Hailey Dhvsicians in -Dreparation for the provision of @diate assistance to accident and injury victi= in the Stanley area summer* (,%Tl@',]?S'I'ATE COMMISSION T@Oft lllil[JEI( Back-up Sheet Region: Mountain States Regional Medical Program/Idaho Office Locus of Activity: Core Activity Project Title: Dnergency Medical Services for Isolated Rural Idaho Area Status'. On going Sponsoring Institution: MSRMP/Idaho and Idaho Hospital Association Pmject Director, Title, Address: Dates: September, 1971 to present @ing: MSRMP/Idaho, Idaho Hospital Association (Kellogg Foundation Grant) Other Fmds: Other foundation mnies, private donations, contributions from co@ty Cooperating Agencies and Institutions: MSRMP/Idaho, Idaho Hospital Association, Washington/Alaska RMP, St. Alphonsus and St. Lukets Hospitals in Boise, physicians in Hailey, Idaho, cannunity of Stanley, Idaho Falls health professionals Area Served: Stanley Basin, near Idaho primitive area Target Population: Congressional Districts: #2 Continuation after RW Support Withdrawn: MSRMP providing funds for training only. Local sources are providing all other funds. Core Staff Contact: Mrs. Eileen M 11, R.N. Date Pm@: Febru@ 14, 1972 Nassau-Suffolk HOME HEALTH CARE It apparent f that many people in need of health care could be cared for at home if necessary services were available. For these people, home care would prove a more humane, less costly procedure -of .. living at - home,--wh@,i@lel-p@l unnecessary overcrowding of hospitals and nursing homes. some people are currently receiving certain home care services r-,@@sferious omissions remain in existing programs. Of major concern is access to services, particularly for patients lacking adequate financial resources. In July of 1971, the Comprehensive Home Health Care Project was established @@t.--to address,--th,is@--@prob-i-em-,--i-n..-a tho h tic-,-mann,,--r..-i-- The project'-,s,---primary,-,@g-o@zrl-@--is the develop coordinated comprehensive home health service System for Nassau and Suffolk Counties. --T-- @-@STU.]aYING.,-,THE--@PROB=-AND BUT PI ,.,A%--MODEL,-- To develop a coordinated comprehensive system of home health services, -it ħ5 i-teee&s-a @g present programs and financing patterns V',4 against the need@for -'In addition to analysis of 6eds as perceived by n Provider agencies, it is essential to analyze needs as inter- L_ireted by users or,potential users of home health services. Such a study will be conducted by The Health Management Group, a health management firm, under contract to the Nassau-Suffolk Home Care Council. During the first year, the study will examine various situations which might benefit from home care, including mental as well as physical conditions. It will consider all types of home services needed such as nursing, homemaker, home health aide, physical therapy, occupational therapy, speech therapy, psychiatric, dental, optometric., "meals on wheels" and friendly visiting. ,Created with related organizations such as planning and coordinating agencies, professional associations and volunteer citizen and consumer groups. -2- Financing procedures will be investigated in order to identify preventing needed services from being rendered. .,Among programs analyzed will be Medicare, Medicaid, Blue Cross, private insurance and individual payment. a result of this study, a "descriptive model" analyzing the existing service system will be created. Proposals for reorganization will then be formulated in a "normative model" and tested in group sessions involving both providers and consumers of service. The aim of the group sessions will be ',\"to arrive at agreement on administrative and organizational changes necessary for the creation of an effective system of coordinated comprehensive home care services. During the second year,@ proposed organizational models will be ield test@, @@ne--,the-ir. During the third year, the final plan for a program of coot- dihated comprehensive home care services for the residents of Nassau and Suffolk Counties will be The Nassau-Suffolk Regional Medical Program, Inc. has been particularly concerned with the problem of home health care as an important part of its commitment to the over-all improve- m6nt of the quality and quantity of ambulatory health care services oh Long island. It has,.therefore, supported both the initial development of the Project as well as its current operation. The proposal for the Project was sponsored by the Federation of Visiting Nurse Services of Nassau and Suffolk Counties and the Nassau Community Health Services Foundation. BACK-UP SHEET 1. REGION - Nassau-Suffolk Regional Medical Program 2. LOCUS OF ACTIVITY - Operational Project 3. PROJECT TITLE - Comprehensive Home Health Care Project 4. STATUS - Ongoing 5. SPONSORING INSTITUTION - Federation of Visiting Nurse Services of Nassau and Suffolk Counties, and The Nassau Community Health Services Foundation 6. PROJECTOR, TITLE, ADDRESS: Mr. Alan N. Fite, Project Director 1200 Stewart Avenue Garden City, New York 11530 516-997-5060 7. DATES - July 1971 - June 1974 8. FUNDING - $285,113 (over a three-year period) 9. OTHER FUNDS: None 10. COOPERATING AGENCIES AND INSTITUTIONS: Health Departments, visiting nurse associations, church sponsored home care services, Departments of Social Services and Mental Health, hospital-based home care programs, and proprietary homemaker-home health aide agencies. 11. AREA SERVED - Nassau and Suffolk Counties, Long Island, New York 12. TARGET POPULATION - All Nassau-Suffolk residents who could benefit ft@m Home Health Care. 13. CONGRESSIONAL DISTRICTS: C.D.# Incumbent Party 1 Otis G. Pike D-L 2 James R. Grover, Jr. R-C 3 Lester L. Wolff D-L 4 John W. Wydler R 5 Norman S. Lent R-C Back-Up Sheet (cont.) -2- 14. CONTINUATION AFTER RMP SUPPORT WITHDRAWN: N-S RMP believes that existing and additional home health services will begin to operate within the framework of the model created for coordinated Comprehensive home care services. 15. CORE STAFF CONTACT - Gladys Rothbe 16. DATE PREPARED - February 10, 1972 17. DRAFTED BY Gladys Rothbell BACK-UP SIIEET 1. REGION Nassau-Suffolk Regional @ledical Program 2. LOCUS OF ACTIVITY - Operational Project 3. PROJECT TITLE - Comprehensive Home Health Care Project 4. STATUS - Ongoing 5. SPONSORING I14STITUTION - federation of Visiting Nurse Services of Nassau and Suffolk Counties, and The Nassau Community Health Services Foundation 6. PROJECTOR, TITLE, ADDRESS: 14r. Alan N. Fite, Project Director 1200 Stewart Avenue Garden City, New York 11530 516-997-5060 7. DATES July 1971 - June 1974 8. FUNDING - $285,113 (over a three-year period) 9. OTHER FUNDS: None 10. COOPERATING AGENCIES AND INSTITUTIONS: Health Departments, visiting nurse associations, church sponsored home care services, Departments of Social Services and llental Health, hospital-based home care programs, and proprietary homemaker-home health aide agencies. 11. AREA SERVED - Nassau and Suffolk Counties, Long Island, New York 12. TARGET POPULATION - All Nassau-Suffolk residents who could benefit from Home Health Care. 13. CONGRESSIONAL DISTRICTS: C.D.# Incumbent Party 1 Otis G. Pike D-L 2 James R. Grover, Jr. R-C 3 Lester L. liolff D-L 4 John W. Wydler R 5 Norman S. Lent R-C Back-Up Sheet (cont.) -2- 14. CONTINUATION AFTER PI.,IP SUPPORT WITIIDRAIA714: N-S RYP believes that existing and additional home health services will begin to operate within the framework of the model created for coordinated comprehensive home care services. 15. CORE STAFF CONTACT - Gladys Rothbell 16. DATE PREPARED - February 10, 1972 17. DRAFTED BY Gladys Rothbell NEBRASKA .00RO.NARY CARE TRAINING & SUPPORT PROGRAM. .The Coronary Care Training and Support Program, existing at Bryan Memorial Hospital,.Creighton Memorial St. Joseph's Hospital, and the University of Nebraska College of Medicine, has completed its second year of coronary care training. During this period, formal training programs were prov@ded for 116 nurses, 75 doctors. and 39 technicians. Refresher courses (presented on an outstate basi were attended by 388 nurses. Five technical service programs hold a@ Creighton attracted participation from 115 persons. Six obe-hour telephone conferences were conducted by the University of Nebraska in cooperation with 18 hospitals. The total number of personnel participating in these con- ferences was 287. A workshop field in Omaha by the University of Neb- raska was attended by 52 physicians. In addition to the Coronary Care d Support Program, ;Ls i prof es s iona Compaq C ced--by,@he Inter-Mountain Regional Medical Programiin response td@requests by,4phys-ke@ for continuing education e materials on given procedures in coronary techniques and patient car audiq-cassettes have been furnished to physicians at six locations@here they are shared in the clinics and hos als. A recent survey of all nurses trained @y oronary Care Training and Support Program,indicated that 70 percent or 528 of these nurses wanted some f inu,'n co narv ed cati n , ft _g" @ ? rm 5 0 -t I&' A course" consisting 'of 6 prog rammed instructural lessons on electrocardiography r@+eldl o nurses, f th g mailed at the rate,of two S.4 to each nursei A course of 120 lessons follow these, mailed at the rate- of ten per month. During the coming year, additional activities are projected with the nurse and @e physician continuing education material. . .gn expansion of the nurses' continuing education courseaplannedwhich @@@iace copies of t-he -,our4p, irk hospitals throughout,the state. iLncorp@t4-i.rilt-o -klelcal libraries and made available to all9tn4Vrses NRMP is currently in the process of obtaining AAGP certification of the physician continuing education course'.so@@that--@,Physi:drdff§"-@siti",- par -a-t -o- rr- t-n- At present, NRMP is undertaking follow-up.evaluation testing 'co4trolly- t4 -for all persons having compl@ he Coronary Care Training and Support Program. Back-up Sheet REGION: Nebraska Regional Medical Program LOCUS OF ACTIVITY: Operational Project PROJECT TITLE: Coronary Care Training & Support Program STATUS: Ongoing SPONSORING INSTITUTION: Nebraska Regional Medical Program PROJECT DIRECTOR, TITLE, ADDRESS: Deane S. Marcy, M.D. Project Administrator Coronary Care Training & Support Program 700 C.T.U. Building 1221 "N" Street Lincoln, Nebraska 68508 Richard Booth, M.D. Charles Hamilton, M.D. Stephen Carveth, M.D. Project Director Project Director Project Director Coronary Care Training Coronary Care TraLning Coronary Care Training and Support Program and Support Program and Support Program Creighton Memorial St. University of Nebraska Bryan Memorial Hospital Joseph's Hospital College of Medicine 4848 Sumner Street 2305 So. 10th St. 42nd & Dewey Lincoln, Nebraska Omaha, Nebraska 68108 Omaha, Nebraska -68105 68510 DATES: January 1, 1970, became an operational.project FUNDING: 02 $95,241 OTHER FUNDS: None COOPERATING AGENCIES AND INSTITUTIONS: American Heart Association, Nebraska Heart Association, Creighton University, Omaha, Nebraska, University of Nebraska, Bryan Memorial Hospital, Lincoln, Nebraska,. Inter-Mountain Regional Medical Program. AREA SERVED: Nebraska, Iowa, South Dakota and Kansas TARGET POPUIATION: Nebraska CONGRESSIONAL DISTRICTS: #3 Dave Martin (R), #2 Charles Thone (R), #1 John R. McCallister (R) CONTINUATION AFTER RMP SUPPORT WITHDRAWN: The staff member responsible is exploring the possibility of continuing the programs without NRMP funding through such means as tuition fees paid by the participants benefiting from the training. He has also contacted insurance companies about assisting the program financially. CORE STAFF CONTACT: Ronald D. Barnfield, Area.Consultant DATF, PREPARED: 2/12/72 DRAFTED BY: Darrell D. Buettow/Dawn Greene Muich NEBRASKA MOBILE CANCER DETECTION@UNIT po@of the Mobile Cancer Detection Un4 prove t e cance control,in this region by making availabi fre C" ing_of_major cancer target organs as well as cancer education. The Mob--L 1-ti-Cancer Target Screening Unit is the first of, s@isdlm- in the world. One of the Unit@ Is to ulate improved medical care in different racial, ethnic, mino Ity, an rural heterogeneous groups.,@ the majority of persons do not periodic cancer screening. Reasons for this are legion and include socioeconomic 3 -1 - - -, and educational factors, @dentia- ----@iom'proximity to physicians, and psychological factors. By literally bringing the detection unit to the patients' doorstep, preceded by an education and publicity campaign, the common denominators of fear, anxiety, apprehension, denial a nd fatalism are often avoided. The Unit provides multiphasic cancer screening, an excellent opportunity for cancer education, And provides the patient with the basis for a communicative and supportive follow-up relationship with his personal physician. The Unit is 60' long and 12' wide. It'contains a reception room where automated cahcer-medical histories are ta end rooms for proctosig- moidoscopy, a dental room for oral cancer screenings rooms for gynec6l- OgLcal screening and a room for mammography. Person@@l consists of recep- tionists,(:j) or a dentist, social worker, nurses, and,v ical society endorsement and publi'city@a., -120 patients each day-at p-r. All patients are given an abdominal examination/@a complete examination-of the skin, oral examination and American Cancer Society information. The time for exam- Lnation in the Unit ranges from about 20 minutes for a male under age 40 (the cutoff age for proctosigmoidoscopies).to about an hour for a woman over age 40 wholin addition to proctosigmoidoscopemust have a pelvic examination and mammography. gach female patient is taught to perform a self-breast examination and @rovided with American Cancer Society information describing self-examination. The entire project is computer adapted so that within a period of 48 to 72 hours, a full report will be sent to the patient's family physician. The report contains every piece of evidence pertaining to patient history and physical findinas, including occupational and hereditary neoplasm hatards. As a double-check, a return postcard is provided with each report which must be checked and signed by the patient-is physician, indi- cating receipt of the report. A follow-up call is made on failure to receive this card. In each case, the patient is urged to see the desig- nated physician. At three specific sites, 932 patients were seen with a confirmation of seven positive malignancies and 320 abnormalities in 27 possible disease areas or categories. Th@:a@e-ptance and documented need at the three specific sites was overwhelming in every instance, and it has been extremely @ra@i:fy@ng_,,f_rom a medical standpoint that people have traveled 200 miles in some instances (-ru al locations) to take advantage M-.--the--Mobile Cancer Detection Unit screening.,rThe patients and physicians repeatedly express gratitude to.',@us for providing this opportunity. A:,,ICER DETECTID- IIAOBIL- --4 7I Back-uD Sheet .R=ON: Nebraska Regional Medical Program LOCUS OF ACTIVITY: Operational Pro ect .PROJECT TITLE: A Proposal in Neoplastic Diseases: A Mobile Cancer Screening Unit =US: Ongoing @NSORING INSTITUTION: Creighton University School of Medicine CT DIRECTOR, TITLE, ADDRESS: Henry T. Lynch, M.D. Professor and Chairman Department of Preventive Medicine and Public Health Creighton University School of Medicine 657 North 27 Street Omaha, Nebraska Initial RMPS support, January, 1970 NG: 02 $76,024 .-FUNDS: $1000 from Massachusetts Mutual Life Insurance Company on the contingency that the Unit be operational during t-he-f-irst quarter of 1972 @-PERATING AGENCIES AND INSTITUTIONS: County Medical Societies, Nebraska -Medical Association, Public Health Service, Indian Community Health S6r- itilce, Comprehensive Health Association of Omaha, American Cancer Society, @en's Auxiliary Groups, Extension Organizations, Practicing Physicians, -Churches, Newspapers, Radio and Television Stations. SERVED, Nebraska T POPULATION: Medically indigent of Nebraska -MbiGRESSIONAL DISTRICTS: #3 Dave Martin (R) #2 Charles Thone (R) #1 John R. McCallister (R) CONTINUATION after RMP SUPPORT WITHDRAWN: Applications to the Insurance industry as well as to the State Health Department in Nebraska have been made. At present a grant proposal is being prepared to submit to the American Cancer Society in order to keep this project viable at the end of NRMP grant support. CORE-$TAFF CONTACT: Deane S. Marcy, Coordinator NRMP I)@TE-PREPARED: 2/12/72 I)RAFTED,.BY:--Darrell D. Buettow/Dawn Greene Muich NEBRASKA LEARNING RESOURCE CENTER The Learning Resource Center (Medical Media Library) provides multi- disciplinary programs that represent a broad distribution of overall .categorical diseases and all departments represented in hospital structure The Learning Resource Center has also designed and imple- mented inservice training programs covering a wide variety of areas for 15 hospitals in the state of Nebraska. The media itself consists of: overhead transparencies, sound-slide sets, and sound filmstrip sets. The library purchases only commercially produced media that are first previewed by Cote Staff, and approved or disapproved by two hospitals following their evaluation. The library will also purchase media upon request by a hospital. The library has material in the following areas: housekeeping, food service, nursing service, -inhalation therapy, aid training pharmaceutical service, emergency service, and particular emphasis on coronary and intensive care. The goals of the Learning Resource Center are: To provide commercially produced media to any health care institu- tion at a minimum of cost. To encourage health care institutions to develop continuous and ongoing inservice education proarams for all types of employees. To encourage health care institutions to seek outside,resources for developing inservice programs. To provide consultation to any health care institution requesting such consultation for evaluation of current ins6rvice program or to help design new inservice programs. To encourage local hospitals to form cooperative inservice training groups that can "pool" resources and ideas to promote better inservice training programs. The Learnina Resource Center has acted as consultant for closed circuit television ta many hospitals, and has encouraged the establishing of'revieii committees to preview and evaluate media materials before the hospital uses them in their inservice training procrams. To date, this has been achieved in 88 per cent of the hospitals in Nebraska. As of November 1, 1971, the Media Library has received 3,715 requests. We are projecting that during the second year of operation, the library will receive 4,164 requests. The Learnina Resource Center has planned and coordinated eight inservice 0 training workshops throughout the State of Nebraska and has participated in numerous lectures and presentations to groups on the fundamentals and principals of training. Back-up Sheet REGION: Nebraska Regional Medical Program LOCUS OF ARTIVITY: Core Activity PROJECT TITLE: Learning Resource Center STATUS: Ongoing SPONSORING INSTITUTION: Nebraska Regional Medical Program PROJECT DIRECTOR: John H. George, Director Learning Resource Center. Nebraska Regional Medical Program 700 C.T.U. Building 1221 "N" Street Lincoln, Nebraska 68508 DATES: In July, 1971, the Learning Re source Center became a Core Staff activity, and fully operational. Prior to that, it was a part of a funded operational (Communication Facility)Project from May, 1970 to July, 1971. FUNDING: 01 $15,000 OTHER FUNDS: The Learning Resource Center will be receiving outside supplementary funding from the South Dakota RMP. ,COOPERATING AGENCIES AND INSTITUTIONS: South Dakota Regional Medical Program, Nebraska Hospital Association, Nebraska Television Council for Nursing Education, Nebraska Nursing Home Association, National and Nebraska-Iowa Chapter of American Society of Hospital Food Service Administrators, and the Nebraska Nurses Association. AREA SERVED: Nebraska an South Dakota TARGET POPULATION: Nebraska and South Dakota COIGRESSIONAL DISTRICTS: #3 Dave Martin (R) #2 Charles Thone (R) #1 John R. McCall4Lster (R) OONTINUATION AFTER RMP SUPPORT WITliDRAWiN: The Director, Learning Resource Center, is investigating the Dossibility of phasing out the media library into one of the health associations, i.e., Nebraska Hospital Ass ociatioa or the Nebraska Nursing Home Association. CORE STAFF CONTACT: John George, Director Learning Resource Center DATE PREPARED: 2/12/72 DRAFTED BY: Darrell D. Buettow/Dawn Greene Muich Back-uD Sheet .@-G-ION: Nebraska Regioial Medical Program LOCUS OF ACTIVITY: Operational Project PROJECT TITLE: A Proposal in Neopl.astic Diseases: A Mobile Cancer Screening Unit .STATUS: Ongoincr B2-ONSORING INSTITUTION: Creiahton University School of Medicine P-@MJECT DIRECTOR, TITLE, ADDRESS: Henry T. Lynch, M.D. Professor and Chairman Department of Preventive Medicine and Public Health Creighton University School of Medicine 657 North 27 Street Omaha, Nebraska @ES: Initial RMPS support, Januar , 1970 y YMDING: 02 $76,024 'DTHER FUNDS: $1000 from Massachusetts Mutual Life Insurance Company on the contingency that the Unit be operational during --he -first quarter of 1072 t- @OOPERATINk-i AGENCIES AND !NSTITUTIOINS: Countv Medical Societies, Nebraska -Medical Association, Public Health Service, Indian Communlry Health Ser- .@ice, Comprehensive Heal-th Association of Oaaha, American Cancer Society, Vmen's Auxiliary Groups, Extension Ot@anizations, Practicing Physicians, -Chxjrches, Newspapers, Radio and Television Stations. :AREA--SERVED: Nebraska @GET POPULATION: Medically indigent of Nebraska -CONGRESSIONAL DISTRICTS: #3 Dave Martin (R) #2 Charles Thone (R) #1 John R. McCallister (R) CO,NTINIUA'PION after @ip SIJPI)C,,r"i' WITIIDP-@,W,i: Applic,'Iti-ons to the Insurance industry as well as to Li,,@ State Health Department in Nebraska have been made. At present a grant proposal is being prepared to submit to the American Cancer Society in order to keep this project viable at the end of NZIP grant support. CORE STAFF CON'-PAc,r: Deane S. Marcy, Coordinator N@IP DATE,PREPARED: 2/12/72 I)RAFTED BY:- Darrell D. Buettow/'Dawji Greene Muich CORE Si',AUi' CC)N"PACT: John Georcfe, Director 0 Learnina Re-source Center DATE PREPARED: 2/12/72 DRAFTED BY: Darrell D. Buettow/Da@qn Greene Muich CORE STAFF CONT-KCT: Ronald D. Barii'Lield, Area Consultant DATE PREPjkRED: 2/12/72 DP,&FTED BY: Darrell D. Buettow/Da@,:ii Greene Muicti New Jersey ift@ojmal Meclicai Procram Regional Radiation Automated Dosimetry Project A $67,44S "Regional Radiation Automated Dosimetry Project" sponsored by the New Jersey Regional Medical Program will upgrade the treatment of 8,000 of New Jersey's 25,000 new cancer patients annually. These patients require radiation therapy which, when properly applied, can cure a pa- tient's cancer or at least reduce his suffering by destroying certain cancer cells. To assure, safe, precise and effective radiation doses for their patients, 21 hospitals in New Jersey have formed the first state-wide net- work linked by teletype to the Dose Distribution Computation Service at New York's Memorial Hospital for Cancer and Allied Diseases. Data on patients is forwarded by teletype to Memorial Hospitalls computer which analyzes the information and relays a treatment plan back to the originating hospital. This plan assures the best distribution of radiation during treatment so that the cancer site receives the maxinmm dose while adjacent healthy tissues receive only a minimum amount of radi- ation. Using the prescribed treatment plan, radiation therapy is then administered by the hospitals' supervoltage radiation units. This unique network will alleviate some of the problems caused by a shortage of radiation therapists in New Jersey by providing a system for direct transmission and analysis of treatment lan data to hospitals with- p out full-time radiation therapy personnel. In addition, the system will make it possible to calculate the treatment plans in one-fourth to one- tenth the time it previously took, which means a significant saving in man-hours. Back-up Sheet Region: New Jersey Regional Medical Program Locus of Activity: Operational project Project Title: Regional Radiation Automated Dosimetry Status: Ongoing Sponsoring Institution: New Jersey Regional Medical Program Project Director., Title, Address4 Louis C. flabich Cancer Program Coordinator New Jersey Regional Medical Program 7 Glenwood Avenue East Orange, New Jersey 07017 201-674-7270 Dates: April, 1971 - March, 1974 Funding: 01 year $67,44S Other Funds: None Cooperating Agencies and Institutions: The following 21 New Jersey hospitals which participate in the dosimetry network - Atlantic City Hospital, Bergen Pines County Hospital, Beth Israel Hospital, Christ Hospital, Dover General Hospital, Englewood Hospital, Hackensack Hospital, Mercer Hospital, Monmouth Medical Center, Morristown Memorial Hospital, Mountainside Hospital, Muhlenberg Hospital, Newark Beth Israel Medical Center, Orange Memorial Hospital, Overlook Hospital, Riverview Hospital, St. Barnabas Medical Center, St. Elizabeth Hospital, St. Joseph's Hospital, St. Peter's General Hospital, and United Hospitals Medical Center, Presbyterian Hospital Unit Area Served: Entire state Target Population: 8,000 new cancer patients yearly who require radiation therapy Congressional Districts: #2 - Charles W. Sandman, Jr.(R); #3 - James J. Howard(D); #5 - Peter ff. B. Frelinahuysen, Jr.(R); #7 - William B. Widnall(R); #8 - Robert A. Roe(D); #9 - Henry Helstoski(D); #12 - Florence P. Dwyer(R); #13 - Cornelius E. Gallagher(D); #14 - Dominick V. Daniels(D); #15 - Edward J. Patten(D) Continuation after RMP Support Withdrawn: The project will become self-supporting as the participating hospitals will pick up the cost, of operating the network after NJPNIP support is withdrawn. Core Staff Contact: Louis C. Habich Date Prepared: February 10, 1972 Drafted by: Virginia L. Reaer Ne,w iepoey ]Ftegioimal Meclical Procrain Comprehensive Stroke Care and Educational Program Six hospitals in Monmouth and Ocean Counties are cooperating in a "Comprehensive Stroke Care and Educational Program" for physicians and nurses to improve patient care in this area, which has a large percent- age of the state's aging population and stroke patients. Initiated in April, 1971 under a $25,800 grant from the New Jersey Regional Medical Program, the project covers preventive, acute and reha- bilitative aspects of stroke. Physicians have attended a series of lectures on statistical and economic aspects of stroke; the anatomy, physiology and pathology, symptomatology and diagnosis of stroke; treatment of the acute stroke patient and rehabilitation of the stroke patient. The nurse education phase of the project has included an acute stroke care course and a course in rehabilitative care of stroke pa- tients for nurse coordinators of stroke programs in the participating hospitals. These courses were held at Jersey Shore and Monmouth Medical Centers, respectively, where actual tare was demonstrated and practiced in the centers' stroke units. Durina the next project year, uniform records for stroke patients C, in all'participatiag hospitals will be developed so that the diagnosis of cerebrovascular disease can be improved. This will result in improved management and treatment of patients. Back-up Sheet Region: New Jersey Regional Medical Program Locus of Activity: Operational project Project Title: Comprehensive Stroke Care and Educational Program Status: Ongoing Sponsoring Institution: Jersey Shore Medical Center Project Director, Title, Address: Mrs. Hannelor6 Sweetwood In-Service Program Director Jersey Shore Medical Center 1945 Corlies Avenue Neptune, New Jersey 07304 201-775-5500 Dates: April, 1971 - March, 1974 Funding- 01 year - $25,800 Other Funds: None Cooperating Agencies and Institutions: Six hospitals in Monmouth and Ocean Counties - Community Memorial Hospital, Monmouth Medical Center Paul Kimball, Point Pleasant and Riverview Hospitals Area Served: Monmouth and Ocean Counties Target Population: Educational aspect - physicians and nurses; direct care approximately 1,375 stroke patients in the two-county area Conaressional Districts: #3 - James J. Howard(D) C. Continuation after RMP Support Withdraivn: Cost of the continuing education programs will be shared by participating hospitals.. Cost of patient care will be absorbed by existing payment mechanisms. Core Staff Contact: Agnes E. McGinnis Date Prepared: February 16, 1972 Drafted by: Virginia L. Reger New Je@y ReclorRaj Moclical Proar Establishment of Tumor Conference Boards The New Jersey Regional Medical Program is assisting hospitals through- out the state to meet new and more stringent standards of service to cancer patients set by the American College of Surgeons. ACS now requires that hospitals have active tumor conference boards before their cancer programs receive accreditation. The New Jersey Re- gional Medical Program's Tumor Conference Board Project has helped 33 hos- pitals to upgrade or establish such boards. During the.three years of the project, which has been supported for a total of $300,177, an estimated total of more than 12,000 patients have been brought under team review of the status of their disease, treatment modes and rehabilitation plan. Another aspect of the project involves the maintenance of accurate cancer registries, which include comprehensive, up-to-date records of diagnosis, treatment and management of each cancer case. Registries also insure lifetime follow-up of cancer patients and serve as sources of in- formation for future cases. Several cancer educational courses for physicians also have emanated from the NJRMP's Tumor Conference Board Project providing the latest medi- cal information on cancer diagnosis,, treatment and management. Back-up Sheet Region: New Jersey Regional Medical Program Locus of Activity: Operational project Project Title: Establishment of Tumor Conference Boards Status: Ongoing Sponsoring Institution: New Jersey Regional Medical Program Pro4ect Director, Title, Address: Louis C. Habich i Cancer Program Coordinator New Jersey Regional Medical Program 7 Glenwood Avenue East Orange, New Jersey 07017 201-674-7270 Dates: October, 1968 - March, 1972 Funding: 01 year $117,770; 02 year - $121,332; 03 year $61,075 Other Funds: None Cooperating Agencies and Institutions: 33 hospitals which have enrolled in a tumor conference board program - Atlantic City Hospital, Clara Maass M6mor- ial Hospital, Cooper Hospital, Elizabeth General Hospital, Englewood Hospital, Hackensack Hospital, Helene Fuld Hospital, Irvington General Hospital, Jersey City Medical Center, Jersey Shore Medical Center, Martland Hospital Unit, Mercer Hospital, Monmouth Medical Center, Montclair Community Hospital, Morristown Memorial Hospital, Mountainside Hospital, Newark Beth Israel Medical Center, Our Lady of Lourdes Hospital, Overlook Hospital, Pascack Valley Hospital, Paterson General Hospital, Perth Amboy General Hospital, Point Pleasant Hospital, St. Barnabas Medical Center, St. Francis Community Health Center, St. Francis Hospital, St. Joseph's Hospital, St. Mary's Hospital, St. Michaells Medical Center St. Peter's General Hospital, Somerset Hospital, Underwood Memorial Hospital and United Hospitals o Newark, Presbyterian Hospital Unit Area Served: Entire state Target Population: Physicians, nurses and allied health personnel; 25,000 new cancer patients yearly Congressional Districts: #1 - John E. Hunt(R); #2 - Charles IV. Sandman, Jr.(R); #3 - James J. Howard(D); #4 - Frank Thompson, Jr.(D)- #5 - Peter H. B. Frelinghuysen, Jr.(R); #6 - Edwin B. Forsythe(R); #7 William B. Widnall(R); #8 Robert A. Roe(D); #9 - Henry Helstoski(D); #10 Peter W. Rod ino, Jr.(D); #11 Joseph G. Minish(D); #12 - Florence P. Dwyer(g); #13 - Cornelius E. Gallagher(D); #14 - Dominick V. Dahiels(D); #15 Edward J. Patten(D) Back-up Sheet - Establishment of Tumor Conference Boards (cont'd) Continuation after RMP Support Withdrawn: Hospitals will continue support for their own tumor conference boards and cancer registries. Core Staff Contact: Louis C. Habich Date Prepared: February 10, 1972 Drafted by: Virginia L. Reger New Jersey lEtecio3m&l Meclical Procram Evaluation of the Status of Implanted Pacemakers Eight hospitals have been linked bv teletype to the pacemaker evalu- ation clinic at Newark Beth Israel Medical Center to form a diagnostic network which is saving the lives of cardiac pacemaker patients. In April, 1969 the New Jersey Regional Medical Program funded the pacemaker evaluation clinic at $29,247. The following year a $S7,804 grant made it possible to expand the evaluation project to include three affiliated hospitals and full regionalization occurred in the 03 year when an additional five hospitals joined the network under a $69,721 grant. With the eight affiliates functioning in collaboration with the base institution, the entire state, and its pacemaker patient population of approximately 2,000, now has access to this service. A pacemaker is a battery-powered device, about the size of a pack of cigarettes, which is implanted surgically in the chest to stimulate the heart to beat at a relatively normal rate of speed. The average pacemaker lasts almost two years and then must be replaced. Evaluation through the new network has eliminated emergency surgery resulting from unpredicted pacemaker failure. This fact is borne out by a report from the affiliated hospitals that during 1971 all pacemaker changes r6quired were made electively. The net effect has been to reduce the cost, inconvenience and threat to the patient's life. In addition, while the psychological effect of the continual need for emergency procedures cannot, be measured, elimination of this need is an obvious benefit to the patient and his family. Back-tip Sheet Region: New Jersey Regional. Modica Ilro@rim Locus of Activity: Operational project Project Title: Evaluation of the Status of Implanted Pacemakers Status: Ongoing Sponsoring Institution: Newark Beth Israel Medical Center Project Director, Title, Address: Victor Parsonnet, @I.D. Director of Surgery Newark Beth Israel Medical Center 201 Lyons Avenue Newark, Now Jersey 07112 201-923-6000 Dates: April, 1969 - March, 1972 Fundina: 01 year $29,247; 02 year - $57,804; 03 year - $69,721 Other Funds: None Cooperating Aaencies and Institutions: Eiaht affiliated hospitals t, ?I Hackensack Hospital, Helene Fuld Hospital, Jersey Shore Ntedical Center, ,Nlorristotin Memorial Hospital, Overlook Hospital, Shore Nlemorial Hospital, Pascack Valley Hospital and Valley Hospital Area Served: Entire state Target Population: Estimated 2,000 patients with implanted pacemakers Conaressional Districts: #2 - Charles l@'. Sandman, Jr.(R); #3 - James J. C> Howard(D); #4 - Frank Thompson, Jr.(D); @'S - Peter 1-1. B. Frolin,-,Iiuysen,- Jr.(R); #7 - William B. lVidnall(R); #).O - Peter W. Rodino, Jr.(D); #12 - Florence P. Dwyer(R) Continuation after RT%IP Support Withdrawn: Since the pacemaker clinics are operated on a fee-for-service basis, they are self-supporting. Thus, the hospitals will be able to continue their affiliation in the network. Core Staff Contact: Charles J. fleitzmann Date Prepared: February 10, 1972 Drafted by: Virginia L. Reoer C, Ne,w Jersey ]Eteglorial Meclical Prowrarn liospital-Based Fa,,iiilv Health Care Service A "Hospital-Based Family Health Care Service" at Middlesex General Hospital in New Brunswick is providing a new system of delivering health care to 4,000 of the city's poor. The project was initiated in October, 1971 with a $143,440 grant from the New Jersey Regional Medical Program. Comprehensive health care is provided to ambulatory patients by a "Family Health Care Team" of physicians, dentists, nurses, medical techni- cians, nutritionists and social workers. Patients receive basic services such as general medical, pediatric, obstetrical-gynecological, peripheral vascular, diabetic, eye and dental. Middlesex Geiieralls specialty clinics are available to provide additional services. Whenever necessary, treat- ,rent is coordinated with inpatient services and home care. This proaran is priTraril aimed at replacing the traditional hospi- C. y tal out-patient system in which patients attend a specialty clinic on a certain day, depending on their illness, age or sex. At the Family Health Care Center, patients are seen on an appointment basis. One problem encountered in treating the poor is the shortage of health personnel, particularly physicians. In order to alleviate this problem, the Family Health Care Center is expanding the role of the reg- .Lstered nurse so that physicians can use their time more effectively, As tfr.urse practitioners," the R.N.'s role is increasing in the management of patients with chronic diabetes, hypertension, stroke and congestive heart disease. To help promote understanding of the program and keep communications open between the center and the community, representatives of the families ,.Ising the facility have been elected to the project's advisory committee comprise 5'1'6 of its membership. Back-tip Slieet Rc(yion: New Jersey Reuional Modi.c@il Program Locus of Activity: Operational project Project Title: flospital-Based Family Ilealth Ctre Service Status: Ongoing Sponsoring Institution: @liddlesex General Hospital Project Director, Title, Address: @Irs. Grace Evans, R.N. Director of Ambulatory Services Middlesex General Hospital 180 Somerset Street New Brunswick, New Jersey 08903 201-828-3000 Dates: June, 1971 @larch, 1974 (Actual operational aspects began in October.) Funding: 01 year $143,440 Other Funds: Nliddlesex General Hospital New Jersey State Department of Health Cooperating Auencies and Institutions: None Area Served: City of New Brunswick Taraet Population: 4,000 urban disadvantaged Congressional Districts: #15 - Howard J. Patten(D) Continuation after R@IP Support Withdrawn: By the end of the third project year, sufficient experience will have been gained in facilities, services and personnel requirements and in per visit and per family cost analysis, that an accurate annual family cost can be determined for i@ledicaid reim- bursement and also for fee schedules for private patients and Blue Cross and Blue Shield reimbursement. When the project development phase is completed in 1974, existina payment mechanisms will pay for the services. t, Core Staff Contact: Agnes E. McGinnis Date Prepared: February 10, 1972 Drafted by: Virainia L. Re-or New Jersey iFteoloimai Meclical Proar@ Urban Health Component The New Jersey Regional Medical Program's three-year old Urban Health Component, funded at $160,000, provides health planners to the staters eight federally-designated Model Cities Programs. Under separate funding, the component provides similar assistance to 16 cities in New Jersey's Com- munity Development Programs. This project, which presently serves a population of 205,000 disadvan- taged residents in the Model Cities and an undetermined number in CDP'S, began in 1968 when urban health coordinators were assigned to the state's first three Model Cities. Working with elected citizens' health panels, the coordinators identified the priorities for health services, developed an operational framework for action in the cities, and helped plan the health component of Parts I, II and III of the Model Cities applications. Since the assignment of full-time urban health coordinators was so successful., the project was expanded in April, 1970 to include New Jersey's other Model Cities. To date, the staff has secured more than $8.4 million from sources other than RMP to fund health programs in these cities. The Urban Health Component expanded again in 1971 when the NJRMP signed a contract with the New Jersey Department of Community Affairs to provide health planning assistance to the 16 cities in the state's 10 Community Development Programs. As in the federally-designated Model Cities, urban health coordinators plan and organize facilities and man- power resources to increase the effettiveness.6f local health care delivery systems by involving citizens' panels, defining priorities and securing operational grants through existing federally- and state-supported programs. '@lack-tif) Sliect Region: New Jersey Regional Medical Program Locus of Activity: Operational project Project Title: Urban Health Component Status: Oncoiiig Sponsorina Institution: New Jersey Reciolial Medical Program Project Director, Title Address: Henry i%l. IVood, Director Urban Ilealth Component New Jersey Regional Medical Program 7 Glenwood Avenue East Orinac, New Jersey 07017 201-674-7270 Dates: April, 1970 - March 1973 .9 Funding: 01 year - $211,000; 02 year - $160,000 Other Funds: $126,769 (New Jersey Department of Community Affairs); 30,000 (local share) Cooperating Aaencies and Institutions: New Jersey Department of Community Affairs, Model Cities Prourams, Comprehensive Health Planning, New Jersey State Department of Health, Department of Health, Education and I'lelfare, Department of Housing and Urban Development and State Law Enforcement Planning Agency Area Served: Eight federally-desialnated Model Cities and 16 cities in the state's Community Development Procyrams Taroet Population: 205,000 in Model Cities Prburams; undetermined number 0 t, in Community Development Programs and other associated cities Conaressional Districts: #1 - John E. Hunt(R); #2 - Charles IV Sandman, Jl-.(R); C, #3 James J. Hoivard(D); 1'14 - Frank Thompson, Jr. (D) ; #8 - Robert A. Roe(D) #10 Peter IV. Rodino, Jr.(D); #11 - Joseph G. Minish(D); #12 - Florence P. Dwyer(R); #13 - Cornelius E. Gallaa.licr(D); #14 - Dominick V. Daniels(D) Continuation after I\IP Support tvithdra@vn: Contracts stipulate that if the Model City is favorably impressed with the Urban Health Coordinator's con-- tribution, the city will take over his salary. Core Staff Contact: Alvin A. Floriii, M.1).; James P. Harkness, Ph.D. Date Prepared: February 10, 1972 Drafted by: Virainia L. Rc(Ter New Jersey neglojmal Meclical Progr@ Statewide Data tank The New Jersey Regional Medical Program has established the count-ry's first statewide computerized health care data bank. Initiated in June,,- 1971, the bank is supported by $18,500 in planning money from the NIRMP and $7,500 from the State Comprehensive Health Planning Agency. Information collected by the NJ@IP on hospital facilities, services and manpower presently available for the treatment of major diseases, which account for 7S-80% of all deaths in New Jersey, has been programmed by the Hospital Research and Educational Trust, an affiliate of the New Jersey Hospital Association. For the first time, all of the state's 102 general hospitals have voluntarily submitted detailed data on specialized services they provide to their communities. Now that this data is available from the Trust, the hospitals will have a means of controlling costs by eliminating un- necessary duplication of expensive equipment. The NJRMP will use the data to plan new programs. The inventory of cardio-pulmonary-renal-vascular-cancer facilities and services will aid the CHP to determine the need for new facilities and services and to plan their distribution to all parts'of the state. Recently enacted "Certificate of Need" legislation requires the CHP to authorize new hospital construction and medical services. A Back-up Sliect l@eoion: New Jersey Regional Medical Program Locus of Activity: Core Project Title: Statewide Data Bank Status: Ongoin- Spbrisorina Institution: Now Jersey Reuional Medical Program Project Director, Title, Address: John Gary Collins Director of Statistical Services New Jersey Regional Medical Program 7 Glenwood Avenue East Orange, New Jersey 07017 201-674-7270 Dates: June, 1971 (continuing) Fundina: $18,500 C, Other Funds: $7,500 - Comprehensive Health Planning Cooperatina Aaencies and Institutions: Hospital Research and Educational Trust 41 C, of New Jersey and State Comprehensive Health Planning Agency Area Served-. Entire state Target Population: All New Jersey short-term, general hospitals Conaressional Districts: #1 - John E. flunt(R); #2 - Charles IV. Sandman Jr.(R); #3 - James J. Hoivard(D) ; #4 - Frank Thompson, Jr. (D) #5 - Peter H. B. Frelinghuysen, Jr.(R); #6 - Edwin B. Forsythe(R); #7 IVilliam B. lVidnall(R); #8 Robert A. Roe(D); #9 - Henry Helstoski(D); #10 - Peter W. Rodillo, Jr.(D); #11 Joseph G. @linish(D); #12 - Florence P. Dwyer(R); #13 - Cornelius Gallac,her(D); I'TI4 - Dominick V. Daniels(D); #15 - Edward J. Patten(D) Continuation after @-IP Support Withdrawn: Since the data bank is a source of basic planning data for the NJI\IP, support will continue. Core Staff Contact:, John Gary Collins Date Prepared: February 10, 1972 Drafted by: Virginia L. Reaer Bicl@-til) Sheet Region: New Jersey Regional Medical ll:r-ogram Locus of Activity: Operational project Project Title: Establishment of Tumor Conference Boards Status: Onaoing Sponsoring Institution': New Jersey Regional Medical Program Project Director, Title, Address: Louis C. @labicli Cancer Proaram Coordinator New Jersey Regional Medical Program 7 Glenwood Avenue East Orange, New Jersey 07017 201-674-7270 Dates: October, 1968 - March, 1972 Fundina: 01 year $117,770; 02 year - $121,332; 03 year $61,075 t, Other Funds: None Cooperating Aaencies and Institutions: 33 hospitals which have enrolled in a tumor conference board program - Atlantic City Hospital, Clara Maass @lemor- ial Hospital, Cooper Hospital, Elizabeth General Hospital, Englewood Hospital, Hackensack Hospital, Helene Fuld Hospital, Irvin-ton General Hospital, Jersey City Medical Center, Jersey Shore Medical Center, Martland Hospital Unit., Mercer Hospital, Monmouth Medical Center, Montclair Community Hospital, Morristown Memorial Hospital, Mountainside Hospital , Newark Beth Israel Medical Center, Our Lady of Lourdes Hospital, Overlook Hospital, Pascack Valley Hospital, Paterson General Hospital, Perth Amboy General Hospital, Point Pleasant Hospital, St. Barnabas Medical Center, St. Francis Community Health Center, St. Francis Hospital, St. Joseph's Hospital, St. i%lary's Hospital, St. Michaels Medical Center, St. Peter's General Hospital, Somerset Hospital, Underwood Memorial Hospital and United Hospitals of Newark, Presbyterian Hospital Unit Area Served: Entire state Taraet Population: Physicians, nurses and allied health personnel; 2S,000-neiv 9> cancer patients yearly Congressional Districts: #1 - Joh@ E. liunt(R); T'r2 - Charles IV. Sandman, Jr.(R); ,13 - James J. Ifoi@ard(D) ; #4 - Frank Thompson, Jr. (D) #S - Peter fl. B. Frelinc,buysen, Jr.(R); lr'6 - Edwin B. I-orsytlie(R); tf7 @Villiam B. lqidnall(R); @'8 Robert A. Roe(D); #9 - Henry 1-fel.stoski(D); #10 Peter 11. Rodino, Jr.(D); r'rll Joseph C. iNtinish(D); #12 - Florence P. Dwyer(R); 113 - Cornelius E. Gallagher(D); -'rl4 - Doi-iiiiick V. Daniels(])); t'r"15 - Edward J. Patten(D) Back-up Sheet - EstablishiTient Of 'I'Llmor Conference Boards (coiit'd) Continuation after RI@IP Support lllithdra@vn: Hospitals will continue support for their own tumor conference boards and cancer registries. Core Staff Contact: Louis C. Habich Date Prepared: February 10, 1972 Drafted by: Virginia L. Reger Hospital-Based Family Health Care Service (cont'd) A year-long pilot project, the Family Health Care Center will be monitored to determine if this system of health care delivery to the poor is feasible for community hospitals to undertake. If it proves success- ful, efforts will be made to secure assistance to initiate similar,pro- grams in other hospitals. THE RMP NEW MEXICO LEUKEMIA-LYM-PHOMA PROGRAM Currently in select cancer centers the median survival of acute childhood lymphoblastic leukem@lis approximately 3-1/2 years with a five year survival rate that ranges between 25 and 50%. Of the five year survivors approximately one half may be considered permanently cured. With intensive radiotherapy, patients in the early stages,,of Hodgkin's disease have a 90% change of being permanently cured. Even advanced disease,current approaches with intensive chemotherapy afford the possibility of cure. In July @ 1972 the Director of the National Cancer Institute was quoted in an editorial appearing in the New England Journal as stat- ing "less than 15% of children with acute lymphoblastic leukemia throughout the country are receiving intensive chemotherapy with a curative approach". In New Mexico approximately 2,000 new cancer patients are diagnosed each year. Approximately 200 of these patients have leukemia or lymphoma. The New Mexico Regional Medical Program Tumor Registry has identified that there are approximately 130 new patients with leukemia-lymphoma problems each year. Approx- imately 10% of these patients are Indian and 20% Spanish-American. The Leukemia-Lymphoma Program is striving for highest quality treatment of patients throughout the State of New Mexi,co. Its purpose is achieved through the mobilization of existing manpower and facilities. In most regions of the country management of these disorders is carried out at major medical centers. The achievement of cure in some hematologic malignancies makes it mandatory for all patients to receive the most current effective therapy. Much of this manage- ment can be effectively carried out by the family vractitione in a Eimall.com- munity through coordination of his efforts and those of )program We have established a team of physicians involved in cancer chemotherapy, radiotherapy, and supportive care for the cancer patient. At the present time a total of 1 7@ ph ,,Y@icians from all regions of the state are actively participating i our @iLeu --Program in the management of more than 200 patients. A current evaluation of effectiveness of this program reveals that 441'a'r"e actively involved in the care of more than 80% of chi ren with acute leukemia throughout the state and more t 5 f tients with Hodgkin's disease, wnigli- 7 two malignancies nav@ t e--p@j@:@ial ot-@cure. Considr-rable effort has been spent in continuing education of physicians, nurses, C--ad paramedical personnel throughout the regions Region: New Mexico Regional Medical Program focus of Activity: Diagnosis and treatment Project Title: Leukemia-Lymphoma Program for New Mexico Status: Ongoing Sponsoring Institution: University of New Mexico School of Medicine Project Director, Title, Address: John H. Saiki, M.D., Asst. Prof. of Medicine University of N.M. School of Med., Albuquerque, N.M. 87106 Telephone: A.C. 505-265-4411, Extension 2465 Dates: Date of Initial RMP support: 9-1-70 Anticipated termination from RMP support: 9-1-75 Funding: RMP budget request - $26,000 - Fiscal year 1971-1972 Other Funds: National Cancer Institute - $26,000 of which $16,000 is specifically ear marked to assist patient evaluation and treatment costs. New Mexico Leukemia-Lymphoma Society - $4,800 annually. Cooperating Agencies and Institutions: UNM School of Medicine and physicians throughout the State of New Mexico Area Served: New Mexico with portions of Arizona, Colorado and Texas Target Population: Patients, physicians and nurses New Mexico Regional Medical Program has intensified its efforts in the field of Continuing Education for Physicians in response to increased demands upon the program. A recently enacted law requiring Continuing Education credits for con- tinued licensure to practice medicine in New Mexico is partly responsible. NMRMP is one of a few agencies @in the State with an active, viable program in the area of continuing education. In an effort to make programs more meaningful in terms of improving patient care a wh i ch'T. ,qLiestiorinaire was sent to all physicians n d be most helpful to them. Response was excellent. A second, follovi-up questionnaire, dealing with specifics is in pre- paration. Most programs, which are given in communities throughout the state, are designed to be practical in nature, making liberal use of case material and are often t@g-followed by rounds at the local hospital the following morning. Physicians have found the follow-up program with current patients most helpful, and are able to relate what was presented direc@ to patient care. Opportunities to come to Albuquerque for an individual.learning experience are also offered. A number of hospitals, institutions and agencies are cooperating to provide opportunities to observe and practice needed skills which the physician requests and to participate in clinics, classes, etc. Several seminars are offered each year in Albuquerque which cover a single topic and are usually related to diagnosis and treatment. The response to all programs has been excellent, @ NMR14P will continue to develop its continuing education potential to meet the needs of physicians to improve the quality of care-of its c-4;64 EMB/jah 2/14/72 r A training school for tile developi,iic.,nt of Emergency @leclical Service Technicians has been established at the University of New Fic)xico by tile Ne@i l,'iexico Regional Medical Program. The Program @-r three months' dura- tion is designed to create an allied health professional who will function in a fcishion,sinlilar,-to the Rei-,iote Duty @lilitayy Corpsman. They will viorl,, under,medical supervision in remote health care clinics, in sophisticated Emergency Vehicles, or in hospital Ei-,,iergeiicy Departments in smaller rural hospitals. In view of tile lack of medical resources in ten counties in the state, they will become Diembers of a priority health care delivery system %@il,licii will provide im,)roved availability and accessability of riled- ical services in those economically depressed areas populations are predominantly of Spanish-American and Indian origin. @y will@-1.1@"' fuiictioni 'in satellite facilities that are tied to hospitals,of excellence) by duplex micro-t,,,ave radio corriniuiiic(@.tioii, The school has several features which rnal,.e it unique. The trainee i's@ not entered-!,-n the school until a contain ttecl position for employment is identified,for-htm'at the completion of his training. Additionally, he is recruited from the community in vihicii he intends to Hear,. Ile will be ).ccepted cis a health professional in that conimunity's subculture. Previous medical military experience is welcomed but is not a specific requirement for admission to the school. [ligh school graduates, men and women, are given favorable consideration if they have shown an expressed interest and desire to ,,iork in the health delivery field. Their rate of compensation upon employment is substantial enough 000 per yeai,) to provide status in tile community and ensure ($6,000 to $8, continued employment in the health industry. Page 2 Tile training progrifii v,,@ is jointly funded by the Regional Medical Prograiii-, tile State Departflient of Voca-Lion@tl Education; the Pi-esbyteri,--tn Medical Services, Inc. ; The University of New Mexico, School of Modicinexl,. ccknsists,Wapproximately 500 hours of training of which 120 hours are spent in classroom and laboratory demonstration activity. The remainder of the training is carried on in the clinical services of the Bei-nalillo County Medical Center and the Presbyterian hospital in Albuquerque. This portion of the learning experience is essentially at on-the-job training Ultirtiately, academic credit be awarded for tile training in order to provide the opportunity for vertical mobility, iH an k4-uea.ti,ona,l sense. The present class of 12 trai iiecs air I I be ei-rpl o@,cd i n Sandoval , Pi o Arriba, Taos, Hidalgo, Grants, and Torrance Counties to work in tile niodel system, designed by the Regional Medical Program t@-io years ago for- delivery of priority health care services to rural coiaunities who have none. continuation after RNP Support Withdrawn: National Cancer Institute and New Mexico Leukemia-Lymphoma Society Core Staff Contact: Date Prdpared: 9-18-72 Drafted by: Dr. John Saiki joy Me rum TLMR REGISTIU PROGP.AM Anmg the 1,016,000 Nev.; Mexico residents, there are about 2,500 new cancer cases and 1,100 cancv--r deaths each year. Surgical treatmnt is provided in any of the State's 60 hospitals. ( -twm.-and-.cjties.@i pathol -t-,at--least@-have @.-d,-,cer-ti-fied-surgical---speciaU@-. There are currently five cobalt units (mostly small) in New Mexico, but there has been only one radiologist devoting full time to radiation Until 197 date chemotherapy often had to ds of miles At present, 51 hospitals -eh-a@-@atL-d, ncn-pr-of-it-,,-,and, ) participate in the New Mexico TL=r Registry. Each hospital receives special reports and regular mnthly and annual reports that pe@t continuing evaluation of their cwn cancer experiences. These reports, in combination with direct telephone cation (WATS line), give each hospital rapid and easy access to their own cancer registry informticn. @sponse tims are often much faster than could be provided by a full-time in-house, tumor recristrv secretary; the variety and complexity of reports are greater than she could attempt, and state-wide data can be provided for comparison. Individual physicians also receive reports regularly and they way request information and special reports for continuing education programs, staff metings "lay education program, If each hospital were to.establish, staff, and maintain its own separate registry, the cost would be over $200,000 per year, according to Amrican College of Surgeons 1968 cost estimates @O . bed@r.,.day.@@ t..600 . it is unlikely that nmy of New Mexicols small hospitals could attract and keep trained tumor registry perscmel and there would be other problem such as lack of quality control and lack of uniformity aTmng hospitals.,' Even if those problem could be solved at the local hospital level, the State HeaIlth Departn-ent, Ccnprehensive Health Plaming, or som other central agency would need to establish and maintain an office, staff, procedure: etc., for accmmiating the data, checking for duplicate registrations, preparing summary reports of prevalence, incidence, survival and mortality, etc. There are scue who say that "not every hospital needs a tumor registry", but throughout the world, registries are recognized as key elemnts of cancer program that plan and deliver and follow through with highest quality cancer care. The Amrican health care system is being asked to mmitor and evaluate the outcome of health care, cancer registries provide one model to accomplish that task. It is also argued that "not every state (county, region) needs a central tumor registry". rIhe United States lags behind nuch of the rest of the world in the deve t of central population-based cancer registries, and as a result, much of the often-quoted cancer incidence data for the U.S.A. are inexact extrapolations based m the data from the Connecticut Tawr Registry. Many hypotheses about causes of cancer are derived from observations of differing patterns of cancer in various populations and geographic regions around the world. The ethnic diversity of New Mexico makes it almost unique in North Amrica for the collection of such information. Pre@nary data fran the NYNR shows that breast, lung, and colcn cancers are higher awng Anglos than armng Spanish Amricans and Indians; gall bladder cancer is high amng Indians, etc. The New Mexico TL=r Registry has recently been admitted to rship in the International Association of Cancer Recristries an organization that p s comparative epidemiologic studies in all parts of the wor The New Mexico TL=r Registry has been innovative and responsive to local conditions and needs and has produced a mique system that has attracted cancer experts frcm France, New Zealand, Hwaii and neighboring states. A consultant fram the N.C.I. to the gove t of Chile presented our system of tra3 "circuit-riding" abstractors as a @l for collecting reliable cancer data in sparsely populated areas with small, often understaffed, medical institutions. The NMTR is designed to serve @of@ multiple purposes with overall efficiencies and econades to the regim's health budget. The sTnall registry staff, with invaluable amputer assistance: (1) assists hundreds of physicians in providing follcw-through and continuing care for cancer patients, (2) maintains 51 individual hosi?ital evaluato@type turwr registries, (3) provides statewide data to the State Health Department and Ccnprehensive Health Planning Agencies, (4) provides cancer data to the United States Public Health Service Indian Health Service, (5) provides data for physicians interested in further study, and (6) provides a unique source of cancer statistics as a base for epideniiologic studies among Anglos, Spanish Azericans and Navajo, Pueblo and Apache Indians. in the ncrt-too-distant future (?1974-75) the New Mexico Tunor @gistry will probably be housed in the proposed Cancer lbsearch and Treatmit center that is planned for the University of New Mexico Health Sciences campus in Albuquerque. The aiin of that center is to be a resource for the entire region and the established cooperative tumr registry system can be one of tiie service,- that the center provides. At the sam cancer epidemiology studies to test hypotheses derived from registry data will be expanded as a major research endeavor of ---,ie center. There is another unique situation in New @xico that m*es the availability of accurate cancer statistics and a patient follow-up system that can be utilized for clinical studies particularly fortuitous. The $56,000,000 Los Alamos Meson Physics Facility is being built primarily for nuclear sics research, but for the forseeable future, it will be the world's most intense source of qative pi@scns (pions) for radiation therapy. Facilities with less intese pion ne sources are being developed at Stanford, Vancouver and Zurich, but many of the pre-clinical studies and eventual clinical trials of this new radiation Modality will be done here in New Mexico. The New Mexico TL=r Regiqtry has provided data used in planning for both the Cancer Center and the Meson Facility and a close association with both projects wi 11 continue. To date,, virtually all of the financial support for the New Mexico TL=r Registry has ccn-e frm the New @co Regional Medical Program. A contract for $27,150 (direct costs) with the Bicmtry Branch, National Cancer Institute was obtained in April, 1972, for the purpose of expanding the existing program into a cmplete population- based registry. It is anticipated that National Cancer Institute support, either direct or through the Cancer Canter, will largely replace New Mexico Pegional Medical Program funding in about three years. It should be noted here that the TL=r Registry participates in the overall New Mexico Regional Program in a number of ways that-are not related to cancer. Ccaputerizaticn of Health Manpcwer Registers, production of niailing labels and cmwterizaticn of the New Mexico Pegional Medical Program administratimis budget nxmtoring gr*w are specific exaiTples. NORTH CAROLINA Chapel Hill Homekeepers In Chapel Hill many of the aged do not want to leave their homes for hospitals or nursing homes, yet they cannot always meet life's routine demands. Their problem was taken to the Chapel Hill Council on Aging, which brought at least a partial solution and a request for funds to the North Carolina Regional Medical Program. The result is the pilot Homekeeper Training Program, a two-month course for semi-skilled home and health service workers. The importance of the program to town residents is demonstrated not only by interagency cooperation but by the town itself, which is acting as fiscal agent. The program's benefits are three-fold: it makes services available to many who need them; it provides a vocation and an opportunity for private employment to many who are unemployed or underemployed; and it reduces the need for or length of institutionalization. Homekeepers will be referred not only to the infirm aged but to the handicapped and those struck by sudden illness or family emergency. Requests for services already triple the number being trained in this initial effort. Bac't.@-i-ip Sheet Region: Association for the North Carolina llegionalil-ledical Program Locus of Activity: Core Staff Developmental Component Pro-lect Title: Chapel Hill Ilomekeeper Training Program Status: Ongoing Sponsoring Institution: Chapel Hill Council on Aging Project Director, Title, Address: Mrs. Bernice Hopkins Executive Director Chapel Hill Council on Aging 304 E. Franklin St. Chapel Hill, N. C. 27514 Dates: This program is funded from January 1, 1972 through May 31, 1972, but it did not become operational until February 1, 1972. Funding: $4,152 ,Other Funds: None Cooperating Agencies and Institutions: Chapel Hill Council on Aging, Home Health Agency of Chapel- Hill, Inc., Nursing Inservice Education Program of the North Carolina Memorial Hospital, the Town of Chapel Hill, the Chapel of the Cross (Episcopal church), local citizens, organizations and radio and t.v. stations. Area Served: Town of Chapel Hill, N. C. Target Population: Unemployed and underemployed, to be trained to serve the aged, handicapped, and those persons temporarily struck by sudden illness and family emergency. Congressional Districts: 4th Nick Galifianakis (D) Continuation after Support Withdtaim: It is expected that the agencies involved and the Town of Chapel Hill will generate or locate funds for continuing the Homekeeper Program after the initial pilot effort. The curriculum developed has potential for incorporation in hospital inservice education and community and technical college curriculums. It is anticipated that similar programs will be offered in other areas of the state. Core Staff Contact: Miss Audrey Booth, R. N.9 M. S. N., Director of Professional Services, NCRNP Date Prepared: February 11, 1972 Drafted: Patricia M.,Jones North Carolina Adult Screening Program for Hypertension, Heart Disease Possible 31 Impending Stroke, Diabetes, and Anemia One out of every two North Carolinians will die of some disease related to the circulatory system unless steps are taken to change current statistics. Early case finding, referral, and treatment offer the greatest opportunity to save these lives. North Carolina leads the nation in devising a model system which rapidly screens adults to detect signs of these diseases, involves a minimum of medical manpower, and incorporates referral to physicians and follow-up procedures which can considerably reduce the incidence of disabling and fatal events. Funded under a grant of $84,933 from the North Carolina Regional Medical Program, the North Carolina and Forsyth County Heart Associations are conducting apilot screening project with three population types: low- income urban residents, rural residents, and employees in industry. Initial testing with members of senior citizens' clubs yielded more than the anticipated 100 screenees per five-hour day. The pilot project expects to screen 40,000 adults in the six-month period. Tests are designed to detect possible hypertension, heart disease, impending stroke, diabetes and anemia. They include the Electrocardiometer test (based on lead 1 information), Blood Pressure Measurement, Carotid Bruit Test, Blood Glucose Determination, and Hemoglobin test. For each 1,000 screened, from 30 to 200 are expected to test outside normal limits for each of the five tests. Testing time is less than ten minutes at a cost of about $2.00 a person. .@The program is utilizing about 150 volunteers ,.and two nurse-coordinators, as well as a small administrative staff. Al@eo@ @@e-ing utilized.,' gro s of physicians and allied health -=.e, -$olunteer UP ' cooperation of the me personnel secure the dical community in accepting referrals and providing for follow-up for the medically indigent. Back-tip Sheet -Loll: Association for the North Carolina Regional Medical Program Locus of Activity: Operational Proloct Title: Adult Screening for Hypertension, Heart Disease, Possible Impending Stroke, Diabetes, and Anemia Status: Ongoing Sponsoring Institution: North Carolina Heart Association Project Director. Title, Address: Robert N. Headley, M. D. Associate Professor of Internal Medicine Bowman Gray School of Medicine Winston-Salem, N. C. 27103 919-727-4331 Datest July 1, 1971 through June 30, 1974 $84,933 (July 1, 1971 through June 30, 1972) Other Funds: None C6operatin and Institutions: Forsyth County Heart Association, Bowman Gray School of Medicine, Stratford Kiwdnis Club, numerous local clubs, organizations, civic and professional groups; volunteer group of physicians and allied health personnel. Area Served: Forsyth County and Winston-Salem Target Population: Winston-Salem aged and low-income persons, employees of industries in the Winston-8alem area and rural residents of Forsyth County. Congressional District: #5, Wilmer Mizell (R) .Continuation after RMP Support Withdrawn: With the experience that will be gained in this project, the North Carolina Heart Association will be able to continue adult screening beyond Regional Medical Program funding through plans that are already being developed and which will be ready for implementation at the end of the Regional Medical Program funded period. Core Staff Contact: John H. Young, III, 14. P. H., Assistant Director, Project Development Date Prepared: February 11, 1972 Drafted by: Patricia M. Jones Addendum t(, Ba(,Ic-up 131,eet Region: Association for the North Carolina Regional Medical Program Locus of Activity: Operational Pro'ect Title: Adult Screening for Hypertension, Heart Disease, Possible Impending Stroke, Diabetes, and Anemia Status: Ongoing soring Institution: North Carolina Heart Association Project Director, Title. Address: Robert N. Headley, M. D. Associate Professor of Internal Medicine Bowman Gray School of Medicine Winston-Salem, N. C. 27103 919-727-4331 Dates: July 1, 1971 through June 30, 1974 Funding: $84,933 (July 1, 1971 through June 30, 1972) Other Funds: None Cooperating Agencies and Institutions: Forsyth County Heart Association, Bowman Gray School ot Dieaicine, Strat ord Kixqanis Club, Winston-Salem State University, Emmanuel Baptist Church, Radio Station WAAA, Model City Commission, Comprehensive Health Program, Reynolds Memorial Hospital; Neighborhood Service Center System, Adolescent Service I-lental Health, Urban League, Health Committee Alpha Kappa Alpha, Daughters of Isis, Sethos Temple, Department of Social Services, Downtown Church; Housing Authority of the City of Winston-Salem, Neighborhood's Advisory Council, Easton Manor, North Hills, Cherryview, Ilorningside Manor, numerous local clubs, organizations, civil and professional groups; volunteer group of physicians and allied health personnel. Area Served: Forsyth County and Winston-Salem Ta tion: Winston-Salem aged and low-income persons, employees of in the Winston-Salem area and rural residents of Forsyth County ConRressional District: #5, Wilmer Mizell (R) Continuation after KIP Support Withdrawn: With the experience that will be ga-ned in this project, the North Caro @a Heart Association will be able to continue adult screening beyond Regional Medical Program funding through plans that are already being developed and which will be ready for implementation at the end of the Regional Medical Program funded period. Core Staff Contact: John H. Young, III, M. P. H., Assistant Director, Project Development, NCRMP Date Prepared: February 18, 1972 Drafted by: Patricia M. Jones NORTH CAROLINA Wake CbufttX Community Health Care Task Force With the assistance of the North Carolina Regional Medical Program,, the 100-member Wake County Comunity Health Care Task Force is working to establish a family health center program to reach rural and urban low- income residents. The Task Force, representing a wide spectrum of community groups and interests, is applying for a federal grant of $750,000 to establish six hospital-based "outreach" centers which provide health information and support, preventive care, out-patient diagnosis and treatment, and rehabilitation. The program will enroll between 5,000 and 20,000 people, depending on money available, on a prepaid basis. Enrollees will be from three groups: those who can pay for care, those who cannot, and those eligible for a third party health program. A great deal of NCRNP staff time has gone into gathering data and consulting on program design. The North Carolina Regional Medical Program is also making $3,500 available to the Task Force for consultant time in preparing the final draft for the grant application. B@ cl@UP She@- ociation for the North Carolina Regional Medical Program Region: Ass Locus of Activity: Professional Staff Activity Project Title: Wake County Family Health Center Program Status: Ongoing Sponsoring Institution: Wake County Community Health Care Task Force Project Director, Title, Address: J. Forest Barnwell Task Force Chairman Charter Industries 226 Hillsborough Street P. 0. Box 25548 Raleigh, N. C. 27611 Date: May, 1971 - present Funding: $3,500d from developmental components funds i Other Funds: Raleigh Community Relations Council, several hundred dollars for postage, etc.; Health Planning Council for Central Nortil Carolina, $1,000. ooperatin@ and Institutions: North Carolina Regional Medical Program, Comprehens- Planning, Baptist State Convention, North Carolina State Board of Health, League of Women Voters, Raleigh Community Relations Council, NCSU Urban Affairs Center, Wake County Pharmaceutical Society, Wake County Health Department, Raleigh Public Schools, Wake County-Raleigh Headstart Program, ESEA Programs - Wake County Schools; Wake County Department of Social Services, Urban Affairs and Community Health Center- Research Triangle Area TB and RD Assoc.,, N. C. Department of Mental Health, Family Service; Health Planning Council of North Carolina, Research Triangle Institute, J. C. Penney Co., Wake County Memorial Hospital Systems, Inc.; North Carolina State University, Division of Continuing Educdtion; Medicenter; Carolina Power and Light Company, Rex Hospital, Mechanics and Farmers Bank; Charter Industries, Inc., Branch Banking and Trust Co., Wake County Courthouseo, Wake County Commission Area Served: Southside of City of Raleigh and Wake County Target Population: 5,000 to 20,000 low-income urban and rural residents ConRressionAl District: 4th, Nick Galifianakis (D) Continuation after MU Support Withdrawn: Since RMP involvement is to secure grant fl eral government, continued funding is governed by Section 314 (e) of the Public Health Service Act (42 U. S. C., 246 (e)) Core Staff Contact: I. Manly Fishel M. S. P. H., Assistant Director, Project Development, NCREP red: February 11, 1972 Drafted by: Patricia M. Jones North Carolina E.dgemont Community Clinic The Edgemont Community Clinic is a new approach to health care delivery. Located in an old house and serving the low-income area surrounding it, the Clinic is open Monday and Thursday nights to provide free health services. But the most innovative aspect of the Clinic is the community health worker. Edgemont's community health workers are a part of the community in which they work and spend much of their time in patients' homes. In this setting they can determine the sociological and environmental factors which are critical to health maintenance and health care as well as providing services not otherwise accessible to the neighborhood people. These tasks vary with individual and family need§: dietetic instruction, hygiene education, diabetic instruction, social services education and referral, and perhaps most important, interpretation of health care services and systems to allay fears and encourage patient cooperation in essential diagnosis and treatment. During the clinic hours the health care workers are available to provide valuable information to physicians and other volunteer health personnel regarding patient and family circumstances relevant to medical problems, and to interpret where educational and socioeconomic differences make communication between staff and patients difficult. They also take general histories and are currently being trained to take medical histories. The Edgemont Clinic staff, which includes medical students, consulting physi4@ns, nursing students, and community health workers, sees about .y'patients an evening for general medical assessment as well as episodic and acute care. The community health workers assist the patient in utilizing hospital or other facilities when referral is necessary, and insure, through follow-up, that patients receive and correct y use any prescribed drugs or treatment. Support@d,,@y,,a $5,000 grant.from North Carolina Regional Medical Program@@' tied 'Edgemont comunity health workers bridge the gap between the community residents and clinic staff and aid in bringing an underserved population into the mainstream of health care. The NCRNP grant is emon- strating the viability of the community health worker as a functional part of the community clinic model. Back-up Slieet Region: Association for the North Carolina Regional Medical Program Locus of A Core Staff Developmental Component Project Title: Edgemont Conmunity Clinic Status: Ongoing Sponsoring Institution: Lincoln Community Health Center Project Director, Title; Address: Mr. Jim Hughes Edgemont Community Clinic 1012 E. Main Street Durham, North Carolina 27701 919-682-1750 Dates: October 15, 1971 to June 30, 1972 Funding: $5,000 (The project received operational funds of $6,627 from November 23, 1970 to June 30, 1971). Other Funds: Donations from a number of sources in the community Cooperating Agencies and Institutions: Lincoln Community Health Center, Duke University School of Medicine, Duke University Department of Community Health Sciences, Edgemont Community Center, Operation Breakthrough (OEO), Durham County Health Department, University of North Carolina School of Medicine, UNC School of Public Health, Lincoln Hospital, Durham-Orange County Chapter of the AMA, Watts Hospital and physicians, medical students, and nursing students from local hospitals and educational institutions. Area Served: Edgemont Area of Durham, North Carolina Target Pop liatiion: 5,000 low-income residents, half black, half white, of the Edgemont area Congressional Districts: 4th District - Nick Galifianakis (D) Continuation after RMP Support Withdrawn: The Edgemont Community Clinic receives support to pay rent, utilities, and janitorial/secretarial services from the community which it serves. With the aid of NCRMP Core Staff, a more permanent source of funds for staff salaries, now being paid by NC@IP, is being sought. This funding may come from federal agencies, volunteer agencies, or community groups. Core Staff Contact: Patricia M. Jones, Communications Coordinator, NC@IP Date Prepared,: February 11, 1972 Drafted by. Patricia M. Jones North Carolina Family Nurse Practitioner The Family Nurse Practitioner will play an increasingly vital role in helping solve the health manpower shortage in North Carolina, especially in communities beset by physician shortages. In a health center or clinic, a physician's office, or patient's home, this new breed of nurse may be the first person the patient sees. She takes a health history, does the physical exam, uses her own judgment to start preventive screening or diagnostic procedures. She coordinates health care needs, makes proper referrals, provides health instruction, counseling, and guidance. If the patient has simple symptoms, she can treat him, using standing orders from the doctor. If his illness is more complicated, she can refer him to the doctor and later handle his follow-up caret Periodically she may visit the patient in the home. A pilot project was held last year for seven carefully,/selected nurses. Six are now the core of a two-county Comprehensive Health Services Program with a central clinic at North Carolina Memorial Hospital and two rural satellite clinics. In these rural areas, the Family Nurse Practitioner is part of a health team which also includes physicians and community health wor rs. This year, through support from the National Center for Health Services Research and Development, the University of North Carolina, and a $70,000 grant from the North Carolina Regional Medical Program, twelve more Family Nurse Practitioners are being trained. These North Carolina nurses are from carefully selected practice sites, including a solo general practice, a State hospital for the mentally retarded, a group medical practice, a county hospital with satellite hospitals, and an organized system of centers for providing comprehensive health care. Rural patients and their families have shown ready acceptance of the Family Nurse Practitioner, and health professionals and institutions across the state are becoming increasingly aware of and interested in this expanded nursing role. Back-up Slieet on- Association for the North Carolina Regional Medical Program Locus of Activity: Operational- Project Project Title: Family Nurse Practitioner Status: Ongoing .Sponsoring Institution: University of North Carolina,School of Nursing Project Director, Title, Address: Dr. Susanna L. Chase, Professor Director, Continuing Education School of Nursing, University of N. C. Carrington Hall Chapel Hill, North Carolina 27514 919-966-1411 Dates: July 1, 1971 through June 30, 1974 Funding: $70,000 (Funding from July 1, 1971 through June 30, 1972) Other Funds: National Center for Health Services Research & Development, School of Nursing, University of North Carolina-, Auxiliary Health Manpower,, Division of Health Affairs, University of North Carolina Cooperating Agencies and Institutions: Private physicians; Western Carolina Center, Morganton, N. C.; Pinehurst Medical Clinic; Wake County Memorial Hospital; Oranae Chatham Comprehensive Health Services, Inc.; UNC School-s of Medicine, Nursing, Public Health Health Services Research Center; and-Wake Memorial County Hospital. Area Served: North Carolina Target Population: Registered Nurses Congressional Districts: #4 Nick Gali'Lianakis (Initial Training Center) .Continuation after RNP Support Withdrawn: Other sources of funds currently supporting this project plus an 'ncreasing interest on the part of North Carolina educational institutions and health professionals should insure that this program, if its viability continues to be demonstrated, will become an institutionalized part of nursing curriculum. Core Staff Contact: Audrey Booth, R. N., M. S. N., Director of Professional Services, NC@T Date Prepared: February 11, 1972 Drafted by: Patricia M. Jones NORTH DAKOTA Dial Access Medical Librag More than 2800 medical messages have been transmitted o.@physicians and nurses through the (media of th6) Dial Access Medical Program pro- vided by the North Dakota Re-g-lonal Medical Program. Begun la emphasis ,,I"69, the program has grown from a library of 250 tapes to +4'0 tapes covering a multitude of medical and health subjects. The user, referi available, selects Ih ng to a listing of the subjects ktape he wants to hear, &4 plac't@ a phone call to the library operator, requests the tape be played over the telephone. The, tal) 's placed on the and the information is are telephone lines. fie telephone connection is automatically terminated. The Medical School, University of North Dakota, has a@ this system in supplementing various lectures. Through the use of speakers located in the lecture rooms, the telephone reception is replayed to the entire class. The program, originally developed by the University Extension of the University of Wisconsin., is being made available through cooperative arrangements with the Wisconsin Regional Medical Program. The tapes, prepared b@,@'-au ities, are continually reviewed and updated so as to pt ical infor- mation,xctatħ.Ig to tits subjee Back-Up Slieet ion: North Dakota Regional ',Icdical Program Locus of A.ctivity: Core Activity Project 'I'itle: Dial Access Medical Library Status: On Going - Being phased into a reduced NDRAP involvement by requiring the user to pay telephone toll charges. Project Director, Title, Address: J. A. Grim, NDRMP 1512 Continental Drive Grand Forks, North Dakota 58201 701-775-5535 Dates: Feasibility status November 1969 - Operational status January 1, 1970 Funding: 01 - $6,397 (No other funds) 02 - 6,170 03 - 6,170 Other Funds: None Cooperating Agencies and Institutions: University Extension, University of Wisconsin, Madison, Wisconsin, and the Wisconsin RMP. Area Served: State of North Dakota Target Population: 600 physicians., Hospital In-Service and Directors of Nursing Service (52 Hospitals), Dietitians. Congressional Districts: #1 Mr. Mark Andrews (R) #2 Mr. Arthur Link (D) Continuation After @IP Saport is Withdrawn: Phase down in 03 year has started. Cost of toll phone call is presently being paid for by the useri Sources for funding of the.program are being sought. Core Staff Contact: J. A. Grim Date Prepared: February 2, 1972 Drafted by: J. A. Grim NORTH DAKOTA Emergency Medical Services Emergency Medical Services is a high priority program of the North Dakota Regional Medical Program.(rJQt@MP), The need for this activity was recognized in the early planning stages of the NDRMP. Working in cooperation with the State Highway Patrol, Highway Department, Registrar of Motor Vehicles and other state agencies, the NDRMP developed and provided an inexpensive colorful sticker indicating the phone numb%;, to call when requiring emergency assistance on the highway. Over 60010 of these stickers were distributed through state agencies andVbver@.-the-counter distribution. The use of this number for emergencies jumped from 900 a year in 1967 to over 1;000 in 1971. There was a monthly high of 1,256 calls for assistance in October, 1971. The demands on this service resulted in a dramatic expansion of the communi- cation facilities (telephone and radio) devoted to emergencies, the develop- ment of a capability data to meet the emergency, and an expansion of the service to meet state-wide emergencies, including assistance for farm accidents. The NDRMP is now serving on the North Dakota Emergency Medical Services Advisory Committee and assisting the North Dakota Committee on T @Ta, American College of Surgeons with their @@Emergency Medical Technicia'@ ulancb training program. The EMT Program is being implemented with the cooperation of the State Health Department, Committee on Trauma NDRMP. The NDRMP has arranged for meetings, provided staff support,, administration T@d secre- tarial assistance, prepared and distributed press releases iradio publicity, provided printing and mailing support, and sponsored consultants. Five training programs are presently under way in various sections of the state. In addition, the NDRMP has cooperated with the North Dakota Heart Association in pla participating in, training courses and demonstration pro- jects teach@ of cardiopulmonary resuscitation. During 1972, a full time NDRMP staff member will work with the State Health Department in expanding the present EMS activities, assist the CHP (b) Area- Wide Councils in North Dakotd.- and participate in the planning and evaluation Of EMS activities in North Dakota. BacR-LJp Sheet legioii: North Dakota Regional @,ledical Program Locus of Activity: Core Activity - Devolopniontal Project Title: EMS (Emergency %Iedical Services) Status: Ongoing and Expandina oring Institution: ND@IP Project Director, Title, Address: John A. Grim, NDIZIIP 1512 Continental Drive Grand Forks, North Dakota 58201 701-77S-5535 Dates: 1969 - 1972 Funding: Staff Support - Non-operational Other Funds: None. Cooperatina Agencies and Institutions: State Health Department, North Dakota Committee on Trauma, American College of Surgeons, @IEDEX, CIIP Area IVide Councils, Hospitals, Newspapers, Radio and T.V. Stations, and, limited to certain phases of the program, State Highway Department, Registrar of Motor Vehicles, and State Highway Patrol. Area Served: The entire state of North Dakota Target Population: The 617,761 people of North Dakota Congressional Districts: #1 Mr. Mark Andrews (R) #2 Mr. Arthur Link (D) Continuation after ND@IP Support is IVithdra.ivn: NDRMP believes that this will be A program requiring continual support, on a special and demand type basis, until the state wide plan becomes implemented. Even then the NDPI,IP support, if available, may be required in this cooperative effort to meet unusual circumstances. Core Staff Contact: John A. Grim, NDPMP Date Prepared: February 2, 1972 Drafted By: John A. Grim NORTH DAKOTA Health Manpower Study North Dakota has an excellent two-year basic science medical school and a number of good educational programs in various institutions for training Allied Health Care profession als. Among the many changes in the educational process now being carried out or proposed throughout the country, there is an almost universal trend towards providing clinical training at an earlier and earlier stage in the medical student's curriculum. Additionally, a number of studies, notably the Carnegie Report on Education, suggest that existing two year schools develop into degree granting institutions or be discontinued. Recognizing the climate of change, the faculty of the North Dakota School of Medicine sought the advice of the North Dakota Medical Association leadership and other physicians. They were in general agreement that a complete survey should be carried out as soon as possib le. It was generally agreed that the major emphasis of the survey would be to consider the future of the School of Medicine. It should also include an overall study of the primary education and subsequent training o al persons who provide any type of health care services. On March 18, 1971, a group of physicians in and out of the medical school met to discuss this subject. The second meeting of a similar.group occurred in Bismarck shortly thereafter. Following this meeting on March 18, in a memorandum to Dr. Harwood, Willard Wright, M.D., Program Director, RMP, submitted some suggestions. In this memorandum, he oIutlined the following suggested procedures: A. Form a Steering Committee representing the Medical School, the University, other educational instit utions, physicians, nurses, other health care professionals, legislators, and prominent citizens. B. Look for Grant funds to finance study. C. Employ a Program Director. D. Study other developing and related programs. E. Be sure and involve as early as possible all health care pro- fessional organizations, and other interested parties. The North Dakota Medical Association House of Delegates, the Medical School Alumni, the Medical Center Advisory Council, and other groups endorsed the project. Th@o-aFd of Directors appointed Willard Wright, M.D., as Executive Director of 'tDM@) and employed Gary Dunn, M.A., formerly Assistant Dean, University of Ala as Research Director. Conduct Of The Study The Initial activity of the research group was to collect and develop infor- mation on the present educational an d other resources available and what -2- the apparent needs are in North Dakota, as well as a consideration of national trends and what types of support might be available from out-of-state sources. (Phase I) Advise and counsel was sought from persons representing the various professions, education and service institutions, state government, etc. During the course of the study, every effort was made to ensure that all interested individuals, organizations, and institutions had an opportunity to participate. The North Dakota Regional Medical Program Regional Advisory Group were (briefed on the nature and progress of the study on November 20. e North Dakota State Health Planning Council held an Interagency Forum November 5 and 6, and discussed the entire range of Allied Health Education North Dakota. ,,'The Board of Directors of NDMRF meeting on December 9, 1971, and discussed in @@@detail some of the more important factors affecting the Medical School. They directed the Study Group to develop definitive information needed for in depth consideration of the following two proposals: (Phase II) 1. Development of a complete clinical training program wit granting of M.D. degree in either three or four years; formulation of a clinical teaching staff; utilization of community hospitals and medical staffs with assistance from full time education di-rectors and development o residency and internship programs. 2. Develop a degree granting school primarily for training ,of family physicians with the student having an option to continue in North Dakota or transfer to another, perhaps more specialist oriented school. The Medical School faculty and Study Group met with the Board of Higher Education and explained the situation. The Board agreed that some plan of action should be developed and further agreed to instruct Dr. Clifford, President of UND to forward a letter of intent to HEW indicating that the school of medicine, UND will be an applicant for appropriate funds available under the Health Manpower Act of 1971. December 20 1971, Mr. Earl Strinden, Bryce Streibel, Dr. Wright, Dr. Eelkema, and Dr. Nelson met informally and discussed methods of keeping members of the State Legislature informed on the progress of the study. Mr. Streibel formed a special nine man Legislative Committee as a part of the standing Legislative Research Council of which he is Chairman. The nine member Legislative Council Committee is composed of the following: Chairman - Oscar Solberg - Rolla State Senators State Representatives Robert Nasset - Regent Art Bunker - Fa'rgo Evan Lips - Bismarck Brynhild Haugland - Minot Lee Christensen - Kenmare Robert Peterson - Williston George Unruh - Grand Forks Ralph Dotzenrod - Wyndmere -3- On January 28, 1972, the Health Manpower Study Advisory Group, Special Committee of the Legislative Research Council, the Medical Center Advisory Council, Board of Higher Education, and the State Comprehensive Health Planning Agency,, -the,.Phase II Report on the requirements and feasibility of a degree granting medical school for the state.@,k@(@@ A final report on total Health Manpower needs for North Dakota and an implementation plan for a degree granting medical school finalized 4y March 18."'@@The report giIven to the State Medical As5ociation, Board of Directors of the North Dakota Medical Research Fo ation other interested groups. L6,ki-@ I a:ttii6. af se of action will be State Medical Association, Board of Higher Education, y and the State Legislature. NORTH DAKOTA Intensive Care Unit And Education Program On October 27, 1971, the North Dakota Regional Medical Program, United Hospital, Grand Forks, the North Dakota League for Nursing, the Great Plains Perinatal Organization, and the Nurses Association of the American College of Obstetrician and Gynecologists-North Dakota Section, co-sponsored a neo- natal workshop,@,at@- the -Westward -Ho Motel, Over 124 nurses,, physicians, student nurses, licensed practical nurses, and MEDEX attended this workshop which included talks on respiratory dis- tress, use of oxygen, @.-the care of the critically ill newborn, intrauter- ing growth, high risk pregnancy, and maternal and infant relationship. Since then, the United Hospital of Grand Forks has met with the Agassiz Comprehensive Health Area Planning Group and have determined that they will initiate an intensive care unit for the neo-nate in the United Hospital and veg h@ conduct continuing education courses to ser ,,comprehensivo health Area. The intensive care unit is now ein Back-IJi) Sliect Region: North Dakota Regional Medical Program Locus of Activity: Core Activity Project Title: Neo-Natal Workshop Status: One-day Workshop in Grand Forks and Minot Sj,)onsorina Institution: North Dakota Regional Medical Program & United Hospital Project Director, Title, Address: Sister Carol Neuburger Assistant Director, Health Education 1512 Continental Drive Grand Forks, North Dakota S8201 701-775-5535 Dates: October 27, 1971 thru 1572 Funding: "In Kind" support from United Hospital cooperating Agencies and Institutions: United Hospital, North Dakota League for Nursing, Great Plains Perinatal Organization, Nurses' Association of the American College of Obstetricians and Gynecologists- North Dakota Section Area Served: Eastern part of North Dakota and western part of Minnesota Target Population: Agassiz Health Planning Area (approximately 200,000 population) Congressional Districts: #1 Mr. Mark Andrews (R) #2 Mr. Arthur Link (D) Continuation After PNIP Support is Withdrawn: United Hospital of Grand Forks, North Dakota will continue the workshops and operate the intensive care unit for the neonate for the area. Core Staff Contact: Sister Carol Nouburger, Assistant Director, Health E ucat on Date Prepared: February 1, 1972 Drafted by:: Sister Carol Neuburger NORTH DAKOTA In-Service Education The North Dakota Regional Medical Program was requested to assist individual hospitals and nursing homes in setting up an in-service education program for their personnel on various aspects of nursing. Larger hospitals with good in- service programs have been of assistance to surrou nding hospitals, bu t many have not been able to take advantage of the programs offered. As a result, the North Dakota R gional Medical Program, in cooperation with the e a State in-servica t_t@q School of Science in Wahpeton, planned a-p e 0 serv:Lt-e p@rs-on@- in the hospitals and nursing homes in the state. The course "Introduction to Teaching Techniques" is taylored to the needs of in-service personnel in the hospitals and nursing homes. The course includes,' preparing instructional objectives, importance of objectives, identifying terminal behavior, how people learn, principles of learning, four-step method of teaching, analyzing occupations for teachable content, determining -wh@at--,t-o@ -teaeh, individualized learning, communicating in,@@th-e--@ci,aS4s-room, use of,.,questions, motivation of the student, learning readiness, keeping records and reports, ins@-tion-al-@-sheets, progress- charts, audiovisual teaching aides, testing as means of evaluation, and use of grades and records. This first course was held in Bismarck and Fargo. Between each sessionz, the participants read assignments and prepared course work for discussion trans- lati6n into actual pr actice. The instructor for the course was Mr. Odin Stutrud, vocational teacher coordinator from the North Dakota State School of Science in Wahpeton. Forty participants attended the course. Two additional workshops on the teaching aspects of coronary care are being offered utilizing the ROCOM Equipment t@-ac-i-l,-it,ate--tear-hi-ng,-"coTona@ry--c.-ar- e@ t, t he coronary care .-Will be taken over by the institutions in the state. Back-Up Sliect Region: North Dakota Regional Medical Program Locus of Activity: Core Activity - Developmental Project Title: Introduction to Teaching Techniques Status : Ongoing Sl!onsoring Institution: North Dakota Regional Medical Program and North Dakota State School of Science in I'@alipeton, N.D. Project Director, Title, Address: Mr. Odin Stutrud Vocational Teacher Coordinator North Dal-Iota State School of Science IVahpeton, North Dal@ota 58075 Dates: 1972-1973 Funding: Staff Support - Non-operatioiial Other Funds: None Cooperating Agencies and Institutions: North Dakota Regional Medical Proaram, North Dakota State School of Science in lqalipeton, N.D. Areas Served: North Dakota Region Target Population: In-service Directors in hospitals and nursi.ng homes Congressional Districts: #1 Mr. Mark Andrews (R) #2 Mr. Arthur Link (D) Continuation After ITNIP Support Withdrawn: The hospitals and nursing homes will take over teaching coronary care ijitliin their own institutions after having a background in teaching techniques. The "Teaching Techniques" Course will be offered by North Dakota State School of Science on a contract Or fee basis. Core Staff Contact: Sister Carol Neuburger, Assistant Director, Health Education Date Prepared: February 1, 1972 Drafted by: Sister Carol Neuburger NEORMP PREVENTIVE AND REHABILITATIVE NEEDS OF THE UNDER 65 HOMEBOUND Through a grant by the Northeast Ohio Regional Medical Program, the Youngstown, Ohio Visiting Nurse Association is studying the needs of homebound persons under 65-years of age. Working with a team composed of a physical therapist, speech therapist, and social worker, the Visiting Nurse Association is concerned with finding, evaluating and referring to existing health care providers and fa- cilities those individuals in need of care. @'Under the direction of Nellie Grant, R.N. the team uses a variety of means to find homebound persons not presently receiving care. Many contacts are made through appeals to the public via the news media and through -Special communications sent to all health and welfare agencies in the community. The Model Cities Program of Youngstown has been particuarly insttu- mental in locating homebound persons and has included a question regarding homebound patients in a survey conducted in the Model Cities area of Youngstown. Service organized parent groups, clubs, neighborhood centers, the Council of Chur@s, and Community Action Center have also been responsible for making a large number of referrals. Studies are cu-rreiiti-T-b-e-ing,@-undeT-t@en- to test the effectiveness of current methods of reaching all homebound persons under age 65 in the area. BACK-UP SHEET egion: Northeast Ohio Regional @ledical Program Locus of Activity: Core Activity Project Title: ' a Preventive and Rehabilitative Needs of the Under 65 Homebound Status: ongoing Sponsoring Institution: Visit ing Nurse Association Project,Director, Title 3Address: Nellie Grant, R.N. Visiting Nurse Association 518 E. Indianola Ave. Youngstown, Ohio Dates: July, 1971 June, 1972 Funding- $ 2 8 , 61 5 Other Funds: Cooperating Agencies and Institutions: Visiting Nurse Association, Model Cities Program, all media, Multiple Schlerosis Society, Library Outreach Project, Community Action Centers, Metropolitan Housing Authority, Goodwill Industries, Service Club, Youngstown City Health Dept. Area Served: Youngstown Model Cities area Back-Up Sheet Page-2 Target Population: several. thousand Congressional Districts: #19 .Continuation after RMP Suppo-rt llithdraivn: N/A Core Staff Contact: Jean Baird, R.N. Date Prepared: Feb. lll 1972 Drafted by: Fran Koneval NEORMP COMPREHENSIVE OUTPATIENT STROKE REHABILITATION PROJECT Since its inception in October, 1970, the Comprehensive Outpatient Stroke Rehabilitation Project in the Lake County area of Northeast Ohio has provided services for over 60 stroke victims. Improvement has been significant in terms of shortening the length of hospita stay, improving the course of rehabilitation, and studying the course of the disease. nder the direction,,of--J -George Furey, M'@D,i@@i the program is housed in the Lake County Society for Crippled Children and Adults, and was begun as a demonstration project to develop and apply a concept of more efficient care for stroke patients in an area where present services were insufficient. Funding through the Northeast Ohio Regional Medical Program. The project utilizes a team approach to stroke rehabilitation@on'sis of a physician, physical therapist, speech therapist, occupational therapist, and social service counselor, all housed conveniently at one facility. When a patient is referred by either his physician or other interested party, his,needs are studied and he then receives instruction in those areas of rehabilitation which best suit him. Lake County has only three hospitals, and more than 6 of stroke victims in the area are treated at the two divisions of Lake County Memorial Hospital. Because of limited facilities, hospital stays for a stroke patient average eight days shorter than other Northeast Ohio hospitals, and rehabilitation facilities after discharge were minimal prior to the project's start. Comprehensive Outpatient Stroke Rehabilitation Project - 2 It is hoped that increasing public awareness of the medical benefits and social economics of the project will make it self-supporting by 1973 and that the rehabilitation potential of many stroke patients will be encouraged. BACK-UP SliEET Region: Northeast Ohio Regional @ledical Program Locus of Activity: Deinonst-ration Project Project Title: A Comprehensive Outpatient Stroke Rehabilitation Project Status: Ongoing Sponsoring Institution: The Lake County Society for Crippled Children Adults Project_Director, Title, Address: J. George Furey, @I.D., Medical Director Lake County Society for Crippled Childre, and A ults 9521 Lakeshore Blvd. Mentor, Ohio 44060 Dates: October, 1970 June, 1972 Funding: $36,174 (Oct., 1970 - June, 1971) $48,233 (fiscal 1972) Other Punds: Cooperating Agencies and Institutions: All area hospitals Area Served: Lake County, Ohio Back-Up Sheet Page 2 Target P all stroke victims in Lake County Congressional Districts: ,Continuation after R@NIP Support Vtithdrawn: N/A Core Staff Contact: Sandra Knott, R.N. Date Prepared: February 15, 1972 Drafted by. Fran Koneval NEORMP CONTINUING EDUCATION OF NURSES IN CORONARY CARE In July@' 1970, the Northeast Ohio Regional Medical Program joined in SI support of a program for continuing education of nurses in coronary care which was initiated by the American Heart Association!8 Northeast Ohio Chapter. Under the direction of Simon Ohanessian, M.D., Cardiologist, and a Senior Clinical Instructor in Medicine at Case Western Reserve University School of Medicine, the project is designed to avoid costly duplication of effort and resources through shared, coordinated planning and instruction. The course consistsof an intensive four-week course with periodic advanced seminars for registered nurses after completion of the initial four-week course. Each course is 120 hours in length, with 80 hours devoted to classroom instruction and 40 hours spent in coronary care units for supervised clinical experience. The ultimate goal of the instructional program is to prolong the lives of patients with acute myocardial infarctibn and other acute car iac condition8,through systematic education of nurses in Northeast Ohio in the disciplines necessary for care of patients admitted to intensive coronary care units. There are now approximately 300 monitored beds in Northeast Ohio. Continuing Education of Nurses in Coronary Care -. 2 A special two-week course is offered to licensed practical nurses in the area in order to give them the knowledge, skills, and attitu es to function optimally as a member of the coronary care team. These courses are offered under the supervision of a registered nurse in a coronary care unit. The program has already been initiated in several of the major hospitals in the 12-county area, and it is hoped that it will ultimately serve as a foundation for future expansion into a univetsity-based program in cardiovascular nursing. BACK-UP SI-IEE'R Region: Northeast Ohio Regional Medical Program .Locus of Activity: Operational Project Project itle: Continuin(i Education of Nurses in Coronary Care Status: Ongoing Sponsoring Institution: American Heart Aseociation, Northeast Ohio Chapter Project,Director, Title, Address: Simon Ohanessian, M.D. Dates: July, 1970 June, 1973 Funding: $8S,381 (fiscal 1970-1971) $65 008 (Fiscal 1971-72) Other Funds: Cooperating Agencies and Institutions: all area hospitals Area Served: 12-county Northeast Ohio area Back-Up Sheet Page.2 Target Population: 4 , 5 0 00 0 0 Congressional Districts: #13 #14 #16 19 20 21 @22 23 Continuation after RNIP Support I-,' ithdraiqn: N/A Corb Staff Contact: Sandra Knott, R.N. Date Prepared: Feb. 15, 1972 Drafted by: Fran Koneval NEORMP LASER TV TRANSMISSION Inter-hospital communications in Northeastern Ohio are being stepped up thanks to a laser system developed at the Health Sciences Communi- cations Center at Case Western Reserve University through the combined efforts of faculty and students of CWRU Schools of Medicine and En- gineering. Grants from the Cleveland Foundation and from the Northeast Ohio Regional Medical Program made possible the purchase of a return link and evaluation system to be added to an existent one-way laser system used to transmit video and audio signals from Lakeside Hospital to the Veterans Administration Hospital. Project director is Dr. William T. Stickley, Associate Professor of Medical Education and Acting Director of the Health Sciences Communications Centeri When fully operative, the laser will provide capabilities for offering intet-hospital communications which could be used for@; noon )Conferences, patient demonstrations, courses, and special events for professional education of health sciences personnel. Future plans include the installation of cabling in the Schools of Medicine, Dentistry, Nursing and in University Hospitals and the possible application of the system to other hospitals in the 12-county Northeast Ohio area. initially, the laser will be used for a patient-care program designed by Dr. J. S. Gravenstein, Professor of Anesthesiology at Lakeside Hospital. The system will facilitate communication between nurse anesthetists And surgeons at the Veterans Administration Hospital and anesthesiologists at Lakeside Hospital. The laser will provide the capacity for immediate communication and consultation needed in some Laser TV Transmission - 2 operating room instances and for constant patient monitoring by anesthesiologists at Lakeside Hospital. The laser av-tv system was developed by Dr. Yoh-Han Pao, Professor and Head of the Division of Electrical Engineering and Applied Physics and graduate students John W. Allen and Jonathan P. Freeman at Case Western Reserve University. BACK-UP StiBET Region: Northeast Ohio Regional Medical Prograin Locus of Activity, Core Activity Project Title: LaAer Tv Transmission Status: ongoing Sponsoring Institution: Case Western Reserve University Project-Director, Title, Address: William T. Stickley, Ph. D.' Yoh-Han Pao, Ph. D. Div. of Research in Med. EdLIcati6n School of @,tedicine, CIVRU 2119 Abington Road Clevela d 4106 Dates: Funding: $8,500 per,-Year Other Funis: W.K. Kellogg Foundation and Cleveland Foundation Cooperating kgencies and Institutions: Case Western Reserve University, VA Hospital, University Hospitals Area Served: Cuyahoga County Back-Up Sheet Page 2 Tar 2,000,000 + Conaressional Districts: 20 , # 21 ,22 , 23 Continuation after RMP Support I'lithdra@vn: 'Cote Staff Contact: Leonard Chansky Date Prepared: Feb. 15@ 1972 Drafted by: Fran Koneval NEORMP DISCHARGE PLANNING FOR CONTINUITY OF CARE Mrs. V. is an 84-year-old woman with diabetes, a peptic ulcer, and cardiac difficulties. Recently discharged from the hospital, she lives alone and refuses to be placed in a nursing home for care. She requires a complicated medical regime, and supervision and assist- ance in preparing special diets to keep her alive. She was referred to a special hospital coordinator, who made arrange- ments with the Visiting Nurse Association and the Homemaker Service in Lorain County, Ohio, to help Mrs. V meet her needs. A container was devised by the Visiting Nurse to enable Mrs. V to remember to take her medications. It was marked with different colors for each day of the week, and subdivided into four cup-like divisions to indicate the time of day each medication was to be taken. The container for Friday was colored red so the patient would remember to save a urine specimen for the Visiting Nurse to test on her weekly visit to the home. Mrs. V and many other residents of Lorain County are learningto meet their medical needs through the Discharge Planning for Continuity of Care Program sponsored by the Lorain County Health Department, and funded under a grant by the Northeast Ohio Regional Medical Program. The aim of the project is to establish a fully cooperative discharge planning program which will insure adequate care for the continuing health needs of patients from all hospitals in Lorain County- Discharge Planning for Continuity of Care - 2 Under the direction of Betty Wolfe, R.N., the project began in September, 1971, and currently is being administered through Elyria Memorial Hospital. By 1974, project administrators hope to have the discharge planning program operative in all Lorain County hospitals. Referrals for patients who will need post-hospital care and treatment are made by personal physicians, therapists, and other interested parties to the nurse coordinator, who confers with the patient's physician to determine the individuals needs. Arrangements are then made with various agencies to provide special s@ervices and equipment to insure optimum care to the individual. In many cases, this includes nursing services therapy programs, social service counseling, dietary consultations, transportation, and coordination of outpatient visits. Programs are tailor made to fit each patient. Through this program., individuals who are not aware of the many community agencies iio can be of help'to them are put in touch with everyone who can assist them in meeting their health -requirements. This program is being studied as a model by the Regional Medical Program in the hope that it can be expanded to other areas of their 12-county Northeast Ohio region. BACK-UP SliEET eg,ion: Nort)ieast Oliio Regional @ledical Program Locus of Activity, Core Activity Project Title: Dischar e Planning for Continuity of Care 9 Status: Onaoing t, Sponsoring Institution: Lorain County Health Department, 880 S. Murray Ridge Road, Elyria, Ohio Project-Director, Title, Address: Betty Wolfe, Program Dire ctor 9880 South Murray Ridge Road Elyria Ohio 44035 Dates: June, 1971 July, 1972 Funding: $ 3 7 , 64 7 Other Funds: Coopdrating Agencies and Institutions: Lorain County Health Department, Visiting Nurse Association, Lorain County Hospital (and generally all health and social service agencies in Lorain County) Area Served: Lorain County BErck-Up Sheet Page 2 Target Pol)ulation: 2 7 0 , 0 0 0 ongressional DistTicts: Ohio #13 Continuation after RMP Support Vlithdraiqn: N/A Core Staff Contact: Martha McCrary .Date Prepared: February 7, -1972 Drafted by: Fran Koneval NEORMP LORAIN COUNTY COMMUNITY HEALTH CENTER Through a planning grant by the Northeast Ohio Regional Medical Program, the Lorain County Community Health Center is working toward the development of a comprehensive health care program for up to 28,000 Lorain County residents who are below the national poverty level and who are presently receiving inadequate medical care. Following two years of volunteer effort by a large number of residents and representatives of community and county agencies, the grant provides for a full-time administrator/planner to study the needs of Lorain County's indigent population and obtain the necessary federal, state, and local funds to operate the comprehensive health center program. Frederick Richards was hired on November 1 and has already set plans for financing and construction of the facility into motion. He hopes to have construction underway by 1974. Lorain County is a rapidly expanding industrial and rural area of 250,1000 people, with over 28,000 people below the national poverty level.,' Current outpatient facilities at two Lorain County hospitals are limited, offering services only one morning per week, and neither facility has a dental clinic. At present, Lorain County has no pre- natal clinic, and no preventive medical care program for the indigent. Plans for the center propose general family medical and dental care Special services would include a well-baby clinic and immunization program, obstetrical and gynecological care, an x-ray department and Lbrain County Community Health Center - 2 laboratory, a comprehensive mental health program, with programs on alcoholism and drug addiction, a health education program, hearing evaluation visual testing, pharmacy, and day care center for children. BACK-UP SI-IEET Region: Northeast Ohio Regional @ledical Program Locus of Activity: Core Activity Project Title: Lorain County Community Health Center Status: Ongoing SponsorinR Institution: Lorain County Community Health Center, Inc., 1536 East 30th Street, 'Lorain 44055 Project,Director, Title, Address: Albert A. Fisk, @I.D., President Lorain County Community Health Center, Inc. 1536 East 30th Street Lorain, Ohio 44055 Dates: July, 1971 June, 1972 Funding-. $26,780 Other Funds: cobVeTating Agencies and Institutions: Hough-Norwood Health Center, Cleveland; Lorain County @lental Health Board, Lorain Cpunty Commissioners, Lorain County @ledical Society, United Community Services of Greater Lorain County, the Lorain County Health Department, Lorain City Health Department, Lorain County Neighborhood Association Area Served: Lorain County Back-Up Slieet Pace 2 Target PoRu ation: up to 28,000 Congressionai Districts: Ohio #13 Continuation after R,@@IP Support Withdrawn: Possibly OEO or other HEII funds Core Staff Contact: Martha E. McCrary Date Prepared: February 7, 1972 Drafted Fran Koneval BACK-UP SHEET Region: Northeast Ohio Regional Medical Program Locus of Activity: Core Activity Project Title: Discharge Planning for Continuity of Care Status: Ongoing Sponsoring Institution: Lorain County Health Department, 880 S. Murray Ridge Road, Elyria, Ohio Project Director, Title, Address: Betty Wolfe., Program Director 9880 South Murray Ridge Road Elyria, Ohio 44035 Dates: June, 1971 July, 1972 Funding. 37 , 64 7 Other Funds: Cooperating Agencies and Institutions: Lorain County Health Department, Visiting Nurse Association, Lorain County Hospital (and generally all health and social service agencies in Lorain County) Area Served: Lorain County Ba ck-U Sh et Pa e 2 p e 9 TaVget Population: 270 000 Congressional Districts: Ohio #13 Continuation after RMP Support Withdrawn: N/A Cbre Staff Contact: Marthd McCrary Date Prepared: F6bruary 7 1972 Drafted by-- Fran Kon6val BACK-UP SHEET Region: Northeast Ohio Regional Medical Program Locus of Activity: Core Activity Proj6ct Title: Lorain County Community Health Center Status: Ongoing Sponsoring Institution: Lorain County Community Health Center, Inc., 1536 East 30th Street, .Lorain 44055. Project Director, Title, Address: Albert A.. Fisk, M.D., President Lorain County Community Health Center, Inc. 1536 East 30th Street Lorain, Ohio 44055 Dates: July, 1971 June, 1972 Funding: $26 780 Other 'Funds: Cooperatifig Agencies and Institutions: Hough-Norwood Health Center, Cleveland; Lorain County Mental Health Board, Lorain County Commissioners, Lorain County Medical Society, United Community Services of Greater Lorain Count , the Lorain y County Health Department, Lorain City Health Department Lorain County Neighborhood Association Area Served: Lorain County eel P ge 2 Back-Up Sh a Target Population: up to 28,000 Congressional Districts: Ohio #13 Continuation after RMP Support Withdrawn: Possibly OEO or other HEW funds Core Staff Contact: Martha E. McCrary Date Prepared: February 7, 19@72 Drafted b@. Fran Koneval BACK-UP SHEET Region: Northeast Ohio Regional Medical Program Locus of Activity: Core Activity Project Title, Preventive and Rehabilitative Needs of the Under 65 Homebbund Status: ongoing Sponsoring Institution: Visiting Nurse Association Project Director, Title, Address: Nellie Grant, R.N.- Visiting Nurse Association 518 E. Indianola Ave. Youngstown, Ohio Dates: July, 1971 June, 1972 Funding, $ 2 8 61 5 Other Furds: Cooperating Agencies and Institutions: VI-siting Nurse Association, Model Cities Program, all media, multiple Schlero8is Society, Library Outreach Project, Community Action Centers, Metropolitan Housing Authority, Goodwill Ind-dstries, Service Club, Youngstown City Health Dept. Area Served: Youngstown Model Cities area @Back-Up Sheet Page,2 Target Population: several thousand Congressional Districts: #19 Continuation after RMP Support Vlithdrawn: N/A Core Staff Contact: Jean Baitd, R.N. Date Prepared: Feb. 111, 1972 Drafted by- Fran Koneval BACK-UP SHEET Region: Northeast Ohio Regional Medical Program Locus of Activity: Demonstration Project Project Title: A Comprehensive Outpatient Stroke Rehabilitation Project Status: ongoing Sponsoring Institution: The Lake County Society for Crippled Children Adults Project Director, Title, Address: J. George Furey, M.D., Medical Director Lake County Society for Crippled Children and Adults 9521 Lakeshore Blvd. mentor, Ohio 44060 Dates: October, 1970 June, 19 72 Funding: $36,174 (Oct., 1970 - June, 1971) $48,233 (fiscal 1972) Other Funds: Cooperating Agencies and Institutions: All area hospitals Area Served: Lake County Ohio Back-U Sheet Page 2 p Target Po.pulation: all stroke'victims in Lake County Congres.sional Districts: Continuation after RMP Support Vlithd-ra'wn: N/A Core Staff Contact: Sandra Knott, R.N. Date Prepared: February 15, 1972 Drafted by: Fran Koneval BACK-UP SHEET Region: Northeast Ohio Regional Medical Program Locus of Activity: Operational Project P oiect Title: .Continuing Education of Nurses in Coronary Care Status: Ongoing Sponsoring Institution: American Heart Aseociation, Northeast Ohio Chapter P 6i6ct Director, Title, Addr6ss: Simon Ohanessian, M.D. Dates: July, 1970 June, 1973 Funding: $85,381 (fiscal 1970-19 1 $65 008 (Fiscal 1971-72) Other Funds: Codperati@g Ag6ncies and Institutions: all area hospitals Area Served: 12-county Northeast Ohio area Back-Up Sheet Page.2 Target Population: 4,500,000 Congressional Districts: #13, #14, #16 , 19 , 20 , 21 , @22 ,23 Continuation after RMP Support Vllthd-rawn: N/A Core Staff Contact: Sandra Knott, R.N. Date Prepared: Feb. 15, 1972 Drafted by, Fran Koneval BACK-UP SHEET Region: Northeast Ohio Regional Medical Program Locus of Activity: Core Activity Project Title: Later Tv Transmission Status: ongoing Sponsoring Insti tution: Case Western Reserve University Project Director, Title, Address: William T. Stickley, Ph. D. Yoh-Han Pao, Ph. D. Div. of Research in Med. Edi4cation School of Medicine, CWRU 2119 Abi aton Road Cleveland-44106 Dates: Funding4 $8,500 peryear Other Funis: W.K. Kellogg Foundation and Cleveland Foundation Cooperating kgeficies and Institutions: Case Western Reserve University, VA Hospital, University Hospitals Area Served: Cuyanoga uounty Badk-Up Sheet Page 2 Target Population: 2,000,000 Congr@essional Districts: #20, #21, #22, #23 Continuation after RMP Support Vlithdrawn: Core StAff Contact: Leonard Chansky Date Prepared: Feb. 15, 1972 Drdfted b@. Fran Koneval Vignette Description: NORTHLANDS MINNESOTA HEALTH CARE OPINION SURVEY A comprehensive survey recently conducted by Northlands RMP, Comprehensive Health Planning, and Blue Cross, revealed attitudes held by Minnesotans toward health care. The study included 2,000 door-to-door interviews and 5,000 mailed questionnaires, which were sent to physicians, medical students, hospital trustees and administrators, and others involved in providing health care. Among the results were the following significant findings: In relation to problems facing society, the highest priority "s.@ @igned to health care problemi-@l-mi-one@an's@,-" Costs associated with health care such as hospital charges, health insurance, physician and dentist fees, represent a major concern to all groups surveyed; The quality of health care is not considered a major problem by consumers and providers, but there is a concern for the continuation of this level of quality; While the findings tend to reflect a rather positive picture of health care, they also indicate some gaps, deficiencies and weaknesses; The findings indicate a considerable willingness by both consumers and providers to permit a physician's assistant to perform a number of services traditionally provided by physicians; There are mixed opinions among the consumer and provider groups regarding the idea of national health insurance; There is a strong difference of opinion within both consumer and provider groups in respect to prepaid group medical practice; No definite patterns emerged identify,@. differences of opinion in the various geographic areas of Minnesota nor between the various consumer and provider groups; The study shows that there is a general\-,acceptance by-. s of providers'participation in seeking solutions to health care problems in Minnesota. Bac@,-Up Sh e@t Region: Northlands Regional Medical Program, Inc. Locus of Activity: Core Activity Project Title: Minnesota Health Care Opinion Survey Status: Professional Staff Activity Sponsoring Institutions: Northlands Regional Medical Program, Inc., Minnesota Comprehensive Health Planning Agency, and Minnesota Blue Cross-Blue Shield-MII. Project Director, Title, and Address: Russell N. Hill, Ph.D. Evaluation and Data Officer Northlands Regional Medical Program, Inc. 375 Jackson Street St. Paul, Minnesota 55101 Dates: Survey conducted in Spring, 1971 and published and released in November, 1971. Funding: 02 $25,000 Other Funds: Funded also by Minnesota Comprehensive Health Planning Agency and Blue Cross-Blue Shield-MII. Cooperating Agencies and Institutions: The Minnesota Health Care Opinion Survey Advisory Committee included representatives from the Minnesota State Medical Association, Minnesota Hospital Association, Institute for Interdisciplinary Studies (Mpls.), Minnesota Planned Parenthood, University of Minnesota Hospitals (Mpls ), Eitel Hospital (Mpls.), Henry Ford Hosi)ital (Detroit), Duluth-Miller H@spital Research Complex (Duluth), Charles'T. Miller Hospital (St. Paul), University of Minnesota (Department of Public Planning and Program in Health Care and Hospital Administration), as well as representatives from Northlands Regional Medical Program, Minnesota Blue Cross-Blue Shield-MII, and Minnesota Comprehensive Health Planning Agency. Area Served: State of Minnesota Target Population: The respondents were divided into two broad categories: health consumers and health providers. The health consumers were further divided into "general consumers" and "specific consumer groups". The health providers were divided into "medically oriented groups" and "hospital related groups." Interviews were conducted with 2,000 health consumers and 5,000 health providers. Continuation after RMP Support Withdrawn: No, but study may possibly be updated in two years. MOBILE CORONARY CARE UNIT PROGRAM Heart attacks kill more than 500,000 persons each year in the United States and of that number better than half die before reaching a hospital and the benefits of a modern coronary unit. Proving that this high mortality rate could be reduced by speeding intensive heart care directly to the patient was the purpose of the Columbus Heartmobile, a feasibility study funded through the Ohio State Regional Medical Program. The vehicle has proven that premise, but what's more has lead to improved emergency medical care for all residents of the city. As a result of the project, three mobile "trauma units" complete with portable coronary care unit equipment are now serving Columbus and all fire department emergency squad, men receive in-depth training in heart-saving techniques, The mobile coronary care unit program was funded as a feasibility study and the 1968 through June p@s an operational project from April@ ,o 1971,@sponsored by the Ohio State University College of Medicine in cooperation with the Central Ohio Heart Association. The specially designed van was equipped with the features of a modern hospital coronary care unit, including electrocardio-, graph, defibrillator, and heart-lung resuscitator plus a telemetry, unit for transmitting the patient's electrocardiogram to a h6s- pital. Staffed by members of a specially trained crew of the Col @ us Fire Department Emergency squad, a physician and occasionally a nurses the Heartmobile began 24-hour service in April. 1969. It served a six-square-mile area encompassing about half the daytime population of metropolitcin-Columbus. The van was alerted at its base at OSU Hospital by calls from the Central Fite Department. After stabalizing the patient's condition at the scene of the attack, the emergency team could transport the victim to the nearest hospital with a CCU while administering continuing care. Evaluation of Heartmobile runs revealed that the time-lag/ between heart attack and trea@ment did make a difference. Of 1,000 calls examined at one point,(346 of which were cancelle@,en route) 59 deaths prior to hospital admission were reported the majority were sudden deaths due to coronary artery @isease. There were 58 cardiopulmonary resuscitation@'with seven long-term survivors. Over half of the myocardial infarction patients required therapy for serious arrhthmias while within the vehicle. The impact of the feasibility project reached far beyond the patients who received treatment in the original Heartmobile. At the program's termination, the City of Columbus assumed sponsorship of the vehicle to assure continuance of the service4 A 64-hour course was developed to train all emergency squad personnel in heart treat- Mont techniques with the van utilized as A training unit. By a of 1971, three additional mobile "trauma units" equipped with portable CCU equipment had been purchased to serve the entire City of Columbus. OHIO CORONARY CARE UNIT NURSES' TRAINING PROGRAM More than 600 nurses have received training for the specialize duties in hospital coronary care units through a program funded by the Ohio Regional Medical Program and sponsored by the Central Ohio Heart Association. In operation since May, 1969, the project is directed by George C. Morrice, M.D., a cardiologist in Newark, Ohio. The purpose of the project is to help hospitals provide qualified nursing staffs for this special type of intensive care unit which is being utilized by many hospitals to provide optimum care for heart attack patients. Initially, the training program was offered through a two- week course held at the Ohio State University Hospital in Columbus. Nurses received instruction in all aspects of nursing care and equipment management currently in use in coronary care units. Topics covered includw.- @ coronary care concept; anatomy and physiology of the heart and circulation; fundamentals of electro- physiology; drugs and treatment; pathology and physiology of myo- cardial infarction; cardiopulmonary resuscitation; the complications of myocardial infarction; arrhythmiasi nursing considerations, an the psychological aspects of treatment. The nurses also received practice on "Rescui Annie" and "Arrythmia Annie" mannikans" learned to operate monitoring equipment and underwent clinical experience in established CCUS. in the program's second year, in order to make the training available to nurses who could not come to Columbus for the two-week class, courses were implemented in 12 more hospitals in nine designate ficore areal? or central communities in the region. To staff these course, 18 local nurses received special in-depth training as instructors. These classes, held over a 20 to 30-week period, offered basically the same curriculum as the original course. To supplement lectures and demonstrations, however, a multi-media instructional system con- taining CCU film strips, tapes and slides in a portable unit was ob- tained for circulation among the core are classes. Overall, during the project's three years of operation, some 643 nurses representing 47 counties and 84 hospitals in Ohio completed the training program. It is estimated that approximately one-third to one-half of the nurses trained are currently working in coronary care units.. Funding for the program the Ohio State Regional Medical Program, wh+",.,amounted to $169,76o@ @@'*e'xpire@,june 30, 1972,, Because of @success training @ support a@sumed by the Central Ohio Heart Association. In the upcoming months, the project staff plans to place in- creased emphasis on assisting community hospitals in establishing their own CCU training programs so the courses can become an ongoing inservice educational activity. OHIO Training Program for Directors of Medical Education A Training Program for Directors of Medical Education is offered by the Ohio Regional Medical Program. Developed originally by the Continuing Education Program of the Ohio State Regional Medical Program, the DME Training Program is based upon the concept that cornr-,iunity hospitals are educational institutions. The program deals specifically with three areas: (1) educational activities, (2) interrelationships between education and other hospital activities, and (3) collateral activities. It is a basic three-month program with an optional but highly r ecommended fourth month Preceptorship with an experienced Director of Medical Education in a community hospital. The functions of a DME v§y from hospital to hospital but the essential responsibilities common to most community hospitals are explored. A systematic approach to developing education programs in con=unity hospitals is stressed and training is both didactic and experience-centered with two-way continuous feedback and evaluation. The first few weeks are spent becoming familiar with-the role of the DME in a community hospital including the functions and responsibilities as well as re- quirements in terms of behavioral characteristics: art of communication, interpersonal relationships, maturity of judgment and self-concept. Whenever possible, a patterned learning sequence is followed. However, the available time devoted to the program by cooperating Directors of Medical Education vary@ as will the available time of consultants in Education and in the Behavioral Sciences. Conferences, sermnars and selected professional meetings also influence the sequence to some de7,ree, but all areas described in an accompanying syllabus are covered during the trainee's program. Consultants are selected from the Social and Behavioral Sciences, Adult Education, as well as Medical Education so that the trainee recognizes the interrelationship of the cultural, social, psychological and environmental factors with the delivery of health care. The tuition for the program is $500 per month, and in addition to program content, the fee includes guest faculty parking permit, library privileges, recreation card, desk space, secretarial assistance, travel expenses to program-related conferences and seminars (off campus), consultants' honoraria.- membership dues in medica education organizations, certain journal subscriptionfees and selected textbooks .,--@-which to begin a core library in the field of medical and allied medical education. ormation or application forms may be obtained from the Ohio Regional Medical ly@, P@ogram. OHIO Patient Care Conferences Patient Care Conferences are aimed at holding hospital-based educational conferences with a goal of improving patient care. Participating in the pilot program was Grandview Hospital in Dayton, Ohio, which continues to hold monthly conferences. Operating on the premise that the quality of care in an institution is directly related to the quality of its educational program, the Patient Care Conference concept was designed as an interdisciplinary program inclu ing not only nurses but LPNs and other allied health professionals. Using a problem-solving approach, a case abstract of a specific, but anonymous, recently Hospitalized patient is presented to the participants along with a description of the nursing care problems encountered with that patient. After presentation of facts, the participants are divided into small groups and asked to recommend solutions to the problems presented. The groups recovene after an alloted time and each presents its suggestions. The remaining time is spent evaluating the actual and recommended metltods of care with emphasis placed on the fact that the particular case presented is not of prime importance, but is used as a means to relate patient care problems in general, as well as potential solutions. Any interested health related persons can arrange to attend a session of the Patient Care Conference for first-hand observation, or contact the Ohio Regional Medical Program for further information in setting up such conferences. OHIO Postgraduate Preceptorship Program The Ohio Regional Medical Program in cooperation with the Center for Continuing Medical Education of the College of Medicine of The Ohio State University and the Ohio Academy of Family Physicians, is offering short Preceptorships for prac- ticing physicians. Originally begun by the Continuing Education Program of the Ohio State Regional Medical Program, the Preceptorships are continuing to be offered through ORMP. The Preceptorships are of one, two or three weeks' duration in the physician's field,of interest, and provide an opportunity for the physician to acquire new or refresh present knowledge or skills. The program is structured to allow ample opportunity for free and informal discussion. Preceptorships may be in a single field or in combined fields of interest a nd are available in most practice areas. Applicants are asked to state in advance what they wish to learn (educational objectives). This information is submitted to the Preceptor so that the training experience can be individualized as much as possible. The Preceptee subsequently is involved in the evaluation of his experience based upon his original educations objectives. The Preceptorships have been approved for a minimum of 10 credit hours by the Ohio Academy of Family Physicians and for a mimimum of two days postgraduate credit by the Ohio Osteopathic Association. The Preceptorships are also creditable under Category 4 for the 1972 Physician's Recognition Award. A tuition is charged, which in addition to course content, includes registration, parking fees, noon meals and library services. The Preceptorships are open to out-of7,state physicians with the stipulation that Ohio physicians will be considered first.@Infor 'tion,@or -applicatio-n-,jLq;rms maybe obtained from the Ohio Regional Medical 'Program MOBILE CORONARY CARE UL@IT PROGRAM Heart attacks kill more than 500,000 persons each year in the@'United States and of that number better than half die before reaching a hospital and the benefits of a modern coronary unit. Proving that this high mortality rate could be reduced by speeding intensive heart care directly to the patient was the purpose of the Columbus Heartmobile, a feasibility study funded through the Ohio State Regional Medical Program. The vehicle has proven that premise, but what's more has lead to improved emergency medical care fo r all residents of the city. As a result of the project, three mobile "trauma units" complete with portable coronary care unit equipment are now serving Columbus and all fire department emergency squad-" men receive in-depth training in heart-saving techniques. The mobile coronary care unit program was funded as a feasibility study and then as an operational project from April, 1968 through June, 1971, sponsored by the Ohio State University College of Medicine in cooperation with the Central Ohio Heart Association. The speciall designed van was equipped with the features y of a modern hospital coronary care unit, including electrocardio@ graph, defibrillator, and heart-lung resuscitator plus a telemetry unit for transmitting the patients electrocardiogram to a hos- pital. Staffed by members of a specially trained crew of the Col @ us Fire Department Emergency Squad, a physician and occasionally a nurse, the Heartmobile began 24 hour service in April, 1969-. It served a six-square mile area encompassing about half the daytime population of metropolitan Columbus. The van was alerted at its ba se at OSU Hospital by calls from the Central Fite Department. After stabalizing the patient's condition at the scene of the attack, the emergency team could transport.the victim to the nearest hospital with a CCU while administering continuing care. Evaluation of Heartmobile runs revealed that the tiTne-lage between heart attack and treatment did make a difference. Of 1,000 calls examined at one point, 346 of which were cancelled, en route, 59 deaths prior to hospital admission were reported, the majority of which were sudden deaths due to coronary artery disease. There were 58 cardiopulmonary resuscitation with seven long-term survivors. Over half of the myocardial infarction patients required therapy for serious arrhthmias while within the vehicle. The impact of the feasibility project reached far beyond the patients who received treatment in the original Heartmobile. At the program's termination, the City of Columbus assumed sponsorship of the vehicle to assure continuance of the service. A 64-hour course was developed to train all emergency squad personnel in heart treat- ment techniques with the van utilized as a training unit. By fall mobile "trauma units,, equipped with of 1971, three additiona I portable CCU equipment had been purchased to serve the entire City of Columbus. Ion: Ohio State Regional Medical Program Locus-. Operational Project ect Title: Mobile Coronary Care Unit Program Status: Past Operational Sponsoring Institution: Ohio State University College of Medicine in cooperation with the Central Ohio Heart Association Prolect Director, James V. Warren, M.D. r -Address: Chairman, Department of Medicine College of Medicine Ohio State University N1013 University Hospital 410 West Tenth Avenue Columbus, Ohio 43210 'Dates: Feasibility study, April, 1968-through June, 1969 Operational Project July, 1969 through June 30, 1911 Funding: Feasibility study $167,702 Operational Project $269r580 Other Funds: None ting Aq Columbus Fire Department, Dave Ellis Design Corporation, Ohio State University Hospital. Area served: Metropolitan Columbus Tar2 o ulation: Columbus residents ressional Districts: 12 Continuation after RMP Sponsorship assumed by City of Columbus su2port withdrawn: at project's termination with Heartmobile incorporated into the Fire Department Emergency Squad. Mobile CCU expanded with addition of three "trauma units" equipped with CCU capabilities and fire squadmeh trained it heart-saving techniques. -Core Staff Contact: Marilyn Fitch, Assistant Director Communications Date Prepared: 6/l/72 Drafted by: Marilyn Fitch OHIO CORONARY CARE UNIT NURSES' TRAINING PROGRAM More than 600 nurses have received training for the specialized duties in hospital coronary care units through a program funded by the Ohio Regional Medical Program and sponsored by the Central Ohio Heart Association. In operation since May, 1969, the project is directed by George C. Morrice, M.D., a cardiologist in Newark, Ohio. The purpose of the proj@ct is to help hospitals provide qualified nursing staffs for this special type of intensive care unit which is being utilized by many hospitals to provide optimum care for heart attack patients. Initially, the training program was offered through a two- week course held at the Ohio State University Hospital in Columbus. Nurses received instruction in all aspects of nursing care and equipment management currently in use in coronary care units. Topics covered include: the coronary care concept; anatomy and physiology of the heart and circulation; fundamentals of electro- Physiology; drugs and treatment; pathology and physiology of myo- cardial infarction; cardiopulmonary resuscitation; the complications of myocardial infatction; arrhythmias; nursing considerations, aAd the psychological- aspects of treatment. The nurses also received practice on "Rescui Annie" and "Arrythmia Annie" Tnannikans, learned to operate monitoring equipment and underwent clinical experience in established CCUS. In the program's second year, in order to make the training available to nurses who could not come to Columbus for the two-week class, courses were implemented in 12 more hospitals in nine designated it core ar6a" or central communities in the region. To staff these course, 18 local nurses received special in-depth training as instructors. These classes, held over a 20 to 30-week period, offered basically the same curriculum as the original course. To supplement lectures And demonstrations, however, a multi-media instructional system con- taining CCU film st@ips, tapes and slides in a portable unit was ob- tained for circulation among the core are classes. Overall, during the project's three years of operation, some 643 nurses representing 47 counties and 84 hospitals in Ohio completed the training program. It is estimated-that approximately one-third to one-half of the nurses trained are currently working in coronary care units. Funding for the program for the Ohio State Regional Medical Program, which amounted to.$169,760, will expire June 30, 1972. Because of the success of the training program support after that time will be assumed by the Central Ohio Heart Association. In the upcoming months, the project staff plans to place in- creased emphasis on assisting community hospitals in establishing. their own CCU training programs so the courses can become an ongoing inservice educational activity. he-et egional egion: Ohio State R Medical Program Locu's of Activity: Operational Project Project Title: Coronary Care Unit Nurses' Training Program Status: Ongoing Sponsorinq Institution: Central Ohio Heart Association Project Director, George C. Morrice, DI.D. Title, Address: Director, Cardio-Pulmonary Division Licking County Memorial Hospital 1320 West Main Street Newark, Ohio 43055 (614) 3 4 4- 0 331 Dates: Funded as an Operational Project from 5/l/69 through 6/30/72 FundinSI: 5 1/69 through 6/30/70 $120,590 .7/l/70 through 6/30/70 41,679 7/l/71 through 6/30/72 7,500 1 69 , 76 9 Other Funds: Matching funds for last year of operation from Central Ohio Heart Association $70500. Cooperatinq Agencies Central Ohio Heart Association, and In., s: Ohio Heart As sociation, Ohio State University Hospitali 84 hospitals in OS-RMP region. Area Served: Entire OS-RMP region of 61 counties Target Population: 600 nurses in 61 counties Congr essional Districts: 4,8,7,12,17,16,18,15,6,24,10 Continuation after PJ4P Central Ohio Heart Association will ort withdrawn: maintain program in modified form. Classes actually conducted by project staff will be reduced while more effort will be placed on assisting hospitals in setting up their own CCU educational programs so courses will become an ongoing in-house activity. Core Staff Contact: Marilyn Fitch, Assistant Director, Communications -7 / -7 1) h-rnf@@ livt Marilvn Fitch OHIO ostgr@td@ t@e Prece torship Program The Ohio Regional Medical Program in cooperation with the Center for Continuing of the College of Medicine of The Ohio State University and t Medical Education I he -Ohio Academy of Family PI-.iysician's, is offering short Preceptorships for prac- ticing physicians. Originally begun by the Continuing Education Program of the Ohio State Regional Medical Program, the Preceptorships are continuing to be offered through ORMP. The Preceptorships are of one, two or three i#eeks' duration in the physician's field of interest, and provide an opportunity for the physician to acquire new or refresh present knowledge or skills. The program is structured to allow ample opportunity for free and informal discussion. Preceptbrships may be in a single field or in combined fields of interest a nd are available in most practice areas. Applicants are asked to state in advance what they wish to learn educational objectives). This information is submitted to the Preceptor so that the training experience can be individualized as much as possible. The Preceptee subsequently is involved in the evaluation of his experience based upon his original educational objectives. The Preceptorships have been approved for a minimum of 10 credit hours by the Ohio Academy of Family Physicians and for a mimimum of two days postgraduate credit by the Ohio Osteopathic Association. The Preceptorships are also creditable under Category 4 for the 1972 Physician's Recognition Award. A tuition is charged, which in addition to course content, includes registration, parking fees, noon meals and library services. The Preceptorships are open to out-of-state physicians.with the stipulation that Ohio physicians will be considered first. Information or application forms may be obtained from the Ohio Regional Medical Program. Back-up Slieet ReRion: Ohio Rcgi.c)nal Medical Program Locus of Activity: Core activity Proiect Title: Postgraduate Preceptorship Program Status: Ongoing nonq Project ]Director. 'ITitlie, Aftdacdtresss: Rose Lee Kennedy Assistant Director Comprehensive Health Service Center Development Ohio Regional Medical Program 1760 Zollinger Road Columbus, Ohio 43221 Dates: July, 1971 din : Self-supporting except for program staff time. erati s and Institutions: Center for Continuing Medical Education of the College of Medicine of Ohio State University; the Ohio Academy of Family Physicians; Ohio Osteopathic Association. Area Served: Ohio (open also to out-of-state physicians with the stipulation that Ohio physicians will be considered first) Continuation after n: It is anticipated that the program will be incorporated into the continuing medical education offerings in selected co unity hospitals. Congressional Districts: All 24 congressional districts in Ohio. Core Staff Contact: Rose Lee Kennedy Date Prepared-- 5/31/72 OHIO VALLEY RURAL PRIMARY CARE COORDINATION Cooperative funding by the Ohio Valley and Tennessee/Mid South Regional Medical program and the Southeastern Kentucky Regional Health Demonstration, Inc. is giving impetus to a primary health care project serving a rural area on the Kentucky-Tennessee border. As a result of the project, residents in the Frakes, Kentucky, and Clairfield and White Oak, Tennessee, areas will for the first time have full-time health care available to them. Planning for the program was based on a study conducted by the Universitv of Kentucky Department of Community Medicine and sponsored by OVRMP which re- vealed that over 57 percent of the households have incomes of less than Z'?3,000 a year. Since there are no physicians living in these Appalachian communities, the 4,500 area residents, not surprisingly, have had to travel to other tommu- nities to obtain medical care. The survey found that the cost of medical care and lack of transportation were major reasons for this population not receiving medical tare. A by-product of the survey, for which local residents served as interviewers, was "An Interviewer's Basic Handbook," written especially for use in similar studies which plan to utilize resident/interviewers having widely divergent back- grounds and educational levels. Staffing for each of the three clinics in the project will consist of a full-time nurse Dractitioner, a patient assistant, a health aide, an automobile driver, and an outreach worker. A physician will serve each clinic the equivalent of l-2 days week@ and the specially trained and certified nurse practitioners will maintain preven- tive, health surveillance, and limited emergency services in the clinics the remainder of the week. Plans also include establishment of dental services, with a dentist, dental assistant, and aide to be shared by the three parti- cipating clinics. 14, The clinics moved from part to full-time operation in January,, 1972, and already over half of the area's residents are now using the clinics. In addition to acute ambulatory care, preventive medicine and health education are integral components of the clinic's programs. The project is sponsored by United Health Services of Kentucky and Tennessee. An executive board composed of 18 local residents has been or- ganized and is responsible for overall program coordination and administration. The Boatd's basic aim is to link the clinic programs to existing resources in neighboring communities to avoid unnecessary replication of existing specialized services. Region: Ohio Valley Regional Medical Pro(yram Locus of Activitv: Operational Project Project Title: Rural Primary Care Coordination Status: Ongoing Sponsoring Institution: United Health Services of Kentucky & Tennessee Project Director, Title, Address: Steven A. Kabin United Health Services of Kentucky and Tennessee Health Planning Office Frakes, Kentucky 40940 606-337-5810 Datet: Summer, 1970-summer activity, part time clinics until present. Full-time beginning January, 19,72. Fundia&: 1970-$11,607; 1971-$9,500 FY 01-860,000 Other Funds: Tennessee/Mid South R,'AP - $40,000 Appalachian Re-ional Commission - $58,000(This may be increased) Local funds Cooperating Agencies and Institutions: Appalachian Regional Commission of Kentucky, Tannessee/@'Lid South Regional Medical Program, Southeastern Kentucky Regional Health Demonstration, Inc., ADDalachian Regional Hospitals, University of Keiituckv DeDartment of Community Medicine, Tennessee Valley Authority, Vanderbilt University School of Medicine, Tennessee State Department of Public Health Area Served: Bell and V7hitley Counties, Kentucky; Campbell and Claiborne Counties, Tennessee Target Population: Rural poor Congressional Districts: #5 Kentucky Mr. Tim Lee Carter (R) #4 Tennessee - Mr. Joe L. Evins (D) #2 Tennessee - Mr. John Duncan (R) Continuation after P,.MP Sup ort 14ithdraim: Expected to be largely self supporting within three years Core Staff Contact: Mr. Collin Hyde Date Prepared: 2/14/71 Drafted by: Pamela Hoskins OHIO VALLEY LOUISVILLE HMO PLANNING An organized coalition of 30 widely different organizations in the Louisville, Kentucky area has produced nning Grant Steering/Liaison the Louisville li@,10 'Pla Committee. The specific role of the Steering/Liaison Committee is to coordi- nate preliminary planning for the H@MO develoDrient in the Louisville area. The impetus to form the committee came from the initial efforts in the fall of 1970 by the GrouD Health Association of America (GIIAA) to begin organizing a prepaid group practice in the Louisville area and a subsequent rise in community interest in health maintenance. Following four months of activity involving an increasing nu,.-t.oer of local in.di- viduals and organizations, an organizational meetina was held in February of 1971 to form the committee. At that meeting Plans were also begun for an area- wide conference on alternative methods of health care delive , and an apdli- ry cation for an HMO plannina grant was subsequently developed. 'The purpose of the conference of health care delivery systems, held in October, 1971, was to outline the range of options available in planning H@10's and thus set the stage for the work of the Steering/Liaison Committee. Moderator of the conference was the noted Dr. Avedis Donabedian, University of Michigan School of Public Health. Studies conducted in the initial stace determined Possible 11@@O candidates and identified those areas with the greatest need for improved care. Also beina completed is the collection, analvsis, and evaluation of health care resources data and the identification of at least 7,000 families willinc, to subscribe to such a health care Plan. The results of these studies are being made available through the Steering/Liaison Cori,.Tni-ttee to groups wishing to develOD IliNIO'.s. To date GHAA and the Jefferson County @tedical Society have initiated such develop- mental work. As a further refinement of the overall Planning function, several sub committees have been formed, including Benefit Package, !location and Facility, Public Re- lations and Recruitment, Legal, and Finance. The information coming out of the work of these subcommittees is expected to provide additional assistance to the GHAA and Medical Society efforts. Work of the Steering/Liaison Committee i.§- suT)T)orted by the HSMHA HMO DeveloDment Grant with some additional support from GHAA, the 'University of Louisville, and the AFL-CIO Labor Council. ',Memb&rship of the Steering/Liaison Committee includes the following sponsors of the conference on alternative systems of health care delivery: Blue Cross-Blue Shield; Falls Regional Health Council; Greater Louisville Central Labor Council (AFL-CIO); Groun Health Association of America- Hospital Council of Metronoli-tan Louisville; International Chemical Workers Union; Jefferson County @iellical Society; Louisville Area Chamber of Commerce; Ohio Valley Pelgi-onal. Medical Program: Park-DuValle Neighbor- hood Health Center; United Auto ',,Ior'L'-Iers-C,@ll Committee; United l@liy Llbor Participation DeT)arl-rient; University of Louisville School of 1-@edicine. Since the conference, the following organizations have also joined the Steering/ Liaison CoT,-,7.ittee: CoTnri)unity Services - A'-qL-CIO: Falls City Medical Society; Flovd and Clark County, Indiana, Central Labor Council, AT,L-CIO; Health In- surance Council; Health and Welfare Council, L7,4; International Union of Electrical Workers; Jefferson County Teachers Association'. Kentucky Association of Older Persons; Kentucky Dental Association; Kentucky Nurses Association; Louisville Dental Society.: Louisville And Jefferson County -Community Action Comraission; Pe@ion Eight Mental Health-Mental Retardation Board; Social Securitv Administration; and the Visiting @,Turse Associat4-on. A continued effort is being made to involve consumers in,the Dlanning of the H@10. BACK-UP 8REET REGION: Ohio Valley Regional Medical Program LOCUS OF ACTIVITY: Core Activity PROJECT TITLE: Louisville HivO Planning STATUS: Ongoing SPONSORING INSTITUTION: Falls Region Health Council, Louisville, Kentucky PROJECT DIRECTOR, TITLEI A DDPESS: Jack Chamberlin Project Coordinator Falls Region Health Council 434 South Fourth Street Louisville, Kentucky 40202 (502) - 583-8367 .DATES: July 1. 1971 to June 30, 1972 FUNDING: 01 $59,700 (Planning grant from HS@HIA HY@O Development Grant) OTHER FUNDS: Group Health Association of America - $30,500-, University of Louisville - $1,000- AFL-CIO Labor Council $8,700. COOPERATING AGENCIES AND INSTITUTIONS: Community Services AFL-CIO; Falls City Medical Society; Floyd and Clark Countv Central Labor Council, AFL-CIO; Group Health Association of America; Health Insurance Council; Health and Welfare Council, 17-'; Hospital Council of Metropolitan Louisville; International Chemical Workers Union; Internationa Union of Electrical 1-lorkers-. Jefferson County Medical Society; Jefferson County Teachers Association; Kentuckv Association of Older Persons; Kentucky Blue Cross-Blue Shield; Ken tuckv Dental Association; Kentucky Nurses Association: Louisville Area Chamber of Commerce; Louisville Dental Society; Louisville and Jefferson County Coipmunitv Action .Commission; Park-DuValle Neighborhood Health Center; Recion Eight 0 Mental Health-@fental Retardation Board; Social Securitv Administration; United Auto 14orkers-CAP Council; University of Louisville School of Medicine; Visiting Nurse Association. AREA SERVED: Greater Louisville, Kentucky, Metropolitan Area .TARGET POPULATION: General Population CONGRESSIONAL DISTRICTS: #3 - Kentucky - Mr. Romano L. @4azzoli #4 - Kentucky - Mr. Gene Snyder (R) .CONTINUATION after R,@ SUPPORT @-IITHDRk@-N, Funding is from IIS@IA, not @T -2- CORE STAFF CO.NTACT:. Mrs. Evangeline Hebbeler, Program Development SDecialist DATE PREPARED: March 31, 1972 DRAFTED BY: Pamela Hoskins OHIO VALLEY LOUISVILLE HMO PLAINNING An organized coalition of 30 widely different organizations in the Louisville, Kentucky area has produced the Louisville HMO Planning Grant Steering/Liaison Committee. The specific role of the Steering/Liaison Committee is to coordi- nate preliminary planning for the HMO development in the Louisville area. The impetus to form the committee came from the initial efforts in the fall of 1970 by the Group Health Association of America (GHAA) to begin organizing a prepaid group practice in the Louisville area and a subsequent rise in community interest in health maintenance. Following four months of activity involving an increasing nu,,-.oer of local ind4-- viduals and organizations, an organizational meeting was held in February of 1971 to form the committee. At that meeting nlans were also begun for an area- wide conference on alternative methods of health care delivery, and an apdli- cation for an HMO plannin- grant was subsequently developed. The purpose of the conference of health care delivery systems, held in October, 1971, was to outline the range of options available in Dlannincr H@tO's and thus set the stage for the work of the Stedring,/Lialson Committee. Moderator of the conference was the noted Dr. Avedis Donabedian, University of Michigan School of Public Health. Studies conducted in the initial stace'determined possible lil'!O candidates an identified those areas with the greatest need for i-moroved care. Also being completed is the collection, analvsis, and evaluation of health care resources data and the identification of at least 7,000 families willina to subscribe to such a health care plan. The results of these studies Are being made available through the Steer-i-ng/Liaison Cor@,.nittee to groups iqishing to develop H@@10's. To date GHAA and the Jefferson County Medical Society have initiated such develop- mental work. As a further refinement of the overall planning function, several sub committees have been formed, including Benefit Package, Location and Facility, Public Re- lations and Recruitment, Legal, and Finance. The information coming out of the work of these subcommittees is exoected to provide additional assistance to the GHAA and Medical Society efforts. Work of the Stoering/Liaison Committee ig- supported by the HS'LIIHA HMO Development Grant with some additional support from CHAA, the University of Louisvillc, and the AFL-CIO Labor Council. Membership of the Steering/Liaiso n Committee includes the following sponsors of the conference on alternative systems of health care delivery: Blue Cross-Blue Slil:eld,z Falls Regional Health Council; Creater Louisvi le Central Labor Council (AFL-CIO); GrouT) Health Association of America; Hospital Council- of Metronoli-tan Louisville; International Chemical Workers Union; Jefferson County @le-aical Soc iety;. Louisville Area Chamber of Commerce; Ohio Valley Pegi.onal 'NI.cdi.cal Program: Vari@-DuValle Nei.glibor- bood Health Center; 'United Auto '.,Ior',,,crs@CAII Committee; United Way Labor Participation Department; University of Louisville School of Medicine. since the conference, the following organizations have also joined the Steering/ Liaison Committee: Community Services - AFL-CIO: Falls City Medical Society; Floyd and Clark County, Indiana, Central Labor Council, AFL-CIO; Health In- surance Council; Health and Welfare Council, LP,4; International Union of Electrical Workers; Jefferson County@Teachers Association; Kentucky Association of Older Persons; Kentucky Dental Association-, Kentucky Nurses Association; Louisville Dental Society: Louisville and Jefferson County Community Action Commission; Region Eight Mental Health-illental Fetardation Board; Social S-ecuritv Administration; and the Visiting Nurse Associat4-on. A continued effort is being made to involve consumers in,the planning of the 4MO. BACK-UP SIIEET REGION, Ohio Valley Regional Medical Program LOCUS OF ACTIVITY: Core Activity PROJECT TITLE: Louisville HMO Planning STATUS: ongoing SPONSORING INSTITUTION: Falls Region Health Council, Louisville, Kentucky PROJECT DIRECTOP,, TITLE, ADDRESS: Jack Chamberlin Project Coordinator Falls Region Health Council 434 South Fourth Street Louisville, Kentucky 40202 (502) - 583-836 7 .-DATES: July 1, 1971 to June 30, 1972 FUNDING: 01 $59,700 (Planning grant from HSNIHA HY.0 Development Grant) OTHER FUNDS: Group Health Association of America - $30,500: University ot Louisville - $1,000; AFL-CIO Labor Council $8,700. COOPERATING AGENCIES AND INSTITUTIONS: Community Services AFL-CIO; Falls City Medical Societv: Floyd and Clark Countv Central Labor Council, .AFL-CIO; GrouD Health Association of America; Health Insurance Council; Health and Welfare Council, L7j; Hospital Council of Metropolitan Louisville; International Chemical Workers Union; International Union of Electrical @qorl@-ers: Jefferson Countv @-ledical Society; Jefferson I County Teachers Association; Kentuckv Association of Older Persons; Kentucky Blue Cross-Blue Shield; Ken tuckv Dental Association- Kentucky Nurses Association,. Louisville Area Chamber of Commerce; Louisville Dental Society; Louisville and Jefferson County Communitv Action 'Commission; Park-Du\lalle Neighborhood Health Center; Region Eight Mental Health-@fental Retardation Board; Social Securitv Administration; United Auto Workers-CAP Council; University of Louisville School of Medicine; Visiting Nurse Association. AREA SERVED: Greater Louisville, Kentucky, Metropolitan Area TARGET POPULATION: General Population CONGRESSIONAL DISTRICTS: #3 - Kentuckv - Mr. Romano L. @,lazzoli 114 - Kentucky - Mr. Gene Snyder (R) CONTINUATION after MT SUPPORT @IITHDRA@@IN: Funding is from IIS,@A, not @T -2- CORE STAFF CONTACT: Mrs. Evangeline Hebbeler, Program Development SDecialist DATE,PREPARED: March 31, 1972 DRAFTED BY: Pamela Hoskins OKLAHOMA INERGENCY MEDICAL SERVICE SYSTEM Five coun ties.in,the predominantly rural, northwest quadrant of Oklahoma have begun d-e@@ve-l@o'pment of an Emergency Medical Service System. Although still in the stages, the interest of local physicians and ambulance personnel coupled with ORMP's support has established a basis for future growth. Of the problems facing the area, the lack of adequate training and equipment for ambulance personnel is one of the most urgent. Some areas are as much as an hour from the nearest medical services, so in many cases, emergency care must be initiated long before arrival at the nearest emergency room. Until now this has not been possible, because the ambulance personnel were not qualified nor did they have the equipment to deliver such care. The absence of any communications among the hospitals an emergency vehicles is another urgent problem. With only A few services located in the area, coordination of activities is a necessity, but any communication link that would facilitate this coordination is still virtually non-existent. A survey, funded by ORMP, is currently in progress. Its purpose is to determine the specific needs and problems of the area by talking with local physicians, hospitals, and providers of ambulance service. Furthermore, the survey will establish the feasibility of such a coordinated emergency medical service system in a rural area. ORMP's involvement also includes presentation of the first training course for ambulance personnel in the area. The 2-hour course, developed in Tulsa by the American College of Surgeons - Committee on Trauma, is designed to raise the abilities of the ambulance technicians to initiate qualified emergency care,o,,immediately. The first class is already filled, as local ambulance personnel are anxious to enlarge their own capabilities. The course utilizes lectures, demonstrations, and practical exercises to increase the skills and understanding of an ambulance technician's functions and responsibilities. In addition, each student@ill serve a full shift in a ncyservice area/,during the third of the course. This , s ended to develop an appreciation of the interdependence of the ambulance-emergency unit-patient relationship. ORMP is also assisting in stimulating public interest locally, through a series of feature articles highlighting local needs and @eltp'fffg solutions. Ultimately the success of a cooperative Emergency Medical Service System will depend upon the support of the people using it and paying for it. BACK-UP SHEET ion: Oklahoma Regional Medical Program Locus of Acitvity: Core Developmental Component Pro Title: Emergency Medical Service System - Okeene Status: Ongoing Sponsoring Institution: Oklahoma Regional Medical Program Proiect Director, Title Address: Bill Dotter, M.D. General Surgery P.O. Box 389 Okeene, Oklahoma 73763 D,ates: Initiated January 1972 Fu in ORMP has committed funds not to exceed $3,000 Other Funds: None Lcoo ency and Institution: American College o urgeons 100@ Committee on Trauma; Area Hospital and Ambulance Services Area Served: Sections at Blaine, Garfield, Major, Dewey, and Kingfisher counties. TarRet Population: Consumers and Providers of EMS in the area. Congressional District: District #6, Representative John N. "Happy" Camp Continuation after ORMP Support: Support being developed locally Core Staff Contact: Dr. George Cooper, Coordinator, Division of Planning, Research, and Development. Dat ared: 2-14-72 Drafted by: Brian Nasky Oklahoma Pl,,P VIGNETTE #2 I (Project i'r-2R) p ar secondary - P@culs -Heart Disease - Patient Care Demonstration -Remote Monitoring -Impact on tiorbidity/Mortality - Training -'gegionalization - Inter-regional -Rural Continual electronic heart monitoring services comparable to those available in large urban hospitals are being introduced into Oklahortia's small comlnunity and rural hospitals is a result of a 8tate-wide coronary care program initiated by the Oklahoma Regional. Medical Program. Under the direction of Dr. Charles W. Robinson, Jr. cardiologist at the University of Oklahoma School of Medicine., about 43 monitor- equipped beds for heart attack victims, or attack-threatened patients, in 28 small community hospitals have been linked by special telephone lines to 12 central monitoring hospitals,(CMU's). These figures include a few beds in neighboring towns of Kansas and Arkansas and 2 central monitoring hospitals in Arkansas. By mid-1972 a total of 59 beds will be equipped. Dr. Robinson describes the program as "a-boon for small rural hospitals which cannot afford the services of the highly trained I personnel required to operate an independent coronary care unit." Specially trained nurses in the central monitoring units help monitor remote patients, and, when an abnormality is detected, confer with local staffs by telephone "hot lines." The iri ortance of immediate p coronary care sterfis from the fact that most heart attack victims 2- who die, do so within the first few hours. The general hospital mortality rate from acute coronaries (myocardial infa-@--ction) is about 30 percent. With coronary care units, this is usually reduced 15 to 20 percent. An October, 1970 survey of Oklahoma hospitals by the project staff showed,that 46 percent of that State's hospitals with 50 beds or less had no facilities for coronary care, and 33 percent of hospitals with 51 to 150 beds had none. Besides training fgr nurses, the project also provides continuing education and training for physicians and para- medical personnel, including preparation of Job Corps students as coronary care technicians. REGIONAL UROLOGY PROJECT During the three years of this project 2,242 patients with cancer of the prostate have been identified. A retrospectrum methodology was utilized whereby all patients admitted to the 176 hospitals in Oklahoma for any reason who had a diagnosis at sometime of cancer of the prostate during the three year period of 1967, 1968, and 1969. In addition admissions at forty-four hospitals in bordering states where Oklahoma residents are likely to go for hospitalization (i.e. Fort Smith, Arkansas) were reviewed. This is being done by a field staff of registered nurses specially trained for this project. A twenty-two page system profile form was designed for computer utilization for this purpose. The nurses utilized the hospital medical records to complete this @orm.9@This project represents a joint effort of the Department of Urology and the Department of Biostatistics and Epidemiology. The statistical consultants have selected three hundred patients from the total for a more in-depth study including follow-up information. This sample is a representative of the total and is sufficiently large enough to inidicate statistical significance having a 13% sample. During the in-depth phase the physicians of the three hundred patients were interviewed and records of subsequent hospitalizations were reviewed and the patients and/or their families interviewed. The objective of this project is to measure the level of genito- urinary care in Oklahoma. This includes screening for early diagnosis, diagnostic techniques, treatment procedures for bDth care and palliation, complications of drug therapy, adjunctive therapy, chemotheropeutics, irradiation etc. This information is then used in continuing education programs primarily for physicians but also other health professionals. In -the---@ -atter..-phases the project i s bei ng expanded to i ncl ude cancer of the bladder, penis, testes and kidney. It is anticipated that this type of project can provide a base for developing a state wide tumor registry. Another "spin off" may be the development of a medical record designed for computer analysis using the RUP form as a prototype. urrently sponsored by the Oklahoma Regional Medical Program,,, @is cooperating with the Veterans Administration Cooperative Urological Research Group through the National Cancer Institute. The NCI is currently considering funding of this project in its expansion to other GU malignances. BACK--UP SHEEI' ion: Oklahoma Regional '@ledical Program Locus of Activity: Terminating Project (Future funds sought from NCI) Proiect Title:, Regional Urology Project Status: Terminating May 31, 1972 Sponsoring Institu tion: Oklahoma Regional Medical Program Project Director, Title Address: William R. Parry, M.D. Project Director Department of Urology Oklahoma University Health Sciences Center P.O. Box 26901 Oklahoma City, Oklahoma 73190 Dates: June, 1969 to May, 1972 Funding: Other Funds: None Cooperative Rencies and Institutions: All Oklahoma hospitals; 44 hospitals in bordering states; National Cancer Institute; Oklahoma Urological Association; Oklahoma State apartment of Health. Area Served: State of Oklahoma Target Population: Cancer patients; various ethnic groups (Indians blacks) 9 ConRressional Districts: All Districts, Representatives Albert, Belcher, Camp, Edmonson, Jarman, Steed. Continuation after bMP Support: Proposal has been submitted to the National Cancer Institute for funding beginning September 1972. Core Staff Contact: Vickie Holloway, R.N., Program And Project Development Date PrepAred: 2-14-72 Drafted By: Brian Nasky OKLAHOMA CORONARY CARE The establishment of a remote coronary monitoring network that covers; 46 beds in 32 community hospitals across the state is probablyr,QRMP's most innovative contribution to improved patient care. Initiated three years ago, the project has surpassed its original goals on approximately one-quarter of the requested funding. The major influence in the success of the project has been the interest and support generated by the small hospitals in communities throughout Oklahoma. BasicAlly, the system gives smaller, rural hospitals the coronary care capabilities of larger metropolitan hospitals at a very minimal expense. When patients in the smaller hospitals are placed in the remote monitoring unit, which includes EKG monitoring equipment, the monitoring signal is read at bedside and on a screen in the central monitoring unit many miles away. A tfained_,coronary care nurse watches the signal-." t-he-rq@" from @116mote monitoring units on a bank of -r-reens. She is trained to notice any variations which may be the first sign of a coming arrhythmia. The same telephone line over which the EKG signal is transmitted carries a communication link between the units. Should a problem develop, specialists in the central monitoring unit can signal and talk to personnel at the patient's bedside. Although final decisions rest with the physician in the remote monitoring unit, he does have the opportunity to consult with specialists who are in effect "on the scene". In most cases the small hospitals can offer qualified coronary care at a cost of little more than the equipment and the telephone line. Very seldom is there a need for additional personnel. Realizing that having the hardware makes no difference if the personnel caniti use,@@"t. the project has held extensive training courses MR" for -Dhvs@cians and n-urse, of the state. Their training hysiology, reaain includes Stu p g EKG charts, knowing the proper care in various emergencies, xis@'e of medication,,(a-n faeets--.o@f,-c",o,-ronary care The additional training turn@'the hardware into invaluable tools for improving patient caret What,y'ou have, in effect, is a trained coronary care team - some in the remote monitoring unit at the patient's bedside, and the rest @,@n 4 central monitoring unit many miles awa ) Through training, y teamwork, and use of the hardware, the coronary patient in even the smallest of hospitals can receive care equivalent to that in a large medical complex. BACK-UP SHEET on: Oklahoma Regional Medical Program Locus of Activity: Operational Project (Entering Evaluative Phase) Proiect Title: Coronary Care Status: Ongoing Sponsoring Institutions: O@ ; Hospitals on the remote monitoring network Proiect Director: Charles Robinson, M.Do Project Director, Coronary Care Department of Medicine Oklahoma University Health Sciences Center P.O. Box 26901 Oklahoma City, Oklahoma 73190 Dates: June,, 1969 to May, 1972 (operational phase) June, 1972 to May, 1973 (planned evaluation phase) Funding: 3 year funding $516,233 ($190,000; $216,233; $110,000) Other Funds: Most hospitals pay for the leased telephone line an some of the equipment. Cooperative Agencies and Institutions: Oklahoma Heart Association; Hospitals on the remote monitoring network. Area Served: State of Oklahoma Target Pop lation: Providers and consumers of Coronary Care. ConRressional District: Districts #1 through #6, Representatives Albert, Belcher, Camp, Edmonson, Jarman, Steed. Continuation after 0 @ Support: Networks will become self-supporting. Core Staff Contact: Frank Bexfield, Chief, Division of Review and Evaluation. Date Prepared: 2-14-72 Drafted B@: Brian Nasky SOUTH DAKOTA REGIONAL MEDICAL PROGRAM 216 E. CLARK VERMILLION, SOUTH DAKOTA 57069 (605) 624-4446 February 17, 1972 Ms. Patricia Q. Schoeni Acting Director Office of Communication and Public Information PHS/HSMHA/RMPS Parklawn Building Rm 11-22 5600 Fishers Lane Rockville, Maryland 20852 Dear Pat, In glancing over the vignette I sent you earlier this week I noticed that there was an omission on the back-up sheet. Under the heading of Funding-04, there is an * after the individual amounts. However, there is not a reference for the At the end of the second page there should have been another indicating that this is the funding level requested in out FY'73 application which was just filed with RMPS. Thought you might like to knnw that the * did mean something. Will try and get the other vignettes I mentioned in my February 14 letter to you soon. Sincerely yours, Patricia O'Connor Health Information Specialist South Carolina NUCLEAR MEDICINE TRAINING A training program for r@iologic technicians supported by the South Carolina Regional Medical Program@mg designed to help close the health care gap in nuclear med- icine by providing technician trainin e-, 9.1 @l@@@,@@@,,,@j'is'underway at Self Memorial Hospital in Greenwood, S. C. Self Memorial has engaged in radiation trai es for sev n a limited local basi@@.with SCRMP assist_a to expand ian training statewide a"dvaiiced 0 ntinuing@-in-struction,@fo-, d I Nuclear medicine, the discipline concerned with the diagnosis, treatment and clinical investigation of diseases utilizing internally administered radioactive isotopes and sophisticated electronic detecting equipment, is one of the most useful and rapidly growing branches of modem medicine. Technicians assist physicians in handling much of the equipment used. In the practice of diagnostic nuclear medicine, radioactive substances are qiven orally or intrave These materials then act as tracer doses(throughout the bod an be detected ri by various kinds of nuclear medicine equip- ment. A Some examples include use of radioactive iodine to diagnose disorders of the thyroid gland and other radioactive materials to diagnose abnormalities of the brain, liver, bone, @and various blood disorders including anemia. In the therapeutic division of nuclear medicine, very large doses of radioactive material are used in the treatment of cancer and other diseases. The handling of isotopes in respect to storage, preparation for administration and transferral is a part of the study program. The project is under the direction of Dr. William A. Klauber, Doctor Klauber says, "The primary objectives of the new project at Self Memorial are to provide the specific training necessary to insure that the number of trained nuclear medicine technicians in South Carolina keep pace with the rapidly increasing d@mand in their field; to insure better patient care; to stimulate a greater awareness of the advances in this area useful in hospitals of all sizes throughout the region and provide for the ul- timate self-sufficiency of this program." The instruction is available to 'Pt%technologists, laboratory technologists, and registered nurses in the state-4i p Ik rily concerned with upgrading performance of each participant to the degree necessary to fulfill specific needs of the institution where they are employed. Any hospital in the state, may select and send a person for training in @,one or a combination of @ courses t@-iirjtii@f BACK-'UP SHEET Region: South Carolina Regional Medical Program Locus of Activity: Greenwood, S. C. Project Title: Statewide Continuing Education Program in Nuclear Medicine Status: ongoing Sponsoring Institution: Self Memorial Hospital, Greenwood, S. C. Project Director, Title, Address: William A. Klauber, M.D. , Self Memorial Hospital, West Alexander Street, Greenwood, S. C. 29646, 803-227-4190. Dates: Date of initial RMPS support: 7/l/71 Anticipated termination of RMPS support: 6/30/74 Funding: RMPS direct cost this budget period: $25,000. Cooperating Agencies and Institutions: Medical University of S. C. , Upper Savanna Development Program, S. C. Hospital Association, Comprehensive Ti:lealth Planning, S. C. Chapter the ASCP and ART, SCRMP Medical District Committee for District 2, and representatives of S. C. Technical Education Program. Area Served: Geographical area of South Carolina Target Population: Radiologic technologists, registered nurses and physicians. Congressional Districts: William Jennings Bryan Dorn (D) Continuation after RMP Support Withdrawn: The Project will be entirely self-supporting as of the beginning -of the 04 year by placing whole activity on a fBe basis. Core Staff Contacts: C. W. Bowman, Associate Coordinator, SCRMP Date Prepared: February 11 , 1972 Drafted Charles R. Wyrosdick CARDIOPULMONARY RESUSCITATION TRAINING A stat aining Progra "O develo-pr'-6iiT61'ng' ewide Cardiopulmonary Resuscitation Tr rA r@, 'ng e e ency life-saving ,)for physicians, hospital and allied health personnel in techniques of mouth-to-mouth breathing and closed chest heart massage procedures has had spectacular success in South Carolina. The project started August 1, 1968 under auspices of the South Carolina Heart Association and supported by a grant from the South Carolina Regional Medical Program,,@' Subsequently, 69 hospitals and clinics participated in the program that included at least one hospital-based training program being conducted in 38 of the 46 counties in the state. Thirteen workshops were held and 794 instructors were qualified. Training courses totalled 639 with a combined attendance of 18,169 persons. The Instructors are fairly evenly distributed throughout the state and yai able I for instructing others that meet the requirement standards set by the@,,"6.@R Task'Force of the South Carolina Heart Association and those of the American Heart Association. The lists of names,and addresses of these instructors are available to all allied health, -Medical and.Plara-medical encies in the state. Trainees have included emergency rescue and industrial safety personnel, ambulance personnel, nurses, inhalation therapists, coronary care unit nurses, physicians, dentists and dental assistants. The CPR techniques can revive victims of heart attack, suffocation, electric shock, drowning and many other incidents that may result in sudden death. Dr. Ambrose Hampton, Jr., of Columbia, a chairman of the Heart Association's CPR Task Force says, "if a trained rescuer can reach a victim within four to six minutes after his heart stops beating, there is a 40 percent chance of restoring life. The grant support for the CPR project from SCRMP ceased fuly 1, 1971. However, as planned and envisioned for all RMP-supported projects . the CPR program is continuing in South Carolina under auspices of other agencies. In meeting the ob s of phasing out SCRMP support for CPR tral-ning, the of@, Medical University in their schools of Medicine, Dentistry, and@rsing have added the training to the curriculum as,have all the schools of nursing in the he @"'d,'@Association of Rescue Squads had their training officers complete courses to serve as faculty and instructors within their organization. VIG%TETTFs #1 South Carolina P@IP (Projects #15 Lrid 16) Primary Seco d@arX - Stroke - Patient Care Demonstration - Impact on Morbidity/Mortality - Team Approach - Reha ilitation A dramatic reduction in.death rate of stroke patients in the Columbia (S.C.) Hospital recorded over the past year has been attrib- I uted to a special stroke unit established as part of the Acute Stroke Management Demonstrati-or, Project supported by the South Carolina @IP. Dr. Ro'i)ert R. Taylor, Jr., project di-rector, compared a previous death rate of 52 percent among all. hospitalized st-.coke patients prior to opening of the unit.to the death rate, over a 26-month period, of 19,percent within the special unit. These results he attributes to an innovative "stroke tea@' approach for handling victims of acute cerebral vascular (stroke) disease. An extremely high incidence of the disease in central South Carolina was the basis for establishing the project in August, 1 8. -A complementary RMP activity, the Stroke Recovery and Rehabili- ta@ion Project, was established simultaneously in the hospital under the direction of Dr. Joseph W. Taber, Jr. He and Dr. Taylor coordinate the team of stroke nurses, a speech tlierapist,'discharge planner and public health nurse. The acute stroke project provides co;npre liensive study of the patient's condi-tioii,optimum nursing, and, if necessary, corrective surgery. intensive rehabilitation undc-r'-the companion project is -2- b.,.gun on patients shortly after admission to the unit and has resulted I in a reduction in hospital stays from an average of 21 days to I ays. The service area of the project covers a 50 mile radius around Columbia with a population of more than 335.,000. South Carolina POISON INFORMATION CENTER OPERATING A computerized Poison Information Center, designed to provide data within four to fifteen seconds to South Carolina's physicians and dentists, is in operation at the Medical University of S. C. in Charleston. The Center, a first step in the planned development of a comprehensive medical and pharmaceutical information system for the State, is supported by the South Carolina Regional Medical Program. Located in the Medical University Hospital Pharmacy and operating around-the- clock since October 1, 1971 the new PI Center has the capability of providing imme- diate information concerning poisonous plants and animals, household products, pes- ticides, herbicides,, cosmetics, commercially available drugs and chemicals and proprietary drug products. When a request is received,the computer responds almost instantaneously with the name, formula, potential toxicity, symptomology, prognosis and treatment of potential poisons. All physicians and dentists in the State have been advised of the special telephone number for the PI Center at MUSC. However, callers require identification before the Center will dispense poison control information. Persons calling the Center who cannot be identified as a physician or dentist are told to take the victim, along with the poison to their family doctor or to the nearest hospital emergency room. The capability of the Poison Information Center is expanding to include computer- ized information on adverse drug reactions and drug interactions @'@'a's the SCRMP support- ed comprehensive system swings into operations The Center has the capability to provide original journal article information (150 journals monthly) concerning drug therapy, indication/contraindications, drug inter- actions, and adverse drug reactions. During its first three months of operation, the Center responded to more than 100 requests for information from across the state and the requests are increasing daily. SOUTH DAKOTA COPDNARY CARI', TRAINING PROJECT In an effort to deal with South Dakotals leading cause of morbidity and mortality., the Nebraska-South Dakota Regional Medical Program formulated an Operational Project to train 4h@health personnel in improved coronary care delivery. The Coronary Ca-re Training Proiect,@ begun in April @ 1970,. -0 onal Project si :nc" tion of the Ne r@ka has continued as perati e the separa and South Dakot@"-@ in July 1971. Of the 6,500 resident deaths in South Dakota in 1970, almost 40'-o were due to heart disease. The difficulties in treating the Coronary patient are further magnified by the rural nature of the State with its commnication and transpor- tation problems, a lack of advanced coronary tare training, and a population which has a significantly large number of older -persons. The Project is divided i eams., One team is-@@,c@ted at@Si( Valley-Hospital in Sioux Fall @,@s ani surrounding area. The Universit) 0 outh Dakota School of Medicine team operates from Vermillion in providing training to the hospitals east of the Missouri River. The third team is at St. John's McNamara Hospital in Rapid City and provides basic training and field work west of the Missouri River. Several types of training are provided by the Project. Basic training courses are taught on either a three evenings per week for four weeks basis or a one- two evenings per week for thirteen weeks basis. An intensive,,training course is currently offered at St. John's McNamara and another w441 beRTii at Sioux Valley in Marcht 'tiese courses meet daily for three weeks and provide more clinical as well as class room experience. Several refresher workshops §,yinposia are presented du @ g the year. act,--c,,ontent@.rE@ courserit-ies with the needs of the health personnel,whe-,are.,to,be@@@-,i The final type of training provided by the Project is with the Roche Laboratory's ROCOM Un-it.'-At Sioux Valley Hospital, the IRDOOM is used as a supplement to the basic course and is available for use by coronary care uni . The Medical School places their ROCOM Unit in a hospital for a six-weok period. The visuals of the ROCOM are the fotal point of this course;@ local physicians, trained nurses, and members of the Project team provi@ @ supplemental lectures. More than 1,500 physicians, nurses, and allied health personnel have participated in at least one of the various types of training provided by the Proiect during the past year. Physicians who attend the symposia are able to earn credit through the American Acadeiny of Family Practice. In add@ t-r ining i-n@l e,@-area-@@@ @2 t )er - --ie Project sta ticipated in two EmergencyMedical Training woi s(con- ducted duri" instructors in(the area o'f)cardiopulmonary physi gy. They have given tures and demonstrations on cardiopulmonary -resuscitation. In-service education programs on pacemakers, cardibanatomy and physiology, and arterial blood gases have also been given. Du-ring thef years @.f the Project)there have been several positive results. The confidence apd abilities@of those dealing with the coronary patient, especially the nurse,, have been greatly,)increased. In the 47 hospitals in eastern South DakAta, the Project has helped in establishing(twenty-@ive)coronary car6/monitbred CORONARY CARE TRAINING PROJECT--2 t bed uni s E other hospitals are currently 4ft s estab lishing units,w@th-t-he--P@j.ect.!s-assistanc&. This increased knowledge and ability on the part of the nurse 'one factor which resulted in legislation being introduced in the 1972 session of the South Dakota legis- lature to extend the role of the nurse as outlined in the State's Nurse Practice Act. The quality of care being received by the patient in the South Dakota hospital has definitely been upgraded. It ia estimated that deaths resulting from heart disease have decreased from 3-1-40,@, e p r hospital as a result of the additional coronary care facilities. Back-up Sheet CORONARY CARE TRAINING PROJECT Region: South Dakota Regional Medical Program Locus of Activi@: Operational Project Project Title: Coronary Care Training Project Status: Ongoing Sponsoring institution: The University of South Dakota School of Medicine, Vermillion; Sioux Valley Hospital, Sioux Falls; and St. John's McNamara Hospital, Rapid City. Project Director, Title, Address: Warren Jones, M.D. Associate Director Coronary Care Training Project School of Medicine University of South Dakota Vermillion, South Dakota 57069 Dates: April, 1970-July, 1971 - Operational Project of the Nebraska-South Da(ota July, 1971-to present - Operational Project of the South Dakota RMP Funding: 01 $119,480 (School of Medicine, $57,615; Sioux Valley, $25,615; St. John's McNamara, $36,2SO) (April 3, 1970 - December 30, 1970) 02 $58,205 (School of Medicine, $28,809; Sioux Valley, $11,271; St. John's McNamara, $18,125) (January 1, 1971 - June 30, 1971) 03 $120,000 (School of Medicine, $57,790; Sioux Valley, $25,788; St. John's McNamara, $36,422) 04 $104,662 (School of Medicine, $45,844; Sioux Valley, $29,868; St. John's McNamara, $28,950)* Other Funds: None Cooperating Agencies and Institutions: South Dakota Heart Association, American Academy ot Family Practi&e- (the physicians who participate in the symposia can receive credit from the AAFP), 65 South Dakota hospitals (public, private, state, and PHS), practicing physicians, nurses (R.N. and L.P.N.), newspapers, and television stations. Area Served: State of South Dakota Target Population: All South Dakotans; especially those in rural areas. Congressional Districts: #1, Mr. Frank Denholm (D); and #2, Mr. James Abourezk (D) 2- Continuation after RNP Support Withdrawn: At this time, it is anticipated that the Project will run until Tu-1y, 1973. At that time the Sioux Valley and St. John's McNamara units will probably be absorbed by their respective hospitals. The future of the Medical School unit after July, 1973 is uncertain at present. Core Staff Contact: John A. Lowe, M.D.,, Director South Dakota Regional Medical Program 216 East Clark Vermillion, South Dakota 57069 Date Prepared: February 11, 1972 Drafted by: Patricia O'Cormor Back-Up Sheet EMERGENCY MEDICAL TECHNICIAN TPAINING WORKSHOP (140 hour) Region: South Dakota Regional Medical Program Locus of Activityi Core Activity Project Title: Emergency Medical Technician Training Program Status: Completed Sponsorinz Institution: The University of South Dakota School of Medicine, Vermillion; McKennan Hospital, Sioux Falls; and State Department of Health, Pierre. Project Director, Title, Address: George R. Halter Assistant Director - Education South Dakota Regional Medical Program 216 E. Clark Vermillion,, South Dakota 57069 Dates: December 8-22,, 1971 Funding: 01 $1000 Other Funds: EmerRency Employment Act-Salaries and expenses of the twelve students. Department of Transportation - matching funds with MUHS counties for ambulances. Cooperating Agencies and Institutions: Sioux Falls Ambulance, Minnehaha County Civil Defense Unit, p@ physicians newspapers, and television stations. Area Served: Counties in the AW Project (At the present time the exact South-Dakota counties to be involved in this p 'ect have not been deter- roi mined. They will probably be Millette, Todd,, and Bennett, in addition to at least one other.) Target Population: Persons in the MJHS counties. Congressional Districts: #1 - Frank Denholm (D) - where the course was taught #2 - Mr. James Abourezk (D) - some of the counties involved are in his district 2- Continuation after @ @ort Withdrawn: At this time it is difficult to speculate on this as it is an area into wnicn SDRMP is just beginning to direct its efforts. Past work in this area has been done by the Department of Transporation in cooperation with the South Dakota State Department of Health. Cote Staff Contact: George R. Halter Assistant Director - EducAtion South Dakota Regional Medical Program 216 t. Clark Vermillion, South Dakota 57069 Date Prepared: February 29, 1972 Drafted by: Patricia O'Connor SOUTH DAKOTA EMERGENCY MEDICAL TECHNICIAN TRAINING WORKSHOP 'Ihe South Dakota Regional Medical Program in conjunction with the University of South Dakota School of Medicine, the State Department of Health, and McKennan Hospital in Sioux Falls, recently SDonso Emergency Medical Technician Training Workshop at McKerman Hospit@l.",-T wexe students in the course. The graduates of the 140-hour workshop will be driving ambulances in those counties which are participating in the Minimum Uniform Health Services (MJHS) Project to serve counties which currently lack adequate emergency medical personnel and services. The training program began on December 8th and concluded on the 22nd. Members of the McKennan Hospital stdfflvarious Sioux Falls physicians- representatives of the Sioux Falls Ambulance Servicerthe V.D. Control Section of the State Department of Health,-and the Minnehaha County Civil Defense Unit provided the classroom instruction. Also instructing were: Dr. Robert H. Hayes, State Health Officer; and Dr. Joseph D. Welty, Assistant Director, SDRMP Coronary Care Training Project, The University of South Dakota Scho6@ of Medicine. (, 0.l@ IRA, classroom instruction wa6--, . Areas covered included bleeding and cardio"-"pulmomry resuscitation, extrication and lifting, shock and burns, psychiatric emergencies, childbirth, fractures, and environ- mental in uries. Each student also spent 80 hours in clinical observation of the Recovery, Obstetric, Surgical, Coronary Care, Intensive Care, and Emergency Wards of McKennan andViding with the Sioux Falls Ambulance Service. This course is the latest in a series of EMT Courses to be presented in the State. Seventy-two hour training programs have been given in South Dakota during the past two sumers. The first of these was in August@ 1970 at the School of Medicine in Vermillion. The second was at St. John's McNamara in Rapid City dur- ing June,@ 1971. Both were cosponsored by the School of Medicine and tie State Department of Health in conjunction with the Department of Transportation and under the standardized requirements of the National Highway Safety Act. 'Ihe workshop was also part of the initial phases of the NUHS project. The students will be assigned as ambulance drivers in three-man te@, one per county. ambulances provided for by matching funds from the county to which they are assigned and the Emergency Health Services Section of the State Health Department in cooperation with the Department of Transportation and the South Dakota Highway Department. Funding for other parts of the MUHS project was presented to the South Dakota State Legislature during its 1972 session. The Project was unanimously passed by both houses. The ambulance drivers were hired through funds provided bv the Eederal Emetg ent Act,. s@@ George R. Ha er, Assistant Director oi Education for SDRW@ the 72-hour courses4 Assisting him with the clinical phase of the training was Dr. Michael Rost McKerman Anesthesiologist. SOUTfi DAKOTA Rosebud ect Four University of South Dakota Medical School students will be spending this summer at the U.S. Public Health Service Hospital on the Rosebud Reservation. Funds for this project are being provided by the South Dakota Regional Medical Program (SDRMP). The idea of having some of the medical students spend their summer at Rosebud was developed by 2nd year medical s "ke Haley of Mitchell, who grew up in the area of the Reservation. He @ other students-i@ r c am@ t in the project and then approached the Regional M d a Progr possi- bility of.@ funding the project. OE&bruaiT 9th, the Regional Advisory Group of SDRMP heartily endorsed the program @ approving its fu The project will add to the education of the medical students, Z-Idti@- w@ll greatly benefit the health care delivery system at Rosebud. Though other medical students have previously participated in sumer work on the Pine Ridge and Eagle Butte Reservations,, none have been to Rosebud. The hospital at Rosebud has S5 beds. It serves apprbxi- mately 25,000 outpatients and has 17,000 active charts. During the summer the one first-year and three second-year students @@ assist-4 I the five Public Heal@ Service doctors by administering physicals and taking his- tories, freein the doctors for work in other areas. The students also conductira survey 9as to the incidence of pulmonary e 4T?@g the Indians. No d' of this nature has be eviously e 0 @u en undertaken pr e t some of@.the Indian Youth in pursuin@ e rs-@ in -med@icine - or a. par@. Community Health Worker Training Program Many residents of the impoverished Hamilton District of Harrisburg, Pennsylvania, are getting personalized health care for the first time. This care is being brought about through the efforts of ten Community Health Workers. These worker virv st, r @'rd'd n- Et ... t@,et-ves,) started training in Janudry, throu@ a $9,000 grant from the Susquehanna Valley Regional Medical Program. After several weeks of classes, they conducted a door-to-door survey of the one and one-half square mile District. This survey was designed to get Community residents to be tested for Sickle Cell Disease and lead poisoning. (Preliminary results of the survey indicate that 80 percent of the families visited agreed to testing.) Although the workers' initial contact with the community was aimed at bringing residents to the newly-created Hamilton Health Center for tests, it also served to make residents aware of the Center's existence and the person- alized care it offers. Through the training program, the Community Health Workers are being taught how to establish @ rapport with the residents. Once this rapport is formed, it is expected that the Workers will be able to determine residents' needs. If they can be met through the Center, the Worker will refer clients there. If not, she will advise families assigned to her whom to contact for assistance. Selecting the trainees from the Hamilton District serves a double purpose. v r First, it is expected that persons who have 1 will be most capable,QL relating to @ other residents. Second, the training program provides an excellent starting point for someone desiring a health @career)@ who is unable @'to@ @more costly educational programs. After the first ten Workers have completed their 12-week training program, the Hamilton Health Center, Incorporated, plans to continue training through 314B funds so that an adequate number of Workers will be available to meet the tommunity's needs. Rural Health Service I* until. several years ago, when a farmer in rural Columbia or Montour County- @eriously ill, he faced an extended hospital stay. Even though heim-, recovers* enough to convalesce at home, there was no physician nearby to Since then things have changed. The Columbia-Montour Home Health Service, supported by a grant from the Susquehanna Valley Regional Medical Program, began training home health aides to supply skilled nursing care, therapy, and preventative medicine in the home. Last year, 17 home health aides made over 5,500 visits. They were able to care for patients with a number of different illnesses: heart disease, non- communicable diseases diabetes, stroke injuries, chronic diseases arthritis, cancer., and others. Most of the patients (3 out of 4) wore over 65. Noarly 20 percent were on medical assistance. To receive home health service, a patient must have written orders from his physician. Then, every two months a report on the patient's progress is sent to the physician for further medical orders. Status: Operational as of 10/70 lst year $15,900 2nd year 13,100 3rd year 10,000 Tennessee Mid-South Regional Medical Program A young mother gave premature birth to her twins. Physicians at a rural community hospital knew they would lose one of them and possible both. There was only one thing left to do. A call was placed to the Intensive Care Nursery at the University of Tennessee Memorial Research Center and Hospital. Within five hours both twins had been transported to the nursery by Volkswagen bus. Today, both of the twin girls are alive and healthy. This is a story of just one of many mothers in the East-Tenhessee Appalachian Region who is thankful to the Intensive Care Nursery. Since the Infant Intensive Care Unit was set up in October 1971, 278 babies have beet saved. Many have been transported from rural areas for treatment. One of the unique features of this service is the transporting of these infants in distress in a converted Volkswagen bus. It contains a portable isolette and other equipment necessary to sustain life until the infant reaches Knoxville. Two years ago the pediatrician in charge discovered there was an alarming infant mortality rate in Eastern Tennessee. The rate of 25.5 compared to 11.7 in the entire United States. The figures revealed highest death rates were in counties with inadequate equipment and few physicians. Many of the mothers received no pre-natal care and many had insufficient diets. Concern by the pediatrician led to the development of the Infant Intensive Care Unit, and his attempt to share information gained through its develop- ment throughout the region. The Tennessee Mid-South Regional Medical ProgramA as approved funds to allow a physician-nurse team to travel to rural ospitals in the area. They will try to upgrade skills and to evaluate the health care facilities and make practical suggestions regarding equipment. The physician and nursing staff has participated in many teleconferences and seminars sponsored by TMS/RMP. Nurses from all areas of Tennessee and Kentucky participate and observe in a one-day training program in the ten- bed Infant Intensive Care Unit at Knoxville. Effects have already been far reaching. Many of the nurses and doctors in isolated regions have adapted their nurseries in an attempt to give newborns a better chance at life. Many of the hospitals have purchased warmers. Some have changed feeding and bathing methods. The unit currently serves an area that stretches in a 200-mil6 radius around Knoxville and the staff also provides a 24-hour telephone counseling service to physicians. Tennessee Mid-Sou-Lh Regional Medical Program A two-year study designed to allow nurses to do follow-up care on patients with high blood pressure at the Alton Park Health Center has been approved by the Tennessee Mid-South Regional Medical Program@,-,@ The Center is located in a predominately black area of Chattanooga, and average family income is $8,500 to $4,000 a year. Hypertension, or high blood pressure, is a serious problem among blacks. According to national statistics, one in four has high blood pressure and three in four with high blood pressure have heart disease. Currently, the center treats 1,000 patients with high blood pressure but many do not bother to be treated and many do not continue treatment on a regular basis. However, hypertension can be serious. Many people with hyper- tension die not only from stroke, but also from heart attack or heart failure. There are not enough physicians to take care of people with hypertension. The TMS/RMP is hoping to find a way to alleviate this problem by assigning tasks previously carried out by physicians to specially trained nurses. Three nurses at the center will be responsible for follow-up care of hypertensive patients. It is hoped the project will demonstrate that close care of patients will lead to lower morbidity rates in the Alton Park Health Center area. Two family health workers will also be involved in the program at the center which currently serves over 33,000 people in this area of Chattanooga. -South Regional Tennessee Mid Medical Program Residents of three rural Appalachian communities will have full-time health care available for the first time this year. The Tennessee Mid-South Regional Medical Program has approved a grant which will allow clinics in Frakes, Kentucky and Clairfield and Duff, Tennessee to operate daily. Each clinic will be staffed by a full-time nurse practitioner, an assistant, a health aide, an automobile driver and an outreach worker. Doctors will visit the clinics on a weekly basis, but the nurse practi- tioher will be able to perform some duties without direct physician supervision. She will be a specially trained registered nurse who has received additional certified training as a nurse practitioner. The three clinics, prior to funding, operated on a part-tim6 basis. More than half of the 4,500 residents of the region are now using them. Many people have not had any full-time care because there has been no medical service available. There is not one resident doctor in the area, Many of the people, over 57 percent, have incomes of less than $3,000 a year, do not oqn motor vehicles and are unable to travel out of the region for medical care. The program will also emphasize good dental health and a dentist, dental assistant and aide will also be hired. Education in health areas and prevention of health problems are t-wo other aims of the program. The project was planned by residents of the three communities in an attempt to find a solution to their health need problems. A board, made up of citizens of the three communities, will be responsible for the distribution of funds and they will administer the program. The Clear Fork Community Development Projects, Inc. is located in the Clairfield Tennessee Community Center. The White Oak Clinic in Duff, Tennessee is in a 12 foot by 60 foot converted house trailer. The Frakes, Kentucky clinic is currently located in the basement of the Post Office. The project has also received funding from the Ohio Valley Regional Medical Program. Tennessee Mid-South Regional Medical Program Health professionals in 65 health facilities are now continuing their educations without leaving their employment. An extensive teleconfer- ence system was set up by the Tennessee Mid-South Regional Med:ical Program in November 1970 to enable health professionals to continue learning without sacrificing valuable time and money traveling. A teleconference is really a group telephone conversation. A lecturer can speak to many professionals in the region by using a conference phone. The hospitals participating also have conference phones and there ore, there is a two-way communication between lecturer and audience. This system is one method being used to disseminate information to health personnel outside academic institutions. In November 1910, bight hospitals and 40 people participated in the teleconference network. Today, 65 health facilities are participating and as mnay as 400 perople have taken part in a single teleconference. Currently, there are two series being presented. An eight-week program on beginning librarianship is being attended by 66 "students" in four states. Also, a hine-week overview for medical record personnel is being held in the Middle Tennessee area. The Tennessee Hospital Association is now planning a nine-month state- wide course on "Modern Techniques for Supervisory Development." This course will emphasize cost containment and supervisory techniques. A clinical content teleconference is also an integral part of the total program. These conferences are presented separately for three networks. Each month there are at least four programs on each network aimed toward the health care professional. The programs are planned by curriculum,,committees comprised of health professionals from the areas 8erved,and TMS/RMP",)core staff. Tennessee Mid-South Regional Medical Program Patients discharged from the Oak Ridge Hospital of the Methodist Church in Oak Ridge, Tennessee will now be assured of continued care. A liaison nurse will serve as a link between the hospital staff and health centers in the community to insure continued health care for patients who require it. The Tennessee Mid-South Regional Medical Program has funded this project to see if it will result in reduced re-hospitaliza- tion and shorter hospital stay for some patients. The liaison nurse will act as a bridge between the private physicians and the patient and those providing direct community service. She will also educate the nursing staff of the hospital to make them aware of patient needs for further health care outside the hospital complex. She will serve an area that includes Anderson, Campbell, Clai- borne, Roane and Scott counties. CARDIOPULMONARY RESUSCITATION Many people in East Tennessee are alive today because ambulance attendants and health professionals have learned how to care for and treat heart attack victims in emergency situations. The East Tennessee Heart Association in cooperation with the Tennessee Mid-South Regional Medical Program is training health professionals and emergency medical personnel in the use of cardiopulmonary resuscitation techniques. Since the program began in January, 1971, more than 180 health professionals have attended all-day sessions in Knoxville. Health professionals are taught intubation techniques, open heart massage, drug therapy, and mouth-to-mouth resuscitation. Many of the health professionals have returned to their own hospitals throughout East Tennessee and Southeastern Kentucky and have instructed their staffs on use of these methods. According to Mrs. Gertrude Killebrew, inservice education director at New Tazewell, a week after the staff completed the training, a patient went in to cardiac arrest. She said if they had not had the course,, no one would have known what to do. Over 2,000 ambulance attendants, rescue squad personnel and police and firemen have taken the three-hour course offered for them in mouth- to-mouth resuscitation techniques. Mr. George Duell, Jr., of the Jellico, Tennessee Rescue Squad says members of his department used artifical respiration prior to taking the course. They now all use the mouth-to-mouth resuscitation met hod and have had some "saves" as a result. Miss Edna Workman of Knoxville is one of the women saved by an ambulance attendant who took the cardiopulmonary resuscitation course. Her friend, Juliaette Jones, who accompanied her to the hospital praised the work of the attendant. "He knew how critical it was," she said, 11 and gave her mouth-to- mouth resuscitation all the way to the hospital. The experience pointed up the necessity of people knowing what to do in an emergency situation." jpc September 26, 1972 Tennessee Mid-South Regional Medical Program CANCER REGISTRY Cancer patients, physicians and thirty Tennessee hospitals are currently being helped by the cancer registry project of the Tennessee Mid-South Regional Medical Program. Since the program began, records of more than 7,000 cancer patients have been fed into a computer at the Meharry Medical College in Nashville, Tennessee. According to Project Director, Dr. Charles Trabue, accumulation of this information provides a service to the patients, serves as a source for investigative work by physicians writing scientific papers an allows hospitals and physicians to evaluate results of cancer care at their facility. The program encourages and promotes life-time followup care of cancer patients. Participating hospitals receive forms each month from the cancer registry listing patients treated at their facility who are due for annual re-examination. All information gathered by the cancer registry is available to any of the participating physicians. He may use this information for scientific research or to evaluate methods of cancer care at his hospital as compared to methods at other participating hospitals. Hospitals belonging to the cancer registry can effectively notify people of the need for re-examination and through this, can play the role necessary for it to provide comprehensive health care to the health consumer. The dancer registry also makes other information available to hospitals and physicians during the year. Each hospital receives a complete list with data on all patients treated at their facility four times a year. Once a year, physicians are sent lists of patients he has treated. Each month, the registry publishes a site review giving pertinent data on all patients in the registry who have cancer of a specific organ with a brief scientific article relating to cancer of that organ. ipc September 26, 1972 Tennessee Mid-South Regional Medical Program EMERGENCY MEDICAL SYSTEM A coordinated trained emergency medical service system is now operating in Tennessee. Dr. Robert Lash, head of Emergency Medical Services at the University of Tennessee Memorial Research Center and Hospital, has brought together trained physicians, nurses,, paramedics, rescue squad people, cardiopulmonary resuscitation personnel, Red Cross volunteers and a contingent of the Tennessee National Guard medical battalion to form a coordinated emergency medical service system in East Tennessee. The system demonstrates the value of forming cooperative arrangements between health professionals. The cardiopulmonary resuscitation people were trained by the East Tennessee Heart Association wi@---h funds from the Tennessee Mid-South Regional Medical Program. Rescue squad and Red-Ctoss volunteers received training from the Red Cross. Nurses have been trained in coronary care and emergency medical treatment by the University of Tennessee Memorial Research Center and Hospital through continuing education courses. Emergency Medical Teams have also received training at the Hospital. Company C of the medical battalion of the Tennessee National Guard received Army training. Dr. Lash said most of these people have been trained during the past two years. He brought them together to form the coordinated emergency medical corps. The corps will be available in case of disaster in Tennessee. Some members are trained in ski slope and mountain rescue. The teams are also available for use at large public gatherings in the Knoxville area. Currently, the team is workirg at all home football games at the Univer- sity of Tennessee in Knoxville. During the season opener, over 50 persons were treated for various injuries and illnesses. The most serious was a heart attack. One man, accorindg to Dr. Lash, fell on the track while leaving the stadium after the game. His heart had stopped beating. The medical team worked on him with the emergency equipment and he is now a patient in the coronary care unit at the University of Tennessee Hospital. "He would have been dead," said Dr. Lash, "if the equipment and trained personnel had not been available." At the names, fifteen teams of trained medical personnel patrol the stadium which holds 80,000 patrons. There are four vehicles available which have been converted to mini-ambulances to take injured or sick from the stands to four mini-emergency rooms set up within the stadium. If hospitalization is necessary, five fully equipped ambulances are also available. ipc October 1, 1972 Tennessee Mid-South Regional Medical Program. TEXAS Project GRO (Grass-Roots Organization for Health Services Education) Patients in at least three large geographic areas of the vast Texas region have already felt the results of shared, expanded and improved education for health professionals. Approximately 1800 registered nurses, physicians, licensed voca- tional nurses, nurses aides and other allied health personnel typical of rural Texas have learned new patient care skills at 23 works@ops and t@,af educational sessions conductedias of February, 1972@,)within their own hospital or at a nearby institution." Attendance and active participation has been termed excellent by both the community health providers who learn new skills and health professionals who travel from the larger resource institutions to share their knowledge and the latest treatment modalities. Begun in September/1971, this cooperative, coordinated health service educa- tion is available because three groups of approximately ten community hospitals each agreed with theiRMPt@concept of sharing expenses and efforts to bring -the 'i@- by the health providers in the three di eren kind of education nee e'd rural areas. Project GRO is a prime example of RMPT's new program ac tivity. Its purpose is to extend health services education into the smaller community hospital groups, and,more than that, to establish a self-supporting system for continuing this training with person-to-person linkages between resource centers and health personnel in the outlying, inaccessible areas. Under the project's first year plan, three hospital groupings are organized for cooperative sharing of a local health professional as a coordinator of health services education. Located in county groupings west of Fort Worth, in the Huntsville-Lake Livingston area, and in extreme northeast Texas, each group averages ten hospitals, representing collective capacities of 500 beds plus the addition of area nursing homes. The local education coordinator determines current needs and implements educa- sessions within this interdisciplinary pilot program. To arrange quality training, the coordinator acts as planning liaison between the hospital group and institutional resource centers willing to provide specific, needed education programs to allied health professionals. Visiting faculties of physicians, dentists, nurses, speech therapists, occupational therapists, physical therapists and others have presented sessions including coronary care, stroke rehabilitation, burns treatment, inhalation therapy and speech therapy. Related subjects have ranged from library reso@rces, nursing care plans and inservice training, orderly training and legal aspects of nursing to virological and immunological studies of human neoplasia. The latter was attended by 200 physicians nurses and hospital personnel in the West Cross Timbers Council. Interest continues high by the health professionals who are eager to learn and by multi-disciplinary health professionals who have enthusiastically shared their expertise. In short, project GRO is growing into a healthy success. fourth hospital group staff ready to join this cooperative venture of hospitals in rural Texas' at the beginning of Project GRO's second fiscal year-,i@n-Septenib'e@, 1972. TEXAS MEDICAL PHYSICS ORGANIZED, COORDINATED "MediQal Physics in a Regional Center", a Regional Medical Program of Texa funded project which is based at The University of Texas M. D Ande@on Hospital and Tumor Institute at Houston2has improved radiation patient care in Texas by standardizing procedures and providing-patient treatm.@itdata One of several outgrowths of this project has been'the a-ti" o f the statewide organization, Texas Regional Medical Physicists, In collaboration with this organization and M. D. Anderson Hospital s Physics Department, one of the major elements of this project is the calibration of radiation measuring instruments. Members of this organiza- tion are encouraged to bring their instruments for calibration at Workshops which are held twice yearly. Between sessions, members may mail thermo- luminescent dosimeters to verify exposure rates of radiation therapy machines. A fee is charged for this service in the hopes of making the entire program self-supporting when RMPT funds are phased out at the end of the current fiscal year. The M. D. Anderson Hospital Physics Depart-, ment facility, which is available for this service, has the support of the National Bureau of Standards and can promptly provide these services because of its proximity to its members. At bi-annual@.meetings of the Texas Regional.Medical Physiciststcommittees review means of standardizing procedures. The subjects of some of the meetings held to date include "Calibration of Radiation Therapy Machines; X-rays, 10 Kev to 35 Mev; Electrons, 5 to 50 Mev- Cobalt-60 and Cesium-135 Irradiators" and "Room Planning and Facility Design for Radiation Installations". This RMPT project not only provides instrument measurement but also data on individual patient's treatment as well. A centralized computer calculates the distribution of radiation dosage used in treatment. From the resulting isbdose curves printed by the computer, radiologists can determine the amounts of radiation delivered to the tumor and surrounding tissue. This data is available for patients treated by interstitial, intracavity or external beam radiation. Graphical information such as the contour or placement of sources is trans- mitted to the Center by mail or telecopier. The resultant isodose distri- bution is returned by the same means. Twenty-one telecopiers operate in the network. The system is available for physician communication, but the Center offers no clinical advice. In addition, a project staff member regularly publishes a bibliography of physics journals containing articles of interest to physicists in the health sciences. A central list of participants available for consultation is also main- tained. Some of the areas ,-f specialty include external beam dosimetry, leak testing of sealed sources, radiation accidents and decontamination, radiation protection measurements, etc. Other pro'grams related to diagnostic radiology and nuclear medicine have been developed more recently. 2 TEXAS IDENTIFYING ELEL(CTI[R@IltC-IAAL HAZARDS L n mL- t' Identify,ing electrical hazards in hospitals, the major goal of an@RMPT shed. project(@,,-in@the.j%@Co@-@d,i,@ 1--@---E)ffi,ce@@ has been accomplix target spitals were visited and sufficient information gathered to develop report. This information, intended to help elimina vide tii,,uing, prevent on to hospital personnel involved, disseminated to all interested hospitals and clinics. Overall results of project efforts will lessen a major health concern in Texas, reducing the problem of electrical hazards in m dicaal electronics nta@i.on. "Electrical Hazards in Critical Care Areas" seeks to provide useful infor- mation to the medical community about hazards of electrical apparatus in hospitals, critical care unit electrical systems and safety areas of medical-elettronic engineering concern. In the process of gathering, assessing and disseminating information, the increasing hospital responsi- bilities in the area of electronic services, their potential hazards, and the need for adequate monitoring are being stressed. T@he @@r"@ogram will improve health manpower understanding and the use of latest advances in surveillance,and of sophisticated electrical systems. Project efforts have been developed and coordinated i cooperation with the Texas Medical Association/, Texas Hospital Association7and Texas Nurses Association, and The University of Texas Department of Electrical Engineering. For example, contact with the THA Su Committee on Electronic Hazards has been made and liaison will continue. THA as recently taken action in the elec- trical safety area and RMPT project personnel are coordinating their efforts with T[IA. Sources of support for the continuation of this program are being sought as an integral project effort. The project's electrical,consultant and a biomedical instrumentation techni- cian visited Si target hospitals selected for testing of electrical outlets in pdtient care areas and medical electronic equipment in specialized critical areas. Earlier, major hospitals in both Dallas and Houston were visited to assess their existing electrical systems safety programs and to plan the extent of the project tests. The project resulted from concerns expressed by the Heart Task Force and is receiving guidance from a Medical Advisory Committee composed of Task Force members. TEXAS DENTAL REHAB METHODS EXTENDED Many ckrice-r rehabilitation patients in Texas have another common bond - the inability to resume an active role in society because of the residual effects of treatment required to arrest their disease. While extensive surgery and radiotherapy have prolonged the lives of many patients with cancer of the head and neck, some of these disfigured patients are in danger of losing their personal and professional lives. A project in its third year of funding by the Regional Medical Program of Texas has helped to effect rehabilitativ e ,-e procedures for thes patients and to extend the use of restoraC@@6-methods throughout the region. The "Reduce Complications Following Radiotherapy" project is based at The University of Texas Dental Branch at Houston with support from The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston. These institutions, close neigh!,,,)rs in the Texas Medical Center, are a central focus of the project. While the project's original purpose has been to reduce complications of head and neck cancer patients following radiation therapy, efforts have since focused on sharing these new methods of managing patients and bringing the d@tist into the health care team to achieve a lower incidence of complica- tions. Because the first objective has been substantially accomplished,, the project staff is focusing on informing the clinicians throughout the state of the problems that exist)with special emphasis on radiation patients, i @@o @t w@ltechniques &Valid to manage and prevent the ,eand on shar ng,ne problem@, Needed changes have been effected and are still ongoing in this once neglected field. Target groups include radiotherapists, radiologists, dentists, head and neck surgeons, pathologists, and internists in Texas as well as the various @maj.-@,a,nd,.sm&I.I) radiotherapy centers in Texas. Information emphasis is on training the local dentist to provi e consultation and methods of management, and, above all, to approach the dental problems of the head and neck canter patient without fear or reluctance. @With thi s knowledge and the closer working relationship between dentists and physicians, another goal is being accomplished - to continue to increase the quality of living and qualitative survival following successful treatment of head and neck cancer. Interregional activities have also been conducted at five major professional meetings of clinicians and interest has been stimulated to establish similar programs. "Refresher Course Booklets" concerning various types of oral care for the head and neck cancer patient undergoing radiation have been published and distributed as part of the interregional efforts. @ RMPT support endL(,August 31, 1972, it- is ,p@li,a7rtne@d,tftat,,individual support from local institutions can@--,be-,uti,l,iz-ecl in@ the main@ 6-f- these patients. TEXAS STRENGTHENING INHALATION THERAPY PATIENT CARE PROGRAMS The Texas Hospital Association has almost completed a two-phase educa- tional program to help regional hospitals organize and strengthen inhalation therapy patient care programs. Funded by the Regional Medical Program of Texas,(f@r fiscal year 1971-1972, the first phase of the inhalation therapy educational project included four two-day institutes conducted in the East Texas Chest Hospital, Tyler.' ; Hendrick Memorial Hospital, Abilene,' 4. 1:@9-7-1-; Memorial Medical Center, Corpus Christi; Dec-,@@@ and St. Joseph Hospital , Fort Worth -2. Hospital administrators, nursing directors, nurses and other hospital personnel attended the sessions to ga4@@practical, organizational and clinical applications i -r--t-o,Oevelop effective inhalation therapy patient care programs. The second phase involved clinical experience workshops held in two-week sessions in five Houston hospitals including The Methodist Hospital, The M.D. Anderson Hospital and Tumor Institute, The Veterans Administration Hospital, St. Joseph Hospital and Heights Hospital "These in ---iperience to t two-day hospita ps served as follow-up 6 institutes. A.,total of fou,r were held during October-4'Novemb,e entry, "4-F Lectures, demonstrations, supervised laboratory observations and practice were used in the five clinical settings to provide versatile experience in inhalation therapy administration and first-hand insight into the organi- zation and functions of inhalation therapy departments. Each hospital'/whose personnel attended the two-day institute, selected one or two employees to participate in the clinical experience phase. Participants were then qualified to assist the hospital administrator, nursing director, and medical staff to organize and develop the inhala- tion therapy patient care program. Inhalation therapy is a relatively new and rapidly expanding specialty involving the administration of oxygen and other gases and drugs to treat patients with cardiopulmonary diseases and other respiratory disorders. Attendance and response to the inh@,tion therapy educational activities has been reported as excellent by (THA,4 The association will tabulate and analyze the project from "baselineil--information collected before and after participation by hospitals. The information will be studied to compare progress in improving inhalation therapy patient services and to develop an operational plan for hospitals. TEXAS STROKE PROGRAM RESPONDS TO OUTREACII NEEDS The primary purpose of the Stroke Demonstration Program, based at Presby- terian Hospital and The University of Texas Southwestern Medical School at Dallas, is to demonstrate comprehensive, progressive care of the stroke patient and provide education to physicians, nurses and allied health personnel The multidisciplinary team of health specialists)@'includes neurology, nursing, speech pathology, occupational therapy, physical therapy and social service,@.iu,-,c=pre-h-e4vsive education effort on.,,the.-l-atest techniques for -treaty -and .- r@@bi l@,itat-@o,n ... o-f-,---@t@@-S-trc)ke Regular stroke workshop conferences for physicians in the North Texas area and for nurses from across the state are conducted by the project director, a neurologist, and the education director, a registered nurse. The two-day physician's workshop, "Diagiosis and Treatment of the Stroke Patient", discusses all phases of medical and surgical management and the rehabilitation of stroke patients)and draws physicians primarily from the areas of North and East Texas. While a two-day program based within the stroke unit is superior Dr.,,N6@,@li' reach programs as an n' '@ e@U favoysout excellent alternate mode for conti ulng ca- tion, and he acknowledges the increasing need to take the program to the, doctor. is on taking the stroke team's one-day post-graduate education program into the outreach area at least monthly, depending on the number of on oing nursing rehabilitation workshops and other commitments. ',-Another@l,,effort is to interest the larger area hospitals in developing stroke care hos ital training programs. (", There are some 36,community hospita,ls@out- p side,@of Dallas,with-in-the North Texas area with 100 beds or more,which the project @e-terr hopes to reach'i Area physicians have been invited to spend a working day or more in the Presbyterian Hospital Unit. The five and one-half day nursing workshop conferences are conducted on a semi-monthly basis. They aru also held at the Presbyterian Hospital and include a field trip to a long-term rehabilitation center, the Dallas Insti- tute of Rehabilitation. Response to the nursing workshops,, has k r 'r @q good; attendance is usually booked six months in advance. I%L-.n@enrsing renabi- litation @-ea-4y been taken into la number of outlying communities and other institutions within the Dallas metropolitan area. 14hil'e the one-day program is t as detailed or comprehensive as the regular nursing 0 j@ workshop,, i ' to'u-@yv ue @eyb Nurses become aware that some- thing tan be done for stroke patients; they receive literature and become knowledgeable about inservice education possibilities. Education for nurs and allied health personnel now includes more nursing home perso; -,I in the workshops. Participation by these,nur5es, is increasing and oil,e result has been nursing inservice educatio4h"i@" nursing homes conducted by workshop participants. The Stroke Demonstration Program is now in the final year of a three-year funding period. RMPT support will be phased out at the end of the 1971-1972 fiscal year, but it is fully expected that the program will be continued. -U Sheet ion: Regional Medical Program of Texas Locus of AC Core Activity and operational Project Project Title: Grass Roots Organization for Health Services Education Status: Ongoing Spohs 1) Mid Trinity Valley Council for Health Resources Development 2) West Cross Timbers Council for Health Resources Development 3) Northeast Texas Council for Health Resources Developmen (Each of the three councils averages 10 hospitals representing collec- tive capacities of 500 beds) Project Director: N. Don Macon Director, Community Health Proqrams Regional, Medical Program of T6xas 1600 Holcombe, Room 1005 Houston, Texas 77025 713-747-9442 Dates: September 1971 - September 1972 (Proposed funding is for a three-year period at $225,000.) Funding: $75,000 Other Funds: The three hospital groups or councils are assessing nominal mefb-ership fees to accrue partial operating funds beginning the second year. Cooperativ Aqencies and Institutions: The approximately ten member hospitals within the three hospital groups and various member nursing/convalescent homes and central resource institutions such as The University of Texas medical and nursing schools; Texas Womah's University Nursing schools, larger hospitalsliand other RMPT projects who have supplied personnel to conduct multiple health services education workshops and seminars. Area served: 1) Huntsville-Lake Livingston area in East Texas 2) Stephenville area west of Fort Worth 3) Extreme Northeast Texas Target Population: Health professionals and allied health personnel within the hospital groups and areas described above. Congressional Districts: # IRep. Wright Patman of Texarkana # 2Rep. John Dowdy of Athens # 17 Rep. Omar Burleson of Anson # 6Rep. Olin Teague of College Station # 11 Rep. Bob Poage of Waco. Continu,-Ition after RMPT support will diminish at the rate of 25 percent per year beginning the second year. Thus, RMPT pays 100 percent the,first year, 75 percent the second year and 50 percent the third year. Each of the three groups of hospitals assumes the gradual deficit and, beginning the fourth year, pays 100 percent of cost. The diminishing cost to RMPT provides funds during the second and thir,ul year for implementing three additional groups of hospitals. @e Lo n- Virginia Regional Medical Program, Inc. Locus of Activitv: Core Activity Project Title: Public Education on Sickle Cell Disease Status: Ongoing S22nsoring Institution: Vir@inia. Regional Medical College, Virginia State In College, Medical Collece of Virginia Project Director, Title, Address: Mrs. Evelyn Jemison Associate Professor of Bio ogy Virginia State College Petersburg, Virginia Dates: I December 1971 30 November 1972 (Sickle Cell Screening & Study) 1 September 1971 31 August 1973 (Core Staff activities) dill 01 $6,200 Other Funds: None Cooperating Agencies and Institutions: Virc,-inia State College Medical College cf Virginia, State Department of Education, State and County Health Departments, Community Action Program, Model Cities Programs. Area Served: Statewide program with concentration in areas of predominantly hi.Lyh Black r)-,-oula-Lion: Norfolk, Pc)rtsiiioatti, Nev@ipo@-t j\lc-ws, Hampton, Roanoke, Target Population: Black population and Health Professionals (Core Staff aspect of program) 3000 Black Students (Sickle Cell Screening) Congressional Districts: # I Mr. Thomas N. Downing (D) # 2 Mr. G. W. Whitehurst (R) # 4 Mr. Watkins M. A@bitt (D) -# 6 Mr. Richard H. Poff (R) Continuation after RMP Support XVithdrawn: Core Staff Contact: Mrs. Harriet Peoples, Assistant in Allied Health, Virginia Regional Medical Program, Inc. Date Prepared: Drafted Bv: Tandy T. Shields, Editorial Assistant Region Virginia Regional Medical Program, Inc. Locus of Activity: Operational Project Project Title- Cardiopulmonary Resuscitation Training Status: Ongoing Sponsorino, Institution: Virginia Heart Association, Inc. Project Director, Title, Address.- J. H. Stone Virginia Heart Association, Inc. Richmond, Virginia Dates: 1 March 1970 - 28 February 1973 Funding: (unavailable at this time) Other Funds: Virginia Heart Association Cooperating Agencies and Institutions: Virginia Heart Association and Community Hospitals throughout the State. Area Served: Statewide Program. Target Population: Reduce deaths of Cardiac Arrest Victims through training and retrainino- of hospital and ei-nergency personnel. Congressional Districts: All Continuation after RMP Support Withdrawn: At the end of RMP support, the project funding is to be assumed by the Virginia Heart Association, Inc. Core Staff Contact:_ Mrs. Ann S. Cann, Communications & Community Relations Officer, Viroinia Regional Medical Program, Inc. Date Prepared: Drafted Bv: Tandy T. Shields, Editorial Assistant Cardiopulmonary Resuscitation as an Emergency Measure A program to train health professionals and emergency personnel in closed chest heart massage (cardiopulmonary resuscitation or CPR) is making quite an impact on the State of Virginia. The program is sponsored. by the Virginia Regional Medical Progran-v@@'and conducted through the Virginia Heart Association. The aim of the CPR program is to train instructor training teams from community hospitals (generally two physicians and two nurses), who @-,e'then train other hospital and emergency personnel in their home communities. To date, S. (600) instructors have trained almost f a4W (15, 000) persons affiliated with oile,- (127) hospitals throughout Virginia. Since the requirement of emergency training under the new "Safety Act, instituted by the Department of Labor in June 1971, industry has shown considerable interest in CPR training. Important advances have been made in helping @high risk industries @ implement basic emergency systems. A total of 1222 industry and emergency personnel were trained during 1971. To give insight into the remarkable success of this project: in one small urbaii hospital (E',O beds), the term CPR was barely known until the, VRMP program was launched. Since the hospital team was trained, there have been four cardiac arrests--with three successful resuscitationsr The survivors are all less than 50 years old and have returned to useful, productive lives in their community. The CPR program will be continued and maintained through cons@Lant retraining of hospital and emergency personnel. It is hoped that further CPR program activities can be a part of core staff efforts in other emergency health services areas. Sickle Cell Anemia Long overlooked both on National and State levels is the area of Sickle Cell Disease. In support of this statement, attention is called to the President's Health Message. "It is a sad and shameful fact that the causes of this disease have been largely neglected throughout history. We can not rewrite this record of neglect, but we can reverse it. To this end, this administration is increasing its budget for research and treatment of Sickle Cell Disease five fol , to a new total of $6, 000, 000. Shortly after Nixon's speech, the Blue Sheet Drug Research Reports featured a'4 I./2 page report on current research in the field of sickle Cell anemia. The following paragraph appeared: "Another type of program is dev eloping in Virginia. Under the leadership of the Governor's Special Assistant, William Robertson, and Dr. Robert B. Scott of the Medical Colleo-e of Virginia, the State is becoming involved in wide-sprea screening of the black population. Upon seeing this report, Virginia Regional Medical Program staff ii-nmediately consulted Dr. Scott and Mr. Robertson to discuss ways in which VRMP might aid the sickle cell program. It was decided that our main thrust would be in public education. VRMP con-imunitv liaison staff were oriented in certain aspects of sickle cell disease and its effects on potential carriers. This informa- tion is'@i@seminated to the black population, to health professionals, and other interested groups. Presently underwaN, through direct efforts of the VRMP, is an attempt to incorporate the tbpLC of sickle cell anemia into high school biology curriculums. Meetings have been held with rer)resentatives,o @,h State Department of Education, and -v@@av@ll"f@,,responseo er@e,r@eeived.-, To implement the program, one school district in "each VRMP subregion has been selected for pilot study. The second aspect of VRI\AP involvement is the fundin@ of a sickle cell program at Virginia State College in Petersburg. The $6, 200 grant is the first one made in the State for determining the frequency of sickle cell trait carriers. This sced i-nonev will aid in the beginning of a five-vear study, which will encompass public education, mass screening and eugeni@.-tt)couns--Iing services for all black Vir@inians. Treatment and Reliabilitition of Stroke Patients in a Rural Community Man rural communities in Virginia r@ miles away from hospital facilities, ly I kA,, iiiiiti-es-"cont@a-in@aiiy older citizens who are prone to strokes. In an attempt to improve care and rehabilitation of stroke patients in such communities, a pilot project has been initiated in Virginia. In t e target area are a privately owned medical center and two nursing homes. The project links health professionals in the rural area of Blackstone, Virginia, with the Medical College of Virginia in Richmond. The strategy is a multidisciplinary approach with two-way consultations, patient referrals, and reciprocal personal visits in order to up-date knowledge and skills of the health provider. Identified as the four major stages of activity are: 1. determining past treatment methods; 2. studying and implementing new treatment methods; -3. evaluation of what has been learned; and 4. application of findings to other rural areas. One of the key efforts of the stroke program is patient rehabilitation. To accomplish this@, health providers, institutions, and families of the patients are all working together. In addition to continuing education programs for the participating physicians, core and project staff hold monthly sessions for all ar@a nurses and i-iursing assistants. Families of stroke patients also attend . Subjects discussed are acute care of the stroke patient, emotional status of patients and families, aphasia and dysarthria, working with patients ,vith speech problems, positioning and exercises for the patient, and trans fer and a.-nbulation training for stroke patients. Providing physical therapy consultation are graduate students in tl-ie Medical College of Virginia School of Physical Therapy, and speech therapy has been provided by a speech therapist on the Virginia Regional Medical Program staff. WASHINGTON/ALASKA MOBILE INTENSIVE/CORONARY CARE UNIT Sixty-six victims of heart attacks in Seattle, Washington, owe their lives to the immediate, on-the-spot intensive care-provided by the City Fire Department and its Mobile Intensive/Coronary Care Unit system in the first 18 months of service. Hundreds of other residents had life-threatening situations averted by prompt response to their calls for help. The fullqequipped mobile van, known as Medic I, or one of the 10 smaller aide cars, 11 staffed by trained firemen, can reach the scene of a cardiac emergency within two to five minutes and begin their life saving treatment immediately. The large van can continue the treatment while the patient is on t e wa often a crucial o@ t h ,Vospital. Previously, heart attack victims were one t hours away from this intensive hospital care. This demonstration project for cardiac emergency care proved so successful that Seattle and its citizens have how taken ovpr the funding for it; at least five nearby communities. are establishing similar emergency services4, and its training course for personnel has stimulated three community colleges to introduce classes for emergency medical technicians for the area's firemen, policemen and ambulance attendants. Medic I crews themselves have held 500 cardio pulmonary resuscitation classes for more than 10,000 ordinary citizens,- and,,so far, 30 firemen have completed a total of 500 hours in a trauma care course. The Mashingto@./Alaska REgional Medical Program provided the bulk of the money 4($243,57 - to-introduce the system, with a strong assist from the STate Division of Health, the STate Heart Association, and Harborview Medical Center administered by the University of Washington.Subsequently more than $200,000 was contributed by civic groups and private citizens to insure continuation of the service,(.,foll-dWih4 the--lead-,in per@iod.) The City Fire Department is responsible for communications, response of the ai&cars, dispatching, personnel matters and v-.hicle maintenance. During the first 10 months of operation, a physician- accompanied Medic I on each run, now the paramedical fire department personnel travel with the van and rely on monitoring by a physician through radio and telephone contact. Resuscitation of circulatory arrest is carried out by the staff under standing written orders. Originally Medic I operated out of Harborview Medical Center, now all of the 14 hospital coronary care units in the city participate in the program. Averaging 250 runs a month, Medic I made 3,058 runs in the first 18 months at an average cost of $72 per run. A lurge number of patients with ventricular fibrillation were treated - 324 in the initial months, 36 percent of these patients being resuscitated with.a long-term survival rate o percen WASHINGTON/ALASKA HOSPITAL SHARING Fifty-five percent of the residents in the Willapa Harbor area, a lumbering and fishing region on the west coast of WAshington state, had sought medical services outside their area in one year and 37 percent had not been able to see a doctor when they wanted to. Only one physician, close to retirement, resided in the area serving nearly 9,000 people ' The administrator of the small hospital became concerned about what was happening to medical care. He telephone, @he Seattle offices of the Wash- ington/Alaska REgional Medical Program,130 mile@@ "io@ eth, asking for help. That was in 1969. Two years later, the picture had changed radically@'due to W/ARMP response to his call for help. Today the town has two resident physicians', A Health Board'@ Ielected@ A Comprehensive Health Planning agency is functioning Mi'litary helicopters fly emergency cases directly to 6 specialized care center@,fihd an unusual cooperative arrangement between the 39-bed Willapa Harbor Hospital and Virginia Mason's 300-bed medical center in Seattle is proving to be a model for coordination of medical care throughout the entire region. In September of 1971, the State Hospital Association established a special task force to inventory existing shared programs betweh hospitals and "to study methods of developing, expanding and financing additional inter-hospital sharing activities on a local, regional and state-wide basis." What happened to Willapa Harbor should happen to other small towns who face a typical health care problem - the uneven distribution of resources and manpower between large cities an rura towns. First W/ARMP's Comirunity Health Services activated a citizen's group to conduct a survey.outlining the residents' health needs and wants and assisted them in carry- ing out the recommendations,vviiuc' ---Ul u@tui-e. Practical advkn- tages for local patients and hospital staff in sharing the resources and expertise of a big city medical center @ were soon demon§trated.,,@, A "hot-line" for consultation was set up between the two hospitals. Transportation, both by air and land, was coordinated. Continuity of patient care was established. A drug inventory and development of a formulary resulted in savings of $5,000 in a one year period. Unit price of one drug, for example, dropped from 82*to 32t. A local pharmacist was encouraged to provide daily hospita service. Continuing staff education is another big plus. Nurses wore trained in coronary care and the region's lumber company provided the equipment. Inhalation therapy equipment and technics were updated. Regular nursing seminars have been extended to include another small hospital staff 45 miles away and rotate between the three hospitals. Willapa Harbor Hospital morale became high. "Virqinia Mason is learning from this experience,, too," says that hospitals "It's a professional boost for our staff who are challenged by what- they --s- -e-e --and 1 earn i n a di fferent envi ronment. W/ARMP is producing a 20 minute film which CHS field staff will use in explaining the concept and possibilities of hospital sharing in other communities. . .... WASHINGTON/ALASKA STROKE NURSING PROGRAM For three long years, the elderly stroke patient had lain in his bed in a nursing home,,unable to speak. A nurse's aide, who had attended a local course in restorative patient care decided to apply some of her newly-learned skills. In a short time; she had the patient up and walking, able to perform voutine daily activities. Soon he was talking, too. In a nearby nursing home, an R.N. decided to help a wheel-chair patient regain the use of his left hand, which he had not used for 19 years. Her success, too, was added to the store of incidents which demonstrate the direct results of a locally-initiated training course of restorative care. January, 1972, marked the fourth anniversary of the Central STroke Nursing Program, begun in the Centralia College in WAshington state in 1968 and the only rehabilitative course in the state for licensed practical nurses and nurse's aides as well as for R.N.s. Since then, nearly 300 nursing personnel have completed the 12 week courses; the program has been extended to cover the neighboring county; and courses to involve physicians, patients' families and nursing home and hospital administrators are scheduled this year. In 1971, 15 R.N.s, eight L.PN.s and 37 nurse's aides participated in 144 hours of classroom instruction and 179 hours of laboratory experience. After each person completes formal training, Course Instructor Gail Wrzetinski, R.N., makes a follow- up visit to the home institution. Last year she gave 500 hours of follow-up visits, including one and two day session for the entire nursing staff in some institutions. Skills taught in the course include exercises for strengthening muscles, learning causes and treatments for various chronic illnesses, working with speech and communication pr-oblins and how to institute crafts and other activities for mental and physical stimulation. The first courses at Centralia College were the result of one local resident' s dissatisfaction with the care given his uncle. They were planned and funded by, the college, the State Heart Association and local hospitals ana nursing homes. The following year, WAthington/Alaska Regional Medical Program granted funds to expand the program to the next county and enlarge the scope of the courses. "We must get over the idea of a nursing home as a place to go and die," said Mrs. Wrzesinski. "The attitude of people who work in the nursing home is most important. More people should visit nursing homes and find out what is going on in them. Our experience shows that one concerned citizen can help to revolutionize the treatment.'' I" @ VIGNETTE Under the sponsorship of the Regional Medical Program for Western New York The Rural Externship Program has become an effective means of directing health manpower toward delivery of primary care in underserved rural areas. The program places teams of Health Science students from a variety of disciplines in a number of rural health care settings for a period of eight weeks during the summer. By so doing, the project provides rural communities and community hospitals with access to Health Science students and a means of attracting them to careers in rural medicine. At the same time, the program provides Health Science students with A powerful exposure to primary care, And to health care settings not currently utilized in their formal clinical curricula. During the summer of 1971, the Rural ExternshipCp@laced 22 students in 11 communities in outlying areas of Western New York. During the eight weeks they spent on assignment, the students q6re exposed to over 50 prof easional Oreceptors. The Regional -Medie&.I-@,@@@Preg@r-am@@-for--West-ern--New -yo@ played the central tole in coordinating the program, identifying suitable preceptors, overseeing student selection, developing program guidelines and methods for evaluation, raising local funds to subsidize the cost of student stipends, and developing outside financial resources to carry out the program. Gene Bunnell of the core staff served as co-director of the project during 1971 along with-'iwarren Perry, Ph.Do, Dean of the School of Health Related Professions, S.U.N.Y. at Buffalo. @,,@iw,l@WNY core funds were used in a developmental fashion to establish this innovative student-oriented program. In addition, $9,000 in local contri- butions was raised in addition to obtaining a $20,000 grant through the Appalachian ReRional Commission. PM/WNY"hopes to see the Rural Externship expand in 1972 -2- to include 50 Health Science students. Also planned is close coordination of activities with the National Student Health project, sponsored by the Student American,Mbdical Association. IWNY is hiring a full time director to coordinate and expand-the program in the future. The program has many benefits for both student and community. During their ext-ernship, students receive a first hand exposure to the rural health care system and to the health problems of these communities. In addition, our evaluation of the 1971 program strongly indicates that the Rural Externship is a means of positively influencing students' career choices: specialty and preferred locations. At the same time students augment existing health manpower in rural areas and assist in giving atten- tion to critical aspects of health maintenance: continuity,6f care, prevention and follow-up. The presence of Health Science students stimu- lates rural communities to consider their manpower needs and ways of improving the organization and delivery of health services. Finallyi the program provides a means for bringing new ideas to rural practitioners who often suffer from professional isolation. This contact with students may, in fact, encourage health professionals currently practicing in rural communities to remain in those settings. rt, RNP/WNY believes that the Rural Externship represents a concrete and meaningful way of making the training of Health Science students responsive to the primary dare needs of rura areas. -7// WESTERN NEW YORK Treatment of Skin Cancer An effective cure for skin cancer has been developed in Buffalo. Edmund Klein, M.D., Chief, Department of Dermatology, at Roswell Park Memorial Institute has poineered a new method of treatment in which a cream containing an anti-cancer drug, topical 5-Fluoroucil, is applied to the skin. Each year in the United States 4,000 people die of skin cancer and 100,000 new cases appear. In addition, at least 5 to 10 million people develop very early stages of the disease. Until recently, skin cancer was.treated by a laborous surgical procedure Now, applications of the cream@cure skin cancers in fp -_ur weeks or less. The cream is also ry helpful to the doctor b makes skin cancersINvisible at very early stages c ,(which would otherwise remain undete te Since this simple procedure is readily usable by the community physician, the PMP for WNY supported a project funded as of March 1, 1970 to dis- seminate the method and materials on a large scale throughout our area., and through analysis of data received, to develop this region as a model in skin cancer treatment for the entire nation. The Buffalo-Rochester Dermatologic Society formed a six-member "liaison committee." These liaison directors trained community physicians and provided a link with the canter treatment center at Roswell Park in Buffalo. Many physicians in various parts of the region who already had specialize training in the use of skin drugs were eager to cooperate in the project. They used the materials and provided information necessary to establish the feasibility of large-scale use of the cream by community physicians in this region. The feasibility of general use of the cream by community physicians was established. t-@ it is now marketed commercially by several pharmaceutical'@ompanies and is available to all physicians. WESTERN NEW YORK Area Health Education Center Residents of Erie, Pennsylvania and the surrounding area will benefit from improved delivery of health care and the advantages of a health science center right in their own location by the establishment of the Lake Area Health Education Center (LAHEC). Through the efforts of the-,,;, the deans of the health- science schools of the State University of New York at Buffalo, the director of the Roswell Park Memorial Institute in Buffalo, and admin- istrations of the three major hospitals in Erie, Pennsylvania came together to discuss methods of establishing the center. The Regional Medical Program recruited a full-time director for the Center, Michael C.J. Carey, w@,- c'ame. aboarcl.Ju@ne@@li,--1971. Since his arrival, the organization of the center has moved along quickly. L&HEC is the first area health education center to be funded by the Veterans Administration, and will soon achieve the status of a public nonprofit corporation for educational And scientific purposes. To better meet the health needs of the Erie, Pennsylvania area, com- mittees are being established for medicine, dentistry, pharmacy, and allied health professions. Local colleges will coordinate their health- science programs through IAHEC so they can train the health personnel that are most needed in the area. As a measure of the local interest in the development of I.AHEC, the Erie, Pennsylvania hospitals, the Veterans Administration, and the Regional Medical Program have all made monetary commitments to the Center. Mr. Carey has been active in discussing the development of the area health education center in Washington. He has also been invited to many areas across the country to review the development of IAHEC,and help other areas establish their own Centers. Back-up Sheet Region: Regional Medical Program for Western New York Locus of Activity: Operational Project (locally supported for I year, through carryover or rebudgeted funds) Project Title: Topical Chemotherapy Treatment for Precancerous Lesions and Cancer of the Skin Status: Terminated Sponsoring Institution: RMP/WNY Project Director, Title, Address: Edmund K ein, M.D. Chief, Department of Dermatology Roswell Park Memorial Institute 666 Elm Street Buffalo, New York 14203 716-845-3163 Dates: March 1970 - February 1971 Funding: I year from carryover funds, $47,454 direct costs Other Funds: Research supported in part by the Albert and Mary Lasker Foundation, New York City, N.Y., Research grant #CA 08578 from the National dancer Institute, and Research grant Y@AI 09479 - 01, from the National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, Research grant #T-429 from the American Cancer Society, New York City, N.Y., Research grant G-64-RP-15 from the United Health Foundation of Western New York; the Marge Tinjanoff Fund, Buffalo., N.Y., and the Arcade Community Chest, Arcade, New York. Cooperating Agencies and Institutions: Buffalo-Rochester Dermatalogic Society, Roswell Park Memorial Institute, National Institutes of Health, practicing physicians, newspapers, radio and television stations, pharmaceutical companies, county medica societ es. Area Served: Western New York and Rochester regions Target Population: the 3,300,000 residents of Western New York and Rochester regions; community physicians who serve this population. Congressional Districts: 38, 39, 40, and 41 in Western New York 23 and 24 in Pennsylvania Continuation After RMP Support Withdrawn: The cream is now available commercially. Core Staff Contact: John R.F. Ingall, M.D.$ Executive Director, RMP/WNY Date Prepared: 2/10/72 Drafted b_y: Sandra Berlowitz WESTERN PENNSYLVANIA PAP SMEAR SCREENINGS Routine Pap smear screening has been recognized as an effective means of determining cervical cancer, the third leading cause of death from cancer in the United States. Six such screenings, combined with a program to train registered nurses to collect the cervical smears, were carried out in Western Pennsylvania by county units of the American Cancer Society, cooperating hospitals and the Western Pennsylvania Regional Medical Program (WP/BM) in 1971 And 1972. Almost women in Clearfield, Clarion, Crawford, Jefferson, Somerset and Greene Counties were screened in free public programs. Repults of five screenings (aħi ti.- ip Crawfo@county screeningaare not in yet) @ uncovered four positive smears,ca women @ were referred im- mediately for treatment. In five of the six areas, nurses specially trained in Pap smear collec- tion participated in the screening programs. In many cases, women preferred a nurse to Perform the Pap test although physicians were available. ../This one of the many advantages in training registered nurses to perform Pap testst f-.Iwhom- n, m -an. Ot' er Y CLL L@in advantages include: 1) because the Pap test is largely a technical skill, nurses can be md efficiently trained to perform the procedure; 2)-ph-ye & 6ft@rr give-...the rea@on, having nurses collect the Pap smear'-- 3) hospitals can adopt t@e policy to screen all female inpatients of proper age, thereby insuring that a certain percentage of the female population is screened. Almost a third of the women screened(in areas-@lfrom.-@-ich-,--resu-Its are,,.,c@@d--au&..,infa i s., -a-va i-I a-b I e, 'ad never had a Pap test. Another significant number of women had not receii@e'd a Pap test in four years or more. Combined with the nurse training And screening efforts were public education pro- grams designed to encourage women to continue scheduling regular Pap tests an O&kformi@ monthly breast self-examination! The public education programs involved a variety of media. I@ilms on cervical cancer were shown on cable television and at screening sites@ v ..d ir n one area. articles and brochures publicizing the screenings and outlining the need for Pap tests and breast self-examination T, *In addition, a survey was conducted i@ a teaching hospital and an ambu- latory cake facility in June, 1972 to determinelevidence @@4cr@-support t assumption that many women in Western Pennsylvania, even those cared for in these facilities, do not have adequate histories of cervical smear screening. Four hundred interviews were conducted, half in the teaching hospital and half in t e ambulatory care center. it was found that:50.5 percent of the women surveyed at the teaching hospital and 35 percent of the women interviewed at the ambulatory care center either had not had a Pap test in three years or had never received a Pap test; "N.Tant- percent of the women interviewed at the teaching hospital and 11 percent of the women surveyed at the ambulatory care center had never a a Pap testa 2 participate in a program in which properly trained female paramedical personnel or nurses would obtain the Pap smeArs,';7,1 percent of the teaching hospital interviewees and 80 percent of the ambulatory care center interviewee@' The results of both the interview and feelings expressed by partici- pants in the six Pap smear screenings seem to indicate substantial patient ac- ceptance of the nurse in performing the Pap test. *At this time, a proposal outlining a comprehensive program to prepare nurses to screen for cervical cancer is being submitted to the Wdstern Pennsyl- vania Regional Medical Program. The project, if funded, would train nurses to collect Pap smears; at- tempt to initiate a program that would screen all hospital female inpatients, eventually expanding to other health care facilities; encourage the medical community's acceptance of the nurse in collecting Pap smears; and demonstrate the expanded role of the nurse in gynecological nursing. The main goal of the project is the reduction of the number of deaths from cancer of the cervix in "@'Western Pennsylvania by 50 percent. VIGNETTE BACK-UP SHEET Region: Western Pennsylania Regional Medical Program L4ocus of Activity: Core Activity Project Title. Somerset County Pap Smear Program Status: Completed Sponsoring Institution: Somerset County Unit, American Cancer Society Project Director: Ms. Shirley Schweitzer Somerset County Unit, ACS Somerset, Pa. 15501 (814) 445-2584 Dates: April 3 to April 8, 1972 Funding: None (Assistance provided by training nurses to collect Pap smears) Other Fund§.: (Services provided by cooperating agencies) Coolperating Agencies and Institutions: Somerset County Unit of the American Cancer Society; Boswell Medical Associates; Pennsylvania Division of the American Cancer Society; and the WP/RMP. Area Served: Somerset County Target Population: 911 women in a rural area in Western Pa. Congressional Districts: #12 Cont tio RM n: American Cancer Society will screenings. other factors are as indicated probably continue to sponsor such on the other screening fact heets. ct: Ruth Mrozek, R.N. m S ff Con a@ Nursing Specialist in OncolOgY WP/RMP September 21 1972 kP're @ ed' Drafted b Maureen Ryan VIGNETTE BACK-UP SHEET Region: West6rn Pennsylvania Regional Medical Program Locus of Activity: Developmental Component (Planning Study) Project Title: Punxsutawney Pap Smear Program Status: Screening completed; Reading of slides completed SponsorinjZ Institution: Adrian Hospital Association, Punxsutawney, Pa. Proiect Director: Mrs. Ruth Fleckenstein, R.N. Adrian Hospital Association Punxsutawney, Pa. 15767 (814) 938-4500 Dates: April 6,, April 13, April 20, and April 27, 1972 Funding: $1,46(t, *(WP/RN:P trained nurses to collect Pap Smears) Other Funds: (in-kind services contributed by cooperating agencies) Cooperating Agencies and Institutions: Punxsutawney Jaycee-ettes; Adrian Hospital; Nurses Alumni Association; and the Jefferson County Unit of the American Cancer Society; and Magee-Womens Hospital, Pittsburgh. Area Served: The town of Punxsutawney and surrounding area in Jefferson County. Tarizet Population: 681 women in a rural area Conjzressional Districts: #22 *Core Activity Continuation After RMP Support Withdrawn: Incorporated into the screening program was the training of registered nurses to perform the Pap smears. It is hoped that by training the nurses, Pap smear screening:will become a regular service of the hospital for female inpatients. Therefore, subsequent screenings will be built into general health care costs. Proj%ram Staff Contact: Ruth Mrozek, R.N. Nursing Specialist in On6ology WP/RMP Date Prepared: September 20, 1972 Drafted bY: Maureen Ryan WP/RMP Communications Assistant VIGNETTE BACK-UP SHEET Region: Western Pennsylvania Regional Medical Program Locus of Activity: Developmental Component (Planning.Study) Proiect Title: Meadville Area Pap Smear Program Status: Screening completed; results to be completed Sponsoring Institution: Meadville City Hospital and Spencer Hospital, Meadville. Proiect Director: Jean Clegg, R.N. Meadville City Hospital 751 Lib6rty Street Meadville, Pa. 16335 (814) 336-3121 Dates: June 5 - June 30 1972 Fundiniz: $2,500 *(WP/RMP also trained nurses to collect Pap smears) Other Funds: (in-kind service contributed by cooperating agencies) Cooperating Agencies and Institutions: Meadville City Hospital; Spencer Hospital,41 Crawford County Unit of the American Cancer Society; and Magee-Womens Hospital, Pittsburgh. Area Served: The city of Meadville and surrounding area in Crawford County Tarizet Population: 1,250 women in a rural area in Western Pa. Coneressional Districts: #24 *Core Activity Continuation After RMP Support withdrawn: Future efforts to be conducted by the American Cancer Society. Efforts will be made to encourage hospitals to take Pap smears on all female inpatients, thereby making screening part of general care costs. Program Staff Contact, Ruth Mrozek R.N. Nursing Specialist in Oncelogy WP/RMP Date Prepared: September 22, 1972 Drafted by: Maureen Ryan VIGNETTE BACK-UP SHEET Region: Western Pennsylvania Regional Medical Program Locus of Activity: Core Activity Proiect Title. Greene County Pap Smear Program Status: Screening and results completed Sponsoring; Institution: Greene County Unit of the American Cancer Society Proiect Director: Mrs. Lewis Vance, Mrs. Walter Atalski, Mrs. Harold Craft Members of the Education Committee Greene County Unit, American Cancer Society Milliken Building - 51 W. Hig treet Waynesburg, Pa. 15370 Dates: April 30, 1972 Fundiniz: None (Nurses trained to collect Pap smears by WP/RMP) Other Funds: (Services contributed by Carmichaels Clinic and American Cancer Society) Cooperating Agencies and Institutions: Carmichaels Clinic; and American Cancer Society Area Served: Greene County Target Population: 179 women in rural area of Western Pa. Conjzresgional Districts: #26 Continuation After RMP Support Withdrawn: American Cancer Society is likely to stage such screenings periodically in the future. If the concept of nurses taking Pap smears becomes well accepted for female inpatients, expenses could be built into general care costs. ProjXram Staff Contact: Ruth Mrozek, R.N. Nursing Specialist in Ond6logy WP/RMP Date Prepared: September 21, 1972 Drafted by: Maureen Ryan VIGNETTE BACK-UP SHEET Reizion: Western Pennsylvania Regional Medical Program L4Dcus of Activity: Developmental Component (Planning Study) Proiect Title: Clarion County Pap Smear Program Status: Screening and results completed Sponsoring Institution: Clarion Osteopathic Hospital, Clarion, Pa. Proiect Director: Dr. David Humphrey, Radiologist Clarion Osteopathic Hospital 214 S. Seventh Avenue Clarion, Pa. 16214 (814) 226-9500 Dates: June 1, 1972 Fundinlz: $700 *(Nurses trained by WP/RMP to collect Pap smears) Other Funds: (In-kind services by cooperating agencies) Coo,perating Agencies and Institutions: Clarion State Teachers College; Clarion Osteopathic Hospital; Clarion County Unit of the American Cancer Society,, and Magee-Womens Hospital, Pittsburgh. Area Served: Clarion County Target Population: 341 women in a rural area of Western Pa. Congressional Districts: #22 *Coke Activity continuation After RMP Support Withdrawn: Future screening efforts are likely to be undertaken by the American Cancer Society. If drea hospitals adopt a policy to screen all female inpatients, Pap screenings could be built into general care cogts;i Program Staff Contact: Paul Martin Area Liaison Representative WP/RNP Date Prepared- September 21, 1972 Drafted by- Maureen Ryan VIGNETTE BACK-UP SHEET Reizion: Western Pennsylvania Regional Medical Program Locus of Activit3c. Developmental Component (Planning Study) Project Title: Bucktail Area Pap Smear Program Status: Completed Sponsoring Institution: DuBois and Maple Avenue Hospitals, DuBois, Pa. Prolect Director: Dr. Ernest F. Getto DuBois Hospital DuBois, Pa. 15801 (814) 371-2200 Dates: April 30, May 6, May 12 and May 18, 1971 Fundiniz: $1,173 Other Funds! None (in-kind services were provided by cooperating agencies) Cooperating Agencies and Institutions: Young Womeng Club of DuBois; DuBois and Maple Avenue Hospitals; and the Clearfield County Unit of the American Cancer Society. Area Served: The town of DuBois and surrounding area in Clearfield County. Tarizet Population: 1,524 women in a rural area Conp-ressional Districts, #23 Continuation After RMP Support withdrawn: It is anticipated that the Clearfield County Unit of the American Cancer Society will continue to sponsor such programs from time to time. Built into the public education and information aspects of the screening was the importance of regular Pap tests and monthly breast self-examination which hopefully encouraged many women screened to schedule future tests themselves. If the project (The Preparation of Nurses to Screen for Cervical Cancer)which is in the process of submission to WP/RMP is funded, area nurses are likely to be trained to collect smears from female inpatients and the screening can be built into general costs of the hospital. (In this first screening that WP/RMP was involved in, physicians collected the Pap smears) Proj%ram Staff Contact: Ruth Mrozek, R.N. Nursing Specialist in Oncology WP/RMP Date Prepared: September 20, 1972 Drafted b-y: Maureen Ryan Back-up Sheet Region: Wisconsin RNP Locus of Activity: Developmental Funds Project Number: #32 Title: Health Care Delivery System R&E Status: New Project Sponsoring Institution: Marshfield Clinic Foundation Project Director, Title, Address John H. Mitchell, M.D. Dept. of Comunity Medicine Marshfield Clinic Marshfield, Wisconsin 54449 Dates: 3/l/72 to 8/31/72 Funding: $25,691 Other Funds: None Cooperating Institutions: Marshfield Clinic St. Joseph's Hospital Marshfield Clinic Foundation Blue Cross-Blue Shield Areas Served: Greater Marshfield Area Target Population: 40,000 people living in Greater Marshfield area. Congressional Districts: Continuation After RNP-Support Withdrawn: Application References: r Project #32 Continued Other Re rences: Specific Evaluation Reports: Core Staff Contacts: Date Prepared: 1/26/72 Drafted By: F. Wenzel Project #31 (Wisconsin RIT) The 16th Street Community Health Center (HOPE) is located in the Inner City--South, and contains over 74,000 people in an area of 7.15 square miles. Approximately 19,400 families live here. one-fourth of them earn less than $5,000 per year, and of these less than one-fifth receive some form of public assistance. About 12.,Vl. are over 65, with one of every 20 persons over 75. One dwelling unit of every thirteen is overcrowded. Approximately 10,000 of its residents are of Latin AmericAn descent. HOPE has engaged in many activities relating specifically to this community. It has been determined, both through objective criteria and the articulated perceptions of the local community, however, that the most important need in the community is primary care, especially for adolescents and adults. Secondly, many people are motivated to seek proper health care, but lack an appropriate knowledge of health, espe- cially in the areas of self-care prevention of illness. Hence, there is also a considerable need for community health education activities. The specific objectives of this project are to: -- provide primary health care to persons in ;the local coumnity who are unable, financially or otherwise, to obtain care elsewhere -- demonstrate the capability of a nurse practitioner to function as the focus of a primary care system -- develop relationships between the Health Center and other sources of primary and secondary care, both public and private, which facilitate patient service - 2 - -- demonstrate the effectiveness of using community health workers as outreach personnel collaborating with a nurse practitioner develop coumnity group health educational activities demonstrate the effectiveness of using community hea t workers as organizers of community health education groups -- upgrade the skills of Center staff, and community health worker personnel in other southside agencies, through an ini- tial and an ongoing training program In general, the Community Health Contact Center activities will include: I. Direct Patient/Family Health Services -- entry into health care for persons identifying own needs for service a. triage (medical and health history, evaluating of signs and symptoms) b. treatment of minor illnesses C. first aid and treatment of minor injuries d. appointment to Center or other local medical c inics e. referral to diagnostic or treatment resources- management of chronic illness a. assessment of current status b. evaluation of and assistance with management in the home C. patient-family education regarding care d. assessment of temporary illnesses physical examinations and immunizations follow-up of patients a. receiving Center services b. referred to other resources family health management a. counseling it child-bearing, rearing and management b. health supervision and education C. referral and collaboration with other persons and agencies serving family patient advocacy assistance with and arranging for babysitting and transportation 3 assistance with obtaining prescriptions, equipment, transla- tor or interpreter -- assistance with filing health and social service aid applica- tions II. Community Service (These services are "outreach" in nature and re- flect the Center's attempt to respond to community needs identified by local residents.) -- assistance in organizing people to meet their own needs (babysitting, transportation) -- providing resources for health-related education (first aid, 'ght e wel -watching, ven real disease) -- arranging for local screening and testing programs (multiphasic screening, TB screening, lead poisoning) III. Relationships of Center with Other Health Care Resources -- development of arrangements with major public sources of medica care (Milwaukee County General Hospital, Children's Hospital, Milwaukee City Health Department). These relationships wou en- able a nurse in the Center to treat some patients on the spot, pro- vide some patients with medical care at the Center through expan- sion of clinics, providing some patients with informed care on arrival at the hospital or clinic. -- develop relationships with dentists and doctors in the neigh- borhood which provide "crisis" appointments for some patients, continuing care by private practitioners for selected patients, and patient education to facilitate home management -- develop arrangements with hospitals (Mt. Sinai Medical Center, St. Luke's Hospital, St. Mary's Hospital, etc. medical and nursing staffs) to provide inpatient care for selected patients, and co- operation to help implement needed services for patients -- foster communication and cooperation between local health centers and clinics to coordinate patient services, develop needed patient services and implement conminity education programs. In addition, this relationship would assist in staff development ptogrdms, and resolution of commn problems. Back-up Sheet Region: Wisconsin RMP Locus of Activity: Operational Project - Milwaukee Inner City South Project Number: #31 Title: Health Center - Inner City South Status: New Project Sponsoring Institution (Grantee): H.O.P.E., Inc. Project Director, Title, Address: Mr. Greg Kusiak 16th Street Community Health Center 1036 South 16th Street Milwaukee, Wisconsin 53204 Dates: 9/l/72 to 8/3/75 Funding: 72-73 73-74 74-75 $109,951 $112,322 $il6,995 Other Funds: None Cooperating Institutions: Marquette University College of Nursing University of Wisconsin-Milwaukee School of Nursing State Department of Health and Social Service The United Community Service Independent Learning Center Esperanza Unida Federation of Community Schools Milwaukee Health Department Milwaukee County General Hospital Social Development Commission Area Served: Milwaukee Inner City - South Target Population: 74,000 people, largely Mexican-American, living in an area of 7.15 square miles, 60,000 of whom live in an area of 3 square miles Congressional District: Fourth Continudtion After FM Support Withdrawn: - 2 - Appli6ation References: Other References: Spedific Evaluation Reports: Core Staff Contacts: Date Prepared: Drafted By.- Project 32 Society today is vitally interested in the cost, availability, accessi- bility and quality of medical care. Committees are being formed, books are being written and proposals are being formulated all which relate to the medical care system. However, one major deficiency that exists is the develop- ment and accessibility of concrete data and information to assist the medical community and state and federal agencies in making specific devisions. In- formation on regionalization, utilization, referral patterns, disease entities and specific costs are difficult to obtain. That data which is presently available is often from large prepaid programs with a selected patient popula- tion and are not all encompassing in their services nor the population which they serve. The lack of organized information has led to the proposal for the development of a research planning and evaluation section within the Marghfie d Clinic Foundation. Definitive data on costs of medical care, utilization of services, specificity of disease patterns and other tangibles will be evaluated so that intelligent decisions and planning can be carried forth to assist in the development of a model regional health care delivery system. Since the Marshfield Clinic is the main source of medical care for ap- proximately 40,000 people for which it gives primary, secondary and tertiary care through numerous methods of payment, an immediate data bank is present. A data system has been developed which includes all patients covered by the GMCHP. This system will provide part of the important data for studying changed in medical care patterns and the problem related to financing medical care. A great deal of data is also available on non-plan patients who are seen at St. Joseph's Hospital or the Marshfield Clinic. There is, however, no research section within the above institutions to use the currently available data and develop new studies and evaluation of the delivery of medical services on a broad base regional level. The plan, in general calls for the development within the Marshfield Clinic Foundation of a section devoted to this broad purpose. The short range objective of the proposal is to assemble the staff an begin outlining studies of the health care system. The data that is presently being generated in conjunction with GMCHP plus the records of the Marshfield Clinic, St. Joseph's Hospital and Blue Cross-Blue Shield will allow or start jW of an immediate systematic study of some of the health systems. other data sources within the area and state will also be used as well as@the non-GNCHP patients. The data from these programs will be made available to all areas of the state and nation. rous reasons that-@oulA. w for the success of t is pro- gram. ", Within the GMCHP area all physicians are cooperating with the plan, and almost all medical care for GMCHP patients can be traced.' Another reason.-is that the population is stable and is of mixed ethnic religious and national background. Approximately fourteen percent of the population fall under OEO's guidelines as economically distressed, and approximately twenty percent of the patients are covered under Medicare and/or M6dicdid. Information on all these groups would be available plus those under the prepaid and fee-for-service program. The developmental award has four principal objectives: 1. Allow hiring of the personnel for the research planning and evaluation section within the Marshfield Clinic Foundation. 2. Begin definitive and in-depth research programs on the health - 3 - care system and regional planning. 3. Develop complex computer programs to assist in the research designs. 4. Provide temporary funding during which a three-year project proposal will be written and submitted to WRMP for further develop- ment of the section and its studies. Some of the primary research efforts that would be undertaken during the developmental period and would extend into and be part of the three-year pro- ject proposal are as follows: 1. Quality medical care: What is it and how can it best be evaluated? There is much discussion of quality of medical care and yet there is no good definition of what good quality is and how it can be determined particularly on the regional level. 2. Cost of medical care: From the existing system and data presently available, specific costs for medical care can be determined on patients within the immediate area. This would provide data on the cost for total comprehensive care over a period of time. Dependent variables that could be observed are: the family, disease specificity, sex, age., ethnic nationality, educational level, income level, urban-rural area and numerous other para- meters. Through cross-correlation of the above data, through the comparison of the prepaid and the fee for service plus Medi- care and Medicaid and hopefully other federal fundings, the costs and financing of medical care could be evaluated. 3. utilization of medical services and facilities: Medicare has mandated utilization review committees and pending legislation - 4 - is doing the same. The central Wisconsin area provides a natural laboratory for research on the methods of the delivery of health services and the utilization of medical services by patients. This would include not only patients within the immediate area but also throughout the whole region of central and northern Wisconsin. It could also include =re specific services that are over-utilized and under-utiliz6d by various groups of con- sumers and providers. This should lead to a peer review system which would then be part of the research project. 4. outreach programs: Through the diagnostic mix and referral pat- terns specific information on the unmet needs of the rural area and potential services that should be provided to areas of central and northern Wisconsin would be defined. This in time should lead to relationships and cooperative services on a =re organized regional basis. 5. other studies: Methods of record linkage, patient flow, health education, screening techniques and other projects as deemed worthwhile could be explored. In summary, with the new developments in health care delivery systems, changes should not be made for the sake of change alone but on the basis of predetermined studies and data. All the components of a total medical care system are available and accessible for research in the Marshfield setting. With the GMCHP in operation and expanding plus other sources of data, this research endeavor should be fruitful. The principle needs at this particular time are start-up funds for staff development and program planning. FORM 15 RMP Wisconsin PROTECT SUMMARY 1 yr. report 3 yr. report Date of initial RMPS Support (mo. yr.) 9 1970 Project Title Anticipated Termination RMPS Support 8 1971 Final Report - Colposcopy Project Project No. Geographic Scope State of Wisconsin Disease Category None Related Federal Programs None I-Tealth Care Focus Objectives Reduce medical costs 2 improve com- All women over 20 years of age Target Group(s) in Wisconsin fort of patient through improved testing Primary Purpose technique. Progress: Project successfully terminated ;Almost everything people are trying to September, 1971. do--decrease the cost of medical care, bring thi advancements of medical science and technology to the community level for implementation, eep the health and welfare of the patient foremost in mq')nd--is exemplified by the recent success oJ the Wisconsin Regional Medical Program's Colpos- copy Project. Evaluation of the project has shown that the cost of a uterine cancer examination, done as a result of an abnormal Papanicolaou (PAP) smear, can be reduced as much as 93 percent. The project, under the direction of Dr. Adolf Stafl of the Medical College of Wisconsin, is part of Wisconsin Regional Medical Program's Gynecologic Malignancy Program under the direc- tion of Dr. Ben M. Peckham, Chairman, Departmeni of Gynecology and Obstetrics, University Hospit. als, Madison, and Dr. Richard F. Mattingly, Chairman, Department of Obstetrics and Gynecolol Medical College of Wisconsin. It is a good example of how Regional Medical Pr( grams are succeeding in bringing the advancement of technology and science to the local level foi general implementation in an effort to keep the costs of medical care at a minimum and patient care at an optimum. Colposcopy is a procedure used in the detection of uterine cancer following a PAP test. If the PAP test indica@ @abnorma@, the colposcopic examination is used in place of a diagnostic conization procedure. It is esti- mated that 750 cases of uterine cancer will be found in Wisconsin in 1972 and approximately 43,000 cases will be found in the United States ci-nfl 'knc hplnpd train six t)hvsicians FORM 15 RMP Wisconsin PROJECT SUMMARY 1 yr. report 3 yr. report Date of initial RMPS Support (mo. yr.)_ Project Title Anticipated Termination RMPS Support Project No. Geographic Scope Disease Category Related Federal Programs I-Jealth Care Focus Objectives Target Group (s) Primary Purpose Progress: Proposal: , vho have become highly proficient in uti- lizing the technique. They are located at St. Francis Hospital and the Gunderson Clinic, La Crosse; Marshfield Clinic, Marshfield; St. Elizabeth Hospital An!"e n and University I 0 s to ; ntly training Hospital Madis n. re e ,_p s il '-?ue several phy icians :wa k e County General Hospital, "Several of the hogpitAls have been able to develop a cost analysis which reflects the sav- ings to both the hospital and the patient," Dr. Stafl "St. Francis Hospital at La Crosse estimated that the average cost of a con.- zation is approximately $493, $319 for the hos- pital, $24 for anesthesiology and $150 for the surgeon '"With the introdudtion of the colposcopic procedure, the total cost was reduced to only $35.11 V I It 7 I)rojoct #15 (IVJ,scolisill riii,ary Seconda,. - Access Iiiipro@rc-,rilent - A\IBUIATORY C-AIZE - Coiiibiiiatioi-i Traini.ng/Patieiit Care - IL-Y DISF:ASE , KID,\ - Comprehensive Care - Legislation - lioino I-lealth Care - @laiipoljor 'k - PATIEK.F/PUBLIC EDUCKFIO,\' - organ Bai-i's -. Prevention )i-id Screening -. Regional - REDUCTION IN HEkLni CARE- COSTS li year 6iiter the final staues of in Wisconsin, about 140 persons eac -r enal (kidney) disease who are judged good candidates for kidney trans- plants or artificial kidney machine dialysis. Until recently, the latest advances in care of such patients were high in cost and not uniformly available Statei,,,lde. I\Ioi\r, a carefully organizaed, comprehensive renal di sease program sponsored by the Kidney Fo,,indation of Wisconsin and supported by grants from the Wisconsin Regional @,ledical Procram (i@'R\,IP) totalling more than $1 million, is beginning to change this picture. The program is designed to develop a Statewide cooperative kidney transplant program to prevent tissue mismatches and reduce expensive, long delays in transplantation; and to establish a program of dialysis located within patients' homes and in strategic community hospital dialysis units. A prevention and early detection program is noii under- way, providing local physicians with information and ine ensive testing XP kits for detectiiic, 'kidney disease. As a result of the pro ett a "Catastropl-iic Costs" bill has been introduced into the State Legislature to establish a program supplementing the high costs of treatment for families of modest means. -2- In February, 1971, a large dialysis training facility began operat- ing ati\ladison Methodist Hospital, with a capacity to train 20 to 30 patients per year, along with their spouses in performing dialysis at home or in community dialysis centers. The substitution for hospital space and staff substantially reduces costs (from $20,000-2S,000 to ab.out $7,000 per patient each year in Wisconsin). As of December 31, 1971, 11 individuals had successfully completed the training and performed 1-iemodialy5is at home. The project is planning distribution of dialysis centers -.:or most economic use of machines and staff. The Madison facility and a post- graduate trainina proaram at Milwaukee County Hospital also provide education and training for physicians, nurses, dietitians, and technicians on the latest knowledge of renal disease and its management, dialysis equipment and establishment of dialysis units. As part of the Statewide transplant procram, three tissue typing labs have been established in Milwaukee and Madison to ensure successful trans- plants by pairing kidney patients with coitipatible.tissue from deceased donors in the State. As of April, 1971, 2SO donor/recipients had had 407 tissue t)Tings performed by'-the labs. Current information on potential reci ients, prepared by the Marquette Biomedical Computer p Center, is provided to transplant surgeons each week. iViscoi)sin Locus of Acti@,i@ty OI)critiOll,-Il P"c)jf-'ct Proi ect I\kLiil,),or l,'l 5 CO!IIPI-Ollcllsive Reiial Disct-@(,, I-)i-oc,rani Title: C> Status: , 'Oii@,oi.ii(T (i\7.ote: termiii-atiii,, I)roject, "Tissue T)Tillg," being phased i-@o 5). ]I: li\'idiiey l'Otill,@,-ttioii of I'@7i.scoii@iii §POTI-I;Orina II- tiCtltio r ject Di-rc@c-co-@, itl @@]Lc@ss: (Co-directors) Ricliard F@,. Riesclb?cl-i, @I.D., Assi.stAjit Professor University of I,,isconsin @\IeCiical Scl,,.ool @ladisoii l@iscoiisi@ii S3706 (i@hoiie: AC 608-262-1722) and Ari,j-n B. ivei-nsteiii.1 @,I.D. Associate Professor University of Wisconsin Medical Scliool Dates: 6/70 - 8/73 1-7ujidiiia: 01 02 (dco) $4SO,000 $469,234 92)155 (rebudactina) 0 C, IVilson cut $S30,807 Otl)cr Fiuids: Kicbicy Foui-iclation lias p., 'd soiiie fund-raisiii rforme 9. @ladison \Ietlioclist Hospital Mili..,au'l@ce County Hospital Kidney Foundation of I't'iscoiisiii Area S6-i-ved: Stateiiide lal5iot Poptil.,iti-oii: Anjiu@il-ly, about 140 pe),-sons cacli ),ea@ i@l-io develop cr,.Ll- stz , pl@us all tliosc I)otciiti,,i]. ]@i.cljie), patients screened be( b project's iii(I eirly (101-.Octioii 2 Vi('jictte #7 ,@oiiQrcss-ioii,il- Di@st-i-icts: All Conti.rili@tioii ,\4-tcy ]?,','@,p Sl,,iil,)o-,-t l@T.,\U') expects that the l@icliio), 01- .'o ilici@,, iqitli tjie "Catasti-or)liic Costs" 'Bi@ll- (S,21lato I,,593---. l@i.sconsiii lei,,isattirc) as oiie source of funds. I- -Lr passed, 'c'jic l')ill A@oiil.cl increase 'clic present level of State assi.stL@lico from about @l,,300 per to a l,ase of $1.0@000 per family. 'llic bill i..-Oold also os'c@ibl-isli a l@i.cliiey I)j,seasc Boi-rd of professionals to certify r;-qtj-e;lts (cli(,ibl.e for assist-mice) a3icl trcatinc@iit centers. I)plic,4tioii l@\cfercjices: Coiitiiiuation AI)plicati.oii dated 9/i/70, pp. 181-237 Tri.ei-,niLb-,i Application dated 9/71, foi-ni IS-6 Otlier Rof orciices: R'xll'S Si,@.1--@ ry of jVfl-iiversary j\I)I)Ilcatioi-i for July, 1970 Revieij Coin-nittecp pp. 14-15 ocif ic F@ 7@ Itiation PP-Inort,-; - Site Visit Report - Decoi,.iber 8-9, 1970., pp. 18-20 Report of Site Visit Teay,- (oji Project :'lS), April 21, 1971. Core Staff Coiitacts: @1r. Roy Ragatz (,NladisoD) AC 608-26')-2851 and @ir. 14. Scott Ai.-nsi@ortli Executive Director Kidjicy Fouii(latioii of I'@'isconsin AC 608-241--1279 Date Prepared: 11/10/71 Drafted By: Teresa Sclioen F ORM 15 RMP Wisconsin PROJECT SUMMARY I yr. report 3 yr. report Date of initial RMPS Support (mo. yr.) 9 1969 Project Title Anticipated Termination RMPS Support 8 1972 Nurse Utilization Project No. 17 Geographic Scope State of Wisconsin Disease Category None Related Federal Programs None Intermediate Care of Medical Health Care Focus Surgical Patients Objectives To design a system of patient care Nurses,.Ph sicians, Hosp. Admin, sty Target Group (s)_ Niarm4ci s & Engiiieers based on patient needs. Primary Purpose Provision of service for patien:s Progress: Proposal: The project was successfully terminated in Thein@'e"e'ds and wants of the patient rather than August, 1972. A what health personnel think he should have is par,@and t, the basis for this Wisconsin aT project. fe thank Started in 1969, the project was developed to meet the needs of the patient through the re- design of the traditional hospit setting. The needs of the patient were looked At first, not last, and the means of providing this service came next in line. Two-way supply cabinets were installed enabl- ing personnel to stock the cabinet from the corridor rather than entering the patient room. A center communications system was de- signed allowing a non-health person to moni- tor patient requests directly and to allow easy access to health personnel anywhere in the facility. In short, many innovations were made to more efficiently utilize health and allied health professionals and equipment allowing for improved care and more bedside nursing care by hospital personnel In September,, 1972, the Wisconsin RNP received an award for the project from the Gerar L@ett Foundation which is administered through pollster George Gallup. The award, the first ever presented to a Regional Medical Program, is made annually to encourage vations designed to improve patient care and reduce the cost of health care. More than 1,000 ideas were reviewed by the Awards Committee.