*EO(D 1 431 SPECIAL ACTION REQUEST Colorado/Wyoming Regional Medical Program Purpose: The purpose of this request is to raise the current recommended National Advisory Council level for the Colorado/Wyoming RMP from $1,102,346 to $1,252,346.effective July 1, 1972. This recommended increase of $150,000 is exclusive of any EMS or Community Based Manpower Educational System applications (out-of-phase supplements) which might be presented to this meeting of the Council membership. Rationale of Request: The Colorado/Wyoming RMP was-approved for Triennial status and was awarded developmental component funds by the November, 1971 NAC. At the time the Region submitted its application, a tight-funding policy was in existence since all Regions had suffered a 12% reduction some 4 months earlier. Because of this reason, the Colorado/Wyoming RMP had submitted a three-year application which requested a most conservative budget proposal. All activities which had been approved by the RAG were rated utilizing a priority system. This process allowed only 9 of the 24 approved activities to be included in the application in order for the request to stay within the limited funding forecasted for the Region. As a result, an additional 12-15 proposals could not be considered for funding during the first year of the Triennial which started January 1, 1972. Additionally, at the end of this calendar year, only 3 of the 9 project activities currently being funded are due to terminate. These terminations will provide only $73,000 for new activities next year. Also, of - paramount interest is the fact that several new activities have already been stimulated'which have a direct bearing on the new mission of this Region. One such activity is entitled, "Student Health Program for Migrant Agricultural Workers and Rural Poor." This proposal has come about through the leadership of a Chicano who now serves on the RAG. This particular type of activity had been strongly recommended by the site visit team which had visited the Program in-September, 1971. Conclusion: RMPS staff are of the opinion that this Region is beginning to move and needs additional funds in order to pursue those activities which have been stimulated with developmental component funds. In view of the tight turn-around monies available next year, we feel that an increase of $150,000 (d.c.) for each of the next 2 1/2 years, starting July 1, 1972, would be a good investment. If approved, this Region would be receiving an increase of approximately 15% over the pre April 1971 level. Respectfully submitted, Mid-Continent Operations Branch May 25, 1972 .2 Com.,nonent And Finnnclnt Stimrnnry Anniversary Apollcation IE C I f D v D F.@ i'T qEIIT CURII YFA@_ YF/,R YRIS AWARD #COU.'@C'L FUIM I 'IC OPER. fECO,"G,2@'DED 'REQUEST x SARP YF,AR T,FVFT, REV. coal 1,020,400 CORP 93Z,846 Sub-(,oiitracts 415,757 577,500 OPER, ACTIV. DISAPPROVED 'DF,VET, COIT. 134,860*') Yes or 1', F,ARMARKS., V 125,000 ,T,T),,-F (125,000) ,y (@,40) 111,826(d( cities (i@T45) 5.2,810 (.-15,550) (dci) @BES Y@51 See Below P,Iin DIRECT 1,348,603 1 800,boC,'-D' 1,732,760 1,425,000*@, R F, 2L@, F, S -, F D2,750,577 COJNCIL APPROVF'N TEVEL 1,800,000 NON-Rl4PS nnd TIZCO,V,E Under 2/8/72 Nr@C Policy, the approved RF N@C level for @Lhe first year of th6 KANSAS Tri erni um prevail s June t972 klithdra,,,in by KRo',P R'EVIEII CYCI PLUS kidney funds of $125,0'00 This amount inc Iti4e s. $125 000. f or #4-0 and $3 9', @5-0. for #45 @*'--**Pendl'.ng is the fiNIlowing requ6sts: CBES, $123,3.04:-(for one year) Current program request 1,732,760 CBES request 123,304 $1,856,064 -Revi.sed 5/25/72 KANSAS REGIONAL MEDICAL PROGRAM Anniversary Application within a Triennium PART I Staff Briefing Document Page Face Page. . Map of Kansas Subregions . . . . . . . . . . . . . . . . . . 2 Kansas (State) Profile . . . . . . . . . . . . . . . . . . . 3 Component and Financial Summary . . . . . . . . . . . . . . . 4 MIS Breakout of Request (06-07 period) . . . 5- 6 Accomplishments, Problems, Issues. . . . . . 7 Staff Review Report. . - - - . 8-10 RMP Review Criteria . . . . . . . . . . . . . . . . . 0 . 0 11-13 PART II Kidney -- not applicable PART III Funding History (01-07 period) KDIP Funding Statement Summary of Core Feasibility and Planning Studies KRMP Core Breakdown and EEO Breakdown KRV,P RAC and Committee Data PART IV KRMP Trip Report: Staff Visit KRMP Trip Report: Staff Evaluation Report: Meeting of Dr. Margulies, KRMP Staff PART V Advice Letter PART VI Management Assessm,ent Visit not applicable PART I R4S STAFF BRIEF@a'G DOC FEGION Kansas OPERATTONS Eastern Mid-Continenr, BRANCH South-Central Z7 Wester.-. BRANCH rYPE, APPLICATION: B LAST RATING Tel. No. 443-1790 Room 10"15 E7 IAL Feb. 197 1 DATE BRANCH CHIEF Michael J. Posta C&7 lst ANNIV YEAR SARP BRANCH STAFF Mary E. M@hy Z7 2nd ANNIV YEAR Z7 REV. COM. RO. REP. Ray Maddox eL7 OTHER ZV OTHER Staff Last @%t. Assin't Visit 10/7 Chai,man LAST S. V. Mar 4-5 197 1 -; Chair,,im Alexander M. Schnddt, M.D., @l'..aff Visits, last 12 mos. (DaLes, Ch Is Name and Type of Visit) /i6/71 - Technical Site Visit - Cc=rehensive Nephrolo@@ r@rain. Prog. MC Francisco Oonzales, M.D4 12 1 - -,,ET Eva]-T-aL@icn -iisit Harold O'Flahe 1-Y ai Z' zi.avs-@,7 icL L L KAJOR EVENTS @l. CH OCC IN THE R'PGIOIN @(,.II\TG alE RMP SINCE ITS LA.ST FEVIEW in 197 1 Ki'disAS L@TS r)f, tl?? (7/1 2. 366--'L,al and Rehabilitation SePvice Contract of $55,800 to Atchison, TO'Oeka and Santa l,b Memorial Hospitals Inc. to exolore a possible FHO (r@y 172) IDIP EVE, NTS 10 I@ m Anderson, forTrer @@ctor,of Planninc, Services Kansas Blue Cross-Blue Shiel-@ Topeka, and Regional Advisory Council @rrber, a-,opointed l@ Associate Director 2 . Mr, Roy C. Hoi e nc)r,,iinalu-ed and app--oved as Chai- Re@Lonal Advisory Counci . i@irs. Tom Gordon approved as Vice-Chaii-r;an. 30 SubreFaonal Office changes: (1) Northwest (Colby) Coordinator resigied; (2) Flint H'--,' (E,.@6ria) Coordinator resigned and office closed 7/71; (3) Central (nureat.Bend) CoordinE,,tor resigied 2/l/72- (4) l@orthcentral (Salina) Coordinator resi@ed. Coor-l-ina- mp acemnts appointed to Great Bend and Saliiia. KA@SAS RFGIONAL O,:DICAL P,ROGRAM Subregional Areas anc: Office Locations July 1, 1971 "CATOR tiaotrag F;4iLLI SMi7'ii REPUBLIC t4ARSHAt-L t4EMAIIA BRO" CIL A R PA COLBY I Sol Wi@47A SCOTT Lagci I ASC GFEAT R@CE 4 i Lroq vc@y F1149LIf GiL ci c WED ,Aar ICHA CLARK @VOR QRPER FUIONAL CL@CTERISTTCS Kansas @ encotrpases the State of Kansas.(82-OL18 sq. r@ules) Counties - 105 Congressional Districts - 5 POPUIATION (1970 Census) Total Population: 2 249,loo Popu-lation Density: 27 per sq. i-aile. % Urban: 66 % Non-White: 6 (Amri 8 can Indians. ,700) AGE DISMIBIEION % Under 1 yrs.: 33 % 18 - 65 yrs.: 55 % 65 yrs. & over: 12 @INCOIC Tv-erage Incorne per Individual @1970) $318011 U.S. Average - $3,910 MORTPJJTY RATES per 100 ooc (1968) Kans@ U.S. Heart Disease 3bO.b T7 2-.'6 Cancer 157.2 159.4 " ar I-esi ons -Afl', NS) Vascu 115 4 105 8 40 All c uses, all qqes 97Q.0 @065-i- FACILIT]FIS AND RESOTJRCES Tch-cxu Medical School - Univ. of Kansas School )f Medicine i,o69/70 - Student Erirol-i@lent: 497 1969/70 - Graduates: -'L-'L9 Pro fessi.onal. Nursing.-, Scho6is 19 Sdnools - 5 Colle,--e Affiliates Accredited Schools for health Professionals Cyto @chnology - 3 (Hospitals: 1 -- Medical Centers: 2) Medical Technolo,@ - 9 '9adiologLc Technology,- 22 (Hospital or Medical Center Based) Physical 'Iherapy @- 1 Inhalat-li n Therapy - 3 HOSPTTALS - Co ty General and V.A. General No. Beds Short Tem l@ 11@, 13 Long Ten'n (special) 1 154 V4A. (General 2 947 .POSTER ans - Non-Fiedera.'l II.D.s and D.O.s (1967) M.D. Grou-p Praci,!-ces (1969) ve: 2,388 Single @l)--cia'lty: 24 @Inadtive: 292 Genera 1 71"1,ac'ullce: C'-l Ratio: 106 actiie per 100.,OOO population Multispecialty: 5 U.S. Rate: 132 per 100,000 populeL,41on Graduate Nurses 4 IVERSARY APPLICATION COMPONENT AND FINANCIAL SUMMARY ANN D T FUNDING YR'S AT,]ARD COUNCIL 05 OPER. RECOMMENDED REQUEST E7 SARP COMPONENT @EAR LEVEL L3 REV. COM. 1/l/70-6/30/71 CORE and 932,846 1,020,400 577,500 OPER. ACTIV. 415,757 DEVEL4 COMP. DISAPPROVED 134@860 EARMARKSI: 111,826(dc) Kidn ode Cities (#45) 52,810(dc) 1,732,760 RMPS DIRECT 1,348,603 4PS INDIRECT 413,441 414,387 1,,762,044 47 1 NON-RMPS and INCOME loi@AL BUDGE-!' REQUESTED 2,750,577 COUNCIL 1,900,000 ROI @-Withdtawn by KRMP REGION Kansas June 972, REVjEiel CYCLE REGION - KANSAS MARCH 17,1972 RM 00002 06/72 BREAKOUT OF REQUEST RMPS-OSM-JTOGR2 06 PROGRAM PERIOD (4) t5) NOT CURRENT CURRENT NTIFICATION OF ( LI I TOTAL IDE COMF()NENT CONT WITHINI CONT. BEYON")L APPR. NOT NEW# APPR. PERIODI APPR. PERICOI PREVIOUSL PREVIOUSLY DIRECT I INDIRECT CF SUPPORT Of SUilPORT FUt4OLD APPROVED COSTS I COSTS COOO P,40CPAM CORE U-OTO-ZTV-EL-C-P@ll-EN-T COt',PONEtiT PRI 001 GREAT BE DUCATICNAT. Pi -Ia2jL3Z() ----- 122-,32Q-l 021 KT:,SAS MEDICAL LIPR,%RY Si - - - -- - - - - - - QQ a 040 UEVEL (IF Co@;"tElIENSIVE Ni 041 C,%@'@CER I!,FGRMATEL;N SERIVII - ----------------- - -- --- - -- - - - - C,@'@CLP CARE r-ONTl-'4UING El 044 NLi@(.@f- LLit4[CiAN flf@CGRA14 04 5 PIt:r@@ L C II Y @tE ALT H - a-, I:-? I ! 046 14EAL I) I SERV I-@ES Tik AI Pi ING I LTI J.. ---------- 047 DIA@FIES DETECTION AND El II Z@QCLQ I 048 Pf4C)BLEM CPIE%TEU MEOICALI I 04q S@TA@ED 8A,4AG:;tl@ENT ENGINEI I 050 HEALTH OCCUPATIONS PROMCI T[ZBUL PP@Ony@tMS-' _$22.000 t S262t860 1 $1*7329760 1 $4l4t367 1 $29147tl47 TOTAL *Wi@hdrawn by l'IRMP MAFTCH 17,f972 REGION - KANSAS BREAKCIJT OF REQVEST RM 00002 06/72 PROGRAM PERIOD AMPS-OSM-JTOGRZ (4) IDE4TIFICAT ION OF COMPONEt4T CONT. WITHINI CC4T. BEYONOI APPR. NOr I NEW, NOT ACCOL YEAR TOTAL I APPR. PERICCI A;l@IR. PE;ZICCI PREVIOLFSLY I PREVIOUSLY DIRECT I I ALL YEARS I CF SUPPORT I OF SUPPORT I FUNDEv' I APPROVED COSTS I JOIRECT COSTS I COGD PROGRAM CORE ODOO DEVELOP-IIENT COMPONEN-T PRI --I -1 s 001 GP.LAT BEt4D EDUCATICNAL PI - -20 cl.,:j M- - I I E23 K t, N S A @t4 E Ti C t.-L @ I -0 R-A-R Y-5 I 340 C E V E T- C-F U@M 1-t -E H E N S 1 V E N I 041 CANCER INTORMATION SERVII I 042 CA!4CER C4;(E CCt.@Ti.@,Ul@4G El 044 NTRSE CLlf4lClAh PRCGRAP I I s 1 045@ lOPFL CITY HEALTH MANPOWI --E? --- 046 HCAL"@L SEPVICES TRAININ'@L 1 4 4 D.Q.0@ IA64JODD-1. 01. 7 C)lAtiETES DETECTION AND El I I S.IOXQQQ-I- $3QXQQO-l t -@.E.LQCO I 048 PPI;I)LE-4 ORIENTED ME31CALI . ..... ....... I s@QOO I 049 i SHAPED H-'NAGEME.NT ENGINE I 050 HEALTH CCCU;>ATIO.14S PROMOI -TOTAL S 9@,7@2 1 $313,276 1 $l,8O4wO $3 9536,'Iaa *Withdrawn -by.-K-RMP. FEVIEW CYCUI Jme OUSTANDING ACC94PLISIEOZ@ITS BY H,'iP since Fiat__ 197 1 1. Regional Advisory Council redirected ProFrai-a activity from a project oriented dire ction to on@ with major er,@has 1 s on iiiiorovement in the distribution of rredica. care services throug-i @gionalization. 2. @ had an active role in data co.@i-latiori on which were based the plans for. estab shm,--nt of the Uni-v. of Kansas School of Medicine at V,ich-2Lta State Univ. (I,,7,' pending Kansas Le@lsl.aL@ion. YailP,actively assisted WSU College of Health Rela@ue Professions in getL-ing undeniay and supports it in part. 3. Nogotl*lations are mdc-ntay to develop several cities, in addition to Wichi:u-a.1 as Area Health Educatio,-i or Area Health Service Centers, namly, TopelONE14T CURPF'IT 09 YEAII 1 @5 YEAR RECOMIL9@,DED YR'S AWARD COUI"C'AIL FM;DING -04 OPER. RECOi'@IIDED 'REQUEST SARP YEAR TEVEL REV. C014. 788,286 947,034' CORE Sub-Contracts OPER, liCTIV. 6305066 708,345 approved but DEVEL. CO!@. Linft-,rided yeg or 110 EAP14ARKS: KTr)lirEY -0- Di-sanoroved Kidney @k?4- 74,576 4: Ilealth Trng. @,23 (CBES) See bel.o.i,) EMS @'25 See below** R14ps I)TRFCT ]@,418,352 1,741,000* 11,829.955 1,725@000 RPQUESTED 2,449,24n conlc I'L AI'PROVED LEVET, 1,741 000 l@ NON-RI-TS and it@COME *11-nder 2/8/72 National Advisory Council REGION Mountqin States @policy the approved NAC level for the first @year of the triennium prevails. Ma@/Jtine 2 t97 .REVIEW C@ **Also pending are the following requests 01 02 03 EMS 3755576 234,945 CBES 219,575 182,000 100,000 Current Prog. Request 1,829,955 Total is Request 2,425,106 5/23/72 VIOB/RMPS Page 1 RMPS STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mid-Con /-7 South Centrll rx7 Western REGION MOUNTAIN STATES REGIONAL MEDICAL PROGRAM BRANCH - BRANCH ryPE APPLICATION LAST RATING Tel. No. 443-28 Room i. 2 TRIENNIAL 197- DATE BRANCH CHIEF Richard.. BRANCH STAFF James A. Sm-ith Lxl lst ANNIV YEAR /x / SARP pEp. Dan Webster 2nd ANNIV YEAR LI REV. COM. RO OTHER /-7 OTHER Last Mgt. Assm't Visit N/A 19i Chairman LAST S.V.Mardh 197 1 Chairman Clar aix@.tn's Name and Type of Visit) aff Visits, Last 12 mc (Dates, Ch 1971 Jessie Sa Staff visit to observe the ReRibnls Droie t review anel. Major Events Which Occurred in the Region Affe,ting the MT Since Its Last Review in 197 1 Alfred Popma, M.D., Coordinator, retired in December, 1971 after five years of service to the program. His deputy, John Gerdes, Ph.D., was hamed interim coordinator until a new coordinator is appointed. Dr. Gerdes is a candidate for the job. The other significant happening for MS/RMP during the past year has been the emergence of long suppressed feelings of discontent with its grantee, WICHE MS/RMP complains that the grantee (WICHE) maintains undue restraint on the programmatic efforts which hinders the Region from being responsive to many of the hew national priorities. The Region feels that its progression of development and maturity is at the level where it can consider the possibility of becoming a nonprofit corporation. WICHE is resisting that notion, maintaining that the success of MS/RMP to a large degree has been through its affiliation with them. Currently, it appears that the two parties art workiftg toward an acceptable compromise. WICHE will probably remain as grantee, but extend more programmatic latitude to the MS/RMP. Page /Aountain 5tates Re8lonol /AeJlccil Pro8rom IDAHO MONTANA NEVADA WYOMING REGIONAL OFFICE - Boise SUBREGIONAL OFFICES o Idaho - Boise 0 Montana - Great Falls 0 Nevada Reno 9 Wyoming - Cheyenne Page 3 ADDITIONAL Mountain States P-'4P (Wiclie) INFORMATION 3/72 Ge6graphv and Demograohy 4 State area: Idaho, Montana, Nevada, Wyoming; interface with Colorado-Wyomihg and parts of Intermountain Land Area: 435i643 square miles ation (1970 Census compared with 1960) Total in 000's 1970 Per Capita 1970 1960 (1970) Income Idaho 694 667 8.7 $3206 Montana 713 675 4.8 3381 Nevada 489 285 4.2 4544 Wyoming 332 330 3.3 3420 (,U.S. Total 2.,228 1,957 3910 Average Rounded to 2,230,000; average density 5.1 per sq. mile increase of 14% compared to 1960 Median age: (1960) each State below U.S. average of 29.5 Perc.ent Urban: Idaho 54%; Montana 53% Nevada 81%; I-lyoming 61% 4 State average - 59% urban4, 41% rural Metropolitan areas - 1970 preliminary population, compared with 1960 -1970 1960 Billings, Montana 86.1 79.0 Boise, Idaho 109.4 93.15 Great Falls, Montana 79.7 73.4 Las Vegas Nevada 2-70.1 127.0 Reno 120.0 84.7 665.3 457.6 Non-white - 95,100 (4.2% of 4 State total) Bla('@ - 34,500 Other 60,600 (mainly Indian and Spanish-surname) Vital Statistics - mortality rates (per 100,000 @( 1967 U.Sl Idalio Montana Nevada in Heart disease 364.5 305.9 326.5 239.6 31-2.4 Malignant neopl- 157.2 131.3 142.9 122.7 130.2 Vasc. lesions 102.2 95.1 96.7 68.9 91.4 (off. CNS) Diabetes 17.7 18'.7 20.1 11.3 16.5 Br neho Dneumonia 14.8 18.8 17.0 20.7 27.3 O(excl.'infl. & pneum) Accidents (1968) 57.5 79.5 79.4 85.1 89.2 Page 4 Mountain States (continued) Facilities and Resources Medical School - 1 developing 2 year school Univ. of-Nevada, Reno; first class (24) to enter fall of 1972 Allied Health Sch - Idaho State Univ. coil of Medical Arts, Pocatello Professional N Licensed Practical Nurses 15 - each affil. with school Idaho - 4 (4 College or Univ. affil..) district or college Montana - 6 (4 College affil.) 5 - 4college or high s,ch affil. Neva(la - 2 (2 University based) 8 - 6hosp; 2 priv. schools Wyoming.-7_L(3 College affil.) 2 - 1college based Total 1,5 fl3 college or 30 (20 are high school or university based) college affiliated) cal Technology Schools'of Radiologic Tech o Schools of Medical Tec,,noio Idaho - 6 Idaho - 7 Montana - 4 Montana - 6 Nevada - 3 Nevada - 7(2 Univ. based) Wyoming - 1 Wyoming - 2 spitals) 22 (20 at hospitals) 14 (each at ho cytoteclinology training - no schools Z. Community General and V.A. General n te@ s gi Short-term ec V.A. General T s Beds Beds # Beds Idaho 48 2,879 1 37 1 172 3,841 1 228 2 256 Montana 56 Nevada 17 1,951 --- 1 224 Wyoming 27 1 825 2 698 1 174 4 963 5 826 148 10,496 *1965 report -142 short term, 8814 beds 5 V.A. General hospitals, having total of 826 beds Special Hospital Facilities 1969 idaho-Mont@Aa nevada W@oming Intensive CCU 17 19 9 13 1 4 1 3 Cobalt Therapy Radium 5'. 8 5 2 Isotape Facility 6 7 5 4 Renal dialysis Impatient 4 5 4 1 Rehabilitation Impatient 3 0 2 2 Page 5 ower llhvslcians Non-Federal Graduate Nurses 1966- Empl. in Active kDs and DOs 1967 Not empl. Nursing -,MD DO Total Inactive Total in nursin_& (-adi.) I.daho 610 37 647 29 3049 1090 l@34 Montana 656 40 696 30 3404 916 2483 %levada 423 28 451 26 1533 470 1060 Wyoming 293 13 306 16 1621 410 1209 Total 1982* 118 2100 101 9607 2886 6706 Ratios of active practicing physicians About 70% were actively range from 89 per 100,000 population employed in nursing. in Idalio to 102 in Nevada. Average Average ratio for region for region is 94/100,,OOO compared about 301 per 100,000 with national average of 132. compared to 313 for UiS. as a whole. *Of the total active practicing MDs (1982) 802, about 40%, are in general practice. The majority of the remaining are specialists; a small number are hospital based And a smaller number are in other professional activities. Group Practices 1969 Single General. multi- By State Total Specialty Practice Specialty Id-aho 28 10 7 11 Montana* 36 5 9 22 Nevada 27 18 2 7 Wyoming 10 2 4 4 Component_and Financial Summar@Annivernary Anplicatlon Page 6 YEAR YEAR RECOI*IENDED COMPONENT CURPE?IT it FMING YR'S AWARD COU'NCIL v o4 OPEP,. RECOi4MFNDED 'REQUEST SARP REV. com. YEAR LEVEL 947,034 CORE 788,286 u -- u Sub-Contracts 630,o66 7o8,345 OPER. ACTIV. 0 100,000 Yes or No DEVEL. COMP.-- EARMARKS: KIDNEY Kidney #24 0 74.5-76 Health Train- ira #2@ 219,575 Network 0 li5ll'3000 2,049,@30 R@TPS Z;l ECT i@4180@92 RELUESTED 449 0 q4o COUNCIL 1,741,000 APPROVED LEVEL NON-RMPS and 374@000 INCOME Mountain States RMP REGION June t972i,REVIEW CYCLE eceive $354,588 for. i-llr-ie 04 Year is be@ extended to 9/1 and the ivegion will r -rd-of $1,772,940 for 15 months. the three month extension resulting in a direct aost awa REGION - MOUNTAIN MARCH 17,1972 OREAKCUT OF REQUEST KM 00032 06/72 05 PROGRAM PERIOD R14ps-osm-JTOGRZ (2) t 4 1 IDENTIFICATION OF COMPONENT CONT. W[THINI 'CONT. BEYONDI APPR. NOTINEWV NOT I CURRENT CURRENT I cd APFR. PERICtl APPR. PERICDI PREVIOUSLY PREVIOUSLY DIRECT I INDIRECT I TOTAL I P4 OF SUPPORT I OF SUPPORT I FUNDED APPROVED COSTS COSTS cooo CORE 1 s94 7. il 34 12@6&7 I-Ilsist.6al 1 0000 DEVELOPt4ENTAL COMPONENT I I I --- - I I - I sleo.ODD-1 002 PROGRAM IO PROVIDE COACNI I I -ll5-dl2 I S12S,200- 003 YfjU.IITA[tj STATES TUMOR l@ll I I I 216SLQQO-l 143,566 1 -=@U- I DDT CO@4T[NUING EDUCA71ON FOR] I I. I b LI-RSI N G @ E YA DA - ------ -.L 164.lnl1 oii cciilpiuipig ERUCATICN FC$tl I -- --L--152AI2(L] .15.L2R6 I S&A.356 ;iZ- CORONARY CARE TRAINING Si I I U41UNESL'Lo&tlo----- - I--ll2.Lfigm I Jkl"5jLt 11,3_a 6 61 013 CUNTZ'iU[t.G EDUCATION FCRI I I I . I I 181,276 1 127 1 s=Aii2-i ots Cc,%TlhulKG EDUCATION FCRI I @ l@ I IJAAia -1 163,901 1 21 NEW MAt@PoWER FOR THE MOUI I I I I I-- I I S199,311 1 023 P.EGTCNAL AREA )iEALTH EDUI I I I I --- LAII -- I - ----I 1 I--121@@ 11219,575 1 -135,612 1 -1255,2471 024 KtU4EY DISEASE CONTROL PI I I I I I I I p@'I til&!i -- I I SZ4 576 L S74,576I lil.769 1 186,345 1 5-25 PFtE-DEVELOPM-%TL PLANItINr. I I I I ' I I' LUER Hmn .I- Islas1 114,216 1 TOTAL $1000000 $407#976 1 S2tC49*530 1 $412*401 1 S2v46Lo931 1 MARCH l7tl972 REGION - MOUNTAIN BREAKOUT OF REQUEST AM 00032 06/72 06 PROGRAM PERIOD RMPS-OSM-JTOGR2 (2) (4) IDENTIFICATION OF COMPONENT I CCNT. WITHINI CONT. BEYONDI APPR. NOT I NEWI NOT I A DiTi@L "YE A R TOTAL I I APPR. PERIODI APPR. PERICOI PREVIOUSLY I PREVIOUSLY I CIRECT ALL YEARS CF SUPPORT GF SUPPORT FUNDED APPROVED COSTS IDIRECT COSTS I cooo CORE B;5-0-@7@iTC-PMENTA-L CO-MPONENT O@P-ROGRAM TO PROVIDE CORONI I ZB3 MCUNIAIN STATES TU?I.UR INI I I I 007 CCITINUING EDUCATION FORI I 1 164,101-1 31-1- CONTINUING EDUCATICK, FCRI I I 152,370 1 (;CFTONAPY CARE TRAINING Si I S12,808 1 013 CONTINUING EUUCATION FORI I 5. 406 1 7 el - @'4 - 75 CONTIfli(Nr, EI)UCATICN FCRI 0 157,701 1 -oi2- NEW MAIIPCWER FUR THE MOUI I REGLL[Iti I L I 1 --112@21 ]-- 112()- 091 1 -1 S294.6il I 023 PEGIOttAL AREA HEALTH EDUI I I I I I I I S234@945 I 123A.ARA5- I I 1454,52t) I Zi4 KIDNEY DISEASE CONTROL PI I t 112 slael2.576 I 025 PREDEVELDPMNTL PLANNING -ANn IIAL=AUF.FICFR H-40 I I Sig TOTAL $1,13L#433 I $2000000 S642,036 SIP9739469 $490229999 .. . - @ - I- .-I . I . r aL t: Re v i c@.; c I e I 197 72 BY )t, since The reorgan ization of RAG from a unwieldy group of 156 members to one of 30 is one of the Region's most significant achievements. This refinement of RAG has resulted in a more effective working RAC, that has increased awareness of their responsibility for the direction of the program. Other significant achievements has been the success of the Region in gaining acceptance of new concepts of health care delivery such as the nurse family practioner and Ht4O development. Also, the Region has led the way In sponsoring continuing medical education in nontraditional methods through participation and involvement in WAMI. 1AS/RMP has recognized the need'to shift to a more balanced program which is not so heavily oriented to continuing education. This is reflected by the new projec.ts: (1) Kidney Digeaie Control, and (2) Predevelopmental Planning and Liaison Officer.for HMO, which are directed to developing health services. PRItiCIPAL PPOBIXIIIS the past., the grantee (WICHE) has maintained a close and careful scrutiny 14S/R'MP. program activities. On one occasion, it actually restrained the MS/RMP core from accepting an Experimental-Realth Ser44ice Delivery Contract. nt in programmatic decisions by the grantee is seen as a problem This involveme by the region. The selection of a nev coordinator could have considerable implications in the future development of the MS/RMP. no ities on core and project staffs has presented a problem. The lack of mi r The acting-coordinator admits the region has not faced up to this issue. The ever continuing squabble between the (Kountain,-State RMP, Colo'rado/Wyoming RMP and 'Intermountain) over territorial rights is causing problems'. XS5Ur:.S, REQUIRING ATrElITION O'Ll REVIE.IIERS F year of its triennium (05 operatio.nal year) the region or the second is requesting $2@049$530 for support of Core, Developmental Component, seven continuation projects and 4 nqy projects. This figure ex6eeds the Regioo's Council Approved level ($I$511,000) by $538,530. The complete lack of minority staff, professional or,supportive, on core and project staffs needs attention. James A. Smith DATF@: Mountain States 1. COALS, OBJECTIVES, AND PRIORITIES (8) --The region's goals of Subregional Centers for Continuing Education, Health Services for Rural Residents, Stimulating Health Man- power Development and Specialized Centers Development have not been changed or altered from those originally proposed in the triennial application. Site visit report (3/71) states that the region seems to have very adequately assessed its needs, problems and resources; objectives and goals are congruent with National priorities. To some extent, funding of operational programs to date appear to have been developed with political considerations in mind to give each of the states a share in activities. Site visit report approved this concept. New program proposals of New Manpower for the Mountain States Region, Health Training' Network, Kidney Disease Control Program and Predevelopmental Planning and Liaison Officer for HMO's appear to be congruent with the region's stated goals and objectives. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - @.econ,i,-,ended Action: ACCO@f.DLISH@MENTS AND IMPLEMENTATION (15)--ES/RNP has provided the momentum for expansion of the role of the nurse in health care services in rural areas. Two nurses training at Stanford's Nurses Practitioner Program are now providing primary health care in two remote mountain communities. @/RMP developed an outstanding coronary care training program in Montana which set the pattern for similar programs in Idaho, Nevada, and Wyoming. The RAG reports that as a result of this program, the majority of small remote hospitals now have special units with trained personnel. MS/RMP has been instrumental in the development and support of the Mountain States Tumor Institute located in Boise, Idaho. For the first time, patients in this region have close access to a highly specialized diagnostic,treatment, and educational program. 'MS/RMP continuing education efforts for nurses have resulted into four separate state ..programs that have@ a common thrust, training for the nurse outside the campus setting. eloped and supported the Montana Medical Education and Research Foundation through MS/RMP dev .@@@which representatives of all health professions and the educational institutions have been @'@'.--.,:'brought together in-a common bond. A total of 105 continuing education programs for @,.i.@22 health professions have reached 4,909 participants. The RAG report states, 'W/RNP program activities are now proliferating through cooperative arrangements and co-funding which not only extend limited RMP dollars, but reinforce and qnrl hpalth orizaniiations. YSIRNP is now Page 11 untain States James A. Smith I)AT 3. CONTINUED SUPPORT (10) The region's policy for technical review requires the reviewers to ascertain whether there is a reasonable plan for the continuation of the proposal after RNP funding has expired. M/RNP phased out Project #9, Cardiac Care Training/Nevada, after two years of operations because it did not meet stated objectives. Four projects are stated to terminate at the end of this (04) grant period ending May 31. Only one, Project #8, Inhalation Therapy, will not be continued to some extent. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - @mmnded Action: 4. @IINORITY INTERESTS (7) MSIRM has two minorities represented on a 30-member RAG. One black and one Spanish surname. There are no minorities working on core or project staffs in either professional or nonprofessional positions. Minorities account for approximately 5% of the total population in the region, 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - RECONMNDED ACTION: Page 12 James A. Smith COORDINATOR (10) The coordinator, Alfred Popma, M.D., retired in December 19'71, after serving five y ears in that cap ac i ty . H is d eputy , Tohn Gerd es , Ph . d. ,was appointed interim coordinator until the RAG makes a final selection out of a field of 65 applicants. Dr. Gerdes is a candidate for the job. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ..ecomrended Action: 6. CORE STAFF (3) The programmatic operation of core is decentralized into sub-regional offices located in each of th e f our s tates . The @central core of f ice wh ich f unctions in an adminls trative and coordinating capacity, is located at Bosie, Idaho. The site visitors to the region in 1971 reported that the @IRW core reflected a broad range of profess ional competence and had been highly effective. Page i3 James A. Smith DATE! ountain States DI 7. REGIONAL ADVISORY GROIJP (5) The RAG was reorganized in 1970 from an original group of 160 members down to a more manageable and effective number of 26. However, the site visitor in 1971 found the smaller new RAG to be largely weighed ith medical people w and generally inadequate in minority, allied health and consumer interest. In response to advice from RMPS to broaden the representation of the RAG, the Region increased the membership from 26 to 30 members. The four new members were selected from nominees chosen to represent minorities and non-health related consumers. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ded Action: 8. GRANTEE ORGANIZATION (2) The site Visit report of March, 1971, found no reason to question the Western Interstate Commission for Higher Education (WICHE) role as grantee agent for the MS/ P. WICHE as the "backdrop" for MS/RMP seemed to the site visitors to be A reasonable and functional organization that providesstrong management expertise. However, there are currents of discontent on the part of some members of the MS/RMP staff and RAG regarding what they consider WICHE's over zealous involvement in programmatic affairs. They see WICHE's responsibility limited to fiscal management and accountability. These differences have surfaced and the RAG has begun deliberations to determine whether MS/RMP should remain with WICHE as grantee or form a separate non-profit corporation. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 'RECOMMENDED ACTION: Page 14 JaMr.-q Slgith T)ATE Mountains. States PREEARRI) 9. PARTICIPATION (5) The site visitors-reported that practicing physicians and organized medicine .are significantly supporting and participating in the program. Many community hospitals,.including their boards and staff are firmly committed and involved. The involvement of nursing professionals is extensive. In general, there seems to be satisfactory political and economic interaction in the MS/RMP. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - Recommended Action: 10. LOCAL PLANNING (3) The Regional AdvisoryGroup reports that the advisory boards and councils of CHP, Model Cities, Community Action, Division on Aging and others include RMP representation. Also, RAG or staff members frequently serve as consultants on projects developed by these agencies. The RAG recognizing the need for close dialogue and relationships with these local planning agencies has thought about the possibility of a general chairman of health for all four (Model Cities, CAP, CHP, and RMP) agencies. Page 15 Mountains States Ryf James A. Smith 11. ASSESSKP-,NT Ol,' NEEDS AND PESOLIRCI--,S (3) The site visit ors reported that the Regionb efforts in determining its needs, problems and resources have been adequate in most respects. However, planning efforts appear to be limited to the immediate future. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- ,ecomme-.ided Action- 'I 2. MANACE@ENT (3) a'he retirement of Dr. Popma could raise the (luestion as to whether the ex6ell6nt management of core activities will continue. However, Dr. John Gerdes his deputy, is well qualified and has Dr. Popmals endorsement for appointement as his replacement. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ZEC %NENDED ACTION-. Page 16 Mountain States PTZF-R P@T) RY! -Tamas A. Smi-th 13. EVALUATION (3) The site visit,report stated that MS/@IP evaluation methods are under ver\l capable direction, and evaluation for the program is of very high quality In response to advice from RMPS to develop better feedback fo program and project evaluation to the RAG, the RAG has formulated a four-member evaluation committee. This committee will assist staff in the development and dissemination of evaluative information to assist RAG in decision- making. - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- @Recommen8ed Action: 14. ACTION' PLAN (5) MSRMP has established a rating system which is used by RAG to establish priorities for all operational and supplemental projects. The priority rating procedures appear to carefully asses whether the programs are congruent with national and regional goals. Page 12 James A. Smith RMP-, Mountain States RMP EREPARED 5. COORDINATOR (10) The coordinator, Alfred Popma, M.D., retired in December 1971, after serving five y ear,3 in that capacity . Ht deputy , Yohn Gerdes, Ph d. ,was appointed interim coordinator until the RAG makes a final selection out of a field of 65 applicants. Dr. Gerdes is a candidate for the job. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- R-ecommended Action: 6 . CORE STAFF (3) The programmatic operations of core is decentralized into sub-regional offices located in each of the four states. The -central core office which functions in an admint trative and coordinating capacity, is located at Bosie, Iddio. The site visitors to the region in 1971 reported that the M/RW core reflected abroad range of professional competence and had been highly effective. p b 2 I a- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - S RECO@NDED ACTION: a, Page 18 IMP; Mountain States RMP PARF.T) RY James A. Smith k," 17. IMPROVEMENT OF CARE (4) The complexity of this region is manifold. This is-a four-state region that contains not only vast rural areas but also urban concentrations. With the limited funding available, the region feels it can be the most effective through their programs to up-grade the skills and knowledge of the health care providers. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Recommended Action: 18. SHORT-TERM PAYOFF The /,'O/RIAP's operational programs to improve the availability and quality .of health care in the region is beginning to pay off. The RAG reports that the.Coronary Care training project has'provided most of the small isolated rural hospitals with trained staff. Also, through the support and development of the MS/Tumor Institutefor the first time, cancer patients in the region have access to a high quality treatment center. Page 19 Mountain States dL EIZEARED U.. aamgs A, 5.%ith 19. REGIONALIZATION (4) The RAG reports that MS/RMP efforts toward regionalization has done much to dissipate the historic sectionalism in each of the Mountain States. There Ate few, if any, areas in the Region which have not felt the thrust of MS/RMP-supported continuing education@ich professionals now consider a tight as well as an obligation. The patient in an isolated area, as well as the health practitioner is benefitting from this impact. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - @comnended Action: 20. OTHER FUNDING (3) MS/RMP is formulating an increasing number of co-funded and con"jointly sponsored programs. The MS/Tumor In6titute.with 365,000 local funds and coronary care ttaining--Southwest Idaho with 9,000 dollars, illustrate this trend. - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - 'RECO@NDED ACTION: NTORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND NVELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND NLENTAL HEALTH ADNFINISTRATION TO Acting Director DATE: April 18, 1972 Division of Operations & Development FROM Director, Regional Medical Programs Servic SUBJECT: Action on April 10-11 Staff Anniversary Rev iew Panel Recommendation Concerning the Mountain States Regional Medical Program Application RM 00032 May/June 1972 Accepted (date) Rejected (date) Modifications: Comnone'nt AnL4 Financial Summary_- Anniveranry Applicati2n C014PONENT CUPPEL;T YEAR YEAR RECOMIE'.IIDED 'CJYL YR'S AWARD coul,, FUTMING 04 OPER. RECOIOENDED 'REQUEST SARP YEAR 'LEVEL REV. COM. CORE 788 286 947,034 Sub-Contracts -@o -0- OPER. ACTIV. 630,066 708,345 approved but 1)EVET,. COMP. unfunded ioo,ooo r No EARMARKS-. xi DITEY -0- 74,576 Disapproved Ki:pendi- ture of grant funds to both the P-',IP rnd CIIP as their ci'anting agencies. Accountability for the expenditure of grFiiit funds throughout the- year is. based on the budget requests submitted to the two sponsors. @At the beg.inning of the grant year, Core staff establishes a ratio of @@M-CHP grant support requested and awarded. Then as grant funds are spent the costs are attributed to P@,T and Cl-iP grants on the basis of the 'ratio. Thus costs incurred throughout the year are charge to the two sponsors on a prorata basis. The demands placed upon I,--IPS dictate that more accurate accounta- bility should be based upon expenditures ii-id not budce-t estimates. 'A system should be developed and implemented throuoh which -ra,-it expenditures are periodically identified and allocated between and CHP grant support. The minimal requirements for suc,i a-systei,.i will be developed jointly bet- ween the P-IIPS and CHP. The CIIP has been contacted to initiate joint development of minimal acceptable grant fund accountability requirements. RE@GIONAL ADVISO@RY GROUP Al\'D CORPORATION The duplication of responsibilities and membership between the NSR@T Regional Advisory Group and the Coi-poration.has been the source of considerable confusion and some concern. The difficulty in understanding the organization at this level results from thinking of the Corporation and RAG as separate bodies, each with its own identil--y,-i,,Iien in reality there' is little difference. Intervie@.7s with 'NSL@IP officials and a review of the By-Lai4s bear out this conclusion. As an example, there is only one set of By-Lai.:s which'incorporates both Corporation and RAG rules. Again, it must be kept in mind that except for the semantics, there is virtually no dif- ference in the two. Ori ginally it was the plan of NSKT that there be only one gr-oup and that the incorporators would also be the RAG. The Regional lledical Programs Service would not permit this arrangement and required that there be both a corporate body and a Regional Advisory Group. To satisfy this requirement, NS%'IP added more members and designated them as non-corporate members of the RAG. The 67 Corporate members remained as voting members of the 82 member RAG. Although all RAG members may vote only Corporate members may hold off-ice in the RAG or be a committee chairman. The dual nature of membership in the Corporation and RAG and of the By-Laws is inconsistent with the basic need for the RAG to be separate and distinct from the gra'ntee. To remove the appearance of dominance by the Corporation, the Corporate membership should be reduced to the minimum number necessary to meet the legal requirements of the State of New York and to provide the fiscal, personnel and other administrative affairs of NSI@'.IP. This small Page 4 group should be considered as the Board of Directors of the Corporation and should conduct its iffai-rs in periodic meetings ipart from the total R@i, C. There is no objection to the Board of Directors being Ti,,C@,P.Ibers of the RAG; however, they should not hold office. The designations of corporate and jion-corporat(-@ members should be removed. The B),--La@qs should be re-i,7ritten to establish the regional Advisioi-y Group as aii independent, self-Fustainii-ig entity responsible for all program decisions. It should not coiicern itself with the administrative deli- berations of the Board of Directors. OF CONTROL The Executive Director shares his time equally between P-%D-l and CHP activities and in addition, is responsible for the management of the Core offices a-,id supervision of the Core staff. On the surface this would -appear t'o be a herculean'task. In reality, the Executive Director does not perform his managerial duties without assistance. The combined r,,'T-CIIP staff is organized into three Divisions; namely, Administration, Program Development and Evaluation, and Sub-Area Planning. Eacli6Division is headed by an Associate Director'i,;ho is responsible for the management of his Division and who reports directly to the Executive Director. Appro-,,)riate delegations of authority have been made in writing to the Associate Directors to carry out their day-to-day duties and to service the appropriate committees of the RAG and CIIP Council. The Associate Directors also serve as-Deputies in the absence of the Director and in the performance of'tlieir assigned responsibilities, relieve'the Executive Director of a great amount of detail. The team concludes that the span of control of the Executive Director and the supervisory staff is reasonable and that responsibilities and delegations of authority have been assigned in a manner to provide for a properly managed program,. The team did not review the management practices and actions of the supervisory staff and, therefore, draws no conclusions on how well the staff is directed below the Division level. P@ge 5 SUl,-FOLI,- appro-,@. 13% overlap Clip in incifiberst-iip Pd-@ G Council. (82 tri-,nbers') (119 1.0,-ibc@rs) Bd Directors Aiins & Goals Exec. DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE Director, Regional 1-fedical Programs Service Marc-'q 27, 1972 IIIROUG',I: Acting Director, Division of Operations & Development, @@-TS Chief, Grants I-lanagement Branch Division of Operations & DeveloDment Regional IL--dical Programs Service Visit to Nassau/SuffoL'r, Regional 't4edical Program to Resolve the Problem of Accouatability of iUTS Funds/ Enclosed is a copy of 1-ir. Miller's subject report indicating alternatives for adininisterin- the subject pro-raL-s grant funds. We have two decisions C> C, to make: 1) flow to satisfy expenditure in the current budget period, and 2) llcw to simplify an existing complex situation. To facilitate Accounting for cucrent budget expenditure, I feel that Mr. Miller has indicates that detailed re-cords must be maintained to identify the efforts of the employees in the pursuits of the two grant @rograms to the ,xtent that tiiey are able to charge costs appropriately. 'fhey have tried this on a weekly, one-time basis and have slia4n that to a great extent it can be a-co-,nplished. This we must do in order to batsify requirements,based on two separate budgets and awards. For those activities th-t c-rinot ;)e identified oi a spec,.-':ic percentage of efforts basis, I concur in I,lr. 1-filler's reco.@ndations tki-t the percentage established in the budget as miarded be applied. '.Lhis @Tould be communicated to the grantee so that there will be a basis for future audit. With respect to future years, I stronoly urae that we pursue a joint award with CIIP. This is what Dr. Ilastinc.,s would like to do and has so stated orally to me. If you concur, we will pursue this matter with CHP and appropriate offices. It is ironic that this program is viewed by both It-[P S an d CHP as b c in gso-@thing iess than we would hope tlie'-pro-ram could be. This point might well be one for consideration when and if we review a budE t jointly with CIIP. In a jointly-funded grant, a percent of support is established by the programs and is fu.-ided on that basis unless during the year--the efforts vary, In that case, the grantee should advise us and request an appropriate revision to the budget. If the volume of business in the future remains as it is, in all likelihood we would be the lead agency. OFFICE SURNAME, DATE 11 OFFICE SURNAME I OFFICE SUP-NA2,iE L E nn rn) Mn \\ /7 Page 2 Director, RMPS My alternate reconnendation for future years would be to require the organization to beco-,ic separate. As Mr. Miller points out, total costs would then be increased and we would probably not end up with that clean a br@ in the total picture anyway. We should be glad to discuss this matter with you. Gerald T. Gardell Enclosure cc: Official Grant File Nash/Stolov Mr. Chambliss Mr. Miller Board File CM/ GTGarde 1: rc' -,.3/27/72 MEMOI,tANi)U2, 1)11.UIN L @L I 'L@rl- @ ,1.@ - -1 . @ . -@ I I I .1 @ @- . . --- - -- -- PUBLIC HE,@t,Tli SERVICE HEALTH SERVICES AND @IENTAI, HEALTH ADI\IINISTRATION 00 Chief, Grants Management Branch' DATE: March 20 1972 Division of Operations and Development Grants Management Officer FRONI Grants Management Branch, DOD SUBJECT, Visit to Nassau/Suffolk Regional Medical Program to Resolve the Problem of Accountability for IOIPS Funds The individuals participating in the discussion of this subject from both the Grantee, RMPS and the Regional Office were as follows: Mr. Glen Hastings, Coordinator, Nlassau/Suffolk RMP, Mr. Harrison Owen, Associate Coordinator, I\Iassau/Suffolk RMP, Mrs. Elaine Kaldor, Accountant, Nassau/Suffolk RMP, Mr. Gerald Hunt, Grants Management-Officer, Region I and Mr. Roger Miller, Grants Management Branch, @NIPS. The Nassau/Suffolk organization c.urrently allocates expenditures to its two Federal Programs based on the relative amount awarded by each Program. The basis for allocation, however, does not include funds set aside for direct PDIPS "project" activities. The basis for distribution is RMPS funds provided for Core activities versus CHP Federal and matching funds provided for the same type activities. As the grant funds are spent the cost attributed to FIIP and the CIIP grants are distributed on the basis of this ratio which at the present time is 61.8% RMP and 38.2% CHP. Where contributory funds from either @IP, CIIP or matching varies substantially, then the percentage ratio of each programs' contribution to the total, is revised And a retroactive adjustment for the entire budget period is made, to reflect the current level of contribution by each program to the total. The grantee's-method of recording its expenditures, is to enter all joint RMP and CHP expenditures in the RMP cash disbursement ledger. once this is accomplished, at the end of each monthly period the CHP portion is allocated from each expense nomenclature account in the cash disbursement ledger at the contributory percentage of 38.2%. This journal entry in effect, represents the transfer of the CHP portion of its total expenses to the CHP program; the balance naturally represents the RMP's share of its expenditures. Since generally accepted accounting procedures dictate that an allocation of expenditures should be based on actual experience rather than initial budget .estimates, I felt it was my assignment to determine a means of resolving the above situation. During the week immediately prior to mv visit the staff of the Nassau/Suffolk organization prepared individual time-sheets by employee, whereby each employee accounted for their time on 15 minute intervals for an entire weekly period: A careful review of these time-sheets by the members Participating in this group indicated that time fell into three major categories which were (1) directly attributable to @IP activities, (2) directly attributable to CHP activities, or (3) falling into a category that could not be specifically identified to either program. Chief, Grants Management Branch, DOD 2 Based on the review of the records and the ensuing discussion, it was resolved that we would come up with'five alternatives solutions to this problem. These are as follows, and are discussed in greater depth in a latter section of this memorandum: RECO'i4MENDATIONS: 1. Combine the organizations by issuance of a joint award under the joint funding concept. 2. Completely separate the organizations by requaring two separate staffs at two separate locations. 3. Allocate costs as presently operating. 4. Prepare a time study on qu arterly basis for all employees to determine what portion of effort is devoted to each program. If it is found that a larger portion of effort is devoted to one p- gram than the au-ual funds provided then it would be recommended that the operational program be adjusted accordingly. 5. Place a restriction on the RMPS grant award that funds could not be used for tho Core activity that would result in more than a 50-50 split of Core costs between those funds provided by the RMP program and the CHP pro,-am inclusive of both Federal and matching shares. Based on my study of the entire situation, the following are my pros and cons to the above recommendations which I am listing in priority order with one being my most favored recommendation: 1. I feel the most efficient recommendation which would encompass the least problems would be to joint fund this entire operation with a combined grant of RMP and CHP funds. Since RMP provides -the major portion of funds for the operation of this organization, this option would include RMPS admiristration of the total grant. Since RMP is now extending the grant to this organization to August 31, beginning 9/l/72, the CHP grant and the RMP grant would be on the same fiscal period. Since there are costs of the combined operations that dannot be specifically identified with either one program or the oth,r, I am of the opinion that this option would be the most feasible. In addition, since Dr. Wilson has proposed this concept, "ir- would be a feather in the cap" of RMPSto be one of the first programs to attempt to implement such a concept, with the results of the implementation being made available to the Administrat'or. 2. My second recommendation would'be to require the grantee to prepare a time study on a quarterly basis utilizing a period of an entire week each quarter as the basis for the allocation of costs to 3. Chief, Grants Management Branch, DOD each program. In discussions with the Nassau/Suffolk representatives on this recommendation, they feel that if a hypothetical situation resulted where 30% of time could be specifically allocated to CHP and 30% of time could be specially allocated to RMP, and 40% of total time fell into the category of both, they were of the opinion that they could make the managerial decision to allocate the time into either category as they saw fit, to come back to the current allocation ratio of the 61.8% and 31.2%. I did not agree with their conclusion, since I feel that the time that fell into both categories would have to be allocated 50-50, and if'this study indicated a disproportion of effort based upon funds provided, they would have to redistribute their program activities accordingly. 3. l'y third recommendation would be to place a restriction on the RMPS award to this organization, that RMPS funds could not be used for the Core activity, in a larger percentage than those funds provided by either Federal or matching fundi by the CHP program. The representa- tives of the Napsau/Suffolk program were adamantly opposed to this proposal since they said it @uld severely restrict their operations. 'I felt, however, that since Mr. Hunt indicated that their is little or no community involvement in CHP, that such action would force them to stimu-.atc r-)mmunity involvement in CHP to obtain increased local support for tne CHP operation which in eff-ct, allow them to put more RMP funds into the Core activity. I realize this suggestion is harsh in nature, but I feel we may have to take such action if this is the recommendation that is proposed. 4. My fourth recommendation would be to allocate costs based on the original budget estimates as is the current practice. Although I am completely opposed to @his proposal, this is the procedure the Nassau/Suffolk organization would like to continue following. CHP programs are de- creasing while funds available to the RMP program are increasing. As a result of this situation, continuation of the current method of allocation could eventually evolve -'-n RMPS picking up 90% of the total Core staff salaries ai,d related expenses while CHP would only be picking up 10%. It.is currently the practice of Suffolk County, who contributes a pnrtion of the matching share to the CHP project to be very restric- tive as far as the amount of funds that are actually provided for the CHP operation. Suffolk County is trying their best to cut costs in view of a potential deficit, and as a result the Nassau/Suffolk CHP operation is looking forward to less of a contribution from this county. A lower contribution from Suffolk County by $5.00, in effect, results in a lower contribution from Nassau County of the same amount and a lower contribution from the Federal Government of twice the amount. So a loss of $5.00 from Suffolk County results in a tota oss of $30.00 to the CHP program. 5. My last and.least favored recommendation would be to completely separate the organizations. This in e.ffect,. would solve the problem, but would result in increased,administrative costs to both the RIIP and CHP for duplicate staff in all administrative areas. I feel that taking such a step would be an extreme measure since I do feel that there Chief, Grants Management Branch, DOD is some merit to having these organizations combined and within close proximity to each other. I am willing to discuss all of the above recommendations at lenath and write a letter to the Nassau/Suffolk Regional Medical Program indicating the recommendation selected for adoption by the Nassau/Suffolk organization. I indicated upon leaving the Nassau/Suffolk organization that we would inform them of our decision within the next week, so that the site visit team visiting the Nassau/Suffolk organization during the last week of March would be aware that this area has been resolved. Iler cc: Dr. Margulies Dr. Pahl Mr. Chambliss Mr. Nash/Stolov JVI iV/1 kJ l@ @ i N @ U IVJL PUBLIC IILAI,'Fll SI-"ItVICi-, IlrALTH SLIKVICLS AND MENTAL I-ILALTII AD,\41NIS'I']tATION DATE: March 21, 1972 r I@'or the Record FROi\f Edward T. Blomquist, M.D. SUBJECT: Post-Mini SARP Meeting, March 20, 1972, Nassau-Suffolk Regional Medical Program Renal Organ Donor P ram Purpose of Program - To procure cadaver kidneys from 24 donors each year from seven named hospitals in which there is a physician committed to the program. Part time physician coordinator and a secretary will be employed to administer the program. Participating surgeons and hospitals will be paid a standard fee for service Cost for developing and training procurement teams for maintaining transplantation registries, and for payment of cadaver kidneys will be $27,060 for the first year. Jitient selection, histocompat,-.bility testing. and transplantation will 2 performed at facilities located in New York City. Action - RecomT-erd approv-1 of application as submitted for the first year of operation. Futur.2 funding will be determined after review of application from Metropolitan New -York Region requesting support for a Tri-Regional (New York City, few Jersey, Nassau-Suffolk) Transplantation Program is reccived. Home Dialysis Tra. am Purpose of Program - To develop 50 validated, modular, single concept lessons and tes s@for homa dialysis patients after a period of studying dialysis units in New York City and after developing patient behavioral objectives. Costs are projected for the firs!: year only. During the first year, 6 validated lessons and tests will be completed at a cost of $31,200. Action - Disapproval with advice to s@ek consultation from mature home dialysis training programs, as previously recommended by staff. Information for Local Regional Medical Program The objective to train the majority of patients for home care is admirable but the time and expense of the proposed program is excessive. It is page 2 - For the Record rccoi,,liiiciided that full idvaiitige be talcon of the experience and teach- iiig aids now available at nature home training dialysis centers. Specifically it is recommended that contact be made with such resources as the Northwest Kidney Center in Seattle, Washingtonand those listed by staff in earlier letters of advice. Furtlier,it is recommended that the anticipated caseload of patients needing dialysis and transplantation be reviewed. The quoted rate of 70 patients per million population needing dialysis requires validation. Purther,the need for expanding existing dialysis facilities as implied in General Objective 1 requires additional study. Edward T. Blomquist, M.D. Region: Nebraska Review Cycle: June 1972 Type of Application: Anniversary prior to Triennium Rating:- 298 B Recommendations From SARP /X-X7 Review Committee Council /-7 Site Visit 02 03 Recommended Level of Funding $725,000 $700,000 eview Committee concurred with the funding-recommendations of the March 30-31,1972 Site Visit Team and agreed that the Nebraska RMP has demonstrated substantial progress by adequately responding to the eight specific issues raised in the June 11, 1971 RMPS advice letter. The recommended $725,000 funding level included full support of the Program Staff in the amount of $4ol.641 which includes $25,000 for the initiation of small planning and feasibility studies. *he Review Committee accepted the Ad Hoe Renal Disease Staff Committee and.the site Vist,tor's recommendation to disapprove Project #6 entitled, Kidney ContinUina Education Program and Project #7 entitled, Renal Dialysis Trainin2 Proposal. In this connection, th;-reviewers strongly suggested that the Program develop a comprehensive statewide plan before pursuing any specific operational activities in the kidney disease area. When comparing last yearts Program Staff Budget with the current request reviewers agreed the proposed increase was justified. The Reviewers believed that the additional four Program Staff will greatly strengthen programmatic efforts needed to develop a Triennial Application. Members of the Review Committee were impressed with the progress achieved especially since it had been accomplished within a six-month period. Favorable comments included the increased involvement of the RAG membership, its vasti improved review process, its committee structure and its monitoring of ongoing @ y activities. Reviewers recommended that the composition of the RAG and its supporting committees should be strengthened through the addition of more minority group representation and allied health disciplines, CIO, nt and Financial Summary Anniversary Application Compone COMPONENT CURRENT Of YEAR 02 YEAR RECO14MENDED YRIS AWARD FUNDING 01 OPER. SARP YEAR COUNCIL RECOMMET]DED, REQUEST REV. LEVEL C M. CORE 232,196 3.76 11641 4ol,641 0 Sub-Contracts 0 OPER. ACTIV. 267,804 405,556 323,359 DEVEL. COMP. Yes No(X) EARMARKS: KIDNEY #6 4,640 Di sapprovecr KIDNEY #7 44,198 Disapproved RMPS DIRECT *500,000 782,197 725,000 REQUESTED 850,120 COUNCIL APPROVED LEVEL 790,070 NON-RMOS and INCOME REGION Nebraska @June 197 2 Review tyc for the 12-month budget p riod 7/71-6/72i Reg $500,000 was awarded e ion has been extended two months to accommodate the three cycle review system. A pro-rated amount of $88,834 has been awarded for the two month extension. MEMORANDUM DEPARTMENT OF I-TEAI-:FH, EDUCATION, AND N%'ELFARE PUBLIC IIE.,%L-I'll SERVICI" -III-"ALTII Sl-"I@VICES AND ',NILN'FAL, IJEALT14 ADIvflNISTRATION TO For the Record DATE: March 23, 1972 FRONI Edward T. Blomquist, M.D. ,SUBJECT. Post Mini-SARP Meeting, March 20, 1972, Nebraska Regional Medical Program Kidney Continuing Education and Renal Dialysis Training Programs Purpose of Program - To produce 6 unspecified one-half hour t6acbing tapes at the Good Samaritan Hospital in Kearney, Nebraska, for use in undescribed training courses to be given an unknown number of patients and public groups and To develop an inadequatelydcscribed multidisciplinary continuing education program in r-tal care for hos-pital personnel. cost - $48,838 over one year Action - Disapproval. During the scheduladsite v-Ls-Lt to Nebraska, atten- tion should be drawn to t-ae instructions for the preparation of kidney grant application as punished in November 1970 and as contained in the p-sit@on paper dated January 1972. Particular emphasis should be given r to the need for a comprehensive regional plan on which specific projects can be related. Advice to ReRion - The reviewers found the applications incomplete. They had difficulty understanding what contributions the propose programs would make in the absence of better documented need and plans for a regional renal disease Drogram. Comment§ contributed by local consultants were noted. In the opinion of the reviewers, the criticisms raised by local consultants, Drs. Touhave, Smitll and Holmes, had not been corrected. Specifically, the plan of action is still not adequately documented and quantitated to give the reviewers confidence that the objectives can be met. RIIPS STAFF BRIEFIliG DOCLNEN'T E Or PATIOI;S Eastern /x I mid-cc,,t. -7 Western WION Nebraska BRANCII South-Centr'l f 'CH BRA14 VPE APPLICATION: None U.IOIT RT.TIIIG Tel. No. 443-1790 Room 10-15 -TRIEh'14IAL 197 DATE BRANCII-CIIIEF Michael J. Posta LU lat'AN14IV Y 0 SARP FF Frank Zizlavsky FAR BRANCII STA 2nd. AN14IV YEAR L7 REV. COM. RO REP. Ray @ddox OTHER L7 OTHER Last 14gt,. Assm't Visit Feb. 11-13 1970: Chairman Tom Simoods AST S.V. April 107 1 Chairman Joseph W. Hess, M.D. taff Visit& Last 12 mos. (Dates Chairiran s Name and Type of Vigit). 'November 21-24, 1971, Frank'Zizlavsky & Ray Maddox, Staff Visit JanuarZ 21, 1972, Frank Zizlavsky, Staff Visit lajor Events IThich Occurred in the Region Affecting the RMP Since Its Last Review n may 1971 1. NewCoordinator'- Deane-S. Marcy, M.D', its of-July 1, 1971. 2. Subregional offices Un!,versity of Nebraska andcreighton U-nivers@ty phased out -as of February 15 1972. 3. February 25, 1972 Community O'f'Creighton,'-Nebrarka, received- E'xperimental,Health belivery Sub-System site visit-fiom Nitiofigl Center-for.liealfh Services Research and D&velopment. *Com2onent and Financial Sut-.varv AiTniverso@t, 21.i cition 01 Current 02 Year 02 YE tTll COI-IFONr-.t\'T FUI@DING YR'S AWARD -c SARP OPER. R E 0'4- L@- I-, D F,D REQUEST Y EAR LEVTL L3 REV. COli. 232,196 @76,641 CORE and 267' 405,556 OPEP,. ACTIV. 804 DEVEL. CO',',T. EARIIATU' S: @iDl\'EY 4,640 #6 44 198 #7 Rtf-S DIRECT 500,000* 7SD,070 782,197 RMPS ITIDIRECT TDTAL NON-R@UIS and I @c o.@ T OT A L B V. 1)%t LT 0 was aw the-I -month .$500,00 REQUT-STR,D 850,12 budgetx@eriod d@72. Region has' been e ended t,*o m-)nths asV-3mmodate the thre-e -cycle REGION' @e@ra a COUNCIL rsvi Sysit m Apro-rated amount of 0,070 8 3 hl ttgn I ii Sr J,,ne' 197 2, RFVIL-W CYCL-Z- itrpRovED alwar d '3 e - two month estens-ion. 0 'N 0 REGION - NEBRASKA AP@@k IL 4, 1972 BREAKOUT OF REQUEST RM (JO068 1)6/72 RMPS-OSK-JTCGR2-@ (%2 PROGRAM PERIOD 1 5) (2) (4) (1) NOT CURRENT CURRENT :NTIFICATION 13F COMPONENT CONT. WITHINI CONT. BEYONDI APPR. NOT I NEW* TOTAL IAPPR. PERIODI APPR. PERIODI PREVIOUSLY PREVIOUSLY DIRECT INDIRECT. OF SUPPORT OF SUPPORT FUNDED APPROVED COSTS COSTS CORE NEP@-.@ASKA REGIONAL ?II ,@.UAJ.-2 641 LA COPOtiARY CAPE TRAINING Si Lil CORCt4APY CARE TRAINING Si IC COPCINARY CARE TRAINING Si L 3 i'iCjBl LE CA lialL 4 PUN- ICAT 10,'iS I EREPROVASC JIL@lp alln- Rl--La@!)@.EA.5-@ 5 NF3RASKA PPOJECT FOR RESI 1, 1.21- r n S45sad 6 KI'DNEY CLtITINUItIG EDUCAT 7 PENAL DIALYSIS TRAINING TOTAL $6739898 $108t299 $782tl97 $162,656 REGION - NEBRASKA APR IL 4t 1972 RM 00068 06/72 BREAKCJUT E)F REQUEST RMPS-OSM-JTOGR2A 03 PROGRAM PERIOD (5) (2) 4) (1) AC)DIL YEAR TOTAL' E@4TIFICATION OF COMPONENT- CONT. WITHINI CONT. BEYONDI APPR. NOT I NEW, NOT ALL YEARS APPR. PERIODJ APPR. PERIODI PREVIOUSLY I PREVIOUSLY DIRECT IDIRECT COSTS OF SUPPORT CF SUPPORT I FUNDED APPROVED COSTS 0.3 CORE @4EL)'ZASKA REGICTJAL Ml @ICAL ERO-,-AM I S398,439 I $775sO IA CORONARY CARE TRAINING St I f 1 156,656 IB CORONARY CARE TRAINING Si UPPOPT P4'IOGRA$4 I 1 S222408 IC COPC?;ARY CARE TRAINING Si UPPGF',T P"P LI----- I 3 q I CriLrl(@rjr'-,T TOTAL I( 511@6 3 MOBILE CANCER DETECTION U.4 T T 4 PUBLICATIONS CEIZEBROVASCI 778 $12, 1 127.,156 -ULAP-'@-2.EL@TFD DIS-E'XSF'; 1, 5 NECIRASKA Pt'IOJECT FOR RESI I 1. t- !&42,145 142,14@ 187.229 @6 KID-NEY CCNTINUING FDUCATI YON I!RC-GU- $4264r 7 RENAL DIALYSIS TRAINING t!A.76tg S33.748 182 94f2 I -PRNPOSAL- TOTAL $3989439 $939672 $492*111 $1,274,308 @9 12 13 1 14 is is NRMP AC IVITY SITES A K. Sioux DAWES SHERiDAt *Codf KEYA PAHA A CEDAR 0 W@ L.A., *0 he'll Box roo.0 siph W" THOIAAS @INE vmEELER RILL CA A tiADI r@04 Aso,#$*" BOONE GRANT HOOI(ER . A @E- McFt4ERS@- - LOGAN CUSTER I IREELEY Ubi-V PLATTE St fd-.d AAthw mo,th fkmd rly-A emenij St o A,"Id A@.,E C.... 0 LINCOLN SAUNDERS m-o,, POLK a I MERRICK *O.JCT ')EUEL A ossi 4po North ?Iaffo 00 to.h.0 Lncol@n lilb.)y &.4, SEWASCO DAWSO". IA@l I- YORK. -,K[Nti flop L OTOE &. t!-A.MILTI in' -ifi -1 "7@,5 -CLAY- rtLLM014E Sr "mid L KEARNEY CIIAIIE -d- *C. A rnONI iER GAGE c@ v.: AOAMS u@- UNOY RF@ILLOW 0 AN ;E F F CRIO B;Ogtf;t* (?"A* WEBSTER 1-d-.1. FURNAS FIMIlin A C,i A? Red ?.,d r t E,,ft A D. LEGEND NEBRASKA st.le of Miles 0 Learning Resource Center St.#* cop;fot co..Iy Soots 40 00 MADTSON Couoty N@41 Drug InEorinaLion & Tape Library POPUIATION KEY =Coronary Cire & ROCO@L o@ yoocoo a )n,000#.20,000 AMERICAN I.IAII COF.4PANY. INC. MMobile Cancer Detection Unit 50,ODO 1. looooo 5.(Wto 10,000 25,Lw Po soovo t,oool. 5,000 20.(IOOIO 25,@ U.d., 1.000 R,4 00068 -6- PROF ILE STATE OF NEBRASKA Geography: 93 Counties 76, 612.square miles Population: Total - 1,483,500 ( 1970 Census) Density - 19 per sq. .nile ( 1/3 as high as U.S. average of 57.5) Urban - 61.5 % ( 912,800) Non-White - approx. 1% ( 50.,800) Negro - 40,000 Other - 10,000 about 6,600 are Amer. Indians) Age Group: Under 18 yrs. 347. 18 - 64 yrs. 54 65 and over 12 Metropolitan Areas; Lincoln 166,000 Omaha,Nebr-538,700 Iowa Sioux City,lowa- 113,900 Nebr.*( Dakota Cty) 13,200 Average Income per Individual, 1969 Nebraska $3642 UOS. 3680 Political Information: Governor - J.-I. Exon (D) Senators - Carl T. Curtis, (R) Ronan L. !Iruska (R) Appropriations Conmittee Representatives - Cong. District I Charles Thone (R) 2 John Y. McCollister (R) 3 David T. Martin (R) - - - - - - - - - - - - Vital Statistics Rates* - Leading Causes of Death, 1968 Nebr. uoso Heart Disease - 407.1 372.6 @lign. Neopi - 176.3 159.4 Cerebro vasc. - 125.4 105.8 Accidents - 65.3 57.5 Related Diabetes 20.1 19.2 Arteriosclerosis 22.3 16.8 Bronchitis, emphy. 24.4 16.6 -Uuubd State of Nebraska -7- FACILITIES AND RESUURCES SCIIOOLS Medicine 1969 69/70 Enrollment Graduates Creighton Univ. School of Medicine, Onaha 316 73 Univ. of Nebraska,Co.11. of 14edicine,O@ha 397 94 Dental - 2 Creighton and U. of Nebr.,Lincoln) 422 Phar,mcy - 2 300 Nursing Professional 13 of which 4 are College or Univ. Based Licensed Practical - 7 Allied !iealth Schools 2Yr. Community and/or Cytotechnology - 1 Univ. of-Nebraska Junior Colleges 7 - majority Jr. Colleges Medical Technology - 9 Radiologic Technology- 9 Physical Therapy - None Medical Rec(,.ds - 1 - College of St. Mary FACILITIES Non-Federal Short and Long-Term General qospital@, 1970 Beds Short Tern Gen. & Special 101 9149 Hong rerm Gen.& 51-acial 2 334 - - - -- -- - - - - Veterans Admin. Genera' 3 850 Number of Hospitals wit%_Special Facilities, 1969 iccil 30 Cobalt Therapy 6 isotope Facility 11 Renal Dialysis 7 . Inpatient Rehab - Inpatient 9 Long-Term Care Facilities( ExLendod Care) 1969 Skilled Nursing lomes 152 9174 Beds Long-term care Units --5 1482 Beds -8- State of Nebraska i4ANPOWER Physicians Total Physiclans ( tncl. inactive) 1711 Total Active Practitioners, reporting 1439 (inc. interns and residents) 1188 Office-Based 251 Other Active Practitioners, by Specialty General Practice 506 Medical Specialties 258 Surgical Specialties 385 Other Specialties, Resear,ch, 290 admin. and other Group Practices: Total 81 Single specialty 37 General prac,;ice 17 Multispecialty 27 Doctors of Ust,:opathy ( as of Dec. 31, 1967) 32 Professional ..'urses. Actively employed in nursing 4,730 Not activel- employed in nursing 2,547 Licensed Practical Nurses! Actively enpl. in nursing 1,147 No,, actively e-npl. i-. nursing 348 Licensed Pharmacists ( in active practice) 1969 -1,020 X-ray Technologists 485 Radiation therapists( technologists) 3 Physical Therapists, 1970 members in active 60 full-time practice APT Assoc.) 9 part-time -9- BACKGROUND & HISTORY The November 1970 National Advisory Council approved the separation of South Dakota from the Nebraska-South Dakota RMP. To provide interim support for the Nebraska-South Dakota RMP's core staff and three projects (beginning January 1, 1970), the first year award was extended for six months until June 30, 1971 at the Region's current level of support. The February 1971 Council recommended approval of South Dakotals planning application for three years including support for their part of the coronary care activities for one year. Nebraska RMP was site visited on April 1-21 1971 because an initial application for operational status as a separate Region was submitted to RMPS. The site visitors assessed the program structure, achievements and capability. The site visit report, which received National Advisory Council concurrence, recommended that the Nebraska Regional Medical Program must develop and accomplish, as soon as possible, solutions to the following: 1. There is the need for stronger and more effective central program direction. The operating objectives and priorities need to be better defined and understood. 2. The role of the RAG should be strengthened. For example, the RAG should have a strong role in the selection of the Program Coordinator. It should display, also, its interest in his continuing education in program management. 3. The following documents should be developed and officially adapted by the RAG: a. Mechanism of appointment of Committees b. Objectives of each Committee C. Procedure for reallocation of funds within RMP d. Procedures for monitoring projects over programs e. Procedures for project development f. Procedures for project review g. Procedure for project termination 4. The role of grantee organization should be re-defined in a way which will delineate the manner in which its responsibilities and authorities are separate from those of the Regional Advisory Group. -lo- 5. The capabilities of already available resources on Core staff should be more effectively Utilized in program planning, monitoring and evaluation. 6. Available resources should be utilized more effectively in defining needs and carrying this through to project operation. 7. There should be organized plans for phasing worthwhile projects to funding mechanisms other than RMP. 8. There should be strong involvement of core staff and RAG in directing the course of the mobile cancer prO3ect. The May 1971 National Advisory Council recommended approval as a separate and new Region with operational status for three years at the current level with the following conditions: 1. The concerns of visitors be communicated back to the Region, 2. The review of the second year continuation request include a site visit to assess progress during the next year, and 3. The level of funding be increased if significant progress is achieved in the first year. Additional concerns are contained in April 1-2, 1971 site visit report. During June 1971, Harold S. Morgan, M.D. resigned as Coordinator. Deane S. Marcy, M.D. became the. n-ew: .@r-dimat@or, r-&s -bt -.July Il,"',1971. The Nebraska RMP is currently in its 01 operational year. The direct cost award for the present budget period is $500,000 and indirect costs amount to $125,639 (24.4%). The current budget period has been extended two months until August 31, 1972. The Region has submitted an Anniversary Application before the triennial requesting 02 year support of $782,197 direct costs for the following: I. Continuation support for Core 376,641 II. Continuation support for two ongoing projects 297,257 III. Support for four new projects 108,299 Total 782,197 Region Nebraslci Review Cycle ulle 197'@' OANDING ACCOIAPLISHMEUS BY RMP SINCE April 1-2 197 1 1. Region has defined RAG, Grantee, and Coordinator responsibilities. RAG has been actively involved in the Regions review process. 2. Developed "Procedural Manual", "Administrative Policy Manial". (pg 13, 15) 3. Core Staff is developing outreach to community rather than strict confinement to medical comunity. 4. Good relationships with CHP exist. CHP is actively involved in RMP review process. 5. Assisted comunity of Creighton, Nebraska in developing an Experimental Health Delivery t Sub-systeim proposal. 6. RAG is active in terms of overall developmental aspect of programs . Nine functioning committees are involved. T. Program Coordinator has made successful accomplishments in reorganizing the MW. 8. Education projects seem to include a methodology for evaluation. 9. Inter-regional cooperative arrangements have been excellent. LO. Central program direction has been strengthened. PRINCIPAL PROB@ 1. f@ has clearly articulated its goals, objectives and priorities, however, they are not tim-framd and an overall plan for the Region does not emerge. 2i Program is still quite "project-oriented". 3. NRMP is not focusing its attention on LTroving the total delivery of health care. 4. Collection and use of data to determine funding priorities or delineation of program @direction. ere are no minority group m@ers on core staff or the various project staffs, nor on lWhe 9 G Committees. (One black on the RAG) Special health problems of Indians and migrant farm workers have not been addressed. 6. Too much conceptual planning (CHP responsibility). 7. Emphasis of kidney programs. 8. Needs should be defined before action statements on goals, priorities and objectives. @ ISSUES REQUIRING ATMWION OF REV The emphasis of NFMP is still categorical, and continuing education and trai@- they should be encouraged to broaden their health "Horizons". RAG should be encouraged to become more involved in the evaluation process. SUGGESTION: A "Planning and Evaluation C@ttee" to assist in monitoring overall program as well as specific projects and core staff activities. (Compare this to role of Planner-Evaluator, pg. 22.) 3. The data accruing from the Westinghouse Corporation study should be used as a basis for carrying out an overall needs assessment of the Region for developing a related 3-year plan of action. 4. Two part-time salaried positions of grantee being paid by Core funds. 5'Clarification of CHP 'lb" representative on RAG. 6. Future relationships with two medical schools. 7. Core staff position descriptions. 8. Position Of RAG chairmn and president of Nebraska State Medical Association (same) 9. Although manpower is a stated objective, what activities are planned. i e role of 2 "Kidney projects" in NRMP statewide Kidney plans. TABLE OF CONTEYRS NORTH CAROLINA REGIONAL MEDICAL PROGRAM ANNIVERSARY APPLICATION Staff BriefiM Document Pa-qe Face Page 1 Regional Maps 2 (;eography and Demography 4 Component and Financial SummaTy 6 Breakout of Request 7 Problems, Accomplishments, Issues 23 Review Criteria 27 Addendum to Briefinst Document 37 Organizational Structure 38 Regional Office Comments 43 Supplement to Application 46 RMPS STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mid-Cont EGION North Carolina 00006 BRANCH /X7 South Centr'l Western BRANCH N/A LAST RATING Tel. No. 31740 Room in - 22 YPE APPLICATION TRIENNIAL April 1972 DATE BRANCH CHIEF Lee E. Van W@Li lst AN.NIV YEAR SAR.P BRANCH STAFF Bill Reist 2nd ANNIV YEAR REV. COM. RO REP. Ted Griffith OTHER OTHER is,*, Planned for 197' Last Mgt. ASSM,T V 1L. Early Chairman- Nov. 1970 ChairmanHenry'Lemon, M.D. (Comittee); Bland Camon, M.D.(Coiincil)o AS@V. Edward Coppola, M.D. (Consultant) RMPS STAFF* Dan Spain -, tallisits, Last 12 mos. (Dat6s, Chairman's Name and Type of Visit) Buddy Says, & Ted' Griffith November 15, 1972- Bill Reist- Met Staff- Attended RAG Meeting- Consulted on Migrant Projec March 7-9, 1972- Bill Reist- Met Staff- Obtain supplemental Information for AMlication- A REVIEW PROCESS VERIFICATION VISIT is scheduled for April 27, 1972 @jor Events Which Occurred in the Region Affectitg the RMP Since Its Last Review n May 1971 Eastern Carolina University in Greenville has been appropriated funds by the State legis- ature, for a 2 year Medical School and School of Allied Health. State Legislature has passed a bill which provides payment for dialysis of Kidney patents Legislation Research Committee has been appointed to study and make recommendations on EMS in North Carolina It will be announced on April 7, 1972 that University of North Carolina has been selected by NOiSRDas 'd-tegrantee for a University Center for Health Evaluation award North Carolina RW Map of Congressional Districts, Counties, and Selected Cities Metropolitan Areas: (11 Districts) @heville -135.4 liarlotte -406.0 )urham -188.8 @reensboro- V. Salem 598.9 Police 225.6 STOKES ILKES y .ME ETTEVIL coli@ EGIONS )RTH CAROLINA MULTI-COUNTY PLANNING R Establ.ished By Executive order Robert W. Scott overnor Of North Caroiina G May 7, 1970 ,q NORTH CAROLINA RMP RM 00006 3/15/72 Regional boundaries coincide with the State cts - 11 Counties - 100 Population (1970 Census) -- S,082,100 Land Area: 49,067 sq. miles Urban 45% Density 103 per square mile litan Areas: (5) - Total population of 1,SSS,000 Asheville - 135.4 Greensboro - Winston Charlotte -406.0 . Salem - S98.9 Durham -188.8 Raleigh - 225.6 Race: White -77% - 3,891,SOO e Distribution Un r 1 Y_rs _ 5, Negro - - 1,137,700 e Other - S2,900 18-64 yrs. - 57% (majority indians) 65 Over - 8% Home Based 17,307 Migration intoTState 9,OS3 0 1 ta 6,360 Per Ca-oita Income: North Carolina $3,188 - (Ranks #39) (197b) United States $3,910 - @-rta@: @aths per 100,000 population, 1967 NORTH CAROLINA U.S. Heart Disease 303.6 364.S Malignant neopl. 115.4 lS7.2 Vascular lesions (aff. CNS-Stroke) 105.2 102.2 Diabetes 1S.2 17.7 Broncho-pneumonic 11.0 14.8 (other) Accidents 67.2 S7.5 1970-1971 Enrollment Graduates Resources and Facilities: (3) Medical Schools Bowman Gray, Wake Forest 273 S8 Winston - Salem Duke Univ. School of Med. 383 80 Durham Univ. of N. Carolina 337 76 Chapel Hill (1) Allied Health School, University Based Bowman Gray School of Med.,Winston Salem Division of Allied Health Programs RM 00006 3/15/72 Professional Nursing Schools Practical Nursing Schools 40 - 17 are college or 37 Schools University-Based Accredited Schools - Allied Health Cytotechnology - 7 @dical Technology - 14 Radiologic Technology - 28 Physical Therapy - 2(University Based) Medical Record Librarian - 1 Hospital§-c eneral Hospital Special Facilities Short Te-nn 36 iccu Si Long Tenn- Cobalt 12 (special) 7 484 Radium 34 Isotope (g.eneral) 3 i,sos Facility 37 V.A. Renal Dial- 13 ysis (in-patient) Rehabil. 6 ower: (in-patient) Active 4,484 Inactive 199 osteopaths 21 Graduate Nurses, 1966: Actively employed in -nursing 12,126 Not employed in nursing 3,475 Group Medical Practices, 1969: Total 153 single Specialty 92 General Practice 18 multi-Specialty 43 RMPS/SCOB/DOD component and Financial Summary - Anniversary Application COMPONENT CURRENT YEAR YEAR RECOMMNDED YRIS AWARD COUNCIL FUNDING .04 OPER. RECOMMENDED REQUEST SARP YEAR* LEVEL REV. COM. CORE 558,193 643 9bi2 Sub-Contracts -0- <, XI (73 OPER. ACTIV. t,152,129 1-248@175 ,I)EVEL. COMP. 168,605- IBZ.8ql Yes or No RKS*. KIIDNEY #28 (145.400) AREC #41 (200,000) RMPS DIRECT 1,878,927 2,194,400 2.080-008 3,875,178 REQUESTED COUNCIL 'APPROVED LEVEL 2,194.4 NON-RNPS and INCOME 34,691 REGION North Carolina J ne 1971 REVIEW CYCLE The 04 year is being extended to 9/1 and the region will received $365, 733 for the two month extension resulting in a direct cost award of $2,244,660 for 14 months. REGTON - N CAROLINA MARCH l7*t972 BFTEAKCUT OF REQUEST RM 00006 06/7Z RMPS-OSM-JTOGRZ'el 05 pRorFtAM PERIOD (4) (1) 15) (2) CURRENT CURRENT II)E,'4TIFICATION OF COMPONENT CONT. WITHINI CONT. BEYONDI APPR. NOT I NEW, NOT DIRECT INDIRECT TOTAL APPR. PERICOI APPR. PERIOCI PREVIOUSLY PREVIOUSLY COSTS SUPPORT OF SUPPORT FUNDED A PPRE)VED COSTS CF :000 COQE STAFF 0- PMEKTAL 3 OFZE;7E'LC--- OMPCNENT Fr,i--El B@EIIC CONSULTATICN ANI t 7@O ..L Fylc@r ------ - --- -- 015 CCYPREFEP-SIVE STROKE PROI .125.0 ---- @TE TRAI @19 A ----------- - 026 N C EmPtiYSEIIA A.%D LUNG DI N- OZ8 CARE c@ PATli TS WITH CFl 029 CF)@IJED PHY ALF)H PERSON-%EL[ o3o CC@P'ZCIIE.'iSIVE RtiEU!'ATIC .1@gz? ICUAZO I 03L CARC!AC PA[ 032 CAPI@E,4 LAD',)ER P,UilStk.'G EDI 034 FA?IILY N,,PSE PRACTITICNEI -B--- --- --- I- ---- 112 ACULT S -@4.lt,,G ;7ROG@AR I 035 036 CUM; ,RE@IE,SIVE CANCER PRCI ---CgLf- sl5z4zbA-l- SZ?.736 I 039 t;EI-G-H.Bt-@RH-OO-D-FG-MT-CTRS Cl I --O@ 040 EZ)UCATIO'QAL Yt:ST114G SERVI 04t 'AREA tiEALTti ECUCATION CEI $14594GO $277,468 $29080PCOB $46OR480 1 $2954Ov488 TOTAL I $1,657tl4O I IO.ARCH II.L97Z REGION - N CAROLINA BREAKCUT OF REQUEST RM 00006 06/72 06 PROGRAM PERIOD RMP S-0 SM-J TO GR 2@f (5) (2) (4) IDENTIFICATION OF COMPONENT CONT. WITHINI CONT. BEYONOI APPK. NOT I NEW, NOT ADC'L YEAR I TOTAL I APPR. PERICOI APPR. PERICEI PREVIOUSLY I PREVIOUSLY olit[cy ALL YEAR$ CF SUPPORT OF SUPPORT FUNDED I APPROVED C057S JOIRECT CCSRS I COOO CGPE STAFF --- - --- 5-P TF T, T-A F C-L) ; -P 0- @E N- -T C)COO CEYLL 03 C) CTIC RNSULTATIUN ANI 015 CC!IIIRLIFNSIVE STPCJ@,E FIRCI - -r.?@@ ------- --- -- - --------- - - -------- -I 019 P)IYI@ICIAt@S ASSOCIATE TRAI - ----------- - - - -- - 026 t, C Emfllty@LMA AND LUNG 01 - - - - - - - - ---- - - - I- S13@U4 -L---- I 023 C-Ikt: (@f PATIENTS WITH CHI I 029 CUT@ED P)iY ALUii PERSCTJNELI I I I I 030 C C @N S I V E R ii E Utl,.@T I C I E L Y r-@.- P 0 Li. I': 1 1'3'1 P -' 0 C,,2 L CII.PUIAC PAI I 1 15 JUAa9.& 00 0 3 2 C,'@:li'F.P L.@P)LP t,",RSltiG 101 I 034 rt,@iLy i.,ui@SE Pil.ACTITICr,[l --?-- - ---- - ----------- - --- I 3 5 A(.ULI ',CP.LENING PP(JGRAM I -- - - -------- I- CANCER PRCI &276.L2.12 039 @.ElGliPCk@ICOD P.GMT CTRS Cl I I n I_ 16 1 .6z9.-I- 16@6Z2- 040 c@OUC.'@T.0@.AL TESTING SERVI 041 AREA HEALTH EUUCATILN CLI TOTAL S145,400 1 $74?719 1 $2*195*500 1 $4,275,506 I__@it9.75, 381 RMPS-OSM-Jtotlm@ll MAP Cift t)72 RFGln'4AL mFr]ICAL yPFt ()GP AM S e SUMMARY BUDGET tl TYP@ OF I FEBRUARY 1, 1972 DEADLINE ,EGIn', 1)6w APNL REQUEST DIRECT CF)ST Rmps RMPS PREVIOUS RMPS RMPS .OmPrl,14ENT PERSONAL PATIENT EQUIP. CONST. OTHER TRAINING DIRECT INDIRECT TOTAL YEAR DIRECT DIRECT IST YR IST YR IST YR AWARD ZND YR 39D YR NO. Svc CARE t FELLOWS. NEW NOT PREVIOUSLY APPROVED ,39 39#325 14#25,S 53,sst 61,629 31 681) 1,500 6,145 4-1 219343 38,143 7,5-)2 45,695 13te9l) 2.)o,(,.on 141 NEW SUB-TOTAL 47,980 19500 77,988 277#468 2l,8L)A 2999276 74,719 APPROVED NOT PPEVInLtSLY FUNDED )Zo I I fl, 4'1') if) 7 000 25,nOO 145,4')O 47,240 1 87,64,1 I 45,4f)O-. 40T PPEV SUB-TOTAL 1 1 1), 4)f) I'l,000 25,:)Ol 145,4,)O 42,240 IR7,640 145,4'@)O C',lk4TINIIATID'i WITHIN APPRNVED PERIOD OF SUPPORT r)4,330 29000 5 137*610 643994) 241,q39 685,879 558,193 839,765 IqB,eoo lR79$q3 )n3 4',l , I L@'4 r,.141 45, 25() 12,506 -T,756 62,550 )15 65v3l4 2t750 56,nO6 124,070 29,392 153946Z 109*000 -ilg 5(.)#794 66,no-) o,oon 124,7q9 27,090 ist,sag 169,662 176 5793sq 11,246 63,635 53#295 135,n34 ')29 2692rlT 29000 39,743 67,450 7955) 75,000 52,233 112,743, 13f) 1699';8 9,54D 76,498 3,922 30,42') 33,821 110,RT6 031 '- 28p3ZO 9,040 37,360 7,611 449'971 26,861 219236 f)32 359893 35,893 32,0(18 84,237 11.1,704 24,?D? 127,915 r)8,493 107,641 134 839659 11850 MARCH 11),1972 PFC.InN,\L mrf)JCAI. PPNG!)AMS ,rRVICE ItMPS-OSM-JT(IrMB MARCH 1)91972 REGIONAL MEDICAL PROGOAMS srRVICE RMPS-OSM-JTC(,MSV;,- SUMMARY BUI)GET BY TYPE f)F ST)OPOPT RECIQN M6 Nn CAROL REQUEST FEBRUARY ly 1972 DEADLINE DIRECT COST Cr)MPONE,'4T PERSONAL PATIENT EQUIP. CONST. OTHER FTMPS RMPS PREVIOUS Rmps RMPS TRAINING DIRECT INDIRECT TOTAL-- YE SVC - C/.R E . . . AR DIRECT DIRECT 9 FELLOWS. IST YR 1ST YR I s,.T' I yik AWARD 2"10 YR 3RD YR 035 37,986 179640 51;t626 8t233 63,859 74,176 9qvO24 )36 32t5l2 31750 66*()OZ 152,264 229736 175tOOO 9lt4l2 276t932- CNNT. WITHIN SUB-TQTAL 93/)tl@8 12,350 424,427 8,,')nn 1, 657, 4t). 31)6,432 2,053tS72 19520*504 1 99?5ir38l.. PEQUEST TOTALS lvO94,568 23 t85,) 477,415 Ft, oon 2, (tan, of) 13 46n,480 2,540,488 1,520,504 2*1959500 tuirl'i T@l S 1.094,568 23,350 477v4l5 89'10() 2,')BD,008 463v48O 2954Dt488 1952OPS04 29-195,509' C.'IIPONFPJT COMPnqF-.NT 1111). TITIF YF Alt ),4 tjrlcp.@rikii,ir,r) CT;Z', CO'JTRNL HYPT A4D LIZAB 01 ')t,o @QtJrATIr)@'AL TFSTI@JG SFRVICR: TEST AND EVALUATION I t.5)FA lir,@ALTH E@IJ',ATIO-Y CE.N-TERS ')2 A CARE I)F PATIE,@ITS WITH C@4PONIC UREMIA C' Ir) C'IPF @TAFF ') " r)) ;;@VFI,(IPMENITAt. CP@PFINENT l@3 riAOLrric Cn@lSt3LTATn,l AN) Fr)IJCATInNAL SFRVICES 1) 5 STNUKE (15 cl:Z 0 rO A M I 1) tSS:)CIATE T;ZAI!JIPJR PRC;GRA.4 03 2 6 N C EI,4PHYS@tlti AN[) LUN(, I)ISCASE PROGRAM 02 1)29 Crl,'@FO PHY ALOH PfPS()Pl@JEL [@j E N C (%2 030 Cr)MPI)F@iF,%ISIVF RtiFtlItATIC FFVFR PREVENTION PROGRAM r)2 .') 31 COMP;ic,'IiENSIVF CAROJAC PACEMAKER EOI)CATION PROGRAM n2 ')32 CARE-FP LAN[)ER NI)PSING EDI)CATION 02 -) 34 FAMILY NIJRSR PRACTITIO'4ER ') 2 135 tf)ULT SCPFE,'.'114G PROGRAM 117 @)36 Cr))IPREHEtJStVE CANCER PR)GRAM 12 RMPS-OSM-JTU'7,Mt m HE(;INNAL MEL)tr.AL -RnrOAMS, CF I irri-jr. nf: An,iirriipjAi FTEGI(INAL MEDICAL PRORRAMS RMPS-OS)4-JTOGMRII@- ARcl*972 L[SRING OF Ant)ITI41PIAL REQTJEST FEBRUARY 1, 11)72 DEANLINF,- ,G,b.m.6 APOL., OTHER OTHFR TOTAL D@PO@EN'T 9-ps GRA4T RELATED INCOME STATE LOCAL FFNERAL NON-FEDERAL DIRFRT TOTAL FUNDS NU1414ER TOTAL INTEREST OTHER FUNDS FUNDS FUNDS FUNR)S ASSISTANCE THIS PERIOD NEW NOT PREVIOUSLY APPROVED 03q 539581 53r58l 451695 14f) 45#695 - -- --- 20f), nOO 2nltnoo NEW SUB-TOTAL 299, 6 219#276 APPROVED NnT PREVIOUSLY FUNORO 187#640 2.R l87v640 IOT PREV SUB-TNTAL 187,640 187,64n COIITINUATI(I@L WITHIN APPPNVED PERIOD OF SUPPORT 885,879 CI)OF) 885,879 n,Nnn 187,893 187,893__ 5T,756 57,756 115 li.3. 462 153,462- 1)19 1 51 i 88'3 63,635 026 6 3 ,',3 5 n7q 7c, , r)O'l 3@3,421) 3n,420 031 44,971 44,971 70,584 A3? 3-),893 '449691 127,915 334 1279915 63,859 1 .)35 639859 n36 175vOln t MARCII l-).1972 REGIO14AL MENICAL PRORRAMS SFRVICE ftmps-osm-jTOGMS 4 1 t- AI )I) I, iL uliu REQUEST FEBRUARY 1, 19 72 DEAR)L I t42 (%6 .140 CAROL ()THER OTHER TOTAL Cn4p,itiE,JT kmps r.RANT RELATED (NCIJME STATE LOCAL FEDERAL NNN-FFI)ERAL DIRECT TOTAL FUNDS NV.'413ER TOTAL 114TEREST, OTHER FUNDS FUNDS FUNDS FIJNn,.; ASSISTANCE THIS PERIOD CNNT. WITHIN SUB-TOTAL 29053#572 34#691 2tO889263 9EG1')N TOTALS 349691 2,5759179-- 2,541)#488 - --- - ------ M,AP' -919 72 PEGTnN4L mEnICAL PRnrTZAM$ 'VICE Ftmps-nSM-JTOGMS SUMMARY BI)OGET MY TYPE O', @nftT REQUEST FEBRUARY it 1972 DEADLINE PFr,ln,4 I), ISSCIUPI 4Ai@CH 10,11)1? P@FCI()%'AL '4Fr)IC&t. PPrl(;ftA.4S FRRVICF S(JMMARY lti)DC.FT iiy TY@ll- 'IF stjpp.,IRT N CAft(',LINA P.MP Sli!,P YR PEQIJFST MAY/JUNE 1972 kf-VIPw CYCLE [)cSK S(!UTH CFPIT'-AL R - M-i C(;Ra @IMPS HMPS RMPS Rmps TNT.L C 0 M P n N F N T cnP4PnN;:NT DIRECT INNIPECT TOTAI. DIRFCT OFRECT OIRECT P4 L) TITLE SuppnRr YFAR IST Yit IST YR IST YR 2ND YR 3RD YR ALL @%kS NEW NOT PREVI()USLY 6PPROVEr) )30 14@@ YGITT CTPS CG 10 , -42,; 14,256 53,50'@ 61,6Zq 1 0!7,, 9 54 @:T@CL HY,"T Al.;) 4," F 0 1. :,' @, T I L T c @ T I '! r, S'z P. V I ol -4,1,143 7,-;57 5,6q-) ill,091) .51, 2 33 Ct@ TEST Al@L) EVALUATICj%l )41 %.4FA HEALTH EDUC?.TlrjN CEN ot 2')", 00') 200,0@o TLRS NEW STJB-TOTAL 277.4f,@i 21,ROO 299,276 74,719 357,187 k@IOT PRE.Vlr"JSLY FUNI)@@D )?B (t.I!E (IF P.@Tl@@ITS WITH CtiP nj 1 4 -,, 4 O-) 4?1240 187i640 145,41o 29r", s@') r,'41C URFVIA .'40T P;ZEV SUB-TOTAL 145,4)-) 42,24(, 187,64n 14';, 4,),) 290,90,0 PFRIOR) OF SI.JPPORT C') n I CIRE STAT-F 05 641,q4l 241,939 RAI,,379 839,765 1,483,7@5 D') 0 .0 DFVF.Lf)P4FiNTAL Cfl"P('@-11@@IT 112 IST,RQA 187,AI)3 187,89-4 375,766 ')')3 OIA,3FT[I Ct,N@JL,TATlOt4 A14D Or) 49,2S') 57,756 45 , V I Cf.' STPI;KF PFZUG ;I Is 1 24 29,392 151,4f,2 124. (17" )lq AS@LICTAT@.' TPAT t)3 124,791@ 27, Jl)(% I -,I 'I B.) 124,799 N I Nf; P r It M ')76 N C FMP'IY'FkiA A@%4,) L(1'4G ni 02 -)@,399 11,246 63,635 135.034 187,423 sr.@';F Pi':;(.RA'4 ,)2 n C.Illlf,) Pi@Y Al ')if Pt'R@("@;JFL I;) 67, 4 5-) 7,-,50 75,,IOO 112.743 180,1-@3 114 I- ri c i,i o cr,,,PRrHrtisivF F 26.4qS 3,922 30,420 lll),876 137,',174 )31 P.@c (12 11,361 7 1,11 44,971 21,236 58,596 FF4t.KFR PQI@t,RA4 )37 CA;tFFk LAI)DFP NI)PSINR. rDU ()2 15,891 35,893 84,237 1 Z,'), I 3Z; CATICIN I nlv 71)3 I,) 7.641 1)34 FAMILY NT]RSF PIIACTITIONER ..02 24,207 1 27.9 1 li 211,349 li5 AUULT SCREEP41ilG Ppnrg,%m !%2 55,626 8,233 61,8'i') 9). OZ4 154,65n -CNNTTNUED ON NEXT PAGE- REGIF)NAL kiFnICAL PRO@'RAMS SERVICE @r(,.ION RMP S(JPP YR 01; SKJ@IMARY BU()GER giY'TYPr OF SLJPPRJRT -Cf)NT.- f)E SK SOUT@I CENTL?AL PFOIJEST MAY/JIJNF- 1972 RRVIFW CYRLE Ps RMPS RMPS R4ps TRTAL CC'@'4PC.iENT COMP@)NIFNT nlr(rCT ltl.'r)IH@CT TilTAL I)TRECT DIRECT n[RECT TITL@ SU,-'P')PT YEAR IST Yx IST YR IST YR 2t:D YR 3RD YR ALL 3 YRS 1)36 CO)JPqEHn,NSIVE CANCFR PROC 02 152,264 22,736 175,000 276,932 RAM 429#196 COIIT. WITHI@L SUB-TR)TAL 1.657,14,') 396,432 ?,151,572 lol)75,381 31632,521 T.)T 'tL5 46(',430 2 i 5 4) 4 R q 29105,50i 4 2 75,.5') 8 -M Ai' mF 0 1 C A L I'Rn f P V I r F -C!i I'll 11)7? PF.G(P,'@AL LISTIN(; OF Au;)[Tlll-'i&L REOUF.;R MAY/Jt)NF 197? RFVICW CYCLE N PI-P SLJPP YR r5 T @iF. k I)T@IF ti TOTAL COMPIINENT 12mps t',RA@IT RELATEL) I%C:IME STATE LnCtl. FFI)ERAL '4f)N-F! )FRAL r)IP.ECT TOTAL FIINOS @ILIMIIER TNTAL lil.'TEREST F U.\'I) S r u,it) S -i)hlf)S ASSISTA.NCE THIS PE@l,')D @@Ew qOT PREVICTJSLY APPROVED 53*581 53,591 5, f,'; 5 45,695 r'41 2 ') NE,d SuB-TOT.@L 299,276 APPROVE[) NI)l PRRVIOUSLY FU'4DFr) 2 4 7 t f-4,) 187,640 ',,,,3 TPS.EV SUi;-T()TL 197,640 Cn@4TI14UATIott WITHTN APPRI.)VEN PERIOD OF StJOPf)RT 865,871) I F;7 , fk-) I 57,756 57,7i6 153,462 5 l';I,462 olq 151,889 63,635 ,)26 7 5 2 7i, C)',- 30,42) 2,j 44,971 '131 c 44,-;71 032 34,691 70 , 5ki4 034 127,<)IS 1 27,'41 5 63,859 035 63,859 036 1 75 ()f)O 1 75 !)Oo REGIO@.IAL MEL)IRAL PporkAMS SFRVICC MAKC@I ll,),.1972 LISTIN(; @IF Al)[)ITlr.INAL F()NDS REUur-ST MAY/ -,E -VIEW Jij 11)72 RE CYC.LE PEGION 06 N CARRILINA RMP SUPP YR 05 OTHER nTIJFR TOTT.L %'IN-FFOCRAL DIRECT TNTAL FUNII)S ,'CqPnl,,ENT RIAPS RFLATEI) STATF LRICAL @rr)FkAL ASSIST.NCE THIS PFRIon TOTTL ITITFPF.ST OTiirR FI)NN.S $:L'NnS F U%'@)S CotiT. WIT.41N SIJP,-TOTAL 2,08S,263 7,0539572 34*691 kEGI,)N TR)TALS 2,575,179 34, t, "Rvvrr RFClfl-;-%L mFr-ICAL PI:(, 11), 9 72 PAGE 5 REGIONAL MEDICAL PROGRAMS SERVICE RMPS-OSM-LFKRFQJ MARCH RAps FUNDS RFOIIESTED REQUEST MAY/JUN 1972 REVIEW CYCLE r) El;t[)N 06 N CAROLINA Rmp.supp YR 05 (PERCENT OF TOTAL FUNDS REQUESTED) TNTAL PMPS FUNF)S OTHER SOURCEN TOTAL SUPPORT ---.-,RMPS 't TITLE ALL SOURCES OF TOTAL ()MPONENT NUMRER REQUESTED OF SUPPORT 885,879 too es5,679 0 COOD CORE STAFF 187v8gl 0 1979893 Ino ot)00 DEVELOPMENTAL COMPONENT -DUCATIONAL SERVICES 57 9 7-56. 0 57,756 lo@ - .- [)IASET$r@ CONSULTATION AND E C) 1539462 0 153t462 1 015 COMPREHENSIVE STROKE PROGRAM 151,889 10?) 1)19 PHYSICIANS ASS(@)CIATF TRAINING PROGRAM 0 6.4. 6",i 10 LUNG ',)ISFPkSF PROGRAM 63,645 ')26 N C EmpIlYSF M fA A4 1) n 1879640 I O') 187*64q ')28 CARE OF PATIENTS WITH CHRONIC UREMIA 0 750000 100 029 CONF.D PHY ALOM PEPSr)4NEL tN F N C 75,000 I n,) Compq HR-UMATIC FFVR-.R PREVENTION PROGRAM -4 0 3#),420 0,420 .FHF 030 NSIVF R 0 44,971 i3i COMP'AEHENSIVE CAQD[AC PArEmAKER FI)UCATION pFtnCPAM 44,q7l 84 51 '45,89-t 349691 70,5 SINR, FOUCATin.4 032 CAREER LADDER NUR 7,915 0 127.qlS 034 FAMILY 04URSE PPACTTTTNNER L2 n 63,8'i9 Ion ili@ (135 ADULT SCREENING PRr),@RAM 639859 1 7 r, , ') t.) ',) (I 17'i.00() ll,)O 036 CDMPREHFNSIVE CANCFct PROGRAM 539581 ' - -. 101) . a 53*581 NEIGHBORtIO00 MG'4T CTRS CONTROL HYPT AND ()IA 040 EDUCATIONAL TESTING SERVICE TEST &NO EVALUATION 45,695 n 4 .5,695 100 2,no, DO') 0 2 DO, 00t) ji) 0 t) 41 AREA HEALTH E-F)UCATION CENTERS qq 2*54C,488 34,691 2, 5715,179 REGION 6 TOTAL OF t7 COMPONENTS MARCH 0891972 REGIONAL-MEDICAL PROGRAMS SERVICE DESK SOUTH CENTRAL AREA RMP-OSM-PEM001 LIST OF-COMPONENTS REQUESTED Fz)R NEXT SUPPORT YEAR REGION C)6 RMP-SUPP-YR 05 REQUEST MAY/JUN 1972 REVIEW C-CLE COMPONENT COMPONENT NEXT DIRECT COST EST DATE OF NUMBER TITLE SUPPORT YEAR NEXT PERIOD TERMINATION COOO CORE STAFF 05 643,940 DODO DEVELOPMENTAL COMPONENT 02 IS7,893 003 TION AND EDUCATIONAL SERVICES 05 45,250 06/73 DIABETIC CONSULTA 015 COMPREHENSIVE STROKE PROGRAM C)5 1249070 n6/73 019 PHYSICIANS ASSOCIATE TRAINING PROGRAM 1.) 3 124,799 06/73 026 N C EMPHYSEMA AND LUNG DISEASE PROGRAM 02 52,309 06/74' 028 CARE OF PATIENTS WITH CHRONIC UREMIA 01 145,4r)O 06/74 029 CONED PHY ALOH PERSONNEL IN E N C 02 67,450 06/74 030 COY.PREHE@ISIVE PHEIJMAIIC FEVFR PREVENTION PROGRAM (%2 26,498 06/74 031@ CC!IPPEIIENSIVE CARDIAC PACEMAKER EDUCATION PROGRAM 02 37,360 06/7 -,-. . I ... -"- -. - . - .. -- - 032 CAREER LADDER NURSING EDUCATION 02 35,893 06/71- 034 FAMILY NURSE PRACTITIONER 02 103 708 06/74 035 ADULT SCREENING PROGRAM 02 55v626 06/74 036 COMPREHENSIVE CANCER PROGRAM 02 152,264 06/74 039 NEIGHBORHOOD MGMT CTRS CONTROL HYPT AND DIAS 01 3c), 325 -7 06/74 040 EDUCATIONAL TESTING SERVICE TEST AND EVNLUATION 01 38,143 06/73 041' AREA HEALTH EDUCATION CENTERS 01 200,OCO TOTAL REGION 06 COMPONENTS 17 2,080*UO8 MARCH 23*1972 REGIONAL MEDICAL PROGRAMS SERVICE PAGE I SUMMARY BUDGET CATEGORIES BY COMPONENT RMPS-OSM-JTOrM2 "19 PEGION (116 N CAROLINA REQUEST MAY/JUNE 1972 REVIEW.CYCLE PONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT com NO COOO NO DODO NO Or)3 NO 015 NO 019 NO 026 NO 028 NO 029 No 030@ I PERSONAL SERVICES 09364 22,748 l4t494 4479780. 35,830 58,884 45,150 43i243 10 SALARIES, WAGES 5,644 2,344 100036 3,459 21464 EMPLOYEE sENEFI.TS 56,550 4,279 69430 10*400 26,207 16.950 ,TOTAL 504,330 4OwlO9 659314 50,794 45958T It PATIENT CARE IN-PATIENT OUT -PAT I ENT TOTAL ECUIPMENT BUILT-IN 10,000 2,000 MOVABLE 2,000 29750 TOTAL 2t750 101000 2*000 IV CONSTRUCTION N EW MAJ ALT &REN TOTAL V OTHER C'@.'-.'S U L T ANTS 4*,IOO 3r2l6 Ifooo 5*000 249000. 4,200 SUPPLIES 10,000 Boo 11250 7,000 3,680 5*500 39743 [)MST TRAVEL 27,110 750 4y8OO 29500 29000 6#500 2, 500 1,000 - FRGN TRAVEL PENT SPACE 3,240 2tl4D--- 2,100 1,000 RETJT OT HE R 7,000 MIN ALT & PEN 1,500 i,ooo 5,000 12Z 2,000 PU BL I CA I 19N S 2tOOO 38,200 4:0,000 3,000 COTITRACTUAL 73,000 1879893 3,000. 2slOO C EJIAK UN I C A TI ON 12,000 1,191 3,000 2,000 COMPUTERS -51000 1, 300------ 2,405 .80000 10; OTHER i,ooo TOTAL 1379610 1-87,89,' 5tl4l 5690')6 66*005 6,802 25wCOO 39t243 99540 VI TRAINEE COSTS STIPENDS 8,000 OTF.EP BVOOC- TOTAL TOTAL DIRECT COST- 6431940 187,893 45t250 1249070 124#799 529389 1459400 67t450. 26t498 l2v5O6 29t392 27,090 119246 429240 7*550 3,922 INDIRECT COST Z4lt939 TOTAL DIR IND 8859879 187,893 57,756 153,462 151,889 639635 187,640 759000 30,4ZO MARCH 23vl972 REGIONAL MEDICAL PROGRAMS SERVICE PAGE 2 SUMMARY BUDGET CATEGORIES BY COMPONENT RMPS-OSM-JTOGM2-01+ REGION 06 N CAROLINA REQUEST MAY/JL$NE 1972 REVIEW CYCLE COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT REG104 .NO 031 NO 032 NO 034 NO 035 NO 036 NO 039 NO 040 NO 041 TOTALS I PERSONAL SERVICES SALARIES* WAGES 24,451 32,566 73,00'J 32,818 75,011 28,800 16t3OO .1*0519439 EMPLOYEE BENEFITS 3,869 lt723 109658 5,168 79501 2t880 123POO5 TOTAL 28v320 34,289 839658 379986 829512 3lt680 169300 191749444 II PATIENT CARE IN-P AT I ENT OUT-PATIENT TOTAL III EQUIPMENT BUILT-IN MOV AOL E 1,850 3,750 1,500 23,850 TOTAL Ite5o 3,750 1 i 500. 23r850 IV CrNSTPUr-TION @4 EW MAJ ALT C REN TOTAL V OTHER CONSULTANTS 80300 10,000 6,800 62#316 SUPPLIES 1,500 49200 6,800 8#414 2,000 1,175 60*262 OMST TRAVEL 29500 1,604 5,t)00 zvsoo 7,050 300 29335. @68,449 FRG'4 TRAVEL RFP,T SPACE 2,140 2t98O 12, 90-,% P-E t4 I OT!IER io,too MIN ALT & REN 11 501) PUBLICATIONS 100 200 2,074 200 12,69b CONTRACTUAL 22#983 21000 200#000 567#076. COMMUNICATION 29700 500 3,660 4,567 19045 35,763 COMPUTERS 9t3OO 600 4 5) 15 t3.50 OTHER 100 1,700 1,614 11,083 27,3f)Z TOTAL 9tD4O 1,604 l8t2OC 17,640. 66,002 6.145 Zlt843 200*000 873,714 VI TRAINEE COSTS STIPENDS 81000 OTHER TOTAL stooo TOTAL DIRECT COST 37v360 359893 lO3v7C8 559626 1529264 39#325 389143 200,000 29080*008 INDIRECT COST 7v6ll 24,207 8,233 22,736 14#256 79552 460,480 TOTAL DIR IND 44,971 35,893 127,915 63PB59 175,DOO 53,581 45*695 2009000 2954ot488 II IN At M i 1) It. Al CtiPR f 1, I AS oF 1(1/31/71 PAGE: I RUN DATE ollit/T2 PROG YR 04 LEVEL F,JNOI@4G i)[1@ICT T(Il AL RLG iEGION camp CUMPL)NT- r4Y II I t 1: @, I,.% k a AI%AP U AYII.R 0 NO NAME NO 558.2',O 22r,,800 779tOCj 06 @NO CAROL cooo CORE ADM RES kVAL 196,800 06 NO CAROL Dooo DEVELOPMENTAL 74,r,'OO 19t3Oo 9393CO t)6 NO CAROL 001 EOUC RES Comm MED CAPE NEEDS 44,,400 T,BDO 52*200 CCU TRG DEV CONED MD N 06 NO CAROL 002 62,600 159200 779800 06 NO CAROL 003 OIAS MGT TO PRACT CONS CLINIC 16,000 4,230 2Ct2OU ,6 xEGISTRY REGIONWID NO CAROL 004 DEVELOP CA 23,600 6,800 3C,,.60 @6 NO CAROL 005 ME() LIBR XTN SLR 57,OGO -T2,300 69#300 06 NU CAROL C;()$ ED PHYS DENTISTS UNIV NC 42 S;)G 7,5DO 50, C; ')O ST Cp RESUS UNIT 06 NO CAROL 013 CLOSED CHE UL ED t,,LM MISS ASHV 7,100 300 7,4CO NO CAROL 014 HEART CGNS 015 COP.PR SIR PRG 1306MAN (,RAY. lrg,ooc 24,slc 133# 5,JO NO CAROL 3C,000 12'stoo 42,8 NO CAROL 017 REG CTITR GT:ST TF(OPHOOL NEOP 4 @16 16q,7c)o 53,600 2Z3#300 06 -t4C CAROL C19 TRG MD ASSYS DUKE U kURL MDS C6 NO CARGL. 023 PILOT STI)Y SCH CHLD PHNCASCAN 22,200 3,30C, 25,500 CONED 10@OS ALE)H AECRT EAST NC 5C-,Or@o 10,000 6C,CCO 06 NO CAROL 029 2 8 4(10 4,230 32,60r, 06 NO CAROL 030 RHEUM F PRG(, CHLURN 06 NO CAROL 031 CARDC PACEMAKER EDUC INFO PRG "6;jO 3,600 14,200 50 , G(7ic 20,000 7C., c co 06 NO CAROL 034 FAMILV N PPACTLTIONER 72,6%10 12 *3()O 841900 6 NC' CAROL R AtiE.IAIA RELATED FU 035 ADULT H ST 759')CO 250000 loo,occ 06 NU CAROL 036 CA PRG CUNED PKUF LAY 06 NO CAROL 037 Coop CONED PRG STWD 2(i,ooo 1,6@o ic9coo 1,503 111,5cc, C6 NO CAPOL 038 CA TLPH CONF MU$ U REG CTRS gErloN TOIALS 1,73l,guu 466,603 2,lq8,5GO NO OF CCMPON-E'ITS 22 out P'AQCH 14, 197 2 REGI@INAL k'EOICAL POOL;RA'4S SEPvicr DESK SOUT14 CENTRAL AREA RMP-OS-4-Pr.m,)Il REGIGN 06 NO CAROL BkIOGr.,T Pfklt)') LIS.'ING AWARD AS OF 12/31/71 RMP C04P FY ACT TYP TYP RMP COMP CompnN(,NT TITLE PUDGET PERIOD pi f] NO DATE ACT SUP SUP YP SUP YR FROM THPU 06 C')OO 71 11/71 4 2 n4 04 C-IRE 07/71 06/72 06 0000 71 11/71 "5 5 04 ot DEVELOP'I[NTAL L)7/71 06/72 )6 DOI 71 11/71 4 2 04 04 EOUCATINN AND PCSIARCH IN C(IMIAUNITY ?iEDICAL CARE 07/71 06/72 CJ6 i)02 71 1 1 / 7'1 4 2 f)4 04 CI)KONARY CARF TRAINING AND I)EVELnpMENT C@7/71 06/72. 6 71 11/71 2 04 f)4 rIAI3[.TIC AND Cl)kICATIO.'4AL SERVICES 07/71 06/72 003 CONSULTATION ')6 4 71 11/71 4 2 04 11) 4 CANCER PtrIS,rRy UTILIZATION Piii)GRAti 117/ 71 06/72 06 71 11/71 4 2 )4 C4 MT.'OICAL LI-IRARY FXTI'NSILIN srkvice 07/71 06/72 j6 008 71 11/71 --4- 2 fi4 04 CONTINUING EOLJCATION IN DENTISTRY 07/71 06/72 (j6 013 71 11/71 4 2 04 C4 CLCS[D CHRST CARD10PULMONARY RFSUSCITATION i,)7/71 06/72 )6 014 71 11/71 4 2 )4 04 litA;JT CA"C.LR ST@,@KL CO@;,LJLTt.Tlt)t*' AND ED:JCATION Li7/7l 06/72 )6 .11 5 -71 11/71 4 2 1)4 04 COMPi@Flif',t@SI'JC- ST;znKE PF,('CRAM 07/71 C6/72 IJ6 017 71 11/71 4 2 04 03 REGINNAL CENTEK FOR TROPtiD3LASTIC DISEASES 07171 06/72 36 71 11/71 4 2 u4 L)2 Pi4YSICIA'.'% A,SISTAliT TFAillINC. PPTICRAM 1 ',7/71 06/72 ;)2 2 71 11/71 '4 2 t)4 13 cocqi)i%,.@TrD r)NCI)L(ICY CIIEIJOTPCRAPY PRCGRAM ')T/71 t)6/7Z )6 023 71 11/71 4 2 04 03 lirAItT Sl',I@,:)S SC!tEF!4lNr. PRllr.RAP- 07/71 06/72 36 ",26 71 11/71 -4 I n4 01 N C [14PHYSEMA A4D LUNG DISEASE PROGRAM 07/71 06/72 16 129 71 11/71 '4 1 04 01 CONT ED roR PHY ALLIED 14,LTH PERSONNEL IN ENC OT/71 06/72 04 GI CIIMPRE.IIF.4rIVE R'IC()14ATIC FEVEP. PRFVENTINN PROGRAM 07/71 06/72 ,6 -13') 71 11/71 4 1 06 @)31 71 11/71 4' 1 04 )I COv.FIRFlir,4SIVC CARDIAC PACFt'.AKFR EDLICAIION PROGRAM 07/71 06/72 ut, 032 71 11/71 4 1 04 ut CARFER LADDER NURSINC. EDUCATION 07/71 06/72 @3(, 034 71. 11/71 4 1 04 01 FAMILY NURSE PRACTITIONER 07/71 06172 16 035 71. 11/71 -4 1 04 DI ADULT SCPFENING PROGRAM 07/71 06/72 .)6 036 71 11/71 4 1 n4 LI I CO','rEHrN%[Vr CANC@R PRr.C.PAM. 07/71 06/7Z '6 .11 7 71 11/71 4 1 Al 4 .11 C(;(ii,rt;ATIVr r'RrrWAM nF Cn.'4TINI)I.NG LI)UCATI(IN t) 7/ 71 ')6/72 1 6 ')3 8 71 11/71 4 1 ',I 4 I rFGIOPif%L TFLEPH(INF CA.4C[R CO@IFEKFNCE 07/71 06/72 'TOTAL (:rtI.PONENTS REGION 06 25 Region North Carolina Review Cycle PRINCIPAL PROBLEMS: The November 1970 Site Visit Team identified three chief weaknesses of the North Carolina program. These were subsequently reaffirmed by the April 1971 Review Committee and May 1971 Advisory Council. They were: 1. Gaps existing in the composition of the RAG - it was felt Blacks, Allied Health and Consumers were not properly represented. 2. Of the two governing bodies, the RAG and the Board of Directors, it was the 17 member Board that had final authority for program and operation ec s ons. 3. The Research and Evaluation Division of Core Staff which was centered in UNC was not instituting adequate evaluation practices. The site visitors believed a stronger evaluation section should be developed in the central core office. Other observations of the reviewers were: Nearly all health agencies were involved in NCRNP planning and/or operational activities with the exception of the Black Medica Association. Little enthusiasm could be mustered for support of the arge number of renewal projects. One exception was the Stroke Project. It was believed the Region must come to grips with phasing out new projects. OUTSTANDING ACCOMPLISHMENTS: During the past year NC/RNP has concentrated on strengthening the weakness identified (above) by the National Review Bodies at the time of their triennium submission. 1. They have improved the composition of the RAG by adding a Nutritionist and an X-ray Technician to the existing three Allied Health representatives. Public representation has been increased from 4 to 12 and Black representation has been increased to 9. To accommodate t ese new members the total RAG has been increased from 36 to 51. 2. The Region has reorganized its advisory bodies, disbanding the Board of Directors, and giving final authority for all activities and policy matters to the RAG. A 13 member Executive Committee, consisting of members of 7 designated institutions and associations and 5 other representatives elected by the RAG, manages affairs in the interims between quarterly meetings of the total RAG. 3. The Research and Evaluation Division of Core at UNC has been disbanded. Replacing it is the Division of Planning and Evaluation within Core which will be directly responsible to the Director. This Division will be staffed by a Director (newly hired) a biostatistician (TBA) and an evaluator (TBA). This Division will also be supported by a $30,000 budget item to enable subcontracting for data services with appro- riate agencies. Consideration has been given to involving the Black Medical Society "Old North State" which has approximately a membership of 200. However, the Black doctor currently on the RAG and other Black physicians informed the Director this is not really a viable organization and they feel its representation would not.be that relevant. This is believed to be particularly true since the State Medical Society now has integrated representation. Of twelve renewal project requests incorporated in the triennium submission the Region saw fit to support nine during the current year. The 05 Anniversary Application requests continuation of only two renewals, one the Stroke Project mentioned as an exception by the national reviewers (see above) and the second a Diabetic Education Project. Each request one additional year support. A third renewal the Cancer Registry is being incorporated at a much reduced level into another (non-renewal) project, Comprehensive Cancer Program. In summary, of the nine renewal projects, six are being supported from other sources, two are being continued one more year and one is being incorporated into another project. In one general statement, it is Staff's opinion that the Region should be commended on the accomplishments resulting from its effort to respond to weaknesses identified by the national review bodies a year ago. ISSUES REQUIRING ATTENTION OF REVIEWERS: While Staff in its review of this application was highly complimentary of the Region's achievements over the past year in correcting major deficienc es, it identified a number of issues which should be brought to the attention of the anniversary review bodies. 1. The goals and objectives, while having been moderately revised since the triennium review, like many Regions remain extremely broad and non-specific. It should be remembered,however,that they were developed by a subcommittee appointed by the old Board of Directors, right at the time the program was undergoing the stresses of organizational change. It should also be noted that RMPS reviewers have never before been critical of NCRMPs goals and objectives. Recently a Long-Range Planning committee was appointed by the RAG Chairman. One of its functions is to re-examine and refine the goals and objectives, relating them to specific time-frames and measurable,indicies. Staff believes the Region should be praised for recognizing the need to develop more sophisticated goals and objectives as the Region matures, and would recommend that encouragement be extended and RMPS assistance be offered as part of the forthcoming advice letter. 2. While the Region is making significant strides in its attempt to seat more minority representatives on the RAG and to hire more minorities to core staff positions, there has not to date been any significant effort made to include minority or underserved health interests as a major consideration of the North Carolina Program. In the past year, less than $100,000, of program funds, have been spent in underserved health related activities. This might be explained by the fact that NCRMP has concentrated basically on quality of care in categorical disease areas which consequently relates primarily to those consumers who have some means of meeting medical expenses, with little relationship to the health needs of the underserved. While Staff recognizes NCRMP has commitments for future years to certain ongoing program activities which emphasize quality health care, the myriad of accessibility and avail- ability problems faced by the underserved of N.C. combine with the priority RMPS places on these problem Areas would indicate a need for NCRMP to devote more attention to availability and accessibility. Consideration must be given to the fact that the Region's program was accepted last year by Council, without criticism of.the direction it was taking at that time. 3. Within Core is a Continuing Edutation Component which supports part-time Institutional Coordinators and their Staff at Duke, Bowman Gray, UNC and UNC/SPH at a total of $97,158 (d.c.). At the December '72 RAG meeting these positions came under close scrutiny and a sub-committee was assigned to make an assessment of the value of supporting these positions. It is speculated by the Deputy Director that this support will be cut 2/3 to 3/4 and the institutions have been notified of the possible cutback. The Director feels a need to institute Rradual phase-out in order to maintain these institutions cooperation. As a result of supporting these positions, the schools make available faculty consultants to NCRNP and its affiliates, free of charge. The subcommittee is also evaluating the entire RMP organization outlined in the application which was developed at the time the Board and RAG were in a state of transition. It has not as yet been officially adopted by the new RAG, although NCRNP is functioning basically along these lines. There is a disagreement among Staff as to whether the insti- tutional coordinator problem should influence the funding recommendation. One side argues that the Region has not .2 hese positions and reduced taken it upon itself to eliminate t Grants Manage @ t funding would help it make this decision (see gnize The other side argues the Region does reco attachment). d has taken positive steps in the form of a the problem an it, and given the Region's record of subcommittee to resolve MS directives we could expect N.C. with proper responding to p ed changes (without punitive advice from us would make the desir his should be funding action). Besides the aregument that t done on a phased basis is reasonable. Also the funds supporting iewed by the Region as an incentive these positions can be v in that as support is reduced , these funds become available for other activities. It should also be remembered that the national reviewers a year ago had no problem with this arrangement. 4. The fact that the four Institutional Coordinators being paid out of core funds also serve on the RAG and Executive Committee, and that one serves as Chairman raises a question of propriety. Staff does not see this as a legal question as the by-laws do not specifically provide for this type arrangement. While it is obvious the Region sees no problem with this arrangement, Staff agrees it is not one which insures against suspicion or criticism of conflict of interest, excessive medical school influence, and an ackward relationship between the Director and the Coordinator/RAG members who must play duel roles to each other. Staff would recommend the Region discontinue this --arrangement, and perhaps provide against such future arrangements by means of a provision in the by-laws. North Carolina RW prepared @iwilliam Reist Date: 4/3/72 a2 The goals and objectives presented in the Anniversary C)bjectives and -Priorities: Application were developed by a subcommittee appointed the old Board of Directors. They differ moderately from those of the triennium a year ago but remain like most regions, very broad and non-specific. The RAG, recognizing the need to update and refire them, has appointed a subcommittee which is in the process of developing new ones which will be measurable and relate to specific time-frames. The national reviewers, a year ago had found the goals and objectives to be satisfactory, however as the region matures, so should the entire program. Their simplicity would indicate they are well understood, here again the reviewers of a year ago saw no problem in this area. While short-term objectives and priorities have not been identified, plans are to include them in the new ones being developed. National priorities are to serve as the general guidelines. Related local needs are to be identified taking into account data and resources. While the current goals and objectives leave much to be desired, theregion should be comended for recognizing a weakness and taking remedial action prior to it being pointed out from an outside source. - - - - - - - - - - - - -- - - - - - - - - - - - @d Ar-tim: Staff would encourage and endorse NCRNP's action -and offer RMPS Staff assistance if the Region would so desire. Arcmplishmen-ts and Implementatiots. Core can be comended on the number and types of activities it nas engaged in and stimulated. Nbst activities have been unique to the particular problem and in most instances were not readily applicable to other problems or areas. Unique activities which could have national implications are the Stroke Program and,the Test and Evaluation Strategy for Improving Quality of@Nursing Care. Practically every project is desi2ned to,or has some component which,promotes new knowledge and techniques. The effect on moderating costs can be assumed, in that the more skilled health providers are,the more efficiently they operate. Quality of care as it relates to categorical diseases is probably the most outstanding a@ievement area, however it relates mostly to those who can cover medical care expensps. Certainly the major health provider groups and institutions in the state recognize NCRMP as a source of professional expertise assistance and information. ------------------------------------------------------------------ ------------- ----------- ended-Ar-tion: No Action Recomended William Reist Date: 4/3/72 o@ 12 renewal project.requests incorporated in the triennia Continued Support,: -he current submission, the Region saw fit to support 9 during t year. The 05 Amiversary Application requests support of only two renewals, one the Stroke Project was mentioned as an exception by the national reviewers a year ago although tfiey were generally critical the large number of renewals. The second is a Diabetic Education ect. Each request one additional year of proi support. The third.ren Cancer Registryis being incorporated at a much reduced level into anotrear (non-renewal) .project, CQm-prehensive Cancer Program. It should be noted that an overwhelming success of the'Stroke Program in and mortality influenced the decision of the Region reducing hospitalization to continue it for one more year. NC@ is now pursuing a policy of insuring other sources of support for the continuation of projects it funds. With few exceptions, outside sources have picked up continued support of projects. In those exceptions the projects were not worthy of continuation. Recomenclec' Act'on: The Region should be comended for its actiOn in teminating -renewed rojects. p 4. Wmority InteTests:NCWs _goals and objectives do not place any emphasis on 1w,rovijig iiea care to the underservea. Project activity tends to reflect no particular comitnent to serving the disadvantaged. O'L the total NCRMP budget less than $.loo.o@ has been spent in this service, all in feasibility or developme@ta'!'(foinponent activities. While some of the training programs might indirectly result in some atloyment benefits to the minorities, it is only a matter of coincidence. The Director has made an outstanding effort to include minorities on the RAG and is presently try@ng to recruit three Black professionals and three Black secretaries to Core Staff.. NCRMP does work closely with CHP and in some instances Model Cities. It might relate more closely with Indian Health, Appalachian Program and Migrant Health. --------------------- ------------------------------ e North Carolina to look more closely to Recomencled Action., Encourag the needs of the undersexed -.are these not infact some of the more important needs of the Region. Encourage th6 Region to balance quality- of care with accessibility and availability, particularly as it relates to the i in(I P--r-, erved. lbte: 4/3/72 North Carolinil PMaTed By,: William Reist bordinator: Dr. Patterson has served as Director since April 1970 (2 yrs.). Before 7e-was a practiciiig.surgeon in east North Carolina and did some cancer pMming as a member of Core staff. He is highly dedic'ated and.very conscientious. He works extremely hard on his job and is respected by ail members of Core staff. He can be credited for the new RAG organization and other major accomplishments over the last year, all of which apparently were very difficult tasks,(Particularly since Dr. Patterson is not an aggressive and bold individual, but rather a person who avoids confrontation and.respects individual opinion). He relys heavily on Mt. Ben Weaver, his Deputy.to@carry out many administrative and managerial details. Ben is highly competent, but does not always take advantage of other Core members knowledge and e!Kpertisp, to the extent that he might. Core members feel they are frequently excluded from.activities to which they could make a contribution, and that their ideas do not always get proper consideration. ded Action: Dr. Patterson feels a Management Assessment Visit ould be of great benefit and will be making a written request for one to be conducted early in the next calendar year. 6. Core Staff: Administrative Core Staff consists of 12 professional Staff, 11 of whom are full time, and 9.5 secretaries. Not included in this is a new Director of Planning and Evaluation coming aboard on May 1 and two subordinates,- a Bi6statistician and an Evaluator wl)ich are being recruited. Also a Nutritionist and three secretaries are being recruited. Core staff at uNc which has served as Research and Evaluation Division has been dissolved and is being replaced by .the e lanning and Evaluation Division which will be responsible directly to tRewDirector- Within Core is acontinuing education component which supports part-time institutional coordinators at Duke, Bowman Grey,,TJNC, LJNC/SPH- totaling $97,158 (d.c.). At the December 1971 RAG meeting, these positions came under close scrutiny and a sub- committee of the RAG was assigned to make an assessment of the value of continuing support for these positions. It-is speculated by the Director that this support will be cut by 2/3 to 3/4. The institutions h=llb%en notified of possible cutbacks and are'somewhat disturbed. As a result of supporting the coordinators, the schools make available other faculty consultants to NCRMP and its affiliates, free of charge-. The evaluation of the contribution of these people is done subjec@ tively. Some members of Core Staff 'are skeptical that dollar value to NCRMP is received, howev.er, most can see the overall continuing education effort of the Lmiversiti6s in North Carolina is enhanced. The Committee evaluating the Continuing Education c6mponent is also examining the current organization including t.],- rr.,@-litee.-qtnirtllrp ------------------ -------------------------- Recomended Action: Coimnend the RAG in its effort to examine the,continuing education component and 'internal organization. Point out that organizational planning should be'done in concert with establishing goals objectivesand priorities. epaTed By: Willinm Reist Date: 4/3/72 .jo Aclv-isory (;Toup: Reviewers of the Triennium Application one year ago 7. Regional deficient in consumer, allied health, Jay and Black - e=l ( representation. The RAG now has or will have in the near future twelve members Of the public at large, five allied health representatives and nine Blacks. The recommendation that the Board of Directors and the RAG be combined into one governing t. An Executive Committee meets on a monthly basis to aqt body has been carried ou Itings generally have a 6S- on business for the RAG which meets quarterly. RAG mee ecutive Committee, 70% turn out. out of -the five ele6t6d members to the 13 -member Ex , at uNC-none are Blacks .'i The RAG has one.,represents the public and is a professor orted only met twice in its new capacity as a @olicy-making body, however, it is TeP that it has demonstrated new st're@gth at- the last meeting by questioning the organization of Core staff. As a result it appointed a committee which is currently reconsidering NCRMP organization. lVhile Staff has offered the current organizational chart, there is some doubt that it will be accepted. Althouah the committee has met once it has not made known what in fact it is considering. --- - ------------------------------------ - - ----- ed Action: Comments relevant to the RAG and the related by-lawl are part of the attached Grants Management Branch report. Du serves strictly a,. antee Organization: the Core staff member who works closest to the grantee reports 8. G-r Duke has never tried to use its position as grantee to influence decisions being made by NCRMP. He reports that the only problem arises out of the attempt on his part and personnel at Duke to maintain books and records which comply with both Duke and RMPS regulations . He claims this at times strains personal relationships. He claims that Duke is not enthusiastic about serving as grantee and tends to be quite in@ ependent. It has recently dissolved, for no apparent reason, its relationships with another federal agency from which it was receiving indirect costs. ----------------- ---------------------------- ---------------------- ent Branch sees a problem in the relationship Recommended Action. Grants Managem between Duke University, the Grantee and the RAG. This problem is outlined in detail iik the attached Grants Manaizement. Branch Report attached to the Prog@am Analysis GuicLe. @IP: North Carolina Prepared By: William @eist @]Date: 4/ Most key health interests are represented on the RAG. Numerous other articipation- health institutions are involved, in that-they are active participants in ongoing projects.. llhile NCM has recently worked-closely with Migrant Health, and in fact is supporting one of its projects, there is.little evidence that rapport has been established, or cooperative efforts have-been made, with Indian Health Services or the Appalachia Program. History indicates that the program has been highly medical-school oriented and dominated.. The recent RAG related changes, appeared to be having a significant change in -the balance of power. This is exemplified by the RAG's new initiative in assessing the total program and in particular the institutional coordinator's role,. ------------------------------------------------------------------------------------------- -R6c6men'ded Action: (,iven the new emphasis North Carolin is placing on deliv a ery systems and the considerable number of migrants,Indians and rural poor in North Carolina, it may be beneficial for the Region to work more closely with the Appalachia Program, and Indian Health Services. Consideration might be given to including these groups on the RAG and subcommittees of,the RAG to which they might relate. 10.' Local Planning: North Carolina has not subregionalized and developed local planning groups as have many other regions. Rather, it has assisted and is-continuing to assist both with Core personnel and financial support the.development of health., Planning Councils in the seventeen multi-county planning regions designated by the governor. With this assistance available, planning, councils are now organized in the eight western planning regions-A handicap faced'by these planning organizations is the extreme difficulty in recruiting program directors. The -Region is assisting the planning councils in this area. Planning councils are developing in the other nine regions which are located in the east. The Region envisions its close working relationship with these organizations through the chief staff members(Fishel and Young) who have respon'sibility.for the continuing coordination of activities. These two people have almost daily contact with the planning regions. NCRMP policy-is now to involve local planning group@ in the initial stages of program proposals. ----------------------------------------------------------------------------------------- @mended Action: No Action Indicated Date: 4/ RW: North Carolina RMP PrL-2ared B So long as the Board of Directors existe 11. Assessment of Needs and Resources: needs were determined primarily-by this g and to some degree were based on institutional interests. Most programs,however, include some analysis of data. There-is continuing collection and updating of relative data particularly as it relates to heart, cancer and stroke, and attempts are being made to.relate@it-to new program goals in an effort to develop more specific objectives. This effort should be greatly enhanced by the new Director of Planning and.Evaluation scheduled to,join,NCR\lP. in June. The centralization of the Planning and Evaluation Division at Teer House, as opposed to previously being split with UNC, should also strengthen plann.ing efforts, as should the reorganization of this Division directly under Dr..Patterson. Hopefully, the new organization of the Planning and Evaluation Division and the new Staff will provide the needed back-up for the planning bodies in their effort to change program direction, including the establishment for the goals and objectives which are relevant to national priorities, but which have special significance to North Carolina. In addition it is hoped this division will provide the -expertise for defining measurable objectives related to specific time-frames. ------------------------------------------------------------------------------------------- P,e'comended Action: No action indicated, with perhaps the exception that the Region should be complimented'on its-reorganizational efforts related to the Planning and Evaluation Division and the hope on the part of RWS that this division will play a significant role in identifying the needs of the .Region based on valid data, and that the decisionmaking bodies w@ll use this data in the development of,their program. 12. Management: Core Staff is a relatively small group of individuals who demonstrate a e of team spirit. They respect each other and consequently take advantage of e'ac others knowledge and capabilities in the consideration of their own program interests. They have weekly staff meetings which are designed to coordinate.activities, however, much coordination is done on a one to one basis as need arises. Each member is responsible for monitoring projects and other activities. lqhile most have monthly contact with their related activities, formal evaluation reports are required-every six months. ..Final reports are required as are monthly fiscal reports. -------------------------------------------------------------------------------------- ,Recommended. Action: - - - No action indicated at this time. It should be noted that this aspect of the program will be covered in more detail in'the upcoming verification visit. Date: jj North Carolina: RUP Prel3ared BY: w ation Visit-it is Without the benefit of a Review Process VerifiC difficult to make any-valid assessment'of the evaluation process in North Carolina. In discussing the subject with @aff, they e is a need for incorporating more thorough evaluation techniques in developed and more stringent demands should be put ,projects as they are being on pvogress,reporting wh@ich-takes place twice a year. it is anticipated that der the new Director of Evaluatioii will have a significantly stronger position un the hew organization than the previous one. site visits of Technical Review Comittee's does take place when indicated. In one instance negative results in national program emphasis-has resulted in discontinuance of a project. --------------------------------------------------------------------------------- Fbdoimehcled'Action: None indicated at this time. Evaluation process as presented in the application is vague and should be clarified at the@time of -the April 27, 197: .Verifica:Clon visit. 14. Program Pro-Dosal: Goals and objectives are vague and priorities have not been set in any meaningtu.L way. The RNP claims-this will be incorporated as the new goals.and objectives are developed. Two of these in.the past have related quite well to the goals and objectives, concentrating on Categorical Diseases, Continuing' Education,Manpower imd Rekionalization. The intended results of able of being quantified, however, this does not appear to activities are cap be done with any consistency. Progress report-s are-required twice annually but thei relevance is unknown at this time. Staff--claims attempts to rank.p@ojects against a -standard set of criteria has been rejected by the RAG. Each RAG member is individual criteria. ranks.projects according to h ------------ ----------------------------------------------------------------------------- Recom6nded Action: Given the relatively l'ittle information we have with regard --tcf this aspect of the North Carolina Program it is difficult to make a valid ass sment.. Clarification should be ma4e at the time of the es upcoming Verification Visit on April 27, 1972. Date: 4/3/72 William S. Reist North Carolina RMP, prepared By of Knowledge: Since a large number of NCM proj ects are 6ithef Dissem, inatiori educational in nature.or have educational components, they o in fict,.do disseminate knowledge to larae numbers of individuals in a la@ge number of facilities throughout the state -many involving the three major technical schools. Recently attempts are being made to involve more community schools. We can only assume better care to more people will result in some upgrading of the skills and kriowledge-of medical personnel. Most activities relate td more.serious problems of the categorical diseases, still others in health manpower relate more to the lack of allied health personnel. ---------------------------------------------------- -------- ------------------ 7------ Should @ommend the Region on its eEfort to de-emphasize categorical Recommended- Action . disease@. Encourage'the Region's awareness.of problems related to availability and accessibility of care in.the use of paramedical personnel -to make improvements in these problem areas 16. Utilization of Manpower and Facilities: The cancer, Stroke, and CPR projects all emphasize the need to-utilize or improve certain medical facilities,. so that they may serve an expanded role. As stated above, wIe can only assuneproductivity,of physicians is increased through education but it might be increasecy-more rapidly by concentrating more on delivery systems. Three projects are developing new allied health personnel.While manpow6r has been a goal of the region for some time, NCRMP is placing more emphasis on it.. 'Ihe Family Nurse Practitioner and the Nurse Associate projects should ha@e particular influence on the underserved.. ------------------------------------------------------------------- -------------------- Recommended Action: No action indicated. Date: pj,lp: North Carolina RMP Prepared By: Wilriam eist 4/3/72- Programs designed for the improvement of health care relative] Aftl7. Improvement of Care: lacking in NCPM. None of the current p-rojects.relate to improved primary mbulatory care delivery systems and, in particular, non' relate specifically to the poor, black,.and red minorities. Six activities related to improvement of care are.supported by developmental component funds. While the Region has the capability to make studies related to access and availability of care few, in fact, have been conducted. @st of those-which have been undertaken resulted in outside support for operations. One of the new goals being considered is health services delivery systems. As stated before, this is an area which staff would encourage greater emphasis. It should be remembered when considering this aspect of the program, that.NCRMP is somewhat @6mmitted to a categorical program related-to quality of care by the fact that this is-hoiv the original Triennium Application was designed'two years ago by the Board of Directors. --------------------------- -------------------------------------------------------- -Action: Conveyed to the Region, RMPS' endor ement and encou ement of Reconn. ended @ag- s greater emphasis,on availability and accessibility of care,- @ary @o the under-7 p served. 18. Short-term Payoff: We can only,assme activities being undertaken by NCRMP will have sitive-effects on accessibility, quality of care, and cost moderation, @ Po since the Region has not reached a s@age of sophistication by which it can evaluate progress in these areas. -The p'rograih is still highly geared to quality of care particularly in categorical diseases. Support in most instances can be withdrawn in three years or less. It should be notbd that th6,November 19-70.Site Visit Team did s.ight numerous' @p-roj.ect atcompli bments of the Region, although they did not relate specificall Y to criteria of accessibility, quality of care and cost moderation. Similar accomplishments, are sighted in'-the current application, most of which demonstrate significant achievements in training, expanding activities into other institutions, @development,.Publication, and distribution of -educational materials, mortality rates hospital stay rates, screening and follow-upand expanded use of paramedical personnel. ------------------------------------------------------------------------------------------- @ehded Action: Convey tothe Region our.hope-.that the new Planning and il-da-ri:cFn 'Divi7s@6n'will make an increased effort to access activities as they Late to availability of and access to services quality of care and moderation of costs. Date: '4/3/72 William Re ionalization, Re i?na-,,-zaT-loi iple provider gT s) and newly lanned activities serv.e Mult While most ongoing p -rvices are sharing of facilities has been a by-productstscarce resources and se ilabl'e but on a som&what unpyoportionate -rate between .6xamples of being made more readily ava d S@roke projectsa-re prime . The.Cancer-an the affluent and underserved Th re is no and. '.lity of resources and services e q.ua is involved have served improving both the q'uantity I-an and in which NCR4P -K- doubt that the many activities Lmderta efforts@of the heaath organizations to strengthen linkages and coordinate planning in many instances. within the Region. NC@ has served as a major catalyst - - - - - - - --- - - - - - - - - - - - - - - -- - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - No action indicated. 20. Otlier Funding: NC@ staff have worked on a number of activities which,once developed into al.$ have attracted OEO and MO funds for operational support. potential propos They have attempted to help other-pro@osals identify sources of support. -.Many. are co suPPOr of the Regiorl's activities ted with other funding sources and,iii turn, tend to c lement each Others efforts. OMP ------------------------------------------------------------- --------------------------- Recommended Action: the role it has played in identifying an The Region should be complemented on t of-activities which will serve to.improve the total soliciting outside suppor health care system in North.Carolina. ADDL,NDIR@I Ti) CAff)LF-iA r,7Ar-F- tAs an oversight ir, nr)r Staff Briefin@, on lqortit Ciroli@-ia, I neglect@-, to iwlude ttic f,,ict t@4,it t'iic observations !,,-adc, ivcre collectively agree(. uf*n @v Sti'Lf at its re,,riew oi-i Staff attending include,-': Gene Iiclson PlaiL-iii-W -.2iid Pyalu.,,tiort Di@,.Lsior. Teets Grants Itmst Bra,-.cii t T(Xl Griffith Regional Office Representative - Region TV Lee Van Winkle Soutii Cc.--,tral Operatiorz Prar-cli Bill Reist Soutli CentTal Operations 'Br;mich Joeme Parks @th Cejitral ErancJ) Gloria flicks Souti Central Operatio.,,is @i@rancii .5MTon Dt@ @th Cmtral Operatior-s il-r-,an&. Staff could not unani;wezly apTee on a rcca,.,rvndation. I%.to recc4incmtatimis %4ere therefore ma@ for SAPP consi-,ie-ratioii. 1. The Rej, m be anrove,li for the 05 operatioial ye-,ir ,it the r@tod level of $2,080,008, wILicli is I,:)wEr ti-ian tlic NAC level of $LI,194,400. pmved 2. The Region be app-roved at the rftluested level, but that fundin- @orizatio,.i for the Instittitional @rdinators/Contiyriing Education @nent of ('@re I)e withheld rLtil StAff 'was reviewer the RAG -r n@ations for t'iis cm.Wnent bi mUition to receiv:big a justi Fication for t'ic ne@i of tl)ese representatives to Core Staff. time c ts woul(-' =ost appropriately apT)ea-r on page -16 olr ycKtr North Carolina Briefiitp,, liocuntent. lllillian S. iZeist Ptitilic Ilealtl--l Aclvisor Soiith k',entr,-il @,eTations Brancii mii @,.i-;@cai rropr". Service SR:cmg Board File 303B/ -DOD/@, IEMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION Acting Chief DATE: March 31, 1972 South Central Operations Branch Chief ,@OM Grants Management Branch jBjECT: Review of Continuation Application for North Carolina Regional Medical Program Grants Management Branch's concerns, as expressed in the Continuation review of the application submitted by the North Carolina RMP, have been accommodated by an in-depth review of existing documents. The results of this review are reflected in the enclosed material which is provided for attachment to the documents prepared by your staff for review by SARP. The organizational structure of the North Carolina RMP appears o be compatible with the advice given by the Operations Desk, as evidenced by the attached letter dated, March 13, 1971. Therefore, any constructive recommendations for change ought to be carefully phrased in the Advice Letter, to the RMP subsequent to SARP- Council action. Your attention is invited to the recommendations contained in the last paragraph of the GMB review concerning the funding of the Core component for Institutional Coordinators and Directors of Continuing Education. d T. Gardell Enclosure Grants Management Branch March 31, 1972 North Carolina RMP organizational Structure The North Carolina RMP is organized in a manner which places Duke University, the grantee, in jeodardy of audit exceptions for situations over which it has no control. The transfer of its responsibilities as grantee to the "Association" also Approaches sub-granting. . The By-laws of NCRMP recognize Duke University as the applicant organization and fiscal agent. The same By-laws almost immediately dispose of Duke with that one sentence of reaognitidn a'tid proceed to the Association and RAG. All duties and responsibilities for both the program and administrative management of NCRMP are assigned to the RAG. The Association appears to function more as the Board of Directors in'an incorporated RMP, but it in fact has no such legal foundation. The RAG can be controlled by a very small number of people. Provision is made in the By-laws for more than 60 members of the RAG and there is a good balance. However, aquorum is only 25 .,nd 2/3 of those present and voting where a quorum is present shall be an act of the total RAG. This then means that 17, or fewer, can act for more than 60 peop'-e. A similar situation is even more diL irbing in the case of the RAG Executive Committee because ot the inherent power of an executive committee. The NCRMP Executive Committee is composed of 13 members with 7 constituting a quorum. Again, 2/3 of th-se ?r-sent and voting act for the entire committee which in ti-n speaks for the total RAG beLween meetings. Therefore, 4 or fewer me@ :a of the powerful Executive Committee can act for the total RAG. Changes in the orgA--ii-;ational structure, 'Trantee involvement, and the By-laws are necessary. Apparently Duke University is willing for the Association to assume Dukes responsibilities as grantee. Since there is no indication of trauma.resUltilLg from a change, the Association should become legally incorporated and be made the grantee for NCRMP. The By-laws should be rewritten to clearly assign program responsibilities to the RAG and administrative responsibilities t the grantee. The By-laws should also be changed to require a quorum of the RAG and Executive Committee to be one inor6 thnn 50% of the total membership. .Ala,,, the wording should, be changed to r-quire that a majority vote of those pre,sept at a quorum@be necessary for the vote to represent an act of the tota.L body. This would cause the words "and voting" t:o be removed from that ortion of the By-laws s eaking to the number of votes required p p at RAG or Executive Committee meetings. Included in the budget request for Core is.$97,158 for Institutional Coordinators and Directors of Continuing Education. The program has supported this service thru the three medical centers and are of two types: (a) a physician in each institution serves in a liaison role to the program on a part-time basis of 25% time and effort. (b) the program has supported approximately 10% of the salaries of the Director of Continuing Education in each of the three medical centers. These physicians work closely with Core Staff Director of Continuing Education in planning and conducting NCRMP supported educational activities throughout the State. Because of the decline in importance of continuing education, the RAG has designated one of its committees to study the situation and possibly reduce the funding requirements, if they determine that this activity should be reduced. These activities have been supported in the past. In reviewing financial data obtained from the region, a total of $132,328 is being requested to support these activities ($97,158 D.C. and $35,170 I.C.). Institutional Coordinator and Continuing Educatio A copy of the n Component budget is attached. It does not indicate in which capacity the individuals serve, clerical, Institutional Coordinator or Director of Continuing Education. Although one individual may serve in two capacities, the total time and effort should not exceed 35%. However, the budget requests for Dr. Emery Miller (Bowman Gray) and Dean Fred Mayes (University of North Carolina) exceed that figure. There are 6 professionals listed which average 36% effort. Since there are four Institutional Coordinators at 25% and 4 Continuing Education Coordinators from the three medical centers, (according to the application) at 10%, the maximum % of effort would average 17.5%, so the salaries claimed are somewhat out of line with that stated in the application of the individuals listed. The followind individuals receive compensation from the Institutional Coordinator and Continuing Education Component and are also members o.f the RAG and the Executive Committee of RAG; 1. Dr. E. Harvey Estes, Chairman, Dept. of Community Health Sciences, Duke Medical Center, also Chairman of RAG and Executive Committee 2. Dr. Robert Smith, Professor and Chairman, Dept. of Family Medicine, UNC., School of Medicine, also Vice Chairman of RAG and member of Executive Committee 3. Dr. Emery.C. Miller, Associate Dean for Continuing Education, Bowman Gray School of Medicine 4. Dr. W. Fred Mayes, Dean, Schoo'@ of Public H ealth, UNC. There are thirteen members on the Exe cutive Committee of RAG and four are paid from Core funds, including the Chairman and Vice-Chairman of the RAG. Because of their Core-related activities and their responsi- bilities as members of Core, it is indeed hard not to assume that some of-the activities for which the individuals are being compensated are for RAG-related activities, particularly in light of the rather large percentages of effort charged to the grant. Furthermore, there may be a conflict of loyalties resulting which would infringe upon their abilities to perform in their capacities as members of RAG and Core. It is recommended that staff withhold funding authorization for the institutional Coordinators/Continuing Education component of Cote until they have reviewed the RAG recommen dations for the Continuing Education component in addition to receiving a justification for the need of these representatives to the Core staff. We further re- commend that no member of RAG (excluding the Executive Director of the RKP) receive any compensation from the program other than for travel expenses for RAG meetings. The final recommendation is that the Chairman of RAG (currently an employee of the grantee institution and a member of Core staff) should not be permitted to serve as a ,voting member of the RAG. Efforts should be made to replace the present Chairman at the next election of RAG officers with an individual not employed by the grantee (Duke University). or and Continuing Education Component Institutional Coordinat FY 1973 Approx. Fringe Name of Salary Benefit Duke UNC 71,4c/SPR BG -Effort Harvey Estes, Jr&p X*De -36 $13,320 $1,065 $14t985 .len'Bivins 50 @@351 419 3,770 27 5,600 .625 5,.625 lliam DeMaria, MOD. 668 bert Sinith, M.D. 15 4,575 59.243 ncv Vernon 20 1,400 204 1, 604- .7,950 11161 Glenn Pickard, MOD. 30 9,111, Glenn "Zilson 15 4,725 690 '5$415 @an Fred ',Mayes 50 13,542 1,977 ,dia Holley' 10 1,818 265 2,083.- terv I-lill.er, M.D. 60 17,000 1,700 $181,700 @llv Rae McCartney ioo 500 5.500 $2lp373 $173,§02 .$24,200 Tota'u Salaries $77,681 $9,874 $24;380 627 431 500 Travel & Other 45 8 Totals $24,,425 $30,,OOO $18,033 $24,700 Total Direct Costs $97,158 Indirect costs, $32 677 Total $129,835 FY 1977 --)st UNITED STATES GOVERNMENT DEPARTMENT OF HEALTH, EDUCATION, AND WELFAR' emorandum REGION IV - ATL..ANT.A Mr. William Reist TO South Central Desk DATE- March 20, 1972 Regional Medical Programs, Rockville REFF,R TO: FROM Regional Health Director, Region IV, Atlanta SUBJECR: North Carolina Regional Medical Program Continuation Application I have reviewed the North Carolina RMP Continuation Application and have requested reviews from other programs represented in the Atlanta Regional Office. I want to give you a summary of the comments that were made: Grants Management stated that they do not have the guidelines against liable costsj etc., and that it would be hard to come up with specific suggestions since they are unfamiliar with Regional Medical Program ServicesIpolicies. This has been discussed with Mr. Gardell who has promised to send updated information regarding Grants Management policy for Regional Medical Programs. office of Comprehensive Health Planning stated that "this is a very impressive, agressive and bold application. It is well coordinated, clear and concise. The justification for additional funds seems realistic in terms of program activities and there is an interlocking membership between Rt4P and CHP. Although the applicant states that this application has been reviewed by all appropriate health planning agencies and without any adverse comments$ the application is void without these comments. It would have been of interest to this reviewer to have seen these comments in order to analyze how CHP views the activities of RN]?. It is the recommendation that this application be approved with the additional funds requested." Health Maintenance Organization program states "In addition to a somewhat unique and abbreviated format, the writer was impressed with the attitude of the North Carolina @ regarding new and current trends in health, with particular emphasis on alternate health care systems and Health Maintenance Organizations. Although one might readily say that their activities have been somewhat limited in regard to HMO development to date, this could be expanded considerably through one of the following methods: (1) utilization of both a formal and informal reporting system through the Regional DUCTION PROGRAM Mr. William Reist, RMP, 3/20/72 Representative concerning HMO potentials as well as developing activities in North Carolina, (2) that a conscientious effort be made to involve North Carolina @ officials early in the planning sphere of any HMO activities, and (3) to further consider possible funding potentials for RMP and HMO development; this would also relate to programs that would be concerned with future HMO potential, such as Family Health Centers, Neighborhood Health Centers and indeed any type of prepaid or fee-for- service delivery system with specific population groups in mind. Again, I would.reiterate that the North Carolina RMP proposal is brief and concise yet covers the,realistic elements of a very diversified program in the health field." Community Health Service program states "At the present time there are four county migrant health projects receiving federal grant funds from HSMRA to provide services to migrant and seasonal agricultural workers in North Carolina. In addition to those four projects the State Board of Health receives some HSMHA funds to provide health services to the migrants located in areas of the State other than within the four project counties. The limited categorical funds do not allow for providing adequate health care services to the migrants and the added problems of lack of accessi- bility and residence requirements to participate in state programs further magnify the problem. Education and income levels and language barriers, in some cases, tend to isolate the migrants from necessary health services. The developmental component of the North Carolina Regional Medical Program contains a category in the amount of $35,000 to provide health care ser- vices in conjunction with the State Board of Health to migrant farm workers in North Carolina. When combined with the migrant health categorical funds of the North Carolina State Health Department project, this will allow an extension of health care services to migrants outside the four county project areas where the needs are probably the greatest. In addition to the migrant health categorical funds, the funding of projects involving emergency health care services and providing health services to the rural underserved areas of North Carolina will have a significant impact on the migrants' health care needs. The North Carolina Regional Medical Program has apparently recognized and is responding to the health needs of this particular segment of the population which is in a difficult position in obtaining health care. Migrants in other states are in the same status in regard to health care needs, and the problem recognition and efforts of other Regional Medical Programs would influence the services made available and have a positive impact on the migrants' health status." Y-S Mr. William Reist, REP, 3/20/72 Division of Emergency Health Service states "In general, the references made in this plan to emergency medical services are peripheral. They seem to overlook the total EMS system approach. I am unable to find reference to the State Comprehensive Emergency Medical Services Systems Plan and how EMS activities of R4P are coordinated within the scope of this plan." In summary, I was impressed with the organization of the material, the conciseness, and I was very happy with the application. I have not received comments from Health Manpower, and @ternal and Child Health Service. When they are available, I will forw on to you. Emil E. Palmquist, M.D. BY: Theoda H. Grif'fl'th Public Health Advisor, RMP -Y fo THE ASSOCIATION FOR THE NORTH CAROLINA REGIONAL MEDICAL PROGRAM Executive Office 4019 North Roxboro Road, P.'O. Box 8248, Durham, N.-C. 27704 919 - 477-0461 F. M. Simmons Patterson, M. D. Executive Director March 29, 1972 Mr. William Reist Operational Branch Regional Medical Programs Service ParklaNqn Bu4-lding 5600 Fishers Lane Rockville, Maryland 20852 Dear Bill: In an effort to keep you and the Regional Medical Programs Service Staff abreast of new developments concerning the North Carolina Regional Medical Program, ,-he progress that is being made, I would like to emphasize the following: and (1) As you know, whereas in the past the North Carolina Regional ',,Iedical th a Board of Directors and an Advisory Council, we now have only Program had bo one goverpiii- body, the Re-i6nal Advisory Group. At the last L.Leeting of the ? b Regional Advisory Group on March 15, 1972, the Membership of this body, on the recommendations of the Nominating Committee, was revised so that we now have an increased number of Allied Health representatives and Ifinority representatives. I am happy to state that at the present time that in rel.ation to the total Membership of 51, 18% are Nlinority members. I am enclosing a copy of the Regional Advisory Group Membership on which the Minority members are specifically designated. (2) On November 18, 1971, we received a document from the Regional Medical Programs Service stating the specific requirements that should be covered by the Articles of Association or Bylaws of a Regional Advisory Group. lqe have met several times with our attorney, Mr. Charles Dameron, of Greensboro, North Carolinai and have amended the Articleb of Association with the unanimous approval of the Regional Advisory Group, so that at the present time we feel our Articles of Association satisfactorily encompass the requirements listed. For your edification, I am enclosing a copy of the Articles of Association in its recently amended form. (3) At present there are three vacancies on our Professional Staff. I have made a sincere effort to recruit Minority members for these positions. Tomorrow, I am intervie@qing a Minority member for a position on our Planning and Evaluat4.on Division, and feel that this individual will sign an agreement to join our Staff ,terview. -.i- 'I)osit at this ir. For the two atlic ions we have c(-jnticLc-d Minority individt,-.@'s that I will interview in tli(! next wc,el( oi- so. T fc!t-I t-li;it I will I-,c. In two @lli 'I(Itlitioll!i I() ()tlr '; t ;i f 1'. q7 Mr. William Reist Page Two If I am unsuccessful in this endeavor, I will further pursue my efforts in this direction. (4) In regard to the matter of the Institutional Coordinators and Directors of Continuing Education that you have discussed with me several times, an Ad Hoc Committee was appointed by Dr. Harvey Estes, Chairman of the Regional Advisory Group, to study this matter in depth. The first Meeting of this Committee was held yesterday and much progress was made. Another Meeting will be held in several weeks, and hopefully, a wise and just decision can be made concerning this matter. (5) A Long Range Planning Committee of the Regional Advisory Group has been appointed and its recommendations concerning the goals and objectives in keeping with the new emphases and directions of the Regional Medical Program have been adopted unanimously by the Regional Advisory Group. (6) Subconunittees of the Reg4-onal Advisory Group are being appointed so that the Regional Advisory Group Members can be more int.imately involved in the operation of the North Carolina Regional Medical Program. As developments arise concerning our Program, I will continue to keep you informed. With kind personal regards, I am Very truly yours.j,-, @.f. P2tterscn, @!.D. Executive Director FMSP:mh dc: Dr. Harold Margulies Mr. Lee R. VanWinkle Enclosures REGIONAL ADVISORY CROUP of the NORTH CAROLINA REGIONAL MEDICAL PROGRAM CHAIRMAN: E. Harvey Estes., Jr., M.D. VICE-CRAIR!.IAN: Robert Smith, M.D. SECRETARY: Joseph G. Gordon, II.D. Medical Society of the State of North Carolina Charles W. St yron, M.D., President Medical Society of the State of North Carolina 615 St. Mary's Street Raleigh, North Carolina 27605 Phone: 919-832-6307 John Glasson, M.D., President-Elect Medical Society of the State of North Carolina 306 Soi,th Gregson Street Durham, North Carolina 27701 Phone: 919-688-1059 resEtntatives-at-Large from the Medical Sncietv of the State of North Carolina Edgar T. Beddingfield, Jr., M.D. .*John R. Chambliss, M.D. Wilson Clinic Boice-14illis Clinic 1704 South Tarboro Street 100 Nash Medical Arts @iall Wilson, North Carcilina 27893 Rocky Mount, North Caroll.na 27801 Phone: 919-237-2151 Phone: 919-443-884". represents Eastern North Carolina represents Eastern ',worth Carolina 'Joseph C. Gordon, M.D. George W. Paschal, Jr., M.D. Kate B. Reynolds Memorial Hospital 1110 Wake Forest Road 1101 East Seventh Street Raleiv-h, North Carr-'l.-'@-- '-)7(-04 Winston-Salem, North Carolina 27101 Phone: 919-832-3431 Phone: 9i9-@24-26:3i represents Central ',\orth Carolina represents Central North Carolina *Julian S. Albergotti, Jr., M.D. Louis deS. Shaffner, M.D. 4101 Central Avenue Bowman Gray School of Medicine Charlotte, North Carolina 2820 Wake Forest University Phone: 704-537-0020 Winston-Salem, North Carolina 27103 represents Western North Carolina Phone: 919-727-4502 represents Western North Carolina Chief E-.@ecutive Officer. Duke University School of Medicine William G. Anlyan, ii.D. Dr. Anylan's designee: Vice-1.1r@.s-.'der,t for Ilealth tLf- 'Lairs *E. Harvey Estes, Jr., M.D., Chairman Duke University Department of Community Health S,'-n( Durham, North Carolina 27710 Box 2914, Duke Medical Center Phone: 9101-684-3438 Durhain, North Carolina 27710 P]IOII)C: 919--684-531+ Cc)rmlttee School of Medicine @icf @cutive officer, Bowman 11(@tads, M.D. Dr. Meads' designee: ,,.,,;ident for Medical Affairs *Emery C. Miller, II.D. Vice-) Bowm;lil ii-ay School of Medicine Boiman Gray School-of Medicine Wake University Wake Forest University Winstt'l$ !;alem, North Carolina 27103 Winston-Salem, North Carolina 27103 Phone. 919-727-4301 Phone: 919-727-4683 Chief-.I,@(?cutive Officer, Univ hool of Medicine Christ4liolier C. Fordham, III, M.D. Dr. Fordham's designee: Dean *Robert Smith, i@I.D. Univel-@.@lLy of North Carolina School of Medicine I ,f Medicine Department of Family Medicine Schoo Chapel North Carolina 27514 Wing D - 3rd Floor Phone: 919-966-1116 Old Nurses' Dorm'itory Universit of North Carolina y Chapel Hill, North Carolina 27514 Phone: 919-966-5152 Chief l@,i, cutive Officer, University of North Carolina School of Public Health W. Frc,t Mayes, M.D., Dean Dr. Mayes' designee: School i,f Public Health *Mr. Charles L. Harper A&ivcr,@ity of North Carolina Associate Dean en,,,, liall School of Public Health lwapel 'lill, Nortli Carolina 27514 University of North Carolina Phone: 919-966-1113 Rosenau Hall Chapel Hill, North Carolina 27514 Phone: 919-966-111 reE,,,tiiatives of the N rth Carolina Hospital Association Mr. Jo,,@,@tili James *Mr. Robert R. Martin AdMini,,.I&aLor Administrator !@,L :7,Dspital y Goldsl,@@lt,, North Carolina 27530 Laurinbtirg, North Carolina 28352 Phone: 1)19-723-2211 Phone: 919-276-2121 represents Eastern North Carolina 14t. Eai-I Bullard Mr. Don C. Morgan Admini.,iirator Administrator P,owan @iitiorial Hospital C. J. Harris Community Hospital Salisbti,V, North Carolina 28144 Sylva, North Carolina 28779 Phone: Y04-636-3311 Phone: 704-586-2151 er tial North Carolina represents Western North-Carolina repr ,oiil-s Cen Direct(", North Carolina State Boara of Health @.acob M.D., Director Dr. Koomen's designee: rth (',(rjl.ina State Board of Health W. Burns Jones, M.D. 5 Nolli, McDowell Street Assistant State Health Director post Box 2091 North (,arolina State Board of Health 0 i$vrtil Carolina 2Y602 Post Office Box 2091 Raleigli, North Carolina 27602 Iortli Caroli.nii Scl,001 of Dciitistry Chief E% -or, Universitv Of ,:cct,,t ive Of Jam@s I,. Ila%,iden, D.l@. Dean Dr. Baw(Ic@ii's designee: School of.Dentistry Ben D. Barker, D.D.S. Associate Dean for Acad mic Affairs University of North ro 1 ina e Chapel Hill, North C,---.-olina 27514 School of Dentistry Phone: 919-966-1161 'University of North Carolina Chapel Hill, North Carolina 27514 Phone: 919-966-1161 Chief Executive Offi@er, North Carolina Medical Care Commission Mr. Ira 0. Wilkerson North Carolina @ledic-,t'- Care Commission Post office Box 25459 Raleigh, North Carolina 27611 Phone: 919-829-7461 Director, North Carolina State Boardo of Social Services Mr. Clifton M. Craig, Commissioner Mr. Craig's alternate: State of North Carolina Mr. Emmett Sellers, Director Department of Social Services Medical Services Division Post Office Box 2599 State of North Carolina Raleigh, North Carolina 27602 Dgpartment of Social Services Phone: 919-829-3055 Post Office Box 2599 Raleigh, North Carolina 27602 Phone: 919-829-4550 Chi f Executive Officer, North Carolina State Nurses' Association *Eloise R. Lewis, Ph.D. (designee) Professor and Dean School of Nursina t, ,,I--,itv of North Carolina at Green@boro Univ Greciisb:)ro, North Carolina 27412 Phono: 919-379-5177 Chief Executive Officer. Office of Comprehensive Health Planning Mr. I.'ln,2r M. Johnson Post Office Box 1351 Raleigh, North Carolina 27602 Phone: 919-829-4139 rc,r,o,itativ of Comprehensive Health PlanninR "b" A5zenci.es Mr. Co-orge @t. Stockbridge 1975 ExceLitive Secretary "laiiLiitig Council for Central North Carolina Home St,.,.urity Building 505 Chapel Hill Street Post off-ice Bo--< 61. north C-qroli,,-t 2770'-) Plioiit@: 919- 682- 3640 lir,a e Veterans Administration- system of Nortli Caro Ilospitizl Director Veterans Adm'nistration Hospital 508 Fulton Street Durham, North Carolina 27705 Phone: 919-286-4934 Representatives of Public-at-Large East:_ *Mr. Charles James 1973 *Mr. John Taylor 1973 Director Darden Funeral Home Cho noke Development Association Wilson, North Carolina 27893 a Phone: 919-237-2169 104 Third Street Murfreesboro, North Carolina 27855 Phone: 919-398-4131 'Mrs. Marjorie B. Debnam 1975 *Mr. 0. T. Faison 1974 - Post Office Box 728 1615 East Davie Street New Bern, North Carolina 28560 Raleigh, North Carolina 27610 Phone: 919-637-5632 Phone: 919-834-4602 a J)avid G. Warren 1974 'Mr. Walter T. Johnson, Jr. 1975 institute of Government Attorney-at-Law Southeastern Building Knapp Dii'Ldiiig North Carolina 102 North Elm Street University of Chapel Hill, North Carolina 27514 Greensboro, North Carolina 27401 Phone: 919-933-1304 Phone: 919-274-8463 "Mrs. William J. Kennedy, III 1975 Harvey L. Smith, Ph.D. 1975 102 East MAsondale Avenue Social Research Division r-- r i'L a I 'L Phone: 919-682-7645 University of North Carolina Chapel Hill, North Carolina 27514 Phone: 919-933-2007 estern,- Carl D. Killian, Ph.D. 1974 Mr. John B. Rogers, Jr. 1973 Box 2672 Post Office Box 337 Cullowbee, North Carolina 28723 Davidson, North Carolina 28036 Phone: 704-293-9611 Phone: 704-892-0564 Mrs. Evalyn trdndeJ, M.P.H.- 1975 Mr. Donnell VanNoppen 19 160 Cotintrv Club Road Box 337 @heville, .North Carolina 28804 Morganton, North Carolina 28655 Wone: 704-253-8424 Phone: 704-437-5261 *Members of Executive Co:nmittee Ot:licr Thati l@',edi-ccil Scllo,)ls 1974 Mr. E. 11. l@173 *],?dwin 1-1. Monroe, M.D. Vice-Presi.,dent for Health Affairs Vice-president Dept. of Community Colleges School of Allied Health and Social Professions N. C Post Office Box 2772 State Board of Education Building East Carolina University Raleigh, North Carolina 27602 Greenville, North Carolina 27834 Phone: 919-829-7051 Phone: 919-758-6310 ollr. George T. Thorne 1973 "llr. Earl Murphy 1975 Controller Assistant Dean North Carolina Central University Craven Technical Institute Durham, North Carolina 27707 Post Office Box 885 Phone: 919-682-2171 Nei4 Bern, North Carolina 28560 Representative of a Philanthropic Orpanization *Mr. James R. Felts, Jr. 1974 The Duke Endowment 1500 North Carolina National Bank Building Charlotte, North Carolina 28202 Phone: 704-376-0291 ies Mr. W. James Logan 1974 William A. Robie, M.D. 197?-.I- Executive Director 5437 Thayer Drive North Carolina Heart Association, Inc4 Raleigh, North Carolina 27609 No. 1 Ile-art Circle Phone: Chapel Hill, North Carolina 27514 represents N. C. Chapter of American Phone: 919-968-4453 Cancer Society represents N. C. Heart Association Eloise P. Hathcock 1975 *T. Reginald Harr-is, M.D. 1974 615 St. Mary's Street 8OoO @lor@,'i D-@',@alb S,:r@eL Raleigh, North Carolina 27605 Shell)v, ':North C.-ir-lira 2SIc)n Phone: 919-832-6307 Phone : 704-482-1482 represents N. C. Diabetes Association represents T.B. and Respiratory Assoc Clark R. Cahow, Ph.D. 1975 Duke University Registrar 114 Allen Building Duke University Durham, North Carolina 27706 Phone: 919-684-3146 represents United Health Services Representatives of Other Health Providers Including 3rd Party Carriers & Government @encies Mr. W. J. Smith 1975 Miss Sally Far'riiid 1975 Executive Secretary Physical Therapy Section North Cl-:roli-na Pliarmicetiticil- Association N. C. State Board of licaitli Ro>: 1 53 Po s t -u f f ic c i@) x @z, o'-@, i Chapel I ill,- ',orLli Carolina 27514 Ralei.gli, North Cirolina 27602 Phone: 919-967-2237 Phone: 919-829-@J131 -- - -. @,l r, T)I,,,cionl I'l@,@rinv rd Party Carriers Mr. George Hider 197'3 Edwin S. Preston, Ph.D. 197-' Pilot Life Insurance Company 2711 Anderson Dri-%,e Post Office Box 20727 Raleigh, North Carolina 27608 Greensboro, North Carolina 27420 Phone: 919-782-1@478 Phone: 919-299-4720 represents 1\1. C. Health Council represents N. C. Health Insurance Council Mr. Ken G. Beeston 1974 N. C. Blue Cross and Blue Shield, Inc. Durham-Cliapel Hill Boulevard Durham, North Carolina 27707 Phone: 919-688-5521 represents N. C. Blue Cross & Blue Shield, Inc. Executive Director, North Carolina Regional @ledical ram *F. M. Simmons Patterson, M.D. (non-voting) Executive-Director North Carolina Regional Medical Program 4019 North Roxboro Road Durham, North Carolina 27704 Phonei. 919@477-0461 *Memb6rs of Executive Committee 'Members of Minority Groups "-M-EMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PTIBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION Acting Director DATE: April 18., 1972 Division of Operations & Development FROM Director Regional Medical Programs Service SUBJECT: Action on April 10-11 Staff Armiversary Review Panel Recomendation Concerning the North Carolina Regional Niedical Program Application. Accepted @l. (Ddte) Rejected @te) Modifications Region: North Carolina RMP Peview (,),cle: une T'ype of Application:Amiversary within riennium Ratiniz: 324 REC ATIONS FROM SARP Review Comittee Site Visit Council RECO ATIONS: The Reizion be approved for the 05 operational year at the requested level of $2,080.,008, pending'additional information and@satisfactory review of the $200,000 request for conmmity-'based edumtio@ programs. The Region be advised.,Of n*,weakaesses identified by SARP (see below) and that Staff follow up with careful study, advice, and assistance. I UE: SARP was presented with two divergent recomendations by Staff who conducted a preliminary review of the North Carolina a-D-Olication. The recomeMations were: I'he Region be approved At the requested level"of $2,080,008. The Region be approved at the requested level, but that funding authorization for Institutional Coordinators/ Continuing Education Component of Core be withheld until Staff has reviewed the RAG recomendations for this component in addition to receiving a justification for the need of these representatives on Core Staff. The members of SARP, with minor exceptions, agreed NCRNP must be viewed with a high degree of credibility and reliability, and therefore, can be entnisted to strengthen its weaker areas (dee below) with encouragement and advice from FMS. It was not felt restriction or reduced funding, which might@'be interpreted as punitive action, would serve any@meaningf-ul. -Durpose. This rationale was based on the fact that the Region has done a connendable job in responding to, and resolving all of the problems identified by the national review bodies a year ago. Pag6 2 - Critique North Carolina RMP The composition of the RAG has improved by increasing allied health, public and black representation. The advisory and decision-making bodies have been reorganized, disbanding the Board of Directors, giving final authority for all activities and policy matters to the RAG. The Resear and Evaluation Division has been centralized in Program Staff and is directly responsible to the Directors. With few exceptionsrenewal projects are being terminated at the end of the current year. Staffing plans include the hiring of minorities, three professional and three secretarial. While the reviewers were compl entary of the Region's progress, they did identify areas of needed strength, and/or correction. it@was believed these weakness-es could be corrected with proper assistance from RWS Staff. The goals and objectives while having been moderately revised, since the triennium review; like many Regions remain broad and non-specific. The Region recognizes this weakness and is taking corrective measures. While the program is de-emphasizing categorical and continuing education activities, there is a need for it to accelerate change toward direct impact on improved care,, particularly to the underserved. The role of and need for the Institutional Coordinator/ Continuing Bducation Component of Program Staff is highly questionable, particularly in view of the apparent changing program direction. The Region shares this skepticism and has designated a comittee which is studying the matter. The fact that the four Institutional Coordinators are paid as part-time program staff wh3,, of the RAG and Executive Committee both from the standpoint of conflict of interest anct dual relationships to the Director. The relationship of the grantee to the RAG as presented in the By-laws is inappropriate. The By-laws should be rewritten to clearly assign program responsibilities to the RAG and administrative responsibilities to the grantee. RNPS/SCOB Bill Reist 4/18/72 -AM211cation Component and Financial Summary Anniver3iry_ COZIPONENT CURREIIT YEAR YEAP, RECOMIIEM YRTS AWARD COU',,'CIL @UND I N .04 OPER. RECOIOMNDED 'REQUEST SARP YEAR LEVEL REV. COM. 558,193 643,940 CORE (73 O- Sub-Contracts OoL OPER, ACTIV. 1,152,129 1,248,175 1,248,175 DEVET,. COMP. 168,605 187,893 y EARMARKS: KIDITEY #28 (145,400)__ 145,400 AHEC #41 (200,000) 200,000 R14PS ii@.,FcT I-8Z8,227 ft non Ana 2.080@008 94. RELUESTED 3,875,118 COUNCIL APPROVED LEVEL 2,194,400 NON-P,14PS and 1009000 34,691 INCOME REGION North Carolina June 197 REVIEW CYCLE The 04 year is b@ing exte.nAi4 to 9./1. and the, region will receive $365,733 for th@,,two-month extension resultih' ina direct-cost 9 award of $2-,244,660 -for 14 months. s at i s f actery. 4T-Ia" **P iclin2,.additionAl-.-informat-ion an Of-@tl* $ZOO-t@000 Tequest f6r com=ity-based educational p@og-rams. 4 18/72. SCOBIRMPS Re2ion NORTHEAST OHIO RMP Review Cycle June 1972 Type of Application Anniv. Prior to Triennial Rating 132.S Recommendations From SARP Review Committee Site Visit Council Recommendatio'ns: 1. The approval of a one year period of support (September 1, 1972 through August 31, 1973) of the Program at a funding level of $600,000 direct cost. 2. That the NEORNLP would, during the 02 year of support., develop and submit an application more consonant with the priorities of the Region justifying the continuation of this program or face the alternative of a merger with the other Ohio Program or termination of funding. 3. 'That the present operational projects be phased out and that the funds be utilized to support planning and feasibility studies indicated by the program's data base. @4. That attention be given to the recruitment of a Deputy Coordinator and Program Directors in evaluation and communication. S. That the NEORMP give considerable attention to the delineation of the relationship and responsibility between the Board of Trustees, Fxecutive Committee., and the RAG. That all technical assistance recommended by SARP be provided to the Program. Critique: Committee members were very concerned over the fact that NEORMP had decided to remain separate from the merger of the Ohios and it was the feeling of some of the members that all funds should immediately be withdrawn from t program. The Committee Agreed with SARP that there was little apparent relationship between regional goals and the operational activities presently supported by the Region and also, that Program staff needs additional development. ortheast Ohio IW -2- Th6"Comittee expressed concerns in basically the same areas as did staff and SARP reviewers. Also, Comittee members considered the fact t at NEORNP hadbeen without a full-time Coordinator for 17 of the just 19 months of operational status and were in agreement with the types of assistance recomended by SARP. Committee felt that the NEOW had been anything but satisfactory up to the present time and that a year of planning was needed. Comittee indicated that their action was not intended to be vindictive, punitive, or anything of that nature, but felt that a strong directive was in order. uomponenu ana ti.nanciat bummaiy ONENT CURPEITT @'FAR YFAR RECOMI'tEliDED YRIS AWARD COUTICYLL FUNDING OPER. RECO'LViElIDED 'REQUEST "W YF,AR LEVEL REV. COM. 481 CORE 424 637 796 8ub Contracts 55,000 OPER, ACTIV. 208,763 193,501 114P. yes DEVELO Cb or No EARMARKS.# Klirb viRECT 690,187 .803,696. 831,297 600,000 '75 REQUESTED 1.1232,0 COUNCIL 78 6,187 APPROVEB LEVEL NON-Rl4PS and TL'COME Does not include 24 month extension for 01- year of $2,376,158 REGION Northeast Ohio M@y/June 1972,.REVIEW CYC' 01 Al 01 A2 Cor 67i Core., .865,918 e @8-26. -Proiects 359,,284. -Projects -473,1-30 Direct Cost-1,037,110 -Direct 'Cost 1,339,204& SCOB/RMPS ay 24, 1-972. TABLE OF CONTENTS NORTHEASTERN OHIO REGIONAL MEDICAL PROGRAixi ANNIVERSARY APPLICATION Staff Briefing Document Pace Page Regional Map 2 Geography and Demography 3 Component and Financial Summary 4 MIS Printouts 5 Problems, Accomplishments, Issues 14 RN? Review Criteria 15 STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mid7Cor RM 00064 South Centr'! /-7 western NEORMP BRANCH - BRANCH yp2 APPLICATION NA LAST RATING Tel. No. 3-1740 Room 10 2" 197 DATE BRANCH CHIEF Lee t. Van Win le TRIENNIAL ist IV YEAR SARP BRANCH STAFF V@tnie D-Ashby 2nd ANNIV YEAR REV. COM. RO REP.- ice C THER LI OTHER Last Mgt. Assmlt Visit 19" Chairman AS'f S@@V4 2/5-6 1970 Chairman- ilin T- Whirp, M 'n haii@-.,%nls Name and T e of Visit) a f %7isits, Last 12 mc (Dates, C yp Ashbv 3/30"31/72 Staff Assist-a-nep i6h Occurred in the Region Affe,,-ing the RNP Since Its Last Review 97 T"-,e employment of Dr. Donald Glover as Coordinator on January 1, 1972. 2 Rj'.l 00064 NORTiE;'6TERN 0310 Enco,npasses 12 counties in northeast Ohio centered around Cleveland. Population ( 1970 Census) Total; 4,115,000; 86% urban o,ier 3.5 iiillion) Land area; 5,784 square miles; densit@ 710 per sq. nile Major metropolitan areas: Akron, Cleveland, Lorain and Youngstown-Warren Cleveland - 38% Negro Cleveland S,'ISA#. Per Capita income - 3,705 .9 Congressional I)Istricts Part of i@ 18 OLEDO at N @G OPAI"4 WOOD ELYRIA* WEN*, 5 SENECA yoi FINDLAY ""COCK AS.L VAN W(RI *,A-POT CANT @OAAANSFIE 0 MASSILLO] ARION 0. STEUBEN ,on cos@ION CUC*@SEY ..O.so, Maus IIA R TTEI,, @MIDDLETOWN .,PRE' *"S I'O,tTs.k@OUT) RM OU064 3 Northeastern Ohio R,',IP Facilities and Resources 1969/70 Enrollilent Graduates Medical Schools Case Western Reserve Univ. Cleveland 362 92 :,try 287 60 Dental : Case Western Res* Univos School of Denti Prof* Nursing Schools: 21 - 6 at colleges and Universities Practical Nursing schools - 6@ Allied Health Schools,, cytotechnold- - 7 Medical Technology - 16 Radiologic Technol.- 18 Ph sital Therapy - 1 (Case West. Reserve) Non Federa1 No. of Beds General 65 16,545 Osteopathic 10 reported in planning application) Veterans Administration:- 1 -780 beds -InclIudea for Cleveland SMSA 32 hogp. 9229 beds ( about total reported for all 12 counties.) Personal Care Homes levelaod SMSA: Beds are qomes Nursing C Personal Care Homes 19 1345 'with Nursing care p yst6ians - Cleveland SMSA ( 1970) Total non-Federai ( practicing and not practiting)- 4,148 Total Active - 3626 Gen. Practice 375 Med. Spec. 621 Surg. Spec. 724 Other Inactive 150 m rsos ( Prof.)- Cleveland ST.LSA 1966) Active - 6305 Inactive - 2838, P,,'IPS DOD March 1972 4 Co mponent and Financial Summary Anniversa ry Application COMPONENT CURPIENT YEAR YEAR RECOMMENDED YRIS AWARD COUNCIL FUNDING first 12 months SARP 01 OPER. RECOMMENDED 'REQUEST YEAR LEVEL REV. COM. 481,424 637,796 CORE Sub-Contracts 55,000 208,763 193,501 OPER. EVEL. C Yes or No EARMARKS: KIDNEY IR'MPS DIRECT 690.187 831,297 REQUESTED 1,232,075 COUNCIL 786,187 APPRO NON-RNPS and NONE Does not include 24 Month extension for 01 yr. of $2,376,158-. REGION Northeast Ohio 01 Al @--.-Ol A2 - y/June 1972,.REVIEW CYCLE Core 677,826 Core 865,918 54 -284 Projects 3 I.:i" Projects 473,130 Direct Cost Jo 7,1 0 Direct.Cost 1,339,048 -,@,72 PrGinN N5 CHI(, 9RF-AKC@JT CF REQUFST QY flmr'64 (,6/72 2 rpnGRAm PFQfnf) OMPS-CSti-JTrGR2 2) (4 )rNTtFTrATICN CF Cr'vFrNEN'T I Cf!@NT. WlTfJTNI CCNT. REYNNOI ADOO . N-T I NFWV NCT CtJOQr%'T I CIJDP ENt I APPP. PFRICrl APPP. PEPIR)CI PQE\JfntjSLY I EIDEVirL;SLY rjlRP(-.T INDIPFCT TRTAL OF SUPPI)QT CF SUPPCOT FUNCEP I APPRCVFD COSTS COSTS coc?F ]__-@.37. 7q6 $ 21.L A 'I@ ibi @p I I HNSPITAL LTPQ'APY Cf'tN'SLLTI .-I N, @,E r - - - - - - - ------------- l@ @rCU NU;ZSF TOAft\T@G - --------- - - - - - - 13 STPEP CTLTURF PRCGRAM 7 STQCKF OEHAPILITATICN OEI IIZ A Ti S76,11 7 -------- - 7 6 TCIAL $F?1#21;? %831 2q7 $51, 1 I!i 98 41 5 MARCH 23,1972 REGIONAL MEDICAL PROGRAMS SERVICE PAGE 1 SUMMARY BLOGET CATEGORIES BY COMPONENT RMPS-OSK-JTOC.M2 REGION 64 NE CHID REQUEST MAY/JUNE 1972 REVIEW CYCLE COMPONENT COMPONENT COMPONENT COMPONENT COMPONENT REGIO!i NO COOO NO 001 NO 002 NO 003 NO 007 TOTALS I PERSONTL SERVICES WAGES 3359522 26@920 4 79 226 75,000 20,034 5O4w7O2- SALARIES. EMPLOYEE OFNEFITS 52,876 3,365 5,668 39IZ5 1#042 66,076 TO TAL 438,398 30,285 52,894 289125 2lwO76 570977B 11 PATIENT CARE IN-PATIENT OUT-PATIENT TOTAL III EQUIPMEf4T BT)ILT-IN )O,OVABLE 109000 Soo 169899 70TAL 6*399 109000 500 169 899.- IV CRINSTRUCTION NEW M AJ AL I C R EN TOTAL V OTHER COti@ULTANTS 16#628 29200 18,829 SUPPLIES l2v597 250 59750 24o371 550 43,513 DMST TRAVEL 850 3#500 lo,750 25, 94 5 191845 FPC.N TRAVEL SPACE 30tooo TOO -.309 70',) RENT PENT OTHER 6,300 6,300 MIN AI.T C PEN 28,772 Pt)[ILICArIONS 2Ov272 500 89000 .55,000. CR)NTRICTUAL 55,-On COM,-iUttICATION 199857 200 2tOOO .22 G 5 I., COMPUTERS 129500 -,@12# 500- OTHER 19t250 24ip3TI 243 9 620 TOTAL 1929999 2t5OO 40500 VI TRAINEE COSTS STI PT tiDS OTHER TOTAL 8319297 TOTAL DIRECT COST 637,796 32,785 629144 52IP496 26PO76 51,118 INDIRECT COST 319890 6PO57 69347 61824 - - 269076 SSZ9415 TOTAL DIR F. IND 6699686 389842 889491 59t320 MARCH 08.1972 REGIONAL MEDICAL PPOG$KAMS SFRVICE DESK S(IUTH CENTRAL AREA LIST OF COMPONENTS REQUESTED Ft)R NEXT SUPP(IRT YEAR AMP-OSM-PEMot)l REGION 64 NE OHIO CL RMP-SUPP-YR 02 REQUEST MAY/JUN 1972 REVIFW CYCLE COMPONENT COMPONENT NEXT DIRECT COST EST DATE OF NUMBER TITLE SUPPORT YFAR NEXT PERIOD TERMINATION CODO CORE 02 637t796 001 HOSPITAL LIBRARY CONSULTING SERVFCE 02 32t7B5 06/73 002 CCU NURSE TRAINING 02 829144 06/73 003 STFIEP CULTURE PROGRAM 02 521,496 06/73 007 STAOKE REHABILITATION DEMONSTRATION 02 26,076 06/73 TOTAL REGION 64 COMPONENTS S. $3lr297 MARC@I l')91972 PFR.I(INAL MFNICAL PROGRAMS SFFTVTCF SU4MAPY RUDGET,F%Y TYPE nF SUPPORT r PERTI)N 64 @'E I)Hlf) RMP SUPP. YR 02 REQVFST-MAY/JUNE. @1972 REVIEW CYCLE ')ESK SOUT14 CENTRAL RMPS-OSU-JTOGRB RMPS Rmps RMPS RMPS TR)TAL C 0 M P 0 N E N T Co.MpnNENT DIRECT INDIttFCT TG;AL' nIPECT DIRECT r)IRFCT No. TITLE SUPPORT YEAR IST YR IST YR l@i YR-- 2ND YR 3RD YR ALL 3 YRS COIITINUATIO@4 WITtilN APPRNVEO PERIOD OF SUPPORT COAN CORE 02 6379796 31,890 669,686 637,796 I') I HOSPITAL LIBRARY CONSULTI 02 32,785 6,057 38,842 32t785 Nrl SERVICE 'DZ CCU F.'URSE TRAINING 02 8ztl44 6,347 813,491 §2,144 nO3 SRPFP CULTURE PROGRAM 02 52,4q6@ 6,824 599320 52,496 ')t)7 STNOKE REHABILITATICN DEM 02 @6,n76,. 26,n76 Z6o376 ONSTFTATI ON CONT. WITHIN SUB-TOTAL 8310297 519118 8829415 8319297 QFGT(Ilq TOTATS-. 00 .10 PC" 11,1147P PfCt(tf4AL MEC)ICAL s @(PVICF. 0 tiSTING nF Af),Ivbt@t@ filNOS 0 PFOUR-ST MAY/JUNE 1972 RR-VIFW CYCLE RFGtnf@ 64 NF Otllf) Pmp SUPF@ VP (%2 nT)4f Ft OTHFP TOTAL rim Pnt@E NT RMPS GRANT R@LATFD lf4Cn4f-. STATE LOCAL Ffn&RAL NON-FEDERAL DirFCT . TOTAL i:u.%")S Nulor)ER TOTAL INTEPLSI OTi4F. A FUNDS FUNN$ ft)NI)S F t?Nn S ASSISTANCE THIS PERT(ID COt4TlNUATION WITHIN APPPOVED PEPIW OF SUPPORT 1 669,606 crj,),) 661) t 616 38 #842 . 88,491 i)02 SA9491 599320 ')Ogooo 26*076 26.076 CNNT* WITHIN SUB-TOTAL- 939p4ls 8879@415 30, (I'@)O ottion toTALS SR2#415 279n.10 30*"'%O 939,415 f, 04) P MPS-OSM- JTOC,@'k 11), 11)7z RFr.InNAL MFOIC&L r-PO.rP@"S @rPVTCr- SummAR.Y bkjf)GFT LIY TYPR 'IF SkiPPO;,T RROLI@ST FFARIJAPY 1, 1972 DEADLINF 64 rHID CL UIPECT Cr'ST RMPS pmps PRFVIOUS AMPS RMPS DIRFCT INI)IRECT TNTAL YrAr@ DIRECT DIRECT PcPl@n!IAL PATIFNT EQUIP. CONST. OTHFR TRAINING ZN") YR 3.qO Yr%@ p@71. SI)C CAP E C FELLRIWO,. IST YR IST YR IST YR. AWA',Zf) Cr',-@T l@,UtT WITHIN' APPROVED PERIOD OF SUPPDPT 6,3q9 19zpqq9 637,796 31*890 669,686 865,QIB '%2,7it5 6,-$T 3R,84? 48,2?4 10,285 AR,4@l 130,944 I') 2 5?,934 1907 .5n 82rl44 i%,347 gi7 , 496 6,q'24 51)03zn 2.').), 1 55 3 76#07h 76,076 84,907 ,r,NT. WIT14IN Slig-TOTAL 811,297 51,IIA .3s?,415 1,3.i9,048 521*577 16,3q9 2l4t74q ;kFOUFST TOTALS 571,577 l6p399 714,74Q 8-11,2qT 51,118 R82,415' lt339#048 arr.,L"l @YALI 521,577 16,399 214,749 q3l,247 5191IR 8829415 1,33q,048 C n,, Pn F CIIVPI)NRNT TITLF YFAR r2 C )I) Cf' R E I) I Pr.)S,)ITAL LTRQAIZY CONSULTING SERVICE ')IZ CCU NUGZS@ TRAINING (2 )()3 STFTFP CIJLTURE PP(i-.RAM (2 '11)7 STRNKF REHABILITATINN DEMONSTRATInt4 07 (I$ A t@@) I I t i CL R I' ()I i I s II t BR@UAQ YI tIl)Y., t)rADIINF lociT m r A n T14F it TOTAL T rPt.@;T RELATED INCtimE STATF LN(AL FEDI:PAL NnN-Fr()F$tAL DIRECT TOTAL FU40S F k TOTTL I,%TEREST OTtirA FU,4n,; t jj n,; F U 14 L) S F I I N i) S ASSISTANCF THIS PERinC) C"rINUATICt4 WITHIN-APPKOVEO PERIOD OF SUPPORT c) ),I 669thpb 669,686 or.1 M9842 lt8vR42 ,)'2 88,491 08,491 t)') 3 116,320 1) )7 76#076 26oO76 WITH,,14 Sul-T()TAL P-82,415 27,000 3r),O(40 939t4lS REGION TOTALS 270 O)OO ln,olo 919*415 t'AP.CH 17,1972 REGION - NE OHIO BREAKCUT OF REQUEST RM 00064 06/72 OZ PROGRAM PERIOD RMPS-OSK-JTOGR2 (5) (2) (4) (1) IDE'4TIFICATIC)N OF COMPONENT CO,-iT. WITHINI CGNT. BEYCtDl APPA. NOT I NEw, NOT CURRENT I CURRENT I APPR. PERICOI APPR. PERIGOI PREVifUSLY I PREVIOUSLY DIRECT INDIRECT TCTAL OF S'@'PPORT I CF SUPPORT I FUNOtt) APPROVED COSTS I COSTS COOD CCKE @6@9.6P6. I c-I -I ;5i-P-ITAL LIERARY C014SULTI - I t tL r, v lap --- 1 132,785 1 I 1.32.TS5 1 4? 1 002 CCU T@UPSE TRAINING I I I -- S9 Zal4@--@.LIAZ OD3 STP.EP C.'--LTUPE PkCGPAli I I I 5 1) 2.L.J.2 6 1 I 552@2@ S6,1124 I 159.12e-) I E07F TREKE@ -ADILITATION DEJ TOTAL--,. --.$831#297 S6319 297 $519 118L I -S882o4l5 1. MARCH l79L9?2 SUMMARY OF ALL REGIGNS BAEAKOUT OF REQUEST 06/72 IST BUDG(T YEAR AMPS-OSM-JTC@;Z2 151 (21 14) (1) I CCNT. WITHINI CUNT. BEYONC)L APPR. NOT I NCW. NOT IST YEAR IST YEAR I I APPR. PERIODI APPR. PERICOI PREVIOUSLY I PREVIOUSLY DIRECT I INDIRECT I TOTAL OF SUPPORT IOF SUPPORT I FUNDED APPROVED COSTS I COSTS I GRAND-TOTAL 1 $14,062#690 1, SI,893,8501 $lv467,376 1 $4,21lt693 1 $21,635.609 1 $4,108.768 1 $25,744,377 1 2NO DUEGET YEAR I CCNT. WITHINI CCNT. BEYONDI APPR. NOT I NEWE NOT 1 2.40 YEAR I I APPR. PERICDI APPR. PERIODI PREVIOUSLY I PREVIOUSLY I DIRECT I OF SUPPORT IOF SUPPORT I FUNDED I APPROVED I COSTS I -G;tAND-TOTA@---- 1 SllF363,076 1 $704.148 91,038,745 I'- $4,002.273 1 $17 #128 t242 -1 3;tD 6UDGET YEAR I CUNT. WITHINI CONT. BEYONDI APPR NOT---I NEW. NOT --I-3r3 YEAR-1 -I---TOTAL I APPR. PERICOI APPR. PERICOI PREV;OUSLY I PREVIOUSLY I DIRECT I I ALL Y--@ARS I I OF SUPPORT Ci; SUPPORT FUNDED APPROVED I COSTS I IDIRECT COSTS I GRAND-TOTAL $4379719 $269966 $1916OPS44 1 $lv627,529 1 I $4C,391&380 I I f I Region 14 Rev. Cycle PRINCIPAL ACCOTPLISliMENTS BY RNP since 197- The Region has excelled in the development of cooperative relationships throughout the area and has involved large numbers of providers in the committee and overall organizational structure. It has a good data base and has the cooperation of all of the resources necessary to establish a complete data system. Strong ties with CHP, state health planning agencies and other institutions and agencies have been developed. PRINCIPAL PROBLEMS 1. The absence of critical staff members. 2. Relationship between the Board of Trustees and the RAG and the question of where decision making authority rests. 3. Currently supported activities for the most part do not reflect program goals or priorities. ISSUES REQUIRING ATTENTION OF REVIEWVRS Same as problems. LI 15- - I)ate: 3/7// N'ortlieast Ohio,. BN,,: Vernie 1). As'tib@- Prepared Afts.- 'Obj active ana -Priorities: la,(,, statement of goals and priorities submitted with the first operational grant cojitiTui@l,s t,lithout change. I',.,Ich problem i.$ classified on a scale of urgency (Urgent.- 4, Important Significant- -nd 6rt' nt - 1) and this scale is used in the priority-rankiiig b@ the Board of Trustees p ine of the protects that go through the review cycle. .1. @@.i,m-mediate fiealth service needs of the poor of the cities of-,NE Ohio (priority 4 -.urgor 2. NFORMP organizational goals (priority 4 - urgent) p Prevention and early detection of disease ( riority 3 - important) .) - important) 4. Increase in the potential for the delivery of health services (priority ' 1 Faudlitation of the distribution of health services (priority 3 - important) rovement of the quality of medical services (priority 1 - pertinent) IMP ('Lirrently supported activities for the most part do not reflect program goals - - - - - - - - - - - - emphasis. -Recomended Action: ents and implementation: ll'ne NEO/IW has done a good job in conceptual planning. It has a good data base and has coop r4tion of all resources necessary to establish a complete data system. A p 's6d computerized network should be a valuable tool in improving the distribution 0 dical services in the Region. All 56 hospitals, having 4004000 discharges per year, area coo tat'na in submitting summaries of those respective discharged patients. p 1 - co e supported feasibility planning studies which-show promise are-. 1. The@Laser TV Tr ission with Case Western Reserve University, a prototype one-way laser system for TV transmission will be expanded into a two-way 'System for health.services-co ications. @fh' St will examine the value and reliability of the system as well as implications fo @ ide aDi)lication. 2. corganization for university cooperation in health which was formed to encourage @i cob@i@at6 oint planning for health manpower education through Greater Cleveland @f t iOi ons (Cuyahoga Community College, Cleveland State LJniv6rsity and Case Ilest6rn I s re Univer ity with the Metropolitan Health planning Corporation and NEO/R4P representi cons r and provider interest in the c ity. This study will explore the feasibility of establishing a formal mechanism through which the resources-of the three i ti ions could be used in the preparations of personnel in existing health occupations @new catejzo ies of'health manpower as these develop., If such a mechanism is feasible, t is@@-could be the foundation for the establishment of a jointly sponsored School of Allied eal W Co staff has always been very active and have excelled in providing c functions for the program. stantial staff effort is spent in convening litatinR activities. There is a Very. close working relationship among agencies, ,:t8soc ati6ns and institutions within the Reizion. 16 Northeast Ohio prepared 2Z: Vernie D. Ashby 'Date: 3/7/72 3. Continued Support-- The Hospital Library Consulting Service project #1 to insure continuity of services following the phase-out of NEORMP support now has a fee for service arrangement. At present fifty institutions are now providing support.for services instituted as a result of the project. Income is expected to increase thus insuring continuity of services to member institutions. Project #2 continuing education of nurses in Coronary Care will probably be university-based following termination of RMP support. %leans to finance this activity are being explored. There is no indication,that the other two operational projects will be continued after termination of I\TEO@1P support. 'Recommended Action: 4. Minority Interests: There are eleven full-time professional and technical positions on Core staff. Six of these positions are - filled with females and five with males. However, none of these are filled with blacks. The Coordinator of the NEO@ffl is actively recruiting a black physician to fill the position of Deputy Coordinator. Minorities occupy three of the seven clerical positions on Core staff. @@o of the eightben professional and technical positions on project staff are filled by minorities and one of the five clerical positions. Seven of the members of the 55 member RAG are minorities. The Coordinator of the NEORMP will strive for a balance with regard -Lo employment of minority employees and minority representation on the RAG and committees. 71he plannina study to develop a comprehensive health care program for the medically 0 indigent of Loiain County is a plan to bring high quality care to tliese'people in their own neighborhood. This is an area with a large minority population. --------------------------- ------- - - ----------- - -- - -- ------------- - ------------- Recommended Action: 17 'Alp NEOhio !=aTed -B3r: Vernie D. Ashby 3/7/72 Coordinator@- PMP was without a Coordinator or Deputy Coordinator for approximately eighteen months, Dr. Donald M. Glover was appointed coordinator on January 1, 1972. Dr. Glover was not on board in time-to hav6 input into the present application. Although Dr. Glover is 76 years old, he seems to be in excellent health and also seems to be quite alert. - - - ------------ ended'Action: 6. Core Staf e Cor staff includes eleven full-time professional personnel. The majority of the e St it physically located in the central offices in Cleveland with regional Offices i stown and Akron housing small contingents of Core. The following critical staff Po$ s ave never been f:'Llled 1. Director Evaluation 2. Di tor,@Communica'tions I., Dep Coordinator -------------------------------- - ------- - ---- --- - - ---------- - ------- ------------- ed Action- e D. Ashby Date: 3/7/72 hio Regional Ad 7. visory Group'. f"iie RAG has been meeting quarterly for the past year with a membership changed- significantly from previous years. There is now a broader.repte,sentation according to vocation of individual members. There has been a marked improvement in attendance at i@G meetings during the past year. After a study by an Ad Hoc Committee 6f RAG, RAG itself concluded that its functions were purely advisory. This would'indicate a serious weakness in the entire organizational structure of the NEO@1P., There is a need to-involve the RAG more actively in both the planning and dec'lsionmaking process. -- ------------------- - - - - - Ikecomended Acti@. 8. Grantee Organization: 'Fhe grantee is a non-profit corporation which receives fiscal services from the Case Western Reserve University. The members of the corporation are the Board of Trustees. Decisiomaking responsibility for program policy and direction rest with an Executive Co@]@.ttee, whose members are drawn from the membership of the Board of Trustees. This arrangement has raised serious concerns as to whe,ther.th6 decisionmaking responsibility in this Region rested with the Board of Trustees or with the Regional Advisory Group. ------------------------------------------------------------------------------------------ RecomFnended Action: - ----------- @lp: )Iortficast oflio 19 Prepared By: Vernie D.'Asliby Date: 3/ Participation: cooperativeIarrangements and close working -has succeeded in the development Qf tionS With4 relationships among agencies, associations, and institu in the Region., i.e., Blue Cross, CHP 314(a) and (b), the Health Department, the IVelfare Federation, the Medical School faculties, the Academy of Medicine, volunteer organizations, and the Community Qolleges. --------------------------------------------------------------------------------------------- Recommended Action: io. Local Planning: The area planning committees meet on a quarterly basis. These committees are responsible for assessing area needs and for advisin the Coordinator, Bo g ard of Trustees, and the four approved feasibility ;,-AG on NTEORMP proposals. Core assistance to proposers led to studies including developmental planning for an AHEC for the Youngstown-lVarren area involving major Universities, medical centers, physicians and health organizations. NF,O@FP has a field office adjacent to the Summit-Portage County CHP office. Staff and office equipment a@e shared. CHP circulates pertinent applications to for comment and CHP reviews and comments upon NEORMP proposals. Also a NEO@ Istaff person is located in the@'4ahoning Valley Health Plannin Association office and shares many 9 ,.Iaily planning and coordinating activities with CFffl. --------------------------------------------------------------------------------------------- Recommended Action: Preparj By@ -Vei-nie D. Ashby Date: 3/7/72 PM: Northeast Ohio 11. Assessment of Needs and Resources:, Liai k method of total program evaluation has been.designed and is under development. in Akron resulted in a' discharge planning study. Assistance to proposers led uo four approved feasibility studies including,developmental planning for an Area 'Flealth Education Center for the Youn'gstown-Warren area involving major Universities, ,.iedical centers''physicians, and health organizations. NEO@ in conjunction with Blue Cross 'of Northeast Ohio and four CHP "B" agencies are co-founders of Center for Health Data' of Northeast Ohio. This. center has supplied the necessary,data for a series of studies concerning hospital utilization and discharges and manpower data analysis. Joint data collection has been carried out in the areas of health manpower, he'alth manpower training programs, emergency services, and other surveys. - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - Recommended Action: 12. Management. The real meat of the iNEORNlP has been in the realm of its Core functions. Core activities have been varied and imaginative. 'Fhree critical positions remain vacant, these and tlle positions of Deputy Coordinator, Evaluation Director and Communications Director.. ';N'EORW has a written procedure for the review of project applications with Core staff input beginning with staff assistance in the development of projects, regular and systematic monitoring and evaluation with quarterly expenditureand progress reports. --------------------------------------------------------------------------------------------- RecoiTnended,Action:.-. 377172 %IP: Northeast Ohio 21 Prepared py: Ver'nie D. Ashby Da.-. I'he position of Evaluation Director on Core staff is vacant and considered to be a critical.1y@needed sition. Howeve , specific Core staff are assigned to monitor and PO .]: provide supportive services to individual projetts. Major Core staff responsibilities are evaluation and financial administration. Two reports are required quarterly from oath vrbioct. These are expenditure reports and progress reports. An Assistant Director for E @tion was hired in April 1971. A system for appraising and strengthening funded pyojects with periodic reports, com.ittee review and consultation is under @'ay. A method of total program evaluation has been designed and is under development. ----------------------------------------------------------------------------------------- comeiided'Action, Program PTODOsal: ,r rog priorities against'which projects are reviewed are: I diate health service needs of@the tJrban poor. 1. eve ion of Disease: Prevention of CoApli6ations of Chrbnic Disease: Early Detection of Chronic Disease. .1@l.@Incre sing the Potential for the Delivery of Health Services. ,v. on 46 Eauilitation of the Distribution of Health Services. 9 V. improving the Quality of Medical Service ,;k.Li proposals.receive an evaluation rating which determines funding. Present operational orojects show little relationship to goals and priorities. However, certain Core activities ani Core- orted feasibility and planning studies show promise. F6r,oxample: 1) The de clopnient of indices of com=ity health through the Center for.Health'Data. 2) Develop- m lit of t model for Youngstown-Warren AHEC. 3) Expand discharge planning throughout th Region and 4) dev(-,]@opment of an educational data system. ----------------------------------- ------------------ ------------------------------------ o elided Action. Pre-pared VCL t. 15. Dissemination of Knowledge: The NEORMP has developed cooperative arrangements and close relationships among agencies, i.e, Blue Cross, various hospital administrators, CHP 314(a) and 3i4(@)-, the Health Department, the Welfare Federation, the Medical School faculties, the Academy of Mediciiie, and the Communi ty Colleges.. Data.-collection needs have been identified and publications on health-related data have been compiled and distributed. ---------------------------------------------------------------------------------------- Recome,nded- Action: 16. Utilization of @lanpower and Facilities: A structure has been developed which can stimulate grass roots interest-and need major health factions in the region. Close relationship.$ prevail among agencies, i.e., Blue Cross, hospitals, CHP I'All & "B" ag@ncies, the Health-Department, the Welfare Federation, the Medical School faculties, the Academy of.Medicine, and the Community Colleges. ---------------------------------------------------------------------------------------- Recommended Action: Date: PrcT)a-rel 17. Iiiil)rovernent o-f- Care: A planning study is in progress to medically indi'gent orain County. Initially, it will serve 5,000 of 28,000 poo'r in the county.. A discharge planning study for continuity of care will test the feasibility of a coordinated discharge planning system for the improvement of corit'inuity of care. A study titled "Preventive and Rehabilitative Needs of the Under Sixty-five Homebound" is di@ected toward a typical inneir-tity with a population of approximately 40,000 to determine the magnitude of the needs of.homebbund persons.under 65 years of age. --------------------------------------------------------------------------------------------- Recom,ended Action: 18. Short-term Payoff: The Hospital Library Consulting Service provides a network of informational services@to fifty institutions which are now providing support to the project. This project will be expanded further and should be self-supporting upon Germination of NTORNP support.in June 1973. The Continuing Education of Nurses in Coronary Care project has developed the necessary components to structure an effective educational program. Means of support are being explored for this project'which if terminate-- on or before June SI, 1973. .Since the i@eption of the Stroke Rehabilitation project over sixty patients have benefited from treatment received in this program. Improvement has been.noted in terms of shortening the length of hospital stay, the course of re.habilitation, and the course of the disease. --------------------------------------------------------------------------------------------- Reconimeiideci ACtion: 24 Date: Prcpared By' Regionalization: For the most par@, peratibn'al activities are aimed at nurses and.other hospital health professionals. Fifty hospitals are participating in the Hospital Library Consulting Service project and-the network 'of informational services will be @anded further. -------------------------------------------------- --------------------- 20. Otlier Funding: The Strep Culture Program which is NEORMP operational project #3 has $27,000 State funds and $30,000 Local funds allocated for this budget period. Blue Cross of Nor.theast;Ohio has jointly sponsored a computerized tumor registry, supplied basic data for Radiation Therapy Guidelines and helped develop average cost of kidney transplants and'other procedures-,; ------------------------------------------------------------------------------------------ Recommended Action: DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE .KEMORANDUM PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION TO Acting Director DATE: April 18, 1972 Division of Operations & DevelopTnent Directo FROM Regionalqd@ical Programs Service SUBJECT: Action on April. 10-11, Staff Anniversary Revieil Panel Recommendation Concerning the Northeast Ohio Regional @ledical Program Application. Accepted (Datd) Rejected (Date) bbdif ications Financ Componont__and ial Summary - Anigivetoary Application COIIPONENT CURRENT YEAR YEAR RECOMMENDED YRIS AWARD COUNCIL FUNDING OPER. RECOMMENDED REQUEST SARP YEAR---- LEVEL REV. CO@. CORE *-481,424 637,796 Sub-Cootracts 55,000 X/ X OPER. ACTIV. 208,763 193,501 DEVEL. COMP. Yes or No (X EARMARKS-. KIDNEY RMPS DIPECT 690,18 7 803,696 786,187 831.297 1,232,075 RE2MESTED COUNCIL 786 187 APPROVI&D LEVEL WON-RMPS and INCOME Does not include 24 Month REGION Northeast Ohio extension for 01 yr. of $2,,376,158 01 Al 01 A2 May/June 1972,,REVIEW CYCLE Core 677,826 Core 865,918 Projects @359@284 Projects 473,130 Direct Cost 1,037,110 Direct Cost 1,339,048 4/18/72 SCOB/RMPS Region NEORMP 197Z Review Cycle June Type of Application: Anniv. Prior to Triennial Rating 45 Recommendations From SARP Review Committee Site Visit Council Recommendations: 1. The funding level and period recommended by the National Advisory Council at its February 8-9, 1972 meeting be approved. Specifically that the Program be continued for 1 year at the present level of funding.(786,187 D.C.) 2. That RMPS recommend to the Region that they take a good look at Program staff to see if there are unneeded positions and that they give consideration to phasing down or out the present operational projects, utilizing any funds freed-up to mount new programs and initate activities indicted by their data base. 3. That RMPS take a good look at the organizational structure I of the Grantee and make specific recommendations. 4. That technical assistance be provided to the Region by RMPS. This assistance to include strong RMP Coordinators in addition to @S staff. 5. That the new coordinator, Dr. Donald Glover and the RAG Chairman be brought into Rockville for RMPS indoctrination. 6. That program progress be assessed by RMPS at the end of 6 months. The Panel concured with staffs recommendations including the continuation of the Regions funding for 1 year at the current level. Decision making responsibility for NEORMP policy and direction. rest with an Executive Committee, whose members are drawn from the membership of the Board of Trustees. Reviewers were very concerned about the relationship between the Board of Trustees and the RAG and the question of where the decision making authority rests. Page 2 - Critique The reviewers of the application were in agreement tiat very little progress had been made by the Region since it attained operational status July 1, 1970. The panel agreed with staff that there was litt e apparep relationship between Regional goals and the operational activities which are presently supported by the Region and fur+.-her that there was an absence of critical Program staff members in the areas of evaluation and communications. The panel was concerned about the lack of minority repre- sentation on the Board of Trustees and the Executiv6 Committee and the inadequate representation on Program staff, RAG and committee structure of the NEORMP. Panel in their deliberations considered the facts ,',iat NEORNP had been without a full-time coordinator for 17 of the first 19 months of operational status and that Dr. Donald Glover was appointed full-time coordinator on January 1, 1972 and was not on board in time to have input into the present application. It was the opinion of panel that NEORMP was actually back to a planning grant basis and that Dr. Glover, the new coordinator, should be given all of the assistance possible to give him a chance to turn this program around and head it in the right direction. Panel felt that some of the following forms of assistance could be helpful to the Region: 1. Staff assistance visits. 2. Strong RMP Coordinator going out to the Region as a part of the technical assistance process. 3. Have the coordinator and RAG Chairran participate in site visits to other regions. 4. Refer coordinator to Regions that have sol-,7ed programs. 5. Have the coordinator and RAG Chairman visit Rockville for RMPS indoctrination. 4/18/72 SCOB/RMPS Region OHIO Review %'Iycle June 1972 Type of Application Anniv. Recommendations I?rom -Prior-to Triennium Rating 197.7 SARP Review Committee Site Visit council Recommended Level of Funding: The Region requests one year of support, 9/72 8/73. However the Review Committee recommended two years of support to- (1) 'provide the Region with the opportunity to,tAke the necessary steps Of putting the two prog.rams together and (2) to build a strong and effective Program Staff. The Committee recommended a total of $1,400,000 for the (01) year as compared to th6 Rekion's request of $2,082 820. In arriving At this amount, members of the Review Committee: 1. Recommended $900,000 for Program Staff. This amount is approximate 10% over the current Ohio State and Northwestern Ohio RMPs one year expenditures for the Program Staff component'. 2. Recommended $500,000 for operational activities. Included in this amount was the proviso that this include $201,535 for Project #3, Ohio Renal Disease, if the project was approved and that this amount was to be deducted if it was not approved. (The 3 part Ohio Renal Disease -project was reviewed on May 8. 1972 by a staff AD HOC panel. The recommendations of this group are the subject of separate documents). Also included was $162,393 for the 10 month continuation of Project #12 Ottawa Valley Council for Continuing Education, and #2, Computer Assisted Instruction, which have one additional year of Council approved support through the merging RMPS. 3. Recommended no support for Project #8, Health Careers of Ohio, as the activity was believed to be outside the guidelines of RNPS. e Committee recommended a total of $1,515,000 for the (02) year. This was built on a 10% increase for Program Staff, $990,000 versus (01) year $900,000, and a 5% increase for operational activities, $525,000 versus (01) yearl$500,000. CiiticLue: This application@was not reviewed by SARP. A site visit was not performed. Members of the Review Committee had a great deal of difficulty in considering this application. Page 2 - Critique First, they commended the very poignant comments of the two members of Council who participated in a January 10, 1972 Factfinding visit to the three Ohio RMPS. They we're.then in the dilemma of attempting to consider total program rather than individual projects when in reality there was, as yet, no total program to consider. Two of the present three Ohio RMPs Ohio State and Northwestern Ohio, .9 have complied with Council's recommendation to merge, effective September 1, 1972, to become the Ohio RMP with the Ohio State University Research Foundation as Grantee agency. The Review Committee considered the following as concerns: 1. The Acting Coordinator, Dr. William Pace, will resign, effective June 30, 1972. (He has elected to assume a full-time position with the Medical School). 2. The Region has no formalized review process. 3. The goals and objectives are very general, non-specific statements. @4. The Regional Adviso Group is temporary and is in the ry process of expansion. 5. Major staff changes will not occur until the Region becomes operational. 6. Nine of the twelve proposals in the application are from the existing Northwestern Ohio IM. (Members of the Committee had a considerable amount of concern that previous activities in the Northwestern Ohio Region were aimed towards the support of the newly developed Medical School at Toledo with emphasis on that rather than to a greater degree on the PJW component). Conversely,, the Committee believed the Region had taken some positive ste7p@sr to deal with the problems. These are: 1. A Search Committee has been active (and successful) in locating several qualified candidates for the Coordinator position. A final decision is expected by June 30, 1972. 2. The local review process is being prepared and will be completed before the Region becomes operational, 9/l/72. The review process will be a part of a developing policy and procedure statement. Also, the Region plans to have all projects proposals, feasibility/planning studies and many of of the program activities in this application reviewed by an external review group prior to June 1, 1972. Time constraints Page 3 Critique made this impossible prior to the submission of the application. The application describes a detailed program management planning process. 3. The Region has established a committee to reconsider and monitor the goals and objectives. 4. After September 1 1972, membership of the RAG may be expanded 3 to include broader representatives as outlined in the By-laws. 5. Because of the pending appointment of a new Coor inator, t e Region has made little effort to recruit personnel. In the mei'ging Regions there are currently a total of 22 professional positions - this is to be increased to 32 professions s in the new organization. 6. The Region has agreed on a grantee and fiscal agent, the Ohio State University Research Foundation, which has demonstrated competency in the fiscal area. 7. The Region currently has a relatively strong Acting RAG Chairman, Dr. Brian Bradford, (who, it is understood, will remain in this position) and an Interim Regional Advisory Group that apparently has participated fully.and actively in the merger effort. 8. The reviewers commented that the RAG has established an innovative task force arrangement to continually monitor the progress of the new program. Conclusions: - That the Region has made progress in merging. - That they have attempted, as requested by Council, to merge with the Northeast Ohio and Ohio Valley RMPS. This has not been effective. - That the Region be encouraged to devote themselves to planning and development activities rather than to immediately launch new project activities. - That the Region be encouraged to attract additional minorities to its staff, RAG and Committees. - That the new Region has some unusually strong support through the Director of the CHP "at' agency as well as the Director of health. Page 4 - Conclusions That the new organization appears sound and indicates intent to establish field offices. Also, the.planned assignment of field personnel to work in CHP "b" areas should add a demension heretofore unknown to this area. DOD/SCOB 5/23/72 Component And Flnnncial Summarv Anniversary Applicntion 01 COZ,WONEliT cLjRPE.@rr %'FAR YFAR RECOMI,!E?iDED YR'S AWARD COU',,'CTLL FM4DING OPER. RECOI-IY4ENDED 'REQUEST YEAR #LEVEL REV. C014. 01 02 CORE 1,23Z,668 900.000. 990.OC Sub-Conttacts OPER. ACTIV. 643,617 500,QOO 52,5,00 -0@ DEVP,L. COMP. Ye g or 'No EARMARKS: YIDITEY #3 201,535 CBE #15, 16,1- See Below R14PS DIAEDT 2,082 0 515,00 is 00,00 1 RE2UESTED COUNCIL APPROVED LEVEL NON-P,14PS and iizcom -0- Also pending are CBE requests as follows: it 15 01- 78%019 Total Costs REGION OHIO #16 Ol-' 87'0,169 @irec't Costs. June REVIEW CYCI #17 01- 49.,900- Direct,Costs .19721. Corrent Program Recruest .21082,820 t -e Supplemental CBE Re4u,st - --998,088 's.Total Reqxiesv- - 3 080$908. RO-gion OHIO STATE N.W..OHIO TOTALS Total.Direct Costs 702,467 69-2-,800 1,3959267 811 751 Program Support -(CORE) 451,8@l 358,900 @projects 249,616 -333,900 583,516.. Summary of actual expenditures for-the one yeat period ending March 31, 1972 2 Revie;,l CYcle, Ma 'u 7 Type of 3 c Appi _a i Anniversary Continual-ion-(ly prior. to submission of a recon,.mDnd;itionG Proll. triennial .. . . ...... . Rat'ing: Review Co@ttee-lE (C SARP. Review Committee Site Visit Cotincil @Olq ION.--.-'Ihe-LRP-vi @ttiie @enr-ur-@d.-with.-. or ne-year in the reduced 205 (d.c.) that the application be approved,r ... 0 amount 39 '.-.advice to the Region as follows This recommendation also inclL4&-s 1) recruitment of a strong Coordinator, including consideration 'of a.,qualified non-physician; 2) strengthen the 1Drogram by reorganization of RAG and Program Staff,' as well as continued subre 'onalization;-and 3) improve relationships and responsiveness 91- to CHP "bl' agencies. This action does not include Emergency Medical Services (EMS) p-roj ect #25 Pending a-special review. @As reported-by.-staff, it-vas alio.-noted that a-supple@-ntal application for planning several local health.manpower systene was e@ct&d review prior June,l@for;special, to the June '72 Council. RATIONALE FOR FUNDING RECOMMENDATION: Recommended funding is at-the 03 yea.r level prior to the April-'7i boardreductions; and sh6uld be adequate to increase Program Staff, necessary-reorganization activities, and to fund some projects (particularly continuation of those w±thin the previously-approved support periods and activities developed by the Tulsa:NE Subregion and approved by the CHPagencies)'.. C!IITIOUE: The recommendation was reached after long discussion'and debate about the status of this.RogiGn.and an appropriate level of'funding.- StafP's narrative comm@nts including ORMP'S. strengths and we@esses,'the subject of SARP's discussion were noted. 'The Review Coffdttee expressed concern about some of the disparity in.project ratings., and they questioned whether CHP comments were considered in the RAG ecognized and discussed the need for d6cisionmaking process.. -The reviewersr a -different administrative mechanism to provide the needed'leadership for a meaningful reorganizational thrust in Program Staffing and continued education of the RAG and'its,committee-s..- r-@f staff added.to. e difficulty in identifying current Pro' am Staffvacancies and new positions. Concern waIs gr expressed abotkt-the number.of.proj-ects 'SubYpitted f6r support, during a time when major efforts should be in reorganizing to-turn the Region around in-the right direction. Even though minimal breakthroughs were recognized, sorqe members of the Committee questioned.-wheth6j? OR6P had really.gotten the message and favored sharp funding reduction. On. the Positive side, staff reported that the Coordinato@ has 'announced his decision to resign as soon as the active Search Committee recruits a qualified successor, and the Committee is thinking about the kind of leadership and organization that,is needed including competence which does not require a M.D. Region Oklahoma Review Cycle June/July 1972 Recommendations,From Review C@,ttee Page 2 Another hopeful sign recognized by staff is that the Director of the University MedicAl Center and the people in Oklahoma more and more are defining the University Health Science Center as an institution to serve the State, and the ORMP represents the necessary link for community service. Other noted progress included the implementation of subrevionalization in the Tulsa Area, the Macer,Co@ttee Study, and efforts by some Program Staff to strengthen ORMP. COMT10nent And Financial Stimmnry Anniveranry ApE@icntion YEAR RECOMl.ic-ItDED COI,al0liENT CuRrE@IT YRIS AWARD FUNDING o@ 'OPER. RECOi@i NDED REQ'JEST @SARP @7,EV . C YEAR LEVRL-. CORE $354,ooo $677,300 4'(,100 -0- Sub-Contr@icts 629 782 OPER. ACTTV. 384,500 -0- -0- yes or No (X DEVEL. CO.@. EARMARKS: 0- -0- -0- See Below E4S #25 --,9 2 0 5 1,35@,182 FCT 7@8, 0 RE2UESTED 224.%o64 COUNCIL o62,564 APPROVFD LEVEL -Rl4PS and NON > -o- I.NCOM REGIOII Oki,@o-Ta REVIEW CYCLE /June t972@. ch"" t 6/71-8/72 (15 months) This Region'4 currqnt-period ia being @pd o and funds be Increased to $923' % 125 d-. The DIS-iDrooosal-was a part of the basic-application and is pendi' rIg special revie@i. Punds ($140,690 for 'one-y@ only) for that project t included in this figixe. are no Current Program request $]:.1354,182 Supplemental F-@ request 14o,69o Region's-Total -request $1, 9 72 O@HOMA, REGIONAL MEDICAL PROGRAM @versary Application, For Consideration by June 1972 Advisoi-y Council TABLE OF CONTENTS PART I: STAFF BRIEFING DOCUMENT Page Face Page . . . . . . . . . .. . . . . . . . . . . . . . 1 Map, Geogr-aphy & Demography ......... .......... 6........ 2- 4 His tory . . . . . . . . . . . . . . . . . . . .0 . 5 Canponent and Financial S ..... .................. 6 MIS Breakout of Request (04 year) .. .................... 7 Accoirplishments, Principal Problems & Issues ........... 8 Pre-Sai-p Staff Meet@ Carznents in Rating crif-@ia Order .......................... ........ 9-14 PART II: KIDNEY ACTIVITIES None III: APPENDIX Site Visit Report - July 1971 ..................0 ....... A-1 Advice Letter-August 1971 ............................. A-P Staff Visit Report -.January 1972 ....................... $,".A-3 Macer Report December 1971 ........ ...... A-3a rx I,, It p s Eastern Mid-ccl@ OPI?.RATI-01,'.S 10. r7 S uth-Cotitr 1 Wi&G'teri R t I,,ttefj LAST Pt.rIlIC Tel. Lo. 44-3-l')O@0- Room ]@o-15 197 DAT E BRta;cit -ci,.icr. Michael Portl @ist ililiv YEtiR r7 SARP BRANCII STAFR- Luther Says P- Dale Robertson 2nd '41V YV"R Ptil COX. rlo RE. liER anniversary r-7 OTHEP, Ne x t I-Ig t Asein'.t Visit June @19 /1 4th Chairmdn s.v. iuly@ 1071 Chairr,-in Leonard Sherl,is. M.D. Last 12 mos. (Dat6s, Chairman's Natne @A;id Type of Vigit). J. vis3'@t) 14oni.tor ProErecis and consultation prior to submission. 0 t ap lication. .S aff visited P,@111S. Ftaff for 2, try(-) staff fc)- 2 d-N,@ 3 7-@---@ sidr--Ilt for @IGdical Affair,-, and Dir. of LIMC ra et A;7iti,, ,3 a Director 10/71. 3) l.h(- R.OIR. visited,ORMP several tim(--,,,; inci@uc!s. h (iccutt64 in the Region Affecting the RMP since Ito Last Review @197 1 T e site vi ified manv ORMP problems which must be seriously addressed if th4. $it s en -is to move forward. Th6 visitors' main concerti. was lack or capa 10 Core e e li p@ @(retioit And advice 16t-ter Are included in this document). ollowin@ i 'Site visit, the ORMP ap ointed a s .pecial p6tmnittee et commi te 2@ e p ("Mac e i ding t Coordinator from Colorado/Wyoning JIMP to assess the Region. 3 n ih6l Retina of the OR@IP Co6rditiator, Director of khc@ Uiiiv. Med. Center with title tor@of@alPS at-id other staff, there was a clear understanding of the site visit .I- ti d ng It'was reported that the Coordinator intended to resign. 4 u n D cbmb6i 171 rettdat.of@the RAC, and Core staff,@prdgram directions were d d light of'the site vi6itors-.and Macer Cbmittee@fiiidings. n 172 meeting, the RAG aoptbved some affirmative changes in the PAG and 0 ty tee structure, iubregionalizdtton and strengthening the Cote staff ... in 9 wit new goals And objectives. Map of Con@ssional District @.inties, and Selected Cities (6 D -S) OTTAWA BEAVER WOODS GRANT KAY @ALFA'LFA BARTLESVILLE4 7- a ENID wo GARriELD NOBLE ELLIS MAJ PAYNE BLAINE KINGFISHER LOGAN c A CUSTER N 14 A C WASHITA CADDO @CL 01,E.L A.'4 0 110111,IAN GRADY KIOWA M.C CL",@, FLORE GARVIN Pi T PUS"M KA County with @o or more Congressionol Di5tricts U.S. Dcpar-mcnt of Commcrcc Berclu of t,@ C, 3 RDB 3117/71 glil,-ilio@a liMP pr,,ipity Region encompasses the State. Counties'. 77 Congres8ionAl Districts: 6 Population (1970 Census) - 2i559,300 Land Area: 68,887 square miles Density: 37 per square mile Urban: 68% areas: (4) 1,356,600 Fort S-,nlthp Ark--Okla. 156.8 Oklahoma City 623.6 Lawton 104.5 Tulsa 471.7 Race White 89% 'Negro 7% Other 4% (mdj6rity Indian) deaths per iOO$Ooo population, 1967 Oklahoma U.S. 364.5 Heart Disease 368.8 @Mali--nant neopl. 157.6 157.2 s ".ir i 127.4 102.2 a c II- (a f.- CiiS - stroke) 16.9 17.7 Diab tes 14.8 ro - -ic 16.6 n6ho pneumop (o her) Lesour es an FacilLties M dical Schools - univ of Okla., S ool of Medicine, Okl e ch a. City @'1969/70 - Enrollment 442 1969/70 - Graduates 94 Allied Health School, Univ. Univ. of Okla. School of Health Related Professi6ns, Okla4 City NuTEin Schools Practical Nurse Training, Lr-l 15 - 7 of them college or 16 Schools university based Accredited Schools Cytotechnol.ogy I (Univ. of Okla. M.C:) Medical Technology - 13 Radiolbgid Technology - 9 Pllyt;ir-@il Tiieriipy - 'L (ULI.iV. of Okla. @I.C.) @medical-Recotd Librarian - 1 Inhalation Therapy Technician - 2 4 RDB 3 17/ 7 Oklahoina (continued) 3-tals Community General -,nd V.A. General. Beds Short tem 127 10,438 Long term (Special) 3 153 (130) (10,591) V.A. (general) 2 739 Manpower Ph icians - Non-Federal M.D.s and D.O.s (1967) y_q Active 2622 Inactive 382 Ratio of active (per 1.00,000 pop.5.. 106 providing patient care Graduate Nurses, 1966 Actively empl. in nursing 4650 Not empi. in nursing 1842 Rat-'Lo of Etnti'L. (per 100,000 pop.): 188 l@, A LO, RE(@IONAI. I G14AM L This Regi-on was approved and funded for 2 years and 8 months of planning) 8/i/66 - 4/30/69, $835,902, including $121,032 indirect costs. Kelly@West, M.D., now Professor of Medicine and Continuing E,dudation, University of Oklahoma School of Medicine, served as Coordinator during the planning phase. H6 currently serves on core staff (20%) as Coordinator for Related Disease,,. @ollowing a favorable site visit in November 1968, the ORMP was approved for three years of operations and funded At (d.ci) $1,074,145 -010 $1,162,157 -02 and $738,500 -03. The 02 year application was St of their concerns were answ red satisf reviewed by staff. MO e actorily by 0 P. A 1-@PS staff team visited the Region in June, 1970. Within d d4rectly to most of their questions s x months the Region responde I S. Conce s not addressed Iby ORMP, were defeiied and recommendation rn until the n6xt application was received and reviewed. Ilpon review of the ORMP Triennium Application for the 03, 04 and 05 ea]: by the 'i@evic-w Committee and May 1971 National Advisory Committee, approval was recommended for one year only in a significantly reduced amd t including disapproval of the Devolopmental C6mponenti A sj.'te Visit WAS recommended to determine actual progress; to study activities' impact on health care delivery; and to offer guidance to the Region i de-,,2,L6pin,-, a MCL-A meaningful Triennium Ap lication for submission tllc p ollowing year. T e July 1971 site visitors were greatly concerned about the leadership. There was some question about the Coordinator's capability and commitment. The isitors were also skeptical about the strengths of the incoming G chairman, January 1972. The outgoing chairman appeared to be imm ginatl.ve and relatively liberal. Other identified areas in need Of strengthening: (1) development of more optimistic core attitudes, (2) ttemp,t to adopt a program philosophy more consistent with the 'RMPS iis,-.00h and Oklahoma health care needs- (3) evaluate and strengthen the professional core staff; (4) involve more "real" consumers on the RAG"(5) involve IIAG in actual projcict monitoring; (6) reconsider goals and;'ob'pctives@relative to current trends (including time i-rames) and de tify priorities; (7) implement slibregionalization- (8) establish @dtter working relationships with appropriate groups including F@ed6r4l sup ortdd programs, i.e4i OEOO,Model Cities and CHI' "a & bl"; and (9) :stt gth6n evaluation, q I Componeiit -ird Fitiinciil COI-il'Ol@l;'LNT PREVIOUS 04 Y ]AP, P, I.- C O,'. i) E D Ylt'S. t.@.'Al',D F U.r,, D I,'; G 03 -OPER. R L7 C,. I D D rL,:QUI-;ST SA;@r 'V. coil. YEAlt LY r,'- CORE and 354,000 724,14-00 384,5-00 770,472 OPER. ACTIV. -0- -0- -0- P. AR @'LA RI%'. S -0- KIDNR,,Y IRIIPS DIRI@CT 738,500 94,872 RI-,ri>S !!IDIRECT 224,,064 255, 77 O-- -TOTAT, RI-,PS 962,564 Z--5 O@ NON- @S and -0- .01, 962 564 TOTAL BU.'PCII.,7 RP.QUESTR@D REG T 0,Nl Oklihomlli COLIZ@CIL 913,500 2 ArilRollET) LEVFT, June 197 REVILW CYCL:-- This R(@gioiis current period -is I)ciiig cl)a@ged to 6/7-1-'8/72 (15 months) and funds ai-e to be increased to $923,125 d.c. REGI'NN @ CKLXHI!VA F F $):Z @no23 06 BOFAKC UFST @4 rrr(lwlon, (2) PCNENT CCNT. WITHIP-,'! CF-NT. (1-yr@@,')l APIIO. @@@T CUIZPFNT Cl@tcl ENT r) E- @k4T I F I C AT i r-@ N, r;F C Csl C T iNctfzFCT TC" AL o@ 1: V ', CI, SLY @IPFVTI-USLY A r PI' - PER I r)(i A P P@- 7 i (.@C I CfjSTS (CST S CF SUPPORT CF SUPP@PT FUNOC@ APP?CVFO lop CCPF COOCNARY CARF PPCCOAM FOI - - - - - - 51. I 7' 7 ------- I ---------- Rrri@N@L UZCLCGN' Pqr-JECT 'c cl-@T i %$." I Nr, cf7,!,rtT I ON C FN I ',I T ------------ C.@'PF STT'rl t $f,4_tl 4 - - -- - - - - _tl44 --------- - -- L T @-'c C A T I- E I - - - - - - - - @'t.3 a 7 36-- 1 7:F- PRF!G FCO PT;'ZALI t,'Al-t'4 1 14.6 14rs2 I F' 0 71 T@ITS@ FL CITIF --------- -------- CcrTr'%"L 'CrOF'ItTTVF VFCI 4 q ---- ------- -4 ---------- -- - ------- - - - - - - i@2 -1 f 1 T F F N t k C r@H I L _n_ w@,-l -:a ------------ ------- 34 7-- e rcIlTill.,@,li,.", F,-,jf:j5 CCNTFP T.R!TAL $876lpqgg 164 744 $155 11 1 29 $1,4944872 $255,7?C, SlvT5t9642 '-"i @y I., 1,,71 in to 1)(I i-@,c-w fL)Ilctir-)iaal L.@icy iy--co&@ize the, nc-ed fo.- Rti!3 training, iri e-,.alL'13ti.011. 1. 2. c@@ and tire t c@ 3 O")jc-cti-vt-,.@ t,,o bc@ and i-iot y is t r u o. f c a n.,i P c ,7", ii3I.i@,e Ptlt'uil-)Fr the cai,'U- be.-Lorp- thc2 oz-oc. iy pj,, P.ppt,o,jall. -'Ln Of' c;.e. dc),-@,; nc)' "a ',T. 7T. 1.)oth 2 E' c.,,n T A.@D D A'f r,,: ADril 3@ 19'12 Tffi@, BE, coi@ C)pera,tioll,5 Officer atioris Bi,),Jcll ,Lci-Col,it.inc,,,nt, Op@,-r '/,'7/'-(2 R@,gardiribr the Ar,,i.,,eed I)poi-i tL the Oll P arti. c:l. p@,-,trit @@3 J. Pc)sta Cl-ii@,f, 14CO13 .1 J. Sa\js. (),oeration,-3 Officer, TACO.16 *Carol Lar,son, U."U.,D A- 'Mary . dell, D?fD Prepared written *Joan @,i-iscr, OPIIF@ coments. -x-CL-ittieriiie Scurloc',,,, OPPE "'Annie Stubbs, G,@.3 *H,u@old O'Flclierty, MCOB, w@,- unable to be present, ayid, .Di--! o,.-') tics (1),@ir@c It'i @)i6) T-ie ri@,w goals, and objectives lialie been. eyl)anded but are still too gc@iieral. According to r@,dent telephone conversations with Dr. Coc)nek-, the in concert with trick new Cc)],n@litir)ity and Consuirc-r Health and, Iiivolv(-@rfp-nt (,,c)rrfAttee; he is in the process. of goal_.s and objectives (.-Lorig and s@ioi.-t tlc.@nn) vil)!.cli be rfore specific arl(j eq@it(--@d to ll:r:i@or:Ltic,,@, vjill @3.'i.Fo be (curr(.@,nt prioriti-e.,i are not listed., t@)ul, the sw@, listed in last y(@@ars appl.icatJ.on). Ol:i@IP ft@-s workiii-)v, wi@i CIIP ",,L" '2afk Force on hcaltla statistics to a data I)at,Lk for Okl,,JioTric@.R(--,.I@ative to goals ,md is ncnq better, cooperal.-,.@i.on with o,(-)n.,.DL7LTrp-r a- it@ @,l 'lb") and a move toward 2. Acccfi,,P.I-I.sl,2i-ients and Ii-i addition to the site visit recr)trrri(-,,i-idat@Loris-, O@IP appointed a CCT@ffnittee to study its orL@anjz,,t,tiori incltj.(Il-rig core staff' after vihich attempts have been made to r-L! @,e arid s-r-c;,nrthei-i it- c ks indicated in the Coor(I.I@riLttor's lc@ttc-.r, and IV@r., renort, t-Irl@l-liticli-I inclu(-I(@s broader rc@,presentit,-.'tori fi-,oi-n an@l ii-d.Tioril;y iz, i,jc--I, as ne'vi fizictic),Il,,tl ,@ilriacti.ire -I.n f,tL@,-,i.dt't-,.I-on,,Ll catcrorica'L ap 'Ile nc@.@w Norti) I,',ac3t @-,taff' . proacli. e and Ci.,roup is evider,)cc-@ of tli(-I.r rn@)-v(@- to stu( -e,,,, should be helpf)-il. iri -1 al li ri(:.,,4 outi:,c,.@ c-i lie ti- care d 3. C,@nt@,Lriue Suol)ort (page 89-90) Projects are monitored by inoi,it-,I@ly c-xpeiidj-tLU@ pror@'le,@is reports, ceiTli-afLi-iua-1. monitoring arid (.,val.ij;-.,ti.cn t,,-y JR.PG d Cu-i@iLittec,, sit(, visit-,.,,. li@.ivc, bc.,(.,@n irrirle to teriLin,,ttc-@ FIIP stipl)c)rt aft-f@@T., rr@azc)i-iabl.e pc-r,i O(i,;. C)f t,@le 11. siric(@ l,ii(, R@f@ori b(-,cairie (.)f 3 t,wo yE!,.i.r,, w@,, P (03 yc,,-jA,) a 1-ii@ee f't(,r t ',@@lpl)OL't W@'Lll has for -,u@)port-, frc),,,i C)rlc,@ an(I for three y(@ars will t)c.- extended, tt)t@-e iff)nth@-,, coi-it,Jtiu@d f()r or,(,' more yc!Lir is rcclii(,@,-ted f'c)r tlle CCU project furi@l(.@d for years. ('The CO(J p:r,olcct vjill coiitl.yii.ie and thin uroIc)&y project is supf)oi,,t from IIIII/1,TCI). Contir-iued ,,,upport is requested for three pro,j(:?cts which beL,-,an in the 03 operational year (each approved for tl-li,ee years). Minority Interc@sts Al.thouL,4a some progress had been made there is an obv:ious need fo'r much more tir@eal't minority and consumer p@icipation at all levels of or@zation. Goals and objectives do not specifically nr-nti.on minorities, bat speak to advancing the delivery of health services so each individual mV I)avc- access to the system. 'The Coordinator',-, letter and RAG report (page 38) address,,,) more J-nvolv6,rmnt of RAG i-neiijl)ersl-iip been eyp,-,jiiJed to incaude- more cc),ns@r inpi-I includ!iT, CI-11) "all hn(i llblt :repi-(-sentative@-,. r,,AG (60) includ(@.@3 11 (18%) minority representatives (I 7 Anc,,i'j.car, (I'Ilo) :serve on (12) - only 1 minority no fema-l.es). All Carrpitte@,s (192) only 3 PLinoxity ije-,-bers (black) and 42 (22%) are females. Core professional staff (FTE@) 13-15 - 8.65 mal.e 4.5 female - only 1 black. Core clerical staff (PIE) 8 - all female 1 blaclc. Project professional staff ( iME) 1.6.5 - 6.4 male, 10.1 female, no rdnor,-'LL-,ies. Project clerical staff (@i) 4.3- all female, no minorities. 5. Coordi.i,,,itor Ifne Coordinator is extremely lacking in Ic,,ader,-iliJ.p ability necessary to mov(@ this RE-p-,,.'Loi-i foniard. '.the furture of the Region, despite the efforts of a fevi of the more cc)iTpeter-it and committed core ,,,taff, racists in erq)loyrrr@i-it of' a new coordinator as ,3oon Ew A stticly by the Operations Of'ficc:r, -indicates: (1) Of 16 professionals on board at the time, of tYir,, JillY 1971 site visit, 8 have tf-,rTnl.r-iated. Of' 9 employed since that v.!-c,.It, 2 have t(,.Tlnj.riat('d. (2) Of 9 clerical ,@,taff ern@)I.c),v(@(I at-, tlic-.@ times of the 1,11-ite, v-1:@.-I t, ).I have since terTiii-iated and 2 have been hired. It's INT'c")' that the Coor(li.riator is to bc@ replaced. llo,,ievei.,, as of 3/31/7@' there has been no forflial annomcc@irent of his leaving or effective date. 6 Core St,@Lff' @).r id c ti 'The lack of @,, .@'ar li,@iii:@licaln particularly since tire ,:irrival. ol' I)r. C"Oof)c-@r, I'lami(:,xl 3 ill l@,ovc@rr@@r,@r Th(3 Pd@,ri-T-)S ooc.-!raticias Ofi'.Icr-@r@ has O,)-@ei,,vc-d his clig,@r!Lsiia with MO,o-t of the staff, i.e. Director SI)bmgion, Evaluator, and Cl-iief' of (iiants ltmage-ment. ID-le I'@@er'@' Committee report contains some very worthwhile recafnc@ndat'Loi-is fbr reorganizing core. R@IIPS staff' a3.so @-.,rrees with the concery@ abottu the Communications Media Staff fundtions which c effective and less expensive on a contractual basis. jet be mor Ilbe RAG vepci,t (page 112) is also @t.on tarfet. RAG Conipo,,@,.-,I.tion of @G and they C) anrl t-,h-is report;. Of' tt)c@ 1-U@G (60) 6P% @3-@ (22 '13';f (@rit Vol.ur@itam lir-@al,th Af,('@ncies and 2 and /, otlicr@. FC)@,',y-tlir(@,c pe@.r,cc@nt (,)6) of' the l@(@ ,irE- f'rorOi O'@:lF,.'-iorna City, (F)) frc,,Yn Ti-ilFa, and 4)1% (26) arc-, f-r@o,-a 1.9 other c-,orfnun:'Lti-e,-:). p@ ,@@d 3 co.-Is@'@ners) 5 Oklahomc'L City, 2 from @ilsa, and 5 fro.-,,i other communities). T@i(@ 1,P.G met 3 t@rm@s and the E,-ecutive Cori-nittee met 6 times. ID-ie Manpc)@!er Corn-riittee met once and the Continuing Edu,,-at'o@-i ConTrd.ttee @, d not meet ID-le c@itegbiical comqattees have been replaced by six new, mom @ctional committees. Hcfgever, these coifrdttees v;efe not approved until Jan@ 1972 and all members have not been retruited and no meetings @ reported. As indicated in the RACT report, there is a need for better 0 crita@t.!,on, well @ j-mprov(.-@d ociTunurL!-catiori,,-@ with the staff. Acc@!nV, to conversations with con@ -3taf'f l@G will be iT.,ore involvf,,,,' in the futiia,@.. i.e., Site cc)rfvryiltt,ce vioi@k, and earlier involvement in development of ari(I review. 8. Grantee Trist.t@iition ,lyle (xrant(,(-@@ 3(:,enr3 to prOVL(I(@ a(Icqu,,tte adininii3trotive support to OIW and J-@G flexibility deol.,,ioia -Mcl policy making. '11)e tJnivcr,,3-,I.I;y Mod:Lc,,.,L.'L C(@,nter J..,,, applicant of 9 of the io r)ropo,@,e@(i projects, in -Gne pre ent application. .9. Participation and 10. 'Local Plbnning TLiere 1-ia,- been some imor@oveiri@,nt in cooperative including the CHP a and b and the application Includes comments. not included in the applications indicates Analysis of data from ORMP) ing by RAG Core and the Tulsa-iTi', significant disparity between rare s ovals Subregion. 'Ehere are some divergencies in CHP a and b appr and'di als. -sapprov rit of Tweeds and Resources 11. Assessrri@ )rier serves .on a "task force on health statistics" to The C)R@ll-' Plar establish a data bank for Okla@io@,,qa. O@4P has some reciprocal data shariii@,, arr@,eiiic-ritr,. C)IUln) data f,,,ithey-ing includes h(-,altli status in 14E Okla. , rural health :3tudi(:,-s, @tyid cont-,.i-nuiri,,,P, E.@ciucatl.orl and needs. Prol)usccl fe,,-tsilDili'-Iy 'jji(l pl,-qwli@, ,3tudi-es child health,cnil)@iy.,z@c-nia, rural he'alt@i delivery,@ problem;; of' the urban poor, and o two Indian Ilospitals. hc-iiiotolo(,r,y/oiicology consultative services t Proposed project activities relate to stated goals and objectives., 12. MaWelnent Fiscal management seems good. Chief of Grants Management is recently visited attc-rrpting to strengthen fiscal control and Texas PSJ-T. ifi(D,.Iitoririg of activities by core and R A,@,s w-idei-viay. An FMPS T@gement Assessment visit is tentatively scheduled for June '72 13. alu liOn In addition to the infori@,).tion (form 14, pafrc 89-90) and the staff Visit to ofq4p, the Planner and P,valuator visited at length with ReS' PlanrL!nf-,, revaluation -,taf'f since submission of the - application. In C,(.@iier,al the tvio ,-eem to work well to@rether. There is reason to be optimistic in terms of ORMP developing a viable planning proces [2he Planner seem to understand the need to carry out an assessment of needs, relate them to resources, establish objectives and priorities, and building appropriate methodologies (including tine-p@ed objectives and terminal points for evaluation). ,Ihe Evaluator is 1 ess impressive than the Planner, but nevertheless appea-es to possess the skills and experience to effectively carry- out his task. ft\ffs Review Criteria have been modified and are used in OF,@\'Ulls evaluation. Concerns: 1) does not seem to be a procedure ; and 2) there fo@, and evaluation core staff activities does riot to I)c- @i @y3'Ll-crii to det-,(L-r-r@)e Jjiil)act of activities, Oi'l targe'U uoui-115, lical't-II-) deiiVE@i,,y (qualiLy@ oil 77 14. Action Plan (one year application) review, tti(4, current period h conL"T,Lwnt with the now three Cycle as ext(,.ri(ded to 15 month.,,,, Aufr. 3.@L) "I-972 (new -,t,-vt date pror@ill(.,(l nri the currc@nt 1(,,vel. 3, 172), with additional This vlas not known to O@ when third 8Lt)plicatli.on was submitted. MCQB staff is concerned about the ayftjitiou,.-, 011-Droposal - viore than the amount of the current level. WI)i",.e 01@ has made some progress, begiminZ, about Nov. '71, the nuriber of new activities proposed see= unreasonable. As the Region develops a progTain daring, the reil(vilryder of the current year and the O)t and prepares for Tric,nm'.;-Ll-sub,pi.ssion, potential projects iMy have more iirportance than those currently proposed. . Ileyiee, the pre-sazT staff reviewers are concerned about- their subndssion of 11 new projects. It would appear that much of the effort should be accorrplisla6d throuFh core activities until a irc-,,aiii@r ul three.' year spending plan is developed. The proposed core budget could be scaled down by one third or more. !5i Disser,@-nation of Knowle -e Alluded to elsewhere in the report, i.e., approx. 107 project performance sites, core studies, and cooperative relationships. 6. Utilization of M-anT)ower and Facilities C;@H,,a3 do a better i.ob of tli'is tiirouf@i better tie in w'Ltl:-, other agencies including an attenTpt to establish a state data bank. 17. Imp ovement of Care Of those adtivities supported and those to be continued, there are no iTleasurei-nents of their @act on delivery. The CCU project, requesting one additional year, will attempt to do this type of evaluation. It can be reasonably assumed that dare improves through support of these activities, but tangible ovidende is needed. Project #19 Preceptor Pr6@am for Rural Hosp. Ll.b. Training and Consultation is coTrpatible with #6-Litirary Infornution. Support of the lat'6r is being, PI=-ed out and an application been made to NIIiAqT-M (parts not qualifying for NIM support will be supported tiu-oufj-i Core). Activities receiving highest RAG rankings (8 out of 16) care #25 Erric,-rgcncy Health Care Irraining, #2 CCU) #15 Continuing Education Center at Ada. and #14 at Bartlesville, #26 Pediatric Ilurse Trainir-g #17 Stomal Theilap and Catherter Care, #16 Continuing Stroke Care- 'y Ada, #28 Continuirc. Education C6nter-. t4ercy liosp. (Core staff rated 5 of these 8 hi-F est). I the 8 ranked hig@iest by Core, #211 Newboryi .,h n Care in 1,TE, #23 Rural Allied 1-iealth Manpower, and #20 Corrfruriity Ir-L-8ervice @ucation for Health Personnel, took priority over #i4, 17 and 28. assisting in near unfold areas for stirulatilig and Core studies the develop=-nt of new projects in future years. 18. Short Ten-n Pal Of'f 'Ihe bii@pet sheets reflect no shaxed project support. ORMP's history of phase out support (see no, 3 Continuing Support) and continuation of the activities is good. 19. e In-iey m@e well on the wa,.V-havirf,, established the Tulsa NP@, Subregion (PaEr with gn Advisory Group c 65), headquarters at Illulsa with a professional and secretary, Four more are planned in the 04 year at Ada (SE)) Enid,(NC),.Bartiesville (NE,) and McAlester (SE). Perhaps there would be more wisdom in -,taffing one in the SE at Ada or .at Enid, and using two McAlester and one in the north central area other field representatives from the central office to service other areas. 20. Other, FuncdliinE Already discussed... see no. 3 "Continu@ Support" and no. 18 t'Short 'Cem Pay Off". MEMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION TO Acting Director DATE: April 13, 1972 Division of Operations and Developmer, FROM Director, Regional Medical. ProETams Service SUBJECT: Action on April 10-11., 1972 Staff Anniversary Review Panel Recommendation Concerning Oklahoma Regional Medical Program Application RM 00023 dated 2/l/72. Accepted: Rejected: Date Com")on(-nt An(i l,'Ii-i,iiirinl COI-IPONEI%"C CLIRI"FL@IT -04 yi.- YF-,AR [tECOIllif,@iDZD YR' S A14A PD C(I'UICT41. FUli-DING OPER. RECO,,VjEliDED 'REQUEST SARP YFAR TFVET, REJ. CO!4. CORF, $3@54.000 ?C)77,300 Sub-Contracts -n- 47 OPER. ACTTV. 84o5 0 629,732 DF,VET,. CO!-T. -O-. -0- Yes or No (x EAR14ARKS: -0- -0- -0- 1-4o,62o -0- 14o,690 8@g,,20- 'CT 7@8.900 49]i R14PS @872 RYQUESTED @'2LI,c)64 C OIN'C I L APPI@OVFD LEVEL 962,56)i NON-'R]4PS and RECIOII a Tu:,,, t972 REVIEW CYCLE 4 I;,. -d 6/71-8/72 (15 and Am@s are-to'be iti'crease6 I.-O **.,Action on.FX@ 'oroposal. (project #25) pending special review. s ($140,6ab)' L-or that project not D.n.c luded In this fio.Lre. 6kl ah REGI REVIEW: One 197 Z -@ati on AR Type, of.,-. APPI i D.ri or @,to tri enn i 61 Z29 RAti ng, RECOMMENDATIONS FROM Re v i ew. commi tt6e SARP L= CoOncil: Si te Visit RECO MENDATION: SARP approved staff's comments and recommends approva n the reduced amount of $839,205 (d.c.). This does not.include dical Services (EMS) project #25, pending special action on the Emergency Me review. See Briefing Document page B. RATIONALE: The recommended level of $839,205 is the am6unt'@re"c'ommended for the uj year prior to the April '71 funding reductions' Staff anal ysis of the request also reveals this amount is adequate. CRITIQUE: As reported to the Staff Anniversary Review Panel (SARP) by the Mid-Continent Operations Branch (MCOB) staff,. subsequent to the submission of the subject application, all Regional Advisory Group .(RAG) Committees have been recruited and have met once. The re'viewers--were concerned about significant differences of project ratings by RAG and Program Staff. With regard to disparity in Comprehensive Health Planning (CHP)@a and b,agenc-ies response, MCOB reported that Oklahoma Regional Medical Program- (ORMP) met" wi th CHP representatives March 15, 1972 in an effort to evolve@ a better, understanding in this area. In response to questions by the reviewers, MCOB.staff Advised that the status of the current Coordinator remain unchanged. Review Cycle June 1972 Type of Application Triennium Rating 21. Reco@endations From SARP /X Review Committee Site Visit Council- Critique: Committee recommended that Oregon PM 's Triennial application be approved and that additional funds be provided in support of t e R@gion. Funding'Levels Operational Year. Developmental Growth Program Project Total Component Funds Staff Activity -Award 05 year (9-1-72 to 8-31-73) -0- -0- $519,718 $401,812 1/ $9211530 06 year (9'1-73 to 8-31-74) $75,000 $250,000 $427,336 $285,773 2/ $1,0389109 07 year (9-1-74 to 8-31-75) .$75,000 $250,000 $437,719 $246,201 3/ $IiOO8,920 1/ Includes $86,812 for project 26 (Kidney) 2/ Includes $62 954 for project 26 (Kidney) 3/ Includes $47,963 for project 26 (Kidney) Committee agreed withthe site visitors' recommendation to fund the ORNP at the above levels. It was noted that ORMP was moving further away rom a primary emphasis on heart.disease and continuing education programs and has redirected its program toward new health care delivery systems. The ORMP coordinator and program staff are extremely qualified and the site visitors had no question that ORMP had a cleat understanding of their goals and how to obtain them. Oregon RMP -2- RM 00012 Committee questioned growth fund activities but were satisfied that there was a difference between the developmental component (D.C.) funds and growth funds. ORMP sees the growth funds being utilized for specific major --program activities (projects) and D.C. funds as flexible funds to be used with program staff direction. ORMP asked assurance that should ongoing planning, feasibility, and staff directed activities be fully developed, that their levels for 06 and 07 years be adequate to support new projects as they develop. Areas of progress and positive accomplishments include the following: 1. Due to the vigorous efforts of the coordinator and his staff, ORMP has been turned Around from a physician oriented program to one o broad acceptance by many groups. 2. ORMP program staff plays an active-role in stimulating needed activities whereas before the role was a project clearinghouse operation. 3. Project guidelines have been strengthened to include budget take-ovOr and evaluation mechanisms early in proposal development. 4. Progress of activities can be continually monitored by a budget control system which plots monthly expenditures versus units of accomplishments. 5. Most of the continuing education programs and heart disease activities have ended And new priorities focus on health delivery systems to meet local and national goals and objectives. 6. The Region is encouraged to continue their positive efforts in developing and maintaining Peer Review Systems. Areas of concern requiring attention during the coming year include: 1. RAB should be broadened to include more consumer representatives. These should be real consumers without direct or indirect ties wit other organized health agencies or interests. More allied health professions and minorities should be included on RAB And other decisionmaking committees. 2. A deputy coordinator should be hired to assist with the overall program administration. With the new ORMP ventures, the new director of the Needs Assessment Unit might serve in a dual role as deputy coordinator. 3. Additional program staff with adequate salary scales are needed to implement ORMP's new goals and objectives. Current salary scales are inadequate to attract new personnel and to keep the current, highly qualified staff. ORMP should investigate the possibility of higher job retlassifications with the Grantee and resolve the salary problem. Oregon RMP -3- RM OOOi2 4. A health information data bank should be developed to prepare ORMP for new health delivery programs three years ence. 5. Project evaluation studies are needed to show improved health care which has resulted from RMP sponsored activities. Studies should pinpoint I minority access to better health care services. 6. ORMP should carefully review some of the growth fund activities with other areas of the country, and document successful ones which could be adopted in Oregon. Summary of Recommendations Approval of the triennial application is recommended by Review Committee which includes growth funds and developmental component funds for the sixth and seventh operational years. Committee recommends that the above concerns be communicated to the Region in the advice letter. WOB/RMPS 5/22/72 -COMPONENT AND FINANCIAL SUMMARY TRIENNIAL Regionb Oregon RMP Review gycle: June 1972 1 'Previous Yr's Award Requested Committee Recommended Funding LeN From Apr. 1971 to Junel/ From Sept. 1972 to August 1975 Component 1972 Operational Year 05 06 07 05 06 07 ?rogram Staff $ 275,407 $ 519,718 $ 427,336 437,719 $ 519,718 $ 427,336 $ 437i? )per. Activities 470,979 409,940 311 494 289,810 401,812 285,773 246,2 Developmental Comp. -0- -0- 75,000 100,000 -0- 75,000 75,0 ;rowth Funds -0- -0- 775,000 80010000 11 -0- 250@000 250,d )ubtotal 746,386 929,658 1,588,830 1,627,529 921,530 1,038,109 1,008,9 @pecial Funding Kidney -0- (94,940) (88,615) (91,572) (86,812) 2/ (62$954) 2/ (47919 EMS Proj. #027 UPS Direct Cost 86 929,658 921,530 1,038,109 1,0081 dir. 183,402 151 MS In ?654 'otal RMPS $929,788 $1,081,312 1/ Two months extention (July-August 72) approved for $161, 2/ Recommended by Technical site visit team on May 4, 1972 16N-RMPS & Other Pending is the following: Income 26,143 91,009 EMS Project 027 532,950 .Udget Total $955 931 M,172, 321 Current Program Request 929,658 $1,01;7,323(Revised) @) requested Total Requested. $1, 462:0608 ouncil Ap loved P, Level $1,064,291 REGIONAL MEDICAL PROGRAMS SERVICE SUMMARY OF A TRIENNIAL GRANT APPLICATION (A Privileged Communication) OREGON REGIONAL MEDICAL PROGRAM RM 00012 6/72 3181 S.W. Sam Jackson Park Road May 1972 Review Committee Portland, Oregon 97201 Program Coordinator: J. S. Reinschmidt, M.D. The Oregon Regional Medical Program is in its fourth operational year. The direct cost for the present grant period (April 1, 1971 to June 30, 1972) is $746,386 and indirect cost is $183,402 which represents a 48.32% rate for an campus and authorized off campus rates. The Region is ranked 28 in overall funding with a per capita rate of $.44. The ORMP has submitted a triennial application for the period July 1, 1972, to June 30, 1975, which requests direct costs of $929,658 for the first year, $1,588,830 and $1,627,529 for the second and third years. The triennial application proposes: 1. Continuation of core staff beyond approved period of support. II. Continuation of one project beyond approved period of support. III. Continuation of one project within approved period of support. IV. One approved project, not previously initiated. V. Five new projects, not previously approved. A breakout chart identifying the components for each of the three years is included as part of this summary on pages '@-4. It should be noted that ORNP is requesting increased funding in the second and third years of the triennial program for the development of the following activities: Second Year Third Year I. Developmental Component $ 75,000 $100,000 II. Patient Transportation 75,000 50,000 System III. Peer Review System 50,000 50,000 Development IV. Television Communication 125,000 175,000 System V. Demonstration of a Primary 150,000 150,000 Entrance Clinic VI. Demonstration Family Practice 150,000 150,000 Clinic VII. Feasibility Study and Develop- 100,000 150,000 ment of Area Health Education Centers VIII. Patient Origin Study 125,000 75,000 Jo FEtiQuAQY 22,1972 REGION - OREGON tiPFAKLIUT OF PLQUFST Rm 00012 06/72 05 PR(,GRAM PERIOD RMPS-OSM-JTOGRZ 09 0 (4) (1) IDE'4T IFIC AT[ D@4 OF C OM PC@N E.% I ICO'4T. WITT$INI CUNT. !IFYfiNril APPP. NOT I -NEW, NUT I IST YEAR I IST YEAR I APP9. i'ERILIDI APPR. PERI()Ill PREVIOUSLY I PREVIOUSLY I DIP EC T I INDIRECT I TOTAL OF SUPPORT I UF SUPPORT I FUNDED I APPROVED I COSTS I COSTS I COOO CURE SUPPORT I $51q.71R I &I I 3.L5.1" 1633,292 1 -- -------- '70 i)PLJ A Y EARE TRAI'41'IG PI I I I I E211.CL - - --------------I- - ------- - - -- - - -I- $ZI.Ll@- S32.9iO TLiAl.@l-@iG P-Z:),-,QAM F,-!D PELI I I I I ------ t -- - - ----- S24,372 ois optp SERV fit RL.,40T.E Cnpl I I I I ------------- &99.RSI I 322 F-MFRC, FE[) TECH TRAI@4ING I 19,212 1 S67.A64 I --- - -------- ------ 123 MOBILE CANCER NFTECTI@)N I I I I I I I --- :.Lit[IC ---------------- ---i------------- I I &63.4'4 A I n24 CC,,MMUNITY CAPICER SEPVICEI I I I I I I --A!IU-LL AL@UG 12 1 S 2 !I @.1 2 I $24,617 t .IiS C 0 '@ li U-4 I T Y S I; r K E R E @l A A I L I I I I ----------- $29,679 1 ')26 CAUAVF.Q KID%EY PO,),@PFME] I Stlt.444 I ESTIMATEF) GRnwTH F-UNR)S I -- - - - ------ -------- TOTAL $24,373 $546,887 $99.85L S256o547 1 $9291658 1 Sl5lv654 1 $LvO8lo3lZ C) ta REGION - OREGON FEBRUARY 22,1972 flQFAK@Ut (IF kF4jULST pH 03012 06/72 m 06 PKOGPAM P[kit)D RNPS-OSM-JTOGlt2 00 (5) (21 (4) 41) IDENTIFICATION OF C014PONENT ICONT. tilTHI,%l CONT. REYON')L APPA. NOT NEw. NOT I 2ND YEAR APPA. PERIODI APPR. PEO[I)DI PREVIOUSLY PREVIOUSLY DIRECT OF SUPPORT Of SUPPORT FUNDED APPROVED COSTS COOO COPE StiPPIOT .. . ....... --------------- - --- -------------- --- - ------ -018 IIPFR S@"V FOP @Fmi!Tf CURI ILL - - ----------- -12 Z F ME 0 G ME D T EC H T R A I N I NG - - ---------- ------------- 72 3 40f,[Ll CAIICFP DETECTION I I ' I I --.LLINiC --------- - --------- @-24 r.,j),'4U'4lTY CAr4CER SERVICE[ --- AILI-IEAIN N@, ;25 C(:-":)IiITY ST,(O',E RE:HA131LI -- I --- - -------- 526 CAC),\VEP KIL)'4FY PRCCURimEl -------------- --- - - - ----- -------- - ------ --- E:STIMATED GRCIWTH FLIN,)S ----------- TOTAL $436,500 $53,508 SIP098#822 1 Slt58S983C I REG13N - OREGON FEi3PU4,QY 22,1972 eREAK(IUT (IF PEQ@IEST RM 00012 0 6/72 RMPS-G$M-JTOGR2 07 ppoGRtm PERIOO (4) TOTAL LUNT Allil;j . 3ki) YEAR m lt)Ft4TIFICATI,),4 nF C014PO,'.FNT IC(i,4r. i.ITHI.@ll ;)ZTVIJUSLY P@c-V[uUSLY DIRECT ALL YEARS OQ IAnP@. PEPIIIL)I AVP' COSTS JOIRECT COSTS I OF ST)PPDKI ',Li'POiT I FUNr)E3 C)03 r(;E SuPP,iiT S4i --- - -------- ------- p ARE TFZAltll'4G Pi 11) (i ----------- ---------- --- iai@E-T -------------- - --- i-- t) 1 6 Ti-Al,'41N-, PRO-,PAM F,IR PERI kC-i',TL C('RI r,ld qpep SFRV FIJR S46,675 CA!4CEP E--TTZTI [)N I o23 4tia I LE r "IL - 7, I ti 024 Col@m,,JNITY CA@@CFP SFRVICFI --- - ------ - C,2 5 r.(,,-mLr@ITY STRt'KE RE@IABILI Ezj.12L 1 ------------ ---- - -- V @ Q K I y p qoc U4 E M F C A,; ------ 1.L4iz?.- --iq t ESTIMATED Gk.)mTH RUNL)S 44 $1,627,529 $4,146.017 TOTAL $437,719 $28,966 -$1,16098 01% .i - . . I I Oregon RN? RM 00012 6/72 Funding History A complete funding history to date is included on page 6. I. Description of the Oregon Region: Oregon is a roughly rectangular coastal state situated in Northwestern United States and bounded by Washington, Idaho, California, and Nevada. With an east-west length of almost 400 miles and a north-south width of nearly 300 miles, Oregon's 97,000 square miles of area makes it the tenth largest state in land area. Oregon is divided into three topographical areas by two longitudinal mountain ranges, the Cascade Mountains, and the coastal range. East of the Cascades is a high, semi-arid plateau comprising approximately two- thirds of the state's area. On the Pacific side of the western ridge is a narrow coastal strip. Between the two ranges lies the more heavily populated Willamette Valley, which averages 50 miles in width. Eastern and Cascade portions of the state have great seasonal shifts in temperature. The Willamette Valley and coastal areas are much more moderate in climate except for heavy winter rains and considerable low- lying fog. Oregon's weather, together with the distances involved, imposes a great deal of isolation on remote areas during much of the year. Oregon has 2,145,000 people. Approximately 45 percent of the population resides in the Portland Metropolitan area, situated in the Northwest section of the state. Including Portland, 69 percent of Oregonians live in the Willamette Valley. Several immense Eastern counties are populated with as few as 5,000 to 25,000 persons. These counties are several hundred miles distant from Portland and other larger valley towns. Racial and ethnic minorities constitute less than three percent of the total population. (Negroes a little more than one percent; Indians and Orientals each about 0.5 percent; and Spanish-Americans approximately 0.2 percent.) Blacks and Orientals tend to reside in urban areas, while Indians and Spanish-Americans are predominantly rural in distribution. Lumbering, metal industry and agriculture remain Oregon's major industries. The state presently has an unemployment rate of 5.6 percent. The Portland area contains the only medical school; of the state's 2,700 physicians, 2,300 reside in Metropolitan Portland and the Willamette Valley. A similar distribution pattern applies to other health personnel. There are 83 general hospitals in Oregon with 8,738 beds. Of these hospitals, 39 have less than 50 beds. Oregon RMP -6- RM 00012 6/72. OREGM REGIONAL MEDICAL PROCRAM FUNDING HISTORY OPERATIONAL GRANTS (Direct Costs Only) No. Project Awarded 01 Awarded 02 Awarded 03 Awarded 04 Awarded Requested 05 4/i/69-3/31170 4/l/70-3/31/71 4/i/71-@@6172 Total 7/l/72 6 2- /30173 CO 00 Core I/ $198,521 $244,073 $275,407 $718.001 $519,718 1Heart, Cancer, Stroke $1@,242 150,035 174,204 163,578 669,059 Circuit 2Early Diog. & Therapy 152.436 144,012 27,825 324,273 3Surgical Treatment of Vascular Lesions 9,375 10,281 4Comprehensive Stroke 19,656 Care with Regional Ed. 44,800 51,396 56,859 .61,001 214,056 3Project Evaluation 22,578 27,621 31,567 81.766 6CC Trng - Salem Hem Hosp 54,084 46,225 32,164 45,210 197,683 27,169 7CC Trng Sacred Heart Hosp 59,772 69,345 73,848 52,891 255,856 9Central ore& Heart, Cancer and Stroke Pilot 26,367 24,233 23.070 73,670 19 Coronary Care Teaching Aids 12,774 4/ .5,572 713 19,059 11 Guiding Adult Patients With Asphasts 27,120 27,019 21,980 76,,llg 12 SO.'Oregon Diabetic last- -Evaluatt 18,064 22,091 40,155 0" li Mobile Emerg. Cardiac Project 39,499 6,249 43.748 14 Trng. Pro&. Care of Diabetic Patient 32,886 39,285 28,815 100,986 15 Phys. In Res. Course ITech. Cardiology 28,920 32ii99 61,519 16 A Training Program for Personnel of Oregon Hosp. 23,4X9 39,122 62,541 24,373 27 Diabetic Patient Project (9,762)2/ 18 Coronary Care Monitoring 99,851 20 Corn. Coorde/Cont. Med. Education - (9,945) 3/ 22 Emerg. Med. Tech. Tr&. for rural areas 53.452 23 Mobile Cancer Det. Clinic 63,438 24 Comm. Cancer Ser. & Its. Program 24,632 25 Comm. Stroke Reb. Program 22,085 26 Cadaver Organ Procure- men t & Tissue Typing Pro. 94,940 TOTAL 522,287 854.146 837,328 746,386 2,960.147 7i2-9,655 NOTES: 1. Core Budget (first year); merged with operational,in the second operational year. 2. Project 117 funded from Core Budget 8/5/71 3. Project #20 funded from Core Budget 8/5/71 4. Project PIO funded 5,572 + 3,200 from care 8,772 3/25/71 Oregon RMP RH t)WI2 6/-12 II. History of ORHP Development ORNP was funded for planning in April 1967 and became operational exactly one year later, following an enthusiastic endorsement from a site visit in February 1968. In early 1968, OMe was concentrating on recruiting needed staff, assessing the medical needs of the Region, setting proper priorities for action plans and setting up adequate evaluation mechanisms. At that time, the National Review Commi ttee had its doubts about the Region's readiness to move into the operational stage, however, the site visitors seemed satisfied that a working list of.objectives and a scheme for setting priorities had been developed and that core was capable of moving the program into this phase. The Region was encouraged to arrange for assistance from the College of Education of the University of Oregon for better evaluation of the program and some of its projects. In October 1968, Edward L. Goldblatt, M.D., replaced Myron R. Grover, Jr., M.D., who had served as the original program coordinator. The ORNP was site visited again in April 1969 and the team was greatly impressed with all aspects of the program, including core staff, Regional Advisory Group, and evaluation efforts. The program appeared to be heavily provider and continuing education-oriented,.and there was evidence that-staff-was beginning to involve many groups throughout the Region. The report stated that the application was an unusually well-written- cleat "Model" application. The team concluded that ORMP was as good as the words written About it. The ORMP staff had a sound understanding of the purpose of RIIP and the abilities of Dr. Edward L. Goldblatt and Dr. Delbert M. Kole, Coordinator for Project Development, were favorably noted. Relationships between ORMP and Oregon Medical School were more than adequate. The Region's request for continuation of core and ten projects for the third year was well-received by RNPS staff. It appeared that the Region had come a long way in establishing itself as a broadly-based, ongoing program as opposed to a series of isolated projects. The RAG chairman, Dr. Herman Dickel, was proud that all projects submitted by Oregon had been approved for funding at the National level. RAG had seemed to develop an awareness of local autonomy and had developed a mechanism for evaluating both incoming proposals and ongoing projects. Some projects were terminated early as a result of this evaluation. To further this internal evaluation effort, a contract was let to the Northwest Regional Education Laboratory to evaluate the policies and procedures of the core staff. 101 00012 6/72 Oregon RMP -8- Two changes in leadership took place in the third year. Dr. Goldblatt was replaced by Dr. David Johnson, who served as Associate Professor of Public Health and Preventive Medicine at the University of Oregon. Dr. Johnson resigned in November 1970 to become Regional Health Director for Region X, and was replaced by Dr. J. S. Reinschmidt, who had been with the Student Health Service for the past seven years.. During the four years since its first operational award, the ORMP has submitted project applications regularly. Eleven projects plus core activities constitute the current program. The new coordinator has had a year of REP involvement. Some of the more notable events which have transpired since the inception e'--'fi- t ' - of the Program in 1967-ar t a the influence upon heart disease has been unswerving and unmistakable. From the start, the Board launched a concerted attack upon acute myocardial infarction, and ORMP efforts have undoubtedly shortened the interval required to implement improved techniques in the treatment of patients with this condition. Two coronary care unit projects have schooled scores of nurses for a new life-saving role as electrocardiographic monitors and initiators of urgent cardiac therapy. Another project offered analogous courses to physicians, with special emphasis upon the insertion of emergency pacemakers. Exploration of radio-telemetric monitoring of coronary patients while in transport to the hospital has continued. Continuing education grants-have been ORW forte from the very beginning. The Circuit Course Program, the first project funded, continues in its fourth year to provide courses to physicians, nurses, and allied health professionals throughout the Region, Idaho, and Montana. other. training projects have been instrumental in providing a network of volunteer directors of medical education on a statewide basis. With one or two exceptions, the continuing education projects will come to an end on k of a constellation of projects will commence July 1, 1972, and a new loo on that date. III. Performance In planning for the next three years, the Oregon RMP has reassessed core and project activity in the light of changing national priorities. ORMP RAG has adopted three major goals and recognizes an increased Federal emphasis upon them: (1) improving access to health care, especially for disadvantaged urban and isolated rural populations; (2) enhancing the quality of primary and other health services in Oregon; and (3) containing unit costs of health care by promoting greater efficiency within the delivery system. The proposed projects, core endeavors, and other ORHP activities have been designed as a move toward meeting their objectives. Oregon RMP -9- RM 00012 6/72 Core staff's most important consultative and planning contributions during the past year: The newly organized Gresham Clinic for the indigent. The jos6phine-Jackson Counties Health Maintenance organization planning application. Physician assistant/nurse practitioner training program. Family practice primary entrance clinics, and outreach worker training program. Concentrated employment program. Metropolitan Portland Comprehensive Health Planning Association. Multnomah County Public Health Division. Model Cities, Tri-Metropolitan Bus System. Multnomah-Clackamas Counties Association for retarded children. City County Council of Aging. Five feasibility and planning studies are now in progress and one additional study is proposed. These include: patient origin study and health care utilization data system; a patient transportation system; a demonstration family practice clinic; a primary entry health care clinic; and a peer review system in collaboration with the State Medical Society. A. Goals The ORNP has elected to work toward the following: 1. To improve the accessibility of primary health services in impoverished urban and isolated rural areas of Oregon through the stimulation and support of activities which: (a) augment the supply of health care personnel and resources, or otherwise enhance the capacity of the health core systems; (b) encourage a more equitable geographic distribution of health dare personnel and resources; (c) facilitate the more effective emergency and routine transportation of patients or of health care personnel; (d) utilize new types of health personnel or -10- RM 00012 .6/72 Oregon RMP - traditional health team members in innovative ways; (e) kTprove the continuity and comprehensiveness of health care delivery; and (f) facilitate the implementation of the Emergency Health Personnel Act which is designed to place public health service physicians in areas with other- wise unsolvable primary health service problems. 2. To improve the quality of primary and other health services in Oregon with particular but not exclusive emphasis upon the prevent on, early detection, and rehabilitation of heart disease, cancer, stroke, kidney disease and other conditions deemed of major importance by regional agencies by means of: (a) encouraging the formation of peer review and ombudsman committees; (b) promulgating the most efficacious techniques of disease control in primary medical practice, and (c) facilitating the establishing of subregional education centers. 3. To contain or reduce unit costs of health care delivery, an to promote greater efficiency with the health care delivery system by (a) promoting cooperative managerial arrangements which permit quantity purchasing, nonduplication of services, sharing of resources and expanded use of ambulatory care units or outpatient facilities; (b) en- couraging the development of utilization review committees within appropriate medical agencies; (c) stimulating consideration of automated and/or computerized record keeping systems, data storage and retrieval methods, and multiphasic screening techniques; and (d) encouraging the use of those health care resources which provide the least costly method of service per unit without compromising the quality of those services. B. Methodological Objectives The Region has enumerated six methodological objectives for achieving the three major goals. These include the conduct of specific projects with staff support and expertise in developing them in concert with ORNP goals, to provide educational experiences for providers of health services and the general public, to provide data and information on health care resources, to cooperate with CHP agencies, and to continually assess the management and organization of ORNP staff, Board,and Committee systems. IV. Process A number of organizational reconstructions has taken place with the Committee structure and program staffing. The former Grants Application Review Committee has been renamed the Program and Application Review Committee to signify an expansion of preview beyond pre-Board scrutiny of individual project applications. The committees new charges include: (1) assessing compatibility of all proposals with ORMP programmatic goals; Oregon RMP RM 00012 6/72 (2) advising all proponents of unsolicited project ideas on relevance to the triennial plan prior to the furnishing of definitive developments assistance by staff; and (3) recommending to the Board priority rankings for all approval project activities. - Conversion of the Regional Cooperation C, ittee into the Health Resources Development Subcomittee brought about a cadre of knowledgeable Board members, assisted by a rotating panel of experts, to address each health care delivery proposal. Still another change in siibcomittee procedure is the rescinding of a former rule that all project applications be reviewed by the Continuing Education Subcommittee, in view of the program shift,this no longer is a requirement. At the present time, each project proposal is reviewed by the Program and Application Review Committeeby the Evaluation Committee (to ensure adequacy of design), by the new Comprehensive Health Planning Subcommittee, and by either the Health Resources Develop- ment Subcomittee or a single technical subcomittee appropriate to the predominant thrust of the application. All proposals are given a final verdict by the Regional Advisory Board. Eleven committees or groups form the framework of the Region. All are standing committees with the exception of the Ad Hoc Triennial Applica- tim Review. Number of Members Meetings Last Year Executive Committee 9 11 Program Application and Review 10 3 Committee Evaluation Committee 7 5 Health Resources Development 8 2 Subcomittee Comprehensive Health Planning 11 1 Subcommittee (activated November 4, 1971) Kidney Subcommittee 13 2 Ad Hoc Triennial Application Review 10 3 -12- R14 00012 6/72 Oregon RIIP - Number of ir Members Meetings Last Year L 8 2 Heart subcommittee, Cancer Subcommittee 9 8 Stroke Subcouwitttee Continuing Education Subcommittee 9 Organization changes in core staff reflect a markedly augmented level of activities for core personnel. Core is now divided into fIour distinct units: (1) Program Administration; (2) Needs Assessment and Continuing Education Programming; (3) Specific Disease, and (4) Health Resources Development. Each unit professes its own set of operational objectives although personnel fully interchange between units for purposes of economy pnd integration. Some staff members assigned to the Needs Assessment Unit are derived from individuals presently working within the circuit course project. The Program Director is immediately accountable to the Oregon Regional Medical Program Chairman, Executive Committee, and Re ional Advisory 9 effective overall functioning of progiam.staff And project Board of personnel in meeting the goals and objectives set by the RAB. In addition to assisting the Program Director, the Program Administration Unit provides consultation and assistance in development of project activities. This includes fiscal management of projects and activities, designing evaluation techniques, and designing informationa'l-communication techniques. The Needs Assessment and Conti tion Progrann@ Unit, as a major problem-solving and needs omponent, will promote the quality of health services in Oregon. The number one objective will be to establish a network of problem_ solving groups composed' of physicians and led by A trained coordinator. Also, 13 local nursing groups will be established along the same lines. The SDecific Disease Unit will have the primary responsibility for activities focused on improve health service through prevention, early detection, and rehabilitation of the major diseases. Primary monitoring and liaison interface between OPM and projects will be a specialized objective of this Unit. Health Resources Developmen@t UunnittL will focus on improved accessibility of primary health services for impoverished urban and isolated rural areas. Identification of meritorious project activities which can be transferred to other communities and agencies and to offer consultation will be two major thrusts of this Unit. Oregon RIIP -13- RM 00012 6/72 The core positions will be increased to ten with six of these full- time; two, 95%; one, 757.; and one, 507. time. The positions of Healt Care Needs Assessment Unit and Project Liaison Officer are vacant. This staff will continue the facilitator, convenor role in the Region; implement the Needs Assessment Program; develop programs for the medically indigent; assist in terminating projects; and explore area- wide health education activities. Total funds requested for salary and wages of ten positions plus eight supportive personnel is $231,266. V. Program Proposal The ORNP requests $1,081,312 (direct and indirect) for the first increment of a three year period, July 1, 1972, to June 30, 1973. This amount includes core activities, feasibility studies, two continuation projects, and six new programs. Developmental Component funds are not requested for the first year. It should be noted that increased funds are requested in the second and third years of the triennial and these will be extensions of formal projects and potential subcontracts; a variety of other ideas for activities has been explored by program staff. These activities have not been fully developed, however, they are included in the estimated funding section of the grant and will be addressed separately. Core Sgpport (COO) Requested Fifth Year $519,718 The staff will be increased from six to ten professionals and from five to eight supportive personnel. Six feasibility and planning studies will be conducted during the year. The following broad estimates of time/effott allocation have been made for core staff based on requested funds: Program Direction and Administration--267. Project Development, Review, and Management--43% Professional Consultation, Comittee Relations--22% Planning Studies and Inventories--5% Feasibility @tudi-es--47. Sixth Year Seventh Year $427,336 $437,719 RM 06012 6/72 Oregon RMP -14- - project #006--Coronary Care Training PrograiA- ReqiAested Fifth Year $27,169 This project was initially funded beginning July 1, 1968, with April 1 as the anniversary date. on April 1, 1971, it began fulfillment of a 15-month renewal application so that, in total, the project will have completed 48 months of operation on June 30, 1972. To offset the cost of the program, a tuition charge has been implemented. The activity is entirely compatible with the general goals of the ORNP and is germane to the State's comprehensive health plan. Future program activities will be financed by increased tuition, indirect subsidy by Salem Hospital and the development of an endowment fund derived from private individuals and corporations of sufficient size to provide adequate income for the project. Continuation support is requested for one year only to train an additional forty nurses in coronary care. Project #016--A Training Program for Personnel Requested of Oregon Hospitals Third Year $24,373 The purpose of the project is to improve the care of patients in health care institutions in'the ORHP by providing one to-three day courses aimed at the entire spectrum of personnel who deal with patients in various ways. Courses in emergency cardiopulmonary resuscitation, infection control, middle management, body mechanics and safety, and legal problems (a total of 42 courses) have been presented to 1,220 students (nurses, nurses aides, orderlies, various technicians, emergency personnel firemen, law enforcement personnel, and others). The important goal is "to effect cost containment and efficiency in hospital management." This project was approved and subsequently funded beginning October 1, 1970. By June 30, 1972, the project will have completed 21 months of operation. It contains a mechanism for take-over so that the affiliate institution is assuming one-third of the cost of the project. At the end of the second year, two-thirds will be assumed by the association and, finally, after three years, the association will support the project totally. Fourth Year $9,164 Oregon RIIP -15- Rm 00012 6/72 NEW PROJECTS Project #018--Operational Service for Remote. Requested Coronary Care Monitoring First Year $99,851 The objective of this new activity is to improve accessibility of care to patients with myocardial infarction in less populated areas of Oregon. The sponsoring institution, Emanuel Hospital, requests three years support to link five and communities to other consulting coronary care units. Electrocardiographic monitoring will be transmitted on a 24 hour basis over telephone lines. Critical EKG diagnoses and therapeutic suggestions may be made by highly experienced CCR nurses and physicians located at Emanuel Hospital. This project was previously approved by the Oregon RAB, and by the National Advisory Council, but not instituted due to budgetary reductions. Second Year Third Year $28,966 $53,508 Project #026--Cadaver Organ Procurement Program Requested and Tissue Typing Laboratory First Year $94,940 This is a three-year proposal to permit the University of Oregon Medical School to double the cadaveric transplant program to 40 kidneys per year and to increase tissue typing capabilities to support the expanded transplant program. It will serve the interests of the entire state and will cooperate fully with the Veterants Administration Hospital. The public education component of the project will be subcontracted to the Kidney Association of Oregon. This project addresses a special Federal emphasis being Placed on kidney disease, as well as fulfilling general ORNP goals and objectives. Second Year Third Year $88,675 $91,572 Project #022--,EmergencY Medical Technical Requested Training course for Rural Areas First Year $53,452 The Oregon Division of Health requests three years support to expand their ongoing emergency programs to include the training of ambulance drivers and to conduct the prescribed 72 hour course to volunteers. Less than 207. of the 2,000 ambulance personnel have received the recommended course. Training for 500 attendants annually is proposed, utilizing video-taped physicians presentations developed by the University 0 Kentucky Medical School. Second Year Third Year $45,277 $46,675 RM 00012 6/72 Oregon RMP -16- - Project #023--Mobile Cancer Detection Unit Requested First Year $63,438 This three year program will offer advantages of early cancer detection to female residents of Portland and of rural,low income Areas of Oregon. A major;obstacle in reducing mortality from genital and breast cancer is the failure of seemingly healthy,individuals to undergo periodic examinations. Approximately 4,000 examinations will be conducted during the first year, all in the Portland metropolitan area. The van will be manned by physicians, nurses, and volunteers organized through the Oregon Cancer Society, and all services will be provided free. Although the mobile unit will be used for cancer detection, it is recognized that there are a number of organizations and agencies who can utilize the mobile unit to carry out objectives if their programs, i.e.. classroom for education programs for nursing home personnel, a facility for individual genetic counseling, or general well-body care clinics. Second Year Third Year $59,893 $66,325 Project #024--Community Car and Requested Training Program First Year $24,632 The indigent population of southeast Oregon will be the target of this program. Services to 3,000--residents include genital and breast screening for malignant tumors. Diagnostic and therapeutic services are pledged by the Portland Adventist Hospital and medical staff at no cost to the indigent patient. The applicant, Portland Adventist Hospital, plans to test the feasibility of employing nurses specially trained in this project to conduct preliminary screening examinations under the supervision of physicians. Second Year Third Year. 33.932 $34,121 Project #025--Community stroke Rehab litation Requested Projtr,am First Year $22,085 This project is sponsored by Good Samaritan Hospital and its affiliate, the Rehabilitation Institute of Oregon. A multidisciplinary team approach will be employed to coordinate rehabilitation services for stroke patients. Local teams will be developed in six areas the first year and an additional Oregon R14P -17- RM 00012 6/7@ eight c, ittees will be chosen during the first and second years. This proposal appears to be germane to the quality and accessibility of both primary and secondary care of stroke patients in Oregon. Second Year Third Year $21,651 $22,151 GROWTH FUNDS Increased funding of ORIIP is requested in the second and third year of the triennial program. Most of these activities are still being investigated and are scheduled for further staff development. Developmental Component--ORMP has not requested developmental funds the first year of its triennial plan because the Region needs more core support staff to implement such a program. Additional staff will be employed the first year and the Region should assume the responsibility of a developmental program the second and third years of the triennial plan. Est @ ted d requirements: Second Year Third Year $75,000 $100,000 Patient Transportation System--This activity is presently being pursued @y a planning study and will be developed further during the second and third years of the triennial. Egtimat6d fund requirements: Second Year Third Year $75,000 $50,000 Peer Review System Development--A peer review program is being devised in collaboration with the Oregon Medical Association for the establish- ment of a state-wide system. During the second and third years, the system will be tested and refined before the operational phase of the system is implemented. Second Y a@r Third Year $502000 $50,000 RM 00012 6/72 -18- Oregon RHP - Televisi' Communication System--This proposal would link large metropo. al centers with remote rural health care facilities. Continual education$ consultation for physicians, health personnel and others will be fully utilized. "Slow-scan" television techniques could be used at a much reduced cost. Second Year Third Year $125,000 $175,000 Demonst ation of a Primary E nic--The objective is to improve the acc ons living in impoverished urban and remote rural areas of this State, the ORHP plans to assist in .developing primary entrance health care clinics. There are several areas where these clinics may be initiated and, after careful study, ent and coordination, at least one clinic will be established developm in an appropriate location. Second Year Third Year $150,000 $150,000 Demonstration Familv Practice Clinic--A demonstration Family Practice Clinic is planned provi e a model for a geographically or sociologically isolated community in Oregon. It is designed to provide a professional environment capable of attracting, sustaining, and main- taining a family practice physician, and affiliated with a family practice residency program in order to provide consultation, training, continuing education, peer group contact, and innovative use of allied health personnel and preventive technologies. One of the more difficult health care delivery problems of the Region has been the recruitment and the retention of family practice physicians in some rural and impoverished urban areas of the state. One or more demonstration clinics will be established to see how these problems might be overcome by use of paramedical personnel, improved consultation resources, relevant and convenient continuing education, etc. Second Year Third Year $150,000 $150,000 Feasibility St and Development of Area Health Educati n Centerss--ORMP @s followed w rable interest the development of the concept of Area Health Education Centers. There are several areas where this concept could be applied beneficially in the State. Funds will be used to develop Area Health Education Centers that could have considerable impact on the improvement of health care delivery in the Region. Second Year Third Year 100,000 @150,000 .1 LI 1,J ) L)kiL I I kJl\ , 1),I', JJ vy IJ:, D u ivi 'RVICI-',S AND MLN'I'Al@ III,'ALTII AI),%41NIS'I'RA'I'ION III,'ALI'li SL I-or the I'\ecord March 22, 1972 I-'RO,\,f Edward T. Blomquist, M.D. 3Ul3jECT: Post Nlini-SAIU" Meeting, March 20, 1972 Oregon Re-ional Medical Program Cadaver Kidney Procurement, Tissue Typing Program, Public Education and Inforpiation Programs Purpose of the Pr am - To double the number of cadaver kidney transplants from 20 to 40 each year. Under the direction of the Chief, Division of Noplirology, University of Oregon, employs a full time coordinator and secretary to: 1. develop a 24-hour, seven days a week tissue typing service, 2. develop organrrocurement teams in 6 large cities, 3. develop a 24-hour communication and transplantation program between transplantation center and cooperating hospitals, 4. develop public support for a kidney donor card pro-ram adequate to 0 meet the Region's long term need for cadaver kidneys. Action - Approval in principle for a 3-year period with budget reductions to be negotiated by outside consultant and staff at early site visit. Advice to Region - The reviewers were very favorably impressed with the proposed proaram. They were particularly pleased with 1) the degree of regionalization to be effected, 2) with the planned efficient use of resources available at the Veterans' hospital, and at the University hospital, and 3) with the planned integration of dialysis and transplan- tation services. Several aspects of the budget were considered excessive. It was recommended that the site visitors review the total budget with special instructions to: 1) reduce the costs for each year's operation by amounts that can be reasonable expected from third party vendors and from service charges, 2) to examine the need for major equipment and as many organ procurement teams as planned and to recommend any needed adjustments in the budget, 3) to evaluate the means by which the standard fees for hospitals and surgeons were established and to recommend any needed charzes. Edward T. Blomquist,@-@.D. Region Puerto Rico Review Cycle June 1972 Type of Application: Anniversary prior to Triennium Rating - 325.5 Recominendati6ns From SA@RP Review Committee Site Visit i=7 Council The Review Committee recommended that the Puerto Rico RMP be supported at a direct cost level of $l,loOiOOO for the requested -03 operational year. While agreeing with the SARP that generous support should be provided, Committee questioned the Region's capability to effectively utilize too great an increase in support at this time in its development. It was pointed out that the Region would be submitting a triennial application next year and th-ttthe initiation of new activities that do not appear to be terribly exciting could limit the Region's funding flexibility at a time when 'it will be outlining a new three-year plan. Committee viewed the goals and objectives as being clearly stated and in the direction of RMPS planning with the main thrust in education and health manpower, health services delivery system, and collection of data and statistics. The goals emphasize increasing the availability of care and enhancing the quality and the moderation of health care cost. Ongoing activities were considered to be designed to have an almost immediate impact on the provision of health services even if the impact is not directly measurable. It was recognized that some of the accomplishments ate quite dramatic and invblve active participation from official agencies, governmental and nonprofit organizations with the contribution of substantial funding support. The intensive efforts toward regionali- zation, decentralization of treatment centers, the continuing e ucat on of health providers 'In isolated areas, and the comprehensiveness of the educational aspects of ongoing activities in that they include the community, the patients, and their families were favorably recognized. The Administrative capabilities of the newly appointed Coordinator and the Region's activities directed toward the development of leadership roles for paramedical type personnel were also discussed. Committee concerns included the absence of minority interests such as allied health and nursing personnel on the Program Staff and the Regional Advisory Group. Regional Advisory Group criticisms included ina equate representation geographically, from the Caucasians living in the community, and from consumer groups although the Coordinatot's effort in the latter was recognized. The reviewers sensed that the hope for comprehensive accessible health services in Puerto Rico are going to be dependent on governmental sponsorship and expressed concern that very little contri- bution from the private physician and private hospital sector towar a really enlightened kind of health care system was visible. ent nild Firinncial- @;umrlarv 01@LNT CUPI',P.IT YF--ATZ REC@4@IEIMED YRIS AWARD ro, u ,IC IL i FUI@DING 02 OPER. RECOti?ipj E QUEST x ku;@it7xx REV. COM. YEAR T,'@'VL 248,370 $ 447 597 '@'O R V' - 0 - (22,C)OO) Sub-Contracts- 594,813 1,049,034 OPER. /@CTIV..- 0 DEVET,4 COI,,P. yes or EARI,fARY,S'.* 0 0 0 YTI)@TFY $ 843,183 $I,609, 386 $]-,496,631 00 @1,ECT 1,136,564 P UE@'RED COU'NICIL 989,762 APPIIO'IF,?,) LEVEL tiON-Rl4PS and - 980,676_ INCOME IN'DIRECT 95,130 178,969 REGION Puerto Rico /june 1972, REVIEW CYCL .1/ Excludes $28,504,d.c.'re ue-st fo q Project #16--NucleAr Medicin6 per PR7@IP telephone conversatio 3/16/72. RKP S STAFF 9RIEFING DOCUMENT 0 Mid OPERATIONS Eastern GION Pkiertb Rico BRANCH South Centr Wes BRANCH Poom@- TY E APPLICATION 'iO Numerica@t RATING Tel. No. X3-1810 Mr. Frank '@@@ash BRANCH CHIEF TRIENNIAL 197- DATE H STAFF Mr. Ceorge Hint,.le St ANNIV YEAR SARP BRANC Mr. Robert Shaw REV. COX. RO REP. 2nd ANNIV YEAR OTHER Last t V s t None OTHER Mgt. Assm' i Chairman @197 Cj Chairman r I 7-i-pw rnynynittpp; mn its, Last 12 mos. (Dates, Chairmants Name and Type of Visit) 1971, 'C-r. @vill.iain S. Fields, St. Anthony Center, Houston, Texas 6w and evaluate progress on Proj6ct #10 -- @-,troke as per NAC direction sLs@ance to new Coordinator and relative to continuation application Dr ince Its Last Review ch occurred in the Region Affecting the RNP S 97@,@ @16terats iliai5tration-4@s negotiating the establishment of Area T,,eiucation nte- ifferent reizions in Puerto Rico. The sub-regionalitation of their rvic s v erable amore efficient islandwide educational center a .Xrangent--nt is @-l@nvolved in current efforts within the,,,,.aii Juan area). ,,f s-pecial tote -1@s t.qe Jui-Le 21, 1969 enactment of Public Law 56 whit'@i permits Of services of private patients in government hospitals and Payment for @i@ d4 geftt p4tie,.its in private hospitals. 2 - Puerto Rico May/June 1972 Review Cycle Commonwealth of Puerto Rico Northeastern Region San Juan Arecibo Aguadil Bayamon Fajardo Caguas .@Mayaques Region Culebra Ponce Vieques Southern Region PROFILE (Health Related Information) PoDillation: 1-970 census - 2,712,000; Approximately 58% urban; Median Age: 18.5 (US 29.5) @a-r.d Area: 3,435 square miles (Approximately 100 miles long and 35 miles wide) Density: /50 per square mile Health Stat-Lstics: Mortality rate per 100,000 for heart disease-136, cancer-90, CNS vascu,lar,lesions-52, and diabetes-11. First three are low in comparison to U.S.,.diabetes comparison is not available Fdcilities Statistics: U-r,@-vers-'-ty oil Puerto Rico School of Medicine - 4 year school, enrollment of 301 U,ni.vp.rsi-ty of Puerto Rico School of Public Health - Accredited, enrollment '184 prox. Ten of nursing, 5 at University campuses and one junior college, others az hospitals Two schools of medical technology (Department of Health, Institute of Health Labs and the University of Puerto Rico School of Medicine) one school of cytotechnology Nursing and 2ersonal Care Homes: eleven skilled nursing homes and 7 long term care units are reported The L--,ierica-,i Hospital Association reports the following types of hospitals with a zota',@ bed caoacity of 9,999: 33 private (12 not for profit and 21 for profit)'and ic, -,Dca- government hospitals for a total of 49 short term hospitals; three I -I L psychiatric and five tuberculosis non-Federal hospitals; plus two Federal hospitals - 59 total all types. 3 6file (Continued - Puerto Rico): er, the Commonwealth of Puerto Rico has seventy-five municipalities that have ain:res-ponsibility for tovision of health care to the needy. Statistical p provided by the PR-RMP indicates that these municipalities have seventy-three iciDal and five district hospitals to provide public health services. n'Dow r.@2,111 Active physicians (80 inactive) and 4200 professional nurses n Puerto Ri o there are two systems whereby the population utilizes health care e ic 9; the private and the public or governmental systems. It is estimated at 32% of the population utilize private medical and hospital services and 68% iz t 6 public services. Betvdeen 30% and 40% of the population is covered by type Of health insurance. An unknown proportion Of the population uses ivat serv ces at times and public services at other times, depending basically OA its econ ic conditions at the time and on the nature of the illness involved. iv leis than 50% of the general hospital beds in the island are located in @p at sp ta!6, both private non profit and private proprietary hospitals. p ate@Oroprietar,v hospitals are owned and operated b physicians. The y te 6sO tals for the most.part ate located in the main cities - San Juan, ap- z and'Humacao. Private hos itals serve, not only the population in p , ty ere@they are located, but also receive patients from neighboring c di6al and hospital services are administered by the Puerto Rit6 6 H6a!th, the municipal governments and other state agencies such omp6nsatipn. As stated previously, basically, the municipalities onsibility for the provision of health care to the needy. five municipalities ranging in size from 7,000 to 500,000. Co Gov rnments, ow6ver, comp emen e Du and agreements with local governments, public health p a ativ6) have been organized into a single system o ly bv the DeDartment of Health and Municipal GovernTaents; the 0 S n full responsibility for technical and professional service ti a all,municipalitie6, except San Juan. a ma o it t, e municipalities there are healt centers either com let d or r co tr@ ion. EAch health center includes a hospital unit (usually one per 0 inhabitants), general out-patient facilities and a public welfare Component and Financial Summary Anniversary Application COMPONENT CURRENT YEAR YEAR RECOMHTNDED YR'S AWARD COUNCIL FUNDING 02 OPER. RECOIOMNDED 'REQUEST SARP YEAR LEVEL REV. COM. "ORE 248,37.0 447,597 -u- Sub-Contracts (22, 000) OPER. ACTIV. 594,813- 1,049,034 'DEVEL. COMP. - -0- Yes or No RKS: -0- -0@ -0- KIDNEY ,@S DIAECT $8432183 $1,609,386, $1,496,631 REQUESTED $1,136,564 COU'tqCIL APPROVED LEVEL 989,762 NOW-Ri,rPS and iwco,@ 980,676 l@-DID,ECT 95,130 178,969 REGION Puerto Rico May/June tgZ 2,.REVIEW CYCLE 1/ Excludes,$28,504 d.c..-request for Elroject #16 - Nuclear Medicine per PR-RMP telephone'conversation 3/16/72. 5 Region Puerto RICO Review Cycle,May/June 1972 TSTANDING ACCO14PLISHIIENTS BY REP since May -1970 (1) involvement of governmental and private non-profit organizations with the @ope iona projects. This involvement demonstrates the impact of R14P in the ommrxity d guarantees phasing out for ongoing projects. (2) Exoanston of the geographical scope of ongoing projects and the replication @6f su&6 sgful features on an island-wide basis. (i) dtivo p4iti6ioation from the Department of HoAlth, Department of Labor, Labor ions, 4 community and Civic Organizations as well as health related organizations. ou r; t e ealth, and local and FederAl sources. e@ ion's@continued active involvement and emphasis devoted to looki for ther sou s of support with a view toward pha6ing-but PM 6uoport. (6) e c 6hdt6ivenegs of the educational aspects of ongoing Activities that ude e tion t ealth prov ers, e commun ty, t ram S. e4di Ohio role of the RMP as d6oicted by the consultations provided to Saint Croix aint@Thomas and the Virkin !glands in establishing clinicg in their areas. ($) Th @@de_ree of outreach of project activities into rural, mountaineous and 9 etto re s as@well as urban areas. ) @l 1 i in establishment of satellite clinics thus providing greater ai iii of 6alth s6rvide.. c PRABLEMS ship idle of the Regional Advisory Group is a recognized problems n tor has stated his recognition of this situation and is implementing Re 0 Of the current ongoing projects is anticipated beyond the it@ia e year support period before "full" support from,other sources can be ta (3) ory oup re e a ,@ju Only two from the South Region and only 6h6 from-t-he West Region. o t have dd64uate reoiesentdtion from the nursing profession (this a of past reviewers). ,SI procedures (pages 46-47 of the application) appear to subrbgate fi roval authority of the Regional Advisory Group. S R G TE Ou an@e to be rovided the Region with respect to anticipated renewal requii6- p ts 0 6 going activities. Review Cycle May/June 1972 OUTSTANDING ACCOMPLIS@NTS BY RMP (HISTORICALLY) (1) Development of major interest and enthusiasm of lay and medical leadership in Guaynabo, Ponce, and to a lesser extent in Guayama. (2) Establishment of Regional offices in Ponce and Mayaquez. (3) Impressive progress in its sub-rogionalization development. (4) The establishment of a "master plan" for guidance of the Program. (5) Review and selectivity of the Regional. Advisory Group in that only eight of sixt7een projects initially reviewed were included in the application requesting operation status. Six of these eight were approved by the National Advisory Council and subsequently funded. PRINCIPAL PROBLEMS (HISTORICALLY) (1) The NAC requested follow-up on the Guaynabo Community Stroke Project Community Family Prevention Program on Stroke (Project #10) with respect to previously reported organizational difficulties. (2) Regional Advisory Group criticisms: a. Insufficient members from the lay power structure, and model cities programs b. Only top echelon personnel with no representation from allied health professions c. Absence of representation from Western and Eastern Health Regions d. The Regional Advisory Group has not assumed the leadership ro e (3) The private medical sector in San Juan is quite inactive. (4) Nursing profession is being slighted as an ally in health planning and traineeships. (5) Core does not have adequate representation from the nursing and social services professions to enhance their outreach into the community. (6) Project-#15 - Education Program for the General Practitioner in the Western Region overlooks the private practitioner in the community. (7) Goals should include cooperative efforts between private and government medicine. APRIL 4* 1972 REGION PRTO RICO BREAKOUT Or- REQLIF--ST RH 00065,O(,/72 03 PROGRA@'4 PERIOD RMPS-OSM-@JTOGR2.@ 5) 2) (4) IDENTIFICATION OF COMPONENT CONT. WITfilNi-CONT BEYONDI APPR. NOT I NEW, NOT CURRET@T CURREN] APPR. PERIODI APPR: PERIC-DI PREVIOUSLY I PREVIOUSLY DIRECT INDIRECT TOTAL OF SUPPURT OF SUPPORT FUNDED APPROVED COSTS COSTS C003 CENTRAL OFFICE $51 C)CI @L' I TTTI C-C AiD-l 0 AR-1 7 1 002 HFMATOLD(;Y CANCER CHFMOTI I -@F@ ANQ-DL-Q@ANKItir I 4. '7 -3 -OC'3- PEDIAT?IC PULMCNARY 0 is c- I--, AS F- O,-@ 4 ED(JCATIOP, PACORAM IN CIAI - BETFS Mg:L &41* I!k 1. 1 6H 307 ED TRAINING PROG FOR MD I 12 .?.2a- 1 ..tgo.73 - p @ll I IN-LE @L 'D T I @G39- CC)P,@yU@'ITY APPPOACH TO COI I -AFLLA@ L $El 1. 93 6-1 S A. li@- t 190.496 1 010 GUAYNABO STROKE PREVENTIJ --- -- -- t I t t ON I.. 11482916 1 171.66n I st7o.r.7h I Oll COMPUTERIZED DOSE DISTRIJ s I C) 0. 00'0 @015 EDUCATION PRC'VRAM FOR G __p IN, T LLpi4 15-172 1 -SI.116 116.?RR I 017--PUBLIC EDUCATION 0 18.580 t IS6.6Al 1 17 TOTAL $26Ov932 $78,101 $19496t631 $l78v969 $lw675v6OO RMP: PUERTO RICO PREPARED BY: GEORGE HINKLE DATE: 4- 1. GOALS, OBJECTIVES, AND PRIORITIES (8) The Puerto Rico Regional Medical Program goals, objectives and priorities are clearly and explicitly sta-@ed.'-'The PRRMP stated objectives in Education and Manpower, Health Services Delivery Systems, and Collection of Data and Statistical Projections are considered to be consonant with the RNP mission of increasing availability of care, enhancing its quality and moderating its costs -- thus making the organization of services and delivery of care more efficient. PRRMP MASTER PLAN for obtaining the Program's objectives (Annual Report 1970-71) provided an analysis of program priorities with respect to geographical health regions. The current application indicates that a quantitative system is now being devised whereby relative weight is assigned to the technical quality of the proposed project, its relationship to the goals and objectives of the Region, the reliability of the sponsoring organization and the competency of the project director. This system will yield a numerical score that will allow objective classification on the basis of relative merit. Consumer representation on the RAG represented this group in the establishment of goals, objectives and priorities, and the present proposed amendments to the RAG by-laws provided for increased consumer representation from all socioeconomic groups. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - Recommended Action: 2. ACCOMPLISHMENTS AND IMPLEMENTATION (15) the Regional Advisory Group reports that there is no doubt that there has been contributions to the present health delivery systems and to the different governmental agencies involved.with the health care of the Island. All on-going activities are reported as being highly successful with respect to established project objectives. The geographic'scope of the activities are either being expanded to an Island-wide endeavor or plans provide for this expansion. The Program has been successful in establishment of treatment centers, teaching programs for health providers, patients, and families of patients. The training of health personnel in new skills and the training of new health assistants along with the establishment of new treatment centers have greatly enhanced the availability and Accessibility of care. Project activities have been and are being conducted not only in the more affluent areas but also in Model City areasi ghettos, and rural and mountaineous regions of the Islandi Notable Program Staff planning studies include the establishment and utilization of a Program action plan which outlines procedukes.for the development and implementation of education activities by the o erational projects, and the Program staff 'maintained library.and Health Services Personnel Inventory that is made available@to all he lth professions and governmental institutions. - - - - - - - - - - - - -- - --- - - - - - - - - - - - - - - - - - - - - - - - A ION - PUERTO RICO GEORGE HINKLE PREPARED BY: DATE: 3. CONTINUED SB-PPORT (10) The PR-RNP has a definitely established policy toward developing other sources of support. support for only one activity has been discontinued to date and it is being continued with full support being provided by the Depa t@ment of-Health. It@ is reported that as RMP funds are phased-out (such as the recent 12% reduction) other sources of funds have become available to continue the activity. All on-going activities make reference to possible future sources of support as being either firm or highly probable. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Recor@=,ended Action: 4. @/@-LNOR-iTY !NCTERESTS (7) -,'oe goals and objectives are directed to all the people of Puerto Rico. Throu 'n intensive efforts toward regionalization, decentralization of .g treatment Centers, continuation education of health providers in 4-so'Lated areas and educational programs directed at both the patient and th@ patients family, all interests are considered to be served. 1-r_ is noted that the Regional Advisory Group includes female representation. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ACTYLON: PREP DATE: 4-5-12 icico 10) Dr, Jorge Fernandez is the newly appointed Coordinator (PRRM letter of De ember 3 1971) although Dr. Cristino Colon, the previous Coordinator 31 still serves as a consultant to the Program. mb6r of the Dr. Fernandez is described as a brilliant, young faculty me de and inter6 t in the field of education, s 001 of Dentistry with experien s particularly dontinuing education in the health professions- He hag served on ari6us committe6g of the Regional Medidal Program and during the last uatioh He now serves on year ds@Sp6dial Consultant in Education and Eval th Health Manpower Task Force at the National institutes of Health. Dr,; Fernandez has initiated a reorganization of the Program Staff to more closely 4ily it to the new RIMP mission. He has also directed efforts amendment' of existing RAG by-laws in an effort to increase to ard the th consumer representation at all socioeconomic levels. eview criticisms directed Th inadequate involvement of the RAG and past t t d otol6tt interrelationships are also recognized areas of concern i ich Dr.@Pernandez is directing his efforts., He appears to.have g nea the confid4nde of the Project directors and Program Staff personnel. ntly, the PRRMP does not have a deputy director. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - p tafi is almost startin anew in that most of the staff resigned ogram s 9 s 86quent to the.r6cent redudtions in Program funding. T e Cbord nator has reorganized the Central Office in line with the objectives of the program to optimize efficiency. Staff is now organized i to three sections*. HEALTH EDUCATION AND MANPOWER.'ADMINISTRATION AND SERVICES SYSTEMS, and PLANNING AND EVALUATION. Secretarial, ci ticai,,and other t6n-piof6ssibnal and non-technical are@in a Central 0 ice to provide suOPortative services to each of the three sections. esou ces in the development gram@Staff will utilize RAG Task Forces As r r '@the ians of action (RegionAl Planning Health Education and Manpower, P posa a Review). re is an absence of allied health personnel - no nurse discipline; I SL anpl cation ieque6t6a 44 positions - current Application is for 2 h !I on-b r 11 fu 9 oa d, a 11 time, (5-professional are vacant 57 leri al/secretaiiil.) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12 RNP: PUER!,:O RICO PREPARED BY: GEORGE HINKLE DATE:4-5-72@--@ 7. REGIONAL ADVISO@RY GROUP (5) 'i.he RAG report states that the group realizes and has accepted its new role. and responsibilities as a result of the decentralization of procedures wit'.-.,in RMP. The new Coordinator reports that he believes the RAG has not discharged its duties, to date, but that he will encourage the RAG to exercise its prerogatives. He has already assigned a Program Staff member with liaison responsibilities for greater involvement of Staff and the RAG in daily operations. Representative of health interest groups and special task forces and project directors) provide an excellent representation of the most outstanding health professionals in the Region. Currently 28'members - 4 vacancies, four women; 20 are located in the Northeast area, 2 in the South, and one in the West. Curre-,iz proposed amendments to the RAG by-laws.place numerical limits to the types of representation on the RAG and states that "the public and consumers category shall include at least ten health services consumers proportionally representative of all socioeconomic levels in Puerto Rico. RAG has regular quarterly meeting; meeting will be held in sub-regions to encourage attendance. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - Action: GRA.LNTEE ORGLN7IZATION (2) The University of Puerto Rico is the Grantee and Fiscal Agent for the Program. Cordial relationships exist between the Grantee and the Puerto Rico RMP. Adequate administrative assistance is provided and many of the Grantee facilities are made available to the RNP project staff in the day to day operational activities. Dr. Adan Nigaglioni, Chancellor, University of Puerto Rico was the first Coordinator for the Program and is highly knowledgeable with respect to its aoals and objectives. C> There are no indications of Grantee.domination .and/or interference with policy setting functions of the Regional Advisory Group. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - RECO@-@NTDEI) AC,-iON: 13 UEPTO RICO PREPARED BY: QgORGL@ IIINKU- DA PARTICIPATION, (3) Active participation of other health agencies is obtained through member- ships on the PR RN? RAG. Program Staff planning studies are planned in cooperation with the State DeDartmenti prepaid health insurance organizations, the P. R. Hospitals sociation, Department of Health, the San Juan Municipal Government and o her Muni6ipal Governments. V terans Administration has cooperated in continuing education courses, offered hospital facilities in joint efforts, and joined in negotiations for the establishment of community based health education facilities. i int activities have been conducted with the P. R. Medical Association d the Coordinator is a member of the Committee for Medical Education. cal Health Planning Board Director has offered to cooperate with the Mode."L Cities Program of the City of San Juan Collobotative efforts are being initiated. T amounts of funds provided the RMP activities from other sources pt6ximat6ly matching funds)is highly indicative of participation from State and local organizations. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - tings are held with members of the section of the Department ormunication for better coordination and avoidance of ers of the CHP are on the Regional Advisory Group- IL.MP has been appointed to the Municipal Advisory Board of the planning of ice !or the Area of San Juan. C and PR-RNP share the health professions human rIesburdes inventory an 60 era @iv6 arrangements have been made in the publication of the updated tory. Ce-@itral Program Staff Planning and Evaluation section has served as C, Isultant and t@aken ste a to provide requested consultation services p e ning Bo d and the Department of Health. th Plan ar sortium of RIIP and other health agencies is being formed to combine 6rts in the collection of health data relevant to all concerned. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DED--A TION: - L-9 - PUERTO RICO PREPARED BY: GEORGE HINKLE DAT - 4- I-,- 11. ASSESSMENT OF NEEDS AND RESOURCES (3) Health professions human resources inventory has been completed, transferred to the local CHP for sharing and arrangements have been made for updating the inventory. Efforts are underway to establish a consortium of RNP and other health agencies to combine efforts in the collection of health data relevant to all concerned to improve-channels of communication and avoid duplication of efforts. Core staff has planned activities and studies to gather additional basic .Lnf.ormation for the development of the operational plan for the next triennium. Many of these studies are referred to and a direct result of the Program Master Plan developed for the Region. Listing of activities are provided on page 33 of the application. Prior activities associated with need and resource determinations are recorded in the Master Plan and involved collection and analysis of. data relative to health regions, medical, nursing and other paramedical and auxiliary personnel, as well as financial, physical, and organizational resources. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Recornended Action: 12. (3) Writte-,i records of the project review are maintained by staff, the i@egional Advisory Group, and other Review Groups. Specific core staff is assigned to monitor and/or provide supportive services to individual projects. 'Yio-,izhly meetings are held with project directors to share with them all @ plans and activities and thus encourage more constant communication between the Coordinator and the project directors. 'Progress and expenditure reports are required and these are reviewed ?e-j-@odically as follows: Expenditure: RAG - annually, staff - quarterly; Progress - staff bimonthly. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - @@'.)ED ACTION: t5 PUERTO RICO PREPARED BY: GEOBGE HTNKT.F. DATE:4-5-71-- ATION (3) Evaluation procedures are required for each project; all projects are evaluated by Program Staff and consultants; evaluation is of both a .qualitative and a quantitative nature. During the past year evaluation reports have been completed on six p t all that were in't'ally funded except Project #10, this rojec s - 1 i activity wa@s very slow in being initiated. Program Staff is actively working toward completion of the development and implementation of the total Program Evaluation Plan. It is anti- cipated that it will be completed during the coming year. - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - I.CTION P (5) Priorities have been established that Are considered to be consonant wi t, national ,als and the goals of the Region. Th Regior, plans o continue currently ongoing categorical Activities 'aab Vesta-Led its goals and objectives in terminology agreeable to t RIIP8 tublished mission; it is noted that activities appear to'be in complete agreement with these goals. Ongoing Activities are t comprehensive with respect to patient services; education of health p viders, patients, their families and the comunities; manpower utilization and establishment of new skills and types of personnel,, etc. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16 T E 7 TERTO RICO PREPARED 15. DISSEMINATION OF KNOWLEDGE (2) Health professions human resources inventory has been turned over to the CHP agency for sharing and mutual updating arrangements have been made. Analysis of educational plans and activities sponsored by the Program has resulted in establishment of procedures for the development and implementation of educational activities by the Program's operational projects. IT IS ANTICIPATED THAT THESE EDUCATIONAL MODELS and MATERIALS WILL BE MADE AVAILABLE TO ALL AGENCIES AND GROUPS CONCERNED WITH HEALTH EDUCATION to achieve their ample utilization. Data inventory of medical and paramedical personnel is kept and distributed to all health professions. Medical library services is maintained and services are provided to Governmental institutions and hospitals. Three hospitals in different I areas have requested help in establishing their medical libraries. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 'Reco=- ended Act -Lon: --L6. UTILIZATION @OWER AND FACILITIES (4) Efforts directed toward continuing education of health providers and the training of health personnel in new skills and training of health assistants and family health workers tend to increase productivity of physicians and other health manpower. The utilization of facilities of the Department of Health, Veterans Administration, and community medical centers as nuclei for the establishment of Prototypes prior to replication throughout the Island provide for more effective utilization of community facilities. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ,-X-CO@YiYIE'.\,DED ACTION: 17 PUERTO RICO PREPARED ty: GEORGE HINKLE DATE:4-5-72 -I.MPROVF@,@-NT OF CARE (4) Activity progress toward established objectives depicts the practicality of the projects. Establishment of new and satellite treatment centers, the change in patient referral patterns as reported by one project, and the extreme degree of direct patient involvement are positive indications of improvement of care. Health maintenance, screening, diagnosis* treatment and rehabilitation are t t outstanding when one reviews this application. erms that are mos These are most certainly directed toward improvement of care. -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ed Action: SHO (3) 8 6it-term education courses for the development of professional and c, rmnity leaders in the areas are planned and conducted. 0 erational activities appear to have visible payoff in the availability Of cAte4 Periodic reports (bimonthly) are reviewed by Program staff and regular me tiiags of ProJect Dir6ctots and Program Staff are conducted. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ON. 18 -5- 7 PUERTO RICO PREPARED BY: GEORGE HINKLE DATE: REGIONALIZATION (4) The Program Staff is located in the San Juan area, Northeast,. Sub-regional offices-are located in Ponce, Southern Region and Mayaquez, Western Region. However, these offices consist of only an associate coordinator and a clerical staff-member. Project activities are located in each of these areas, but the greater number are headquartered in the San Juan area. Project activities appear to be reaching out into the underserved areas throughout the Region, or at least this outreach is projected for the forthcoming program year. Although activities are initiated in a specific predefined area, they are considered to be prototypes with the expressed intention of duplication and/or expansion of the concept on an Island wide scope. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -- RecoTr,mer-,ded A-ction: 20. OTHER FUNDING (3) The only project to be terminated will be continued with support provided by the Department of Health. All ongoing projects and all except one to be initiated project reIports funding support from other sources. Funding from other sources, as reported, approximates the direct cost support level provided by RNPS. Other funding sources for continuation of the activities after termination of RMPS support is a most active concern of the PRRNP. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Rr,Col,v@,NDEEID) AA(CTII@N: TABLE OF CONTENTS SOUTH CAROLINA REGIONAL MEDICAL PROGRAM ANNIVERSARY APPLICATION Staff Briefing Document Page Face Page I Regional Map 2 Geography and Demography 3 Component and Financial Sumary 5 Breakout of Request (05 period) 6 Probl6ms, Accomplishments,;Issues 8 Review Criteria 15 / aw Ms STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mia-con South Centr'l /-7 W6s tern LEG ON BRANCH - South Carolina BRANCH not Tel. No. 31740 Room 10-22 ,ipE APPLI AT ON applicable LAST RATING TRIENN AL .197- DATE BRANCH CHIEF Mi. Lee Van Winkle - St IV YEAR SARP BRANCH STAFF Mrs. Lorraine Kyttie IV YEAR REV. COM. RO REP. Mr. Ted Griffith /-7 OTHER Last Mgt. Assmlt Visit January 197 Chairman Dr. Albert Heustig .A$@ V. Ma ch' 971 Chairman Dr. Edmund Lew Dr. Rverfkt- Co= a Visit$. att 12 mc (Dates, Chaii.,,n's Name and Type of Visit) 21. 72 - Lorraine Kyttle - to discuss Pre ,Tn obiprtivt--,t and uprnming tr t. Occurred in the Region Affe,ting the PM Since its Last Review i n@State to establish second medical school at CdlumbiA gaining impet s. is as having possibly favorable or negative impact -on relationships ante @(medical University of South Carolina). Favorable in that they assist to their efforts to regionalize way beyond present concepts of iati e in that efforts to counter establishment of second school may ests@of grantee at a time when SCRMP proposes significant programmatic z onal changes. SOUTH CAROLINA SUB-STATE C Eo it GI DISTRICTS 1. Appalachia Regional Planning and Development Commission 2. Upper Savannah Development District 09 3. Central Piedmont Regional Planning Commission *4. Cenlrijl Midlands Regional Planning Council 5. Lo@-ver Sjvannah Regional Planning and Development Comniission 6. Satitt!e-@liateree Regional Planning Council 7. Pea Dee Economic and Development District 8. Waccaniiiw Regional Planning Commission *9, Charleston-8erkeley-DorchLster Development District 10, Low Country Regional Planning Commission Districts with funded CHP "B" agencies 1 f7l COMpbneflt and FlnanClOt SUMMAry Anniversarl Apolication V.) ENT CU-PIP.ElltT YFAR YEAR RECOI*!EttDED 'MI S AWAP.D COUI,'CIL FMMING 04 OPER. RECOOFENDED 'REQUEST SARP YEAR LEVEL REV. COX. E 415,587 499,818 -Contracts R. CTIV* 596,137 2,032,541 t# COMP* 62,500 1003000 Yes or 'No RKS #55 43,500 323,920 vir 9 Dit CT, 1,074,224 1.550.000, 2.632,35c, 2 991.048 IL ED LE L 1,550,000 an RECION South Carolina June 197 2 REVIEW CYCI.E e 04 year jis being-extended to 9/l.an@"ih'e region has been advised that the funaixig-level will be $1.,550,000 for-the 14 month per d MARCH 17,1972 REGION - S CAROLINA BREAKOUT OF REQUEST RM 00035 06/72 PS-OSM-JTOGR2 05 PROGRAM PERIOD (5) (2) CURRENT CURRENT IDENTIFICATION OF COMPONENT CC@T. WITiiiNI CCNT. BEYONDI APPR. NOT I NEW, NOT I OTAL APPR. PERIODI APPR. PERICC)L PREVIOUSLY PREVICUSLY CIRECT INDIRECT I T APPROVED COSTS COSTS I OF SUPPORT CF SUPPORT FUNDED COOO CORE S499.RIB ------- - ---- 8 I s l@bo_ 1 -1681,427 --EEVE7CPM NTA7 LI O,) 022 MEDICAL UNIVERSITY OF Sol uTH I I._ RI6 I s 17,171-1_@R4 .987 039 STATEWIDE HEART CLINIC El I . I I r 159.7LB 1 111,495 1 17t.713 I )IJCAT I 5'9- 218_ 1 040 UNIVERSITY OF SOUTH CARD) 1 1144 SL2.C&E NUEU-I&AitiiN(il 561.2(,Z I_ 042 HEART IMPLEMENTATION I I 1 stllZDA 1 124,111-1 .,A79 044 STATEWIDE CANCER CLINIC I I I rDtJCAT 1 ILL- 1 27 1 ssa@159-1 045 NUCLEAR MEDICINE TRAININI I I I G 1 $60,649 s 6 O.L.6A 9 I 1 t6Q.649 1 048 GYT@ECOLOGIC PADLOTHEPAPYI I I I .6.1 3 i6a,491, A- 62ZO-177 049 STATEWIDE LABCPATORY PERI 1 2 5. Q.9 094 1 TP&Iti.LN5-L 050 CENTRAL MICILAt4DS MEDICAL] liz@@ I !L;)3.77n I 11,@AR 051 CONTINUING EDUCATICN HEAI ? lis.772 1 2 ITLA - SI;4 0 53 INFORM 1 196,617 1120,373 I 054 PLAN ic@D -01 SCFIARGE-ATO PRI I s5L@o I iso.ann I 055. 'iEtODIALYSIS CONTINUING S7.1" HOME TRAINII $156, 184 055B EXPA,'ISIO'4 OF l@8.L480 I C55C PARTIAL SUPPCRT OF 2 BEDI 055D DEVELCFt'Et4T OF TRAI%SPLANI T $96,440 b@4 l@ $2 3.16 5 $11 @56 CO;PREHENSIVE RESPIRATORI 057 SP AR TA@.B UR G MCD I C AL ED uc 05e COMPREHENSIVE COQCTARY Cl @6,997 1 ------------ 059 GF 0 MO H.0FJ-49H)m :3 CD . . . . .0 CA o(a @ 03 MFJ-m F4mPt rt ct F4 F-4 la rt0 F4. t-h Fl. %11 C) onM2 " :iN I co (D tTi :i C,&r," @ (IQ 10 Pi (D ri)0co ti r_ :r 00la rt 0 00 F40C-) 10mtim0 0 0FA- F4 Pi rt 14 :3 F4 DQ F- rt0Fl- t-h rtMnrt :r rt pi OQ co rt ElmEn 0) ri) FJ- 03 t-h0ibM0"'U (D ri) rt P. 0 Mt-h r) r_HFl0MM :r (D (D rL ti0:3 :i 14 to rtn 000 0r)m0 U)mrt :C :r 10 F'6 (D0 CL fD MF4 :J0rhm" 9H. Vr) :J ZI FJ- -0H-'d U) rt (D rt :4 "rt rt :3 Eg CD00H.M rt (D m GQ (D"0:ix 0pi m0 FJ :J0q:3 @ GQ Fl- tJ :3 (D m r@6oC'Y rt F4 rt 0) Iri) mOD H000rt rt (D Fl 11 M03MV40FJ- rL (D :i rt Z,0w:i En -0 rQ F40FJ-nU)ML-J- (YQ Pi mmm0:iz"(D rt0 CL rt ri) aq 10 (Dnzr rr CD Fl- 410 rt (D o; lb o 0Id0En0Fl- 03 rt ri) r?, rt CL :i pi C-) .4 F, Fl- (D (D PI Fl-Mo(D rt 0CL (D > o:3 Li' (D (D :i m -i rtmCL w pi "I r) H- rt (D rt LI) 0 L. Kyttle 4p: South CaLolina CONTINUED SUPPORT (10) 19 of original projects self supporting*RAG Manual (updated January 1972) speaks specifically to concept of SCRMP support to establish needed activity or. service and then shift to other sources if continued beyond general 3 year period. At this time, SCP14P is rather locked in to supporting 3 year projects, most of which were linewlt at the time triennal application was approved and have 2 years to run. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Bcommended Action: NIINORITY INTERESTS (7) While funded activities specify target groups to be all inclusive regardless of race or economic status, most activities primarily concern specialized training programs for health professionals. Wording of present goals and objectives does not lend them to an evlauation on this point. Minority providers and consumers not adequately represented on RAG. In response to specific recommendation last year, member from Palmetto Medical Society added to RAG. At present time Care professional staff all white and all male (form 7 notwithstanding) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ECOMMENDED ACTION: th oli@a Uttle 3/30/', 50 NATO (10) 04rdihito generally acknowledge4 as person with stature in the state who can meld dii ofessionalg and coinmunit interests. He just returned to office y illness. Apparently 46vel6ped competent staff as program generated @f6t hoped,fdr sweeping changes in his absence from office but which he am hospital and convalescence at home. Summetall, a 50% deputy, stepped 100%;during that time. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - de 64 goo range of competence for existing Care structure, but. not neces" str tuieO mission they describe. Very categorical. Housed in increa- I e quarters. Entire staff literally cannot all sit At desks at same time. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ON-. RMP South Carolina PREEABEA EX-. L. Kyttlg 7.' REGIONAL ADVISORY GROIIP (5) RAG has 72 members. Care realizes too large. Very elite Executive Committee. Meetings usually attended by slightly more than half of membership. Last full meeting, RAG adopted an attend or be dropped provision. Mosely hopes to prune by this mechanism and make consumer additions as well. RAG plays very active role in all program decisions. Recommended Action: 8. cRANTEE ORCANIZATION (2) MUSC grantee. Several bones of contention. Most important: Is new and expanded mission which SCRMP sees as its legitimate mandate also viewed as a legitimate mission by grantee? Myrtle Beach retreat at end of April may open this up. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - @COMKENDED ACTION: South Carolina EgEEAREn BXI L. Uttle T)az @/10/ @9. PARTICIPATION (3) Reg on's medical political complek deeply involved it program. RAG membership s;o attests. Coordinator represents astute link between MUSC and SCRMP. CHPA viewed as o fective by SCRMP. Two funded B agencies out of 10 medical districts. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - de 4 A i on: IOCAL P TNG (3) ro a on in review procedure for CHP review and comment. SCRN? structure in medical anized Annual Conference of Health Planning Council whereby d tr s $CP" org .1 i# planning councils of CHP meet to review all programs and plans. Overlapping s d membership on local district committees. - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - 'A I L. Uttle. 2 fp - South Carolina BY; .1. ASSESSMFNT OF NFED.9 AND RESOURCES (3) SCRNP developed South Carolina Health Data Profile which represents most'in depth attempt to accumulate interrelated health data in State's history. Medical Districts update. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - !commended Action: 12. @MANAGE-.14ENT (3) Region received one of the first management assessment visits in January 1970. Very well rated at that time. Recent visits continue,to comfirin original assessment. - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - ECOMKENDED, ACTION: South Carolina L. EXttle DATE,. 3 30/-4 EV UATION (3) There is no full time evaluation director. There is a full time program analysis coordinator. Region proposes evaluation (both individual project and program impatt) i as an area to be specifically spoken to under A reorganization. - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - nded Action- ACT p (5) t is n this area that region proposes sweeping changes to be aired at Myrtle at. As program now stands, goals and obj6c es o no em race nat ona mission entirely. The activities proposed by Region are for most @second Year request for continuation of specialized education activ- kidney propsal expands beyond this concept and some of the flavor of ities is to train patients, link hospitals and expand services. In 4eve n ew u ets uni r ew ing eve , reg on opt6 o Act vate t e new @r e d ling with expanded services and fund a previously approved activity that OP a team approach to preventive and comprehensive medicine out of SP General Hospital. - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - PRRPARE L. Uttle fp: South Carolina 15. DISSEMINATION OF KNOWLEDGE (2) On the basis of information in this application and free standing documents, tlie. region appears to be meeting the requirements under this category. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - @commended Action: 16. UTILIZATION MANPOWER AND FACILITIES (4/) The region's currently identified priority of improving patient care through con- tinuing education is certainly proportionally reflected in the overall program. Existing community health faculities are utilized in the educational programs and it is more than likely that productivity of existing health manpower will be increased. Each of the 10 medical districts in South Carolina is below the U.S. in health resources, the Central Piedmont district showing the largest discrepancy. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ZCOMMENDED ACTION: RY @30/7: South Carolina II. IMPROVEMENT OF CARE (4) Studies pursued under the Developmental Component are beginning to focus this prbgra on the e@tent to which ambulatory dare might be expAnded. Continuity of care is the 6ubj66t of further activity pmpo-sed under the Developmental Component bat not spedi- @fied as an activity in this application. Most of the activities in this proposal eal with improving specialized care. The step of strengthening primary care and the elationshil) between primary care and specialized care is one of the subjects of the upcoming retreat. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ded Act on-. 18. HORT-TERM PAYOFF (1) a proposed adtivities will increase the quality of specialized care and to A esse ex'ent increase services available in,a short,term time frame. - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - cr n L. KVttle -South Carolina PRPPARR- L9. REGIONALIZATION (4) SCRMP is building linkages and in this concept has regionalized well. Its district structure has contributed to this and a strengthening of the medical districts is a priority of the upcoming year. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --co=wnded Action: 20. OTHER FMDING (3) SCRMP, like many other regions.has not done a.good job of telling this part of their story. Without exception, the 16's show no other sources of support and the 15's do not speak to other contributions whereas when the staff described the activities in more depth on a recent staff visit, I found that many of the hospitals had con- tributed financially and otherwise to the training projects and the MUSC had made substantial contributions as well. Conversely, SCRMP has co-authored several grant applications ultimately submitted to Appalachian organizations (federal and state) as well as NCR&D and BHM. - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TECOMMNDED-ACTION; E-M-ORANDUM DEPARTNIENT OF HEALTH, EDUCATION, AND NVELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION TO Acting Director DATEApril 18, 1972 Division of Operations & Development FROM Director Regional Mpi@l Programs Service SUBJECT: Action on April 10-11 Staff Anniversary Review Panel Recommendation concerning the South Carolina Regional @,ledical Program Application. Accepted V/ (Dat@)- Rejected (15ate) lbdifications onent and Financial Summary - Anniversary Application COMPONENT CURRENT U -5 YEAR b@ YEAR RECOMMENDEI) YR I S AWARD COUNCIL FUNDING @ OPER. RECOMMNDED REQUEST SARP YEAR LEVEL REV. COM. 41S 587 499JI818 CORE Sub-Contractg OPER, ACTIV. S96)137 2,0321541 1,550,000. DEVEL. COI,4P. 62,500 100@000 Yes (X or NO EARMARKS: 43,500 323)920 150,363 KIDNEY #5r 1 sso 000 1 1,074,224 2 632 359 )700,368 3 DIRECT 2 991,048 RE2UESTED COUNCIL APPROVED LEVEL 1,550,000 NON-RMPS and INCO',ME South Carolina REGION June 1972 . REVIEW tYCTE *The 04 year is being extended to 9/1 and the region has been advised that-the-funding level Hill be $1,808,324 for the 14 month period. This represents a pro-ration of the $1,SSO,000 Council approved level. 4118/72 SCOB/RMPS Region South Caro 'na Review %'Iycle Tiinp -1972 Type of Application: Anniv. within a Trieiuiial- Recommendations 'From Rating - 240 SARP Review Committee Site Visit council Recommendations: 1. That the Region's funding level be continued at $1,550,000 for its OS operational year. This level is exclusive of the kidney proposal. 2. That the kidney proposal be approved as recommended by the site visitors at a level of $150,368 for the first year and $104,691 for the second year. 3. That disbursement of funds for the second year of the transplantation portion of the kidney proposal be contingent upon an appraisal of the first year's performance. 4. That the advice letter cover the specific points discussed by the Panel and delineated under the Critique portion of this document. Cri The Panel first considered the staff reviewers' proposal for postponement of the review of this application until an assessment could be made of critical programmatic issues to be acted on by South Carolinals RAG at a 2-day retreat to be held at the end of this month. SARP agreed that although the retreat issues were central to moving this Region in expanded and new initiatives, the real program impact of decisions made there could not be assessed in the immediate future. Therefore, Panel decided to proceed with a review of the application as-presented with consideration also being given to the documents presented by staff covering developments in the Region since the application was prepared. The reviewers agreed that the application reflected a failure to respond to specific recommendations included in the advice letter last June. The heavy categorical emphasis of the program; the traditional continuing education activities through which it is implemented; the Region's goals, objectives and priorities; the composition 'of the Regional Advisory Group; all were cited as continuing weaknesses. With what Panel sees as superb lack of timing, the Region did not address these issues in its anniversary application but stands ready to do so at the RAG meeting which takes place while this application is under review. Page 2 -Critique South Carolina PAT Panel agreed that the classical academic approaches characterizing most of South Carolina's activity to date reflect the confinement of the very conservative and influential medical/political structure. To have moved this program in this State to the point of addressing the basic program issue of a mandate beyond that confinement and to have cultivated a preliminary endorsement of the proposal by key members of the RAG's Executive Committee, is, in the Panells view, encouraging evidence of Dr. Moseley's leadership. What South Carolina has undertaken through its operational project activity has been done well, and the reviewers felt the program could be expected to embark on new initiatives with characteristic efficiency. The reviewers voted to accept staff's alternative recommendation that the Region's funding level be continued at $1,550,000 for its OS operational year. In arriving at this recommendation, the reviewers agreed to accept the Region's promissory note and,therefore, felt the funding should be so established as tDallow South Carolina to implement its promised new initiatives. The recommended level would also require the Region to prune the requested budgets for the continuation activities. The $1,SSO,000 level is exclusive of the kidney proposal which will be reported on later in this document. Panel recommends that the advice letter to this Region specifically cover the points that previously identified weaknesses continue in this application; that the recommended funding level represents a reliance on the Region's ability and intent to implement significant programmatic and organizational improvements in the very near future; and that any issues remaining unanswered following the RAG retreat be explicitly identified. The kidney proposal was considered and the recommendations of the site visitors were accepted. The report of the site visit is attached which recommends $lSO,368 for the first year and $104,691 for the second. A qualification was added to the site visitors' second year funding recommendation, that being that funds for the second year for the transplantation portion are contingent upon an appraisal of the first year's performance. 0 RMPS/SCOB/Kvttle/4/18/72 Component and Financini Summary Anniver3nEL i%npticRLiutt P'-coiipoNr.NT CURPE,@IT @rFAlt Y-FAR RECOMIE-ITDED YR'S AWARD COU',,'CYLL FUNDING 'REQUEST PER. RECOIIMENDED SARP jA 0 YEAR LEVEL REV. C014. (14'mo. (12 mo eriod) period) period) (12 mo. p CORE 620,627 499,819 Sub-Contracts OPER, ACTTV. 981,947 -.1,708,621 1,550,000 DEVEL. COMP. 155,000 ioo,ooo Yes (x or no EARMARKS: KIDITEY #55 50,750 323,920 150.368** CBE #63 See below* R14PS ECT 1,.550.,ooo 2 632 359 1,700,368 REQUESTED 2,991,048 COUh'CIL 1,550,000-12 m 1,808,324-14 m APPROVED LEVEL -Rl4PS and NON INCOME Al o pending is,a,request as follows: !3 CBE component #63 01 $722,140; 02 :$820,523; REGION SOUTH CAROLINA '03 $942. 186@' June .197 2, REVIEW CYC The level of approval for the second ypar of the kidney component is $lQ4,@,,l. N Current uest, 2,632,359 ..program req $ ,Supplemefital.CBE request 722,140 Re@ion's total request $3,354,499 5/23/72' .Nl E ivi U i@ Pi i\J L) L) ivi N I- @ I@ @ "I @ .1 @ @ I@ "@ @. I @ . @ . -@ , ,. I ---- - -. I . - PU13LIC IIE.\L,rji SFRVICE SIll@VlCl,'.S ,\ND i\ILNT.\[, For the Record DATE: FRO.NI Yedical Consultant Division of Professional and Technical Develop",nt, PIIPS SUBJECT: Recommndations of the Mini-SARP regarding South Carolina Kidney Disease Proposal (55-B, 55-C, and 55-D) 1. Ptir2aae of the Program To expand an already existing Hor,,e Dialysis Training Prograi@l (55-B), as xfell as to establish a satellite dialysis unit at Colu,-,bia, South Carolina (55-C), and to initiate a university-based transplantation program (55-D). .TI. Action A. The recoTn,@.ndations of the Mini-SARP were for the general approval but with the stipulation that a site visit be i-tiade with the use of an out- side consultant plus staff for the purpose of: 1. Determining a more realistic, overallll-v-el of funding; 2. Resolving the issue of a proposed satellite dialysis unit at Baptist Hospital versus Richland 14errorial Hospital; and 30 Dlecu.-cin,. in grcater detail the proposed transplantation activity in view of making specific recor@t-,endations regarding the level of IIITS supports B. It is advised that this consultative activity be carried out as soon as posEiibiLe, prefera'oly in time for our recoT@-i.Tendation that can be t-@-de to the SARP at ito next in(!eting on April 4, 1972. JAIZS B. GRO M.D Reg i on: South Dakota Review'Cycle:J6ne 1972 Type of Application-02 continuation plannin2 Ratin @ 90.3 Recomqiendations From /-7 SARP /X-X7 Review Committee /-7 Site Visit /-7 Council RECOMMENDATION.4 The Review Committee concurred with staff re viewers and SARP that the a placation should be approved in the time and for the amount requested ($424,662). p This figure is exclusive of EMS and CBES supplemental requests which are presently under review. CRITIQUE: The Committee reiterated many of the points raised by SARP during the course of their review of this application therefore, they will not be repeated in the blue sheet. As mentioned previously, the Committee strongly endorsed SARP's recommendation. However,, mention was made of the fact that even though the Regional Advisory Group it comprised of 51% consumers, there appears to be a dearth of consumer representation from such interest groups as the poor, farmers and organized labor. Of interest is the fact that the primary reviewer lauded the Region for its efforts in terms of establishing what @arS to be a very viable working relationship with the Nebraska Regional Medical am from whom it was divorced, In summary, the Review Committee agreed with other reviewers that the Region has demonstrated considerable progress during its first year of development. Further, the Committee reinforced the recommendation made by those who had previously scrutinized this application that the Region's planning status should in no way deter it from being considered for out-of-ph6se supplements in the areas of Emergency Medical Services and tommunity-Based Education Systems. In conclusion, Committee noted that they concurred with SARP and were recommending an additional years support for the Coronary Care Unit Nurse Training Project. Component and Financial Summary Anniversary Application ENT CURRENT 01 YEAR 02 YEAR RECOMMENDED YR#S AWARD FUNDING 01 OPER. L= SARP YEAR COUNCIL RECOMMENDED REQUEST /x-x7 REV. LEVEL COM. 2590500 3201000 CORE Sub-Contracts NA (30,000) OPER. ACTIV. 120,000 1041662 424t662 DEVEL. COMP4 NA NA Yes No (X) EARMARKS-. NA NA KIDNEY EMS 2 see below CBES #3 see below RMPS DIRECT -- *379,500 313,000 424,662 42496@.2 786t5OO REQUESTED COUNCIL 379,500 APPROVED LEVEL NON-RMPS and INCOME Region 6xtended for 2 months at $63,250 for a total of $442 750. REGION South Dakota I In considering an in.creased NAC funding level for t e ',June 197 2 Review Cyc 02 year, it should be noted that out-of-phase supplements in the areas of EMS and CommObity-Based Educational Systems have been submitted. Pending are the following requests: EMS, $470,1000 (for one year);' CBES, $165,000 .(for one year). Current program request $424,662 EMS request $470,000 CBES request $i65,ooo keaions total request 1-OSq.662 SOUTH DAKOTA REGIONAL MEDICAL PROGRAM 02 Planning Grant Application TABLE OF CONTENTS Paqe Part I Staff Briefing Document Face Page I Geography and Demography 2-3 Fiscal Summary 4-5 MIS Printouts 6-7 A6comblishments, Problems, Issues 8 Staff Comments 9-11 Part If Kidney - not applicable Part III k-uO Material S ato-ment of Need for Coronary Care Training Program T ip Report Harold O'Flaherty and Luther Says, Jr. P rt I Site visit Report Trip Report Bruce Everist and Clark Millikan Part V Advice Letter - not applicable P rt VI Management Assessment visit report - not applicable @s STAFF BRIEFING DOC@ South Dakota OPERATIONS 08ASTFFN ZO-7L,@, , BRANCH OSOLnH-CENTRAL 4-@@tSWM BRANC$I CATION: NCNE LAST RATING @l. No. 443-1790 Room 10-15 Z7 ENNIAL -197- DATE BRANCH Cl= Michael J. Posta St ANNIV YEAR s BRANCH STAFF Harold F. O'Flaherty L7 nd IV YEAR L7 FEV. COM. RO. REP. Daniel Po bs r 02-nlgnniniz L7 MER t mgt. Assmlt Visit NA 197- airman t Sv. Oct.27197-L; Chairman Bruce Everist and Clark Milli@ National Advisory C 3 Visits, Last 12 mos. (Dates, Chaiman's Narfie and @pe of Visit) October 5 6, 1971 - Richard Clanton 7 to meet with new Director 6-27, 1972 - Harold O'Flaherty - to assess the overall program progress WHICH OCCU= IN THE IEGION ANECTING THE IM SINCE ITS LAST 19T 1 I @As o 9-1-71 the W recruited a full-time Director, Dr. Jdm A. Lowe. e Dean of the Medical School has been removed from his position. 3. A decision regarding the establishment of a 4-year medical school has been put off @till the next session of the legislature. 40 e State legislat@ has fmded a project entitled 11@mm @fom Health Services" which will make it possible for persons to have access to the health care syste in a@4-c6mtv area where there are no doctors, nurses., dentists or hospitals. ($186.00 G'@"'OGFAP 67 couPties Districts 2 C P14CRSO" CAMPOELL co;fsof. t b;kow;i DAY PERKINS EDMUM WALWOR H ocwcy SPINK CI.AitK' ZICOACH AtJTfc MEADE STA MAAKON OPAPID CITY JONES LYMAN PENNING'OM CUSTCR SMANNON@ CHARLES Ml rALL RIVER TODD @f-004 14( Pop@TI@-1 OLI'21CA 4 on 666,300 Total POPulat' : ' A I,= @ckard F. Fneip (D) tion population Llensity: 9 per sq-. overnor: -o@ttee on,Nutri M: 45 senators: George s :11@Gove@-n (D) Seleo-t % Urb 85,ooo-@nly Indian) Karl F. ,undt Congress)-Jan@ 19'(1- 'appro (congressional -c@istrict (92n % @-.on-white: 5 Representatives by @ank E. De@ioL 2. Jaraes G. Abourezd- 3 F,EGION South Dakota PROFTLE REVIEW Turiee 197 2 FESO'URCES -- SCHOOLS --. Enrollmnt Uraduates @ools Nurber (1969/?O) (1969/70)- Location Ddici St e@ IV of S. Dakota 95 Vermillion s ool of Medicine - 2 yr. c d. .-Pcience ti (19b7/bb) State v. College (1) 171 49 Q Cy . , -.t Brookings 8 ursing 9 (5 of which are college or Univ. Based) P ct ca3- @Nursing 5 (Technica.1-Vocational Schools) ty C61le e@ 1 Jr. College vexisi ased S ol e z4th chools @approved program)' c 010 0 i Therapy 2 Te@,iology 6 ,V,i Technology 7 e apy 0 co L-Lbrarian 0 AND RESOURCES -- HOSPITALS @on and Long-tem G. als, 1969 Nursina & Personal Care Homs. 1967 N@er Nuaber !a Nunber of Beds- @e NuTher of Beds te 3!0572 116-& Nursing Hornes 134 3.,5 ,Ong te 1 76 Personal Care Homes [A Ge 1 IOST)itals 2 560 with Nursing Care 4o 1,704 )HS an 5 194 Long-tem Care Units 9 249 Number of Hospitals with Special Facilities of o Faci ties 'iype va ty of Facilities 14 Ilberapy b ,ob(, -- Renal Dialys s (in-pt.) 3 [so lity 5 Rehab-in patient 7 AND IWOTJRCES -- MANPOWER 7 Nu&er % Total Per 100,000 Prof 100,000 actite- 485 Professional nurses ce 40 actJ .1089 308 cialties 13 ina( 8o4 cialties 25 LC. I s ir activ( 31 in nursing 615 92 1 not errpl. in nursing 159 77 4 coMliEtfl)ZD CURPF.QT AR YE RE collwoNrIlIT C 0 U 't,CL FUNDING YRIS AWARD @R@P ol RECO',4MNDED 'REQUEST OPER. -REV. C014. LEVE Y-LA 320,000 259,50Q ,ORII. 14A ;ub-Contrllctg io4,662 )PE'R. ACTI'V. 120,000 NA or '00 (XX NA )EVET,. CO','P- ,'?AR14ARKS: NA NA Y,TDI@Y 4@4,662 424,662 R14PS DIRFCT 379.,500 .313,000 D 786,237 R COUI,,CIL 379,500 APPROVED LEVET, ,NON-Rl4pS and flA REGION South Dakota June t972 REVIEW CYCLE Re ion cxt,-ndpd .ifor 2.months at $ 63' '2 5 0 '.r -fit a Iof $442,750. .0 9 'ndinq lev@l'f.r,the 02 year, it should be In cQpsidering an increased NAC.fu 0 ted tilat-out-of-phase supplcments'in the areas of ETAS and C orr-mun i't b a s c d no .:educational systems have been submitted.'; South Dakota Rm 00067 OUT OF REQUEST 01 PROGRAM PERIOD ID IFIIW' ONENT AMOUNT AWARDED AWARDED DDWT COSTS AWARDED INDBKT COSTS TOTAL Core 259.500 80.3 339 8 9 Care 120,000 120.000 12@3 132 -IOTAL,S 79 50C 379 500 92.16! 472.198 FFBRUA@Y 2.1,lq72 PEGION S DAKOTA BREAKCUT CF PEOUEST RM r)0067 C6/72 RMPS-OSM-JTO n2 PPCNRAM PERIOD (5) (2) (4) CURRENT CLI@IZPENT IDENTIFICATIO'4 OF COMPONEI%'T CCNT. WITHINI CONT. BEYCNOI APPR. NR.IT NEW, NOT APPP. PERIODI APPR. PERICCI PPEVTCUSLY PREVTOUSLY I niPECT INCIP@ECT TCTAL CF suppnRT CP SUPPOQT FUNCFC APC)POVFD COSTS COSTS CO@n COPE STAFF PLANNING -- - - - - - - --L 3 n- @'FA -C 5 P7. N A P Y-4 -P @ -T P A I I,, I N G U S A 5.L P 4 i.1 it s 4 t 9 P -t 2 q.2 ONIA Cr)RnNAPY CARE TRAINING Ui __ NIJT_5T_.Jr!INS 'IrkAutRA 1 3-t P ?.I- INIC COPON4PY fAcF T-RAINING Ul FV $1(24@@ A 7 II TOTAL $4249662 $4249667 $1269472 $551*134 REGION S DAXOTA. FEPRUARY 28,1972 BPFAKEUT CF AEOIIFST Rm ono67 06/72 03 PPCGRAM PERino RMPS-OSM-JTVCP (5) (2) (4) FNTTFI@ATICN CF COMPONENT CCNT. WITHTNI CONT. SEYCNOI APPR- NrT I NEW, NOT I ACOIL YEAR TOTAL AOPR. PERIOni APPA. PERIODI PREVICUSLY I PRFVTOOSLY I nIRECT ALL YRAPS OF SUPPORT I OF SUPPORT I FUNDED I APPROVED I COSTS I IDIQFCT CNSTS nt) CF)RE STAFF PLANNING -- ---------------- -------- JA CflqrN'ICY irjAPE TPAINING Ut -NIT 18 COOOMAQY CARE TQATNING Ul IC COOONAPY CAPE TRAINING Ul CD ,-rbiEN --i ------- - - - - - - - - TOTAL $376*t)00 $376,cc@ $Erc,662 8 REGION South Dakota REVIEW 7CIE j-q7 2 )uTSTANDING ACCOPTLISHMENTS BY since 1 197 1 1. The relationship between and CHP has been clearly delineated. 2. The RAG plays a very active role in the development of the overall,program. 3. A process-problem-oriented approach has been utilized for planning. 4. Goals, objectives and priorities have been clearly articulated. 5. A talented core staff has been asserted. 6. The core curriculum project funded by BHME to the State DepartTwnt of Health has brought together representatives from all 60 manpower training progranB in the State to determine similarities, gaps and duplications in health curricula now being offered in South Dakota. 7. The Medical School component of core staff was phased out. -- - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PRINCIPAL PROBLEMS 1. SDIW is requesting a 3rd year of support for the CCU Nurse Training project in line with the c@trwnt made to the project sponsors when there,existed a Nebraska/South Dakota HvT. Review C@ttee and Council when they acted to establish SDRMP felt that only a 1-year c@tment should be made in order that the Region might determine if the project was gerume to their goals, objectives and priorities. SDRE feels that the project is both relevant and ijTportant and should be funded for only one more year; staff concurred. 2. 'Ihere are no minority group representatives on core staff. 3. Goals, objectives and priorities are somewhat global 4. The mechanism to be used by RAG to monitor the progr@ is unclear. - - --- - - - - - - - - - - -- - - - - ISSUES REQUIRING A=@ T'ION OF FE@RS 1. South Dakota became a free standing @ separate from Nebraska on July i, 1971, it was awarded planning status. 2. The review criteria that will be used to rate the 02 planning grant application are geared primarily to be used in rating an operational grant application; therefore, some adjustment in the system is warranted. 3. Ihe question was raised as to whether or not a need exists to fmd the CCU Nurse T'raining project for an additional year. 4. The staff reviewers agreed that the $313,000 dco for the 02-year was too low; all those attending the p@-SARP meting recomended approval in the amount requested $424,662 dco 9 REGION South Dakota REVIEW CYCLE u@ne 197 2 STAFF DOC 41A. PERFORMANCE 1. Goals, Ob@ectives and P@ties (i) a. goals, objectives and priorities have been determined b. lack time-frame but represent areas of program emphasis for their three-year plan 2. Accomplishments and Implementation (2) a. as a planning Region they have been Lmderwav six-months when application was subrdtted b. have delineated staffing patterns and organizational structure c. only one operational project underwav - has more than mt its objectives d. staff felt Region accomplished a great deal in only a few months 3. Continued S22port (3) a. reduced funding requested for CCU project b. plans made to continue it with local dollars once its initial three- year cmdtment terminates 11. Minori@ Interests (4) a. izdnority interests are at parity in terrm of minority interests on RAG b. Emil Redfish, Indian leader, member of RAG has been appo ed to Governors cabinet to head up Indian affairs c. should encourage Region to follow through on condiment to hire ndnority group representative for core staff B. PROCESS 1. Coordi tor (5) a. excellent Coordinator b. been on board since 9/l/71 c. has established himself as leader of the Prograin --- - ---- - - - - - 2. Core Staff (6) a. small but talented core staff b. know the Region well c. are very competent d. need to establish senior level position for evaluation and planning purposes 3. Regional Advisory Group (7) a. geographically, organizationally balanced b. very actively involved in the Program C. should be encouraged to establish a co@ttee for monitoring an( evaluation purposes I 0 Review d. RAG Chairman being nominated for membership on National Comittee e. RAG serves both CHP and RE role of both agencies clearly articulated Grantee Organization (8) a. grantee is medical school b. role to be trustee c. does not have veto power over RAG d. reviewers felt - does not provide enough services for funds received in the indirect costs category - - - - - - - - - - - - -- - - - - - - - - - -- P (9) a. key health interests'participating b. program is not captured by any particular group Local Planning (10) a. RMP has field staff assigned in major areas to do local planning b. no "b" agencies have been formally established C. ?la" agency not interested in establishing "b" agencies - - - - - - - - - - - - - - - - - - - A (11) a. RAG and core staff have systematically attempted to assess needs and resources b. these were translated into priority areas c. feasibility studies are and will be carried out in each of these areas ement (12) a. core staff activities well coordinated b. Region needs to formalize its monitoring procedures c. time-framed reports gathered from project sponsor and other recipients of core staff funds Evaluation (13) a. full-time Evaluation Director not hired b. highly trained person on core staff provides this function as well as establishing an EMS plan c. Region still in planning - therefore little to evaluate d. application indicates that evaluation to be built into each phase of the three-year plan e. Region should be encouraged to move more rapidly in this area 0 PROGRAM PROPOSAL Action Plan (14) a. Region still in planning stage b. have set priorities and objectives to be addressed in three-year plan c. these relate to National mission ------------------- 2. Dissemination of Know (15) a. only one operational project - CCU Nurse Training widely accepted has done well in this area of dissemination of knowledge b. reviewers hoped that this would be a microcosm of what @t happen regarding the dissemination of knowledge - - - - - - -- - - - - - 3. Utilization Manpower and Facilities (16) a. most of the major medical care facilities represented on IA( b. too early to tell about utilization c. manpower high priority d. health manpower education systems viewed as common denominator to all other priorities e. out-of-phase supplements in this area will soon be received in Rockville - - - - - -- - - - - - - - - - 4. overrient of Care (17) a. improvement of chronic care high program priority b. EMS number one priority C. out-of-bha6e @ supplement to be submitted by April 15 ----- ----- ------------ 5. Short-Term Payoff (18) a. reviewers felt too early to te7 b. experience with CCU Nurse project indicates progress in this area 6. Regionalization (19) a. regionalizatior; conceptually speakinF, used as a frame of reference for planning b. considerable interchange of resources and information takes place among various health related groups 7. Other D@ding (2C)) a. concept of decremntal funding is a part of Regions philosophy b. plans have been made to phase out support for CCU nurse training project C. ±,eviewers felt this was a positive siEp EMORANDUM DEPARTMENT OF HEAL]-H, EDUCATION, ANI-) WELFARE PUBI-.IC HEAI,Tli SERVICE HF,,ALTH SERVICES AND ML-"NTAL IILALTI-I ADMINISTRATION .110 Acting Director DATE: April 17, 1972 Division of Operations and Development l@'R(-)M Dirc;ctor, Regional Medical Programs Service @;(jBJEC,'T: Action on April 10-11, 1972 Staff Anniversary Review Panel Recommendation Concerning South Dakota Regional Medical Program Application RM00067 dated 2/14/72. Accepted: Da e Rejected: Date 2 Component and Financial Summar_v Annlversanj Application oRr,NT CURPIV.IT YEAR YEAR RECOK@iElfl)ED YR'S AWARD C 0 U,'l C 'A. L FTRMING - Ol OPER. RECO14MEt;DED 'REQUEST (S A YEAR LEVEL REV. COM. CORE 259.500 3201000 14A X.. 0,000 OPER. ACTTV* 120,000 104,662 NA NA DtvtL. COMPO Yes or No _(XX' EARMARKS-, NA NA 424,§62 li@4 662 > DIRECT 379-,500 .313,000 RE2UESTED 7869231 CottNCIL AP O"IED LEVEL 379,500 NON-P,?4PS nd LI?CO-ME NA REGION South Dakota June t97 .REVIEW CYCLE ion extend Reg pd'for 2 months at $63 250 fo,re tal of $442,750 in considering 'an increased NAC.funding level' f6r-the 02 year, it should be noted that-out-of-phAse supplements'in the areas of EMS and Communi'ty-based -!educational systems have bd@n submitted. 3 - REGION South Dakota REVIEW CYCLE June 197 2 RECOMMENDATIONS FROM 7@7 SARP Review Committee /7 Site Visit /7 council :ECOMMENDATION: The Staff Anniversary Review Panel concurred with the staff-reviewers that the second year planning grant application submitted fromthe South Dakota Regional '.t4edical Program should be approved in the amount requested for direct costsi $424,662. 1,ATIONALE: The justification for recommending an increase in the funding level from $313,000 dco to the above mentioned figure was predicated uoon the fact that the Coronary Care Unit Nurse Training Project has requested support for an additional year. An initial three year commitment was made to the project sponsors when it was under the purvue of the Nebraska-South Dakota Regional Medical Program. The present request in actuality represents the last year of that initial three year commitment. The panel also was aware of the fact that when the South Dakota Regional Medical Program was initially established, it would be given the prerogative of determining whether, or not the Coronary Care Unit Nurse Training Project was consonant with its overall goals, objectives and priorities. Based upon the material presented in the application as well as the data appended to the briefing document, the reviewers agreed that the Coronary Care Unit Nurse Training Project was relevant to the overall goals of the Region and should@receive an additional year of support. -,RiTIQUE: In view of the fact that the RMPS review criteria were desioned to rate a Regional Medical Program that has achieved operational status, the panel agreed not to rate the Region, as South Dakota is still in the planning phase of development. However, the panel did indicate that the Region's planning status should in no way deter it from being considered for out of phase supplements in the areas of Emergency Medical Services and Community Based Educational Systems; proposals in these two areas will be submitted on or before the appropriate deadlines. In assessing the region, the reviewers were pleased with the progress that has been made to date. The panel felt the new director, Dr. John A. La%-je, hired affective September 1, 1971, has established himself as the leader of the program and is supported by a talented though small staff. It was the concensus of the reviewers that the goals, objectives and priorities that have been delineated are somewhat global and lack a time frame, but it was felt that they represent areas to be addressed in the triennial grant application to be subrlitte'd one year hence. From all the data that were available to the panel it seemed that the Regional Advisory rroup was very much involved in the affairs of the program; therefore, the RAG was viewed as being a major strength of this Region. Also, the reviewers were pleased to learn that the relationship between RMP and CHP had been delineated and the two agencies seem to be working together in a positive fashion. The reviewers did note that no one on program staff is assigned the responsibility for planning and evaluation perse. Therefore, It was felt that a senior level position in this area should be established. In this connection, the reviewers further suggested that the Region consider the feasibility of establishing an evaluation 4 Page 2 @ Recommendations From SARP Region South Dakota Review Cycle June 197 2 mmittee to monitor not only projects; but also, the activities of program staff. A major area of concern to the reviewers was the act that t ere are no minority group representatives oh the program staff. While the application makes reference to ameliorating this situation, the panel felt strongly that the Region should be encouraged to actively recruit for such individuals. The reviewers felt that at least two types of technical assistance should be provided the Region during the insuing year: 1) As the Region continues to implement its planning processi outside consultation should be provided to insure that: a) needs have been adequately assessed I b) the identified needs have been translated into time-framed action-oriented goals, objectives and priorities, and C) the programs that are proposed include a viable strategy for evaluation which should be carried out at specifically planned intervals. 2) l,t was suggested t at the central headquarters staff from both RMPS and C@IP visit South Dakota to evaluate the unique relationship between the Regional Medical Program and the 314a,icomorehensive health planning agenc , I.e., the RAG, which is comprised of y 51% consumers is the advisory board to both agencies. 16 addition, the panel agreed that It would be most helpful to Dr. Lowe if he were to b6 invited to take part in a site visit to a Regional Medical Program in the neat future. The panel felt that this experience would greatly enhance Dr. @Lowe's orientation to Regional Medical Programs. TABLE OF CONTENTS WESTERN PENNSYLVANIA REGIONAL MEDICAL PROGRAM -.ANNIVERSARY APPLICATION Staff Briefing Document Page Face Page 1 Regional Profile 2 Regional Map 3 Component and Financial Summary 4 Breakout of Request (04 period) 5 Breakout of Request (05 period) 6 Ac6omplishment, Probl6ms, Issues 7 RMP@Review Criteria Form 8 Additional Printouts RMPS STAFF BRIEFING DOCUMENT OPERATIONS Eastern Mid-Con EGION Westert Pennsylvania BRANCH South Centr'l /-7 Westerr BRANCH YPt APPLICATION N.A. LAST RATING Tel. No. -3ol-44@-181o Room 10-'35 TRIENNIAL 197 DATE BRANCH CHIEF Frank Nash ist ANNIV YEAR SARP BRANCH STAFF Norman Anderson REV. COM. RO REP . C y 2nd ANNIV YEAR de Couchman OTHER OTHER Last Mgt. Assmlt Visit III.A. 197 March Chairman- AST S.V. l@0-11. 197 1 Chairman Leonard Scherl.is.-.i-D. taff Visits, Last 12 mos. (Datesi Chairman's Name and Type of Visit) Verification of Review Process Visit, Sei)tembe 71 (Roland-.,.Petprson) ajor Events ich Occurred in the Region Affecting the RNP Since Its Last Review n Niav 197 i. The Development of an Experimental Health Care Delivery System in the Region with I.ittle relationship to other plans for the health care system. 2. HMO's of both pre aid group practices and Medical Foundatioii types have begun to p develop with little relationship to Region-wide planning. 1 3. in 1970, house till 1311 was enacted. It established a program for the care and treatment of persons suffering from renal disease. The legislation calls or an appropriation of $1,000-,OOO for fiscal,year 1971. 4. Dr. Carpenter, Coordinator of WPRMP is resigning June 30, 1972. i(3nal Advisory Committee. 'L@iarry K. Wilcox, elected Chairman of the Reg 2 D nd Resources Data: (.;eography and Demography: l'opulation--1970 Census 4,138,000: no real increase since 1960. Race: no updated data from 1970 census available: 1960 census: State of Pa. non-white--7.5%. For 28 counties, non-white ranged from 0.1% to high of 8.3% in Allegheny County (Pittsburgh). Re@;ources and Facilities: Medical School--University of Pittsburgh, School of Medicine School of Allied Health Professions, University of Pittsburgh Inhalation Therapy - Community College of Allegheny Physical Therapy - Dept. of P.T., D.T. Watson School Medical Technilogy, university affiliated Schools of Nursing - 32 (16 in Pittsburgh, of which 4 are college or university affiliated). Practical Nurse Training - 14 (3 in Pittsburgh and arrangement with public schools) Accredited Schools: Cytotechnology (2 in Pittsburgh); Medical Technology-,-8 (4 in Pittsburgh; plus 1 at School of Allied Health Professions) Certified Laboratory assistants - 7 (2 in Pittsburgh); Radiologic te chnicians-23 (6 in Pittsburgh); Medical Record librarian 1 "ios2itals - Non-Federal* short-term and V.A. General Community V.A. Gen. itals Hospitals Beds Beds Pittsburgh 20 6,919 1 945 Other 60 10,555 1 170 Total 80 17,474 2 1,115 *These counts are s6bject to revision; they were determined on the basis of county location, from A.H.A. Guide Issue, 1970 Edition. ,,'.a.@power --Physicians and Osteopaths Practicing MDs Osteopaths Total Active 4,593 (as of 12/31/67) 182 4775 Inactive 172 (not updated) Ratio: 115 per 100,000 population, compared with 132 for U.S. Professional nurses (no data available by county) 1962: Total 27,569; active 16,574 ratio of 395/100,000 pop. B UFFALO K,@IESTERN PENNSYLVANIA REGIONAL tv',ED,IC.AL PROGRAM IVEW YORK 7 a i Western Pa. RMP Tg counties Lupulation-"-1970 Census OFZEST 4,138,000 CLEVELAND 6 rJi MERCES Metropolitan Areas declining pop sir 127,17 1970 1960 1960 YOUNGSTOWN ON JEFFER toona 134.1 137.3 LAWRENC 43k9. town 260.7 280.7 CLEARFIE IOI,Q74 @LER burg 2383.8 2405.5 12; q4l WRV) 0 74,610 /0 T'@stern Pao 2 0 A8@41F@ STRONG, OH ,, BE ER Comprehensive Health p T'l PENNSYLVANIA -annj-ng tpencv Hi NGDON STEUBENVILLE HERSHEY sI ELA (,reater 'Pela@ lley PHILADEL RMP WHEELING 11 364 166 7 ETTE C.'OLUMBUS. MO;?ANTOWN MARYLAND West Virginia PMP I wEsr VIRGINIA 4 Cory.nonent and Financial Summary Anniversary Anpkication RECOMliENDED YEAR 04 YEAR COMPONENT CURPElrr - FUNDING YRIS AWARD COIP,'CIL SARP 03 OPER. RECOliMENDED 'REQUEST YEAR LEVEL 9/l/72-8/31/72 Cy REV. COM. 887,900 CORE 79 X/ Sub-Contracts 388,169 OPER. ACTIV. 378, 359 99,633 Yes or No DEVEL. COMP. 13,500 EARMARKS: RMPS DIRECT 996,338 $1.450,000, 1,375,702 REQUESTED 1, 7 5 7, 5 50 COUNCIL ,APPROVED LEVEL $1)450,000 .N'ON-Rl4PS and ? IIZCOME *7/l/71-6/30/72 2 mo. extension 7/l/71-8/31/72 $166,056 REGION lqestern Pennsvlvania extended (2 mb,)--new grant period 9/l/72-8/31/72 June 1972,,REVIEW CYCLE MT,;ZCH 17,1972 REGION - WESTERN PA BREAKCUT CF REQUEST RM 00041 06/72 04 PROGRAM PERIOD RMPS-t]SM-JTOGR2 (5) (2) (4) II)E14T IFICA T 10@4 OF C I; PI PON F.@'4T CO'4T. WI THI NJ CONT. BEYONol APPR. NOT NEW# NOT CURRENT CURR EN T APPP. PERICOI APPR. PERICCI PRCV:(IUSLY PREVIOUSLY DIRECT INDIRECT I TOTAL I OF SUPPORT I OF SUPPORT I FUNDED APPROVED costs COSTS CC,OL (J E PIZ,'IfCSS[Ot,AL TRAINII ,)OC@O [)EVELr:Pilt@,TAL COMPCN@CtsT I --.. ------------- 0 r a i@Ai'k r L k,'@T 4 It., ii Elm C 0 @ 9 7, f, r ,, R r, Y I f r 4 T SI -.-ji I I tJ 1 L L L- P,!l @ t I A rJI2 RCG FOR ;lt.T IE114TS1 013 L",YC .Yt@IL A@t-A Pijt--,C.NAPY @,T CF t @,LIPSE P 4 CCt)@4TY LIPID SCREI 017ii f [i ')',TY LIPIC SCaEl I TCTAL $1#127#938 1 $63,000 $1849764 1 $1#375#702 1 $414t$79 1 $1,790,581 1 db db db RERION - WESTERN PA t P, Cii I 1, I'? 7 2 (IREAKOUT or REQUEST RM 00041 06/72 R@MPS-OSM-JTDGR2 05 PRCGRAM PERIOD (2) (4) (5) flEYONDI tPf'R. NOT I NEW, NOT ADO'L YEAR I I TCTTL I IDE.@@TIFICATION OF COMPO?,CNT I CC14T. WITHlf4i CCNT . DIRECT I I ALL YEARS I I Af'PR. PERIODI APPR. PF.RICDI PREVIOUSLY I PREVIOUSLY OF SUPPORT I CF SUPPORT I rutiDED APPROVED COSTS ]DIRECT COSTS I @u Q -CEC C E P CF,-- S I 0 t4 A L T P A t, I C I I -'I t I C M E I i E I - - ------- T @'A fn@', P@Tt@'4TS I @LTLI_L@C.Y.LL-" @FG PPC-@P.@m FOP, P-@TiEt@TSI 612 0- I I -ii5 7. f,@i- 013 AHLA PUL,'G-@ARY I I I I I Ti 5 CC-V[L')P@E.4T Or A NUZSE Pi I I - @ III -0 -1 l@ t r, L 1 1 @'A 0 C k,%M I N 0 R '@ Li k2.,; T Y L I P I D SC R C I -- --------- @l7@ @l-A'4E4 Ctl@.NTY LIPID SCREI 11-111,,L p@u I:IT Z4,-O,)o TOTAL S I 10 7 5 7 0 $122#000 $191*000 $1#4209570 $2v796t272 7 Region W. Pa Rev. Cycle 0OUTSTANDING ACCOMPLISHMENTS BY RNP since May/June 197 2 I.. Subregionalization seems to be well-designed and functioning adequately. Loca.] leadership appears to be en thusiastic and well qualified through stibregionalization. Core staff has strengthened it's efforts to assist in project development. 2. Projects and studies are for the most part well coordinated with overall goals and priorities of the program. The Region has begun to move beyond the categorical disea into the areas 3 se of primary care. Two new standing committees have been developed, "New Health Care Systems" and "Evaluation of the Health Care System." 4. The acceptance of standing orders for coronary care units and stroke patients by a large number of community hospitals. 5. The Developmental Component will be used largely to develop a system of primary care. 6. They are actively recruiting to fill the requested position of an assistant director for evaluation. PRINCIPAL PROBLEMS 1. Although it was agreed At the time of the triennial site visit that the RAG would expand to include more consumer interests and provide more balanced geographical representation, not a great deal has been done in this area: a. Of the 8 new nembers, 6 are representative of medical interests, while only 2 are consumers, and only one of these reprIesents a social welfare organization; total consumer representation is approximately 14%. b. Geographical balance has not bedn achieved. A full 70% of the RAG membership are from Pittsburgh. C. Minority group, female and allied health representation remain low, with pprrentngas of 8- 12- and 2 respectively, 18SUES REQUIRING ATTENTION OF REVIEWERS (Same as reported in "Principal Problems) d. The RAG's Executive Committee breaks o,tit as follows: (1) 2/3 are physicians; (2 73% are from Pittsburgh-, (3) no minorities; (4) no women; and (5) only one (of eleven total) consumer. 6. The review of RMP applications by CHP "b" agencies seems to have been worked out. The executive director'for. 'th'e "b" agency has agreed to provide a programmatic review, and not a technical review, of RMP application. David E. Reed, M.Di has been appointed the Acting Director of W. Pa. RMP effective March 15, 1972. Dr. Carpenter will be available on a consultant basis through June. REGION Western 1'entisylvizi, l@Mi' RMPS REVIEW CRITERIA FORM REVIE@CY L@E 1 9 7 A. PEPFORMAINCE 1. Goals, Objectives and Priorities (1) The goals and objectives are clearly stated and well aligned to the Regions operational approaches. Overall plan is to coordinate all resources of Health Care Providers through technical assistance to improve the delivery and quality of Health Services. Identify deficiencies and use RMP funds to bridge the gap to improve the Health Care System. 2. Accomplishments and Implementation (2) T The region has begun to move beyond the categorical diseases into the areas of primary care - 2. Evaluate the health care system through assessment of the problem - 3. Recruiting a full time evaluator. 3. Continued Support (3) our of the original six funded projects will largely be funded from private sources beginning July 72. Component elements of four projects will be partially supported through core regional service. 4. Minority Interests (4) The program takes into account the medical need of the poor, which includes a wide variety of medical services, and attempts to make these services available in terms of social and physical distance, costs in money, and time in services, to all persons living in the Region. B. PROCESS 1. Coordinator (5) avid Reed, M.D., Acting Director effective March 15, 1972. Dr. Reed has functioned as the unofficial deputy to Dr. Carpenter all along. Excellent leadership has been demonstrated. A energetic core staff - very competent, esprit de corps. -re Staff (6) Approximately 19 full time professional positions. Core staff seems to be very competent and well movitated. Almost all have Masters Degrees working toward Ph.D. 3. ReRional Advisory GrouD (7) al authority in deciding policy, setting priorities, goals and objectives. Allied Health, consumer, female and minority representation should be increased. A better geographical distribution of representation should be attained. 4. Grantee Organization (8) The site visitors felt the grantee seems to have delegated almost all the general responsibilities to the @ to the extett that the grantee may be a paper corporation. Apparently the grantee had delegated to the RMP a free hand. 5. Participation (9) W. Pa. RNP is provider-oriented and ask providers already workino. in the delivery system or vo untary efforts to change and increase the system, establish a well balanced program through coordinates of providers, medical societies, community hospitals, and other health planning agencies. 6. Local Planning (10) RMP in conjunction with CHP have developed effective local planning groups. There is early involvement in the p anning process review by CHP agencies of RMP projects have been worked out. Core staff serves as a liaison to the nine area Advisory Groups in their planning efforts. 7. Assessment of Needs and Resources (11) 1. Pre-study plans for project development 2. Develop projects on 6xisting data from the Hospital. Utilization Plan System 3. Manpower needs is a high priority. 8. Management (12) core staff provides considerable assistance in project development and staff surveillance for the (financial, management, and progress) of funded projects. 9. Evaluation (13) Dr. Reed devoted a great deal of time upon evaluation. They are currently recruiting for a full time coordinator. They have an adequate review process, priority system, and provide feed back to unsuccessful applicants. C. PROGRAM PROPOSAL 1. Action Plan (14) W. Pa. MD is in the process of updating its overall p an an reviewing its priorities. A greater emphasis will be directed toward primary care and evaluation of the Health Care System. 2 . Dissemination of Knowledge (15) 1. The acceptance of standing orders for coronary care units- and stroke patients by a large number of community hospitals. Active participation of community hospitals in continuing education. 3. Utilization @lanpower and Facilities (16) Nurse practitioner project is expected to increase allied health manpower which should benefit the entire region. Continue to concentrate health resources of community hospitals. 4. (17) Efforts are being directed to develop a system of primary care. This will include development of nurse practitioner programs, and rural and urban primary care demonstrations. 5. Short-Term Payoff (18) Pro4ects such as the coronary nursing training program is a example of short-term payoffs. Continuation of activity is self supporting through charging for services without appreciable change in participation. 6. Regionali2ation (19) W. Pa. @ has established nine sub-regional advisory committees. Through these committees they involve all the health planning agencies and consumers in the total planning efforts to improve the health care system. 7. Other Funding (20) W. Pa. RMP has been somewhat successful in obtaining outside support to continue activity supported by RMP funds. AL -4r norlIA!IS srpvlcf P A Cr P. ri L WEStEf@K PA PTXP SUPP YA D4 fPE$tCENT OF T@ JNDS REQUESTFR)) REQUEST MAY/JUN 11;72 REVIEW CYt. TNTAL CD?'.Pr,'@4c Pi T N@PER- TITLI: R4cs FulqDs nT@iElk S"UPCES.- TOTAL SUPP,)RT. Rx:,S % RFQT)[STFO OF SUPD(',;tT ALL SOLIRCES OF TI)TAL CORE 7 7 9 , 169 0 T7FJ,169 lf)l C@ol Cnpe PROFESSIONAL TRAtNItir, AND EDUCATtn,4 41R,696 110750 452,4/.6 97 DEVELOPME14TAL COMPONENT 990633 a 99#633 1 O?) r)nR LAUP.FL MOU@,ITAIN H)MF HEALTH AlnE TRAINING PONJFCT ;S,615 5.0n,) 6(l.6 1 5 02 1) @) 14 TRAINING OF CATJCCR CHEYfIT14FItAPISTS '42,9c)6 32,956 A REG PROG FOR PATIE14TS WITH SICXLE CELL ANEMIA 83t7ol 3m,nnn 74 D12 REG PRnrPA'4 F9R PATIENTS WITH DIADERC$ MFLLirt)s /,I,31- n 41*313 lo@ rty niSFASF PQrrPAM 31%.759 2 4 'Ol)-i 54,259 56 BU(KTAI(- AREI, PULMO-4.% nl7A GE-AVER COUNTY'LIPID SCREF14114G PROJECT 26rf86 n 26,486 illo 017a BEAVER C)U@.TY LIPID SCRFFNING PROJFCT 299544 e) ?q, 54,4 1 nis I)FVFLOPYENT OF A NURSE PRACrITIONrk Ppnr.RA4 116,042 10@1) 016 AFGTNNALIZED P;tr,,GRAM IN RA')IATION THERokPY 58,168 59,168 103 TOTAL.flF IZ CCMPC)NE.I;TS REGION 41 1179,)VSsl 7?t?Sl 1*8&3vl3l 96 ki CtL p f G f nN AL @'@ : I @u,,;rVt l@Y tyllf @IORT FtEoUrlt FFFIRUARY 1, lq7Z.DrA@)t.TNE, DTRRCT C(I ST It M PIS PREVIOUS AMPS Ftmps T TOTAL YEAR DIRECT DIRECT C?@; P,T P F @ SnN AL P AT ' C I,,T EQUI P. CONST. CTHER TR 4 1 Ni Nr DIFECT INDIREC 2NO YR 3RO Y;k Svc & FELLNWS. IST YR IST YR 1ST YR AWAGD r\ @@rW Nr)T P@,=')IOUSLY AP@@CV@C) eS,734 3-4,808 116,042 @15 67,659 3,000 14,575 51,501 f,9,.j3- 8,638 58,168 116 24vplar) 7,80(.) 16 , 85') 1,400 9,178 26,4R6 26,486 26,000 .)I 7A 15191)5 6,FII4 23v5l4 6,030 29#544 24,()@)O 117B @IEW SUB-TCT,@L t 191,000 125,147 lz,$200 47,4%7 184,764 45,476 230,240 Bay@40 AP@P.OVED PERIOD OF SUPPORT Oil 45,0@O 90') 1 51 50t, 1, 3 e) Zn,703 n397(3 60,0')O CONT. PEYr@".r) SIJLI-TOTAL 6310flO 2OP70'S. 83,703.... 60,000 CONTI NL,?,T I @')N W ITH l@'4 IPPROVEO PEP10r) OF SI)PPNRT cno-) 4 5 7, 6')'i 4,5nO 107,6')5 5 6 Q , F;')) 2nA,16q 778,169 612,50n 6f)5 r ri 251,47!) 3,500 63,130 318 , I,')O 120,596 438,696 365,000 99,633 99,633 137,570 1) @) a 4 7 , 7 90 300 7,525 55,615 55,615 76,600 1) 1; 4'41 22, 'i'@ 4.Q56 -.42,056 2 21,6?5 6,075 6 10 I 0 , 7 I'l 41,-Ilo 3 7 , Ol-) 3 17,50t) 76,190 4 , ()6 9 3n*21)9 25 t@100 CC,'4T. ',?.ITHIN SUB-TOTAL 794,67n 8,300 2Z5t335 19127,93A 348,700 1,476v638 6A9@,100 lv,169,570. 7 14'1'1 414,q7) I /')I, '@Hl hiq.l@o 1*42L),li7l) '@t i 'I 14 Mt I, it@,4A@ @ IIII k At, I'll I."Vlk 11 fl: rjy w PrNN4 @UMMAIIY I%lll@rf T IIY t I AROUFIT i-f BRUA%TY 1, 19TZ DrA9LI';E C(IST PMPS PREVIOUS AMPS FTMPS TPA[ NIN@. DIPFR.T 11,401PECT TOTAL YF.AR OTRECT DIRECT cn.Ap,@!:E'4T PE@Sl@4AL P,%Tl ENT Eaut P. CIINST. OTHFR Svc CAPE C fELLOWS. IST YR IST Y$t %ST YR AWAFTO 2NO YR_ 3;kD YR ?9 l,79,)o58l 6809103 lo420*570 045,417 22,400 2881,252 1,37S,?f%2 T I T L F YEAR O@V-LnP"rliT OF: t, P;7ACTIrICI,.R P;,nr.RAM P,)rGOA!j Itl Czo',Ol.Titkl TH@;tli?Y Al ,il ?A Cn@,,@jry LI DIn SCPEF@ I,,;C, P4CJ[rT II 7k C"@)'JTY LIPti) PR@JCCT nt III P@r, PtG FnP@ PATIF'ITS @ITH SICKLE CCLL ANEMIA A? c If I,) Crop M4 CNRE POnFFSS"n%,At TRAI@liNr A@iD EDt)C4TIO-4 n4 H)@F HEALTH '.IDE TRATNI,%G PRRIJECT n3 9 I-F Ct.@,ICFP. CHFIAOTHRP.@DISTS (% I -it ? RFr, PpnrRA-4 Frrp ;14T[FNTS WiTm nIAIETF-S ME.LLITIJS 112 al3 BUCKTAIL AREA PULM,').'iA;tY DISEASE PRIlrKA#4 A2 II 11, I11) I? ArGintl,%L HEOIC.AT. ('kOC.;AAmS @('ItVICE wrr,@ W PF':14A Ll'ITINC. Or AOi)ITI.ot-14L FUNOS RFQUE@T FE@RU,%r4y It 1972 DEADLI.N; PIT nTii'R T(ITI-L P -r-S GRA@IT RELATED I'l,r.)4E STATF LI)CAL Fr-I)rP 6.L NO','-FFI)FRAL 0 lkf-C T TOTAL FUNI)S TOT tL lt4TEREST OTHCR FUNI)S rt)NDS Ft)Nt)S F u,,4 1) s ASSISTANCE TtilS PERIOD '4EW NOT PREVIOUSLY APPROVE() 116,,)42 116,042 'I' 6 58,168 017A 58,168 0175 29,544 26,486 e-. 29,544 ':FW SUB-TOTAL 2 3) , 740 230,240 Cn@!TINUATIn@, PEYOND APPROVED PERIOD OF SUPPORT nil 83,7r)3 113,iO'3 Li ro@,4r. BEYOND S'JQ-TOTAL 83,703 3f)tODO 113,703 CONTINUATION WITHIN APPROVED PERIOD OF SUPPORT 778,169 778pl6o (F) conj 438,696 13#750 :452 .446_ q9,6i3 99,63]k 6Ov6l5 O@9 32,956 32,956 012 41*310 41.310 F) 1 3 3,) , 2 59 24 ')f)O 54p259 CO.'iT. WITHIN SUF@-TOTAL 19476i638 18#751) REGIO@4 TOTALS IV790,581 18,750 54,000 IY8639331 @ .11 I I 'II - @ O' MARCH l)ol972 REGIO14AL MFI.)ICAL PROu,.kMS SERVICE SU-414ARY BLJUGET BY TYPE OF SUPPORT REGION 41 WESTERN PA- RMP SUPP YR 04 REQUEST MAY/JIJNE 1972 PEVIEW CYCLE DESK EASTERN RMPS.-OSM-JTGGRB RMPS Rmps Rmps RMPS TT)TAL c 0 m p 0 14 E t4 T C04Pr)NE4T DIRECT INDIRE-CT TOTAL DIRECT Dl;tFCT DIRECT N). TITLE SUPPORT YEAR IST YR IST YR IST YR 2NO YR 390 YR ALL I YRS NEW NOT PREVIOUSLY APPROVED 1)15 DEVElopmr-NT nF- A NURSE PR .11 Ar),234 30PROB 116,q42 eg,-,O,) 174,734 ACTtttnPirD, PRSGRAM 016 PFCT(l'IALIIEI) PROGRAM IN A 49,530 0,638 54,164 51,-)Ol 101,030 A@')I.%TltlN THERAPY 1)17A F@fi%VFP C,-d)'4TY LIPID SCFTEE -n 1 26,486 26,466 2 61'3011 S2,4B& PR@I.IRCT ')I?B REAVRR CfIU14TY Lt PTO SCREE 01 23,514 6,030 20,544 2 4 479514 NING PROJECT NEW SUB-TOTAL IR4io?64 45#4'r6 2 30 2 4) 1 91 (),I., 375,T64 CONTINUATION BEYOND APPROVED PERIOD OF SUPPORT ')I I A REG PPR)G Fnp PATIENTS W t" 2 6'4, I)f)o 2119703 81 p 7i)l 6.1, -in 1 ITH SICKLE CELL ANEMIA CDNT. BEYOND SUB-TOTAL 63,t)or) 2%19?03 839703 611,000 1232100 VW CnNTI-41JATtn'l WITHIN APPRnvEn PERT(ID OF SUPPORT Cfllln C)PF '14 56q,Rn) 20S,369 ?Tatl6q 6 t) 5 , D')') ltl74#RO'3 CO') I CI)RE PROFFSSIO'4AL TRAININ 1)4 31 n I I 0 1) 1209596 430,,696 365,()f)O -683*101 G AND EDUCATION 0101) DEVELOP14ENTAL COMPR)NENT oz 99,634 99,613 l,4T.57p) 2371,2',13 I)IIB LAUPFL Mr',IJ14TAIN HNMF HF&L 1) 3 55,61, 55,615 S5t6t5 TH ALIF TRAIPIIP:R, PPr)JeCT I') 0 TIZAI'41@@G -'IF CA'4r.FP C!IEMOT 1 7i3,,lol 4,956 32 9-56 28,001 lirRAPIST'; it? pcrl PprlrlptPA FOP PATI@t4TS r, 2 -1) In,71o 41 , 'k I,,) 37,)e)O* 6 7, 6!),) WITII DIABETES OFLLITUS '113 RUCKTAIL AREA PULMONARY D C%2 26,19) 4,069 31), 2 59 25#01)")* 5 I I I q,) !SEASE PROGRAM t-, CONT. WITHIN SUB-TOTAL lolZI9938 340*700 1.476,616 1,169#570 2#29T*508 1937itTO2 414,glq 1,T90,1591 1,421,57n 2p796*2TZ RCH 10, 1972 RRGI(IAIAL MFni@AL LIST %'G OF 4S SFRVICE R;:Gft.)N 41 WESTERN PA RMP I iAL FUNDS SIJDP YP' 04 REQUEST MAY/JUNE 1972 REVIEW CYCLE OTIICR OTHER TOTAL CnHPn,NF?4T P t,.Ps GRANT ;ZELATFD INCOME STATE LOCAL FEDERAL NNN-FEDERAL DIRECT TOTAL FUNC)S TNTAL INTEREST OTHER FI)NDS FUNDS FUNDS FUNDS ASSISTANCE THRS PERIOD NF 'ri NOT PREVIOUSLY APPROVEO 015 11-5pC42 ll6rD42 016 539168 5SPI68 017A ?6t486 26r4B6 nl7fi 29t544 .29,544 NEW SUB-TOTAL 23@'),240 2309240 CONTINUATIO'4 BEYOr4r) APPROVet) PER10r) OF SIJPPOR T 83,703 -lo, 30, ..I 13, 703 CONT. BEYOND SI)B-Tr)TAL 83,703 30,04)0 113t7O3 CONTI@4UATIO,4 WITHIN APPPOVEO PERIOD r)F SI)PPORT C f),-) r) 773,169 778tl69 co,)l 43-1,696 452,446 99,633 99,6.33 of)8 55,615 60jr6l5 32,91;6 32,956 012 41,31,') 41*310 013 3f)g 259 24,r)00 54,259 COt4T. WITHIN SUB-TOTAL 1,476,6.39 18,75P 24,')OO 19519,388 REGION TOTALS I 7 Q.-), 5 81 19863*331 DEPARTMENT OF HEALTII, EDUCATION, AND WELFARE I&EMORANDUM PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION TO Acting Director ATE: APR 2 0 197Z Division of Operations & Development, RMPS FROM Director, Regional Medical Programs Servic SUBJECT: Action on April 10-11 Staff Anniversary Review Panel Recommendation Concerning the Western Pennsylvania Regional Medical Program Application RM 00046 6/72. Accepted (datle) Rejected (date) Modifications: Region Western Pennsylvania Review Cycle June 1972 Type of Application: Anniversary Within a Triennium Recommendations From Rating - 330 SARP Review Committee Site Visit L7 Council The Staff Anniversary Review Panel accepted staff's recommendation that WPRNP be approved At the requested amount of $1,375,702. This is a well organized application designed to coordinate all resources of Health Care to improve the delivery and quality of Health Services. The Region has begun to move beyond the categorical diseases into the areas of primary dare. Two new standing committees have been developed, "New Health Care Systems" and "Education of the Health Care System." They are actively recruiting to obtain the services of a full-tim6 evaluator. His immediate task will be in the development of a system to evaluate primary care. They have been somewhat successful in obtaining other funding to continue project activity initiated by RMPS funds. Four of the original six funded projects will largely be funded from private sources beginning July '72. They are requesting continuation of five operational projects and the initiation of three new projects all consistent with the Region's stated priorities. Support for project #11--A Regional Program for Patients wit Sickle Cell Anemia and Related Hemoglobinopathies is requested beyond the approved period of supporti SARP recommends that advice be provided to the Region and make them aware that a sickle cell anemia program has been established within HSMHA and continued support should be directed to that program. The Regional Advisory Group is physician dominated and a full 70% of the RAG membership are from Pittsburgh. Minority, female, and Allied Health representation remain low, with a percentage of 8, 12, and 2 respectively. SARP recommends that appropriate advice concerning the issues identified be provided to the Region. component and Financial Summary Anniversary Application- COMPONENT CURREIIT YEAR YEAR RECOMTENDED YRIS AWARD COUII,C'A.L FUNDING 03 OPER. RECOIOENDED 'REQUEST SARP YEAR LEVEL 9-1-72/8-31-72 eProgram 604.479 887,900 Sub-Contr acts OPER. ACTIV. 378,359 388,169 DEVEL. COTT. 13,500 99,633 Yes x or No EARMARKS: KIDITEY RMPS DIRECT $ 996,338 $1.,450,000 $1,375,,702 $1,375,702 REQUESTED 1,757,550 COUNCIL APPROVED LEVEL 1,450,000 NON-RMPS and INCOME 7/l/71-6/jO/72 2 m6nth extension 7/l/71-8/31/72 $166,056 REGIO,R Western Pennsylvania:' Extended (2 m6.)--New grant period 9/l/72-8/31/72. June 19@2,. REVIEW CYCLE