Dr. LEE. Yes, I think as we develop our capabilities at the State level for planning and a capability in the areawide planning, it will encompass concerns with migrants, with other kinds of disadvantaged groups, and it will also include considerations of regional medical programs. Mr. ROGERS. In the comprehensive plan, don't we give money for treatment of heart disease to a city? Dr. LEE. In the partnership for health, a formula grant goes to the State, and project grants for the development of comprehensive health services, and these may include services for people who have heart disease or other diseases. The focus of the regional medical programs, and I think this is fundamental to an understanding of the program, is that they have developed a foundation for cooperative arrangements that simply didn't exist before. We did not have this-in some areas, there were programs of continuation of education, such as in Kansas, or we had the Bingham Associates in New England, but we had not seen the kind of grassroots participation focusing on improving patient care. The comprehensive health plan has to encompass manpower, environmental health problems the full spectrum-and the project grants can relate to a variety of these things. Mr. ROGERS. I realize we are getting this program started now, and it is in a beginning stage, but I would think your planners should be giving thought to combining these programs where there will not be an overlap, because I would think that there would be some areas where there would be rather considerable overlap within a State plan, particularly for heart, cancer, and stroke. Dr. LEE. We are concerned not only about the relationship of the regional programs with the partnership for health, but also the better and more efficient use of all of the programs, such as OEO programs, and we have seen in the Watts area an excellent example of close cooperation between a regional medical program, the development of a community hospital, and the neighborhood health center program funded by OEO. We are concerned at the national level with stimulating at the State and local level the close integration of these programs so that we can make most efficient use of manpower, which is our scarcest resource, but also the funds available. Mr. ROGERS. Yes. I hope to see some of these OEO programs under your department. I feel strongly on this. I realize this was an innovative approach, but I think it should be tied in more closely. Let me ask a few questions that you may want to give answers for the record, that you may not have with you. How many regions are actually operating as of January 1968? Dr. MARSTON. There are now 12 with funded operational programs. Dr. MARSTON. Yes, sir; they are beginning. This will vary from one I signed yesterday, which is obviously not doing much, to ones that have been operating a year. Mr. ROGERS. Would you just give us for the record a rundown of each of these 12, the personnel, how they are involved, how much money they are getting, and I would like to know where that money is being spent, how much on television tie-ins, and how many hospitals are tied in, what improvements are made in hospitals. In other words, when we passed this bill, the idea of the thrust of this program was to make sure the new methods of treatment were going to get to the people. Now, I realize it is very early and too soon for us to make a critical judgment, probably, but I get the feeling that this may be stopping in the dean's office at the medical colleges. Well, I just want to find this out. [Laughter.] Dr. LEE. It had better not be. (The following information was received by the committee:) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE (PUBLIC HEALTH SERVICE) REPORT ON 12 OPERATING REGIONAL MEDICAL PROGRAMS ALBANY REGIONAL MEDICAL PROGRAM The Albany Regional Medical Program was one of the first regions to receive an operational award on April 1, 1967. Currently funded with $755,605, the region has approximately 43 operational staff members, including approximately 14 physicians, 17 nurses, 5 other allied health personnel, and 6 general support personnel. Over two-thirds of the staff are from the community hospitals, and they are working closely with the local medical center and RMP staff to increase the capabilities for quality care at the local hospitals. Approximately 60 hospitals from the Albany Region are participating in the program. Approximately 30 of these hospitals are directly participating in the operational projects outlined below. Two hospitals are represented on the Advisory Committee, and the remaining are involved in on-going planning activities. Operational Projects 1. Two-way radio communication system, direct cost-$144,100 This project will expand an existing two-way radio network to include 57 hospitals and 24 high schools. It will provide continuing education for physicians and allied medical personnel. It will also provide information and education programs for administrators, members of boards of trustees, voluntary health agencies, adult education classes, and selected civic groups. 2. Community information coordinators, direct cost-$73,800 Former pharmaceutical representatives will be used to contact local physicians to tell them about Regional Medical Programs and to evaluate their attitudes towards RMP. 3. Postgraduate Instruction Development Panel, direct cost-$102,600 This program proposes to have experimental and control groups of doctors to determine their educational needs. These doctors will then participate in instructional programs. Afterwards they will be tested to determine the effectiveness of the instruction. 4. Community hospital learning centers, direct cost-$75,800 This project will establish learning centers at community hospitals using "Self Instruction Units" and audio-visual equipment for rapid dissemination of new medical knowledge. Eventually, the directors of this project hope to evaluate physician progress. Initially, 8 hospitals will be involved. 5. Albany Medical Center coronary care training and demonstration programs, direct cost-$125,200 A coronary care unit will be established at Albany Medical College to serve as a model and training unit for training physicians and nurses who will then be able to establish similar units at community hospitals. This project will augment the existing Coronary Intensive Care Unit at the Albany Medical Center. 6A and 6B. Community hospital coronary care training and demonstration program, direct cost-$55,400 This will complement project #5 by establishing coronary care units of three beds each at three community hospitals: Pittsfield General, St. Lukes, and Vassar Brothers. These will serve as demonstration and educational projects for other hospitals in the region. A continuing educational program will serve the permanent Unit Staff and staffs from smaller hospitals. 7. Training and demonstration project, intensive cardiac care unit Herkimer Memorial Hospital, direct cost-$3,500 The initial phase of this project is to train 6 or 8 nurses from small community hospitals in cardiac anatomy and physiology, coronary disease, the principals and staffing of a cardiac intensive care unit, and in handling the complex equipment. These nurses will also be sent to Albany Medical Center for active training with specialized equipment. INTERMOUNTAIN REGIONAL MEDICAL PROGRAM The Intermountain Regional Medical Program received its first operational grant award on April 1, 1967 and its current operational award totals $1,832,800. Approximately 80 staff members are serving in the operational projects, about one-third of whom are from community hospitals working together with the Regional Medical Program staff from the medical center, they are bringing to local health practitioners and hospitals throughout the region modern techniques for treating patients with the categorical diseases. Approximately thirty hospitals are currently participating in the Program. Three hospitals are represented on the Regional Advisory Group, and almost every major hospital in the region has established a local planning group to study local needs and to serve as liaison with the Central IRMP staff. Seventeen hospitals are participating in the operational projects outlined below, and as the program continues to grow, it is anticipated that additional hospitals will become involved. Operational Projects 1. Regional faculty and core-staff seminar, direct cost-$12,600 The University of Utah Medical School will hold a series of quarterly seminars on comprehensive health care, continuing education, contemporary learning theory, behavioral science principles, and measurement technology. The faculty, experts from across the country, will address an audience of health professionals involved in IRMP. 2. Network for continuing education in heart disease, cancer, stroke, and related diseases, direct cost-$243,000 The objectives of this program are to develop a communications network between patient-care and research institutions to encourage liaison between health care personnel in the area. The currently existing 2-way radio system, including 11 hospitals in 7 communities in or near Salt Lake City, will be extended to remote hospitals to serve as one link. Closed circuit TV and use of KVED (University of Utah education TV) is also planned. This may establish the community hospital as the locus of continuing education. 3. Information and communications exchange service, direct cost―$40,000 The CIES is a region-wide clearing house for information about IRMP. Staff will be put in local communities to act as public relations representatives and also to distribute information to medical personnel and the public. The community staff will also gather information on community needs and resources and resources and serve as a station for collecting economic, social, and medical data. 4. Cardiopulmonary resuscitation training program, direct cost $63,400 The University of Utah will give a 3-day course in resuscitative techniques to selected physicians from small communities. Each physician will then be responsible for teaching the techniques to health personnel in his community. This "resuscitation consultant" will also collect data about the number of times resuscitation is employed and the results. 5. A training program in intensive cardiac care, direct cost-$118,600 A core faculty of experts in using Cardiac Care Units and diagnosing and treating heart disease will teach short courses in their subjects. The students will be interested physicians and nurses from community hospitals building coronary care units. 6. Training for nurses in cardiac care and cardiopulmonary resuscitation, direct cost $34,000 This is an integral part of both the cardiac care and cardiopulmonary resuscitation programs for physicians (#4, #5). Nurses trained in Salt Lake City will return to their communities to serve as a core faculty for reaching the techniques at the local level. The nurses will work closely with the similarly trained physicians. 7. Clinical trainee program in cardiology, direct cost-$65,700 This program has two emphases (1) To provide general practitioners, internists and cardiologists with training programs in heart disease techniques tailor made to their individual situations. (2) To increase the number of formally trained clinical cardiologists through a training period (3 months to one year) at the existing cardiology school at the university of Utah. 8. Visiting consultants and teacher program for small community hospitals, direct cost-$14,800 Small communities will be given the option of requesting one or two-day clinics. A minimum number of four cardiac patients will be required. These clinics will upgrade the level of care to victims of heart disease living in remote areas. Visiting physicians will assist the local physician in a precise diagnosis in a precise diagnosis of his patients. 9. A regional computer-based system for monitoring physiologic data on-line from remote hospitals in the regional medical program, direct cost-$637,100 This project's purpose is to test the feasibility of using a central computer to process a variety of physiological signals generated by patients in remote hospitals, feeding the results of calculations from these signals back to stations within the hospitals, and using the information for diagnosis. 10. Cancer teaching project, direct cost-$94,300 This project attempts to upgrade the level of care available to local communities. The coordinator will direct a program of physician education to create trained cancer specialists who in turn, will become centers of cancer information in their local communities. The physicians will receive a small stipend for teaching and obtaining information. A region-wide tumor registry will be started, as will a training program in new techniques for pathologists. 11. Stroke and related neurological diseases, direct cost—$98,700 This project will establish clinics to bring expert consultation service in stroke and related neurological diseases to local communities; will provide continuing education to local physicians and Nurses; will collect data about stroke patients seen and the problems they present to the practitioner. A 24-hour telephone consultation service and information library service will be maintained at the Utah Medical Center to provide community physicians with immediate advice. In addition, practicing physicians will be trained at the medical center in the latest diagnostic and treatment techniques. The courses will last from 4 weeks to one year. 12. Educational program in respiratory therapy for physicians and nurses, direct cost-$25,300 To train physicians and nurses to utilize the special techniques and equipment in respiratory therapy. Five day seminars and follow-up 2 day refresher courses will train participants to administer therapy and to teach others. 13. Regional endocrine metabolic laboratory, direct cost-$237,900 To provide service facilities where practicing physicians can obtain laboratory data essential to the diagnosis and treatment; to create awareness among physicians of the possible presence of metabolic and endocrine abnormalities; to derive statistical information. Three laboratories will be established: an immunoassay laboratory, a chemical laboratory to measure steroid hormones, and a developmental laboratory to refine techniques. Seminars will be held both inside and outside of the laboratories. Abnormal findings will be reported to the referring physician by telephone by a physician who is competent to offer consultation. KANSAS REGIONAL MEDICAL PROGRAM The operational activities of the Kansas Regional Medical Program began on June 1, 1967, and are currently funded at the level of $699,852. Approximately 80 individuals with varied backgrounds, comprise the current staff, of which about one-sixth are physicians, one-fifth are nurses, and an additional one-fifth are other types of allied health personnel. The remaining staff includes related health personnel, such as communications specialists and social scientists, and general support personnel. About half the staff are from the medical center and the other half are from community hospitals. Together they are working on programs to improve community capabilities for treating the categorical diseases. Approximately 20 community hospitals are currently involved in the Kansas Program, and it is anticipated that additional hospitals will become involved as expansion takes place during the next few years. Ten of these hospitals are directly involved in operational projects, two are represented on the Advisory Committee, and eight are involved in on-going planning activities. Operational Projects 1. Educational programs-Great Bend, Kans.-$261,000 (direct cost) To develop a model educational program in this small community a full-time faculty, which will be affiliated with the Kansas Medical Center, will be in residence. Included in this comprehensive program are plans for continuing physician and nurse education and clinical traineeships for heath-related personnel. Studies will be made of community needs, resources, etc. 2. Health Sciences Communication and Information Center-$77,900 (direct cost) This project is engaged in conducting studies to determine the feasibility of establishing communication linkages vital to education, service, and research programs. Specific studies to be undertaken are a physician communication system, TV teaching, electronic linkages, and Medlars search capacity. 3. Study of the quality and availability of medical care-$149,000 (direct cost) To determine unmet needs of patients, locations, professional education, and -working arrangements of physicians and those in the health related disciplines. 4. Hospital information system and data facilities—$67,500 (direct cost) To conduct studies within the region concerning various aspects of community resources and needs, epidemiologic data and participation of health care personnel in continuing educational programs. A computer system will be used. 5. Cardiovascular nurse training—$98,500 (direct cost) To develop an in-service training program to prepare nurses, who are the mainstay of coronary care units in community hospitals, with basic physiological knowledge of coronary care, ability to use instruments and equipment in coronary care units, experience in home care, and familiarity with social agencies that can aid in the rehabilitation of patients. 6. Cancer detection program-Providence Hospital-$25,000 (direct cost) To evaluate the strengths and weaknesses of the Cancer Detection Center now operating as an area referral center in Providence Hospital in Kansas City, Kansas. The records of patients will be studied to show effectiveness and yield of test results, type of personnel who have used the clinic and their source of referral, and effectiveness of follow-up. 7. Cardiovascular work evaluation $21,100 (direct cost) This project will demonstrate the Cardiac Work Evaluation Unit and show its usefulness for the evaluation and rehabilitation of the patient. It is developing an effective technique for showing physicians and the community at large the ability of patients to return to work after receiving the appropriate rehabilita tion. |