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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 endocrinc 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 rurses, who are the main. stay 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.

METROPOLITAN DISTRICT OF COLUMBIA REGIONAL MEDICAL PROGRAM This region began its operational activities on March 1, 1968, with an award of $418,318. A staff of 47, including about 11 physicians, two nurses, seven other allied health personnel, and 27 other types of supportive personnel such as computer programmers, coding clerks and secretaries will work together to improve local medical capablities and resources. About half of the staff is from the medical center and the other half is from community hospitals and other local health agencies. This combination of medical center-community personnel helps assure a quality, community oriented program.

Seven hospitals are currently participating, and this number will increase as the program expands over the next few years to reach out to the entire region. Three of these hospitals are directly participating in the projects outlined below, two additional hospitals are on the Regional Advisory Group, and two are serving on planning subcommittees. However, several additional hospitals will benefit from these programs as they send their personnel to be trained in the programs outlined below.

Operational Projects 1. Freedman's Hospital Stroke Station for the Diagnosis, Treatment, and In

vestigation of Cerebral Vascular Disease, direct cost-$181,889 This project is a comprehensive approach to stroke, from diagnosis and treatment to home care and rehabilitation in an urban Negro area. Based in the Freedman's Hospital, a community hospital in the region, the stroke station will serve as a teaching component for physicians and medical students. Related epidemiological and socio-economic studies will be undertaken. 2. The Washington, D.C. Regional Cerebrovascular Disease Followup and Sur

veillance System, direct cost-$94,200 Under the sponsorship of Georgetown University, this project is attempting to establish a uniform system for measuring and evaluating medical care given to stroke patients in the area, in order to facilitate nursing and follow-up services. It will provide information helpful in determining community medical facilities requirements, and in carrying out epidemiological or demographic studies. Patients entering the system through the various community hospitals in the region will receive follow-up attention and therefore greater continuity of

care.

3. A training program for cardiovascular technicians, direct cost-$74,707

Qualified students are being trained at the Washington Hospital Center in Washington, D.C. in specific areas of medical observation and procedures to complement nurses' activities. In addition to training personnel for work in hospitals throughout the region, this project hopes to produce a manual for training these technicians in the other regional hospitals.

MISSOURI REGIONAL MEDICAL PROGRAM

Operational activities began in Missouri on April 1, 1967, and current opera. tional funds amount to $2,619,000. An estimated 160 operational staff people, with diverse backgrounds, are serving on the Program, including approximately 15 physicians, four nurses, 16 allied health personnel, three social scientists, and approximately 60 computer specialists and their supporting personnel. The remaining staff provide overall support, such as research and staff assistants and administrative and clerical personnel.

The developmental approach being employed by this region and outlined in project descriptions below suggests that hospital involvement will increase rapidly over the next two years. Currently, nine hospitals are involved in the program, including two hospitals which are represented on the Regional Advisory Committee.

Operational Projects 1. Smithville community health service program-direct cost $200,957

The purpose of this project is to establish a model community health service program including continuing education and training programs and health education for the public; emergency intensive and restorative care facilities; home care programs; public health, preventive medicine, and school health ; coordinated with voluntary health agencies. Program centered around Smithville

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and to include about 50,000 persons in county (Clay). Activities are centered around Smithville Community Hospital and the group practice clinicas nucleus. 2. Multiphasic testing of an ambulant populationdirect cost $421,471

This project is designed to establish centers for performing series of diagnostic laboratory tests to identify the most useful tests feasible for screening large rural population groups; determine the different patterns for ill and healthy populations as an aid in detection of heart disease, cancer and stroke in preclinical stages. Model test centers will be established at the University Medical Center, Columbia, Missouri, and the State Mental Hospital in Missouri. A third is planned for the Smithville complex. 3. Computer fact bankdirect cost $279,365

This project is designed to develop and apply techniques for delivering latest information on diagnosis and care of patients with stroke and allied diseases to the local physicians. Electronic data information storage and retrieval system will be developed at the University Medical Center (Columbia, Missouri) and later extend to include Smithville and other communities in the region. 4. Mass screening-radiology-direct cost $54,814

This project will help improve the accuracy of radiologic diagnosis of heart disease, cancer and stroke through electronic communications media. Three small rural hospitals will be hooked into the University of Missouri computer and Department of Radiology to evaluate diagnostic efficiency and determine applicability of ultra-sound and thermography in diagnosis and therapy. 5. Comprehensive cardiovascular care unitsSpringfield, Mo., direct cost $69,347

A comprehensive care unit for grouping patients with heart disease or other circulatory system illness or who have been admitted for other purposes but require close cardiac observation is being developed. The project is to be undertaken at hospitals without a house staff, where it is hoped that grouping of patients will relieve the workload for nurses on general medical and surgical wards. St. John's Hospital medical staff and Greene County Medical Society are coordinating activities with 3 local hospitals in Springfield. 6. Communication research unit-direct cost $61,743

Supporting research unit for program to identify public attitudes and knowl. edge about heart disease, cancer, and stroke; to understand motivations for seeking health care and to determine and develop effective methods for communicat. ing with public and lead them to seek medical care. 7. Data evaluation, computer simulation and systems designdirect cost $329,712

This program will help to determine data needed from the public and physicians for early detection of heart disease, cancer and stroke through studies on the form of data, mechanisms for classifying, storing and retrieving data most effectively. 8. Bioengineering project-$229,129

The aim of this activity is wider distribution in rural areas of sensor transducers, for early detection of heart disease, cancer and stroke and to generate more information on physiological patterns of these diseases. 9. Program evaluation center-direct cost $103,899

Through a multidisciplinary research approach accumulate data in two separate communities about health care, needs and attitudes as a base for developing instruments for measuring quality of care and levels of health in terms of an individual's function in his community. 10. Automated patient history-direct cost $77,561

This project is testing the feasibility of an automated system for obtaining patient history and analyze complaints prior to examination by physicians, as an aid in early disease detection. 11. Automated electrocardiography in a rural areadirect cost $369,000

To provide hospitals and physicians in rural areas with automated facilities for transmitting electrocardiograms and an automated system for analyses of ECG's; to demonstrate the feasibility of such systems where this service is limited or non-existent, and to develop, test and implement the use of bioengineering signals as aid in diagnosis.

12. Operations research and systems design-direct cost $39,055

This activity will help develop systems concerned with testing "early detection” hypothesis-develop operational methods of early detection tests for a large rural population. 13. Population study group surveydirect cost $65,200

Using National Health Survey questionnaire study factors contributing to use of health services in small towns, with emphasis on the influence of availability of care. 14. Automated hospital record systemdirect cost $52,100

This activity is testing the automation of hospital record data through use of computer systems to organize a ready reference service and easy access to hospital data as a base for measuring effectiveness of changes. 15. Computer Assembled On-Going Manual of Medical and Paramedical Sert

icesdirect cost $26,842 16. Central core administration, planning and coordinationdirect cost $238,805

(University of Missouri Medical Center, Columbia, Missouri) Missouri Regional Medical Program.

MOUNTAIN-STATES REGIONALMEDICAL PROGRAM

This four-state region (Idaho, Montana, Wyoming and Nevada) began its operational activities on March 1, 1968 with an operational award of $206,913 to include one activity in coronary care. An operational staff of approximately eleven will serve in the project, and includes five physicians and six nurses. The hospitals involved will include the community hospital in which the activity is taking place as well as those hospitals who will send their staff to the unit for training. The Regional Advisory Group also includes two hospital representatives.

Operational Projects 1. Intensive coronary care in small hospitals in the region-direct cost $206,913

Hospitals in the Region will send Registered Nurses into St. Patrick's Hospital, Missoula, Montana for coronary care training. This 3 week course will be offered three times a year for 21 nurses, and there will be follow-ups at the home hospitals four times a year. In addition, a 4-day training program especially designed for small town physicians will be held at the University of Montana four times a year.

NORTH CAROLINA REGIONAL MEDICAL PROGRAM

On March 1, 1968, the North Carolina Regional Medical Program received a combined planning and operational award totalling $1,485,341. The operational component of this award totalled $753,759 in direct costs only. The operational staff includes approximately forty individuals, including twenty-eight physicians, one nurse, six other allied health personnel, and five general support personnel.

North Carolina has already involved twenty-seven of its hospitals in the Program. The Advisory Group includes four hospital representatives and planning subcommittees include an additional ten hospitals. Approximately twenty-one hospitals are participating in the operational projects outlined below :

Operational Projects 1. Education and research in community medical care, direct cost—$209,200

To develop resources for training more medical and allied medical students; to provide new types of educational experiences which will make family practice more attractive; to have a post-graduate education program at the medical school ; to strengthen ties between the medical school faculty and practicing phy. sicians; and to have the medical school become involved in community planning for improving the quality and availability of medical care. Affected by this proj. ect are the following groups: the University Community; the Caswell County Rural Health Services Project; the Regional Health Council of Eastern Appalachia, Inc.; the State of Franklin Health Council, Inc.; the Charlotte Memorial Hospital; the Moses Cone Memorial Hospital, Greensboro; and the Dorothea Dix Neuromedical Service.

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