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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 Investigation 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 Surveillance 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

and to include about 50,000 persons in county (Clay). Activities are centered around Smithville Community Hospital and the group practice clinic as a nucleus.

2. Multiphasic testing of an ambulant population-direct 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 bank-direct 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 units—Springfield, 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 communicating with public and lead them to seek medical care.

7. Data evaluation, computer simulation and systems design—direct 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 area—direct 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 survey-direct 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 system-direct 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 Services-direct cost $26,842

16. Central core administration, planning and coordination-direct cost $238,805 (University of Missouri Medical Center, Columbia, Missouri) Missouri Regional Medical Program.

MOUNTAIN-STATES REGIONAL MEDICAL 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 project 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.

2. Coronary care training and development, direct cost―$56,938

To use the project as a medium for developing cooperative arrangements among the various elements in the health care community. Initial and continuing education will be provided to nurses and physicians in community hospitals, consultation will be available to hospitals in establishing CCU's, and a computerbased system of medical record keeping will be developed. This project has led to new working arrangements: (1) between the university medical centers; (2) between medical and nurse educators; (3) between doctors and nurses in community hospitals; (4) between university medical centers and community hospitals. 3. Diabetic consultation and educational services, direct cost-$132,081

To establish three medical teams to deliver services throughout the state; to assist in expansion of diabetic consultations and teaching clinics; to provide seminars for physicians and teaching sessions for nurses and patients to assist in organization of a State Diabetes Association and local chapters; to test techniques of data collection. Many people of different disciplines in many communities are involved in this project.

4. Development of a central cancer registry, direct cost-$66,615

To devise a uniform region-wide cancer reporting system, integrated with the PAS, the computer-stored data from which can be retrieved to serve a broad range of educational, research, statistical, and other purposes. The following hospitals are participating in the first year of the project: Duke University Medical Center, North Carolina Memorial Hospital, North Carolina Baptist Hospital, Charlotte Memorial Hospital, Veterans Administration Hospital, Watts Hospital, Hanover Memorial Hospital, Southeastern General Hospital, Craven County Hospital. In subsequent years the registry will be expanded to include all hospitals and physicians in the region.

5. Medical library extension service, direct cost-$25,839

To bring medical library facilities of the three medical schools into the daily work of those engaged in medical practice. Local hospital personnel will be trained to assist medical staff; libraries will be organized into a functional unit for responding to requests for services. Bibliographic request service will be established.

6. Cancer Information Center, direct cost $41,716

To provide practicing physicians with immediate consultation by telephone and follow-up literature. Each of the three medical schools will be responsible for providing service in its geographic locale. The aims of this project are two-fold: (1) to assist physicians in providing optimum care of patients with cancer; and (2) to continue the education of the physicians by giving new information in a patient-centered experience.

7. Continuing education in internal medicine, direct cost-$33,313

To bring practicing internists from all over the state to the Medical Center for a month of up-to-date training in their subspecialities. They will share responsibilities with attending physicians and make ward rounds with students, staff, and together. This experience should enhance the appreciation in the University, both at faculty and student levels, for the expanding role of the medical center for the quality of care in the community.

8. Continuing education in dentistry, direct cost-$67,500

To provide physicians and dentists with the knowledge of mutual concern which will enable them to be more effective members of the health team. Courses will be given at the University of North Carolina and in communities. Studies will be made of facilities needed to provide dental care in hospitals. The purpose of this project is to insure that as many patients as possible who suffer from heart disease, cancer, stroke, or a related disease receive appropriate dental care as a part of their comprehensive treatment.

9. Continuation education for physical therapists, direct cost-$27,838

To develop and establish regional continuing education programs for physical therapists in order to strengthen physical therapy services for patients in all parts of the state. Subregions will be delineated where needs and interests will be identified and committees will be organized to arrange local activities.

10. The establishment of a network of coronary care units in small community hospitals in Appalachia, North Carolina

This is a proposal to develop coronary care units in seven hospitals in this rural, mountainous area. RMP will supply the monitoring equipment (the hospital provides suitable space) when adequately trained physicians and nurses are available. An intensive training course for physicians will be conducted in the geographic region, and continuing education programs will be conducted when necessary.

ROCHESTER REGIONAL MEDICAL PROGRAM

On March 1, 1968 the Rochester Program began its operational activities with a modest operational grant award of $255,487. Approximately 15 people are currently serving on the staff which will expand with additional recruitment. The current staff includes 13 physicians, and two allied health personnel. A majority of the staff are from community hospitals, and are working closely with medical center and RMP staff to improve the quality of local patient care.

Approximately eleven hospitals from the region are now participating in the program, and this will expand as the program moves forward over the next few years. Four hospitals are initially participating in the operational projects. Three of these four are represented on the Regional Advisory Committee. Seven additional hospitals are serving on the Advisory Committee and planning subcommittees.

Operational Projects

1. Renovation and equipping of facilities for a learning center for projected training programs related to heart disease, cancer, and stroke, direct cost$26,400

The awarded funds are for the purpose of altering and renovating space in Helen Wood Hall, which houses the Departments of Nursing at the University of Rochester. It is planned to convert five rooms into two rooms for self-instructional learning. These facilities initially will be used for four 4-week coronary care training courses for nurses and physicians in the region. New techniques that are disseminated by means of these courses will then be caried to the various community hospitals and rural areas in the region by the training course participants. 2. Postgraduate training program for the physicians in the Rochester 10-county region, direct cost-$83,900

The objectives of this project are centered around the further development of a postgraduate program in cardiology. Learning opportunities will be made available for general practitioners and internists, as well as cardiologists practicing in the region. Several different programs are planned and vary in length from one-half day to two weeks. It is anticipated that a number of the participating physicians will represent community hospitals in rural areas.

3. Registry of patients with acute myocardial infarction in the Rochester regional hospitals, direct cost-$21,200

One objective of this registry is to provide a uniform data collection system from which both periodic information as well as longitudinal analyses may be extracted. Appropriate information as to prognosis and treatment will be disseminated to participating hospitals and cooperating physicians in the region. Strong Memorial Hospital in Elmira, New York is already participating in this project, and it is anticipated that several other community hospitals, especially those in rural areas, will soon also be participating.

4. Proposal for establishment and support of a regional laboratory for the educacation and training in the care of patients with thrombotic and hemorrhagic disorders, direct cost-$69,400

At the present time no single, central facility concerned with the diagnosis and therapy of patients with thrombotic or hemorrhagic disease exists in the Rochester region. Laboratory technicians from the regional hospitals will be invited to spend three or four days in the new facility. In addition, the physicians directing this project will visit the participating communities so that a continuing educational program for practicing physicians in the care of patients with thrombotic diseases will be maintained.

TENNESSEE MID-SOUTH REGIONAL MEDICAL PROGRAM

On February 1, 1968, the Tennessee Mid-South Regional Medical Program began its operational activities with a diverse array of programs designed to

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