provide local health practitioners and hospitals with advanced techniques and facilities necessary for quality health care. Over fifty people are currently serving on the staff of the operational program, including approximately thirty-five physicians, five nurses, five other allied health personnel, and nine general support personnel. About one-fourth of the staff are from community hospitals and the remaining are medical center staff who are working on the community oriented projects discussed below.

Seventeen hospitals are currently participating in the operational projects, representing broad geographic spread throughout the region. Ten of these hospitals are also represented on the Regional Advisory Group.

Operational Projects

1. Continuing medical education—Meharry, direct cost—$44,800

Meharry Medical College is informing Negro physicians in the region about more effective techniques for treating heart disease, cancer, and stroke. Teams of physicians will teach two-week courses in the three areas at the Medical Center, using various audio-visual aids and, where feasible, programmed instruction. One of this plan's interesting provisions is sending a senior resident from Meharry to care for the physician's practice while he is attending the course. 2. Continuing education-Vanderbilt, direct cost—$141,600

Vanderbilt proposes to establish continuing education centers at community hospitals linked to a proposed Department of Continuing Education at Vanderbilt. Libraries and information centers at the local hospitals will bring Vanderbilt's information resources to the local physician. The program, though planned and coordinated by Vanderbilt, will function through the local centers and emphasize bringing information to the physician at the times he needs it.

3. and 4. Hopkinsville Education Center and Chattanooga Education Center, direct cost-$73,700

These are the first of the local continuing education centers specified in the Vanderbilt plan. At each hospital, a full-time Director with an appointment at Vanderbilt and an assistant director will supervise resident and physician education in their area. Their services will be available to physicians at smaller community hospitals in each area, as will the enlarged hospital library facilities. The Chattanooga and Hopkinsville locations provide the basis for looking at problems in continuing education in urban and rural settings.

5. Special training for practicing radiologists-Vanderbilt, direct cost-$50,400 This plan focuses on developing practicing radiologists' skills in vascular radiology, but might later be broadened to include all aspects of diagnosis and therapeutic radiology. Two post-graduate educational methods will be used. One to three month courses for technologists will be offered. In addition, eminent radiologists will preside at two-hour monthly seminars to which all radiologists in the region will be invited.

6. Cardiac nurse training program-Mid-State Baptist Hospital-Nashville, direct cost-$49,600

The key factor in reducing mortality from cardiac arrest is the immediate availability of a knowledgeable person to initiate resuscitation. Mid-South Baptist proposes to instruct cardiac nurses in new resuscitation techniques by holding three four-week courses. These nurses will then be available to hospitals throughout the region.

7. School of X-ray and technology-Meharry, direct cost $19,500

Meharry plans to establish a two-year program for training at least ten X-ray technologists per year. The faculty will be Meharry's Radiology staff. Feasibility studies for establishing nuclear medicine and radiotherapy programs will be conducted.

8. Radiology technologist training program-Vanderbilt, direct costs $30,300 Vanderbilt proposes to increase the number of X-ray technologists, improve the quality of their training, and increase their opportunities for continuing education. Three small hospital training programs in the area will be discontinued as separate entities and subsumed by a new school of X-ray technology at Vanderbilt. Practical clinical experience will be both at Vanderbilt and the smaller hospitals.

9. Nuclear medicine training program-Vanderbilt, direct cost-$25,300

A new series of courses taught by paramedical and medical personnel will be made available to physicians and technologists to increase their skill in nuclear medical techniques. When possible the physician and his technologist will spend some training time together to work out procedures suited to their situation. Trainees will be accepted from smaller community hospitals planning to establish or improve nuclear medicine services.

10. Expansion of School of Medical Technology-Baroness Erlanger Hospital— Chattanooga, direct cost-$35,400

To augment medical technology capabilities in the area, this plan makes two proposals: (1) Expand the Baroness Erlanger program for medical technologists; and (2) establish a school for certified lab assistants who could free technologists from more routine work for more complex procedures.

11. Vanderbilt Coronary Care Unit, direct cost-$51,600

This project's purpose is to establish a network of coronary care units with adequate equipment, staffed by well trained personnel. Vanderbilt will be the training and information center for the region; a demonstration unit there will provide a focal point for continuing education. In addition, communication systems will be set up to facilitate the flow of information from Vanderbilt to the community hospitals. Studies are being made to see if the small hospitals connected with Vanderbilt can become, in turn, centers for local networks of coronary care facilities in still smaller hospitals.

12. Franklin Coronary Care Unit-Williamson County Hospital-Franklin, direct cost $31,400

This is one of the subsidiary units mentioned in the Vanderbilt proposal. This is primarily a pilot project to study the feasibility and usefulness of establishing a center in a small community hospital.

13. Hopkinsville Coronary Care Unit-Jennie Stuart Memorial Hospital-Hopkinsville, Ky., direct cost-$49,500

This plan is similar to the Franklin plan, except that it mentions establishing links to smaller community hospitals by helping set up smaller care units in them, thus providing for the grouping of rural community hospitals for more efficient use of existing resources.

14. Clarksville Coronary Care Unit-Clarksville Memorial Hospital, direct cost— $19,000

As the Franklin program, this project is a subsidiary of the Vanderbilt proposal. Since this hospital has been operating a unit, the plan calls for its expansion, continuing education and a phone hook-up to Vanderbilt.

15. Nashville General Coronary Care Unit-Nashville Metropolitan General Hospital, direct cost-$42,100

Again, this is like the Franklin plan. Nurses here will be included in the inservice training programs initiated throughout the participating hospitals. 16. Meharry Medical College Coronary Care Unit, direct cost-$35,800

Meharry intends to establish a demonstration unit of coronary care facilities which will serve as a continuing education center for smaller hospitals in its region.

17. Murray Coronary Care Unit-Murray-Calloway (Ky.) County Hospital, direct cost-$38,800

Murray-Calloway County Hospital, the training center for Murray State University School of Nursing, will serve as a demonstration center for the subregion. Direct phone communication will be established with Vanderbilt, which will send consultants from its school of continuing education. This project has the dual objective of relating the Murray State Nursing program to an established medical center and providing regional training resource to a remote area.

18. Chattanooga Coronary Care Unit-Baroness Erlanger Hospital, direct cost— $14,400

Baroness Erlanger plans to establish a coronary care unit in a program of cooperation with Vanderbilt. Both telephone communications and electronic maintenance systems connected with Vanderbilt will be installed. This unit will serve as a center for the smaller hospitals in Chattanooga.

19. Baptist Hospital Coronary Care Unit—Mid-State Baptist Hospital, Nashville, direct cost-$51,000

This plan is similar to the others included in the Vanderbilt plan. Baptist Hospital will expand its present facilities and aid establishment of smaller centers at Tullahoma and Crossville, Tennessee. Direct telephone lines will be established for consultations. The unit director will have a clinical faculty appointment at Vanderbilt. He will devote approximately 25% of his time to the unit. 20. Crossville Coronary Care Unit-Uplands Cumberland Medical Center, Crossville, direct cost-$28,300

This project has two purposes: (1) to establish a two-bed coronary care unit in the hospital; and (2) to determine the feasibility of operating acute coronary care units in rural areas. The hospital will cooperate with Mid-State Baptist Hospital and Vanderbilt.

21. Tullahoma Coronary Care Unit-Harton Memorial Hospital, Tullahoma, Tenn., direct cost-$28,800

See Baptist Hospital Program.

22. Meharry supervoltage therapy program, direct cost-$58,300

This project is aimed specifically at improving cancer therapy for a large indigent population. Meharry will use its funds to obtain a cobalt 60 High Energy Source for therapy and a computer hook-up with Vanderbilt. These facilities will also be used to improve undergraduate and graduate radiology training programs at Meharry.

23. Project to improve patient care in a remote mountain community by recruiting and training health aides for a new extended care facility-Scott County Hospital-Oneida, Tenn., direct cost-$10,300

Manpower shortage in this isolated mountain hospital is critical. Personnel to man an extended care facility now under construction will be obtained by two methods: (1) In-service training for hospital personnel; (2) an educational director (an RN) to serve as a liaison to the high schools to encourage young people to enter the medical field and come back home to practice. In addition a training program leading to the LPN would be initiated. Clinical training will be supervised by the Educational Director while local high schools provide basic training.

24. Health evaluation studies on a defined population group-multiphasic screening-Meharry Medical College, direct cost $436,000

Meharry will determine the effectiveness of a comprehensive health program and multiphasic screening examinations in early diagnosis of heart disease, cancer, stroke and their precursors. To run this experiment, a neighborhood medical center supported by OEO will serve a selected population of 18,000. The test population and a control population will be evaluated with reference to morbid. ity, changes in health attitudes and utilization patterns, effectiveness of the screening procedure and the cost per patient diagnosed or treated.

25. Experiment to test and implement a model of patient care-Vanderbilt University Hospital, direct cost-$110,400

This is an attempt to define a new structure for patient care. New personnel called stewardesses will be trained to take over the nurses' non-clinical duties. Nurses would then be free to spend more time with the patient and to keep up their specialized skills. After the model is refined at Vanderbilt, it will be tested in community hospitals-specifically Baptist and St. Thomas.

26. A medical surgical nurse specialist graduate program to improve nursing care of patients with heart disease, cancer, and stroke-Vanderbilt University School of Medicine, direct cost-$23,600

Vanderbilt is developing a program to train medical surgical nurse specialists to improve nursing care of heart, cancer, and stroke patients. It will be a master's degree program staffed by physicians and clinical nurses (1 calendar year) plus one year of clinical experience half at Vanderbilt and half at the community hospital. Stipends will be provided during the first year only.

WASHINGTON-ALASKA REGIONAL MEDICAL PROGRAM

With an operational grant award of $1,032,003 on February 1, 1968, this twostate region began its efforts to bring quality care to the dispersed populations

of this area. About forty operational staff members are currently serving on the program, including about seventeen physicians, three nurses, six other allied health personnel, and fourteen related health and general support personnel. About one-third of the staff is from the medical center, another third is from community hospitals and the last third is from other health and medical organizations. The entire staff is working in concert to bring up-to-date medical tech. niques to communities throughout the region.

Strong hospital involvement in the Washington-Alaska program is evident in the project descriptions below. Approximately 36 hospitals are currently participating in the program, almost 20 of which are directly involved in operational activities. Six of these hospitals are represented on the Regional Advisory Groups, and an additional four of these are on planning subcommittees. The remaining participating hospitals are involved in current planning activities. It is likely that these, and the many other hospitals in the region, will become increasingly involved in operational activities.

Operational Projects

1. Central Washington-Communication system for continuing education for physicians—$18,181 (direct cost)

This project is designed to bring the medical resources of the University of Washington to physicians and community hospitals in Yakima, who in turn will act as consultants to surrounding smaller communities through seminars and conferences, educational TV, other audio-visual instruction; and exchange of teachers and practitioners. It will also connect internists in Central Washington to Yakima cardiologists via EKG telephone hot-liné, to permit quick analysis (starting with 5 community hospitals). Three general hospitals in Yakima involved are: St. Elizabeth's, Yakima Valley Memorial, and New Valley Osteopathic. Nine other community hospitals to be reached initially are located in Ellensburgh, Moses Lake, Othello, Toppenish, Prosser and Cynnyside. 2. Southeastern Alaska-Postgraduate education—$27,062 (direct cost)

This program will help improve communication between Seattle Medical Com. munity and University to alleviate problems of the isolated physicians in southeast Alaska cities and communities: Juneau, Sitka, Ketchikan (3 largest). As in Central Washington several methods will be used such as telelectures, consultant services, seminars and the EKG hot line to hospitals in Juneau, Sitka, and PHS Native Hospital at Mt. Edgecumbe and Ketchikan community hospital. 3. Postgraduate preceptorship for physicians-Coronary care-$17,610 (direct cost)

A pilot project to provide opportunity for practitioners from isolated communities to spend a week or more under a preceptor at major medical centers to study advances in care of coronary heart disease. The 4 major medical centers in Seattle are Providence Hospital, Swedish Hospital, Virginia Mason Hospitals and Medical Center, and University Hospital and Medical Center; two in Spokane are Deaconess Hospital and Sacred Heart Hospital.

4. Coronary care unit coordination—$70,255 (direct cost)

This activity will serve as coordinating unit for CCU related projects-their development, improvement of operations, and training activities. A mock-up coronary care unit will be used in the educational programs for nurses and physicians; audio-visual self-instruction materials will be produced and evaluated. 5. Cardiac pulmonary technician training $41,554 (direct cost)

This program will help develop a formal program for training cardio-pulmonary technicians to perform non-critical functions in coronary care units and free physicians for other duties. Four larger general hospitals in Spokane will participate with Spokane Community College. The 4 hospitals are Deaconess, Holy Family, Sacred Heart and St. Luke's Hospital.

6. Information and education resource support unit-$522,304 (direct cost)

This program will help provide medical communities with the skilled assistance which will help identify their educational needs and serve as a support unit in developing programs to meet them; to establish a central production unit, to coordinate audio-visual projects and the distribution of materials, to penetrate the entire region.

7. Two-way radio conference and slide presentation $8,445 (direct cost)

Six pilot programs on heart, cancer and stroke topics to be transmitted via two-way radio-telephone slide conferences, to physicians and hospital staffs on topics selected by a panel of physicians, starting with 20 hospitals in Washington are underway. It will explore potential for continuing network series with local and remote regions.

8. Continuing education and on-the-job training of laboratory personnel—$53,446 (direct cost)

Primary purpose of this activity is to train technical personnel in newer clinical laboratory procedures, and shorten gap between availability of advance in techniques and actual use. First phase is to be directed at 5 local designated training centers in Washington (cities of Seattle, Tacoma, Spokane, Yakima and Vancouver) and Anchorage, Alaska. University of Washington will select from a list of available lab procedures, arrange training courses for technicians in specific ones at designated facilities and establish quality control criteria; they will follow through with education of physicians in newer and practical tests for better diagnosis and treatment.

9. Alaska medical library facilities—$21,754 (direct cost)

This activity will help develop a community medical library located at the PHS Alaska Native Medical Center, Anchorage, for Alaska physicians and health related staffs and agencies. It will have close ties with community colleges, Arctic Health Research, University at Fairbanks and to supplement continuing education projects for Southeast Alaska and the Anchorage cancer project.

10. Anchorage cancer program—$51,450 (direct cost)

This project will aid in providing a supervoltage therapy unit for cancer patients to be located in an addition to Providence Hospital in Anchorage. It involves training of radiologist and technical staffs, consultant clinical conferences and accumulation and analysis of dianogstic data. Presbyterian Community Hospital in Anchorage will be participating.

11. Care of children with cancer (study)—$28,030 (direct cost)

This is an epidemiological study to determine the impact of different methods of care for children with cancer, focusing on differences among children treated in local communities and at major centers; to be conducted by the staff of Children's Orthopedic Hospital and Medical Center, Seattle.

12. Radiation physicist consultation program for radiologists in Washington and Alaska-—$56,393 (direct cost)

This project will provide consultation services of a radiologist-physicist for smaller hospitals, in dosimetry and other problems of radiotherapy. To enhance postgraduate education for radiology residents and paramedical trainees outside of the University system.

13. Computer-aided instruction in heart disease, cancer, and stroke and related diseases-$53,390 (direct cost)

To develop and evaluate the effectiveness of computer-aided instruction for teaching medical techniques. Participants will be instructed in the use of computer terminals.

WESTERN NEW YORK REGIONAL MEDICAL PROGRAM

With an award of $357,761, the Western New York Regional Medical Program began its operational program on March 1, 1968. The current operational staff of seven physicians, one nurse, and two secretaries will be expanded to over 20 during the next several months. Over forty hospitals are currently involved in this program, almost all of which are slated to be part of the developing regional two-way TV network for continuing education. Eleven hospitals are represented on the Regional Advisory Group, and an additional two hospitals are serving on planning subcommittees.

Operational Projects

1. Two-way communications network, direct cost-$170,519

A two-way communication network will link hospitals of Western New York and Erie County, Pennsylvania to the Continuing Education Departments

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