Page images
PDF
EPUB

A site visit by members of the Review Committee and the National Advisory Council on Regional Medical Programs to the region is included as an integral part of approving an operational program for a region. As the operational program develops and is expanded additional site visits are made. Finally each Regional Medical Program is required to submit an annual progress report which describes in detail the region's program.

Any proposed modification in program direction by the grantee must be justified in writing and subjected to these review procedures.

Within the context of this comprehensive review process it is possible to determine whether or not a regional program is in fact evolving a regional system intended to improve patient care.

The Missouri, Kansas, Albany, New York, and Intermountain Regional Medical Programs were the first to enter the operational phase of development. The determination of their readiness to begin operations was a result of the review process described above, including a site visit by members of the National Advisory Council and members of he staff of the Division of Regional Medical Programs. The progress of these regions has been further evaluated during the review of supplemental grant requests which have been received from all four regional programs. Further site visits by Council and/or staff to review the first year's progress have either just been carried out or are scheduled for the immediate future. The results of these reviews carried out to date indicate that these Regional Medical Programs are making substantial progress toward the goals set forth a year ago as the basis for the operational grant award. The major problems encountered have been difficulties in recruiting personnel and slowness in the delivery of important equipment. These factors have caused some delays in implementing particular projects.

In addition to this evaluation at the national level, the regional programs are developing their own capabilities for self-evaluation. Special staff has been added to the central staff of the regional programs with specific competence in evaluation techniques. These techniques are being further developed and applied to the operational activities.

Mr. ROGERS. In Kansas, is Kansas City General Hospital involved in that?

Dr. MARSTON. In Kansas City, there is a joint committee from Kansas and Missouri to work together in the Kansas City area, and the Kansas City General Hospital has been involved; yes.

Mr. ROGERS. Could you let us know to what extent?

Dr. MARSTON. Yes, sir.

(The following information was received by the committee :)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT ON THE INVOLVEMENT OF THE KANSAS CITY GENERAL HOSPITAL IN THE MISSOURI REGIONAL MEDICAL PROGRAM

The Kansas City General Hospital is directly involved in the planning for and development of the Missouri Regional Medical Program. The Missouri Regional Medical Program has allocated $82,926 for planning in Kansas City with headquarters located at the Kansas City General Hospital. Several staff share responsibilities for Kansas City General Hospital operations and Missouri Regional Medical Program planning, including the Executive Director of the Kansas City General Hospital. Several proposals related to the Kansas City General Hospital have been submitted by the Missouri Regional Medical Program to the Federal Government for review. A project to develop programmed comprehensive cardiovascular care at Kansas City General Hospital is pending final review by the Review Committee and the National Advisory Council on Regional Medical Programs. Planning studies are underway on manpower training and postgraduate medical education in heart disease, cancer, and stroke.

Mr. ROGERS. How do you evaluate your regional medical program? Could you let us know the criteria used for evaluation? I think the committee would be interested in that.

Dr. MARSTON. Yes, sir.

(The following information was received by the committee:)

DEPARTMENT OF HEALTH, EDUCATION, and Welfare STATEMENT ON THE CRITERIA FOR THE EVALUATION OF REGIONAL MEDICAL PROGRAMS

Each planning and operational activity of a Region, as well as the overall Regional Program, receives continuous, quantitative and qualitative evalution wherever possible. Evaluation is in terms of attainment of interim objectives, the process of regionalization, and the Goal of Regional Medical Programs, easily accessible improved patient care for heart disease, cancer, stroke, and related diseases. The criterion for judging the success of a region in implementing the process of regionalization is the degree to which it can be demonstrated that the Regional Program has implemented the seven essential elements of that process: involvement, identification of needs and opportunities, assessment of resources, definition of objectives, setting of priorities, implementation, and evaluation. Ultimately, the success of any Regional Medical Program must be judged by the extent to which it can be demonstrated that the Regional Program has assisted the providers of health services in developing a system which makes available to everyone in the Region improved care for heart disease, cancer, stroke, and related diseases.

It is also important to note that each Regional Medical Program is encouraged to build self-evaluation methodologies into its ongoing program. These evaluation methodologies then form an integral part of the total evaluation of the Region's program.

A fuller description of the process of regionalization is contained in the Progress Report on Regional Medical Programs (see p. 13) which was submitted for the Record during the hearings on H.R. 15758 and is the process upon which interim evaluations of each program are based.

Mr. ROGERS. I know on page 2, section 103, it is simply a correction to allow the District of Columbia, Commonwealth of Puerto Rico, and so forth, in. This amends the public health law itself.

Doesn't this go to the entire act?

Dr. LEE. Yes.

Mr. ROGERS. So that this would affect every program of the Public Health Service, would it?

Well, perhaps you can give us the information.

Mr. KARL YORDY (Deputy Director, Regional Medical Programs, HEW). Actually, there is a general definition in the Public Health Act which does not include these additions. These additions have been made to certain other programs in the act. This is bringing the regional medical programs into line on that.

Mr. ROGERS. Thank you. I am delighted to see the Department support this program for migrant health, which I have been interested in and helped to write the original law. And I took a very active part since then in following this program.

I have been very pleased with it, Miss Johnston. I think you have done a good job, and I think it is very essential that we recognize this is a program that should be continued rather than letting it get into the partnership as yet, because I don't think this has been well planned for in many of the States.

Dr. LEE. We would agree with that, Mr. Rogers, and also at the time the partnership for health comes up for review again, this would come up for review at the same time. And we would be able to then recommend, and you would be able to decide whether it should continue as a separate special program or whether it could, in fact, be incorporated within the fabric of the partnership-for-health program. Mr. ROGERS. When you look over a partnership plan from a State, will the Department see that this plan has in it the necessary guidelines to carry out this type of health program?

Dr. LEE. As we develop, and as the States develop the capability for planning, the purpose, of course, of the partnership for health will continue to be to create a mechanism in the States and permit the States to set their own priorities. We then review that in relation to the priorities that have been set within the States; and certainly in terms of national needs and national priorities, those are also looked at as they relate to these State plans.

But we want to have the States make these determinations. And this, of course, presents unique problems with the migrants, because they do move from State to State, and it is difficult to encompass that within any single State plan.

Mr. ROGERS. Our time is running out. I would like to have a rundown on the migrant health programs, what is being done, how many people are being affected, and how many people are involved, and in what areas of the country.

(The following information was received by the committee:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT ON MIGRANT HEALTH PROGRAM STATUS, MARCH 1968

Goal. To improve the health status of migrants through improving their opportunities for health services and a healthful environment.

Guidelines.—

Help the migrant help himself.

Help communities recognize and assume responsibility for including migrants in total community health planning.

Promote adaptations of community services to migrants' needs and situation.

Establish continuity of care as people move.

Utilize fully all available resources.

Get migrants included in-not further isolated from-community life.

Status (see also attached directory (p. 88) and report (the PHS report, entitled “Migrant Health Programs-Current Operations and Additional Needs" has been placed in committee files)).—

115 single or multi-county projects are operating with migrant health grant assistance in 36 States and Puerto Rico.

285 project counties offer migrants personal health and sanitation services. 155 additional project counties provide sanitation services only.

More than 200 family health service clinics operate seasonally or year round.

1,000 physicians provide migrants medical care in the clinics, in their own offices and in hospitals.

300,000 migrant workers and famly dependents were in counties served by projects for at least part of 1967. They made

215,000 medical visits; and

24,000 dental visits.

125,000 visits were made by nurses to migrant camps, other farm labor housing, and migrant schools and day care centers.

125,000 visits were made by project sanitarians and aides to home and work sites for inspection and follow-up.

$7.2 million-the total funds appropriated for grants-was obligated in 1967 and tentative commitments for continued grant support were made at the same level. Most projects have submitted expanded requests for continued grant support. These requests could not be met since the 1968 appropriation was the same as that in 1967. In each year since the program started the total amount available for grants has been obligated and approved projects have had to be carried to the next year.

Hospital Component (As of January 1968).—

55 of the 115 grant-assisted projects have hospital service components. These projects are located in 25 States.

162 hospitals have signed agreements with projects to provide migrants hospital care.

190,000 migrant workers and dependents are included in project areas covered by hospital service.

3,000 migrant workers and dependents have had bills paid under the program. (This is an underestimate due to the time-lag in getting paid bills in for processing.)

$1,307,836 has been obliated thus far (1967 and 1968 funds) for in-hospital services, including hospitalization ($946,576) and physician's services ($361,260).

Program Needs.

441 more counties need to be covered with personal health care and 286 more counties with sanitation services in order to meet the needs in all 726 counties with an annual influx of migrants.

Approximately 700,000 additional migrant people need to be brought into contact with services.

Medical and dental services need to be expanded. At present migrants in project areas are using medical services at about one-fifth and dental services at about one-twenty-fifth the rate for the general population. Undiagnosed and untreated conditions among migrants as the result of inadequate access to care need to be brought under treatment. Present estimates indicate that among migrants outside project areas there are

5,600 with diabetes;

5,000 with tuberculosis;

9,800 children with iron deficiency anemia;

3,000 children under 18 with cardiac damage as a result of rheumatic fever; and

many thousands of children and adults with visual, hearing, dental, and other uncorrected defects.

A DIRECTORY OF MIGRANT HEALTH PROJECTS ASSISTED BY PUBLIC HEALTH

SERVICE GRANTS

INTRODUCTION

The Migrant Health Act of 1962, as amended in 1965, authorizes the Public Health Service to make grants to assist communities in extending local health services to migrants. After local plans are approved, grants are made to public or private nonprofit organizations to pay part of the cost of health services for migrant farmworkers and family members.

The 115 projects listed here were receiving grant assistance from the Public Health Service in August 1967. Located in 36 States and Puerto Rico, these projects provide both sanitation services and personal health care in some 330 counties and sanitation services alone in 150 additional counties. The information for each project is from the project's application and report.

PURPOSE

The directory can assist project staff members and others concerned with migrants in identifying places where projects offer services to migrants along the major migratory streams. It can also facilitate intrastate and interstate patient referrals, as well as interproject communication for the exchange of information and ideas.

Each project description includes a reference to the duration of the migrant season. Projects in the northern work area are operational only during the months shown. However, many have one or two key staff members available throughout the year to answer questions between seasons, and to do the necessary postseason followup and preseason planning and negotiation.

ARRANGEMENT

The States are arranged alphabetically, and the projects are listed numerically by project grant number within the State.

The location of family health service centers is included in the description of projects which operate one or more such centers. Typically the centers are temporary facilities, open periodically at times and places conveniently accessible to migrants. At the centers, physicians provide medical treatment, immunizations, and other health services with the assistance of project staff members.

DEFINITIONS

The estimated number of migrants includes workers and family dependents present in the project area. The estimate shown for each project is that made by the project itself. It includes both persons moving within the State and those moving out of the State.

Health services provided are listed by type. The various types are defined as follows:

Medical care.-Care of the type usually provided by a family physician, including both remedial and preventive services. It may be provided in a family health service center set up for the purpose in or near a large concentration of farm migrants, or it may be provided upon referral to a cooperating physician's private office, to a hospital outpatient department, or to a preexisting clinic or health service center. Mobile units are occasionally used.

Hospitalization.-Hospital and related professional care for up to 30 days for any one admission in a general, short-stay hospital.

Dental care.-Care to remove infection and relieve pain. Some projects also provide limited restorative care, especially for children.

Nursing care.-Home visiting for casefinding, family counseling about health problems, and related purposes. Nurses and aides working under their supervision also refer migrants to sources of needed care and make followup visits to determine the outcome of referrals. In addition, nurses work in family health service centers.

Sanitation services.—Inspecting living and work sites of migrant workers and families to determine health and safety deficiencies and obtaining their correction. Health education.-Formal or informal teaching of good personal or family health practices. Health education is shown as a service component only for projects which have a planned program of health education with part- or fulltime assistance from a professional health educator. However, informal health counseling is considered as part of the job of every project staff member. The educational work of the health educator and other professional staff also extends into the community to help develop understanding of migrants, and of their needs for health care and a safe, healthful environment.

Nutrition counseling, and social work.-Only a few projects with sufficient funds and professional manpower are able to provide these important services.

PREPARATION

This directory was prepared by the Migrant Health Branch, Public Health Service. All Regional Migrant Health Representatives and project directors cooperated in providing the basic information.

ARIZONA

Project Title: Maricopa County Migrant Family Health Clinic Project (MG 29). Sponsor: Maricopa County Health Department, 1825 East Roosevelt, Phoenix, Ariz. 85001; Telephone 602-258-6381.

Director: Raymond Kaufman, M.D.

Duration of migrant season: Year round.

Estimated number of migrants: 16,671.

County served by project: Maricopa.

Health services provided: Medical care, dental care, nursing care, sanitation services, nutrition counseling, and health education.

Location of family health service centers: Avondale*, Buckeye*, El Mirage, Glendale*, Guadalupe, Harquahala, Queen Creek, Tanitas Farm, and Tolleson*.

Project Title: Assistance to Pima County Migrants (MG 49).

Sponsor: Pima County Health Department, 161 West Alameda Street, Tucson, Ariz. 85701; Telephone 602-623-5071.

Director: Frederick J. Brady, M.D.

Duration of migrant season: Year round.

Estimated number of migrants: 1,200.
County served by project: Pima.

*Mobile clinic.

« PreviousContinue »