mY 1971 - National Institutes of Healthcims,willbeoneofthetiir~ctsOfaid~dcranr; ... patient....

\

..

-. ..-.

mY 1971

ofHealth,-.

Educatim,

,,

,.

,,

,,‘.:t :.andWelfare ::.,:!.[,,

HealthSemicesandMentalHealthAtitiistration ;~~$(,,.

WgionalMedicalProgrm Sewice , \,,!,

Officeof -unications andWlic Information ~,,’

‘~esevignettesonRegionalMedicalProgFamactivitieswerecompiledessentiallyfxommaterialreceivedfromseveralof fie WS *bgFebruary1971, ~wterial wassubmittedinrespo~etoa requestforinfomtiononactivitiesthatrepresentedinnovativeapproaches;tomeetingregionalhealthneeds,Wyof thevignettesdescribe ~activitieswhichdependon theskillsof tiem professionalstaffs:representingtivestientsof ttieandfundsfromfieprofessional ;staffbudgetsratherthanseparatelyfundedprojects.

ll~ebriefs-ries whichfollowaretitendedtobe anecdotalfor ;purposesof illustrationxathert~ toprovidea fulldescription:of~ activities.Formoredetail~informationontheorganizationandactivitiesof~s, thereadershouldconsultthe”Fact’B6dkon ~~•ˆRegionalMedicalProgramsthathasbeenpreparedby theMglonal :MedicalProgramSenlce.

Manyof thevignettesdescribeactivitiesthatfallwithintiescopeofthe President’snationalhealthstrategy.me President’sHealtiMessageof February18,1971outlineda sfi-pointprogramto @lementthatstrategy.me vignettes,therefore,arearrangedunderthefourpointsof thatprogramthataremostrelevanttoM. Manyoftheactivitiesrelatetomorethanonepoint,andintheseinstancesthesmries arearrangedaccordingto tiemainemphasisinthe ~vi~ette,notintheactivity.h indexisincludedwhichprovidesafurtherbreakdownbysubject.

i.

me selectionofactivitiestobe ticludedintis compilationis ;:.

somewhatarbitra~in thatanequalor largerntier of illustration:withintheses- subjectareasandwithinadditionalareascouldhavebeendrawnfromotherRegionalMedicalPrograms. ;!

(!,i.,,.:,:.{

;:(;i

. f:,,~i;,\,’~

;1i;

Page

Preface. . . . . . . . ● . ● . w . ● . ● . ● . . ● ● ● ● ● ‘ii

A. REORGANIZINGwDELI~Ry OFSERVI~

1. I~rovedSystafor WliveW ofCare . . . . . . : 1

2. HealthMaintenanceOrg~izations. , . . . . . . . 16

3. EfficientUseofHealthCareTe*ologY . . . . . . 20

B. MEETING~ SPECIAL~~OFS~CI~ W

10 RuralHealtiProgr~s. . . ● ● * “ “ s ● ● ● ● ● ●’25

2. NeigWorhoodHealthCentersandCltiics. . . . . . 32

3. AreaHealthEducationCenters. . . . . . . . . . . 43

C. MEETING~pEwwL~E~ OFOUTGROWINGMEDI~ SYSTEM

1. I~rovedServiceby ExistingPhysici~s,Nurses,and~lied HealthProfeSsionals. . . . . . . . . 45 ;

2. IncreasedUtiliZati~ofNw ~s ofAlliedHealthProfessionals. . . . ● ● “ ● c ● ● “ c ● 61

1. EarlyDetectionofDisease. . . . . . . . c . ● . 72 ;

2. HealthEducati~andInfomtion . . . . . . . . . 7g

-v-

WSAS

llX1’1.!l?lMl~Nl’AIJIJJ’AJ;JIIJ)JjJ,I~.RySYSTIM

A ruralArkansascountywhichj.sagriculturallyricht]utwhichhasnophys~cims,willbeoneof thetiir~ctsOf aid~dcr anr;xP~r~mcntal:Jlcalth~livcryProjectbeingadministeredbytheArkansasRegionalMdical ProgramandtheArkansasComprehensiveHealthPlanningProgr~.,,

Motherproject@rget isanareainsoutheastArkansaswith? ~ppulationof 70,000anda physici~wpulationofonlY13c :;

Theprojectwill’covertheentirestateofArkansasandwilldealwith’.,,,;

fiveproblemareasidentifiedashealthmaintenmcemd preventive~sewices;manpowerrecruitment,training~d distribution;distributionofresources;emergingmedicdservices,andqualityofcare. The ,experimentalhealthdeliverysystawillbebuiltupontheregionalhospitalconceptwhichiscurrentlybeingevolvedintheState.Thisconceptproposestheorganizationof eightgeographicaldistricts>bachwitha regionalhospitalcenterwhifiwillsemicethermining ~hospitals-~th~thatdistrict~ .

Status:Professionalstaffactivity“@erimentalHealth%wicesPlminzand DelivewSYst~s”Grant-=$1,064,000(24&nths) ,:

1

Pro~amcoversTheArkansasRegio~l~dical theentireStateof }~k~~, andhasbeenoper&tiOnals”ince”Februaw1, 1969.Its ,commitment-levelform ig70W= $887~506~d for~ lg71WaS$1>209~25}~Thesefundswereusedin1971to’support”atotalof 15projectsyof~;which4 werein theareaofgeneral‘continutigeducation,5for tra}plng.existinghealthperso~e~~.newskills)3 for”a~b~at~on ‘f~t~entandtrainingsenices,l’forcoordinationforhealthse~lces} ~.

,2for:

RGD,anda ntier of coreactivities. ,, .yj,..,

-1-:..,.i:..

MTSSOIJRT

A rehabilitationcenterhasbeenconstructedina ruralMissouricomity as theresultofa programofe~andedmedicalservicestotheareasupportedbytheMissouriRegionalMedicalProgram.Tntensivccareservices,rehabilitationservicesmd a homehealthagencywereset up in%ithville,whichwaswithouttheseservicespriortothethree-yearMRMP project.Aftertheseservicesweremadeavailable,theincreasedabilitytoprovidepatientcaremadeitfeasibleforthecomity toraise$500,000whichwasmatchedbyHill-WrtonfundstoconstmcttheSpelmanRehabilitationCenter.

At theendof thethreeyearperiod,MoRMPwasabletowithdrawa~stallof itsfundsfromtheactualoperationof theservicesastheybecameself-supporting.Ithasnowbeena yearsinceanyMoRMPfundshavebeene~endedinSmithvilleandtheseservicescontinuetobe self-supportingandof servicetotheultimateconsmer,thepatient.

Status:Operationalasof4/67- 4/701styear--$200,9572ndyear--$141,4733rdyear-- $48,745 +.

me MissouriRMPcoversthe’StateofMissouri,exclusiveofMetropolitanSt.Louis,.andhas.beenoperationalsinceApril1,1967. Itscommitmentlevelfor~1970 was$3,074,230,andforH 1971was$1,947,417.~esefundswereusedh N 1971to.supporta totalof 29projects,ofwhich1 wasintheareaof generalcontfiu~geducation~lfor $ralning?xistinghealthpersomelinnewskills,1 fortrainingnewhealthperso~eltiTfor.patientservices’demonstrations,6 fora combinationofpatientservicesandtiain~g,11forcoordinat{onforhealth,sqrvices,~2 for.R&D,anda nmber of coreactivities.

,.,.

-2-

~IH h~ICI~

Inm efforttoraisethequali~’of

CALIFORNIA

medicineh theWatts-Willowbrooksectionof LosMgelestheCaliforniaRegionalMedicalProgramisfin-dinga Department‘ofcomity MedicinefithenewhosPitalfiere.

~.

partof theCharlesR.DrewPostgraduateMedicalSchoolintheMartinLutherKingJr.General1iospital,thedepartmentwilldwelopa systemofmedicalcaret?sene tiecomityts 400)000medicallY~digent ~blacksandMexican-America~.

Scheduledtoopenti~iswinter,thehospitalwillbe thefirstinLosAngelesCountytomakeanefforttoplaceprivatepractitionerson thestaff.heal generalpractitionersIIavebeenencouragedtoenrollinanintensivecourseinfamilypracticeat theDrewMedicalSchoolwhi.~willmakethemelfgibletopasstheFamilyPracticehard. cm md ~theWiversityofSouthernCaliforniaareco-sponsoringthecourse.‘

{

-ty Medicinewillhavea privatelYf~ded ~~•ˆ311cDepartmentofCohealthcareerspro~amtoprovidefinancialassistanceto localresidentsinterestedinhealthcareers.Nso includedinthedepar~entwillbea WDEX programtotrainmilita~ex-co~smen~a s~ool of all~e~healthprofessions,a comity mentalhealthcenter,anda clnlcal~researchfacility.

.’.

Status:Operationalasof 7/681styear.-$211,3752ndyear-$498,3143rdyear-$441,338

.,

‘,

>“

.!;

,:’~,,

Californiaandtiocountiesme California~ coverstheentireStateofinNevada,andhasbeenoperationalsinceJulYl)lg680 Itscotitment

levelfor~ 1970was$8,012,055andfor~ 1971w= $6,220,0g4.~esefundswereusedin~ 1971tosupporta totalof 24projects,.ofwhl~~3 werein tieareaof generalcontinuingeducation;4 fortralnlnge~+stinghealthpersomelinn~ skills~1 fortrainingnewhealfipersonnel,;6forpatientse~i~s de~nstration??8 fora combinationofpatient~servicesandtraining,1 forcoordinationforhealthservices,1 for~~R&D,anda ntier of coreactivities. ‘f

{-3- ~

Thewe ofmilitaryhelicoptersandco~smentoprovideassistancetocivilianvicttiof trafficacci~ts andothermedicalaergenciesisbeingtestedtiththecooperationoftheColorado-~~g, MwtainStates,TexasandWastigton-~as~~gion~ Mdical~ogr~. TheMs broughttogetherCM

.~ providersof emergencymedicalsemices

forthepqose.oforganizingand@lementingthe~lita~ksistancetoSafetyandTraffic(~T) programintheirRegions.

Theprogramusesexisttigpersonnelandquipmentfrmmilitarytits intheareatotransportpatientsfromthesceneof theemergencyto tieappropriatemedicalfacili~or tocarrymedicalspecialistsandquipmenttotheemergen~scene.Interhospitaltransferof criticalpatientsisdso handledbyWT.

ThefeasibilityoftheprogramiscurrentlybetigtestedinareasofTexas,@lorado,Washington,hizonaandIdaho,Theprojectissponsoredby eightgovemnt agenciesandisatiisteredby a projectteamfromtheApartmentsof~fense,Transportation,tidHealth,E&cation,andWelfare.

Status:Professionalstaffactivity

-4-

T1/J-s’rA’l’li

Fivecomity hospitalsonthenorthshoreofmssa~.husettshave,be~home careprogramsthroughtheeffortsof theTS~@ andtheMassachusettsHospitalAssociation.Suchprogr= willprovidecon-tinuityof careforhospitalizedpatientsafterdis~arge~aswel\asreducethelengthofstayinthehospital.TO date>onehospit?lh~.achieveda fullycoordinatedhmecarepro~m withexcellent~mlti-disciplinaryinput.Threehospitalsareplanningtohire ~fill-timenursecoordinatorsad.PAY~.oPeneda~~ mroved info~ationtiterchangewiththelocalVisitingNurseAssociation.me hospitalmovedtheV.N.A.ri~htintothehospitalbuildingandalsoappointedafull-timequalifiedwnurseascoordi~ator. -

status:Professionalstaffactiviv$2,500contract

. ~eTri-State~ coverstheentirestatesofMassi*Wetts,Mode ;Islmd,~dNw Hampshire,’and,has,been’@.era\i~alsinceFeb~a~ 1~1969.Itscmi~ent levelforN 1970was$1,467,436~d for’~TB•€UB••VB~ 1971,was$1,814,132.These”ftidswere~qed”inm l?7~to SUPPOrt ‘a totalof 5 projects,of~i~h”lfiasfol~~aiqingex~s~lngh~?l~personnelinnewstills,z forpatient.se.wlces’demonstrations,~z fora combinationofpatientservises~dtzqiningy~d a n~be~of coreactivities.

\ , , ~,..,’,: l{~

.,

,.

r

MISSO~I

h improvedsurvivalratefollofingcardiacarrest,tiebuildfigof=additiontoa hospital,andthestimulationof stiilarprogramsthroughoutMissouriarethreeresultsof a cardiovascularprojectinSpringfield. ,

Springfield’sprogrmof comprehensiveatiission-to-dischargecareforallhigh-riskcardiovascularpatientslocatedina singleprogressivecaredivisionhasachieveda 30percentsurvivalratefollowingcardiac *

arrestandiscreditedwithsavingat least100 livesoverthelastfouryears.A cardiovascularcarenurse.training’Progr~)whichaccePt5applicantsfromallovertheState,wasstartedaspartof thisproject.

Theprojecthadbeendeadlockeddueto lackof fundsuntil1967,whentheMissouriRegionalMedi=lProgramfundedit. Theco~~itY wasthenabletobuild,tithprivatefunds,a $lOmillionadditiontoSt.Jokis }Iospitalwhichistobe completedbytheendofthisyear.

Anotherlargelyunexpectedresultisthatsimilarcardiovascularprogramshavebeenstartedinsmallercomunityhospit~sintheOzarks.At least18of 35hospitalsinthisruralareanowhave@roved carefacilitiesunderconstructionor intheplamingstages.

Status:Operationalasof 4/67- 6/701styear--$69,3472ndyear--$153,9783rdyear--$373,905

TheMissouri~ covers.the”pt?teofwssouriz‘xclWiveofMetroP1itm ;St.Louis,andhasbeenoperationalsinceApril1,lg67. Itsco~l~entlevelforw 1970w~s$3,074,230~d for~ lg71w= $l~g47~4\7*,~es?:fundswereusedin~ 1971to”~~rt’a totd’of,2gprojects,’?fwhl~‘.

&

1 w=.intheareaofgeneralcontinu~ge~u$ation$1 ‘or‘raining‘xl~tnghealthperso~elinnewskills,lfortralnmgnewhealthpersonnel,forpatientservicesdemonstrations,6 fora combinationof patientservicesR~D,ad

andtraining,11”a numberof core

forcti’rdiwtionforh~alt!se~ic95>2 for.activities. ,,

-6-

ILLINOIS

me mosteconomicallydepressedsectionof ficagowillhavea unifiedheal~ careprogr~toserveits350,000indigentpersons.Local ~D•ˆcitizensformedtheMid-SouthsideIIealthPlanningOrganizationandcompleteda comprehensiveplanfordelivery,ofhealficare.me plansturn thefra~entedavailablesemicesintoa comprehensiveprogrm.,IncludedinthepTogramaretheareafssevenhospitals. ,,.,.;.

ll~eorganizationwasfunded

Status:Professionalstaff1styear$18,432

by theIllinoisRegionalMedicalProgram:

activity

:.

,,,.

,,j:. -’

me IllinoisRMPcoverstheStateof Illinois~’withtheexceptionof’[ ‘.thatpartincluded.intheBi-State~, andhas.been,operatlonalsinceFebmary1, 1970. Its.ctiitment’levelfor~.1970was$l~585,643,~dfor:~ 1971w= $l,5z4~2860~ese fundswere~~d “tin197! tosupporta totalof 7 projects,ofwhich4,wereforpatientsetii:e.s’d~??stra~tions,z forcoord~ati~”for,heal~sevice$>’lfor~~D?ad a~~e~.“!i,ofcoreacti~tie$o., ,. ., ,. ., . , ~~•

i.!,i;;:

II*I

COLOW/wOMING

A newlaborato~intheSanLuisValleywillcutby atleastone-thirdtheamountof ttieneededtodiagnosisstreptococcal~ectiom. ThisvalleyinSouthernColoradohasthehigheststreprateinthenation,a ratefourttieshigherthantherestof theState.Thepopulationis80percentlow-incomesp~isll-~eric~~Inaddition;fiereiSasunncrmigrantfarmworkerpopulation.

Beforetilelabwassetup,spectiensfromSanLuisweremailedfordiagnosestoDenver,adistanccofmorcthan200files.me lapseoftimeoccuringin tieroil-inprogr~oftenkepthealth.perso~elfromtreatingpatientssoonenoug~~topreventseriousco~llcatlonssu~ .asrhcmaticheartdisease.

Theblorado/WyomingRegionalMedicalProgrambroughttogethernearlyqhalfdozengroupstoestabllsnandfundthelabfacility.

Status:Professional$3,118

staffactivity

Regional.andhas

TheColorado-Wyoming MedicalProgramcoverstheStatesofOloradoand,~~g> . beenoperationalsinceJ~MW 13 lg6g.Itscotitmentlevelfor~ 1970was$1,176,282.Wq;for:~ly~l was’.$963,224.Thesefidswere~ed inn 1971’tosuP@fl,?totalof13Ptijects,oftiich,lw- intheareaof generalcont~u~g’edu~!ipn~6 intheareaoftraintigexisting”health’Perso~el:~newskills~;l

3 inpatient’se~ices’d~onst~ti~~,intrainingnewhealthpersomel, ,.,1 incoordinationforhealthse~ices)1 forR~Ds~d”a ‘tier ‘fcore

.

activities.

-8-

.,

(:losingof thehospitfllintl~ciso~atcdco~i tyof Southllcnd,Washington,md ficdr~~tlcredust~oninhealthcareintheareathatwouldhaveresultedhavebeenavertedthroughtheeffortsof theWashington/Al~kaRegionalMedical~ogr~” EarlYin 1~70>the.Ad-ministratorofWillapaHarbor~lospitalcontactedW/ARMPconcerninganextremeshortageofp~lysici~m~powcrintheareafil~~threatened.toforcetheclosingofhishospital.Fornearlytenyearstilecomityhadbeenattemptingunsuccessfullytorecruitnewphysici~s.w M ‘[staffresponded,spendingmanydaysovera periodofmonthswik localcitizensandhealthproviders.W/- wasinstmentalh organizingcomunityinterestandresourcesandin introducingoutsideresources,suchas theWiversityofWashingtonDivisionofComiv Development,theOP “B”agency,theCo~tyHealthDepar~ent>~d interestedphysiciansfromtiene~estlargecities”~ a resultofW/w-activities,thefirstnewphysiciansinyearshavenowlocatedin thecommunity,theCountyliealthDepartmentisprovidingadditionalsemicesbeyondthoseformerlyoffered,andseverallocalhealthservicespreviouslynotavailablehavebeenarranged.me localhospitalwillnotonlysurvivebutwillbe abletoimproveitsservice.Inaddition,contactsinitiatedandencouragedbyW/W ~haveresultedintiledevelopmentofanew andpromisingrelationship, ,“betweentheVirginiaMasonMedicalCenterinSeattleandtheWillapa”1larborHospital.Regularvisitsofhospitalpersonnelareoccurringinbothdirectionstoimprovethequalityof carethroughconsultationservicesandcontinuingeducation.


Washington/Al=~W coverstheentireStatesofWashington~di,MaskaandhasbeenoperationalsinceFebmaw 1,lg68. ~eir Cotit-mentlevelw= $1,606,157for~ 1~70’~d$1)447~8~5for~ lg?l~ ‘~~ese fundsweremed in1971tos~porta totalof 22projects,of -which7 wereforgeneralcontinu~geducation,3 fortrainingexistinghealtipersonnelinnewskills,z forpatientservicesdemonstration;.l,fora combinationof training~d patientse~ices,3 fo~coord?natlonforhealthservices,6 forR6D,anda numberofcoreac~ivlt~es.,~,,.4,, ,.....

-9-

., ..

andstrokearclivingusefulandtheestablishmentoftheIfiartonindependentlivesas a resultof

RehabilitationCenter.TheCenterwassetupwi~ ties~Portoffie. .

Texas~~ toservepatientsfromtheCaneyValleyFlemorialHospital,GulfCoastMedicalCenterandothercomities ofthesurromdingsevencountieswhererehabilitativesemiceswerepreviouslymavailable.ExpertiseinmethodologyandprocedurestoimplementtherehabilitationprogramwasprovidedbytheBaylorCollegeofMedic~eatH?uston:Inadditiontoprovidingdirectpatientse~icesjthepro~~ ~ScoPlngwithproblemssuchasmanpowerneedsfortreatmentandservices,continuingeducationforphysiciansad alliedhealthprofessions,andincreasedcomity involvement.Theprogram!sacceptanceby thecommunityhasbeenassuredby thedegreeofparticipationbyphysicims,hospitals,socialandfrate~al90UPSad comi~ agencies”Acriteriaof theprogram’ssuccesscanalsobe measuredby therecentproposalof comity hospitalstoass~e,wi~~ a shortPe:iod.oftime,theentirefinancialassumptionoftheMartenRehabllltatlonprogram.Theprogramhasservedasa prototypeforthedevelopmentofothersuchactivitiesinvariouspartsof thecomtry.

Status:Oncoin~asof 7/1/68. .1s;ve=r-$100,9472id~ear- $127;0633rdyear-$72,068

,

IheTex~ RMPcoverstheentireStateofTexas,~dhas beenoperationalsinceJuly1,1968. ItscommitmentlevelforN 1970was$2,220,891,andforR 1971was$1,158,696.ThesefundswereusedinW 1971tosupport.a totalof 20projects,ofwhich4 wereinthe’areaofgeneralcontinuingeducation,4 fortr~ningexistinghealthPerso~~lin’n~ skills~1,fortrainingnewhea~thpersonnel,5 forpatientservicesdemonstratlo~,z fora combinationofpatientservicesandstraining,3 fo~$oordin:tionforhealthse~ices,1 forR6D>’ad a n~er ‘fcoreactivities.o

.

II~Cuscof specialstrokefacilit~csmd a‘teamapproachiscrcditcdwitha dropof almst a thirdinthedeathrateofstrokepatientsat theColumbiaHospitalincentralSouthCarolina.

Beforetheinstitutionofthestrokeproject,sponsoredby theSouth@rolinaRegionalPledicalmogr~, thedeathrate~ong patientshospitalizedforstrokewasS2percent.Aftertheopeningofa specialstrokeunitinthqhospital,theratedroppedto19percent. ...

Thereisan extremelyhighincidenceof acutecerebralvasm]]ar’dis~a<’~(stroke)inthecentralregionofSouthCarolina.ThestrokeprojectmakesthefirstcomprehensiveattemptintheStateto tiprovediagnosis,mmagementandrehabilitationofstrokepatients.

Thestroketem includesnurses,a speechtherapist,a dischargeplanner,anda publichealthnurse.Theteamapproachhasbeenfoundto speeddiagnosisandmanagementofpatientsandpermitsearlyrehabilitation.Intensiverehabilitationisstartedalmostimmediatelyafterthepatientisadmittedjmdhas shortenedtheaveragehospitalstayfrom21days”to 16days.Thishasreducedhospitalcostsnearly25percent.

Status:@eratiomlasof 8/68~;~~;;~‘-$108,652

--$69,2473rdyear--$ 62,906

TheSouthCarolinaM coversthe’entireState‘ofSouth’Carolina‘Itsco~ltmentlevel’f%d:“hasbeenoperationalstice’August’1,1968.

. ,.>

w 1970was$988,082andforW1971 was$958~340.‘Thesefundswereusedti.~ lg71toswrt.;a t~t~lof l!P~jectsYof-fiich.2Were”’+ri’:’theareaofgeneral’cont@u~geducation,5 fortr?.~lngexlst~ghe?lthpersonnelinnewskills,7 “forpati&nt’servicesdemonstrations,1 fora combinationofpatientservicesmd training~1 forcoordi~tionforhealthservices,andanumberofcoreactivities.

-11-,,:

fiduseofhelicoptersto transportvictimsofcoronaryattacksandothermedicalaergencies’md for,the”delivefiofmedicalsefiicesisbetigstudiedh a projectqrted by the’WestVirginiaRegional~~mlProgrm. A statewide~st~isbefig developedtomeethealthtransportatiaprobltiina mo~ta~us areawitha rural,Uspersedpoptiation,poorhigtiysystem,andscarcityofhedfi care,resources.Variommodesandreties’ofmodesoftransportationwillbe tialyzedaswellasemergencyfacilitiesandC* cationsnetworks.mestudyisbe@ conductedby the”WestVirginiaWiversityCollegeof~gineeringh cooperationwiththeMversity’sSchoolofMedicine.

Status:Qerationalasof1/70lityear-$22,3082ndyear- $12,104

. . . . ..

~e WestVirginiaM coverstheentireStateofWestVirginia,andhasbeenoperationalsinceJanuary1,1970. Itsc-went levelforn 1970was$S24,048and’for~ 1971w~ $S80,978.~ese fun~ werewedin~ 1971tos~xt,a.tqtal ofq projects>ofwhi~ ~w~ ‘or.traini~exisftighqalfimrsowel ti.newskills~,l-fo~??~lentse~ces d~ons~,fatiq~,,2 for:ND,:anda ntier ofcoreactivities.

, ,, ,.

... :,....- ,.

-12-““

mw

A ~m~~SIW P~GW ~R KID~ DIS~E

me controlof renaldiseaseistheaimof a networkofregionalmedicalcentersinArkans=supported.bytheArkansasRegionalNledicalProgram.me centerswillbe ltied,totheWiversityofArkansasMedicalCenterinthecentralpartoftie’Statetieretreatmentofki~ey disease : ,patientswillbeprovidedthroughprogramsoftransplantation,didysisandtrainingforhomedialysis.me systemofsatellitecenterswillprovidenotonlybackupdidysisforpatientsandtraininginhomc :dialysis.butalsowillserveasProcurementcentersfortransplantationatke ~dicalCenterandas educ~tioncentersforboththeph~siciansandthelaypublicconceningkidneydisease.

Status:@ratioti asof 5/711styear--$201,800

,. .

~eArk~as ~ cove~theentireState ofArkansas,andhasbeenoperatiotil,s@=, February1,1969. Itsco~tmentlevelfor~ lg70was$887~506andforN 19,71,was$1,209,251:~ese’fundswereusedhIg?ltosup~rt’atotal.of”15:projects,oftiifi4;were~ theareaofgeneral.cent-g education,5 fortrainingexisttighealthpersonnelinnewskillsj3 fo~a ctiinationofpatient~d~train~g~~~ices~’:1 forcoordinationforhealthsenices, 2 forR6D,andanwber”of >coreactivities. .,,,,.}:~!.(,... .,;,.

-13- ,,

WRTIICA~J,INA

JUGIONAJ>IZATIONOF SERI~I~S

A regionallaboratoryhasbeenestablishedinonepartofNorth.

Carolinawiththeaidof theNorthCarolinaRegionalMedicalProgrm,AlthoughnoRMPfwds wereputintotheeffort,NCRMPstaffcollaborated ‘witha groupofpractitionersandhospitalatinistratorstoestablisha singlelaboratorythatispresently”servtigthreehospitalsinNorthCarolinaandtwohospitalsinSouthCarolina.Theres~t hasbeen~rovedpatholo~ serviceswithobtioussavingsincapital .outlay.

Status:Professionalstaffactivity J

~eNorth Carolina~ coverstheentireStateofNorthCarolina, .andhasbeenoperationalsinceMarch1, 1968.Itscmitient levelforW 1970w= $2;047,486~d forW 1971was$1,844,692.These

.

fundswereusedinn 1971foratotalof 21projects,ofwhich : ;10were.titheareaof,generalcontinuingeducation,forfortrainingexistinghealthpersonnel:innw skills,1 fortrainingnw health )

~fitipersmel,,lforpatientservicesdaonstrations,5,fora cmbina-tionofpatientservicesandtraining,and antier ofcore

Patientswhoneedhealthcam butdonotrequirehospitalizationarebeingaidedbyaHom HealthCareAgencyfomed tiBartontiunty,jKansas,withtheassistanceoftheKansasM. me Agency,upon

. request of~ physicianinthecounty,willsupplysocialservices,nursing,physicaltherapy,occupational~erapyandotherassistance.

.Status:professionalstaffactivi~

.,..

. .

fieKansasM coversthe.entire”$tateofK+aS~ fidh= been. ~* operational’since,J~e13”1967,‘“’”I@cmi~ent levelfor~ 1970{‘1

w*,.$l;346~744,~dfor:~.,1971titi$ly2362220.~~se.f~~ were j@& in~.1971to s~~rt a totalof.10projects,.of@ich 6 werejin”theareaofgeneral”cm”tinuing”educatiti,3 fortrainingexistinghealthpersonnelinnewstills,1 forWD, d antierof core ~activities. ,’;,

~.$’

.*F

A ~olWrc]lensivchealthcaresystem,incorporatingtheheal.timaintenanceorganizationconcept,isbeingdevelopedina 7-countyAppalachianareain theextremewesternpartofNorthCa~olinaknownastheStateofFranklin,wi’ti~theaidoftheNorthCarolinaRegionalMedicalP~ogram.~~esystemwillincludenursepractitionerclinics,grouppracticeinprovidingprimarycaresemices~back-~hospitalse~lces)ad apre-paymentpl~.

NCM alsohasbeenassistinginthefindingofoneofthesatelliteclinicsinthissystem.TheclinicinCanadaTownshipisoneofseverallocatedinmountain!fcoves1!wherelittleothermedicalse~iceisavailable.

Withtheassistanceof theNCW,.the StateofFranklinHealthAuthorityappliedforandreceiveda IW planninggrantof $40,000fromtheIiealthServicesandMntal HealthMnistration* T

Stfltw:Professionalstaffactivity

TheNorthCarolinaW coverstheentireStateofNorthCarolina,andhasbeenoperationalsince~rch 1,1968. Itsco~i~ent levelforpy lg70w~ $2,047,486md f6f’m”1971was$l,844,6g2.These.f~~ :wereused.inV lg71tosqpprt.atotalof?l.Pr”jects~sofwh~ch10 ‘:wereinthearea’of’generalcontinuingeducation,.? ~ort~alnlng;existinghealthpe~~o~eliri-ny~skills>f?r,~ralnlng‘W,hea?th..personnel,I forpatientse~icesd@onstra~loOS,“s<fora$~b+na~lonofpatientservicesandtralnin~,,andanwberqf coreactlvltles.~ ~..,,, ,.””,.. ,,.,,,...,

.,~.i:,. ,:,~.:!.’:., ,. , ...,. ,...~l.’a,..,,

,’

-16- .,

WISCONSIN

A prepaidhealthcareinsuranceprogramforthcblackcofimunityofMilwaukee’sinnercityhashcendevelopedwiththeassistanceof theWisconsinRegionalMedicdProgram.TheCreamCityCommunityl{calthCenterhasbeenestablishedbynineblackphysicianswhoorganizedintoa grouppracticetoprovidemedicdservicesforthehealthcenterclientele.TechnicalandfinancialassistancewereprovidedbytheWisconsinw forearlyplanningoftheCenter.GrantsfundswereobtainedfromtheOfficeof~onomicOpportmity,withWisconsinRMP=sistance,tohelpsupportthefirstyearofoperation.TheCenterisworkingwith~dicaid,BlueCross-BlueShieldandtheMilwaukeeti~mtyMedicalSocietytodevelopa completelyself-supportingexperi-mentalhealthmaintenanceorganization.

.-.-..Status:Professionalstaffactivi~

.●✎

TheWiscomin~ coverstheentireStateofWisco~inandhasbeenoperationalsinceSeptember1,1969.Theircomitientlevelwas$l,og8,42gforN 1970and$951,781forN lg71.Thesef~ds were ~~usedin1971 tosupporta“totalof13 projects,of,which4were in ~the areaof generalctitinuingeducation,2 fortrainingexisting; -healthpersonnelinnewskills,3forpatientsemicesdemonstratiofi,1 fora combtiationoftrainingandpatientsemi~s, .1forcoordinationforhealthsetitis,2 forR6D,anda.nmberofcore,activities.~D•ˆ,..

-17- ,.,.!..,.

...,.,

-1S

A modelhealthservi~esystemisbetigsetup h a ruralten-countyareasurromdingCornth,~ssissippi.Theareah~ a lowticorne~pdation. Thenewsystemwillbe setup asa healthmaintenanceorganizati(~n~*led~ theKaiserpl~” ~enon-prof}t~oqorationtillbeusingthirdpartypayors,computerrecord-kee~ln~,andpreliminaryscreeningbyparamedicalpersonnel.

TheMemphisRegionalMedicalProgramhasbeencoordinatingthisprogramincooperationwiththeDepartmentof$IousingandUrbanDevelopmentandtheAppalachianRegionalComission.

. .

.,

,

Status:Professionalstaffactivity “–

TheWmphisRegiomlMedicalProgrticoversparts,ofWestem.Tetikssee,NortherntississippiiEasternMkansasandprtionsof Kentuc~and”Missouri‘mdh=.beenqefatio~ls~ce JulY1~lg680,1tsco~i~~~~levelforN 1970w= $1,284~714.~dfirNlg71w* $g5~s7220fundswereused’tiW 1971tosupportatot~:of 13p~jectsl,of@ich1 wasinthe’,aieaoftrati~g?xist~ghe~lthp~rs~~el~new skllls>2 inpati~t sewicesdemonstrations,7 ina cornbfition’ofpatientsemicestidtraining~”2 initirdinationforhealth’services,1 forRGD,andanumberof coreactivities.

“j MUM ~IG-l~R~OODIU~-1 CmR’

~C blackcomity ofWrhm hasorganizeda neig~orhoodhealth

IcenterI)asedatLincoln1lospital,me LincolnNeighborhoodI{ealthCenterwillincorporatehealthmaintenanceorganizationconceptssuch

! as grouppracticeandpre-pa~ent.,i

1

,, ~e”NorthCarolinaRe ionalMedicalPro~m helpedtheblackleaders,1 fobtainStatefundingor fiehealthcenteraswellasnon-NC~ funds,.{ forrenovation,...$ hng d]ec~ ityorganizationsinvolvedin theclinicarethellcalth,.f. ScrviccResearchCenterof thehiversityofNorthCarolina,me:!-{ ~iversityIIospital,~rhm ComtyhealthDcpartient,krhm County.-,,4:, Wntal.Ilcalth@artint, 0~ andmy others.

.;

.1 Status:Professio~lstaffactivity.Z,:

;;~: me NorthCarolina~ coverstheentireStateofNorthCarolina,and,.++ hasbeenoperationalsinceMar* 1, lg68. Itsc~i~ent levelfor-,,.+;.$ H 1970was$2,047,486andforW 1971was$1,844,692.~ese fun~s ~-.4.,,:? wereusedinw 1971.tosupporta totalof21projects,ofwhich10...

!.. wereintheareaof’generalcontinuingeducati~~4 fortraining,- cxistinghealthpersonnelinnew,skills,1 fortra~ingn~ health

i personnel,1 forpatientservicesdemonstrations;5 fora c~ination,-!,+

[

ofpatientservicesandtratiing$~d an~er ofcoreactivities” ~~atiing

-19-

.,

MISSOURI

AUI’OMATJ:DPINSICI~’S ASSTST~.

Intherur:l]townof Salem,Missouri,population4000,thepatient:-ofgeneralpractitionerDr.BillyJackBassarebeingtreatedinoneofthemosthighlyautomateddoctor)sofficesinthenation.IIerethe‘tproductsi’ofthreeyearlsdevelopmentof eightMissouriRegionalMedicalProgram’sprojectsarecombinedina physician’sofficetodemonstratehowthesetechnologicaladvancescanprovidebetter,morecompletecareofthepatientandmre efficientuseofthephysician’stime.

~is system,bymeansofcomputerterminalstidspecialtelephonelines,linkstheautomatedphysicalexaminationequipmentandthepersonnelinDr.Basslsclinictoa computerattheUniversityofMissouri ~CollegeofEngineeringinCol@ia andto theMedicalSchcol’sspecialists.Inbrief,selectedparameterssuchasEKG,spirometry,eyeandhearingexamination,bloodpressure,patienthistory,andlaboratoryandx-raydata,areautomtedandcombinedina singlecomputerprint-outwiththephysiciansphysicalfindings.Thesystemissuchthatallof theelements(exceptthelaboratoryandx-rayfindings)areavailabletothephysicianwhenhe seesthepatientforthefirstttieandtheentirerecordmaybe calledup atanylaterdate. Thisinsuresa standardized,mre completework-upfortheuseofthephysicianandbeginstoattacktheproblemofprovidinga standardizedpatientrecordpermanentlystoredina centrallocation.

Thedevelo~entof thisprojecthas,atonetimeor another,involvedalmosteveryschoolattheUniversityofMissouri>severaltelephonecompanies,manypracticingphysicims,about20comity hospitalsandis,tothebestofourknowledge,theonlysystemunderdevelopmenttodayspecificallydesignedtomet theneedsoftheindividualpractitionerasanAutomatedPhysician’sAssistant.

Status:Cooperativeeffortof 8 MRMP projects.FundingasProject#72--7/1/71- 6/30/72--$153?537

The~ssouri~ coverstheStateofMissouri,exclUsiveofMe~ro~lit~st.huis, ~dk beenoperationalS~Ce APril1>1967*.ltsComltmentlevelforW 1970was$3,074,230andforW 1971was$1,947,417.Thesefundswereusedin~ 1971to.supporta totalof 29projects,ofwhi$h,.1 wasintheareaof generalcontfiu~geducation;1 fortrainfigexIstlnghealthperso~elinnewskills,1 fortrainingnew’healthperso~el>? ~forpatientservicesdmnstratio~,6 foracombinationofpatient“senices’andtraining,11forcoordinationforhealth’services,2 fofjR~D,anda numberof coreactivities. ,i

.::

-20- .,

,.~

..*

msAs

In:1fcasjIIi.litystudyofcon~lutcrizcdJllanagcmcntof theolltpaticntdiabetic,changein i.nsultirc~:o]mlcndcdby thecon~utcragreedwit]]tiloseof theph sician98percentoftilettict Inno fist~~edid ‘

. Ltheco~utcrm ‘ehazardousTecomlendations.. . - -

.

+

,

.

me projectwasfundedby theKans=Regional~dicalProgramandcarriedoutattheKans=hiversity~dicalCenterwiththeuseofalliedmedicalpersonnel.Basedon informationobtainedatpatientvisitsandexamplesofphysiciansprescriptio~undersimilarcir-tances, thecomputerrecommendeddiet,insul~n.dosage~~ddosagefororallyadmtii~teredd~gs. ItalsosPeclfledwhen1abora-toryexaminationsandfutiher

me projectdemonstratedthattheoutpatientdiabeticwouldwithoutsacrificingaccuracy.

consultationwasnecessa~.

useofa computerinroutinecareofcutdownonthephysician’sworkload

..,,


—’—

..me KansasM coverstheentireStateofKansas,andh= been

.5

operationalsinceJune1,1967.Itschtient levelfor~ 1970W- $1,346Y744andforH 1971was$1~236~220*~ese f~dswe”re

‘,

used’inH 1971tosupporta totalof 10projects,’ofwhi*6 were “fitie areaofgeneralcontinuingeducation,3for trainingexistinghealtipersonnelinnewskills,1 forR&D,andan~erofcore ~~activities. ,. .,.:,

-21-

.’

OB,NIOMA

I\c:irtpatientsin42smallruralhospitalsaremonitoredby}~calt~~.Persomelinninemajorhospitalsina p?o~ectsponsoredbY the~klahomaRegionalMediQlPro@am. prel~lna~~ta from.oneparticipatinghospitalbasedon 73remotely-monitoredpatle?tswithconfirmedacutemyocardialinfarctionshoweda 12.5%reductionintoemortalityratefrom22.1to9.6percent.

..,:

Telephonelinesareusedbothtomnitorthebedsmd for?ur~econversationsduringemergencies.&ch phonelme c~monltorsixbeds.Thelineissplit,withthefirstpartbeingusedformonitoringequipmentandthesecondpartforemergen~comicatiqns. Them~imum

nmber ofbedsthatonetecnici~isallowedtohandle1s12.

ParticipatingintheprojectaretheVeteransAdministration,Indi~}{ealthSewice,Statead privatehosPitals~ ‘kl*om~ ~sas adArktisas.

Operationalas 5/681styear- $420,0002ndyear- $414j~~03rdyear- $354,000

me OHa~ w covers-theentireStateofOkl*~ ~d hasbeen,-..

operationalsincemy 1,196g. Itscommitmentlevelform 1970was.$l~050,145ad forw 1971was$738,500.Thesef~~s Wereuse!.in~ ~1971tO sqpOfla totaln~erof @ projects’‘f‘hlch3w?re lnthe’areao.fgeneralwnttiuingeducation,1 fortrainingexlstlnghealthpersonnelinnewskills,4 fora combinationoftrainingandpatientsetiices,anda numberof coreactivities.

;.‘.:.,1,

,

[);1iJl:;Ilo1“(.);l[~C!l.llilS t.() 1“.’rilVCl.:1 .[”CWllUll(lt.L(l IIliICS toa cj.tyhosl)ital..lT(Jr’ilr”l

c1cctrocardj.ogram,1f thedoctorisI)flrtici.patingina pho]kcnctwo,rklinkingtheECCquipmenttoa cityhospital,hecantakethepatjcntts]~(;(;inhisoffice,andbymeansofspecialattachmentstothephonerccci.ver,transfittheECGpatte~toth~hOSPitalc A machine‘n‘c “hospitalwritestheECG,anda specialistreadsit. me doctorIStoldtheresultsoverthephone. ..

~is networkwasestablishedusingColorado~omingRegionalMedicalProgramseedmoney.me costof tienit tothephysicianis$95.hits inruralphysiciansofficesarelinkedtoanyoneof severalhospitalsinrasper.wofing;~nver}ColoradoSprings,GrandJunction,andGreeley,Colorado.

Status:Professionalstaffactivity$9,494

,,

‘:

me Colorado-WyomingRegional@loradoandWyoming,andhas

MdicalProgramcoverstheStatesofbeenoperationalsinceJanuary1, 1969.

Itsremitment-levei-forN 1970was$1.176.282andforN 1971was$963,224.~ese fundswereused.inN ~971”tosup~tia totalof 13projects,ofwhich1“wash theareaof”generalcontinuingeducat~on,6 intheareaoftrainingexistinghealthpersonnel,@’new skillsj1inttiiningn+ healthpersobel’,3 inpatientsemices’demonstratiofis,1 incoordinationforhealth”sefiices,1 forR6D,andanmber df’core”activities.

.,-23- ‘

>,.

WAS]IJN(~l’ON/AJLSW

a)M)U’l’liRI;I:A5JBJ.J.,1.’1Y1’l{~;CI’

Findingoutwhentousccomputersformedicalpurposes,~d whenNOTtousethemisthegoalof theMedicalComputerServicesProjectsupportedby theWashington/WaskaRegionalMedicalProgram.Forexample,onepartof thisprojectinvolvesdete~~figwhi~ iS We mosteffectivewayofgatheringa patientlshistory,by feedinginformationtoa co~uter,by givingt~~epatienta fo~ tOfillout>‘rby 1ettingthedoctorinterviewthepatientandtakenotesinthetraditionalway.Anotherphaseof theprojectisdeterminingtheefficiencyof computersin interpretingelectrocardiogr~.

~roughtheproject,a RegionalConferenceonMedicalco~uterSeniceswasheldinthefallof 1970. Itwasthefirstsuchmeetingin theregion,andoneof tielargestintieCO~tW. me Cofierence‘ad278participantsand22exhibitors.

me M~ projectissponsoredbyWashington/AlaskaRegionalMedicalProgramandtieWashingtonStateMedicalEducationandResearchFomdation.

Status:@erationalasof 2/701styear- $35,0002ndyear- ~re activity

..

1

I

~e~Washington/~askaRegionalMedicalProgramcoverstheStatesofWashingtonandAlaskamd hasbeenoperationalsinceFebrua~1,.1968.~eir chtment levelform 1970was$1,606,157andfor~ 1971was$1,447,885.~ese fundswereusedin1971to supportatotalof 22pro-.jecgs,7 ofwhichwerefoTgeneralcontinuingeducation,3Jfortraining~exi~tinghealthperso~elinn~ skills)2 forpa~~~ntse~+cesdemon-I.strations,l.fors b~ation ofPatient~d traln~g‘e~lces~:3‘o?\ ;coordinationforhealtilservices,6 forR~D,anda numberof coreactlvltles....j

, .:!::‘.,,.; -24-

.

.,

d

AIRTRkNSWRTATIONSYST~

A State-widemedicalairtrans~rtationsystemweeklyfliesa groupofspecialiststoTarboro~wi~~gton ~d otheroutlY~gareastoparticipateinclinicsprovidingmedicalcarenotothetiseavailabletothethousandsofruralresidentsintheseareas.Theairtrans-portationsysta”has~SO flo~ki~ys ~d otherorg~s fortr~sP1atfrommedicalcentersallalongtheEasternSeaboardtouniversitycentersintheState.

Thesmallcraftarealsousedinaneducationexchangeofphysicians.WiversityofNorthCarolinamedicalschooldoctorsareflowntotheNewHanoverHospitalinWilmingtononemoningaweek. On thereturntrippracticingphysiciansfromtheWilmingtonareatraveltotheuniversityforcontinuingeducationcourses.Theruralphysiciansmakea returnflighthomeintheevening.

Threeplanesmakeup thesystemwhichhasloggedmorethanonemillionpassengermilesinitsfirstthreeyearsofoperation.TheairtransportationsystemispartoftheNorthCarolinaRegionalMedicalProgram’sfmded projectinEducationandResearchinComity mdMedicalCare.

Status:Operationalasof 6/68Componentof“EducationandResearchinCommunityandMedicalCaren1styear--$209,2002ndyear--$201,1193rdyear--$240,9934thyear--$ 74,000

TheNorthCarolina~ coverstheentireStateofNorthCarolina,’and .hasbeenoperatiomlstice:k~h1,’lg68”Itscofitmentlevelfor >N 1970was$2,047,486andform 1971was$1,844,692.Thesefundswereused“hW 1971tosupporta totalof 21projects,ofwhich10werein”the-area’ofgeneralcontinuingeducation,4 fortra~ipgexistinghealthpeisonnel’ifinewskills,lfor trainingnew.healthpersonnel,-1forpatimtsetiicesdemonstratio~~’5 fora $o~~m?ionofpatientservicesandtraining,anda numberofcoreactlvltlesi,,

-25-.

,,

.,

:.

..,:.,.,. .,..‘.

~ee tosixtem ofs~dentsofmedicine>nursing>dgntistv~Wdsocialwork’arejoifingalre~yexist~gt~.~ ofP~Qf~55~.on~ls~~workinginurbanandruralpovertyareasthissummer.ItisthehopeofTemesseeMid-SouthRegionalMedicalProgramthats~dentswor@ngfithesete~ willbe rectiitedtotheregion.The’projectispartofHfs healthcareconsortiaprogram.

~ other”consofiiapilotprojectswillbe helptiganumber’of~r~Appalachian~ities developa cooperativehealthcaresystem,andacouragingloctinon-pmfessiOnasto’participateina localruralhe”dthcueprogram.

A consortiumapproach--whichmayormaynotbe alsoa grouppractice--hasbeen”adoptedby theRegiontohelpalleviatetheshortageofhealthmanpower.Itisexpectedthateachlocalitywilladopta typeofcomprehensivehealth~replan whichbestsuitsitsnee~. Mwever$theteamapproach,useofalliedhetithperso~el,andautomateddatamanagaentwillbe includedineachplan.

Theprojecttsgoalistoc~ensate forthelowpatient/phPici~ratiointheRegion*ich is118per100,000.~e nationalaverageis141per100,000.


The’Tennessee~d-%ut~ M’ ~verkthe StateofTennesseeandpartsof.

SoutiesternKentu~,@W:be~fi operatio~lsb@Feb=V 1,lg68~ ;Itsd-t levelforN 1970@ $2~l?8~l10~for ~ lg70~$1,747,3=.These-’were’tisedinlg71 foratotalof 26p~jects,qfwhiti4.werein the”areaofgeneraconttiingeducation,? for

*

train% existhghedthxr~~~el”fin~ s~lls~3.fort~a~w new~ 7 forpatientsetiicesdefinstratlon,3 fora ,:

~dthPrk~el’

@ination ofpatientse~ces andtrahing, 2 forR6D,anda n~erof coreactivities.

-26-

.

,

. .

wRmNm m

A rural,areaofSouthGeorgiaandNorthernnlti>erof seriousautoaccidentswillhavescrviccforthefirsttimeundera GeorgiaProject.

Floridawhichhasa staggeringround-the-clockemergencyRegionalMedicalProgram

Ina typicalyear,December1,1968,toDecember31,1969,therewere1,618motorvehicleaccidentsonthesectionofHighway1-75whichpassesthroughthisFloridaresortarea.At thatttie,allhospitalsintheareawererelyingonpracticingphysicianstobe calledon arotatingbasisforemergencies.Virtuallytheonlyambulancesavailablewerethosefromlocalfuneralhomes,which,’inmostcases,didnot meetmedicalstandards.~e populationof 200,000ina landareaof 3,800squaremilesisseinedby 96physiciansandtenhospitalswithacapacityof 838beds.

~~eprojectwillstaffandequipround-the-clo~emergencyroomsintwoof thelargerhospitals--PineviewGeneralatValdostaandVereenMemorialatMoultree--andprovideemergencyambulanceswithintensivecarecapabilities.Inaddition,MoodyAirForceBasehasagreedtopro-videhelicopterambulanceserviceindireemergencies.

me projecthasbeencoordinatedwiththeCommitteeonWergencyMedicalServicesof theMedicalAssociationof Georgia,theHighwaySafetyBureauandDivisionsof theStateDepartmentsofPublicHealthandEducation.

Status:Professionalstaffactivity.

me GeorgiaRMPcoverstheStateofGeorgiaandhasbeenoperational ;sinceJuly1,1968.~eir cotitmentlevelwas$1,922,571foi,M1970 >and$1,779,862for~ 1971.~ese fundswereusedin 1971to’~support23projectsofwhich6 were intheareaofgeneralcontinuing’education,6 fortrainingetistinghealthpersonnelinnewskills,2 fortrainingnewhealthpersonnel,3 forpatientservicesdemonstration,1 foracombinationof trainingandpatientservices,5 forcoordinationofhealthservices,andantier.ofcoreactivities. J, ,.

-27-

~tter healthservicesforpeopleinruralareashaverestlltcdf~mI.inkagesbetweentheWrshfieldClinic,a 400-bedmultisenicegrouppracticemd researchfacility,andsmall.crgroupandsolopracticesinthesparselysettledNorthCentralandNorthweste~regionsof

Inaddition,,collaboratingarrangementsbetweenrural.

Wisconsin.hospitalsandtheWrshfieldClinicarenowinoperationina numberofruralcommunitiesinthearea.Throughthesearrangements,cardiologists,~temists andothers~cialtyphysici~sprovideconsultation~d

.

clinicalfollow-upservicesforoutlyingphysi~iansandhealthfacilitiesona scheduledbasis.Plansarenowundemayto establishsatellite”healthstationstobemedby speciallypreparednursestowork~conjunctionwitha small~oup ofphysicianswhopracticeinShellLakewherethere isa smallhospital.TheWisconsin~w= inst~-montalinorganizinganddevelopingtheselinkages.


●

✌✎✎

andhasbeen .Plevelwasme WisconsinM coverstheentireStateofWiscons~

-rationalsinceSeptember1, 1969.Theirco~itment$l,0g8,42gforw 1970wd $951,781forH lg71.Thes~f~ds wer~ ~. zusedti1971 to s~rt a totalof13projects,of.~lch4.we~eintheareaofgeneralcontinutigeducation,2 fortr?ln~gexlstlng.healthpersonnelinnm skills,3forpatientservicesd~onstratlon, . ‘lfoi a combfitionoftrainingandpatientse~ices,1 ~0~~oordinatiov,forhealthsemices,2.forRGD,mdanumber of core’actlvltles..\-

-28-

A betterruralhealthcaredelive~systemisbeingdevelopedforthe25,000residentsofWestCentral~ine* The.~ine~h~ aidedtieareaplmers by consultativeservicesandllmtedflnanclalsupport,resultinginanOD operation~projectgr~t fortheprop~. mearea’splanistoapproachthesolutionofmedicalcaredelivewby agrouppracticemethod,comprehensiveprepaymentinsuranceanduseofalliedhealthWrsonnelpaswellasadvancedtechnologiesincludingtwo-way

Status:

.televi~ionad radiocomication.

Professionalstaffactivi~

TheMaine~ coverstheentireStateofMaine,andhasbeenoperation}sinceJuly1, 1968. Itsc-itment levelforW 1970was$956,904,andforW 1971was$814,42?.Thesefundswerewed inW lg71”tosuPPortatotalof’6projects,ofwhi~ 3 wereintheareaofgeneralcontinuingedumtion,2 fortrainingexistinghealthpersonnelinnewstills,1 forcoordinationforhealtiservices,anda ntier of,coreactivities.

GEORGIA

l)lly~icalt]lcrapistsareworkingh partsOf~lral‘eorgia‘]lere‘“home-carephysicaltherapyw& Previouslyavailable.T1-~etlle~aPlstsare’partof a GeorgiaRegionalMedicalProgr~projectlnvolvlngfiepoolingofmedicalpersonnelto providesemicestoremoteareasoftieState.

Ina ~cmnstrationproject,thephysicaltherapistassiL~cdtotllcnorth-eastareaof theStatebecomesself-supportinginl.cssthmlthreemonths.Thepopulationof 90,000isservedbysixcomlity hospitals,onenursinghome,~d oneextendedcarefacility,with250~ot:llbegs.mly onehospitalwasprovidingin-l~osPitalrehabilitation‘ervlccs.IntheSotltkeastarea,theworkloadfortheoriginalsingletherapistbecamesogreatthata secondtherapistw~added.~~efirst~erapistwasself-supportingwi~in sixmonths.me populationOt 100>OOOisservedDV sevenco~ity hospitals,twonursinghomesandoneextendedcarefacility,witi600totalbeds” ~ere wereonlYm~~lin-hospitalrehabilitationservices.

InitiallyGM paidtilesalariesof thephysicaltherapistswhoareresponsibleforprovidingservicestomedicalfacilities,aswellasdevelonin~homecarePro=~o Similarprojectsareplaed witiother

--~lliedhealthpersonnel.typesof

Status:Operationalasof 5/691styear-$23,4342ndycar- $1$,075

me GeorgiaM covers‘tieStateofGeorgiaandhasbeenoperationalStiC~July1,1968. Theircoti~ent levelwas$l}g22?571for~ 1970and$1,779,862for.W lg71.~1,779,862~ese @ds wereusedin1?71toswpor~23projectsoftich 6 wereintheareaofgeneralcontinuingeducation,6 fortrainingexistinghsal~Perso~el tinew skills>2 fortr~in~ng :;newhealthperso~el,3 forpatientse~icesde~~t~atio?>l.fora’combfiationof trainingandpatientscrviccs,5 forcoord~atlonof“hea~thservices,anda ntier of coreactivities”

.,

-30-

A hbdel.CitiesJlealthandWtritionProgramhasbeendevelopedby theAlabamaRMPtomeetthenutritionalneedsof thechronicallyill,dependentpre-schoolchildren,andpregnantadolescentsintheTuskegee-~con tiunty~ea. Nenty nutritionalassistants,aftercompletingasixmonthstrainingcourseattheTuskegeeInstitute,willworkwiththeruralpoorto implementtheprogramobjectives.,TheseindividualswillI)etrainedtoobservefamilynutritionpractices,instructandcounselinsoundnutritionpractices,assistinpreparingteac~,ingmaterialsandmakefollow-uphomevisitstoassistwithmenuplanning,foodbuyingandcookingskills,Ileywillalsoassistwithdietary:su~eysandworkwithcommunitygroups.Othercomponentsof theprogrm.aredirectedtowardestablishinga programofcontinuingeducationinnutritionforphysicitisandalliedhealthpersonnel,andevaluationofnutritionalstatusof individualsservedbytheprogrm. Theprogr~isbeingfundedjointlybytheModelCitiesProgramandthe~abamaRMP,incooperationwithAuburnMversiq, TuskegeeInstitute,TuskegeeVeteransAdministrationHospital,ComprehensiveHealthPlting (a)and(b)Agencies,andthePublicHealthDepartment.

Status:Ongoingasof 1/1/71lstyear(+~reemnths)2ndyear-

-$26,000-$104,000

,.:

-,

TheWabamaRegionalMedicalProgramcoverstheentireStateof ,:,

Nabama andhasbeenoperationalsinceApril.1,1969.‘~eirc-t- ‘.

mcntlevelfor~ 1970was$980,709andfor~ 1971was$766,278.Thesefids wereusedin1971tosupporta totalof 5 projects,3 of ~~w]~i~lwere.fQrtrainingexistinghealtiperso~elfinewskillsad 2fortraining’newhealthpersonnel,andanumberofcoreactivities.:

-31- ,,, ,.;.:

~e’Ficl& CornerNeighborhoodhealthCenterisprov}dingPr~aW carefortheurbanghettopopulationoftheDorchesterneighborhoodof’Boston,witiswportfromtheTri-StateW, thepe~~ent ~aritiesofBoston,theBostonDepartmentofHealthandIlospitals,~d ofiers.me centerisrunby an incorporatedcowiv gro~”called1’~eDc-tcfiinedpeopleofDorchester”andprovidescarefortheapproximately

17,000residentsof thearea.

Status:Professionalstaffactivity., $15,000contract

,,

The:Tri-State’~coverstheentireStatesof~ssachusetts,modeIslmd,=dN~IIWshire~ andhasbeenoperational,sinceFebruary1,1969. Itscommitmentlevelfor~ 1970was$1,467,436andfor~~lg71w= $1,814;132.Thesefundswereus~ inH 1971tosupporta totalof S projects,ofwhifi1 wasfortrainingexistinghealthpersonnelinnewskills,2 forpatientservicesdaonstratio~,2 fora.c~inationofpatientservicesandtraining,ad a n~berofcoreactivities.,!i,,.1

A NeighborhoodHealthCenter,whichincorporatesa mltiphasichealthscreeningfacility,isbecominga realityforthepopulationofoneof SaltLakeCityfslargestpovertypockets”TheHealthCenterwillserveapproximately61,0~0residentsofa 25squaremileareawhichischaracterizedby a lackofmedicalfacilities,privatephysicians,md inadequatepublictransportationrouteswhichwouldenablecitizenstoreachhealthcareh otherareas.TheCenteriswithina~delCitiesareaandanOfficeofEconomicOppfi~itY targetarea. Itinvolvesconjointfundingby theComunityHealthService,OEO,localresources,andtheIntermountainRegionalMedicalProgram.Thesecooperativeeffortsweredevelopedprimarilythroughthel~ staffanditscomity liaisonrepresentative,whowillalsoassistintheHealthCenter’sactivitieswhenitbecomesoperativeinJuly,1971.A memberoftheIW staffwillbe thefull-the~tiphasic ScreeningProjectDirector,andanothermemberwillservepart-timeasphysicimdirector.IN fundswillprovidetheequipmentandpersonnelforthescreeningprogramandthecomputerizationof allmedicalrecordsattheNeighborhoodHealthCenter.Inadditiontoprovidinghealthcaresemices,theHealthCenterresourceswillbe expendedintrainingLPNsasscreen~gaides,ando~er healthassistmts,whowillhe selectedfromtheareasemedby thefacility. . .

Status:Ongoingsince9/701styear--$203,1842ndyear--$358,176

TheIntermountainRegionalMedicalProgramcoverstheStateofUt~tidportionsof~oming,Mntana,Idaho,ColoradoandNevad@’and’~ “.Pbeen~erationalsinceApril1,lg67.~eirc~~i~ent level’was ‘$2,582,727forn 1970and$2,152,682for~ lg71. Thes~wdswe~e.usedin1971to supporta totalof14projects~2.of~1~ We?eforgeneralcontinuingeducation,Sfor traintigexistinghealthpersonnelinnewskills;2 forpatientservicesdemonstration,3 for%~mb~ationof trainingandpatientservices,2 forR6D,anda numberof coreactivities.

-33-”

‘rRI,-STAl’11

~O~INATIONOF SERVI~S

ThecityofProvidencehasnineneighborhoodhealthcentersthathavebeenoperativesince1968.Thoughthecentershadwell-qualified~hY~i~i~s,nonehada continuingrelationshipwitha hospital.l~eTri-StateW becameinvolvedinthedevelopmentof linkagebetweenthecentersandthecomunityhospitals.Contractswereawardedtotwoof thefivehospitalsinProvidencetotiethemto thecentersintheirrespectivesectionsofthecity. Inaddition,a corporationwasformedto combinethecenters.T~ providedtheassistanceof aphysicianwithe~erienceinmedicaleconomicstodeve~oPa Pe~mentmthod of financingcareofthecenters’patients.ThirdpartypaY-

mentsarebeingorganizedwithwelfareeligiblepatientson a cavitationbasis.N1 partieshaveagreedtoanew approachanddetailsare@rrentlybeingworkedout. Thesewillbe thefirstsuchcentersinNewEnglandtobe financedon thisbasis.

Status:Professional-staffactivityTwocontracts--$47,000and$20,000

,..,:

,:,.

i.,.,’

: ,

,~e Tri-StateM coverstheentireStatesofMassachusetts,Rhode ;Island,andNewHampshire,andhasbeenoperationalsinceFebrua~1,1969. Itscommitmentlevelform lg70was$1,467,436~d for ..w 1971was$1,814,132.Thesefundswereusedin~ 1971tosupport’a totalof 5 projects,ofwhich1wasfortrainingexistinghealth@rso~el innewskills,z forpatientservicesdemonstratio~,2 for.a combinationofpatientse~icesad training),%d a n~er ‘fcore~~•activities.

.,!I

-34-

A networkof threecomity healthinner-cityareasof Indianapolisis

centersinthedisadvantaged,beingswportedby tieIndi~a

RegionalMedicalProgramandseveralothera~~ncies.‘me MetrwolitmI1ealthCouncilfoundedandoperatesthecenters.me Comcilisa coalitionofprivate,publicandvoluntaryhealthinterest,professionalandconsumers,thatdecidedtoextendexistingframeworksfordeliveringcare. Ithasdevelopeda systemforbringingpersonalized,comprehensivecaretothousandsoffamiliesforwhom,previously,access”tocareandknowledgeabouttheavailabilityofhealthcareserviceshadalwaysbeenproble~. yleConcilpulledtogetherphysicians,nurses,otheralliedhealtiPerso~elanddevelopeda newtypeofworkers,thetrainedneighborhoodhealthaide.~is teamworkstogethertogetpeopleintothesystem.Publicacceptanceofthecentershasbeenexcellent,witi15,733visitsin1969.About80%of thepatientsseenreturnforfollow-upcare. Dataandexperiencefromthisprojectarenowbefigusedtodevelopevenbroadercooperativearrangements.

Status:Operational1/70- 12/701 yearfeasibilitystudy--$169,550

me IndianaRMPcoverstheentireStateof Indiana,andhasbeenoperationalsinceJanuary1, 1969.ItscofitmentlevelforW 1970was$1,271,411,andfor~ 1971was$968,842.~ese fundswereusedin~ 1971to supporta totalof6 projects,ofwhich2 wereintie~~•areaofgeneralcontinuingeducation,1 fortrainingexistin~healtipersonnelinnewskills,1 forpatientservicesdemonstrations,1 fora combinationofpatientservicesandtraining,1 forcoordinationforhealthservices,anda numberofcoreactivities;

7C

~. medicalclinics,onerequestedbythecitizens~d theotherstartedby localphysici~s,havebeensetup in~or, ~ral areasoftheStatewiththehelpof theArkansasRegionallledicalProgram.In”theblackcomity ofWrightWille,9 milessouthofLittleRock,theclinicwasrequestedbythetownspeoplewhoerectedtheclinicbuildingandset}lpa tokenpre-paymentplandeterminedlyabilitytopay. Thephysicim-lesstownisreceivingphysicimandlaboratows~~rt fromthelocalVeteransAdministration~losPital.LocalpeopleWd personnelfromtheOfficeofEconomicOpportunityworktogetherinperformingclericalduties.Localphysici~sestablishedtheclinicat.Jacksonville,a comity witha 60percentwhite,40percentblack>population.Theclinicoffersfmilypl~ing servicesoncea week,tidhasan tiunizationprogram.Italsohasbeendevelopedwiththeassistanceofthe- andO~.

S{atus:Professionalstaffactivity

. ....

-

tieArkansas~ coverstheentireStateofArkansasandhasbeen+rationalsticeFeb=w 1>1969.Theircotitmentlevelwas$$87,506forFYlg70~d $1,209,251forw 1971. ~le?efids were@ed in1971to SUPPOfl15.P~jectsYofwhich4 ‘ere.in‘hearea‘fgeneralcontinuingeducation,5 fortrainingexistinghealthperso~elinnewskills,3 fora combinationof trainingandpatientservims,1forcoordimtionforhealthse~ices)Z forR~D~~d~~~~ber ‘fco”reactivities.

.;:.,,,

-’36-

.:

,

i

SANIZRNANIXIVALLl~Y0~-PATI~TC~~~CS

‘il~rccout-]~atielltclinicswillbc se~~.ngsixdisadv~tagedinthenortheastSanFernmdoValleyas a resultof a studyundertakenby theCaliforniaRegionalMedicalProgram.

colnllunitiesof thearea

lhcareaisinneedof additionalhealthcarefacilitiesnowduetothedestructionofhospitalsintherecentearthquake.Particularlyneededisa ncwmethodof tr=sportingpersonstotheremaininghospitals.Anewloca]hLIStransportationsystcmforpatientsistobe setUP :1sPartof theproject.

Gearedforfuturedevelopmentjntoa health’maillten:~ccorg~ization,theclinicswillbe staffedbycomity healthaides.1lcpro~~willservesixcomities whicharecontiguo~anddisadvantaged,butwhichdiffergreatlyfromonemotherincharacter”For~xwl~> onegrowiscomposedofretired,middle-classwhiteslivingintrailers,whileanotherismadeupofelderlypoorperso~whoarenotvev mobile.Athirdcontingentisa poorcomity whifiisSOpercentblack>20Per%ntMexican-Americ~.

Includedintheprojectwillbe alliedheal~ careertrafi~gprogr~involvinglocalcollegesandschools.FundsfromtieOfficeofEconomicOpportunityhavebeenr~uestedtosupplatCm monies”However,ifOEOfundsarenotgrmted,Cmwill continueitsfin~cialsWPortuntilothersourcesoffundingcanbe fomd.


TheCaliforniaW coverstheentireStateofCaliforniaandtwocounties;inNevada,andhasbeenoperationalsinceJuly1, 1968. ItscommiticntlevelforN 1970was$8,012,055andforFY 1971was$6,220,0g4.~}esefindswereusedinN 3971tosupporta totalOf’24projects,ofwhl~}3 wereintheareaofgeneralcontinuingeducation?4 fortrainingeXlstillghealthperso~elinn- skills,1 fortrainingnewhealth’personnel,6forpatientservicesdemonstrations,8.fora CotiinationOfPa~ieUt. u

andtraining,1 forcoordinationforhealthse~lces~1 ‘orservicesR6D,anda numberof-coreactivities.

-37-

ILLINOIS

VMLH CLINIC

Alt.l~ollghit.is locatedacljacenttoO1}Cof the].argestmedicalcenters~11‘the’world,(;tlic;lgots‘Yallcy’thadlittl.eav:lilablemedicalcareuntiI theopcnjngof i] freemedicalclinicin 196g.~lepop~ll~tiollof10,000inthislowincomeareaadjoiningtheWestSideMedicalCenteris95percentblack.

Whentheclinicstartedoperattig,itsserviceswerelimitedtoacutecare. Now,however,fullclinicservicesareprovided,includinggynecological,pre-natalandpost-natalcare,emergen~se~ic~s,screeninganddiagnosticcare,nutritionalcounselfig~~d socialservices.DentalandX-raycareareprovidedata back-~institution.Seriouslyillandinjuredpersonsarereferredto thehiversityIfospitalandothernearbyfacilities.

TO date,3500patientshavebeentreated.Itise~ectedtiatthisnumberwillincreaseto6000inthenextyear. Pedlatrlcteamcareisprovided.Otherteamsarebeingformedinadult,maternity,andcomity care.

TheI~ providedinitialfundingandcontinuestofundwe clinicfsinnovativeaspects.Thecostsof routinecarehavebeenasswdbyotheragencies.

statlL~:Professionalstaffactivity$71,400planningstudy

.

me’IllinoisRMPcoverstieStateof Illinois,withtheexceptionofthatpartincludedintheBi-StateIM),andhasbeenoperationals~nccFebfiary1, 1970. Itscmitient levelforW 1970was$1,585,643,andfor,~ 1971was$1,524,286.~ese fundswereusedinW 1971tosupporta totalof 7 projects,ofwhich4 wereforpatientservicesdemonstra-tions,z forc~rdinati~forhealthse~ices~1 for’R&D2~d an%ber’of coreactivities.

,’.

-38-

Indigentpatientswillbe givenprivateappoin~entswiththe-s~ef~nilyphysicianeachttietheyvisitthehospital-basedcllnlchcingsetup athtiddlesexGeneralHospitalinNewB~swick. Oneofthegoalsofthisprojectistoseeifitismoreefficientthanthetraditionalneighborhoodclinicarrangementwherepatientswaitforthefirstdoctoravailable,andthenarereferredtootherclinicsiftheyneedspecialists.

Aimingat a teamapproach,inadditiontogeneralpractitionerstheMiddlesexI1ospitalclinicwillhaveobstetrici=-mycologistsandotherspecialists.Ifa patientneedstoseea typeof specialistnotassignedto theclinic,hetillbe referredtoa specificphysici,~on thehospitalstaff.Stiilarly,ifheneedsX-rays,labwork,orpharmaqsemices,hewillbereferredtohospitalfacilities.

TheclinicwillserveapproxfitelY4,000personsbegi~inginSeptember1971. MiddlesexHospitalwaschosenasthepilotsiteforthistypeofprojectbecauseitislocatedinthemiddleof a low-incomearea. ~ding tfieprojectareMedicare,Medicaid,hospitalresources,andtheNewjerseyRegionalMedicalProgr~.

Status:1styear--$143.000

.,...’.

TheNewJerseyRMPcoverstheentirestateofNewJerseyandhasbeen ;operationalsince@ril 1,.1969.Theircomtimnt levelwas$1,237,781forN 1970and$1,225,026forW 1971,Thesefundswereusedin1971to s~port11projects,ofwhich4 wereintheareaofgeneralcontinuingeducation,2,fortrainingexistinghealthpersonnelinnewskills,1 forpatientservicesdemonstrations,1 fora com-binationof tratiingandpatientsemices,2 forcoordiantionforhealthservices,1 forR~D,anda numberofcoreactivities,

-39-

LIVINGSTON-~~~w~DIW ALLIANCE

As anoutqowthofextracareprovidedformigrantsummer.a commity clinichasbeenestablishedatcooperationwiththeStanfordhiversitySchooloftieassistanceof theGliforniaRegionalMedicalProgr~. Forthe

workersduringtheLivingstoninMedicineandwith

last25years,thisruralcommunityof3,000wassenedbyonlyonephysician.Thephysician’sofficealsoservedastheclinicformigr~tworkers.Aftersearchingmsucessfullyforyearstofinda replacemcnttthedoctorfinallyfeltableto leavethecomity whentheclinic

,.,

tookoverhealthcarere~nsibilities.

Theclinic,Aich beganoperatinglasts~er, isstaff~dqY st~f?rdmedicalstudentsandcom:mityresidents.A heartspeclallst,pedlatricianyandan internistspendtwodayseachattheclinic.Inaddition,sevenmedicalstudentsandtwostudentnursesworkthereona full-timebasis.Theclinicisopento allLivingstonresidents5 daysa weekandemergenciesarehandledon a 24-hour-a-daybasis.

~ity residentsinitiateda fund-raisingc~aign topayforsuppliesintheday-to-dayoperationoftheclinic.~eyhave fo~ed severalcommitteesto workinconjunctionwiththeclinic.Theseticlude;m’outreachprogramwing communityaidestohelpbreakdownthelanguagebarrierandtohelpcitize~ffid--mdtr~spo~ th~ to--ProPer ,medicaltreatmentinthearea;a comitteeon thespecialproblemsoftheillandagedsuchastransportation,properdiet,andregularmedicalcheck-ups;anda familyplanningcomittee.

.Status:Professionalstaffactivity

,TheCaliforniaM coverstheentireStateofCaliforniaandtwocounties “inNevada,andhasbeenoperatio~lsinceJuly1,1968.Itscomi~ent ;ievelfor~ 1970was$8,012,055andforn lg71was$6,220,0g4.ThesefundswereusedinW lg71to supprta totalof 24p~jects~ofwhich *3were intheareaofgenerflcontinuingeducation,4 fortrainingexistinghealthpersonnelinnewskills,1 fortrainingnewhealthpersoMel,6forpatientservicesdemonstrations,8 fora combimtionofpatientservicesandtraining,1 forcoordinationforhealthsenices,1 forR6D,anda numberof coreactivities.

-40-

KTMTE~+ITMIINDIANHEAL~iCLINIC

At theirlocalp~-w~s> Kimte~itapi1ndias1eam ‘fhealthclinicservicesavailabletothem. Mostofthemembersofthe20to 30smalltribesintheSeattleareahaverecentlyrovedfromtheirreservationstothecity.Manyarcindigent.Theydonotknowwhereto go formedicalhelp.

Therefore,theKtiatechitapiIndian1lealthClinicsendsrepres~n~ativ~sto thetribalmeetingsto telltheKinatechitaPis*OU~ thec~lnlccurrentlyoperatinginspaceinthePublicHealthServicehospitalinSeattle.

TheclinicbeginfunctioningonshoestringfundsfromtheOfficeofEconomic@port~i~. Itisnowopenthreenightsaweek!se~ingfrom20to 30patientsanight. TheWashington/~~kaRegionalMedicalprogramhopestoexpmd clinic~Urs ad tien~ber ofPersonsse~ed”

Thepurposeof theclinicistoassisttheurbanIndianinlearninghowtousetheexistingsystemofmedicalmd socials~wices,ra~her.th~toprovidea continuingseparatehealthcarefacilltyfora mlnorltygroup. Itisa cooperativeeffortof theWreau of0~, theWashingtonDepartmentofHealthandSocialw/w..

IndianAffairs,-Services,andthe’

Status:professionalstaffactivity1styear--begmmg 1/72--$44,080

....,,

TheWashington/AlashRegionalMedicalProgr~ coverstheStatesOf .WashingtonandAlaskaandhasbeenoperationalsinceFebfi~l> lg680 ..5

~eir cdtment level’forN lg70was$1,606,157ad forV’lg71WaS$1,447,885.~ese fundswereusedinlg71TOswprt a totalof 22projects,7 ofwhichwereforgeneralcontinuingeducation)3 fortrainingexistinghealthpersofil’innewskills~2 fo~?atient~~e~icesdmnstrations,1 fora combinationof.patientandtralnlngsenlces,3 forcoordinationforhealth.services,6 forR6D;anda n~ber of ,.coreactivities.

-41-

Nineheartclinicsprovidediagnosticandfollow-~careforindigentpersonsinSouthCarolina.me clinicatSpart=burg,whichisf~dedbytheSouthCarolina~gionalMedicalprogr~~is.fairlYtW}cal”Itisresponsiblefora three-co~tyareawitha growingpopulationofapproximately220,000.me clinicprovidessenices--includingcardiaccatherization--forindigentpersonswithcongenitalheartdisease,vasc~ardiseaseorother’complexconditions.ItalsodisseminatesinfomtiontophysiciansinSpartanburg,merokeeand~ion counties.

~ring a recentsix-monthperiod,theclinictreated136heartpatientsandrecordedan averageattendmceof 24physici~sandnursesatthemnthlyclinicconferences.

me clinicissponsoredincooperationwiththeStatebard ofHealthandtheStateHeartksociation.

Status:Operatiomlasof 8/681styear--$24,6g22ndyear--$24,2203rdyear--$22,058

.

me SouthCaroltiaM coverstheentireStateofSouthCarolina,ad ~hasbeenoperatio~lsficeAuWt 1>lg680 Its’coWitment1evel‘or .~ 1970was$988,082=d for:Wlg71W= $g58z3400?hese.fidSwereusedin~ 1971to su~rt a total”of16projects>.of~~ch2Wer~

.

b theareaof generalcofitfiu~geducation>5,fo!:trainlngex~st?ng7 forpatientse~lcesdemonstrations,healthperso~elfi.n~skills>

1 fora combinatioriofpatient.serv$cesmd t~~~~g} } forCOO~~inatiOnforhealthsemices,andari~er ofcoreactlvlties” .,.

llntra~.ncdl~crsonsweretaktigX-raysinsmallerhospitalsh therural[;rcatBendareauntiltheKansasRegionallledicalI)rograminstituteda X-raytechnologytrainingprogram.Fourteenmedicalteclmicians,nursesandotherhospitalpersonnel--whowereservingasX-rayte~icims becausetherewereno trainedtechnicians.available--participatedinclasseslleldattheCentralKansas ~~~MedicalCenter.

Becausetheequipmentusedatthetrainingcoursewasnotalwayslikethatat thetrainees’hospitals,asthesecondphaseof thecoursetheradiologictechnicianfromCm visitedthesmallerhospitalstoassistthetraineesintheirownlaboratories.Fih of thetraineesatworkbeforeandafterthecoursearebeingevaluatedby ~T.

Thistrainingprogramisoneofseveralthatareconductedaspartofa prototypeareahealtheducationcenterthathasbeendevelopedbytheKRMPin theGreatBendarea.

Status:“GreatBendEducationalPro~m’l@erationalasof 5/69l;tyear- $105,757”2ndyear- $105,7573rdyear- $1os,7s74thyear-$105,757

TheKansasM coverstheentireomrationalsinceJune1,1967.

StateofKansas,andhasbeenItscmitment levelforW 1970

w~s$1,346,744andforfi 1971was$1,236,220.Thesefundswerewed inN 1971tosupporta totalof 10projects,ofwhich6were,intheareaofgeneralcontinuingeducation,3 fortrainingexistinghealthpersonnel-innewskills;1 forR6D,anda numberofc~re “ ~activities.

-43-

.,

‘lMoheartattackvictimsintheremoteAlaskacomunityof S~pt:larea]ivctodayI>ccausctheirphysici~sparticipatedina reg~on-~ig~programof continuing~dicaleducation”Inthisprogrmp~~~~c~~~hadlearnedhowto insertcentraltransvenouspace~kers.ledgesavedthelivesofthetwostrickenpatients.

TheprograminwhichthebctorsparticiPated~alongwith.otherphysicims~nursesandotherhealthprofessionalsfromremoteareas)lsheldthroughthekivefsityofWashingtonatseveralcen~ers‘n‘he‘egiono~~ecentersincludeSeattle,T*oma,Anchorage,y~~az Spokme,andWenatchee.”Theyprovidea placeforhealthperso~el~ remoteareastomeetwiththeirurbm colleaguestodiscussthenewestmethodsofmedi=ltreatment.

ThecentersarepartofWWI, a region-wideprogramofmedicaleduca-tiondesi~edtoprovide~re physiciansfOrCO~~itiesfiWashington>~aska,MntanaandIdaho@~).

TheWashington/uaska~gionalWdicalProgramhasplayedan fiportmtroleinthedevelopmentofthew P~9~0 Forex~le> W/_providessupportforre@ar visitsof consult~t-teachersfromthecenterstoremoteareasinwashin~onad~aska” As ar~sulto! thesevisits,physiciansinthe.outly~gareasre@arlY com=cate ‘lththoseinthecenters,andthereismorefrequentreferralof~ml .patientstodoctorsinthecities>whentheiro~physicia.s1acktheresourcestoprovidethebesttreatment.


lkeWashington/WaskaM coverstheentireStatesofWashingtonandMaska andhasbeenoperationals~ce Feb~a~ 1,lg68*~eir co~it- ,.,,mentlevelwas$1,606,157forFY 1970and$1,447,885for~ 1971.~ese fundswereusedin 1971tosupporta totalof 22projects,of. .which7 wereforgeneralcontinuingeducation>3 fortra~lngexlst+ng

,...

healthpers~el innewskills,2 forpatientservices,~ fo;coordln~tionforhealthservices,6 forR6D,anda numberofcoreactivities.

-44-

.,. .

TheuseofreninSsaYs todetermineifa patient’shighblood~ressureissurgicallyremediablehasresultedinthecureofpersonsinruralareaswh othe~isewouldstillbe sufferingfromhypertension.Theexpandeduseofthisnew”diawostictectiiqueis.oneoutcomeof a conttiuingeducationmurse forphysiciansheldin17hospitalsintheCambria-SomersetareaofWesteWPennsylv~ia,withthesupportofth~WesternPennsylvaniaWgionalMedicalProgram.

As anotherpartofthisprogram,physiciansfromtheDiversityHealthCenterinPittsburghvisitcomunityhospitals,andwithoneofthelocalphysiciansastheirguide,helpintheroutine=re ofpatients.Ifnecessary,theurbanphysicianofferstotakepatientsto theHealthCenterlaboratoryfortests.Thisexpandedconsultationandreferralsystembetweenthec- ityphysicianandHealthCenterspecialistshasrestitedinthedoubltigof theuseofmoremodem diagnostictechniquesby localdoctors.~

Status:@erationalasof 7/691styear- $34,0002ndyear- $39,0003rdyear- $25,484

,..

TheWesternPennsylvaniaM coversthecityofPittsburgh,and28surroundingcounties,mdhasbeenoperationalsinceJuIY1, lg6g.Theirmmmitmentlevelwas’$934,041forN 1970~d$996,338forW1971.Thesefundswereused.in1971to”suppo~’?totalof 7 projects;.ofwhich2 were,M the”areaofgeneral.conttiuing~ed~cation,2 fortrainti~.existinghealthpersonnel’,innewskills,2for patientservicesdemonstration,1 for”coordi~tionforhealthsewices~andanumberof coreactivities.

-45-

~ly thirtyregistereddietiti~sservea muchgreaternumberof small

hospitalsandnursinghomesinruralCentralmd WesternKansas.TWO

of thesedietiti~ orgmizeda dietarycenterh CentralKansasMdicalCenter~~eretheyhold coursesforthecookswhosewe theseinstitutions

~~iththehelpof theKans~’RegionalMedicalProgr~,eightclassesfor80cooksfrom12countieshavebeenheld. Subjectsta~ghtby‘ie‘“registereddietiti~sincludedgeneralprinciplesofdletetlcs~sanitationandpersomlhygieneinthepreventionof foodpoisoning,diabeticandfat-controlleddietsandthei~ortanceof sodium-balanc~~diets.

Status:@rational asof 2/6g1styear--$18,2642ndyear--$12,836

me KansasRMPcoverstie entireStateofKansas,andh~ been,operationalsinceJune1,1967. Itsc-itment’levelfor~ 1970W= $1,346,744andform 1971was$1,236,220.Thesef~ds,wereUSd h w 1971 tosupporta totalof10projects;of.~}ch6 yer~intheareaof generalcontinuingdUCati~, 3 fortralnlngexl:tl?ghealthperso~elinn~ skills;1 forR~D)ad ?n~er ‘fcore~,activities.

-46-

‘1’hcst’mdardsoFpaticntcareinthenursinghomesofWesternPcnnsylvani:1havebeenimprovedthrougha tratiingprojectundertakenby thatRegion’sw. AS ofFebruary1971,42homes,one-thirdof thenursinghomesprovidingskilledcareh theRegion,haveparticipatedina trainingprojectto tiprovethequalityoftheirnursingandadministrativeservices.An intensive8-monthcourse,plannedandimplementedwiththesupportof specialistsinhospitalmanagement~dnursfigeducation ,fr~mth~diversityHealth~nter inPittsburgh,hastrained137nursesandadministrators.Wsing practicesinthbparticipatinghomeshavebeensi~ificantlyimprovedashavethesocialsenicesprovidedbythehomes.Variousadministrativeprocedureshavebeenimprovedthroughthedevelopmentof suchpracticesasprospectivebudgetingandpersonnelmagement. Thisprojectisalsobeingstudiedasameansofprovidingalternativestothemore~expensivehospitaltipatientcare.

Status:~)erationalasof 7/691styear- $125,0002ndyear-$136,0003rdyear-$22,000

TheWesternsurrounding

pennsylvaniaw coversthecityofpittsburgh,~d 28 ~count~iesand’h~been.operationalsince’July1 1969 ~eir

comitment”levelwas$934,041forNlg70 ~d $g96~338for~ lg7~. .~ese fundswereusedin1971tosupporta totalof 7.projects,ofwhich2 wereintheareaof generalcontinuingeducation,2 fortrainingexistinghealthpersonnelinnewskills,2 forpatientse~ices.,demonstration.1 forcoordinationforhealthservices,andanumberof :.core.activities.

,..,”.,

-47-

CON1’INUTNGPWNARY ~UTION

Fivenewlungfictionlahratories,twonewinhalation~herapy.~drehabilitationcenters,hd threenewrespiratorylntenslvecaremitshavebeenestablishedasa resultofa conttiuingeducationprojectinpuhonarydiseasesforphysicianssponsoredbytheIndianaRegionalMedicalProqm.

me projectconsistedof a five-dayintensivetrainingcourseattheIndianaWiversityMedical@nter followedby dne-days~posiathroughouttheyearatthetrain=s’parentinstitutions;~?i?g thefirstyearof theproject,12physiciansfromnineareasparticipated.~ring thesecondyear,thentier of traineesroseto2gfrom16a~=”

Aftercompletingthecourse,thetraineestrainedotherphysicimsintheirlocalityinthecareofpatientswithpulmonavdise~e. Thetennewrespiratoryfacilitiesweredevel~edatthelocallevelbytraineesandthephysicianstieytrained.

Status:@erational1/70- 12/71--$15,873

TheIndiana~ coverstheentireStateofIndiana,andhasbeenoperationalsinceJanua~1,lg6g. Itscmitient levelform }g70was$1,271,411,andfor~ 1971was$968,842.~ese f~ds wereusedinW 1971tosupporta totalof 6 projects,ofwhich2werein theareaofgeneralcontinuingeducation,1 fortratiingexistinghealthpersonnelinn~ skills,1 forpatientservicesdemonstrations1 fora c~ination ofpatientsenicesad training>1 forCoordinationfof.,healthservices,anda numberofcoreactivities.

.:..:.,...,,

-48-

.

lhcfirsteducationaltelevisionnetworkdevotedtoservingtheprivatephysici~md othermedicalpcrso~~lhasbecnest~li$hedbYtheGeorgiaRegional~ledicalprogr~. ~len~leProJectbegain1968>sixmedicalinstitutio~werepartofthenetwork.Today,theneti~orkhasgrownto22hospitals,doctors!officesandclinics.

TheAtlanta-basednetworkbroadcastsanaverageof22hoursa weekandhasa tapelibraryofmorethm 500pro~~. ~~loughfieGeorgiaRegionalMedicalTelevisionNetworkhasceasedweeklyState-widebroadcastsinfavorof a tapelendtiglibraw~itdoesProduce~dbroadcastliveandvideotapedprogr~ overanAtlantaMetropolit~Ne~rk. Morethan44percentofGeorgiatsphysici-,~dnurses,mdnearlyone-thirdof alltheState’shospitalemployeesarewithintheGm broadcastrange.~rther,87percentof allphysici=s,80percentof allnursesand69percentofallhospitalemployeesintheStatehaveaccesstoeitherlivebroadcastsorvideotaperecordtigs.

Tobe responsivetoprofessionalnee~, Gm issendinga listof50 topicstoallmedicalpersonnelwithinthebroadcastrangeforrankinginorderofpreference.The25mostpreferredtopicswill heselectedforproduction.Whenprogramsarebroadc=t,a s~ling Ofviewerresponsewillbe taken.Theprojectisa cooperativeeffortofWry ~iversity,theMedicalCollegeofGeorgia,~d GM.

Status:Operationalasof 5/681styear- $522,4gl2ndyear- $355,8823rdyear-$148,561

.

~c Gcorgia~ coverstheStateofGeorgiaandhas”beenoperational s:,

sinceJuly1,1968. Theircoti~nt l~elwas $l,g22,571for~}g70. and$1,779,862for~ 1971,Thesefundswereusedh 1971tosupport

23projectsofwhich6 werein tieareaof generalcontinuingeducation?6 fortrainingexistinghealthpersomelinnewskills,Z fortrain~g”newhealthperso~el?3 forpatientse~icesd~onstration>l.fo.r‘?,.combinationof trainingandpatientservices,s forcoordlnatl?nOf ~~healthsemices,anda ntier of coreactivities;

Strokepati.cntsarcgettingoutofbcdsooner,areabletofeedanddressthemselvesearlier,andhaverfewercomplicationsasa resultofa basiscontinutigeducationprogramfornursesh Centralia,Washington,andtheadjoiningtownof~ehalis.

Centraliahasa populationof 10,000andislocated90milesfromSeattle.Localcitizensandhealthpersonnelsetup theprogramofrestorativealdrchahilitativenursingatCentraliaComity College.Nursinghomesandhospitalsprovidedtheinitialfundingfortheproject.me fund-in~wasmatchedby theWashingtonStateIIeart&sociationandsupplementedin-1969byWashington/M=kaRegionalMedicalProgramfinds.

Tedmiquesacquiredthroughtileprogramareusedby theentirenursingteam--including.registerednurses,practicalnursesmd nurses’aides--inparticipatinghospitals,nurskghomes,andprivatehomes.

.-

.Status:Operationalasof 7/69

1styear-$4,7002ndyear-$13,000

me Washington/MaskaRegionalMedicalProgramcoverswe StatesofWashingtonand~aska andhasbeenoperationalsinceFebruary1,1968.71~circofi~nt levelforW 1970was$1,606,157andfor~ 1971was

I $1,447,885.~ese fundswereusedh 1971to.support.atotalof 22;, projects,7 ofwhitiwereforgeneralcontinuingeducation,3 fortrain-$.. ingexistinghealthpersonnelinnewskills,2 forpatient:se~ices~, demonstrations,l.fora c~inationofpatientandtrainingservices,3i forcoordinationforhealtisenices,6 forRGD~~d an~er Of cOre

activities.

...

j<

.

-50-

~re ~la a quatierofallemployednursesinSouthCarolinareceivedtrai~figtimouth-to-muthresuscitationand$losedch~stmassageduringthefirstyearofa SouthCarolinaRcglonalMedicalProgramand,heartAssociationproject.

~epilot programwasheldinhrchesterCountY1~osPital.First,phusici~sandnursesweretrainedinthemethodsusedtorevivevictimsofheartattack,suffocation,electricsh~ck~~d d~o~i~g: Thenthetrainingwasbroadenedtoincludeinhalationtherapists,firemen,policemenandotheremergencyperso~el.

‘Meprojecthasbeenexten~dtoinclude208freetrainingProg~Y*Ina nwber of counties,allhospitals:staffshavehadthetralnlng.~enty-fiveof thefofly-~eco~ties~ theStateha~~g at 1e=tonehospital,havehadoneormorehospital-basedtralnlngprogrms.

Status:Operationalasof 8/681styear-- $4?J7742ndyear-- $4D,6453rdyear-- $40j341

TheSouthCarolinaW coverstheentireStateofSouthCarolina,and ~ :hasbeenoperationalsinceAu~t 1,1968.“Its,co~.i~entlevelfor~1970was$988,082andfor.~ 1971W= $?58,340..Thesefids wereUSedinW 19,71.to”supporta totalof16projects,ofwhich2~re intheareaof generalconttiutige~cation,5 for.tra~~gexist+nghealthper~nnelinnewskills,7.for~atientsemicesdemonstration,1 for ~a combinationofhealthservices,

patientsetiicb$”andtraining,lforcoordinationforanda number”ofcoreactivities.

-51-

NO~WS.,

S1-10RT-~RMRESIDENCIESFORPW~ITIO~RS

Generalpractitioners,internistsandsurgeonsarebeingtrainedfor ~~periodsofone-tbeemonthsina specialityorcombinationof specialitiesat thefitiyoClinic,mder a regionalpostgraduatemedicaleducationprogramsupportedbytheNor~ads RegionalMedicalProgram.Thespecialitiesavailableareneurology,hematology,gastroenterology,oncology,ad cardiovascularmedicine.Eventuallyenvisionedforstate-wideparticipation,theprojectinitiallyinvolvesphysiciansfromfivesoutheastern~nnesota

status:Professionalstaff

Northlands~ covers

hospitals.

activity

The theentireStateOfMiMesOta,~dh= beenoperationalsinceMarch1,1969. Itscmitment levelfor~ 1970was$1,676,227,andforH 1971w= $1,157,524.Thesefindswereusedin~ 1971tosupportatota~of8 projects,ofwhich6were inthearea ~ofgeneralcontinuingedutition,1 fortra~~g existinghealthpersonnelinn~ stills;1 forcoordinationforhealthservices,anda n~er ofcoreactivities.

-52-

.

.

.

.

LPNPROGMI

Standardizedtrainingplishcdby a trainingc:oronaucaremits.

forLicensedPracticalNurseswillbe accom-programforLPNsworkingintheStaters~is projectrepresentsoneofthefirstattempts

intheNationtoofferstan-~rdizedCm trainingforLPNs.

At present;NewJerseytsLPNshavea varietyofeducationalback-grounds,rangingfromformaltrainingtolicensebywaiver.me of .thegoalsof theNewJerseyRegionalkdicalProgram-sponsoredtrainingisto insurethatallLPNsworkingincoronarycareunitswillhavebeenadequatelytratiedforthenewdutiestheywillbecalledupontoperformasRegisteredNursesmve intosupervisoryroles.Anothergoalistodetefie specificallywhatnewdutiestheLPNsshouldbeallowedtoperform.Clinicalexperiencewillmake@ atleasthalfof thecourse.

Althoughthepilotcourseoftheprogramwillbe givenat}Iackensack~Iospitalthisfall,it isexpectedthataftertheinitialtwocoursestheprogramwillbe decentralizedto 20hospitalsinSussex,Warren,BergenandPassaiccomties.

Status:@erationalasof 4/711styear- $31,10~

~~eNcwJersey~ coverstheentirestateofNewJerseyandhasbeen :operationalsince~ril 1,1969.~eir co@tment levelwas$1,237,781“bfor~ 1970and$l,225,026for~ 1971. ~esc fundswereusedin1971to support11projects,ofwhich4 wereM theareaofgeneralcon-tinuingeducation,2 fortratiing”existinghealthpersonnelinnewskills,1 forpatientservicesdemonstrations,1 fora c@inationoftrainingandpatientservices,2 forcoordinationforhealthservices,lfor R~l),anda numberof coreactivities.

-53-

MShS

InactivenursestitheGreaterKansasCityareaarebe;ngretra~edinsix-weekrefreshercoursessupportedby theK~sas RegionalMedical~ogram. ClassroomworkisreceivedattheH headquartersinK~&sCitywithclinicalexperi~ceatanyoneof 15areahospitalsinK~sas City,Missouri;Kansas.City,Kansasor Independence,Missouri.Thecourse,orientedtoretraininactivenurseswhodesiretomaintain.~d extendtheirprofessiomlcompetence,isdesl~edtost~ulate

.

self-confidencebyupdattignursingskills.Theam ofthe?rogr~isto returnthesenursesto activepractice@d therebyrellevetheshortageof trainednurses.AppmximatelY75%ofthenursesretrainedto datehavereturnedtoactivepractice.

Status:@eratioMl asof 5/681styear--$60,4162ndyear--$72,5133rdyear-- $36,8024thyear--$36,802

,

TheKansas~ coverstheentireStateofKansas?andhasbeen ;

operationalsinceJune1,1967. ItscommitmentlevelforW 1970W= $1,346,744=d for~ lg71W= $1~236>220”~ese ‘redswere

.

usedin~ 1971tosupporta totalof10projects;:o’fwhich6 wereIn tieareaofgeneralcontinuingeducation,3 fortrainingexistinghealthperso~elfin~ skills,1 forRGD~~danqer.of coreactivities. H

’54-,, .

MMmIVA~l)~B;NISTS INSTROmPR~m

RetiredhealthpersonnelhavebeenbroughtbacktoworktomeettheneedfortrainedtherapistsinIndiana,

NllentheIndianaRegionalMedicalProgram~sstrokeprojectbegan,only3Soutof.the112generalhospitalsh theStatehadphysicaltherapyservice,15hadoccupationaltherapyse~ice,~d only14hospitalshadboth. Theprojecthasplacedteamscomposedof a physicaltherapist, anoccupationaltherapist,anda languagetherapistineachof five,are~intheState,kng thetherapistsaremany.whohadessentiallyretired.Aftermakingregularvisitstohospitalsto.helpdeterminetheirneeds,theteamsdeveloptrainingprogramsfornursesor laypersonnelso thattheycanbettercareforstrokepatients.A three-beddemonstrationteachingcenter,wherepatientsinvariousstatesof cerebralvasculardiseasearediagnosed~ldtreated,reinforcesthe1~ stroketrainingprogram.

~ter ~0 yearsOfprojectoperation,thereareonly3gho~pital~whicharewithoutfulltherapeuticfacilities,However,allof the39haveat leastonepersonwhoistrainedinoneof thethreetherapeuticdisciplines.

Status:Operationalasof 1/691stYear-$222,1162ndYear-$281,2413rdyear-’$211,so0

me Indiana~erational

~ coverstheentireStateof Indiana,andhasbeen;“

sinceJanua~1,1969.Itscmitient levelfor~ 1970was$1,271,411,andfor~ 1971was$968,842.Thesefundswereusedinw 1971tosupporta totalof6 projects,ofwhich2werein.the’areaofgeneralcontinuingeducation,1 fortrainingexistinghealthpersonnelinnewskills,lforpatientsewicesdemonstrations;l,fora combinationofpatientse~ic,esandtraining,1 forcoordinationforhealtiservices,andantier ofcoreactivities.

-55-

GEORGIA

~N1’IMjINGlil)U~TION

Twenty-siXcourseswereofferedGeorgiafsphysiciansthisyearinaprogramofcontinuingclfiicaleducationSPO~OredbYtl~eGeorgia ‘RegionalFlcdicalPro~~, ThecoursesarctaughtattheMedicalCollegeof Georgiaandthe~ory ~versity SchoolofMedicineand,includetopicsrelatingtoki~ey disease)heartdisease>respiratordisease~gastrointestinaldisturb~ces,endocrinedise=e)C~CeT>,Yte~almedicine,neurology~,liverdise~e~andobstetricsand~~~coIogy.

Beforetheprojectbegantii1968,therewasno organizedpl~ by thetwomedicalSC11OO1Sto.provideclinically-orientedcont~utige~cationsessionsbecausetheschoolslackedfunds. ;.,

As ofFebruary197140physicianshadparticipatedintheprogrm.Additionalphysici~sandatleast60nursesandotheralliedhealthprofessionalswillparticipatetitienearfu~re- Itishopedfiatthoset~ingpartinthisprogramwillthensene aSresourcesconsultantstocontinuingeducationprogramsintheirlocalhospitals.

Status:Operationalasof 5/681styear- $47,4922ndyear- $91,0853rdyear-$41,000

TheGeorgiaM coverstheStateofGeorgiamd hasbeenoperationalsinceJuly1,1968.Theircomitmentlevelwas$1,922,571for~ 1970and$1,779,862for~ 1971.fiesefundswereusedin1971tosupport23projectsofwhi~ 6 wereintheareaofgeneralcontinuingeducation,’.6fortrainingexistinghealthpersonnelinnewskills,2.fortrainingnewhealthpersonnel,3 forpatientservicesdaonstration,1 foracombinationoftrainingandpatientservices,5 forcoordinationofhealthservices,anda numberof coreactivities.

,.

M:l)l(fil,INIX)[WT1ONS1:WICEVIA‘fl:l,I~l)ll~

j)]~y~i~j;~sp~~cti~ing in smalltowsandisolatedmral areasofAlabamahaveinstantaccesstospecialistsattheMiversityofAlabaa inBirmingham,throughtheMedicalInformationServiceviaTelephone;knowninAlabamamedicalcirclesasMIST. Callscanbeplacedfreeof chargefromanypointinAlabama,atanytimeof thedayornight,on the~ST circuit.To.date,morethan750oftheState’s2,200practickgphysicianshadplacedsome4,500callsre-questingthelatestandbesttrea~entfora varietyofmedicalprob-lems.MISTswitchboardoperatorsaretrainedtolocatespecialistsinallfieldson split-secondnotice.TheprogramwasdevelopedthroughthecooperativeeffortsoftheNabamaRegionalMedicalPro-gram,theWiversityof~abama inBimingham,andtheAmericanMedicalAssociation’sMucationandResearchFred. Ithasservedasa proto~e forsimilarprogramsbeingdevelopedinotherRegions.

Status:@goingsince4/1/711styear- $21,000carryoverfundsand$10,000care

funds2ndyear- unfunded-willbe corestaffactivity

staff

The~abamaRegionalMedicalProgramcoverstheentireStateof ;AlabamaandhasbeenoperationalsinceApril1,1969.Theircommit-mentlevelfor~ 1970was$980,709andfOrW lg71w=$766,278~ ,Thesefundswereusedti’1971tosupporta totalof S projects,3 ofwhich”werefortrainingexistinghealthpersomelinnewskil~sand 2fortrainingnewhealthpersonnel,anda ntier of coreactivities.

-57-

Kansashealthprofessionalsaroundtheclockaspartof

canthe

~4e~ical Libra~SysttimProject.

placerequestsformedicalifiormationKansasRegionalMedicalProgrmlsCallscanbemadetothecentral

libraryorits”tfieebr-m~esona freetelephoneline.Trainedmedicallibrariansanswerphonesonweekdaysandnightcallsarerecordedandansweredthefollowingday.

FromJuly,1969,toNovember,1970,3,779personsusedthelibra~,Of these47percentwerephysicians.~ring thesecondyearof operationtherewasa 120percentincreaseinrequests,md m iqcreascof 87per-centin thenumberofhealthprofessionalsusingthesenice. Itwasfoundthatruralphysiciansusetheservicemorethm urbanphysicians.

IllccentralofficeislocatedintheClendeningMedicalLibraryatthediversityofKansasMeficalCenter.Branchesareatsto~ont-vailhospital,Topeka;WichitaStateMiversiw;andCentralK~sasMedicalCenter,GreatBendo hng theservicesofthelibraryaredrugproductinformation,medicalreferences,preparationofbibliographies,aluinsubmittingrequestsin~DM @edicalLiteraturekalysis)andphotocopyingandmailingjournalarticles.

Status:Operationalasof 2/691styear-$208,545.2ndyear-$88,889

.~eKansas~ coverstheentireStateofKansas,andhasbeenopera-tionalsinceJune1,1967. ItscommitmentlevelforH 1970was$1,346,744andfor~ 1971was$1,236,220.Thesefundswereusedin ,,PY1971tosupporta totalof 10projects,ofwhich6werein theareaofgeneralcontinuingeducation,3 fortrainingexistinghealti,personnelinn~ skills,1 forR~D,anda ntier ofcoreactivities.

-58-

I~IN

r;~)~SI~NOF~~1~ LIB~y E~~SION.SERVI~ ,.

IndianaphysicianscancalltheirlocallibrariesforanYmedicalreferencematerial=d pickup a xeroxedcopyof themat;xialat thelibrarywihtinthenextdayor two. Illelocallibraryteletypesthephysician’srequestto~e medicallibraryat theIndianaMiversitykdicalCenterin Indianapolis,me medicallibrarythenmailsxeroxedcopiesof therequestedmaterialtothelocallibrary.

me networkreaches150c~ itiesandhas1,052patrons,Inanaveragemonth,580articlesaresuppliedto Indimaphysicias,Inaddition,theprojecthasconductedthreesetiars,fora totalot40non-professionallibrarypersonnelwhoworkinhospitallibrariesthroughouttheregion.me seminarsweredesignedtoupgradethe”quali~of serviceinhospitallibraries,

Status:Operationalasof 1/711styear-$26,1972ndyear-$21,800

M coverstheentireStateof Indiana,andhasbeenfieTndimaoperationalsinceJanuary1, 1969.Itscmitment-levelforH 1970was$1,271,411,andforW 1971was$968,842.~ese’fundswereusedinFY 1971tosupporta totalof 6 projects,ofwhich2werein theareaofgeneralcontinuingeducation,l’fortrainingexisting,healthpersmel innewskills,1 forpatientsewicesdmofi’trations,lfor.a cdinationofpatientservicesandtraining,1 forcoordinationfor ●

healthsenices,anda ntier ofcoreactivities. .,:,,

.,::-59-

WSAS

Takingintoaccomtthelifestyleofthemigrantworker,theKansasRegionalMedicalProgramhxdevelopeda methodofputtingtheworkers’medicalrecor~ina concise,durable,andeasilyavailableform.

Themethodincludesa mntrallibravs~tem>~ i~ntific?tionc?rd>and‘aneducationalprogram.Thelibra~housescomprehensivemedicalrecordsforallmigrants.Therecordsareavailableon a 24-hour-a-daybasistoallphysici~ md i~titutionsviatelephone>~>-ortelegraph.Recordsarefiledbynumber,andthenumberscross-filedtwiceby socialsecuritynumberasWC1laSby n~e ~d dateOf birth.

Becauseof thesuccessoftheSocialSecurityAdministrationinconvincingmigrantstocaw socialsecuritycar~~ w evectstheissuingofhealthidentifi=tioncardstobe readilyaccepted.Theplastic-laminatedcardshowsthepatient’scolorphoto,hisn~e,socialsecuritynumber,dateofbirth,MigrantMedicalRecordsnumber,andvitalmedicalinformationsuchasdiabetesorantibioticsensitivity.Thebackofeachcardcamies~tructionsinbothmglish andSpanishforereachingthew libraw.

ParticipationisbeingencouragedthroughMigrantHealthServicefieldworkers,migrantschoolsandthedevelopmentofa shortaudio-visualpro~am,nanated~ SP~iS~>forUSeatbifihcontrolclinics‘dhigrant

Status:

gatheringssuchasfamilynights.

ProfcssiOnalstaffactivity

fieK-as M coverstheentireStateofKwsas,andh= been ~~•operationalsinceJune1,1967. ItscommitmentlevelforW 1970 ~W* $1,346,744andfor~ 1971was$1,236,220.~ese f~ds were~~•usedin~ 1971tosupporta totalof10projects,ofwhich.6j.wereinthe.areaofgeneralcontinuingeducation>3 fortralnlngexistingheal~ perso~elinn~ skills>1 forR~D>ad a n~erofcoreactivities=

-60-

.

. ?,..*

‘lhcabilityofphysiciansto servemore.patientsisbeingexpandedthroughthePhysicim’sksist’antI}rogr.ambeingcarriedoutatl~elkiversitySchoolofMedi&e withsupportfromtheNorthCarolina~@ andfromothersources.Thisprogramwasoneofthefirstofitskindinthenationandisbeingemulatednationallybymanyotherpmgrams.PhysicianassistatgraduatesarepresentlyworkingwithlocalpractitionersintheStateofNorthCarolinaandarefunctioningasa welcomedadditiontothehealthcareteam.

Status:Operationalasof 7/1/701styear--$183,321

TheNorthCarolinaM coverstheentireState.of:NorthCarolina, ;andhasbeenoperationalsinceMarch’1,19680,ItscommitmentlevelforW 1970was$2,047,486andforW 1971was.$l,844;692..Thesefundswereusedin~ 1971tosupport.atota~.of,21projects,ofwhich10wereintheareaofgeneralcontinuing.~ducation’g4 fortrainingexistinghealth~rsotielinnew,skil~s,1 for,trainingnewhealthpersonnel,1 forpatientservices’demonstrations,5 fora combinationofpatientservicesandtraining,anda numberofcoreactivities. \

,.

-61-

IWSTVIRGINIA

]]ecauscofanacuteshortageofpediatriciansinrural‘areas,a progr~hasbeeninstitutedtotrainpediatricnursepractitioners.~~eprogramissupportedbytheWestVirginiaRegionalBkdical.ProgramincooperationwititheWestVirginiaMiversitySdool ofNursingand .

theDepartmentofPediatricsat“tieWiversivtsShool ofMedicine.:

lkcconcepthaswontheacceptanceofpediatriciansaswellas theSchoolof-Nursingwhichmade-anexceptionnursesreceivingpediatrictrainingtobe

Afterfourmonthsof training,thenursesinruralareas.Fournursesweretrainedextensiveprogramplannedforthefuture.

toitspolicyby allowing:

non-baccalaureatestudents.

areplacedinprivateclinicsthefirstyear,witha more

status;Professionalstaffactivity “

TheWestVirginiaM coverstheentireStateofWestVirginia,and.,.2

hasbeenoperationalsinceJanuary1,1970. Itscomitmentlevelforw 1970was$524,048andfor~ 1971was$580,978..~e?e $~ds were

.

usd in~ 1971tosupporta totalof,4 projects,ofwhlchlwasfortrainingexistinghealthperso@elinnewskills,lfo~patient .servicesdemonstrati~s,2,forRGD,and.anumberofcoreact+yities.,.

,.,. ,,,’.

-62- ~

A multipflas:icscreeningprogrmsupportedby theIndimaRegionalMedicall~rograllf13ssho~ thatrelativelyuneducatedindigenouspersonsfromtf~cpovertyareacanbe effectivelytrainedtoconductthetestingaccurately.Today,35 tecfmicians,nlany,ofwhomdidnot havea highschooleducation,havebeentrained,Theprojectalsohasshownthatitcanpickupdiseases.S@ling of screeneestidicatethatapproxi[nately50%ofthesepatientshada significanttestabnormalityofwhichtheyhadnopreviousknowledge,Themultiph~icscrecn~ngprogra]shavebeenmovedrecentlyintoneighborhoodhealthcenterswhichf~asresultedinanexcellentfollow-upon screenedpatients.Effortsarebeingmadetoscreenlargenumberofpatientstobringthecostdowntoabout$35perpatientfor22tests.

Status:@erati.onalasof 12/681styear-$225,0002ndyear-$265,0003rdyear-$196,000

me Indianamerational

N coverstheentireStateof Indiana>andhti’beensinceJanua~1,1969. Itscmitment levelfor~ 1970

w~ $1,271,411,andfor~ 1971was$968,842.Thesef~ds wereusedinW 1971,tosupporta totalof 6 projects;of.which2werein the ~~~areaofgeneralcontinuingeducationalfortrainingexisting’healthpersonnel.innewskills,1 forpatientservicesdemonstrations,’1 fora [email protected];1 forcoordinationfor,hcaltiservices,andantier ofcoreactivities.

-63-

“1’i/J-S’1’A’l’J~

A GcrjatricNursePractitionerprogramhasbeendevelopedattheCam-bridgeHospital(municipalhospitaljwiththecooperationof theBostonhiversitySchoolofNursing.Theprogramwillteachnursestotakeovermuchof thecareof olderpersons,particularlyinnursinghomesandextendedcarefacilities.Supportisbeingprovidedbythe ~Tri-State~, theCommonwealthFundandtheCityofCambridge.

Status:Coreactivity$9,000contract

***

A pediatricNursePractitionerprogramhasbeendevelopedby theMassachusettsGeneralliospitalwiththeaidof a T~ contract.Thecoursewasdevelopedinsucha waythatitcouldbegivenforcreditatNortheasternhiversityandbecomeself-supportingona tuitionbasis.

Status:Professionalstaff$10,000contract

activity

TheTri-StateM coverstheentireStatesofMassachusetts,ModeIsland,andNewHampshire,andhasbeenoperationalsinceFebrua~l,1969. Itscommitmentlevelfor~ 1970was$1,467,436andforW 1971was$1,814,132.Thesefun~ wereusedin~ 1971tosupporta’totalof 5 projects,ofwhich1 wasfor,trainingexistinghealthpersonnelinnw skills,2 forpatientsevices.dmomtratio~~ 2fora c~bina-tionofpatientservicesandtraining,anda numberofcoreactivities.,.<... .. ,,, .,,.:,,,...!

-64-

.

.

,

}ImfllNWUATION TWIMICIAN

Thehealthevaluationtechnician.aprofessional,hasbeendeveloped-inmllltiphasicscreeningprojectfundedbv theMmhis ~. ‘The

newlydefinedalliedhealthcomectionwitha Memphis-based

technicianassistswithphysiological~ests.I~tially,”seventec~i-ciansweretratied,manyofwhomwereghettoresidentswhoserapportwithclients.isofgreatadvantage.Othertechniciansarealsobeingtrainedintheoperationof computerterminalsused!inthescreeningprocess.

Theprojectwillannuallyscreenabout20,000personsfor,heartdisease,cancer,strokeandrelateddiseases.Patientsaredrawnfmm thecityofMemphisIfospitalOut-PatientClinicandWelfarerecipientsintheinnercity.

Status:OperationalTrainingis“PreventionandRelated

asof 5/70componentofproject# 17,Services-Ifeart,Cancer,StrokeDiseases”- 1styear(16months)--$269,470

TheMemphisRegionalMedical~gram coverspartsofWesten.Tennessee,iNorthernMississippi,EasternArk~sasandprtions~fKentuckyandMissouriandhasbeenoperationalsinceJuly1~.1968.~,Itscomitmentlevelform 1970was$1~284,714and,forW 1971,was,$955$722.Thesefunds~re usedinW1971 tosupporta totalof 13:projects,ofwhich1 w= ti”tfiearea,oftrainingexist~ghealthpersofielinnew skills,2 inpatient,setiicesdetinstrations,7,ina mmbinationofpatientservicesandtraining,2 incmrdination1{GD,~d a n~er ofcoreactivities.

forhealth se@ces; 1 for

T~I-STATE

Fomer militarymedicalcovsmen arebeingretrainedasphysicians,assistatstoe~and theavailabilityofprimarymedicalcareinruralNewFmgland.The~DEX programisbeingsponsoredbytheNewHampshireMedicalSocietyandtheDartmouthMedicalSchoolwiththeassistanceoftheTri-StateRegionalMedicalProgram.

Eachassistantwillspenda year,workingfora physicianinprivatepractice.~thoughhewillmaintainradiocommunicationswiththephysician,the.assistantwillmakehousecallsandvisitnursinghomesbyhimself.Hewillalsoassistat surgery,applyandremovecasts,andperfomsomelaboratorywork.

Ina recent’suneybytheNewHampshireMedicalSociety,doctorsfeltthatbetween11and12percentoftheircasescouldhavebeentreatedby a trainedphysician’sassistant.Amonggeneralpractitioners,itwasfeltthat14.5percentoftheircasescouldhavebeenhandledby atrainedassistant.


.

TheTri-State.RMPcoverstheentireStatesofMassachusetts,RhodeIsland,andNewHampshire,andhasbeenoperationalsinceFebruary1,:’1969.“Itscommitmentlevelfor~ 1970was$1,467,436Wd for ‘.W1971 was$1~814,132.Thesef~ds wereused.inH 1971tosupporta totalof 5 projects,ofwhich1 wasfortraining’existinghealthpersonnelinnewskills,2 forpatientservices-demonstrations,.2 fora c~binationofpatientservicesand-trainingj(tida’number ~ofcoreactivities. ~ÿ• ,,.,.

-66-

Nurses:.trcl.c:~rnfi~gtoass~nemy of thet:lsksoftilepediatricia~whi.ICworking,closelyunderIUSsupervisionin?traintigprogra~beingsui>portcdl)ytheMatieRegionalMedicalprogra, The16-weekPediatricNurse~sociatecourseisbetigpresentedat ~ Mine MedicalCenterinPortland,usinglocalnurse,,andph icianresources,

zThefirst

classof stinursesgrad~ted‘~Mar 1970. Thesenurses,areparticipatinginModelCities.,areasofLewistonandPortland,WestCentralMainetsCo~rchensivc[lealthPlanningefforts,[leadStartprogrm, WebbcrhospitalChildren!sclinicandthePcnobscotBayMedicalCenter’shealthprogral. .

Status:OngoingasofWcemer 19691styear-$18,0002ndyear- $10,000- contract

~e MaineM coverstheentireStateof’Maine~andhasbeenoperational isinceJuly1, 1968. Itsc~i~ent levelfor~1970’was$956,904,andfor~ 1971was$814,422.Thesefundswereus~din~ 1971’tosupportatqtalof 6 projects,.ofwhich3 were:in’theareaofgeneral’”continuing@cation,2 fortrainingexistinghealthpersonnel,innewskills,1 forcoordinationforhealthservices,andanfier ofcoreactivities:

,,

-67- ~

WST VIRGINIA

A programtotra~nSchool[lea]thAideswhowillserveprim:lrily:ls1.i.nl<sI)ctwecnschoolhealthprogramsand.[amil.icswhol~avcchildrenw~ti~healthpr@lcmsisbeingdcvclopcdw:iththeissistanccof theWestVirginj.a:W>. TheseAideswillalsoassistinthescmiccandcducation:ll ,programsintheschools.Othertypesofncw,heal.thm~powcrto1)ctrainedarePediatricNursePractitionersandAudit-Tec~icians.Thelatterwillbe trainedtogleanpertinentinformationfromptitientcarerecords,bothinthephysician’sofficeandinhospitals.

Status:professionalstaffactivity

.

TheWestVirginia~ coverstheentireStateofWest,Virginia,and ;’hasbeenoperationalsinceJanuary1,1970.ItscommitmentlevelforM 1970was$524,048andfor~,1971w~ $580,978.Thesefundsw6re. .wdin~ 1971”tosupportatotalof 4 projects,ofwhich.lwasfor ‘trainingexis.tingheal~”.persotiqlinnew skills,lf orpatientserviceS”@monstratiti,2 forR~D,anda numberofcoreactivities.

-68-

IOWA .,

PEDIATRICCLINIW ASSOCIAms

A sumey showsthatparentsareaswellsatisfiedwithextinctionsperformedbynewly-trainedpediatricclinicalassociatesaswiththoseby physici=sh a screenfigprogr~for~ldrenwi~ heartdisease.ThecltiicalassociatesarebeingaddedtotheteamofmedicalpersonneltitheIowaRegionalMedicalProgrmproject.

~C associatesconducttiitialandfollow-qtite~iews)Perfo~limitedextinctions,andco~selthecfildren~d fieirParents.

M a partof theirtraining,tieassociatesarer~ulredtoP=S Wejuniormedicalclasspediatricexamfiationtco~?rlsonsbe~eenth~performanceoftheassociatesandthatofpediatrlci~s~dpedlatrlccardiologistsshowthattiietwogrowstjud~entsarefia~e~nt atleast90percentof thetfie.

Inthelastyear~morethti3300childrenhalvebeenscreenedbytiethreepediatricclinical*sociatestrainedthusfar.

Status:Operationalasof 4/69Co~onentof “DiagnosisandFollow-upCareof~ildrenwithHeartDiseasell1styear- $52,7gg2ndyear-$55,6933rdyear-$51,400

me IowaM coverstheentireStateof Iowa,~dh~ beenoPrationalsinceJuly1,1968. Itscommi~entlevelforW 1970was$716,744,andforN 1971was$573,247.Thesefmdswereused’in~ 1971tosupport ~a totalof7 projects,ofwhich4werefortrainingexistinghealth’ >personnelinnewskills,1 fortrainingnewhealthpersomel,1 forpatientservicesdmonstrati~s,1 forcoordinationforhealthsemices,anda n@er of coreactivities. .1 ,!

.,

WIFORNIA

INDIANCOhfikWImIW~l AIDES

IIealthAidesfromwithintheIndiancomm~ityarehelpingtocreateanawarenessofproperhealthcareina mountaino~;egionfi-nor~e~CaliforniawhichPreviouslyhashadaMost nomedlcalseMces. TheseveralthousandIndimslivinginanisolatedareatilesizeof.modeIslandarcservedby onlyfivedoctors.I1tioldt(andDelNorteCounties,andpartofTrinityCountyarcincludedinthisarea.

Inthenextthreeyears,theIndianhealthaideswillhelpsetUP anextensivehealtheducationprogramstressingpreventionandearlyde-tection.Fosteringanawarenessofproperhcalficareis~ es?ent}alelementof theprogram..ThehealthaideswillstressSUA rout~elte~~asregularcheck-qsforbabies>~dPre-natalCareo

me ~iversityof Califo~iaatBerkeleyiscoo~eratingtitit]leCalifoniaRegionalMedicalPrograminthisproJect.


1

!

‘fieCaliforniaRMPcoverstheentireStateof CaliforniaandtwocountiesjnNevadaYandhasbeenoperationalsinceJuly1,1968.ItscotimntlevelforJW 1970was$8,012,055andforN 1971was.$6,220,0g4.~~esef~ds wereusedin~ 1971tosupporta totalof 24projects,of,which3 wereintheareaof generalcontinuingeducation,4 fortrainingexistinghealthpersonnelinnewskills,1 fortrainingnewhealthperso~el,6forpatientservicesdemonstrations,8 fora combination?fpatientservicesandtraining,1 forcoordinationforhealthsenlces,1 forR~D,anda numberof.coreactivities.

-70-

Revisionof theState~svaguehealthlawswillbe consideredby 40IIcalthleadersduringa two-yearstudyof thehealtimanpowerlawsfundedhy theWestVirginiaRegionalMedicalProg~. me studywillenablehealthe~ertstoadviselawyerson specificrevisionsornewlawsthatwillallowtheStatetocopemoreefficientlywithitshca]thpersonnelshortageproblems.

Il]cpresentlaws,accordingto~~} officials,arctoov:~g~le,:~~1leavetoomuchtointc~rctation.ForCXfUT~C,a lawP:~sscdolllY.re-centlyallowsforthepracticeofnurseass~stants,butdOCSnot:lIICludC?i.nthiscategory,pediatricnursepractitionerswhohaverecentlybeentrainedunderanotherW project.

Itisexpectedthatfiangesinthehealthmanpowerlawwillresultinaddedflexibilityin theuseofhealthmanpowerwhilemaintainingorefiancingprotectionforthepatient.Itisalsohopedthatthroughthesechanges,WestVirginiawillbe encouragedtodevelopa healthManpowerCouncil.

Status:ProfessionalstaffactivitY

TheWestVirginia~ coverstheentireStateofWestVirginia,andh~ beenoperationalsinceJmuaw 1, 1970..Itsc~ifient levelfor .;w 1970was$524,048andforN 1971was$580,978.“Thesefunds.were@ed inW 1971tosupporta totalof 4 projects,ofwhich.lw= for ‘trainingexistinghealtiperso~elinn~ skills>1 forPatient‘enicesd~onstrations~2 forR~D,andanumberof coreactivities.

-71-

S[;IUIENIN(;l.NPAH;RSONWIGUDNl~l)llI:fi.lllCLINIC

Screeningforsicklecellanemiaandforl.eaclpoisontigwillbe twoof tileservicesofferedby a neighborhoodhealthclinicbeingsetupinPatersonwiththecombinedfundsoftheModelCitiesProgram,thecityIleal.thDepartmnt,andtheFamilyPlanningksociationofPasaic.

me clinicispartofanexperimentalrevampingof thecityfshealthdeliveryprograminwhichtheNewJerseyRegionalMedicalProgramisplayingan importantrole. me aimoftheprogramistodeliverclirectservicesto lowincomepatients.Mng servicestobcofferedarcmedicalexaminations,~ screening,dentalservices,familyplanning,pediatricservicesanddiabetesscreening.

PatersonisoneStatewhich,onplanningstaff.Citiesarealso

of thenineFederally-designatedModelCitiesinthetheinvitationof themayor,isprovidedwith~Inaddition,21State-designatedtimunityMvelopmentprovidedwithW staff.


~lcNW Jersey~ coverstheentirestateofNcw*Jerseyandhasbeenoperationalsincc@ril,1,1969.Ihcircomi~elltl~v~lwas$1,237,781for~ 1970and$1.,225,026for~ 1971.~esc fundswereusedin1971to support11projects,ofwhich4 wereh thear~aOf

$

generalcontinuingeducation,2 fortrainingexist.inghcalthpersonncl ~innewskills,1 forpatientservicesdemonstrations,1 fora co-mbinationof trainingandpatientsemices,2 forcoordinationforhealth .stirvices,l.forR6D,anda numberofcoreactivities. ‘,,

Fiestasandchurchservicesarealsotimesforhealthcheck-upsinSanJoaqui.nValley.hder a programconceivedby theSanJoaquinlledicalSocietyandFomdationforMedicalCare,andfundedby the

the

CaliforniaRegionalMedicalProgram,a mobilehealthunittravelstomigrantworkercampsandotherpovertypocketssouthofStockton.Becausemanyof thesepeoplearereluctanttoseekpreventivemedicalcare,themobileunitappearsatplacesandoccasionswherethepeoplewillbe alreadygathered.

~legoalof theprogramistoscreen3,000personsa yearduringthenextthreeyears.Multiphasictestsaregivenby a staffofbi-lingualdoctors,registerednurses,andtechniciansina mobileunitmadeup ofthreetrailers.Facilitiesandpersonnelaremadeavailableby~lealthFacilities-llealthTestingServicesofBerkeley.

OrganizationswhichhelpedformulatetheprogramincludetheBlackiJnityConference,SanJoaquinCountyIIealthDepartment,SanJoaquin&neralHospital,StocktonCo~ ityActionCouncil,StocktonChamberofCommerce.Mexican-hericanPoliticalAssociation.SouthStocktonParish,

status:

:;

and’StocktonWfied SchoolDistrict. ‘

Qerationalasof 5/701styear- $26,6672ndyear- $160,000

me California~ coverstheentireStateofCaliforniaandtwocotities;inNevadajandhasbeenoperationalsinceJuly1,1968. Itsco~tmentlevelforW 1970was$8,012,055andforW 1971was$6,220~094..Thesef~ds wereusedinFY 1971to supporta totalof.24projects,ofwhich3 wereintheareaof general’continuingeducation,4 fortraintigexistinghealthpersonnelinnewskills,1 fortrainingnewhealthpersonnel,6 :forpatientservicesdemonstrations,8 fora combinationofpatientse@icesandtraining,1 forcoordinationforhealthservices,1 forR6D,and,antier of coreactivities.

.,‘1,,

-73-.

OPEW1’ION111-BLOOD

Over1,200highriskindividualsforhypertensionhavebeencontactedandatiost500hypertensivehavebeenseenandbroughtundertreatmentthroughOperationHi-Blood,centeredattheOF~WayneMinerNeighborhoodIIealthCenterinKansasCity. Programsforthephysiciansof theareaarebeingdeveloped.Thetrainingofnewalliedhealthpersonnel.asmedicalassistantsandthedevelopmentofoutreachcentersiswellunderway.Cooperatingintheseeffortshavebeena numberof agencies,includingthe~fissouriRegionalMedicalProgram.

Status:@erational.asof 7/691styear-- $56,7412ndyear--129,9853rdyear--160,237

TheMissouriRMPcoverstheStateofMissouri,exclusiveofMetropolitanSt.,Louis;andhasbeenoperationalsinceApril1,1967.:.Itscommitment ~levelfor~ 1970was$3,074j230andfor~ 1971was$1,947,417.Theseftidswereusedinw 1971to supporta totalof 29projects,of,whiti1 wasintheareaof generalcontinuingeducation,1 fortrainingexisting

.

healthperso~elinnewskillsjl.fortrainingnewhealthpersonnel,7.forpatientsemicesdemonstrations,6 for’acombinationofpatienttiservicesandtraining,11 forcoordinationforhedthserivces,2forR~D,anda numberof coreactivities; , ,.:,,’

-74-

mSSM/MID-SO~l

hULTIPl~ICSCHING PROGW

Sixtypatientsa dayfromtheinnercityofNashvillearebeingscrccncdina Tennesseeflfid-.SouthRegionalfiledicalProgram-fundedproject.Follow-upiscarriedoutwiththecooperationof anOKONeighborhood1lealtl~Centerandthereorganized,comprehensiveout-patientdepartmentofl~bbardIlospital,theteachinghospitalofMeharryMedicalCollege,Thescreeningandfollow-upprogramisbeingextendedtocoveranentireruralpoorpopulationinthecountiesofllumphrcy,I[oustonandStewartinMd-Tennesseeat therequestofco~ity leaders.

Status:@erationalasof 2/68l~tyear- $436,0252ndyear- $605,9063rdyear- $604,5354thyear- $307,897

,

we TennesseeMid-SouthMcovers theStateofTennesseeandpartsofSouthwestem.Ken@cky;andhasbeeno erationalsinceFeb~ary1, 1968. ~ ~~•

!Its,cmitmentlevelfor~ 1970was 2,128,110andfor~ 1970was$1,747,352.Thesefundswereusedin 1971foratotalof 26projects,ofwhich4 werein theareaofgeneralcontinuingeducation,7 fortrainingexistinghealthpers~nnelfin~ skills,3fortrainingnewhealthpersonnel,7,forpatientsemicesdemonstrations,3 foracombhationof,patient:ervices,andtraintig,2.f~rR6D2~d a nuMberof’coreactivities. ~ ‘ ,,,,,,.:

,.,. -75-

Twenty-fivethousandchildrenhavebeenscreenedforheartdiseaseintheMissouriRegionalMedicalB09~ PhonoCardioSc~Project”As of thebegiMingof 1971,356childrenwifiprevio~lYwdetectedmurmurshavebeenrefe~edtofieirpllysici~sforfoll”~-~?‘n:‘fwhomrequiredopenheartsurgeryonanurgentbasis.me screeningisbeing conducted by theMissouriIieartAssociation,Workfigth~ouglltileSChOOl system,tithan ~ressi~e amountof activemvolvemcntbypersonsintheRegion.Therehavebeen40,000letterssenttoparents,over3,000schoolofficialsandteachershaveactivelycooperatedandover10,000hourshavebeenputinbyIIeartAssociationvolunteers.

Status:~crationalasof 4/69

2nd~ear- $34;0553rdyear- $18,000

The:MissouriM’ coverstheStateofMissouri,exclusiveof’~troPO1itmSt:Louis,tidhasbeenoperationalSince@ril 1,lg67* 1tsco~lt~ntlevelfor~ 1970was$3,074,230andforw 1971was$1,947,417.Thesefids wereusedin W 1971tosupporta totalof 2gprojects,?fwhi~1 w~sin theareaof generalcontinuingeducation,l,fort~ainlng,existinghealthpersomelinnewskills,1 fortrainingnewhealtiperso~el,7.forpatientservicesd~nstratio~,6 fora cotiinationofpatient ~servicesandtraining~’11forcoord~~tion.forhealthse~ice~>2forR~D,anda numberof coreactivities.

-76-

NA$SAU-SUI;I;O1,K

Eightyblackphysici- anddentistsIlaveorg~izedinto-anewen:i~callcdtheNassau-SLlffolkClinicalSoci~Wjwi~ tileasslst~’ce‘*theNassau-SuffolkRegional~~e~icalpro~r~” ‘e ‘ociety‘as!“ped.todealwitisomeofthemajorproblemsoflowincomeblacksllvlngInthearea. SixteenhealthComitteesof thisgrouphavefomed,havingbothproviderandconsumerrepresentation.me firstProjecttobeundertakenisaneducationandscreeningprogramforsicklecellanemia..~leSocietywillthenmoveintootherhealthproblempeculiartoblacks.

status: Professionalstaffactivity

me Nassau-SuffolkM coversthecountiesofNassauandSuffolk(LongIsland,NewYOrk)andhasbeenwerati~alsinceJ~e 18,lg7,1.I~s:cmi~ent levelfor=lg71w~ $7g4,4g4.~e?efudsweremed inm 1971tosupporta totalof7 projectstqf.filch1 w= m ‘ieareaofgeneralcontinuingeducation,1 fortralnlngnewhealthperso~el,‘1,forpatient’servicesbo~trati~sz 1 fora ctifitlo?‘fp~t~~~t

. .

servicesandtratiing,2 forcoordinationforhealfise~lces~WD, anda numberofcoreactivities.

-77-

IOWA

SCREENINGFORDIS~E RISKFACTORS

SchoolchildreninMuscat~e,Iowa,arebeingscreenedforearlyriskfactorsof corona~hea~ disease~hYPertenSion~st~ke~‘besity~‘ddiabetes.

The37OOchildreningradesthreethrough12wereex~inedastoheight,,

weight,blwd pressure>sem choleste~l,se~ trigYlceridead bloodsugar.of thefirst160studentsstudied,7.1PercentoftheboYs~d10percentof thegirlshadhighsem triglyceride,11.1percentOf .theboysand10.4percentofthegirlswereobese>~d 1104Percent‘ftheboysand12percentofthegirlshadhighbloodpressurereadings.

FO11OW-UPtestsaswellascounselingforfmiliesof childrenwithhighriskfactorsarescheduledforthes~er. InNov~berof ~g72~childreningradesonethroughthreewillbe tested.Studentswillbe retestedmtil co~letionoftheproject.

SupportingagenciesaretheIowaRegionalMedicalProgr~~theResearch@nter ofthe~iversityofIowa,andtheNationalInstitutesofHealth.

Status:Operationalasof7/68 ,...,1styear-- $88,7g0 1.

2ndyear-- $55,6933rdyear--$51,400

?

~eIowa N coverstheentireStateof Iowa,andkS beenoperationalsificeJuly1,lg68. Itsc~i~ent levelfor~ 1970‘as$716$744‘dfor’~ lg71was$573,247.

:.:

These-fundswereusedin~ 1971to suppotia total.of7 projects,ofwhich4 werefortraintigexistinghealth

.

persomeltinewskills,1 fortrainingnewhealthperso~el,1 for.patient.se~icesd~nst~tiom~ 1 forcoordination’forhealthservices,anda nder”of coreactivities.

,,..,’

-78-

A newschoolhealthprogramconductedby theNledicalProgrmishelpingto compensateforservicesthatacco~aniesgeneralpopulation

WestVirginiaRegionalthelossofmedical10SSin~shur Counw.

Thestrongestremaininginstitutioninthiscomitywi~ amedi~economiclevelis thecountyschoolboard.Workfigbough tieboard,w isaimingitsprogramatfifti,stitl~,~dseven~~@?ders” fl~echildrenwillbe taughtphysiologyofthecirculato~,resplratoq,~dnervoussystems.A pediatricnursepractitioner,a S~OOlhealthaide}anda dentalhygienistwillhelpinticearlydetectionofdiseaseandpreventivecare.An ~ual amountofhealthmanpowerwillbemadeavailableby theschoolsystemthroughitslocaloptionontheuseofTitleI educationalfinds.

Status:Operationalasof 6/711styear-$37,267

TheWestVirginiaM coverstheentireStateofl~estVirginia,andhasbeen@erati~al sficeJ~uav 1,lg70~ Its.c~i~ent level‘or $w 1970was$524,048andfor~ 1971w~ $580,978.ThesefundswereUSedin~ 1971to.supwrta.totalof4 projects>offii~ + w= fortrainingexistinghealfipers~~elhn~ skills,1 forpatlen~;servicesdemo~trati~, 2 forRGD,ad a n~ber O:COr~actlvltles*.,

-79-

~ORGIA

LEARNING

‘tArcYouaimedat

IU;.SO~~SSERVI(XS

IlcadyTo (;o1lomcand1shelpingpatientsmakea

YourIIomc l~cadyI:orYou,” a l}:~)lllctbettertransitj.onfromhospitalto

homeenvironment,hasbeenproducedby theState’sEasterSeal.Societywiththehelpof(;eorgiaRegionalMcdicalProgramtsI,earnj.ngRcsourccsServices.

LRSproductionassistancehasalsobeengiventoa rehabilitationclinicfora sound/slidepatientorientationprogram.Inaddition,GRMPpersonnelarehelpingdevelopa gameideatohelpnonreadingdiabeticslearnaboutproperdiet.

.

ThedemonstrationLRSislocatedinAtlanta.Itprovidesassistancetomedicaleducatorsin thedevelopmentandeffectiveuseof audio-visualaids. Itwillalsosene asa trainingfacilityfor’newaudio-visualtechnicians.Atpresent,thereisnoothermeansof trainingaudio-visualpersonnelrecruitedfromlocalareas.

Status:Operationalasof9/711styear- $20,000

lfieGeorgia~ coverstheStateofGeorgiaandhasbeenoperationalsinteJuly1,1968; Theircoti~ent levelwas$1,922,571forN 1970and$1,779,862forH 1971.~ese fundswereusedir,1971tosupport23projectsofwhi&”6 wereintheareaofgeneralcontinufigeducation,6 fortrainingexistinghealtiperso~elh newskillsi.~,fortr~~n~g.n~ healthpersonnel,3 forpatientsenicesdemonstratlon~lfor acombinationoftrainingandpatientsemices,5 forcoordinationofheqlthservices,andanumberof coreactivities.

?

.s

.

$,.;

,,

,.,,,

.

-80- , ,,

;..

WIS~NSIN

S~>’anisll-speakingcitizenswholivejnthesouthinnercitysectionofllilwaukeearegainingaccesstomedicalcarewifithehelpofa]IcalthInfomatiol~andReferralCenter.Milwa~eeCO~tY~fitafivervfinehealthcarefacilitiesfortheindigent.Somefinditdif~icult,however,toenterthesystembecauseof languageor~wlturalbarriers.Withtheassistanceof theWisconsinRegj-ona~MedicalPro~am tiecenterisaidingtheSpanish-speakingcitizensOC tl~careamakeuseof theresourcesfiichareavailabletothcrnandprc)vi(lcwhatareessentiallysatelliteclinicalactivitieswithintheneighllor-hoodsiCOmmunityhealthaidesarcbeingtrainedtostafftheccntcr.

Status:l)rofcssionalstaffactivity

TheWisconsinM coverstheentireStateofWisconsinandhasbeen .operationalsinceseptefier1,lg6g.~eir cofi~ent levelw~s

,“ :~

$1,098,429form 1970ad $951,781for~ 1971.Thesefundswerewed in1971 to.supporta totalof 13projects,ofwhich4 wereintheareaof generalcontinuhgeduc~tion,2fOrtr?infigexist~g.,. :;“healthpersonnelin“newskills,3 forpatient‘servicesdemonstratlop~1 fora co@inationof train-gandpatientservices’,1 fo~coo;din~tionfoihealthservices,2 forRGD, and ander Ofcore activities” ~•J•H•J•

..

A pllonccalltoticComity Re.fcrral;~dInformationse~i~c (CRJS)

bringsSantaMa residentsinformationonhealthandotherservicesavailableintheareas

WithsupportfromtheCaliforniaRegionalMedicalpro~~, WS bcg~Itisstaffedpri~rilYbY vol~teers> ad

*

operatinginMayof 1970.receives18to20newclientsdaily--mostlYtiroughphonecalls.

rCRIS

staffhasonhandinformationfromOrangeCountyagenciescon:e~ed

4i~

withhealthandothersocialservices.Ifa callerrequeststiormation 1 ~

whichCRISdoesnothave,thestaffmakeseveryefforttoobtaintheIi

information.

Fundingcomesfromm, theAmerim CancerSocietyanda varietyofin-kindcontributio~.

Status:ProfessionalstaffactiviW: :

$15,000contract

.

me Califonia~ coverstheentireStateofCaliforniaandtwo$OmtiestiNevada,md~s.beenWeratto~l s~ce JUIY 1? 1968* 1ts com~~&~”level for w 1970was$8,012,055ad for~ lg71w~ $6,220>Og4*@ds weretiedh ~ 1971toSWPOrta totalot 24projects~.of‘hi+ .3’wereh theareaof generalcontinuingeducation,4’fortra~g exlst~nghealtipersonnelinn~ sR1ls,1 fortraintignewheal~perso~el,6forpatientsefiqesd-~trations~8-fora C~~tiOn ?fpat~~~r:Senices ~d traintig~,l for,coordinatlonfor.heal~se~lces).

,..J

R6D,anda tier of”coreactivities.

-82-

hergency

INDEX

27

8030

70a2al

1459

74

;;55

.

.●

✎

✎

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

. . .,..

. . .

. . .

. . .

.

.

.

.

.

.

.

.

.

.,

.

.

.

.

.

.

.

.

.

.

.

.

70, 77, 79,. 2, 5, 15,

[{ealthEducationE1meHealthCareI .

.

.

.

.

.

.

.

. . . . . 41,IndianHealth. .57, al;

32~35, 38, 39, *7i, 75, 77,InformationandReferralServicesInnerCityHealthProgr-. . .(3,/,17,19,

. .

. .LaboratoryFacilities . . . . a,

.*. 58,. . . . . . . .. . . . . ● ☛☛

. . . . . .

. . . . . ...

.

.

.

...

.

.LibraryServices. .

DevelopmentEhtion . 9, 10, 25, 31,43-45,48-50,56,1,

. .

. .

. .

. .

. .

. .

. .

. .

. . . . . . .......

●3;. .. .. .. .. .

i3;

. . . . . ..*31,33,35,37,. . . . . .*..’. . .

. . . .

. . ..0.

. . .

.,.

. . .

. . . 3,6, 13,46, 47, 5i-53. . . 20, 60

Sp&&y-TtitingMedicalRecor& -11I

Systm . . . ● ✎✎✎☛ .00

● .*** ● . . 8, 40, 60; 73. . . . . . . 31,33,67,72

MigrantHealthModelCities .

. . . . . ● ☛

✎ ✎ ✎ ✎ ✎ ✎ ✎

. 2,’10, 11, 30i5~3i, ’3i, *4b, 46, 57, 62, 75

RehabilitationRuralHeal* .

. “. . .

. 69, 72, 74, 76-7a33, 63, 65, 73, 7S

Screening. . . . . . . .MtiphicS~eAng

.

...

.

...

. .

. .. .. .

.

...

.●

.

...

.

.

.,,.,-

,

-a3-#

Date post:	12-Jun-2018
Category:	Documents
Upload:	vuongdan
View:	213 times
Download:	0 times

mY 1971 - National Institutes of Healthcims,willbeoneofthetiir~ctsOfaid~dcranr; ... patient....

Documents