« DEPARTMENT OF HEALTH, EDUCATION AND WELFARE National institutes of Health Division of Regional Medical Programs National Advisory Council on - Regional Medical Programs Minutes of Meeting February 26-27, 1968 National Institutes of Health Conference Room 4 Building 31 @ DEPARTMENT OF HEALTH, EDUCATION AND WELFARE POSLIC HEALTH SERVICE NATIONAL ADVISORY COUNCIL ON REGIONAL MEDICAL PROGRAMS Minutes of Eleventh Meeting 1/ 2/ The National Advisory Council on Regional Medical Programs convened for its eleventh meeting at 8:35 a.m. on Monday, February 26, 1968, in Conference Room 4, Building 31,.National Institutes of Health, ~~... Bethesda, Maryland. Dr. Robert Q. Marston, Associate Director, NIH, ~~and Director, Division of Regional Medical Programs, presided for Dr. William H, Stewart, Surgeon General, who was unable to be present for all of the meeting. The Council members present were: ° Dr. Edwin L.Crosby Dr. James T. Howell Dr. Michael E. DeBakey Dr. Clark H, Millikan Dr. Helen G. Edmonds Dr. George E. Moore (2/26 only) Dr. Bruce W. Everist Dr. Edmund D. Pellegrino Dr. John R, Hogness (2/26 only) Dr. Alfred M. Popma Dr. Mack I. Shanholtz © _ Liaison members attending: . Dr. Sidney Farber, NCI Council (2/26 only) Dr. J. Willis Hurst, NHI Council (2/26 only) Dr. A. Earl Walker, NINDB Council (2/26 only) 1/ Proceedings of meetings are restricted unless cleared by the Office of the Surgeon General. The restriction relates to ail material submitted for discussion at the meetings, the agenda for the meetings, the supplemental material, and all other official documents, 2/ For the record, it is noted that members absent themselves from the meeting when the Council is discussing applications: (a) from their respective institutions, or (b) in which a conflict of interest might occur, This procedure does not, of course, apply en bloc actions~--only when the application is under individual discussion. ~2- @ PUBLIC HEALTH SERVICE MEMBERS ATTENDING Be. Ernest Allen - Office of the Surgeon General Dr. R. G. Basalyga - National Center for Chronic Diseases Dr. B. H. Cole - Office of the Surgeon General Dr. Samuel Fox III - National Center for Chrenic Diseases Dr. Joseph Gallagher~ Bureau of Health Manpower Dr. K. Kasuga ~ Bureau of Health Services Dr. E, P. Offutt = Office of the Surgeon General 7 Mr. John L, Pendleton + National Center for Chronic Diseases “vo Dr. William H, Stewart - Surgeon General ‘Dr. Francis Weld - National Center for Chronic Diseases ’ OTHERS ATTENDING Dr. Lionel Bernstein - Veterans Administration Dr. J.H.U. Brown - NIH/NIGMS Dr. M. B, Donnald ‘Miss Pauline L. Stephan ~ NIH/NCI DRMP STAFF ATTENRENG Mr. Stephan Ackerman - Associate Director for Planning and Evaluation Mr. James Beattie, Chief, Grants Management Officer Mr. Nick Cavarocchi = Financial Management Officer Dr. Burnet Davis ~ Assistant to the Director for Special Studies Mr. E., M. Friedlander - Associate Director for Communications and Public Information Dr. Louis §. Gerber - Medical Consultant Mrs. Eva M, Handal «+ Committee Management Officer Mr, Charles Hilsenroth ~ Executive Officer Dr. Richard Manegold - Associate Director for Program Development and Research Mr. Maurice Odoroff - Assistant to the Director for Health Data Mr. R. L. Peterson - Chief, Planning Branch Mrs, Martha Phillips - Chief, Grants Review Branch Dr. A. M. Schmidt - Chief, Continuing Education and Training Branch Dr. Margaret Sloan ~ Associate Director for Organizational Liaison Dr. Richard Stephenson ~ Associate Director for Operations Mr, Karl Yordy - Deputy Director, DRMP Mr. Ira Alpert - Office of the Associate Director for Operations Mr. Robert Anderson - Office of the Associate Director for Operations Miss Sheila Beach ~ Committee Management Office Dr. Thomas Bodenheimer ~ Office of the Associate Director for Operations Mr. Cleveland Chambliss ~ Assistant Associate Director for Operatians Mr. Peter Clepper ~- Grants Review Branch Dr. Veronica Conley - Continuing Education and Training Branch Miss Cecelia Conrath ~ Continuing Education and Training Branch Dr. V. J. Corollo - Office of the Associate Director for Operations ©: Mr. Arthur curry - Grante Movers nena Peannh . Dee bavid Goide - Continuiug os .rukien anu Training Branch Mr. LeRoy Goldman ~ Office of the Director I. II, @ Tit. -3- Mr. Robert Jones - Grants Review Branch Dr. John Hamilton - Office of the Associate Director for Operations Mr. Loren Hellickson - Office of the Associate Director for Planning and Evaluation ‘ . Mr, Arthur Hiatt ~ Office of the Associate Director for Planning and Evaiuation . Mr. George Hinkle ~ Grants Management Office Dr. Philip Klieger ~- Office of the Associate Director for Cperations Mr. Robert E. Lee - Office of the Director Mrs. Patricia McDonald ~ Grants Review Branch Mr. T.J. McNiff - Grants Management Branch Miss M.J. Morrill - Continuing Education and Training Branch Miss E.J. Nelson - Continuing Education and Training Branch Dr. RB. M. O'Bryan - Office of the Associate Director for Operations Mrs. Suzanne Paul - Office of the Associate Director for Planning and Evaulation Miss Leah Resnick - Office of the Associate Director for Planning and Evaluation . Mrs. Rebecca Sadin - Continuing Education and Training Branch Mrs, Jesse Salazar - Grants Review Branch Mrs. Judy Silsbee - Continuing Education and Training Branch Miss Jane Shouse - Office of the Associate Director for Planning and Evaluation Mr. James Suter ~ Continuing Education and Training Branch Mr, Lee Teets - Grants Management Office Mrs. Mary A. Teller - Office of the Asscciate Director for Planning and Evaluation Hiss Charlotte Turner - Continuing Education and Training Branch Mrs. Virginia Waller - Office of the Associate Director for Operations Mr. Stephan Walsh - Office of the Associate Director for Planning and Evaluation CALL TO ORDER AND OPENING REMARKS Doctor Marston called the meeting to order at 8:35 a.m. ‘ ANNOUNCEMENTS Doctor Marston made general announcements about the Service Desk, and called attention to the statements on, "Conflict of Interest," and "Confidentiality of Meetings." He also mentioned that the DRMP Conference Workshop, which was held on January 17-19, 1968, was a success. Dr. Helen G. Edmonds, Dean, Graduate School, North Carolina College, Durham, North Carolina, was welcomed as a new Council member. Dr. Je Willis Hurst, Professor and Chairman, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, a former RMP Council member, was also welcomed. Doctor Hurst is now the liaison member from the Heart Council. CONSIDERATION OF FUEURE MEETING DATES May 27-28, 1963 . {ALL o£ these will be held in August 26-27, 1968 Conference Room 4, Building 31, November 25-26, 1968 beginning at 8:30 a.m.) Vi. © VII. VIII. whe CONSIDERATION OF MENUTES OF NOVEMBER 1957 COUNCIL MEETING The Council unanimously recommended approval of the Minutes.of the November 20-21, 1967, meeting as written. COMMENTS FROM LIAISON MEMBERS None of the liaison members had comments to make. EXTENSION OF PL. 69-239 “The Bill requesting a five-year extension of this legislation has not yet been introduced in the Congress. We would anticipate that this will occur shortly after the President's Health Message is sent to the Congress, and that Hearings will take place quite rapidly thereafter. The Draft Bill is still essentially as it was in our previous discssions, and is based on recommendations in the Surgeon General's Report to the President and the Congress. This Bill contains an amendment with regard to the Veterans Administration participation in the Regional Medical Program; it does not contain provisions for construction authority. Copies of this will be sent the Council as svon as they are available. Representatives from many groups such as the AMA are in favor of supporting the Bill. DISCUSSION OF DRAFT GUIDELINES The draft Guidelines have been forwarded for clearance. Mr. Robert Lindee, Assistant Dean, Stanford University, has worked with us in the development of this revision, and the Council Sub-Committee met in December in Chicago to discuss revisions. The draft Guidelines now constitute a fairly extensive reorganization of existing materials that were in the previous one. These were distributed to the &00 persons who attended our Conference Workshop in January, and a few minor comments have been received. They seem to have been accepted quite well by the regions. Discussion ensued concerning the sentence on page 28, itemc, of the Guidelines, i.e., "Physician and dentist trainees may be reimbursed at a rate not to exceed $50.00 per day." It was further recommended that the words, "stipend" and, ‘reimburse’ be eliminated, Other questions to consider have to do with the amount of stipends to be payed and whether the specific doliasy figure should be included, It was suggested that this be changed to, "Tor all health personnel there may be compensation in accordance with the maintenance with income which would have the effect..." There is a new across-the~board training policy which may or may not have an effect on this. INVOLVEMENT OF VETERANS ADIMINISTRATIONS HOSPITAL IN REGIONAL MEDICAL PROGRALS Dr. Lionel Bernstein, Divector of Research Services, Department of Giecusseu Geb oadack pee. we bee see hy BCQGuareu VeeuUrala AUMERLSLYAy LON authovity under Public Law 69-765. This broadened authority permits the Veterans Administration to cooperate and coordinate its programs with other programs such as Reztonal Medical Programs in wayo which were IX, = See previously precluddd, Accordingly, the Chief Medical Direstor of the Veterans Administration through the "Director's Letter" - (copy attached) intends to apprise the Veterans Administration hospitals, Domiciliary, and Outpatient Clinics of these facts and encourage them to further coordinate their programs with Regional Medical Programs, Mr. Yordy, Deputy Director, Division of Regional Medical Programs, then discussed the rationale for and implications of section 107 (b) of the bill which would, if enacted, extend the authorization for Regional ifedical Programs, Section 107(b) would authorize the use of Regional Medical Program grant funds in meeting the costs of participation in a Regional Medical Program by any Federal hospital. Mr. Yordy explained that while the effect of this section would in some ways be duplicative of the Veterans Administration authority under Public Law 89-785 it was necessary in that Federal hospitals other than those within the Veterans Administration be permitted to + participate actively in Regional Medical Programs. CONSIDERATION OF GRANT APPLICATIONS (a) New Applications 3 G02 RM 00013-0252, Western New York (Buffalo) The Council recommends approval in the amount of $174,909 for one year, as requested, plus appropriate indirect costs, Council was cognizant of the immediate need to further augment current program staff so as to assure maximum capability to meet present obligations, as well as future requirements in the area of program development. It was felt that adequate justification for additional staff.was presented in the application and that the results of the site visit on February 5-6, reinforced this identified need, 3 GO2 RE 00028-0281, Alabama The Council recommends disapproval because this diffuse, poorly organized, document failed to describe objectives or project an impact on regional health care, Laek of approval by the Regional Advisory Group is a further major drawback. A major planning activity involves 10 sub~projects in veterans hospitals, including a heavy investment in equipment, It is hoped that involvement of VA Hospitals will continue, but in a way more in keeping with health activities for the entire regional population. Council acreed on the veotommendstion for disannrovel after Disapproval, however, siouid be coistrued a8 an encouragement Co examine goals and priorities more closely, and to present them more clearly in an entirely new proposal. -~6~ 3 GO2 RM 00031-0251 and 5 GO2Z RM 00031-02, Metropolitan Washington,DC. The Council recommends approval in the time and amount requested of $256,089 for one year, plus appropriate indirect costs. The Council felt that experience during the first planning year has demonstrated that the original projection of staff needs was unrealistic. The Council believes that coordinators are needed in each of the participaging universities, the Health Department . of the District of Ccelumbia, and the Hospital Council of the National Capital Area. The Council also approved the staff recommendation that the second year planning grant be increased by $35,163. These funds will support a stroke project director, coordinating personnel at the D.C. Health Department, and Consultant services. 3 GO2 RM 00044-0251, Maryland RMP The Council recommends approval in the time and amount requested, less funds for renovation, The epidemiology and Statistics center, as well as the stroke components of this application, were felt to hold particular promise as RMP activities. The amount requested was: $328,700 direct costs, plus appropriate indirect costs. 3 GO2 RM 00045-0281, West Virginia RMP The Council recommends conditional approval subject to a site visit for purpose of clarification of issues and to assist and encourage the region in its transition to the operational phase. Even though Council believed the proposals to be diffuse, they also felt that the objectives are desirable even though the methods proposed are somewhat unusual. Certainly there was no doubt that this region is making a sincere effort to come to grips with its many problems, and it needs encouragement and assistance. The amounts requested were: $127,632, first year and $58,992, second year, plus appropriate indirect costs. 3 GO2 BM 00046-0281, Georgia RMP The Council recommends conditional approval in the amount of $208,031 for one year as requested, Request for additional personnel is reasonable and consistent with staffing requirements for an active region about to asaume operational status. The Council conditiesed pinted tye . Tas OR tet fence tosses aft place, and that the program being planned will include projects to benefit minority groups. a -7~ © The Council also approved the use of $89,000 of funds unexpended in the first year for a further necessary supplement to the core staff. « . 1 G03 RM 00006-01, North Carolina The Council recommends approval in the time and amount requested, conditioned upon reduction of the amount of compensation to be allowed for physician trainees in the Continuation Education in Internal Medicine project to stipends of $1,500 per month, It was agreed that this was a well-conceived application which would ~@onsolidate planning activities and operational projects into one grant. Although several cf the proposals are not directly related to the categorical diseases, they reflect regionwide cooperation in meeting locally developed priorities for health care resources. The amounts requested were: $1,200,916, first year; $1,317,129, second year; and $1,164,203, third year, plus appropriate indirect costs. Doctor Edmonds absented herself. Two Council members disapproved, 1 G03 RH 00012-01, Oregon The Council recommends approval in the time and amount requested with advice to the Region that assistance be sought from the College of Education of the University of Oregon for designing better evaluation of the project. The Oregon program has demonstrated impressive progress and is sufficiently developed to move into an operating program and the project is appropriate for support by RHP, The amounts requested were: $179,242, first year; $166,706, second year; and $174,204, third year, plus appropriate indirect costs. 1 G03 RH 00031-01, Washington, D.C. The Council recommends conditional approval for approximately $343,000. Projects one and two are to be supported for the time and in the amount requested of $276,098 for the first year; project three to be supported for two years cnly at a reduced level of approximately $66,902. No funds to be calculated in the award for project four. The projects included in the application are: 1. Freedmen's Hospital Stroke Station 2. Cerebrovascular Disease Follow-up and Surveillance System 3. Training Program for Cardiovascular Technicians 4. Home Telecasts of Madirr tS iretast Ceonforenres LHe Gieuals Logue cod wows. igGauy anced year; $296,315, second year; and $158, 447, third year, plus appropriate indirect costs 1 GO3 RM 00032-01, WICHE RMP ‘ Py The Council recommends approval in the amount and time requested. The region is well organized and eager to focus on the solution of their problems, The staffing of intensive coronary care centers in smal] hospitals was identified by the region as of first priority and the region has approached its development in a competent manner, The University of Washington Medical Center shrough its consultants to the WICHE region, will _ continue to encourage and strengthen the program. The amounts requested were: $175,287, first year; $150,666, second year; and $153,306, third year, plus appropriate indirect costs. 3 G03 RM 00002-0151, Kansas The Council recommends conditional approval of all five components of this application subject to a Council site visit to obtain further clarification and determine the amount to be awarded. The Council expressed interest in the over-all development of this program. The Council felt that this was a well planned greup of projects which are worthy of support. : © ‘The amounts requested were: $397,710 first year; $270,923, second year; and $248,887, third year, plus appropriate indirect costs. 3 G03 RM 00009-0183, Missouri The Council recommends deferral, pending a site visit, with return to the Review Committee and Council for final recommendation. Council members believe that both projects in this application need a site visit in order to clarify project objectives, local capability for accomplishing the proposals, and appropriateness of the requested budgets. . Project development has apparently been successful in fostering cooperation between M.D.'s and D.O.'s in the stroke project. It seems likely that the proposed Cooperative Tumor Registry would expand a registry already in operation, In that case, the present functioning and utility of the registry should be described, The amounts requested were: $341,155, first year; $596,834, second year; and $610,962, third year, plus appropriate indirect costs. IX. CONSIDERATION OF GRANT APPLICATIONS (CON'D) (b) Request for Program Expansion in Non-Competing Applications Theos nies fost bee Year gent . a ete Fe ete ty tha socend vant of the the Georgia application snow: above. in addition, the Council recommended Ik. =Qu approval of the use of unexpended funds for the following based on the recommendation of the DRMP staff: e 5 GO2 RM 00043-02, Indiana The Program Coordinator has stated that an additional $23,500 will be essential to carry out the Flanner House studies. This will. pay for personnel, equipment, and cost of laboratory tests. 5 GO2 RM 00021-02, Northlands (linnesota) The Region requested an expansion in thelevel of support in order to cover both the planning studies and the core staff which is now available, and will receive $81,200 to do so. 5_GO2 RM 00048-02, Ohie Valley (Lexington, Kentucky) Based on recent discussion with the Region, the Program Coordinator's expressed need for an additional $40,000 was recommended for approval to support several additional positions for which candidates are now available, , CONSIDERATION OF GRANT APPLICATIONS (CON'D) (c) Report on, "Earmarked Funds"! The Council Sub-Committee met on February 25 and reviewed 23 projects for earmarked funds. Upon presentation to the full Council, the following recommendations were made: CORONARY CARE Mobile Coronary Care Units and Extension of the, "State of Franklin''- North Carolina RiP, 1 G02 RM 00006-0151 The Council recommends approval in the time and amount requested of $25,455 for one year, plus appropriate indirect costs. In recommending approval of this application the Council recognized the specific relationship to two other projects being undertaken by the region - coronary care units in small rural hospitals and training of coronary care unit managers - and to-their over-all approach to regional- ization. Council emphasized their hope that some answers would come out of these projects which would help assessthe value of provision of specialized coronary care in very small hospitals widely separated throughout rural areas, Doctor Edmonds absented herself during the deliberation. -10- Western New York (Buffalo) RMP, 3 G93 RM GO013~O01S1 . 2 The Council concurs with the Sub-Committee's recommendation of deferral for approval of this Mobile Coronary Care Unit because ‘of the absence of approval by the Regional Advisory Group. North Carolina RMP, 1 GO3 RM _00006-01 The Council concurs with the Sub-Committee's recommendation of the: following: Approval for one year of the Training of Unit Managers ($65,823), and Small Hospital Coronary Care Units ($93,019) plus appropriate indirect costs. Provisional approval was given for the Mobile Coronary ‘Units ($16,985). , In recommending approval of these three proposals, the Council recognized the relationships of these projects to ongoing programs and the rate of development within the Region. The cooperative arrangements and interrelationships between the projects were noted. It was also emphasized that mobile coronary care units and coronary care units in very small hospitals have not had sufficient study to prove their feasibility and that this was the proper time and program for such feasibility to be determined. Doctor Edmonds absented herself. Mobile Coronary Care Units, Ohio State RMP, 3 GO2 RM 00922-0182 The Council concurs with the majority recommendation of the Sub- Committee for conditional approval in the time and amount requested pending complete local approval of the project by the Ohio State Regional Medical Program for $164,242 first year, plus appropriate indirect costs, In recommending this mobile coronary care unit project for provisional approval, the Council was aware that it had not yet received Regional Advisory Group approval. They recognized that this project was consistent with the intent of Congress regarding earmarked funds and Regional Medical Program soals, It was noted that the planning and evaluation techniques were not as sophisticated as those of another region and that this region and all regions withmbile coronary care unit projects should work together and develop interrelationships. They believed that these suggestions would accomplish more effective programs for determining the feasibility of such projects and that the capabilities and expertise were available in this region to successfully undertake this project and overcome the project's One Council member opposed. Intermountain RMP, OOO15 “4 The Council concurs with the Sub-Committee's recommendations for disapproval under earmarked funds and that the projects listed below should be resubmitted for review with the other proposals in the complete applications: 1, Small Hospitel Coronary Care Unit; 2. Mobile Coronary Care Unit. In disapproving these two projects the Council recognized their merit and suggested that they undergo the normal review process of the Regional Medical Program, They felt that these proposals were important to the over~all regional program and the continuity of the program would be best served by keeping all of the projects together for review. They were also concerned that the evaluation process was weak and would probably not measure the stated objectives. Rochester RMP, 3 GO3 RM 00025-O1S1 The Council concurred with the Sub-Committee's recommendation for approval in the time and amount requested pending submission of formal approval of the project by the local Regional Advisory Group for $73,676 first year plus appropriate indirect costs. This project is for training nurses as coronary care unit managers. The Council was satisfied that this project was consistent with Congressional intent for earmarked funds and Regional Medical Program goals. Also, it was impressed that this project would satisfy the stated needs of the region, and that the necessary planning and expertise were available to accomplish the objectives, Iowa RMP, 3 GO2 RM 00027-0251, Training Unit Managers The Council concurs with the Sub-Committee's recommendation for - approval in the amount requested of $132,263 for one year, plus appropriate indirect costs. The Council believed this to be a well defined physician and nurse training course in coronary care techniques and unit management and to be relevant to regional development. The Council was impressed that this project would satisfy the stated needs of the region and that the necessary planaing and expertise are available to accomplish the objectives, Albany RMP, Herkimer Hospital Coronary Care Proiect The Council concurs with the Sub-Committee's recommendation for approval for one year in the amount requested of $50,000. NECES GL Lu Legevd oun 1. GUsastivid capadiiily was avaiiabie to accomplish the objectives, Doctor Moore absented himself. California RMP “, The Council coneurs with the Sub-Committee's recommendation for approval for one year in the amount requested of $42,393. In recommending approval of this proposal it was agreed that this physician-training program in coronary care is of high quality and would satisfy the stated needs of the region. WICHE RMP, 1 G03 _RM 00032--01 Council concurs with the Sub-Committce's recommendation of approval of one year in the amounts requested as follows: $175,287 - lst year $150,666 ~ 2nd year $153,306 - 3d year, plus appropriate indirect costs. The staffing of intensive coronary care centers in small hospitals, to which this project is addressed, was identified by the region as of first priority. The region has approached its development in a competent manner, The association of St. Patrick's Hospital with the Western Montana Medical Clinic, is an asset, as are the physicians who will direct the activities of the training center. The Council was confident that the University of Washington Medical Center, through its consultants to the WICHE region will continue to encourage and strengthen the program, STROKE Missouri RMP, University of Missouri Intensive Care Unit The Council concurs with the Sub-Committee's recommendation of deferral for site visit and then submission to Review Committee and Council. This proposal will be considered in the "Missouri package" already under consideration (3 G03 RM 00009-0153). The following questions were raised: _ 1, What is the research-training-demonstration of patient care mix? 5 2. Is the budget too high for what is proposed?; 3, What will be the real regional impact of this proposal? Cerebrovascular Disease Workshop, University of Minnesota The Council concurs with the Sub-Committees opinion regarding the project's high quality. The Northland Regional Medical Program had not expressed intent fo ccsooert the nroiect however, and, therefore, the proposa4i ve Leu be ide -13- Missouri RMP, Western Missouri Cerebrovascular Diagnostic Center The Sub-Committee believes this proposal to be only a slight revision of a similar proposal rejected by the Council one year ago, However, the Sub-Committee felt that Kansas City needed some support, and, therefore, an attempt should be made to fund the project. It was recommended that the project be approved conditionally on the approval of, and in the amount decided by a site visit team, The Council questioned whether the site visit team should be given final authority to make a decision on this project, which was really /a research oriented proposal rather than a primarily patient~care program, After some debate, the Council recommended that a site visit be made, and that the project, with the site visit report, be submitted to the Council for mail vote. California RMP, (San Francisco), 3 GO2 RM 00019-02S1 The Council recommends deferral for additional clarification and information, * The Council felt that it should recommend deferral until the local Regional Medical Program can conduct a full review of the proposal. The Council recognized the merits of the proposal but was concerned that the proposed fit into the over-all San Francisco planning process, Specific questions concerning the large items for renovation and the relationships of the NINDB grant were raised. North Carolina RMP, Comprehensive Stroke Program It was felt that this proposal was vague, and that is showed little indication of fulfilling its stated objectives, The Council concurs with the Sub~Committee's recommendation of disapproval. Doctor Edmonds absented herself, Northeastern Missouri RMP (Kirksville) The Council concurs with the Sub-Committee's recommendation of deferral for site visit and then submission to Review Committee and Council, _. This suggested, in order to obtain more information, and define more realistic program funding for the Region, The specific items which need further elaboration that were asked by the Council are: 1, The neurological capabilities in the project were not adequately demonstrated; 2. Is there a relationship to the Missouri Regional Medical Program and can tha Meteors ve Tae steattes Beer bs ~ mene yf mee There was questions as to the amount of time the Project Director would spend for the project and the 10% listing was not considered a]4- acequate for the over-all scope of the project. Another question was the low budget in the light of vartous comprehensive projects included within the grant application. . * Metropolitan D.C, RMP, George Vashington University Comprehensive Hospital and Home Care of the Stroke Patient The Council concurs with the Sub-Committee's recommendation of deferral until the next meeting of the Sub~Committee. ‘This was necessary because the Sub-Committee had not had the opportunity to study this proposal before its meeting. _ Metropolitan, D.C,, RMP Freedmen's Hospital €troke Station The Council concurs with the Sub-Committee's recommendation for approval in the amounts requested of $183,851, first year, $126,379 second year, plus appropriate indirect costs. Metropolitan D.C. RMP, Comprehensive Stroke Care Program The Council concurs with the Sub-Committee's recommendation of - deferral until the next meeting because there had not been an opport- unity to study this proposal before the meeting. Mississippi RMP, Stroke Intensive Care Unit - _ mee The Council concurs with the recommendation of the Sub-Committee that this project was worthy of support because of the great need for improved stroke care in Mississippi. However, funding of the $93,000 budgeted for hespitalization costs was disapproved because the members felt that this would create a dangerous and expensive precedent, illinois RMP (Chicago), 3 G02 RM 00061-02 The Council recommends deferral for additional clarification and information until the local Regional Medical Program could cenduct a full review of the proposai, The Council remarked on the attractiveness of the concept of involving several community hospitals in a stroke project. Reservations were expressed about the single focus of rehabilitation of the project and its relationship to the over~all stroke program of Illinois RMP. A specific question concerning the details of the support of the various stroke committees was asked. Mississippi RilP, Comprehensive Stroke Detection and Treatment The Council concurs with the Sub-Committee's recommendation of approval for two years in the amounts requested of $278,039 first year; and $174,432 second year, with the deletion of funds for hospitalization of $184,964 first year, plus appropriate indirect costs, The Sub-Committee for Earmarked Funds agreed that this is a reasonable appreach to 2 wrery ee 7 ves : is : : Yr ad eefegtond rection, Th Yerertvai, vit appears co isive a strong training aspect. The project is an extension of the presently funded feasibility study and will serve as a strong base for operational projects for stroke control in the area, -15~ @ Doctor Crosby abstained from voting. ‘Texas RMP, Stroke Detection and Treatment, 3 GO2 RM 00007-0251 + « The Council concurs with the Sub-Comittee's recommendation for approval for one year in a reduced amount of $240,499, plus appropriate indirect costs, All were faverably impressed by this project, They were, however, unanimous in their opinion that the bed costs should not be supported “x27. from Regional Medical Program funds, There was discussion of other prant support to this institutéon for activities relating to this project and staff was directed to check with other granting agencies to be reassured that there is no duplication of program or of funding. Doctor DeBakey absented himself. X, APPLICATIONS WHICH WERE CONSIDERED AT THE NOVEMBER COUNCIL MEETING . AWARDED APPLICATION NUMBER REGION : 1 G02 RH 00063-01 Northwestern Ohio (Toledo) 1 G02 4 99064-01 Northeastern Ohio (Cleveland) 2 GO2. FY 90035~02 South Carolina 3 G02 RM COO1L3-92S1 Western New York (Buffalo) 3 692 RI 99023-0251 ; Oklehoma 1 ¢63. Rit GOOLE~O1 Tennessee Mid-South 1 ¢O3 RM 60025-01 Rochester, New York 1 G3 RM 00038-O1R Washington-Alaska 3 GO3 RM 00015-0152 (Project 2) Intermountain DISAPPROVED 3 GO3 RM 00009-0182 Misseuti 3 GO3 RM 09015-0182 (Project 1) Internountain XI. CONTRACT FOR HEART STUDY~-~?ROGRESS REPORT ON IMPLEMENTATION OF SECT©ON $07 ~ The Division of Regional Medical Programs has the responsibility for implementing Section 967 of P.L. 89-239, which states that: "The Surgeon General shall establish, and maintain on a current basis, a list or lists of facilities in the United States equipped and staffed to provide the most advanced methods and techniques in the diagnosis and treatment of @ heart disease, cancer, or strcke, together with such related tp Frerntion Pt tte AP adyonerd ceoatatiy make such list or iist: and reiated information readily available to licensed practitioners and other persons a . ae a * . . . - XII, requiring such information, To the end of making such list’ or lists and other‘information mast useful, the ‘ Surgeon General ehali frem time to time consult withe ‘interested national professional, organizations, 2 To carry out this responsibility in the field of cancer, discussions were held with experts in the diagnosis and treatment of cancer, with officers of interested professtonal organizations and with the Director of the NCI. Acting on their advice, the Division negotiated a contract with the American College of Surgeons whose C.ncer Commission includes, in its recently expanded membership, representatives cf those professional organizations which could make a significant contribution. Under this contract, the American College of Surgeons has conducted a study to determine how the requirements of Section 907 can best be carried ovt in the field of cancer, They have established an expert committee composed of representatives of the professional organizations represented on the Cancer Cowmission, with the addition of appropriate additional societies and associations, and have pursuaded Dr. arren Cole to serve as Chairman, That committee on the basis of its collective experience and the detailed study of a number of different types of hospitals and cancer institutes, is preparing te make recommendations to the Division of RMP concerning the requixzments for staffing, equipment, and organizations which are needed in a medical facility if it is to provide the highest quality of diagnosis and treatment (including rehabilitation) in the field of cancer. While no decision can be made on the use of such recommendations until they bavwe been studiet, a primary goal will be to make such information available to the hospitals and RMP staffs in each region as a guide to the improvement of their facilities. We now are contacting national, organizations such as the American Heart Association, the American College of Cardiology, the American College of Surgeons, the American College of Physicizns, the American Academy of Pediatrics, the American Medical Assoc#s/,ian, the American Hospital Association and others to determine whether they would be willing to participate in a joint effort to advise the Division as to the most how the requirements appropriate response to Section $07 in the field of heart disease~~and shortly, will initial. similar negotiations in the field of stroke, A follow-up report will be presented at the May 27-28, 1960, Council meeting. , DEVELOPMENT OF THE HEALTH POLICY RESEARCH CONTRACTUAL PROGRAM At the February Council maeting Mr. Ackerman discussed the nature of the proposed Health Policy Research Contract being developed by the Division. The basie policy of the study is to determine, bh dy So ee Po ee EDD Gabe S¥alam, XIIE. wo. » “Fe. The specifications that were sent to the five firms selectedtto receive requests for proposals were divided into five general study areas which the Division Contracts Comittee felt were of primary importance to the program at this stage of its development, The five areas were: (1) Regional Medical Programs as an Instrument for Regionalization of Health Care; (2) Evaluation of RMP in terms of the Accomplishment of the Purposes of P.L. 89-239; (3) Evaluating RMP in terms of the Ultimate Goal of Improved Patient Care; (4) the Economics of Regional Medical Programs; and (5) Division of Regional Medical Programs--Regional Relationships. This delineation of topics was made with the knowledge that there would be overlapping aspects of these areas, and that each area of study was of relatively equal importance. In addition, they are not meant as the definitive boundaries of the study, but are the core to the deve lopment of the study. For these reasons then, it is clear that one contractor would undertake the entire contract, The proposed contract period is to run two years because the complexity of the préblems posed in the specifications and the description of work does not admit to a, realistically shorter project period. . The Council expressed some concern lest the study involve the evaluation of individual Regional Programs by an outside group rather than providing the Division and Council with information, insights, methodology, and possible criteria for their evaluation of the progress of Regional Medical Programs. It was agreed thatthe Division would keep the Council informed as to the further development of the contract, which it is anticipated will be awarded around the first of June. ADJOURNMENT The meeting was adjourned on February 27, 1968, at 10:30 a.m. ASTACHMENT Eva M, Handal Committee Management Officer, DRMP I hereby certify that, to the best of my knowledge, the foregoing minutes and attachments are accurate and complete, “ Vv - . ” v7 fee r¢ : ay fra tg a Robert Q, Marston, M.D, ; Associate Director, HIH, and Director, Division of Regional Medical Programs NATIONAL ADVISORY COUNCIL ON REGIO Edwin L. Crosby, M.D. (71) Director American Hospital Association Chicago, Illinois 60611 Michael E. DeBakey, M.D. (68) Professor and Chairman Department of Surgery College of Medicine Baylor University Houston, Texas 77025 Helen G. Edmonds, Ph.D. (71) Dean, Graduate School North Carolina College Durham, North Carolina 27707 MAILING ADDRESS P.O. Box 432 Durham, North Carolina 27707 Bruce W. Everist, M.D. (71) ‘ Chief of Pediatrics Green Clinic 709 South Vienna Street Ruston, Louisiana 71270 John R. Hogness, M.D. (70) Dean, School of Medicine University of Washington Seattle, Washington 98105 Pe AL MEDICAL PROGRAMS e James f.-Howell, M.D. (68) Executive Director Henry Ford Hospital Detroit, Michigan 48202 Clark H. Millikan, M.D. (68) Consultant in Neurology Mayo Clinic Rochester, Minnesota 55902 George E. Moore, M.D., Ph.D. (68) Director, Public Health Research New York State Department of Health Roswell Park Memorial Institute 666 Elm Street , Buffalo, New York 14203 Edmund D. Pellegrino, M.D. (70) Director of the Medical Center State University of New York Stony Brook, New York 11790 Alfred M. Popma, M.D. (70) Regional Director Regional Medical Program 525 West Jefferson Street Boise, Idaho 83702 Mack I. Shanholtz, M.D. (70) State Health Commissioner State Department of Health Richmond, Virginia 23219 EX OFFICIO MEMBER Dr. William H. Stewart (Chairman) Surgeon General . Public Health Service 9000 Rockville Pike Bethesda; Maryland 20014 May 1968