FACT Book

1935268210973 on
69810307 REGIONAL
732047549 MEDICAL
3695414 PROGRAMS
A 21142 9
72 8037531
40615262591824931074

 

August 1971 —

A SPECIAL REPORT TO THE NATIONAL ADVISORY COUNCIL
REGIONAL MEDICAL PROGRAMS SERVICE
The Fact Book was prepared by

the Office of Planning and Evaluation
with graphic assistance from the Office
of Communications and Public Information,
Regional Medical Programs Service.

Comments and suggestions regarding this
publication are welcomed and should be
addressed to:

Evaluation Branch

Office of Planning and Evaluation

Regional Medical Programs Service

Health Services and Mental Health
Administration

5600 Fishers Lane

Rockville, Maryland 20852

Additional copies may be obtained by writing:

Office of Commmications and
Public Information

Regional Medical Programs Service

5600 Fishers Lane

Rockville, Maryland 20852
 

FACT BOOK ON REGIONAL MEDICAL PROGRAMS

 

A Special Report
to the National Advisory Council

of the Regional Medical Programs Service

August 1971

 

DEPARTMENT OF HEALTH EDUCATION AND WELFARE
Health Services and Mental Health Administration
Regional Medical Programs Service
PREFACE

"The American people have always shown

a unique capacity to move toward common
goals in varied ways... Our efforts to
reform health care in America wtll be
effective if they build on this strength,"

President's Health Message
February 18, 1971

Regional Medical Programs are a pluralistic approach to
dealing with our health problems. The Programs have
developed a coalition of almost 15,000 health providers
and interested consumers to plan and implement activities
tailored to local needs and resources.

This Fact Book presents, in abbreviated fashion, how
RMPs have organized this effort and the progress they
have made. It is hoped that this publication will
serve as a ready reference source for those interested
in Regional Medical Program activities.

bristh hwy ,
Harold Margulies, M.D.

Director ,
Regional Medical Programs Service
SECTION I:

SECTION II:

SECTION IIT:

SECTION IV:

 

TABLE OF CONTENTS

 

. Purpose. se ee ee et

. Legislative and Administrative History .-.---
. Appropriations and Budgetary History ..--->

WHAT ARE THE CHARACTERISTICS OF REGIONAL
MEDICAL PROGRAMS? 2... 2. 2 ee ee ee ee et

. Map of the RMPs. - ee eet rr

. Demographic Facts. - e+ +s er tt ttt

Population and Land-size Ranges .. +--+ ++

Geographic Characteristics .- +--+ +++es-*

. Funding Levels and Ranges - + + + st ste tt
. When Regions Received Initial Planning and

Operational Grants .- ++ seer

HOW ARE THE RMPs ORGANIZED? . . 2. ee ee ees

. Example of RMP Organizational Structure... -
_ Grantees and Coordinating Headquarters --- -
. Regional Advisory Groups - +++ sete?
. Executive Committces .- ++ eset etre
. Task Forces and Committees «++ ++ +t .
. Local and Area Advisory Groups - +++: + oe
_ Core Staff ..- ee ee te ttre
. Minority Representation. - +++ s+: eos

WHAT DO RMPs DO? -- PROGRAM ACTIVITIES .....

. Program Planning . - + ee et ttt tt
Assessments of Needs and ResourceS . +--+: -
Setting Program Priorities «+++ +++:

. Program Implementation «+--+ + tite a ties
Functional Emphasis, i.¢., Education, Training

Health Delivery, Research. . +--+ +:+->
Health Care Emphasis, i.e., Prevention/
Screening, Treatment, Rehabilitation
Disease Emphasis - +--+ -+*ret tc? ae
Areas of Special Emphasis - +++ +++
Health Manpower. - - ee eee totes tt

Ambulatory and Other Out-of-Hospital Care... -

Urban and Rural Health Care. - + +++: >

° 5

. . 13

. .
 

CONTENTS -- Continued

en

Recent Developments .---- srt ttt 4 AQ
Health Maintenance Organizations . +--+ .* °° 40
Experimental Health Services Planning and

Delivery Systems - +--+ ss errr Al
Area Health Education Centers .- +++ sc ° 42
| Who the RMPs Work With «ee ees rt ttt . - 44

Relationships With Other Federally-

Supported Programs - ++ sss ttt 44

Model Cities . +--+ +> De ee ee eee 44

Comprehensive Health Planning. ----:': 7° 45

Appalachia Health... ee eee rors . 48

Veterans Administration Hospitals .- +--+ :-:° 49

Non-Federal Health Organizations .- ++ ++ 50

. Program Evaluation »- ++ eer tr 51

SECTION V: WHAT PROGRESS HAVE THE RMPs MADE? . 2. - + ee ets 53

. Improving Manpower Resources through Education
and Training -- +e etter ttt ts 54
Number and Types of Professionals Trained . . + + 54
. Improving Services through Regionalization ..- - . 57

Hospital Participatio .-+-+-:-> pe ee ees 57

Geographic Scope of Activities - +--+ eer 59

Maps Depicting Regionalization -- +++! 60

. Turnover of Funds to Meet Changing Needs -- ++ > 62

GLOSSARY we 65

vi
 

SECTION I

PURPOSE AND HISTORY
OF REGIONAL MEDICAL PROGRAMS

This section highlights the purpose,
legislative, administrative, and
budgetary history of Regional

Medical Programs.
PURPOSE OF REGIONAL MEDICAL PROGRAMS

The Regional Medical Programs seek to strengthen and improve the Nation's
personal health care system in order to bring about more accessible,
efficient, and high quality health care to the American public. To
accomplish these ends, the RMPs promote and demonstrate among providers
new techniques and innovative delivery patterns, support training

which results in more effective utilization of health manpower; and
encourage the regionalization of health facilities, manpower, and

other resources.

The RMPs develop their programs through a consortium of providers who
come together to plan and implement activities to meet health needs
which cannot be met by individual practitioners, health professionals,
hospitals, and other institutions acting alone. The RMP provides a
framework deliberately designed to take into account local resources,
patterns of practice and referrals, and needs. As such it is a poten-
tially important force for bringing about and assisting with changes
in the provision of personal health services and care.

The initial concept of Regional Medical Programs was to provide a
vehicle by which scientific knowledge could be more readily transferred
to the providers of health services, and by so doing, improve the
quality of care provided with a strong emphasis on heart disease,
cancer, stroke, and related diseases. The implementation and experience
of RMP over the past five years, coupled with the broadening of the
initial concept especially as reflected in the most recent legislation
extension, has clarified the nature and character of Regional Medical
Programs. Though RMP continues to have a categorical emphasis, to be
effective that emphasis frequently must be subsumed within or made sub-
servient to broader and more comprehensive approaches. RMP must relate
primary care to specialized care, affect manpower distribution and
utilization, and generally improve the system for delivering compre-
hensive care.

Even in its more specific mission and objectives, RMP cannot function

in isolation. Only by working with and contributing to related Federal
and other efforts at the local, state, and regional levels, particularly
state and areawide Comprehensive Health Planning activities can the

RMPs achieve their goals.
1964 DECEMBER

1965 JANUARY

OCTOBER

DECEMBER
1966 FEBRUARY

APRIL
1967 FEBRUARY

JUNE
1968 MARCH

OCTOBER

1970 JAN.-OCT.
OCTOBER

HIGHLIGHTS OF
LEGISLATIVE AND ADMINISTRATIVE HISTORY

OF REGIONAL MEDICAL PROGRAMS

The Report of the President's Commission on !lcart Disease,
Cancer and Stroke presented 35 recommendations including
development of regional complexes of medical facilities
and resources.

Companion administration bills--S.596 and H.R. 3140--were
introduced in the Senate by Senator Lister Hill (Ala.), and
in the House by Representative Oren Harris (Ark.), giving
concrete legislative form to presidential proposals.

P.L. 89-239, the Heart Disease, Cancer and Stroke Amendments

of 1965, was signed. The Commission concepts of "regional
medical complexes" and "coordinated arrangements" were replaced
by "regional medical programs'' and "cooperative arrangements ,"'
thus emphasizing voluntary linkages.

National Advisory Council on Regional Medical Programs met
for the first time to advise on initial plans and policies.

Dr. Robert Q. Marston appointed first Director of the Divi-
sion of Regional Medical Programs and Assoc. Director of NIIl.

First planning grants approved by National Advisory Council.
First operational grants approved by National Advisory Council.

The Surgeon General submitted the Report on Regional Medical
Programs to the President and the Congress, summarizing
progress made and recommending its extension.

Companion bills to extend Regional Medical Programs were intro-
duced in the House by Harley 0. Staggers (W.Va.) (H.R. 15758)
and in the Senate by Senator Lister Hill (Ala.) (S. 3094).

P.L. 90-574, extending the Regional Medical Programs for two
years,was signed. Changes were: include territories outside
of the 50 States; permit funding of interregional activities; -
permit dentists to refer patients; and permit participation of
Federal hospitals.

Bills extending RMP introduced; hearings held.

P.L. 91-515 was signed into: law. New provisions: emphasis on
primary care and regionalization of health care resources;

added prevention and rehabilitation; added kidney disease; added
authority for new construction; required review of RMP appli-
cations by Areawide Comprehensive Planning agencies; emphasized
Lasith carvices delivery and manpower utilization.
CEs:

* APPROPRIATIONS AND BUDGETARY HISTORY.

(Dollars in Thousands)

 

Fiscal Fiscal Fiscal Fiscal Fiscal Fiscal

 

year year year year year year

1966 1967 1968 1969 1970 1971
Authorization----------77 777777 eemeece $50,000 $90 ,000 $200,000 $65,000 $120,000 $125,000
Amount appropriated for grants---~-~~~ 24,000 43,000 53,900 56,200 73,500 89,500
#Amount actually available for grants~-- 24 ,000 43,934 48 ,900 72,365 78 ,500 70,298
Amount actually awarded for grants---- 2, "066 27 ,052 43,635 72,365 78,202 70,298

 

.* Includes unspent funds carried forward from previous year minus amounts held in reserve by the
Office of Management and Budget.
 

5 A

os

° Q ‘Q

 

 

 

 

 

SECTION IT

 

WHAT ARE THE CHARACTERISTICS

OF REGIONAL MEDICAL PROGRAMS?

Thais section provides a brief overview
of the 56 Regional Medical Programs,
including their geographic boundaries,
population ranges, land size,
operational status, and ranges of

’ current funding levels.
56 REGIONAL MEDICAL PROGRAMS

 

 

 

 

 

S .
.
PAC:
—_ @
: © MW GLCa*,”
0) © ©\Oce ;
©)
6
THE 56 REGIONAL MEDICAL PROGRAMS BY GEOGRAPHIC AREA COVERED

10.
1l.

12.

13.

14.
15.
16.

ALABAMA REGION - Covering the entire State of Alabama.

ALBANY REGION - Including 21 Northeastern New York counties
Centered around Albany and contiguous portions of Southern
Vermont and Berkshire County in Western Massachusetts.

ARIZONA REGION - Covering the entire State of Arizona.
ARKANSAS REGION - Covering the entire State of Arkansas.

BI-STATE REGION - Including Southern Illinois counties and
Eastern Missouri centered around St. Louis metropolitan
area.

CALIFORNIA REGION - Covering the entire State of California
and interface with Reno-Sparks and Clark County (Las Vegas),
Nevada.

CENTRAL NEW YORK REGION - Including 15 Central New York
counties centered around Syracuse, New York and Bradford
and Susquehanna counties in Pennsylvania.

 

COLORADO-WYOMING REGION - Covering the entire States of
Colorado and Wyoming.

 

CONNECTICUT REGION - Covering the entire State of Connecticut.
FLORIDA REGION - Covering the entire State of Florida.
GEORGIA REGION - Covering the entire State of Georgia.
GREATER DELAWARE VALLEY REGION - Including Southeastern

 

. Pennsylvania, (Philadelphia-Camden) , Northeastern’ Pennsylvania

(Wilkes Barre-Scranton) and the southern part of New Jersey,
and the entire State of Delaware.

HAWAII REGION - Including the entire State of Hawaii, plus
American Samoa, Guam, and the Trust Territory of the Pacific
Islands (Micronesia).

ILLINOIS REGION - Covering the entire State of Illinois.
INDIANA REGION - Covering the entire State of Indiana.

INTERMOUNTAIN REGION - Including the entire State of Utah, _
and portions of Wyoming, Nevada, Montana, Idaho and Colorado.

 
17.
18.
19.
20.

21.

22.

23.

“24.
25.
26.

27.
28.

29.
30.
31.
32.

33.

34.

IOWA REGION - Covering the entire State of Iowa.

KANSAS REGION - Covering the entire State of Kansas.
LOUISIANA REGION - Covering the entire State of Louisiana.
MAINE REGION - Covering the entire State of Maine.

MARYLAND REGION - Including most of the State of Maryland,
(except Montgomery and Prince Georges Counties) and York
County in Pennsylvania.

MEMPIIIS REGION - Including Western Tennessee centered
around Memphis, Northern Mississippi, Eastern Arkansas
and portions of Southwestern Kentucky, and three counties
in Southwestern Missouri. —

METROPOLITAN WASHINGTON, D.C. REGION - Including the District
of Columbia and contiguous countiés in Maryland and Virginia.

 

MICHIGAN REGION - Covering the entire State of Michigan.
MISSISSIPPI REGION - Covering the entire State of Mississippi.

MISSOURI REGION - Including the State of Missouri, exclusive
of the Metropolitan St. Louis area.

MOUNTAIN STATES REGION - Including the States of Idaho,
Montana, Nevada and Wyoming.

NASSAU- SUFFOLK REGION - Including the counties of Nassau
and Suffolk (Long Island) of the State of New York.

NEBRASKA REGION - Covering the entire State of Nebraska.
NEW JERSEY REGION - Covering the entire State of New Jersey.
NEW MEXICO REGION - Covering the entire State of New Mexico.

NEW YORK METROPOLITAN REGION - Including New York City and
Westchester, Rockland, Orange and Putnam Counties, New York.

 

NORTH CAROLINA REGION - Covering the entire, State of North
Carolina. ,

NORTH DAKOTA REGION - Covering the entire State of North
Dakota.
35.
36.
37.
38.

39.

40.

4].
42.
43.

44.

45.
46.
47.
48.

49,
50.

NORTHEAST OHIO REGION - Including 12 counties in Northeast
Ohio, centered around Cleveland.

 

NORTHERN NEW LNGLAND REGION - Including the entire State
of Vermont and three contiguous countics in Northeastern
New York.

 

NORTHLANDS REGION - Covering the entire State of Minnesota.

NORTHWESTERN OHIO REGION - Including 20 counties in
Northwestern Ohio, centered around Toledo.

 

OHIO STATE REGION - Including 61 counties in central and
southern two-thirds of the State of Ohio, excluding
Metropolitan Cincinnati areas and Dayton.

OHIO VALLEY REGION - Including the greater part of Kentucky

(101 of 120 counties), Southwest Ohio, (Cincinnati-Dayton
and adjacent areas), contiguous parts of Indiana (21 counties)
and West Virginia (2 counties).

OKLAHOMA REGION - Covering the entire State of Oklahoma.
OREGON REGION - Covering the entire State of Oregon.

PUERTO RICO REGION - Covering Commonwealth of Puerto Rico,
and the Virgin Islands.

ROCHESTER REGION - Including 10 counties centered around
Rochester, New York and interface with 3 Northeast
Pennsylvania border counties.

SOUTH CAROLINA REGION - Covering the entire State of South
Carolina.

 

SOUTH DAKOTA REGION - Covering the entire State of South
Dakota.

SUSQUEHANNA VALLEY REGION - Including 27 counties in Central
Pennsylvania, centered around the Harrisburg-Hershey areas.

TENNESSEE MID-SOUTH REGION - Including 84 of 94 counties
covering the central and eastern sections of Tennessee,

Southwestern Kentucky and 3 contiguous Alabama counties.
TEXAS REGION - Covering the entire State of Texas.

TRI-STATE REGION - Covering the entire States of Massachusetts,
New Hampshire and Rhode Island.
51.

52.

53.

54.

55.

56.

VIRGINIA REGION - Covering the State of Virginia, except
for the Northern counties and cities of Alexandria,
Arlington and Falls Church.

WASHINGTON/ALASKA REGION - Covering the entire States of
Washington and Alaska.

 

WEST VIRGINIA REGION- Covering the State of West Virginia.

WESTERN NEW YORK REGION - Including 7 Western New York
counties centered around Buffalo, and the counties of Erie
and McKean, Pennsylvania.

 

WESTERN PENNSYLVANIA REGION - Including 28 counties in
Western Pennsylvania, centered around Pittsburgh. —

WISCONSIN REGION - Covering the entire State of Wisconsin.

-10-
 

QGHIARACTERISTICS OF REGIONAL MEDICAL PROGRAMS

 

DEMOGRAPHIC FACTS

There are 56 RMPs which cover the entire United States and
its trust territories. The Programs include the entire
population of the United States (204 million) and vary
considerably in their size and characteristics.

v

ow
co QO >

 

 

 

 

 

 

* LARGEST REGION

In population: California (20 million)
In size: Washington/Alaska (638,000 square miles)

* SMALLEST REGION

In population: Northern New England (445,000)
In size: Metropolitan Washington, D.C. (1,500 square miles)

* GEOGRAPHIC BOUNDARIES: Number of Regions which

 

Encompass single states ..... “ee eee 33
Encompass two or more states. ....... 4
Are parts of single states. ........ 11
Are parts of two or more states ...... 8

* POPULATION: Number of Regions which have

Less than 1 million persons ........ 5
1 million to 2 million. .......... 11
2 million to 3 million. .......:.. 14
3 million to 4 million. .......4e.. 8
4 million to 5 million. .......... 7

Over 5million... ... 2... ee eee 11

-11-
 

CHARACTERISTICS

 

% FUNDING LEVELS: Regions vary from

Highest: California ($8.3 million)
Lowest: North Dakota ($309,000)

* FUNDING LEVEL RANGES: Regions with

Less than $500,000 ......-. . 5
$500,000 to $999,000 .....--> 16
$1 million to $1.4 ......--. 15
$1.5 million to $1.9....... 10
$2 million to $2.4 ....--+.+5 6
More than $2.5 million. ....-. 4

* MEDIAN LEVEL: $1.2 million

 

   
 
  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60 |
= ——
”
oo”
90-T 48f nN
Planning
40 /
é
Number !
of i
Regions 20 /
Operational
20 4
10
0 1 t
1966 "67 "68 "69 70 71
Fiscal Year
Highlights:

To date,only one RMP has not yet received its first operational
grant -- South Dakota. This is because it received its first
planning grant in FY ‘71.

By the end of FY '67, 48 of the current 56 RMPs had received
their initial planning grant. ;

On the other hand, it was not until the end of FY '69 that
most (41) Regions received their first operational grants.

. -12-
 

SECTION III

HOW ARE REGIONAL MEDICAL PROGRAMS

ORGANI ZED?

This section highlights the
organizational structure of the RMPs,
including the composition and function
of Regional Advisory Groups, task forces,
committees and staffs. Summarized also
are overall changes which have occurred

in these groups over the past five years,

¥

‘and minority representation.

“137
~vT-

 

 

 

 

 

 

 

EXAMPLE. OF THE ORGANIZATIONAL STRUCTURE OF A REGIONAL MEDICAL PROGRAM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOLLVZINVOYO

 

 

 

 

 

 

 

 

 

 

 

 

 

Grantee Coordinator Regional Advisory
: Group
Cc {
Operations Administration Executive
Committee
Task Forces
t | | ] and
Manpower Research Subregional Services Committees
and and Offices and y
Education Evaluation Resources ,
T Local Advisory
bee e-em rT Te 4+ Groups

 

 
ORGANIZATION

 

GRANTEES AND COORDINATING HEADQUARTERS

* PURPOSE: Each Regional Medical Program is fiscally administered
by a grantee which may be a public or private non-
profit institution, agency or corporation. The grantee
is responsible for fiscal control and fund accounting
procedures to assure proper disbursement of and
accounting for such RMP funds. A coordinating headquarters
may be described as being responsible for the
implementation, administration and coordination of a
Regional Medical Program. As such, it is involved in
the dévelopment of regional objectives as well as
review, guidance and cvaluation of the ongoing planning
and operating functions.

Grantee and Coordinating Headquarters, Fiscal Year 1971

Coordinating
Grantee 56 Headquarters 56
Universities . 34 31
Public (27) (25)
Private ( 7) | ( 6)
Other 22 25
New Agency/
Corporations (15) (18)
Existing
Corporations ( 3) ( 3)
Medical Societies ( 4) ( 4)
Comment:

In some RMPs, the grantec differs from the coordinating ;
headquarters. For example in the North Carolina RMP, the 3
‘grantee is Duke University, but: the coordinating headquarters
is the non-incorporated agency--the North Carolina Association

for Regional Medical Programs.

a
ORGANIZATION

 

REGIONAL ADVISORY GROUPS

* PURPOSE: Regional Advisory Groups reflect a broad spectrum of
health. interests and institutions, including private
practitioners, commmity hospitals, allied health
personnel, and consumer representation. They have as
their primary function overall program guidance - that
is, determination of the overall scope, nature and
direction of the program. Each Regional Advisory Group
must determine policies, establish criteria and
priorities, allocate RMP grant funds accordingly and
review operational projects.

* SIZE:

1967 1,600 total membership
30 average group size

1969 2,500 total membership
45 average group size

1970 2,700 total membership
48 average group size

1971 2,743 total membership
49 average group size

Ranges in Size of RAGs--1971

10- 19 members: 3 RAGs
20- 29 members: 11 RAGs
30- 59 members: 34 RAGs

60- 99 members: 5 RAGs
100-199 members: 2 RAGs
over 200 members: 1 RAG

-16-
 

ORGANIZATION

 

Composition of Regional Advisory Groups
Fiscal Years 1967, 1969, 1971

Voluntary Other
Agencies Health Workers

 

 

 

 

 

 

 

  

 
 

Medical Public
Practicing Hospital Center Health Members of
Physicians Admin. Officials Agencies| Public Other
| | |
1967
1969
1971
0 20 40 60 80 100

Percent.
Highlights:

. Practicing physician representation has increased
considerably from 23% to 28%.

. Medical center officials have decreased markedly,
from 16% to 8%.

. Voluntary agencies and public health representation
has decreased.

Increase in members of the public from 15% to 21%
reflects more consumer involvement in RVPs.

-|7-
 

ORGANIZATION

nl

EXECUTIVE COMMITTEES

* PURPOSE: Executive Committees are appointed by the Regional

Advisory Group to provide advice and counsel to
the RAG and serve as the day-to-day advisor to the
RMP coordinator and core staff. They also act in
the stead of the RAGs except on final project or
policy decisions.

* COMPOSITION:

Comparison of Membership for 1969 and 1971

 

 

Professional Category Number Percent
(1965) (1971) (1969) (1971)
Physicians 284 266 67% 58%
Nurses 18 16 4% 4%
Allied Health 56 50 13% 11%
Other 67 127 16% 27%
TOTAL 425 459 100% 100%

Highlights :

*

The decline in the actual number and percentage
of physician membership has been countered by an
increase in "Other," from 67 to 127, or 16% to 27%.

The increase in "Other" reflects more hospital

.

and nursing home administrators, members of
the public and others.

Nursing representation has remained stable.

-18-
 

ORGANIZATION

 

TASK FORCES AND COMMITTEES

* PURPOSE: Task Forces and Committees have major responsi-
bilities for project development and/or review
of projects. Nearly all of them assist in the
establishment of objectives and priorities for
program activities. They perform a great deal
of the coordination and liaison in fostering
cooperative arrangements among institutions,
organization and various interest groups.

* NUMBER AND SIZE ;

1969: 492 Committees in 54 Regions: 5320 Total membership
1971: “410 Committees in 55 Regions: 6379 Total membership

* COMPOSITION:

" Comparison of 1969 and 1971

 

By_ Profession Number Percent
(1969) (1971) (1969) (1971)
Physicians 3273 3523 61% 55%
Nurses 486 580 9% 9%
Allied Health 672 802 13% 13%
Other 889 1456 17% _23%
TOTAL 5320 6379 100% 100%

Highlights :

Total membership has increased 20%
Physicians show a 6% decline while "other"' category,

which includes members of the public, hospital
administrators and others, has increased 6%.

-19-
 

ORGANI ZATION

 

Comparison of Task Forces and Committees 1969 and 1971 .

 

By Type of Task Force/ No. of Committees Percent

 

 

Committee (1969) (1971) (1969) (1971)
Heart. 65 41 13% 11%
Cancer 60 42 12% 10%
Stroke 54 36 11% 9%
Other Disease (including 39 30 8% 7%

Kidney) ,
Planning §& Evaluation 30 27 6% 8%
Continuing Education §& 45 47 . 9% 12%
Training
Health Manpower 11 27 2% 4%
Other 188 160 3% _3%8

TOTAL 492 410 100% 100%

 

Highlights:

Number of Task Forces and Committees has declined .
from 492 to 410 or about 20%.

Categorical Disease Committees have decreased while
planning/evaluation, continuing education and
Imanpower committees have increased.

The significant increase. of manpower committees clearly
indicates that RMPs are departing from traditional
approaches and’ are now concerned with the

development of approaches to overcome the existing
health manpower crisis.

The significant number of other committees include health

maintenance organizations, experimental health delivery
systems, finance, legislation committees, etc.

39 Regions have Heart committees; 36 Regions have Cancer
committees; 35 Regions have Stroke committees.

-20-

 
ee

ORGANIZATION

ae

LOCAL AND AREA ADVISORY GROUPS

* PURPOSE: Assist in project development and implementation
to meet community needs and to strengthen
relationships among local institutions, organiza-

tions and with the medical center. They are
generally organized on the basis of population

or medical trade areas. Some are organized
according to hospital areas and to local medical
schools. Some local area and advisory groups do
cooperative planning and coordination with
Comprehensive Health Planning 314 "b'' agencies.
They are often the site for coordination of efforts
between RMP regions where they intersect locally.

* (COMPOSITION:
Comparison of 1969 and 1971

 

By Profession Percent
1969 1971
Physicians ..eeererer 41% 42%
NurseS eeeeeneerre 9% 11%
Allied Health ..--+++77°"" 19% 15%
Other .ceceeerrrer 31% 31%
| TOTAL PEOPLE 4,845 6,047
Highlights
Total membership has increased from 4,843 to 6,047 oF
about 25%.

Nursing representation has increased slightly which /
has been offset by a slight decrease in allied health 3

representation.

"Other"? which includes hospital administration, nursing
home administrators, 4 members of the public has
remained unchangee-

-21-
ae”

eel

ORGANIZATION

eee

MINORITY REPRESENTATION

Appropriate participation of minority groups at all levels of RMP
planning, decision-making and implementation is requisite to
responsive relevant program development. Data below reflects
minority representation on core and project staffs, RAGs, and

committees.
* MINORITIES:

Defined as Blacks, Spanish surname , American Indians, Orientals,
and Others (Asian Indians, Polynesians, etc.), with the
preponderance being in the first four categories. According to
the 1970 Census, 12% of the total U.S. population is classified
as Black or Other. However, the Other category does not include
Spanish surnalc. Therefore, by extrapolating from the 1969 Census
data on persons of Spanish origin, one arrives at an estimated 16%

of the population being minorities as defined above.

Minority Representation on Core and Project Staffs

11-Time E uivalents) » 1971

(Fu q

 

     

 

24,
| 20%
16% NS Minority
16) nnn ---- pepe Ry roe
vnority ~ ~ S is 168
: N N
S

 

 

 

 

 

 

 

 

Professional Secretarial Professional Secretarial
CORFE STAFFS PROJECT STAFFS

 

Highlights:

Only 9% of the total 1,640 FTE core staff are minorities; 17%
of the 2,440 FIE project staff are minorities.

In terms of actual people (i.e-, full and part-time personnel)

the percentage of minorities is Jess in all categories, ranging
from 1% fewer core professionals to 3% fewer project professionals.
In other words, minorities are more likely to be full-time.

personnel.

-24-
 

ORGANI ZATION

Minority Representation on Regional Advisory Groups and Other
Committees of Regional Medical Programs
1969 and 1971

 

 

 

   

 

 

 

 

 

 

 

 

207
16 |---------o errr | eee ener Minority
Population
J . of U.S.
is 16%
12
P. t 7
Minority + 108
2 ee: NS a
4 6%
SS S
4 LS SS
RN SS
4 RS SS
0 SS =
1969 1971 1969 1971
REGIONAL ADVISORY ALL OTHER
GROUPS COMMITTEES
Highlights:

The minority representation on RAGs has increased by 3% to 10%
of the 2,700 membership, but is still 6% shy of being
representative of the nation.

On the other hand, minority percentage on Other Committees has
decreased by 2%, to a low of 6% of the total 12,000 membership.

-25-
Se

———— ne

ORGANIZATION

ee

      
 
   
  

Comparative Distribution of Estimated National

Minorities and Minorities, 1 .
American Other (includes 11%
Tndian a

   
       
 
  
 
 

Oriental)
“Na

  

\
13% \

American
Other |

‘Indian *f3:

26%
Spanish
Surname

 
 

15%
¥ Spanish
Surname

 
 
  
 

 
  

  
  

 
   
  

68% Black 69% Black

timated National Distribution RMP Distribution

Es

Highlight: The comparative distribution is relatively consistent
“ (surprisingly so in the case of Blacks) with one
exception -- the Spanish surnames are under-represented.

cna eecanenen ne neceesnenensa teen gee TT

Female Participation in Regional Medical Programs
Full-time Equiva ents

‘HIGHLIGHTS :

There are over 6,000 females jnvolved in Regional Medical
Programs.

. A majority (54%) of the professional project personnel are
women.

. Only 14% of Regional Advisory Group members are females.
. 31% of professional core staff personnel are women. |

. 98% of core and project secretarial staffs are females.

-26-
     

 
  
 

med” €:
POR

SECTION IV

WHAT DO REGIONAL MEDICAL PROGRAMS DO? --

 

PROGRAM ACTIVE TIES

This section outlines the kinds of
activities carried out by the Programs,
including how and what they PLAN,
IMPLEMENT, and RVALUATE. It describes
areas of special emphasis and new program
developments as well as the relationship
of the RMPs to health and health-related
agencies and programs , particularly to

other federally-supported programs.

-27-
_

PROGRAM ACT IVITIES

_

 

PROGRAM PLANN ING

ASSESSMENT_OF NEEDS AND RESOURCES : The initial step in planning
for Regional Medical Programs is the identification of regional
health needs and resources - For most RMPs, this is 4 two-pronged
approach: One ; the development of health committees and task
forces to assist in identifying, in a consensus manner, what the
needs are, and where they exist. The other is the collection of
pertinent data to determine the extent of the problems and the
resources available for use in their solutions. During 1970 and
1971 the RMPs carried out nearly 400 such data collection

activities in the following areas:

Area of Data Collection Number_of Studies
Manpower distribution and availability. -- °° 50
Services and facilities... 98
Health conditions -+--:*"*" Cee eet 95
Categorical diseases - ccc, 29
cateenimg ee 23
Continuing maucatim se 42
Contin ee TOTAL | 38

TOTAL 375

a ceneeeaneencnnnnnn enna teen TTT

SETTING OF PROGRAM PRIORITIES: Another step in planning is
setting program Priorities ~~ those locally identified health
needs which Regional Medical Programs have determined to be of
the greatest urgency locally. The setting of priorities (usually
done by the Regional Advisory Group) ideally enables the RMP to
review activity proposals and allocate funds in accordance with
the Region's most pressing needs. To date 45 of the 56 Regions
have formally set priorities. Of the 45 RMPs, about 5 named
priorities S° broad they might easily be mistaken for goals;
another 30 presented listings which, while they included some
specific areas of need, were for the most part 4 vast expanse 0
comprehensive issues ranging from "organization and delivery of
care'’ to ‘heart disease, cancer, and stroke"; only about 10

Regions reported definitive, specific priority areas.

-28-

 
i

PROGRAM ACTIVITIES. . . PLANNING PRIORITIES

ns

The priorities which have been set by the 45 RMPs relate gen-
erally to three broad areas: health care organtzation and
systems , health professionals, and patient services and target
groups.

Highlights :

Virtually all of the 45 Regions named education or man-
power as a major regional need.

One-third identified disease prevention and early
detection.

20 identified health care for the poor.

7 specified urban health, while 10 named rural health.

Summary of Priorities
Health Care Organization and Systems

16 RMPs named organization and delivery of care, 5 of
these specified new and innovative models for organi-
zation and delivery.*

12 RMPs named availability, accessibility, and quality
of care. ,

10 RMPs named health needs and resources assessment.

6 RMPs named coordination of existing resources and

distribution of services.*

RMPs named efficiency of health care organization .
and systems; 4 of these specified health care costs
and financing. _.

3 RMPs named specialized and long-term care.

Health Professionals
. 33 RMPs named continuing education and training.*
29 RMPs named manpower development , utilization, and

distribution.* .
4 RMPs named increasing provider efficiency.*

__
* These have also been named as HSMIA priorities for RM..

-29-
__
PROGRAM ACT IVITIES. . -PLANNING PRIORITIES

_ ee

2 RMPs named commmication and coordination among
provider groups.

2 RMPs named education and career mobility for allied
health personnel.

Patient Services and Target Populations

20 RMPs named health care delivery for disadvantaged
groups*; 7 of these specified urban populations ;
10 specified rural populations; 2 named particular
minority groups.
14 RMPs named disease prevention and early detection. *
11 RMPs named public information and education.
5 RMPs named rehabilitation.
3 RMPs named consumer participation in health planning.
3 RMPs named infant and child heal th. *
2 RMPs named health care for migrant workers.
2 RMPs named emergency services.

* These have also been named as HSMIA priorities for RMP.

-30-
PROGRAM ACTIVITIES

 

PROGRAM IMPLEMENTATION

Program implementation follows planning efforts. Once the needs

have been identified and the goals and priorities have been set,
activities to meet these needs are designed and conducted. These
activities may be described in a number of ways, including (1)
functional emphasis or primary purpose, e.g., education, patient care,
etc., (2) health care emphasis, e.g., prevention, rehabilitation,

and (3) disease emphasis. The following scctions highlight what the
RMPs are doing in terms of these three arcas including areas of high
priority and special emphasis, such as special manpower programs,
programs for urban and rural poor, and others.

* FUNCTIONAL EMPHASIS: What the RMPs do to implement their programs
is in five major functional areas:

General continuing education--those activities concerned with
jaintaining or improving the level of practice of health
personnel through improved skills or increased knowledge.

This includes such activities as seminars and conferences for
physicians, nurse training in patient management, dial-access,
consultation, etc.

 

Manpower utilization and training--activities aimed at improving
the distribution, development and utilization of health personnel.
This function includes training in new skills, training new
categories of personnel, curriculum development, and other areas.

 

Organization and delivery for paticnt services--these activitics
relate directly to patient care delivery through demonstrations
of new techniques, development and demonstration of organizational
models for delivery, and improving coordination of paticnt
services.

Research and development--activities which emphasize the testing
or investigation of prototypes for new systems, processes,
techniques, etc.

 

Program coordination and administration--overall RMP direction
and coordination, including policy development, evaluation
activities, program coordination, commmnity liaison, and
interrelationships of health institutions providing multiple
levels of care.

-31-
it

PROGRAM ACTIVITIES... IMPLEMENTATION

 

en oe tc St RR SR

Functional Lmphasis, 1969-71

 

 

 

 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

100
_ General Contin-
uing Education
80 le
Manpower
60 Utilization
| SS SN
40 SN Organization
and delivery
for patient
= hs. WN services
~
20 34 ~. ian .
ies ~ “ee: . > SS Research and
| ~S Development
1 Program Admin-
istration
0
1969 1970 1971
($72,365,000) ($78,202,000) ($70,298,000)

Highlights

Research and development activitics have taken on less

significance due, in part, to

the fact that the new emphasis

is on methods for the actual delivery of patient care.

RMPs are still devoting a large portion of their resources

to patient care, but the emphasis within this category has
shifted to the newer concepts of organization and systems

for the delivery of patient services particularly for primary

Care.

_ Since 1969, manpower activities and studies have shown a steady
increase, with a proportionate decrease in general continuing

education activities.

The trend in Regional Medical Programs

today is toward activities concerned with better utilization of

personnel and improving manpower

distribution rather than only

education to increase medical knowledge and expertise.

 
 

PROGRAM ACTIVITIES ... IMPLEMENTATION

 

* HEALTH CARE EMPHASIS: RMPs are supporting training, delivery,
and coordination of:

Screening and early detection programs such
as cervical cancer, new stroke detection
techniques ;

 

Demonstration treatment and diagnostic
services programs such as in kidney
dialysis and laboratory services;

 

Stroke and other more comprehensive rehab-
ilitation programs, often using the health
team approach; and

Demonstration comprehensive care programs,
such as complete fpertension management .

All such activities are coordinated with other support services
to promote continuous, comprehensive care.

* DISEASE EMPHASIS: The disease focus of program activities has
shifted Since the first few years of RMP implementation. Most
Programs are moving in favor of a broader approach to health
problems and are supporting less heart disease and more cancer
and kidney disease:

‘ Comparison Percent
Disease Category of Funds
1968 1971
Heart disease. . .-. +--+ + + 35% 26%
Cancer .. + ee eee ee es 9% 13%
Stroke... ee ee ew ee 10% 12%
Kidney disease. .-- +++ + 77 4%
Related diseases ...-+--+.+-s % 6%
Multicategorical and
non-specific... +++: 36% 38%

-33-
OPERATIONAL FUNDS (Millions)

30

20

10

PERCENT

 

 

-

-$o-

 

1

'

T q t |

___.Prevention and
Screening

 

 

 

 

 

 

 

 

__Diagnosis and
Treatment

 

 

ome lll
Care

ae

1971 ! i

 

 

 

 

 

The funding emphasis on prevention and early detection
activities has increased by 3% over the two-year period.
This is in line with national and regional priorities.

Comprehensive programs have also gained significance; the
proportion of dollars in this activity has increased by
about 4%.

Activities concerned with diagnosis and treatment are still
the largest portion of the health care picture, but have
shown a steady decrease during this period.

60

NOILVININYTAINT ++

"SHILIALDOV Wvdd0ud
 

PROGRAM ACTIVITIES ... IMPLEMENTATION

 

EXAMPLES OF HEALTH CARE ACTIVITIES

To improve manpower utilization and capability and to
Coordinate the delivery of health services:

Confederation of Coronary Care Units -- California: This
activity covers 11 counties in northwestern California with
a population of over 3 million. Sponsored by the Univer-
sity of California, San Francisco Medical Center, the
activity assists hospitals in designing coronary care units;
provides the necessary training for their operation; and
coordinates the delivery of coronary services. The pro-
gram is multifaceted, including components of data
collection systems, coronary care nurse training, advanced
cardiac nurse training, coronary care teaching for nurse
educators and practitioners, electronics consultation, one-
week physician preceptorships, physician consultation, and
a library for unit directors.

To improve the organization for delivering services and
upgrading quality:

"Acute Stroke Management Demonstration Project in a Com-
fmunity Hospital” -- South Carolina: This project involves

a coordinated team approach to stroke management, and
attempts to encourage additional stroke programs in the
Region. The stroke team consists of stroke nurses, a speech
therapist, a discharge planner, and a public health nurse,
coordinated by the two physicians who direct the project.

To expand manpower availability and utilization in ghetto areas:

Model City Health Manpower Education and Recruitment Program --
Kansas: ‘his activity raises the level of knowledge and
understanding among Kansas City, Kansas model neighborhood
residents about good health practices, and provides a means

of their entry into health professions as health aides. At
the same time, it helps to ease the health manpower shortage
and access problems prevalent in the area. Under supervision
of a health coordinator, health aides are involved in class-
room instruction on community health, practicum activities,
and participate in supervised activities involving communication
with and teaching of other residents in need of education or

services.
 

ae

PROGRAM ACTIVITIES . . IMPLEMENTATION

eee

AREAS OF SPECIAL EMPHASIS

The problems of accessible, available, high quality health services,
particularly in deprived urban and rural areas, are of increasing .
concern to the RMPs and they are addressing these problems through

a variety of avenues, including:

(a) Programs to improve manpower distribution, utilization
and development

(b) More emphasis on ambulatory care programs, including
activities linked to neighborhood health centers, out-
patient clinics, home health programs and the like; and

(c) Training and other programs to increase the availability
and utilization of health services by ghetto and rural
residents and to heighten their involvement in the

delivery of services.
* HEALTH MANPOWER

Approximately one-third of RMP funds support activities to
improve health manpower utilization and development. These
include training programs (1) to expand the duties of
existing health personnel; (2) to develop new health manpower
persomnel ; (3) to study distribution and utilization; and
programs to retrain and improve manpower availability. ~

 

In particular regions have: Nunber of
, , Regions

Established Health Manpower
as Priority. --'rrt ttt tt . 29
Established Health Manpower
Committees - +e rests tt we 27
Designated Core Staff Member
for Manpower - ++ ess t'* ree
Designated Core Staff Representative
on CHP or State Manpower Council ..+ 12

-36-
 

PROGRAM ACTIVITIES. . . IMPLEMENTATION

 

 

Regions have also coordinated: Number of
Regions
Health Manpower Inventories
or Feasibility Studies ....... 17
Health Manpower Legislation ..... 10

Physician Assistant/Nurse
Practitioner Development ...... 29

Health Manpower Recruitment
and Retraining... ....+-e 6+ 2&3

Examples of Manpower Activities

 

. Several RMPs are helping to train nurse

Os, practitioners, particularly in pediatrics.
One region sponsored a feasibility study to
train 6 RNs in an 18-week pediatric mrse |
course and all are now working with private
physicians or home health agencies.

Other RMPs are helping to’ train radiation/
nuclear medicine technicians in cooperation
with local hospitals and community colleges.

Curriculum development is another area --. one
RMP helped develop the curriculum for a network
of 17 rural junior colleges all linked to a
central training institute.

* AMBULATORY AND OUT-OF-HOSPITAL CARE

 

Approximately one-fifth of RMP funds are estimated to support
activities related to ambulatory care and other out-of-hospital
services. These include training, health delivery, and
planning activities linked to neighborhood health centers ;
home health services; and.in a few instances extended and
long-term care services.

-37-
 

PROGRAM ACTIVITIES ,,. IMPLEMENTATION

 

In particular:

Five regions have singled out ambulatory care as a
priority.

Ambulatory care activities are estimated to have
doubled over the past year. Currently over $8
million is supporting more than 50 activities.

Almost half these activities contribute to providing
comprehensive health services. For example, in one
region a hypertension screening program has extensive
referral services and is tied to major hospitals and
home health services.

About ten of the activities are linked to the services
of a neighborhood health center, and include such
activities as multiphasic screening and early screening
for cancer and stroke.

Home health activities have also doubled and now $1.5
million is supporting activities related to extended
care and nursing home services.

* URBAN AND RURAL HEALTH CARE

About 17 percent of RMP funds now support special programs for
the urban and rural poor, reflecting increased efforts in this

area.

In particular:

Almost 10% of the funds are for inner city residents
and include over 30 activities totaling about $4.5
million.

Poor rural residents are the targets of over 50
activities totaling about $3.2 million.

Over half of the inner-city activities relate to
patient services, and include such activities as
comprehensive stroke programs; improving the CO-
ordination of existing services involving multiple

-38-
 

PROGRAM ACTIVITIES ... IMPLEMENTATION

 

e

levels of care, e.g., screening, acute hospital care,
home health and rehabilitation services; and improved
hospital-based primary care. The other half is for
various types of training and planning efforts.

Several inner city programs involve training community
residents to enter jobs with career mobility.

Many of the rural programs include training activities
to experiment with expanding the amount and level of
services which allied health personnel can deliver;
they also include programs which coordinate existing

services for broadened outreach.

-39-
 

PROGRAM ACTIVITIES ... IMPLEMENTATION

 

RECENT DEVELOPMENTS

The success of Regional Medical Programs stem from their capability
to be flexible and responsive to changing health needs and problems.
It is this characteristic which has enabled RMPs to shift from a

- categorical approach, i.e., reducing the ill effects of heart
disease, cancer, stroke, kidney and related diseases to the
development of diversified systems of health delivery tailored to
local needs. Regions are presently stimulating and fostering
planning for such delivery systems.

* HEALTH MAINTENANCE ORGANIZATIONS: The Regional Medical
Programs are involved in the newly emerging Health
Maintenance Organization program in a variety of ways.
Foremost among these is providing assistance to help
HMO's in the developmental stage and in improving and
maintaining quality of care.

 

A Health Maintenance Organization is based on the following
four provisions:

It is an organized system of health care which
accepts the responsibility to provide or other-
Wise assure the delivery of ....

an agreed upon set of comprehensive health
maintenance and treatment services for -.-

a voluntarily enrolled group of persons in a
geographic area and ...

is reimbursed through a pre-negotiated and
fixed periodic payment made by or on behalf
of each person or family unit enrolled in
the plan.

Fifty-two of the 56 Regional Medical Programs (one RMP

was non-reporting and three indicated that they had such
contacts but desired not to be specific) reported a total
of 177 specific contacts with individuals and/or groups
interested in possibly establishing HMO's. In addition
approximately 75% of the RMP's have sponsored or conducted
seminars, panels or discussion sessions regarding HMO's
for the Regional (or Area) Advisory Group, its executive

-40-
 

PROGRAM ACTIVITIES ... IMPLEMENTATION

EEE

or steering committee, for RMP core staff, practicing
physicians and others.

The institutions, individuals and groups contacted have
been rather diverse as the table below reflects:

RMP Contacts Regarding IIMO's

 

Kind of Institution No. Contacted
Medical Schools ....-+-+-- ... 20
Hospitals . . 6 ee ee ee es -.. 29
Clinics ....+-.-+s-. re 22
Medical societies (state § local) .. 17
Individual physicians ....-+-++: + 18
Existing group practices ..-+--+-:+ 11
Planning groups (CHP § other)... - 32
Neighborhood health centers & other

Federally-sponsored programs .. - 12
Private insurance carriers ...+--+ 4
Labor unions ...+-+-s++e-s Le 2
Other... . 2. ee eee tee ew ee 610

177

* EXPERIMENTAL HEALTH SERVICES PLANNING AND DELIVERY SYSTEMS:
The Experimental Health Services Planning and Delivery
Systems Program is a new effort of the Health Services and
Mental Health Administration, with the National Center for
Health Services Research and Development as the lead
agency. It seeks to create a management capacity and
function to rationalize and systematize health services in
those commmities which have come together and voluntarily
agreed to participate.

Sixteen communities or sites have been selected for partici-
pation. The degree of RMP involvement depends on the site,
but in many of these, the Regional Medical Program was a
moving force in putting together the application and is
actively involved in setting up an Experimental Delivery
System, such as in Vermont and the Mountain States.

The sites selected represent a range of experimental
situations, including three States, four rural areas,
three large cities, three moderate-sized cities, one sub-
city, and two counties.

-A1-
 

PROGRAM ACTIVITIES. .. IMPLEMENTATION

* AREA HEALTH EDUCATION CENTERS: The President's Health Message
in February, 1971, and subsequent proposed legislation call for
the development and support of Area Health Education Centers to
meet identified health manpower needs in underserved areas.
These Area Health Education Centers, in part, would be related
to health science centers; their educational programs would be
assisted by the health science faculty, and some patient care
functions would rely on health science center personnel. The
area centers would work with the community and neighborhood
facilities, including the private practitioner.

 

Hospital and other health service organization and educational
institutional linkages will be established to provide both

academic education. and clinical training. Allied health profession
education will be strengthened through the development and
expansion of curricula in comprehensive and community colleges along
with increased emphasis on interdisciplinary learning to enhance

the team concept on the delivery of comprehensive health services.

RMP Involvement

. Despite the fact that there are no fully developed
Area Health Education Centers operating, many of
the components of such a center can be found within
some of the educational programs presently being
supported by the Regional Medical Programs.

Approximately one-third of the Regional Medical Programs are
currently involved in activities related to Area Health Education

Centers, such as:

Assisting in conducting negotiating conferences
of multiple interest for Area Health Education

Centers.

Providing demographic and health data for Center
development.

. Providing ''agency" Linkages for curriculum
development.

Developing criteria for selection of communities
to be included in Center.

-42-
 

PROGRAM ACTIVITIES. . . IMPLEMENTATION

 

Examples
follows:

Analyzing provider needs and attitudes toward
Area Health Education Centers.

Assisting in development of expanded roles for
existing health professionals.

of selected Regional Medical Programs' activities are as

The Kansas Regional Medical Program has developed a

prototype area health education center in the rural

Great Bend area.. The program has established link-
ages between the existing educational system with the
smaller peripheral and regional community hospitals
in an attempt to meet the needs of the area's health
service workers.

The Maine Regional Medical Program has directed considerable
effort toward the development of a health/science

education center with a medical school component ,

using a remote teaching faculty from nearby universities,
commmity hospitals and medical schools in Massachusetts,
Vermont and New Hampshire. ,

The Western New York Regional Medical Program has
effected the institutional arrangements that have
permitted residents and interns from the Upstate

‘New York Medical Center at Buffalo to train at

commmnity hospitals across the state line in Pennsylvania.
These commmity hospitals are seen as prototype area
centers. .

-43-
 

PROGRAM ACTIVITIES ... IMPLEMENTATION

 

WHO THE RMPs WORK WITH

 

Regional Medical Programs have close-working relationships with

the broad spectrum of public and private health and health-related
planning, service, and education organizations, and with profes-
sional societies and associations. These include hospitals, medical
schools, state and local health departments, medical societies, and
the like. These relationships are integral and requisite to the
efforts of the RMPs to influence and contribute to high quality,
comprehensive health care. Of particular interest are the other
federally-supported programs with which the RMPs work.

* RELATIONSHIPS WITH OTHER FEDERALLY-SUPPORTED PROGRAMS:
Included in this category are such programs as: Model
Cities, Comprehensive Health Planning, (both "a" and "pb"
agencies)and Appalachia Health, to name a few. Specific
examples of how RMPs interrelate with these programs are:

Model Cities

RMPs provide: 1) technical expertise to the

Model Cities programs; 2) support specialized
service programs; and 3) participate in joint
planning activities.

. Approximately 26 of the 147 Model
Cities programs in the United States
have active relationships with
the RMPs.

. One-fourth of the RMPs (15) support
a total of 20 operational activities
in Model Cities areas.

. Very few RMPs have Model Cities
agencies represented on their Regional
Advisory Groups or other planning
committees.

. Example: The New Jersey RMP (1) has
detailed staff to serve as health
planners for the Model Cities agencies;
(2) established an urban health task ©
force; (3) supported a heart screening
survey in Newark; (4) is assisting a
new hospital-based family health care
service in New Brunswick; and (5)
helped support a citizens health
survey in Hoboken.

 -dd-
i

PROGRAM ACTIVITIES ...IMPLEMENTATION

 

Comprehensive Health Planning

Cooperation between RMP and CHP is being
fostered through emphasis on their comple-
mentary roles. (iP agencies provide an
expression of the consumer's viewpoint,
while RMPs express the provider's view of
needs. Current RMP legislation requires
that the Regional Advisory Groups include
representation from health planning agencies.
Similarly, CHP legislation requires RMP
represenation on both "a" and "b'' agency
Councils.

* RELATIONSHIPS WITH CHP ''a't AGENCIES: Atl 56 RMPs fall within
the boundaries of at least one of the 56 CIP statewide agencics.
Relationships between RMP and CP '"'a'' agencies include:

A. Interlocking Board and Committee Memberships

RMP's relate to 51 of the CHP State
Agencies through various types of
interlocking memberships.

A total of 48 RMPs have RAG and/or
Core staff as members of CHP Agency
Boards; 42 CHP ''a"’ Agencies have
Board or staff on RAGs.

A total of 23 RMPs reported RAG or
Core staff on CHP '"'a"’ committees; 14
CHP "a" agencies have Board or staff
personnel on RMP committees.

B. Data Collection, Processing or Analysis

43 CHP ''a'' agencies cooperate with
RMP's on joint studies or surveys,
data banks, systems, or centers;
health information conmittces, and
exchange of services in data coliec-
tion, compilation or analysis.

-45-
 

PROGRAM ACTIVITIES... IMPLEMENTATION

 

C. Cooperative Mechanisms for Review of Grant
Applications

In 46 RMPs_ the CHP "a" agency has an
opportunity to review all or part of
RMP proposals and applications.

In another 4 cases, RMPs' proposals are
either sent directly to CHP "b' agencies
or channeled through "a" agencies for "'b"'
review. |

D. Other Joint or Cooperative Activities

Additional cooperation includes the
development of, support or other —
assistance to ''b'' agencies.

Joint sponsorship or planning of con-
ferences and workshops, consultation,
shared staff, and joint projects
development.

* RELATIONSHIPS WITH CHP “b'' AGENCIES: Forty-eight of the 56 RMPs
have at least one of the funded areawide CHP "b'' agencies within

their Regions.
A, Interlocking Board Relationships

Forty-four RMPs are represented on
the CHP Areawide Advisory Groups.

Thirty-three RMP RAGs include CP "Dp"
representation.

B. Cooperative Efforts Relating to Data Collection,
Processing or Analysis

. Of the 48 RMPs having a recognized "b''
agency within their region, 46 have some
data sharing with at least one areawide

agency.

-46-
 

PROGRAM ACTIVITIES, . . IMPLEMENTATION

 

Data activities include: joint preparation
of directories of services and facilities;
joint surveys of manpower needs; and
assisting in the development of data for
Experimental Health Services Planning and
Delivery Systems and HMO applications.

RMPs have assisted new arcawide agencies
in collecting, processing and analyzing
data, especially for their organizational
application.

C. Staff Sharing and-Staff Contacts:

All 48 RMPs having an Areawide
agency within their region have regular
meetings with CHP representatives.

Thirteen RMPs reported sharing staff on a
full-time basis.

In many RMPs a core staff member has been
used as a special consultant by the Areawide
Agency in such areas as manpower development
and data collection.

D. Cooperative Mechanism for Review
Forty-three of the RMPs reported that they
have established a cooperative mechanism
for the review of grant applications and
activity proposals; the remaining 11 RMPs
either have no areawide agency or are now
establishing review mechanisms.

E. Other Joint or Cooperative Activities and Relationships _
Some RMPs and CHPs have merged Program Committees.

-RMP local advisory groups coincide with the
areawide CHP agency boundaries in many areas.

-A7-
ee

PROGRAM ACTIVITIES... IMPLEMENTATION

re

Appalachia Health

The Appalachian Commission was established to
improve the health, economic and social
conditions of those residing in the Appalachian
region of the country. The area covered is
from Virginia to Alabama. This area of the
country has rather pronounced health problems ;
therefore, a logical as well as needed set of
cooperative arrangements have been developed
between Regional Medical Programs and the Ap-
palachian Programs.

Examples of cooperative arrangements:

The Tennessee Mid-South RMP has helped plan
for a comprehensive health care program
in an isolated community in eastern
Tennessee and Kentucky in cooperation
with the Ohio Valley Regional Medical
Program and the Appalachian Regional
Commission. Through RMP support it has
been possible to link three isolated
rural clinics in a mountain valley of
East Tennessee for the first time by
telephone so that the clinic nurses can
communicate with one another and with
the physicians on whom they depend for
consultation and support.

The Alabama RMP has worked with the
Appalachian program in a project involving
Alabama's 17 junior colleges and the
Regional Technical Institute, University
of Alabama, in an attempt to meet the’
needs of health service workers for the
State's community hospitals and health
related facilities.

-48-
PROGRAM ACTIVITIES... IMPLEMENTATION

Veterans Administration Hospitals

A total of 83 (out of 131) Veterans Administration
hospitals are presently involved in activities in
42 RMPs. The breakdown by planning and operational
activities is as follows:

Number. of VA Hospitals Represented:

 

On Regional Advisory Groups 25

On Local Advisory Groups 13
On Task Forces
and Committees 33

TOTAL (discounting
overlaps) 55

Number Participating
in Operational Activities 38

 

 

GRAND TOTAL
(discount ing
overlaps) 83

Examples of Veterans Administration hospitals'. involvement:

The VA hospital in Tuscaloosa, Alabama,
is sponsoring a training program in
"reality orientation technique," which
is designed to improve the care and
rehabilitation of older patients with
cerebrovascular disease and stroke.

The training is directed toward a broad
spectrum of health service personnel
with special attention to lower echelon
personnel in nursing homes.

. The California Medical Television Network
operating out of UCLA is funded in part
by the RMP and includes a package of 36
videotape programs distributed annually
to 30 participating VA installations in
the western United States.

-49-
ee

PROGRAM ACTIVITIES. . . IMPLEMENTATION

ee

* NON-FEDERAL HEALTH ORGANIZATIONS _-- PARTICIPATION IN RMP

PLANNING AND DECISION-MAKING

Representatives of about 6,800 health
and organizations have been or are act
planning and decision-making processes
and numbers of institutions represente

following table:

Kind of Participant
Institution or Organization

Educational Institutions ,
including Medical Schools

Medical Societies, State
and Local

Nursing, Dental and Other
Health Professions Groups

Voluntary Health Agencies

Health Planning and
Related Agencies

Hospitals , Nursing Homes
and Other Care Institutions

Others, (largely non-health)
TOTAL

-50-

and other institutions
ively involved in the

of the regions. Types
d are presented in the

Number
Represented

638
761

546

721
790

4,110
642

————

8,208
Ea eel

PROGRAM ACTIVITIES

ee

PROGRAM EVALUATION

Along with planning and implementation, evaluation is a key activity
used by the Regional Medical Programs both as a means for measuring
impact and progress and as a management tool for decision-making and
future planning. Evaluation within Regional Medical Programs has
only recently taken on significance. In the first three years of RMP,
evaluation received little or no attention at the local level. For
example, findings from a study conducted in the summer of 1969
illustrate that: 1) only 7% of the activity proposals reviewed
nationally included an evaluation protocol within the project design;
2) only 30% of the funded Programs had an Evaluation Director on core
staff; and 3) no Regions had even begun the development of a total
program evaluation design.

As of June 1971, however, significant changes in evaluation have
taken place:

. 20 additional RMPs have hired Evaluation Directors - fifty
Regions now employ 53 Directors or co-Directors: over one-
tnird of these have backgrounds in the social sciences;
about 13% in education; 10% in business administration or
economics; 10% in statistics; 10% in medicine; 8% in public
health or epidemiology; and the remainder in fields such as
operations research, basic science, and community planning.

It is estimated that about 7-10% of the core budget is
allocated for evaluation activities. ,

Several RMPs are developing information systems for use in
regional decision-making.

About one-fourth of the RMPs have developed active evaluation
programs for use in decision-making. Some Regional Advisory
Groups of these RMPs make extensive use of evaluation
findings in their determination of the future direction of

projects and Program. Many RAGs now site visit ongoing
projects.

Program evaluation, though actually being implemented in .
only a few RMPs, is in the developmental stages in many
Regions.

51
 

 

SECTION V

WHAT PROGRESS HAVE THE RMPs MADE?

This section describes RMP progress
toward improving manpower resources
through education and training. It
also describes the extent of hospital
participation as an index of the
regionalization of health services.
Lastly, the section describes the
extent and character of the phasing-
out of RMP support for specific
projects and the reinvestment of
these funds by the RMPs into other

worthy activities.

53
PROGRAM PROGRESS

IMPROVING MANPONER RESOURCES
THROUGH EDUCATION AND TRAINING

 

RMP-supported training, education, and manpower programs are designed
to improve, update, and expand the knowledge and skills of health
professionals so that more and better health care may be delivered
in a more widely-distributed and efficient manner. Over 250,000
health professionals have been trained by RMP to date.

 

 

 

 

Percentage and Number of Health Professionals Trained
Fiscal Years 1968-1971
FY 1968 FY 1969 FY 1970 FY 1971
Percent Percent Percent Percent
; i (as of 4/71)
Physicians 29% 30% 23% 21% |
Registered Nurses 64% 45% 25% 25%
Allied Health 6% 12% 29% 15%
Multi-professional = -- 133 23% 39-4
TOTAL PEOPLE 2,948 51,726 105,613 97 ,706

 

 

 

llighlights:

.’ There has been a considerable increase in the number and pro-
portion of allied health personnel trained.

The sharp rise in the multi-professional group reflects the
trend toward developing training programs which (1) train for
the health team approach, and (2) train physicians, nurses,
and others under one program.

Initial training programs were discretely for physicians. Now,
a broader array of professionals are being trained.

~54-
ee

PROGRAM PROGRESS. . . TRAINING

aaa

 

Percentage and Number of Health
Professionals Trained By Disease Category

 

FY 1968 FY 1969 FY 1970 FY 1971
Percent Percent Percent Percent

(as of 4/71)
Heart 51% 46% 48% 49%
Cancer 7% 4% 7% 7%
Stroke 8% 8% 13% 10%
Related Disease 7% 8% 15% 10%
Multi-categorical 37% 34% 17% 24%

 

 

TOTAL PEOPLE (2,948 51,726 105,613 97 , 706

 

Highlights:

More people are still being trained in heart disease than
other area.. This includes over 10,000 physicians, nurses,
and others trained in coronary care techniques.

‘The early increase in related diseases reflects, in part, an
emphasis on pediatric pulmonary diseases due to an early
Congressional earmarking of funds.

 

Percentage of Total Professionals Trained
"BY Length of Training (FY 1969-1971)

 

ry 1969 FY 1970 FY 1971
Percent Percent Percent

 

 

(as of 4/71)
One day or less 33% 683 60%
2 - 5 days 44% 23% 27%
2 - 5 weeks 22% 7% 11%
More than 5 weeks 1% 2% 2%
TOTAL PEOPLE 51,726 105,615 97 ,706

 

 

Highlights :

. Most of the training continues to be one-day or less with

only a few programs including extensive, continuous training,

such as coronary care.
: -55-
PROGRAM PROGRESS... TRAINING

 

Percentage of Professionals Trained
By Training, FY 1971

Registered Allied

 

 

 

Multi-
Physicians Nurses Health Professional

Percent Percent Percent Percent

one day or less 60% 44% 75% 64%

2-5 days 31% 24% 16% 31%

2-5 weeks 7% 27% 3% 5%
more than 5 weeks 2% 5% 6% “=

TOTAL PEOPLE 20,944 24,366 14,319 38,077

 

Highlights:

RNs are the group receiving the lengthier training, and

this has been primarily in coronary care.

Many of the one-day or less sessions are seminars and

conferences.

-56-

 
et

PROGRAM PROGRESS

aI

IMPROVING HEALTH SERVICES THROUGH REGIONALIZATION

 

 

Hospital Participation

 

* REGIONALIZATION AND HOSPITAL PARTICIPATION: Regionalization
is one of the major themes of Regional Medical Programs.
Working relationships and linkages among commmity hospitals
and between such hospitals and medical centcrs are among
the primary concems of the program. The linking of less

specialized health resources and facilities such as small

commmity hospitals with more specialized ones is a critical
way to overcome the maldistribution of certain resources,

and increase their availability and accessibility. Therefore,
' hospital participation is one key to the development of

Regional Medical Programs. _

 

Percent of Nation's Hospitals* Participating in RMPs**

 

National No. Percent
Total Participating Participating

FY 1968 5 ,850 851 15%
FY 1969 ~  ~§,820 1,638 26
FY 1970 5,853 2,084 36
FY 1971 (est.) 5,880 2,693 46

 

 

 

Highlight: Almost half of the Nation's short-term non-
federal hospitals are now participating in RMPs.

 

Percent of Nation's Medical School-Affiliated Hospitals*
Participating in Regional Medical Programs

National | No. Percent
Total Participating Participating

FY 1969 436 121 28%
FY 1970 480 241 50
FY 1971 (est-) 490 285 58

 

 

 

Highlight: Almost three-fifths of the Nation's medical school-
affiliated hospitals now participate in RMPs.

* short-term, non-Federal hospitals
*k participation includes membership in advisory groups
and committees and in operational activities.

ny

 
 

PROGRAM PROGRESS. . .HOSPITAL PARTICIPATION

 

 

llospitals* Participating in Operational Activities Only

No. Actively No. Generally
Participating Participating

 

Total and Percent and Percent
FY 1968 301 60 203 | 241 80%
FY 1969 1,246 247 ~—-20% 999 80%
FY 1970 1,471 860 «58% 611 42%
FY 1971 (est.) 2,079} 1,221 59% g5g.s«AdS

 

 

 

Comment

Hospitals actively participate by sponsoring
projects or serving as the location for an
activity. For example, many hospitals serve

as coronary training sites or provide intensive
stroke services.

Other hospital participation may include such
activities as sending personnel to be trained.

 

 

Distribution by Bed Size of RMP Participating Hospitals*

‘Total
Participating|Less Than 200-399 400 plus
Hospitals . | 200 Beds’ Beds Beds

FY 1968 _ 851 587 153 110
FY 1969 1,638 1,081 327 229
FY 1970 2,084 1,344 467 273
FY 1971 (est.) 2,693 1,750 592 351

 

 

 

Highlights

About 40% (1,750) of the Nation's smallest
_ hospitals are now participating.

In contrast, about 85% (351) of the largest

hospitals are now participating.

antenatal ER

* short-term, non-Federal hospitals
-5Q-
PROGRAM PROGRESS ... REGIONALIZATION

* REGIONALIZATION -- GEOGRAPHIC SCOPE OF ACTIVITIES: Geographical
coverage of activities offers another insight into the regional-
ization process of RMPs. The trend during the last several
years has been away from program activities concentrated in the
medical center and towards those designed to improve and expand
community resources and services. The following table shows
program funds as distributed by geographical areas (regionwide,
subregional, interregional) within the RMPs. An example of a
regionwide activity might be a circuit course for nurse training
or a coronary care network; a subregional activity might be
support of a multiphasic screening clinic in a ghetto area.

 

Geographic Scope of RMP Activities by Funding
Emphasis, 1971

 

Scope of Activity % Funds
Regionwide . 2... ee ee ee te ee ee te ee 58%

Regionwide involving central and satellite units. . (13%)

Subregional. . 2. 1. 1 ee ee ee ee ee hee 40%
Inner city. .......+-. eee eee ene (7%)
Rural... we ee et et ee ee (9%)

Interregional 2%

enn ww ee Re Re eR Re RR RR KH

* EXAMPLES OF REGIONALIZING SERVICES AND RESOURCES: Two
maps follow which graphically describe:

(1) a regionalized kidney program in the
Washington/Alaska RMP, which includes a
planned, coordinated program for kidney
transplantation, dialysis, and education; SEE MAPS ;

(2) an education program in Georgia with
major area education centers located in
one or a cluster of large hospitals
serving satellite hospitals. Each
major center is linked to a medical
school.

-59-
  
   

EXAMPLE OF REGIONALIZATION
OF KIDNEY DISEASE ACTIVITIES
IN WASHINGTON/ALASKA

 

SsabOdd Wedd

 

-
--"
-
-
-
-

Seattle <

ante Major Medical Centers

@.------- Community Hospitals
PROGRAM PROGRESS

EXAMPLE OF REGIONALIZATION OF CONTINUING
EDUCATION ACTIVITIES IN GEORGIA

 

Valdosta

 

 

---Major Continuing Education Area Facilities

Satellite Continuing Education Facilities
means (Community Hospitals)

-61-
 

PROGRAM PROGRESS

 

TURNOVER OF FUNDS TO MEET CHANGING NEEDS

* PURPOSE: The RMPs hope to support demonstration activities
for approximately three years, at which time local financing
mechanisms should take over the support of the activities. This
approach permits the RMP to reinvest its funds in other areas

of urgent need and allows RMP to be a meaningful catalyst.

* TERMINATING RMP SUPPORT: During the past six months,support for
over 00 activities was withdrawn and reinvested in a comparable

number of new activities.

Activities for which RMP
Support Terminated
(Jan. 1971-June 1971)

 

 

No. Amount
By Disease Emphasis Activities (in thou) Percent
Heart 34 $1, 088 30%
Cancer 13 454 12%
Stroke 6 164 4%
Related Diseases 8 294 8%
Multicategorical 33 1, 426 46%
Total 94 $3, 426 100%
Highlights:

The extensive heart disease cutbacks primarily reflect
a decrease of coronary care training activities.

Multicategorical terminations reflect reductions .in

audio-visual support services, and some multipurpose
continuing education programs, as well as other activities.

-G62-
 

PROGRAM PROGRESS ... TURNOVER OF FUNDS

 

No. Amount in

By Primary Purpose Activities (Thousands) Percent

 

 

General continuing 24 $1,790 23%
education

Training Health Pro- 32 998 — 29%
fessionals in new
Skills

‘Health Care Delivery 22 823 24%

Health Planning §& 5 348 103
Coordination

Research § Develop- 11 467 14%
ment

Total 94 $3 426 100%
Highlights:

Many general continuing education for physicians
programs have been terminated as well as videotape and TV
type activities.

The 29% reduction in Training Health Professionals
reflects primarily the reduction in coronary care
training.

* REINVESTMENT OF THE RMP FUNDS: The funds withdrawn from the

 

above set of activities have,in part, been reinvested with a
different emphasis: .

Highlights:

.

About one-fifth of the funds have been put into stroke
activities, thereby markedly increasing stroke programs,
particularly in ghetto areas.

Correspondingly, smaller reinvestments have been made in
heart, but slightly more in cancer. ,

Over two-fifths of the funds have been reinvested in health
care delivery activities, thereby markedly increasing efforts
in these areas.

-63-
A GLOSSARY OF TERMS

AREA HEALTH EDUCATION CENTER

An Area Health Education Center, proposed under pending legisla-
tion, would be a satellite of a university health science center
for the purpose of increasing opportunities for training,
retraining, and continuing education of health professionals

in an effort to enhance the delivery of health care in deprived
areas.

CATEGORICAL COMMITTEES AND TASK FORCES

Groups of health care providers and other technical experts appointed
by either the Program Coordinator or Regional Advisory Group for

the purpose of planning, evaluation, and review of projects which
emphasize one or more of the following diseases -- heart disease,
cancer, stroke, kidney disease, education, and other areas.

CONSUMER

A non-health professional who receives health care and may be
engaged in RMP activities.

COORDINATING HEADQUARTERS

The agency responsible for the implementation, administration, and
coordination of a Regional Medical Program. It is involved in the
development of regional objectives as well as review, guidance,
and evaluation of ongoing planning or operational RMP functions.

CORE STAFF

Comprised. of professionals and clerical persons whose prime
responsibility is program development, coordination and admin-
istration; providing consultation or professional services

to local institutions and serving as facilitators or conveners

of multiple interest groups to solve local health-related problems.

EXECUTIVE COMMITTEE

Executive Committee usually is appointed by. the Regional Advisory
Group to provide advice and counsel to the RAG and serve as the

day-to-day advisor to the RMP Coordinator and core staff.

-65-
EXPERIMENTAL HEALTH CARE DELIVERY SYSTEM

An Experimental Health Care Delivery System is a new grant program
to create a management capacity to rationalize health services in
a commmity-.

GRANTEE

Grantee is a public or non-profit institution, agency, or
corporation which is responsible for fiscal control and fund
accounting procedures to assure proper ‘disbursement of and
accounting for RMP grant funds.

HEALTH MAINTENANCE ORGANIZATION

A prepaid, organized system of health care which includes a
consortium of health care providers who come together for the
purpose of making available comprehensive health maintenance
and treatment services for a voluntarily enrolled group of
persons in a specified geographic area.

LOCAL ADVISORY GROUP

A consortium of interested providers and consumers who reside
in a geographic subsection of a region and are brought together
by the Regional Medical Program to advise it with respect to
health care needs, priorities, and plans to be undertaken which
should ameliorate many of the existing local health care needs
and problems. —

OPERATIONAL GRANT.

Operational Grant is authorized upon a recommendation of both
the Regional Advisory Group and the National Advisory Council on
Regional Medical Programs to assist in the establishment and
operation of a Regional Medical Program.

PLANNING GRANT

Planning Grant is authorized upon a recommendation of the National
Advisory Council on Regional Medical Programs to assist in the
planning and development of a Regional Medical Program.

PROJECT

Project is a discrete activity which is undertaken by the Regional
Medical Program as an integral facet of its overall operational
program. These may include education, training, and patient
service demonstration.

-66- .
PROVIDER

Provider is an individual whose prime function is to make available
health care services, e.g., physician, nurse, physical therapist,
occupational therapist.

REGIONAL ADVISORY GROUP

Regional Advisory Group is comprised of a broad spectrum of health
professionals, institutions, and consumers whose prime function

is determination of the overall scope, nature, and direction of
Regional Medical Programs.

REGIONALIZATION

Regionalization is the linkage among health care institutions and
resources established for the purpose of improving both the quality
of and accessibility to health care as well as gaps and duplications
in the Region's health care system.

-67-
U.S. DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
Health Services and Mental Health Administration

ry