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Regional Medical
Program
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Western New York
Annual Repert

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JOHN R, F, INGALL, MD.

Director

REGIQnNnak MEODIGAL PROGRAM

     
  

FOR
WES TERN NEw YORK
STATE UNIVERSITY OF NEW YORK AT BUFFALO ~ SCHOOL OF Gms | Vey t

2929 MAIN STREET BUFFALO, NEW YORK 1 ‘ST akes“Area
Telephone (Area Code 716): 835-0728 Cg
egional
edical

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COUNTY COMMITTEES REPORT

Over the past year our program has exemplified greater in-
volvement on the part of all our 9 counties. This direction has
been deliberate, in keeping with the concept of regionalization
and its particular applicability in this geographical area. Our
December federal site visit team recognized this capability, and
urged its fuller implementation through expansion of liaison staff,
and development of a County Chairmen's conmittee.

The expansion of our liaison staff and capabilities is in pro-
cess. Miss Jean Hanna, recruited in March, serves Erie and McKean
Counties in Pennsylvania, and Chautauqua County, New York. Several
other applications are now being interviewed and assessed for the
liaison staff, which will, after development , be recognized as a de-
partment of our program charged with the maintainance of communi-
cations and visibility in each of our counties.

During the past year our program has developed an increased
concern for the health care needs related to the minority segments
of our region. In demonstration of this, various conferences of
inner city needs have taken place at staff and executive levels be-
tween RMP and various inner city organizations and representatives.
In the interests of studying, implementing, and maintaining some
program structure for relating more effectively to the inner city,
Mr. Michael Miller, formally of Model Cities, will join our liaison

department on May Ist.

A third and significant direction reflected by our program over
the past year is a closer alliance with Comprehensive Health Planning,
RMP's "sister agency". While certain interlocking aspects have pre-
viously been featured by CHP and RMP in this region, greater local de-
definition of this direction has in recent months been demonstrated
by closely related CHP and RMP county committees, usually under the
model of an umbrella County Health Organization. Two of our counties
COUNTY COMMITTEE REPORT PAGE 2

are already into an RMP-CHP conjoined arrangement within which dis-
tinct roles will be enacted and coordinated. Five county committees
-are intently developing such a coordinated base. Such conjoined
efforts appear to have a particular appeal in our less populous or
rural counties. While some apprehensions have been expressed re~
garding the dangers of diminishing individual program identity,

the involved counties do themselves feel that a close coordination
of RMP and CHP is essential for the well being and functioning of

both at the local level.

In the context of these directions and developments, we feel
the past year has been realistically productive, anda we anticipate
even more productive articulation of RMP throughout our region in

the coming year.

LEP Fa BPO tn,

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Clifford L.M. Carpenter
Chairman, RAG Committee
for County Committees

i fs ZL ‘ / é

‘Gefald J. Surft'te -
Associate fof County Committees.
Lakes Area F.M.P.

rip
 

 

 

 

 

Our theme is New Directions for RMP/WNY—our emphasis is /nvolvement.

In transmitting the 1972-1975 Triennial Grant Application of the Regional Medical Program for Western New
York (RMP/WNY) to the Director of the Regional Medical Programs Service, the President of the Health Organization
of Western New York, Inc. commented: :

Dear Dr. Margulies:

... It is my personal view that the Regional Advisory Group (RAG) for the Regional
Medical Program for Western New York, namely the Board of Directors of the Health
Organization of Western New York, Inc., has discharged its advisory role to Dr. Ingall with
the utmost industry and enthusiasm. The members of this group are fully cognizant of
their increased authority in the conduct of the program. They are, likewise, very sensitive
to the need for continuous and unflagging involvement.

| am proud, as Chairman, to report that we have met ona monthly basis during the
last year and that this alone has been an educational exercise for all of us. You must be
aware that the transition from a categorical program to one which embraces an attempt
to facilitate the health care detivery system is difficult. | believe this has been achieved.
Furthermore, at a recent workshop in which we clarified our goals and objectives, the role
of the program in the future was well clarified for- the participants. The priority of
projects approved but unfunded was much easier to decide upon in the frame of our new
approach and our statement of goals and objectives. it is quite obvious that there are
areas of program deficit. Action in these areas will be formulated and encouraged as a
most important feature of the Regional Medical Program for Western New York in the

coming year ...

 
   

Sincerely yours,

Irwin Felsen, M.D.
President
Health Organization of Western New York, Inc.

 

 
 

 

 

 

 

The Annual Report of the Regional Medical Program for Western
New York is not a document to support a piano leg or balance a
bookcase. It is designed as a record to be read, to provoke comment,
and above all to indicate the direction in which we hope to move.

An organization that can be considered viable and lively is one
that has the capacity for change, that can respond to constructive
suggestions and influences in a positive fashion. Those familiar with
the old heart, cancer, and stroke program, heavily categorical and
often interpreted as yet another funding agency, now should see the
Regional Medical Program as an enabling organization, inviting the
involvement of all intelligent participants irrespective of the label
“consumer” or “provider,”

! decry the perpetuation of these two labels in any legislation.

We should be involving all those who can provide comment and support
to the fundamental Principle of improving the health and treating the
R. F. Inga,

illnesses of our region.
tive Director

nal Medical Program
for Western New York

   
 

 

 
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Table of Contents

CHAPTER PAGE
Workshop Telegram from Dr. Margulies... 6.6.66 cece eee ee eee rete inside front cover
Letter of Transmittal 0.00... ccc cece ee ene en ene t antenna teens i

1. WHAT ISTHE REGIONAL MEDICAL PROGRAM .....-...-- cere cree terete nes 1
Nationally... 0c c cece ccc eee eee eee ee nee en eee nen e enna n ene e eens 2
Purpose of Regional Medical Programs ......- 00ers ee cere tenet ete e en eee 2
Legislation 2.0.0... ccc ee ete et teen entree e tena nees 2
The RMP Mission .........0- 2c cece ee te eee eee eee eet eee nee eens 4
eyo | 4
The Western New York Region 0... 00. cece eee eee teen eet tenes 3
The Workshop - New Directions for Western New York .. 0.0.06. e eee ee ere re eee 4
Triennial Grant Application 2.0.0.0. ccc cee eee re eee tte etn tenes 4
Health Activities Goals and Objectives... 0.2... cece eee eet eee eens 5
2. WHO MAKES UP THE REGIONAL MEDICAL PROGRAM .... 0... 6-0 eee rere reece rene 7
Regional Advisory Group... 0.2... cree eee teen tenner nent e rene 8
Core Structure .. 0. ee ee eee eet eens Vane e eee ee eee eee 10
The Volunteer Component ........ 00. cece erent ent e ete tent e ett e eens 14
3. HOW DOES RMP/WNY WORK ........ 0.0 ccc eee ee ee teen ne teen e ene ne as 15
Staff Functions ........ ccc cee eee ee ee eee eee ee tee een n tenets 16
Planning .......- cece cee eee eee ee eee nee een eee ene nes 16
Proposal Review and Development ........-. 2. eee eee rete entree eens wees 16
Evaluation 0.2... cc cece ee eet teen ee enenee rere 16
Financial Management ....... 0.0 cece ee ee ce eee ee ee eee enn nees ne 18
Communications ........ 0.000 eee eee eens eee ee ee ee eee eens 19°
The Enabling Role ......- 000. e cece eee ee te tenet ne teen teens 19
Projects and Proposals 6.0... 00 cece cee eee eee teeter eee treet nee 19
Operational Projects... 0... cee ee en ene eee ete nee eens 19
Financial Statement ......- 200 cee eee ee eens cee e ne eee ne eeeeee 22
Status of Proposals .....-.- 00 ccc e eee teen tree een neste eees 23
How RMP/WNY Works With Other Health-Related Organizations Dee eee eee eee en 25
4. SPECIAL CONCERNS OF RMP/WNY ........0 000 ce eee eee eee teen tee et eees 27
Manpower Development ......... 02. c cece eee eee tenet e teen ene nn enes 28
Area Health Education Centers ......0 0... cece eee ee ree een nner e tees 28
Rural Health Problems. ....... 02000 e cece ee eee te eee ee ee ee tee eee a nanan 30
Inner City Problems ......... 000 cee eee ee ene ee eee eee een nets tenet nees 31
Health Maintenance Organizations ........ 6. ccc eee eee eee eee e een e renee 31

 

iii

 
 

 

 

List of Figures

FIGURE PAGE
1 Current Legislation: P.L. 91-515. 2.0.0... eee erence erent rere t esses sere e ees 2
2 Map - The Western New York Region ....-...-+0068 eee e eee nent eee n eee e re nenees 3
3. Health Activities Goals and Objectives .....-.-- seer reese errr er retr rere sers nesses: 5
4 Organization of RMP for WNY oo ccc ecco cece eee eet eee eee eee ene gene eee ner et 9
5 Composition of the Board of Directors

of the Health Organization of Western New York, Inc. 26. cc eee ee ee een ees 11
6 _ Board of Directors of the Health Organization of Western New York, Inc... 2... eee ee ee eee 12
7 Employees of RMP for WNY.... 6-0 seer eee eet tre nse r sess eee e ses eee 14
8 Volunteers’ Contribution ........2. see e etree terete rte seen ees ee see ee ee ees 14
9 Proposal Review Process .....----sseeeeeeerrs essere restr eters rss s essere eee ee 7

10. Financial Statement: March 1, 1971 - February 29,1972 0. cence entree ene tnnes 22

11. Status of Proposals ....... 0. cece eee eee eee terete ert reser e es eee ee eee ee eee 23

12 Proposals Submitted to Washington ......--+++ssret restr eee cece e eee enaee 24

13. RMP. for WNY Relationship to Other Health Related Organizations ...-..--+-ee essere eenes 25

14. Programs in Continuing Education- 1971..... 0. cee cette eee erent arene sess 29

 

 

 

 
 

Chapter1
What is the Regional
Medical Program

NATIONALLY
Purpose of Regional Medical Programs
Legislation
The RMP Mission
LOCALLY
The Western New York region
The Workshop — New directions for
Western New York
Health Activities Goals and Objectives
Triennial Grant Application

 

 

 
NATIONALLY

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 more accessible,
efficient, and high quality health care to the
American public. To accomplish these ends, the
RMP’S promote and demonstrate among providers
new techniques and 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 RMP’s 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 potentially 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 legislative extension—has clarified the nature
and character of Regional Medica! Programs. Though
RMP continues to have a categorical emphasis, to be
effective that emphasis frequently must be subsumed
within or made subservient 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 comprehensive 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 RMP’s achieve their goals.

LEGISLATION

Regional Medical Programs were initiated in
October 1965 under Public Law 89-239. The concern
was for attacking heart disease, cancer, stroke, and

related diseases with emphasis on making available
the latest advances in diagnosis and treatment.

Cooperative arrangements for research, training, and
related demonstrations of patient care were also
stressed.

 

 

FIGURE 1. CURRENT LEGISLATION: P.L. 91-515

In October 1970, P.L. 91-515 was signed into
law. The new legislation:

(1) adds kidney disease.

(2) adds prevention and rehabilitation.

(3) emphasizes primary care and
regionalization of health care resources.

(4) emphasizes health service delivery and
manpower utilization. Directs RMP
attention specifically to improvement of
services in areas with limited health
services.

(5) provides additional authority for new
construction.

(6) requires that public members of advisory
groups include persons familiar with the
financing of, as well as the need for,
services and that such public members be
sufficient in number to insure adequate
community orientation. Also includes a
representative of the Veterans
Administration as an ex ‘officio member,
if there is a VA institution in the region.

(7} requires review of RMP applications by
areawide Comprehensive Health Planning
Agencies.

 

 
 

 

THE WESTERN NEW YORK REGION

The RMP/WNY is one of 56 federally funded, locally
controled programs in the United States. The Regional
Medical Program for Western New York is made up of
nine counties: Niagara, Genesee, Erie, Wyoming, Chautauqua,
Cattaraugus, and Allegany in Western New York, and Erie
and McKean counties in Northwestern Pennsylvania. {t covers
an area of 7100 square miles with a population of approxi-
mately 2,020,000 according to the 1970 census.

FIGURE 2. THE WESTERN NEW YORK REGION

    
 
 

LOCALLY

THE RMP MISSION

A recent document of the RMP National
Advisory Council provides goals and guidelines for
Regional Medical! Programs.

What the RMP mission has become: The broad
goals are to increase the availability of care, enhance
the quality, and moderate the costs. Specific missions
are:

[Ito promote and demonstrate new techniques

and delivery patterns

Cto expand the capacity of existing and new

personnel to fill needs of underserved areas

CJ to stimulate regionalization

(to improve standards and quality control,

How RMP’s are judged: RMP’s will be judged
on (1) program, (2) performance, and (3) process.

(1) Criteria for judging program related to the
RMP’s provider action-plan with emphasis on

(a) increased and more effective utilization
of health facilities and manpower

{b) health maintenance, disease prevention,
early detection, and expanded
ambulatory and out-patient care

(c) an improved relationship between
primary and secondary care.

Other considerations include the extent to
which activities will link multiple institutions or
professions and will tap outside funds or support
other federal efforts.

(2) Performance is judged by whether goals,
objectives, and priorities have been established,
productivity of program activities, and the degree to
which RMP-supported activities have been assimilated
by the health care financing system.

(3) Process criteria include organizational
effectiveness, active participation of those interested
in health problems in the region, translation of
assessed needs and resources into continuously
evolving plans and priorities, and the self-evaluation

process.

There are few organizations with challenges of
this magnitude.

THE WORKSHOP — NEW DIRECTIONS.
FOR WESTERN NEW YORK

The RMP/WNY Workshop, held on September
23-24, 1971, was a great step forward in region-wide
involvement in program planning. About 50 health
professionals from throughout the region, including
Regional Advisory Group (RAG) members, project
directors, proposal authors, and others met at the
Holiday [nn in Fredonia, New York. At the
Workshop, the mission of the RMP was reviewed in
its new context, the framework for future decisions
was established, and priorities were set. Participants
worked with the new concepts of the RMP mission
and discussed the needs of our own region in the light
of this understanding. As a result, in the final session
of the Workshop, a RAG executive group was able to
select from the previously approved proposals those
most pertinent to the goals and objectives that had
been developed.

The RMP/WNY Health Activities Goals and
Objectives 1972-1975 were accepted by the Health
Organization of Western New York, Inc.
(H.O.W.N.Y., Inc.) Board of Directors on October 14,
1971.

WE NEED YOUR IDEAS

Ideas for projects and activities which meet
needs within the region and which help fulfill the
health activities goals and objectives are being actively
sought. RMP/WNY invites the participation of
everyone in the region who is interested in the
delivery of health care.

TRIENNIAL GRANT APPLICATION

On November 1, 1971, the Regional Medical
Program for Western New York submitted a triennial
grant application for March 1, 1972 - February 28,
1975, to Dr. Harold Margulies, Director of the
Regional Medical Programs Service in Washington.
Accomplishments and problems of the last three
years were reviewed and plans for the next three

years presented.
 

 

 

FIGURE 3. HEALTH ACTIVITIES, GOALS AND OBJECTIVES

Goal No. 1. To stimulate and promote preventive services in health maintenance.

OBJECTIVES

4.

To continue defining the need for additional or new preventive services in each sub-regional area, based on a
data profile of resources end services, an assessment of the community’s characteristics and health

problems, and on the acceptability of the service to the community.

To encourage delivery of preventive services through sources of primary care with emphasis on the role of
allied health personnel.

To encourage coordination emong government, voluntary, and private agencies to (a) maximize the impact
of preventive services and (b) assist public health agencies in responding to community needs.

To encourage expanded programs in health education.

Goal No, 2. To develop and improve primary care services.

OBJECTIVES

6.

To continue defining the need for additional altered or new primary care services in each sub-regional area,
based on a data profile of resources and services, an assessment of community characteristics and health
problems, and on the receptability of the pattern of services to the community.

To maximize the role of existing health personnel in delivering primary health care by (a) improving
distribution of health personnel, (b) encouraging the expansion of ambulatory care within or associated
with community hospitals, (c) using inter-disciplinary approach to the delivery of primary care, (d)
encouraging the development and evaluation of innovative methods of health care delivery, and (e)
promoting improved referral patterns to assure continuity of care.

To encourage generat and family practice and other forms of primary health care.
To stimulate development of already defined new roles of health personnel.

To seek feasible solutions to the problems of distance and lack of transportation as barriers to utilization of
primary care, preventive and rehabilitation services.

To promote consumer education regarding availability and utilization of existing health services.

Goal No. 3. To encourage the development, expansion and integration of rehabilitation services into the continuum of
medical services.

OBJECTIVES

To continue defining the need for additional altered or new rehabilitation services in each sub-regional area,
based on a data profile of resources and services, an assessment of the community's characteristics and

health problems, and on the acceptability of the patterns of service to the community.

To promote the continued development of a variety of facilities and programs to assure placement of
patients at the appropriate level of care.

 

 
 

 

 

For the first budget period (1972-73),
RMP/WNY requested $1,821,626 from the federal
government for the program. In accordance with the
federal mandate, several of RMP/WNY’s projects are
moving into self-support. Income thus received plus
local contributions to the program in dollars and in
kind will bring the total resources available to
RMP/WNY during 1972-73 to a value of $2,419,600.

DEVELOPMENTAL COMPONENT

The triennial grant application includes a
request for a developmental component. A sum equal
to 10% of RMP/WNY'’s appropriation for direct costs
during 1971-72 can be awarded to the program for
the coming year. This same sum can also be granted
in each of the remaining two years of the triennium.
The developmental component provides an
opportunity to support needed activities without
delay. Modest funds from this component can be
assigned directly by the Regional Advisory Group.

During the year 1971-72, core and project
funds have been used in a developmental manner
which has achieved:

(a) the ability to respond quickly, while
community interest is high, in
cooperative ventures to develop new
approaches to health care problems

_(b) a major financial return for funds
invested

(c) the opportunity to use staff competence
in the enabling role.

The Lake Area Health Education Center
{(LAHEC) was the first center to be funded by the
Veterans Administration. The monetary investment
by RMP/WNY has been $10,000—the return, $50,000
invested in LAHEC by the Veterans Administration
and the local Erie, Pennsylvania hospitals.
RMP/WNY’s investment of approximately $12,000 in
the Rural Externship Program released contributions
of $9,100 from participating rural physicians,
hospitals, and local governments and $20,000 from
the Appalachian Regional Commission. The industry
and time of the Rural Health Manpower Committee,
the preceptors, and the enormous TV, press, and
journal coverage of this venture show how a
developmental commitment. can catalyze active
public interest.

RMP/WNY looks forward to accomplishing
even more with funds specifically earmarked for
development. Uses planned for the developmental
component include:

(1) capitalizing on the positive approach
being taken by inner city groups

(2) promoting greater involvement by the
county committees.
 

 

Chapter 2
Who makes up the
Regional Medical

Program

Regional Advisory Group
Core Structure
The Volunteer Component

 

 
REGIONAL ADVISORY GROUP

The Health Organization of Western New York,
Inc. (H.O.W.N.Y., Inc) is a group of over 220 persons
who by-and-large meet monthly in county
committees. The H.O.W.N.Y., Inc., Board of
Directors, which serves as Regional Advisory Group
to the RMP/WNY, meets monthly to direct program
development. The Telephone Lecture Network is
used to insure maximum participation at Board and
committee meetings. Those who are unable to leave
their part of the region can still participate in
important deliberations and decisions.

A continuing effort is made to involve the
counties in a greater role in defining their own needs
and priorities. Complacency must be eradicated and a
high level of interest maintained within the
constituency. A staff member is following a regular
schedule of liaison with the county committee
members and their chairmen to promote committee
identification with the goals and objectives of the
program and develop more active involvement.
Concomitantly, staff working in the counties can be
appraised of local efforts and problems. The visibility
of staff in each county affirms the reality of
RMP/WNY’s thrust towards regionalization.

This summer, staff members have met with
each member of the Board of Directors and with
numerous members of the Regional Advisory Group
at-large in. the various counties. These meetings have
brought to the attention of RAG members the new
purposes and directions of RMP and the opportunity
for developing new approaches to problems in health
_ care. Important insights of practicing professionals
and health administrators in all the counties have
involved the RMP/WNY more closely with the needs
of each county.
2-73 JHE 4. ORGANIZATION OF RMP FOR WNY

 

    

_ .Y.W.N.Y. BOARD OF DIRECTORS

   

 

 
 

Constitution and By-Laws
Executive

Search
Proposals

    
   
  

  
  
  

— ee COUNTY
COMMITTEES
OF HOWNY

 
  
 

WNY-RMP

  
 
 

Standing Committees
Coronary Care

    
       
   
 
  
    

  
  
 

   
  
 
 
 

     
 

   
   

  

   
    
 

  
    
     
 

Cancer
Stroke
Kidney and Dialysis
Lake Area Pulmonary Planning
Health Cardio-Pulmonary
Education ——“| Allied Health
Center Rural Health Manpower Allegany
TLN Advisory Group Cattaraugus
Evaluation Chautauqua
Erie, Pa.
Erie, N.Y.
Genesee
Ad Hoc Committees McKean, Pa.
Health Careers Ween ng
"| + Family Management of

 

 
 
 
 

the Chronically Il
Programs for the Aged

  

 

 
10

CORE STRUCTURE

Each staff member has a well defined role in
the organization and a voice in the development of
the total program. To promote the greatest possible
community involvement, RMP/WNY’s philosophy is
to use the small core to staff expert committees.
Thus, grants management staff works with the
proposals committee, evaluation staff with the
evaluation committee, county liaison with the county
committees, and the Director for Nursing and Allied
Health Affairs staffs our categorical committees and
implements their programs throughout the region. In
addition, staff members work with other committees
in the community.

The Executive Director has worked very closely
with his staff, establishing the program and increasing
our involvement in and usefulness to the community.
He has been able to bring leaders together to define
health problems and set policy for their solution. A
measure of the status of RMP/WNY in _ the
community is that the Executive Director holds an
associate deanship in the School of Medicine of the
University and serves on the medical school's
executive committee. In the last year, a growing
percentage of the Executive Director's time has been
spent working with other RMP directors. He is
chairman of the Northeastern group of directors and
their elected two-year delegate to the National
Steering Committee. From these contacts the
Executive Director has brought to the Board and his
staff a much more sophisticated understanding of
health events of national importance, direct
communication with other regional programs, and the
possibility of learning from their experiences.
FIGURE 5. COMPOSITION OF THE BOARD OF DIRECTORS OF THE
HEALTH ORGANIZATION OF WESTERN NEW YORK, INC.

 

100

»

30-4

~~ N
an 3 mn
l l 1

PER CENT OF TOTAL MEMBERSHIP

3
i

 

 

 

 

G H I J

 

COMPOSITION OF THE BOARD

A 9 M.D.'s representing the 9 county medical societies
G1 member representing the Regional Health Director,

B 9 members representing the 9 county committees
C 2 members representing the School of Medicine at the Department of Health, State of New York
State University of New York at Buffalo H 1 member representing the Commissioner of Health,
D2 members representing Roswell Park Memorial Institute Erie County, New York
E 1 member representing the Western New York Hospital Association 1! 1 member representing the Veterans Administration

: F 2 members representing the Comprehensive Health Palnning Council J 5 members at large, including 1 legal counsel
of Western New York, Inc. 33 total membership

14

 
 

a ewe eae tt Bh

 

 

 

 

 

FIGURE 6. BOARD OF DIRECTORS OF THE HEALTH ORGANIZATION OF WESTERN NEW YORK, INC.

NAME
EXECUTIVE COMMITTEE

President:
1. Irwin Felsen, MD

Vice President:
2. Father Cosmas Girard, OFM

Secretary:
3. H. Gregory Thorsell, MD

Treasurer:
4. John C. Patterson, MD

Chairman, Proposals Committee:
5. Harry Sultz, DDS, MPH
Member-at-large:

6. Theodore T. Bronk, MD

Member-at-large:
7. Edward E. Kemble, MD

OTHER BOARD MEMBERS
8. Lester H. Block

9. LaVerne E. Campbell, MD

10. Lloyd Cannedy, PhD

11. Clifford L.M. Carpenter

12. Max Cheplove, MD

13. Kenneth H. Eckhert, MD

14. William H. Ennis*

15. Ivan Harrah

INSTITUTION AND/OR
OCCUPATION

Physician

St. Bonaventure University
Surgeon

Roswell Park Memorial Institute

School of Medicine, State University
of New York at Buffalo

Physician

Physician

Attorney at Law

New York State Department of
Health — Regional Health Director

Bradford Hospital — Administrator
Comprehensive Health Planning
Council of Western New York, tnc.,

Executive Director

Physician

‘Surgeon; Comprehensive Health

Planning Council of Western New
York, Inc. — Chairman

Hamot Hospital — Administrator

Western New York Hospital Associ-
ation — Executive Director

CATEGORIES OF
REPRESENTATION

Allegany County Medical Society

Cattaraugus County Committee

Chautauqua County Medical Society

Roswell Park Memorial Institute

Erie County (N.Y.) Committee

Niagara County Medical Society

Erie County (Pa.} Medical Society

Legal Counsel: Member-at-large

New York State Department of
Health

McKean County Committee
Comprehensive Health Planning
Council of Western New York, Inc.
Erie County (N.Y.) Medical Society
Comprehensive Health Planning
Council of Western New York, Inc.
Erie County (Pa.) Committee

Western New York Hospital Asso-
ciation

 

12

 
 

 

16.
17.

18.

19.

20.

21.

22.

23.
24.
25.

26.

27.

28.
29.
30.
31.
32.

33.

Herbert E. Joyce, MD
Bert S. Klein, PodD

Edward F. Marra, MD

Elizabeth Moore

William E. Mosher, MD

Gerald P. Murphy, MD

William C. Niesen, MD

Mary S. Northington
LeRoy Pesch, MD**
John R. Rowan

Fred O. Rush

Patricia Stopen, RN

George E. Taylor, Jr., MD
Donald R. Watkins, MD
Paul Welsh, MD

R.T. Williams, MD
Duncan C. Wormer, MD

George S. Young, MD

 

ke

The Buffalo and Batavia, New York and Erie, Pennsylvania Veterans Administration Hospitals will shortly all be represented on the

Resigned September 1, 1971
Resigned January 1, 1972

HOWNY Board.

Physician
Podiatrist
School of Medicine, State University
of New York at Buffalo — Chair-
man, Department of Social and

Preventive Medicine

Executive Director, American Red
Cross of Genesee County

Physician, County Health Com-
missioner

Roswell Park Memorial Institute —
Director

Physician

Comprehensive Health Planning
Council of Western New York, Inc.

State University of New York at
Buffalo — Dean, School of Medicine

Buffalo Veterans Administration
Hospital — Director

Bayfront Development Program
Gannon College — Director, Erie,
Pennsylvania

Registered Nurse —

Wyoming County Health Depart-
ment

Physician

Physician

Physician

Surgeon

Physician

Physician

Member-at-large
Chautauqua County Committee

School of Medicine, State University
of New York at Buffalo

Member-at-large

Commissioner of Health — Erie
County, New York.

Roswell Park Memorial Institute

Niagara County Committee
Member-at-large

Schoo! of Medicine, State University
of New York at Buffalo

Veterans Administration

Member-at-large

Wyoming County Committee

Allegany County Committee
McKean County Medical Society
Genesee County Committee
Wyoming County Medical Society
Cattaraugus County Medical Society

Genesee County Medical Society

 

 

13
 

 

 

 

 

FIGURE 7. EMPLOYEES OF RMP/WNY

Professional Staff Employees

John R.F. Ingall, M.D., F.A.C.S., F.R.C.S. — Executive Director

Sandra K. Berlowitz, B.A. — Administrative Associate, Writer

Gene A. Bunnell, A.B., M.C.P., M.P.H. — Administrative Associate for Planning

Floyd Cogley, Jr., B.S., M.P.H. — Administrative Associate for Grant Development
Patricia Shine Hoff, R.N., B.S., M.A. — Director of Nursing and Allied Health Affairs
Elsa R. Kellberg, B.A., M.A. — Research Associate for Evaluation

Gary L. Reynolds, B.S., M.B.A. — Administrative Associate for Business and Personnel
Marion R. Sumner, B.A., M.B.A. — Administrative Associate for Business and Personnel
Gerald J. Surette, B.A., M.A. — Administrative Associate for County Committees
Anthony Zerbo, Jr., B.A. — Director of Communications

Staff Employees

Jean L. Andrianoff, B.S.Ed. — Secretary

Alice J. Bragg — Secretary

Maria M. Dick, A.A.S. — Secretary

Elizabeth M. Eberl — Statistical Clerk

Barbara C. Lamberg — Secretary

Kathleen C. McCron B.S. — Receptionist and Secretary
Rosetta J. Parker — Secretary

Joan L. Philipps, B.S. — Secretary

Urban Batt — Clerk (part time}

 

 

 

70¢ —

60¢ 4
cc
s
«2 50¢
wg
eo
C <q 40é
io
> w
29
an 30¢—
206 =

 

FIGURE 8. VOLUNTEERS’ CONTRIBUTION

In 1968 the RMP/WNY engaged in a study to find out
what was being contributed to the RMP/WNY operation in
terms of money by the many volunteers who take part in its
activities. This included the use of such resources as
meeting rooms, services, time spent in meetings on RMP
business and other such factors.

The 1968 study of the volunteer time contribution to
RMP/WNY was updated in 1971 and the expected level of
volunteer time contribution was projected through 1974.
fn 1968, community time volunteered to RMP/WNY equalled
23¢ for every federal dollar spent. By 1971 this figure had
risen to 40¢ for every federal dollar. By 1974, it is projected
that local participation will increase to 67.5¢/federal dollar.

 

 

 

 

 

 

COOPERATIVE CONTRIBUTIONS TO RMP/WNY

1968 1970 1972 1974

YEAR
PROJECTED BRR

PER FEDERAL DOLLAR EXPENDITURE 1968-1974

 

 

14

 
 

Chapter 3
How does RMP-WNY
work

STAFF FUNCTIONS
Planning
Proposal! Review and Development
Evaluation
Financial Management
Communications
The Enabling Theme
PROJECTS AND PROPOSALS
Operational Projects
Financial Statement
Status of Proposals
HOW RMP/WNY WORKS WITH OTHER
HEALTH RELATED ORGANIZATIONS

 

 

 

15
STAFF FUNCTIONS

PLANNING

RMP/WNY is an operational program with a
planning component. It has been moving in new
directions, identifying deficits in health care in the
region and developing priorities for dealing with these
problems and needs. Stronger working relationships
with the Comprehensive Health Planning (CHP)
Council of Western New York have been developed.
Their overall plan for the region was taken into
consideration in establishing RMP/WNY’s goals and
objectives.

The Western New York program participated in
the Information Support System of Harvard
University, a system designed to help RMP’s develop
program activities which more clearly meet objectives
specified in the legislation. Data generated from the
interviews conducted in Western New York by the
Information Support System have been used to help
identify problem areas and incorporate program
activities to solve those problems.

The research and data acquisition capability of
the RMP/WNY has been both significantly increased
and established as a regional resource through the
employment of the Community Services Research
and Development Program of the Department of
Social and Preventive Medicine of the State
University of New York at Buffalo. Community
Health Information Profiles (CHIP) of county-wide
geographic areas for long-range planning of health
services and facilities have been instituted
collaboratively with the Comprehensive Health
Planning Council of Western New. York and the
Mid-State Committee on Area-Wide Health Planning,
Inc. In each case supplemental funds either from
county government or one of the comprehensive
health planning agencies have been committed to
support the additional field staff required for data
collection at the local level. The first efforts of the
CHIP program are being directed to the rural counties
of Cattaraugus, Genesee, and Allegany. Plans are
underway to develop health information profiles for
most of the communities in the RMP/WNY region.

PROPOSAL REVIEW AND DEVELOPMENT

The proposal review process has been a most
effective mechanism for involving the entire region in

16

RMP/WNY programs. The detailed proposal review
protocol and criteria for RMP review are part of the
RMP/WNY Kit and are available to everyone in the
region. This process of involving the entire region in
proposal review reveals possible duplication of efforts
and encourages cooperation of those actively
interested in a concept from every part of the area.
The proposal author is in personal contact with the
series of groups who review his proposal. In
particular, he must be prepared to explain to the
grassroots organizations, the county committees, his
concept and its applicability to their particular
situation. The H.O.W.N.Y., Inc. Board of Directors
(Regional Advisory Group to the RMP/WNY) has the
final authority. Proposal review serves an educational
function. The review mechanism promotes:

(a) involvement of the sub-regional groups
(b) education of author and reviewers
(c) equity of review.

The Proposals Committee will seek projects
that address themselves to the greatest needs of the
region as documented in the RMP/WNY priorities of
goals and objectives.

A major objective is to involve the entire region
in one unified system of grant proposal review. This
would emphasize the community's need for a
common data base and a coordinated consideration
of health care goals and objectives. Proper investment
of resources available to the region would be insured;
projects receiving funding would have the benefit of
area-wide involvement and support.

EVALUATION

RMP/WNY has developed evaluation tools to

- assure that (1) health activities goals and objectives

remain flexible and respond to the documented needs
of the region, (2) the contribution of activities to the
program's goals and objectives are measured and (3)
the activities themselves are well-conceived and
well-executed. At the end of each operational year,
goals and objectives will be revised.

County committees will report their activities

‘in defining and meeting their health needs, helping

the Regional Advisory Group base health activities
 

 

FIGURE 9. PROPOSAL REVIEW PROCESS

AUTHOR

 

 
  

  
    
    
   
   
      
   
   
    
 
   
 

RMP-WNY
HEADQUARTERS

Staff Review and Comment
Technical Review

AUTHOR

COUNTY COMMITTEES

 

 

PROPOSALS COMMITTEE
OF HOWNY

EVALUATION COMMITTEE
OF RMP

    

 

BOARD OF DIRECTORS
OF HOWNY

 

 

 
 

WASHINGTON
(as part of the RMP-WNY total program)

 

 

7

 
 

 

Se a

 

 

objectives upon real county needs. Using the
reporting form which has been developed will help
each county subunit measure the effectiveness of its
activities and define its own priorities for investment
of RMP resources. The form should also facilitate
communication among the county committees by
giving them a clearer picture of each other’s needs.

Project reporting forms have been developed to
aid the project directors in reporting needed
information. This will allow close supervision of
project efforts as well as provide data for the project
site visit teams. The teams, which consist of at least
two consultants, two Board members, and one
RMP/WNY staff member, have provided the Regional
Advisory Group an independent assessment of our
active and funded projects. These visits are devoid of
punitive or federal overtones and have been very
informative. Yearly site visit reports will therefore
continue to be used as one source for measuring
project effectiveness.

The measure of core staff activities can be
derived from a summary of members’ monthly
reports. This provides an easy summation of activities
for the anniversary review document, reveals excesses
or deficiencies in staff activities in light of overall
program objectives, and serves as a means of
communication among core staff personnel and
between the staff and the Regional Advisory Group.

A cost analysis of the entire program will be
undertaken yearly, taking into account projects and
core staff activities.

Appropriate evaluation techniques for potential
and operational activities are assured by the
Evaluation Committee and RMP/WNY staff.

Evaluation efforts wil! be used to (1) measure
the dimension of achievements in meeting goals and
objectives in a specified period of time and (2)
provide the information needed to effectively guide
RMP/WNY program development. Information
derived from measures of program effectiveness will
be used to periodically reassess goals and objectives,
determine the level of support for ongoing activities,
and actively seek out projects and activities which
address themselves to as yet unmet objectives.

18

EVALUATION WORKSHOPS

On February 11, 1971, Donald A. Schon,
Ph.D., Organization for Social and Technical
Innovation, presented a discussion on the evaluation
of the effectiveness of regional medical programs.
Board and staff members as well as representatives of
various community organizations participated in the
day-long program at the Buffalo Statler Hilton Hotel.

A proposal evaluation workshop designed for
members of the proposals and evaluation committees
and members of the RMP/WNY staff was held April
23, 1971, at RMP headquarters in Buffalo. Key
speakers were Dr. Frank Husted, Dean, College of
Allied Health Professions, Temple University and Dr.
Harry Sultz, D.D.S., Associate Professor, Social and
Preventive Medicine, State University of New York at
Buffalo School of Medicine.

FINANCIAL MANAGEMENT

in its fiscal policy the Regional Medical
Program for Western New York has been operating
under a programmatic approach for several years. The
fiscal management of all funds has been in the Core
office with no direct assignment of monies to affiliate
institutions. It is the policy at the end of the first six
months of a fiscal year to formally consider
redistribution of funds to strengthen the program as a
whole and to seek seed money for projects which
have been approved but not funded.

When the budget was prepared for 1971-72, the
on-going components were reviewed in the light of
their effectiveness and the recommendations of
project site visitors. In 1971-72 funds were diverted
(1) to support a summer student extern program
designed to acquaint students in the health fields with
rural practice and (2) to the planning and
implementation of the Lake Area Health Education
Center. Projects which were deemed ready for
self-support were moved more quickly into that
support, and funds so released were assigned to other
facets of the program.

The grantee institution for Regional Medical

‘Program for Western New York is the Research

Foundation of the State University of New York, a
private non-profit corporation established for the
express purpose of handling federal funds for all
branches of the State University of New York.
 

 

COMMUNICATIONS

RMP/WNY activities are brought to the
attention of the public via the news media, exhibits
displayed at conferences and meetings, brochures for
our special programs, and published articles.
Television and radio have been used to cover program
activities. A newsletter brings news of important
events in the health field, both regional and national,
to the 13,300 people on the RMP/WNY mailing list.
The Western New York RMP brochure and annual
report have been widely circulated. Currently in
preparation are (1) proceedings of the Workshop
together with the goals and objectives of RMP/WNY
for the next triennium and (2) the RMP/WNY Kit, a
compilation of material describing the RMP mission,
guidelines for development and submission of grant
proposals, and the proposal review protocol and
criteria.

THE ENABLING ROLE

The core staff has emphasized RMP’s enabling
role in all program activities: RMP/WNY serves as a
broker for the community. Help is given where
required. If RMP cannot help, other appropriate
organizations are contacted. The staff is seeking to
increase its effectiveness in counseling proposal
authors by learning more about funding agencies and
their areas of concern and becoming more expert in
the development of excellent grant proposals.

Another aspect of the enabling role has been
insistence that projects have a viable marketing
strategy. RMP resources are invested as seed monies
for activities that can be integrated into the
health-care pattern of our region. Centralized fiscal
control has allowed easy shifting of funds from
activities that are developed enough to receive
community support to new areas of investment. The
requirement for a marketing strategy is clearly
defined in the guidelines for proposal development
which are distributed to all prospective authors and in
the reporting form that has been developed for
project directors. ,

RMP/WNY has been successful in attracting
additional monies to RMP-supported activities: (1)
Voluntary agencies and other groups have committed
monetary investment to what otherwise would have

19

been exculsively RMP operations. {2) County medical
societies and hospitals contribute funds to the
RMP/WNY advisory group (Health Organization of
Western New York, Inc.) to meet expenses that could
not be paid for by the Federal dollar. (3) RMP’S
investment in the Lake Area Health Education Center
led to investment in the Center by the Boards of
Trustees of two Erie, Pennsylvania hospitals and by
the Veterans Administration (4) The Rural
Externship project was able to attract private
contributions from hospitals, physicians, and local
governments of $9,100.

The acquisition of two excellent conference
rooms has defined the RMP as a facility used by the
community. The communications devices and
audio-visual requirements are available. In addition to
use by those directly related to the program, meetings
have been held in the rooms by such groups as the
Urban League, Buffalo’s Blue Ribbon Ambulance
Committee, CHP, the local podiatrists, and Parents of
Diabetic Children.

Participants at the RMP/WNY Workshop, held
on September 23 and 24, reaffirmed the crucial
importance of RMP’s enabling function. They asked
that, in pursuing specific health care goals and
objectives, RMP/WNY not forget that it provides a
territory in which individuals and institutions can
come together, avoiding wasteful duplication and
encouraging a large, regional approach to health
problems.

PROJECTS AND PROPOSALS
OPERATIONAL PROJECTS

During the year March 1, 1971, through
February 28, 1972, five operational projects were
supported by RMP/WNY.

Project No. 1 Telephone Lecture Network (TLN)

Primary Purpose: General continuing
education

Health Care Focus: All types of health
care

Target Group(s): All health professionals
and special primary target population
groups, i.e., parents of diabetic children,
and the chronically ill
 

 

 

 

Geographic Scope: Seven counties in
Western New York and three counties in
Pennsylvania

Objectives: To meet the growing need for
training and education in health care for
providers and consumers by increasing
the knowledge and skill of health care
personnel and to be a _ resource for
community health education.

During the three year funded period,the TLN
increased in size from a network of 15 hospitals to
one of 56 hospitals (as of June 1970). In September
1968 the network offered two hourly programs per
week — one lecture series for physicians and another
for nurses. The current educational component
consists of 244 hourly programs scheduled in 20
- separate lectures series and provides for 15
identifiable career fields. Nineteen agencies,
institutions and organizations provide voluntary
support to the educational component of this project.
A Spoken English course for foreign born health care
personnel was developed to alleviate the
communication problem that exists between the
patient and those attending him. TLN programs meet
the Continuing Education requirements of 6 pro-
fessional associations and one state agency.

The results of the 1970 TLN Survey were in
general positive with regard to content, format, and
acceptability of TLN presentations. The survey
accurately predicted hospital participation on the
network for 1971-72.

Thirty six hospitals registered in September
1971 under the new fee structure. The yearly fee
ranges from $1400 for a hospital with 125 certified
beds or less to $1900 for hospitals with over 400
beds. The educational component of the network is
now supported by the member hospitals.

The TLN also serves health and administrative
groups by providing a means of information exchange
at regular meetings and conferences, via the network.
Additional evening programs are directed to certain
groups concerned with the education of relatives of
persons with chronic health problems.

20

Project No. 2 Coronary Care Training Program
Disease Category: Heart Disease
Health Care Focus: Treatment

Target Group(s): Registered Nurses and
Physicians

Primary Purpose: Training existing health
personnel in new skills
National and

Geographic Scope:

Canadian

Objectives: To improve care of heart
patients by training nurses and physicians
in operating intensive care units.

This program for nurses and physicians has
been operational since March 1968. Through June
1971, 302 registered nurses have completed the
course of instruction in the intensive care aspects of
patients with acute cardiac problems. The basic
format of the teaching programs encompasses three
weeks of didactic instruction and two or three weeks
of clinical experience for the practical application of
nursing principles and skills which have been taught.
Nine metropolitan Buffalo hospitals provided the
clinical facilities utilized for nurse practical
experience in Coronary Care Units. Two-day
programs for physicians were conducted each year, in
cooperation with the Office of Continuing Medical
Education of the School of Medicine, State
University of New York at Buffalo.

MAJOR PROGRAM CHANGES
IMPLEMENTED — September 1971:

(1) Tuition fee charged: $350 per session per nurse

registrant.

(2) Discontinued reimbursements paid to hospitals.
Commitments to participate, without pay in the
program, have been received from many of the
cooperating agencies.

(3) No fecturer reimbursement fees being paid,

(4) School of Nursing, SUNY at Buffalo, assumed
the Director’s salary.

As of March 1, 1972, this project will be
supported by the Department of Continuing
Education, School of Nursing, SUNY at Buffalo.
 

Tuition fees will be continued. A pilot study is
underway which will allow combination of the
Coronary and Respiratory Care Training Program into
a Cardio-Pulmonary Care Training Course.

Project No. 3 Chronic Respiratory Disease Program
Disease Category: Pulmonary

Target Group(s): Allied health
professionals, physicians, nurses, and
patients

Primary Purpose: Education and
development of health care facilities

Geographic Scope: Western New York
and Northwestern Pennsylvania

Objectives: Provide home care and
rehabilitation programs for patients
throughout the region; provide
educational programs about chronic
respiratory disease for nurses, physicians,
allied health personnel, and patients.

The following components of the program have

been instituted:
The Screening Program
The School of Respiratory Therapy
Pulmonary Physical Therapy
Continuing Education for Nurses
Continuing Education for Physicians
Model Pulmonary Care Facility
Respiratory Intensive Care Unit
Pulmonary Function Laboratory
Respiratory Therapy Service
Home Care Program
Rehabilitation Program

The first three years have been but a beginning.
Development of staff, a team approach, and lines of
communication has been the major achievement so
far. The bulk of this program will be self-supporting
by March 1972, in the estimated amount of $345,000
annually.

Based on the recommendations resulting from a
project site visit, the regional aspects of the program
are being stressed. At the further suggestion of the
site visitors, an advisory committee has been

21

established which includes one active and responsible
representative from each of the participating,
affiliated hospitals and which also includes wide
representation from the outlying communities. This
advisory committee has determined that the Home
Care and Rehabilitation Programs, established ,as
models, should now be extended into the region.

Project No. 10 Tumor Service Registry
Disease Category: Cancer

Health Care Focus: Diagnosis and
Treatment

Target Group(s): Physicians, medical re-
cords personnel and cancer patients

Primary Purpose: Part training and part
patient services

Geographic Scope: Western New York
and Northwestern Pennsylvania

Objectives: To provide better care to
cancer patients by improving (1) quality
of care by hospital and physician and (2)
access to care through follow-up
procedures.

A tumor registry has been established as a tool
for improving the quality of care for cancer patients.
Tumor Registry activity has been initiated in eleven
hospitals where none had existed. The efforts of all
member hospitals have been coordinated, with
continuous training of hospital tumor registrars. This
assures improved uniformity and quality of data
abstracted, since each registrar follows mutually
agreed upon procedures. A follow-up procedure has
been established through letters to physicians
requesting follow-up information on their cancer
patients. This encourages continuing periodic
monitoring of the patient’s condition. Statistical
reports which reflect regional experience and that of
the individual hospitals have been prepared and
distributed. An advisory committee has been formed
to provide the professional guidance required for
routine Registry operations.
 

 

 

 

 

 

 

 

 

Project No. 14 Information Dissemination Service

Target Group(s): Health institutions,
health professionals

Primary Purpose: Provide library service
to health professionals and health
institutions

Geographic Scope: Western New York
and Northwestern Pennsylvania

Objectives: Provide library services to
health professionals; encourage hospital
libraries to devetop their own services;
provide consultation service to hospital
library personnel.

Implementation of the Information
Dissemination Service began in June 1970. An
advisory group was selected and a policy statement
formulated. Between June and September 1970 the
project director met with the personnel responsible
for library service in the hospitals in the region.
Publicity was prepared and mailed to all health
professionals in the region.

Four basic services are available:

1. Photocopy and mailing of journal articles
and loan of books

2. Preparation of subject bibliographies

Reference service

4. Library management consultation service
to hospital libraries.

wo

During the first year of operation (June 1970 -
July 1971) a total of 12,393 requests were received
and processed. These included:

Photocopy of journal articles - 10,812
Journals loaned - 285

Books loaned - 854

Bibliographies prepared - 359
Reference requests - 83

A questionnaire was used to evaluate the
project in April 1971. Asa result of interest indicated
through the questionnaire, two workshops were
conducted for members of the hospital library staffs
in August 1971. Subjects presented for discussion
included reference tools used in medical libraries,
biomedical communication networks, and principles
of library management. Fifty percent of the requests
have come from health professionals in hospitals
serving the inner city population.

 

 

FIGURE 10. FINANCIAL STATEMENT — March 1, 1971 - February 29, 1972

For the year March 1, 1971 - February 29, 1972, the Regional Medical Program for Western New York was awarded
$1,363,440, including a re-award of $197,108 for the development of an intensive care unit for the Respiratory

Program. From this total the following projects were budgeted:

Core Program $ 453,100
Telephone Lecture Network 122,678
Coronary Care Training Program 50,795
Chronic Respiratory Disease Program 423,771
intensive Care Unit — Respiratory Program 197,108
Tumor Service Registry 65,050
Information Dissemination Service 50,938

$1,363,440

The following special activities were financed from Core Funds:

Rural Externship Program $ 12,000
Migrant Health Program 14,500
Lake Area Health Education Center 10,000
Continuing Education (Teaching Days) 4,500

 

22

 
 

 

 

 

STATUS OF PROPOSALS

 

FIGURE 11. STATUS OF PROPOSALS
The following proposals went through the RMP/WNY review process during 1971-72:
Result of

Title Author HOWNY review Period
Postgraduate Training for General Practi- Thomas Aceto, Jr., M.D. Approved 1 year
tioners and Pediatricians in a Pediatric Sub-
Specialty
Acquisition of Psychomotor Skills in Surgery Gavriel Salvendy, Ph.D. Not Approved 1 year
Master Plan for Planning and Articulation Phyllis Higley, Ph.D. (1972) Approved 1 year
of Allied Health Education in the WNY
Region
Allegany County Mobile Health Clinic Virginia Barker, Ph.D. Approved 3 years
Provision of Homemaker Services in Niagara | Howard Patton, M.P.H. Not Approved 1 year
County
Hospital based Continuing Health Care Pro- Norman Courey, M.D. Not Approved 3 years
gram for Women
Continuation of Chronic Respiratory Disease John Vance, M.D. Approved 3 years
Program
Short-term Group Therapy for Cardiac Lawrence Golden, M.D. Not Approved 1 year
Patients

 

 

23

 
 

 

 

 

 

 

 

Title
Telephone Lecture Network
Tumor Service Registry
Information Dissemination Service

Chronic Respiratory Disease
Program

A Model for Comprehensive Family
Health

Comprehensive Continuing Care for
Chronic Hlness

Master Plan for Planning and Ar-
ticulation of Allied Health Educa-
tion in the WNY Region

Allegany County Mobile Health
Clinic

 

FIGURE 12. PROPOSALS SUBMITTED TO WASHINGTON AS PART OF RMP/WNY’S TRIENNIAL GRANT
APPLICATION FOR MARCH 1, 1972 — FEBRUARY 28, 1973.

Proposals approved in 1971-72; proposals approved in previous years but as yet unfunded; and currently operational
projects were all reviewed by the Regional Advisory Group. The following activities were judged to be most germane
to the new RMP/WNY goals and objectives and were included in the triennial grant application as part of RMP/WNY'‘s

program of activities for March 1, 1972 - February 28, 1973:

Amount requested
Coordinator (for 72-73 period)
Joseph Reynolds 108,117
John Patterson, M.D. 78,052
Jean Miller, R.N., M.S., M.L.S. 54,947
John Vance, M.D. 151,853
Ernest Haynes, M.D. 217,689
Earl Noble, M.D. 243,290
Evan Calkins, M.D.
Phyllis Higley, Ph.D. (1972) 18,542
Virginia Barker, Ph.D. 151,853

 

 

Those interested in health care problems in the
region often wear multiple hats. The presence on the
H.O.W.N.Y., Inc., Board of members who also serve
with other health-related organizations is often an
informal, but highly effective arrangement. It permits
information exchange and collaborative planning and
discourages inefficient and costly duplication of
effort.

There is staff cooperation in committees that
serve both the Comprehensive Health Planning
Council of Western New York (CHP) and RMP, as
well as a strong relationship between the two
directors. The sub-regional county committees, since
they involve those actively interested in health

24

matters in the counties, are serving both RMP and
CHP. CHP currently provides written comment on all
grant proposals that are processed through the
RMP/WNY review mechanism. At the September
Workshop, RMP/WNY profited from the involvement
of CHP staff and Board members in the definition of
RMP/WNY’‘s goals and objectives.

A number of consumer groups — Parents of
Diabetic Children, Hemophiliac Foundation, and
others — have benefited considerably from RMP help. -
RMP has supported their efforts in. education and
information dissemination, made their programs
known to the community, and provided them with a
communication mechanism through the Telephone
Lecture Network.
pect ee oe

 

 

FIGURE 13. RMP FOR WNY RELATIONSHIP TO
OTHER HEALTH RELATED ORGANIZATIONS

VOLUNTARY HEALTH AGENCIES

PROFESSIONAL SOCIETIES

 

   
 
 
 
 
 
 
  
 
   
  
     
 
  

COUNTY
APPALACHIAN HEALTH
REGIONAL DEPARTMENTS HEALTH ORGANIZATION
COMMISSION
UNITED
| HEALTH
FOUNDATION
MODEL
CITIES '
COUNTY MEDICAL SOCIETIES
ERIE COUNTY
ROSW
ae SWELL PARK MEMORIAL INSTITUTE
COMMUNITY
SERVICES
RESEARCH AND
AMERICAN
HOSPITAL DEVELOPMENT
c
ANCER SOCIETY —associATION
HEART
ASSOCIATION
SCHOOL STATE HEALTH OF
WESTERN
Or MEDICINE DEPARTMENT

NEW YORK, INC.

RESPIRATORY AND
TUBERCULOSIS ASSOCIATION

FORMAL RELATIONSHIP LOCAL GROUPS

WORKING RELATIONSHIP
INFORMAL

Ost

The relationship between Working relationships in- Those organizations with

 

various health-related organiza-
tions and the RMP for WNY may
be divided into three categories:
formal, working, and informal.
Formal status entails representa-
tion on RMP’s Regional Advisory
Group, the Board of Directors of
the Health Organization of Western
New York, Inc., as mandated
in the by-laws of the Regional
Medical Program.

volve a continuing cooperation in
areas such as awarding continuing
education credit for participation
in TEN programs, co-sponsorship
of teaching days, or joint planning
for community health.

which RMP has informal relation-
ships are a rather broad group.
Concerned agencies tend to band
together to deal with a particular
program or problem.

 

25

 
 

 

 

Chapter 4
Special Concerns of
RMP-WNY

Manpower Development

Area Health Education Centers
Rural Health Problems

Inner City Problems

Health Maintenance Organizations

 

 

 

27
 

 

 

MANPOWER DEVELOPMENT

Nursing and allied health professionals have a
strong voice in RMP/WNY. The needs of the health
professionals of the region are regularly assessed in
order to establish objectives that will assist them in
providing better health care. An_ allied health
committee, recently formed under RMP/WNY
auspices, has established goals for the proper use of
allied health manpower and presented a position
paper on allied health participation in the
development of the area health education center
concept to the Lake Area Health Education Center.

RMP/WNY is exploring ways to alleviate the
severe shortage of health manpower: (1) Staff
members have attended conferences held to stimulate
the development of new types of health manpower,
and consultants have visited the program. (2) Existing
manpower could be better utilized if health workers
received basic training in a unified core curriculum
which would allow them to work in whichever area
has the greatest need, and advance through more
specialized training after the basic program. (3)
Students are encouraged to consider health careers.
RMP/WNY is currently cooperating with the United
Health Foundation and CHP to plan a summer
experience in health agencies for local graduate
students who are interested in pursuing careers in the
administration of health programs.

Highly trained specialists of the region have
involved themselves with RMP/WNY _ through
categorical committees. Committees have defined the
promotion of educational programs held throughout
the region as their primary role. A small investment
of RMP funds has allowed cooperation with other
agencies to meet the needs of local practitioners for
education and consultation in their own home areas.
These educational activities of the categorical
committees have brought RMP visibility in the region
and. the good will of practitioners. They have
contributed to better utilization of existing
manpower in that: (1) Specialists are brought from
their ivory towers and through lecturing, consulting,
and answering questions they have been provided
access to the community. (2) Knowing about
improved modes of treatment has given local
physicians the opportunity to practice better
medicine. (3) Problems stated and help given not only
influence referral patterns but the personal
involvement has a major role in education and
ultimately in quality of care.

28

- alleviate

Projects funded by RMP/WNY have aimed to
manpower problems. For example,
inhalation therapists, coronary and respiratory care
unit nurses, and medical record librarians have been
trained under the auspices of various projects. The
Telephone Lecture Network offers a program of
continuing education for the entire spectrum of
health professionals. (see figure 14)

AREA HEALTH EDUCATION CENTERS

Early in 1971 discussions were initiated with
representatives of Erie, Pennsylvania- hospitals
concerning the establishment of an area health
education center. RMP/WNY acted as a liaison
between this group and the State University of New
York at Buffalo. Initial understanding and subsequent
commitment to the center concept was obtained in
writing from participating groups. A composite
document contains a record of progress in the
establishment of the Lake Area Health Education
Center (LAHEC).

The center concept was based on four broad
goals:

1. Conduct basic and continuing
education programs under the
supervision of the faculties of the
college and university
health-science centers with which it
is affiliated and in cooperation with
local professional associations

2. Provide guidance to comprehensive
colleges and community colleges in
the area in the development of
training programs for allied health
professions

3. Promote the existence of
community-hospital services of
outstanding quality and cooperate
with health-care facilities,
institutions, and agencies in the
planning and development of a
health-care delivery-system that is
more effective, efficient,
economical, accessible, and
acceptable to all levels of society

4. Conduct research programs
concerned primarily with the
evaluation of health-care
delivery-systems as well as
appropriate surveys of health-care
manpower and their utilization.
During 1971,
allied health professionals. Several of the programs were aimed at multi-

programs in continuing education have been held throughout the region for physicians, nurses, and
disciplinary audiences. ‘Family Management

of the Chronically III’ was also attended by interested individuals from the community at large.

 

 

 

 

 

FIGURE 14. PROGRAMS IN CONTINUING EDUCATION, 1971

 

DATE

2/25/71

3/4/71

4/20/71

4/29/71

5/19/71

5/26 and
5/27/71

6/3/71

8/27 and
8/28/71

9/20 and
9/21/71

9/23/71

12/4/71

9/27, 10/4,
10/18, 14/1/71

11/4, 711/11,
11/18, 12/2/71

PROGRAM

“Family Management of the
Chronically II’

Cancer Teaching Day ‘’Cancer
Chemotherapy — 1971”

"Erom Study Into Action’
Jerome P. Lysaught, Ed.D.,
Director, National Commission
for the Study of Nursing and
Nursing Education

Pulmonary Teaching Day ‘’Re-
habilitation Care of the Patient
with Pulmonary Disease’’

Pulmonary Teaching Day “New
Trends in Pulmonary Disease”

Stroke Workshop “A Multi-
disciplinary Approach to the
Rehabilitation of. the Stroke
Patient’

Cancer Teaching Day ‘Modern
Trends in the Treatment of
Breast Cancer’

“Therapeutic Work with Older
Persons and Their Families”

Pulmonary Workshop “Care of
Patients with Pulmonary Dys-
function: Nursing Makes a Dif-
ference”

Cancer Teaching Day ‘Progress
in Cancer Therapy”

Cancer Teaching Day, “Some
Aspects of Current Cancer
Treatment”

Inservice Pulmonary Teaching
Sessions

Inservice Pulmonary Teaching
Sessions

LOCATION

Statler Hilton Hotel
Buffalo, New York

Buffalo Mercy Hospital
Buffalo, New York

Sisters of Charity Hospital
Buffalo, New York

Holiday Inn
Olean, New York

Ramada Inn
Erie, Pennsylvania

Veterans Administration Hos-
pital, Buffalo, New York

Castle Inn
Olean, New York

Campus School, State Univer-
sity College at Buffalo
Buffalo, New York

Statler Hilton Hotel
Buffalo

Holiday inn
Batavia, New York

Showboat Restaurant
Buffalo, New York

Veterans Administration Hos-
pital, Batavia, New York

W.C.A. Hospitat, Jamestown,
New York

NO. REGISTRANTS

350

300

200

150

130

165

175

150

75

150

100

51

62

CO-SPONSORS

Continuing Medical Education
School of Medicine
S.U.N.Y.A.B.

Department of Surgery, Buf-
falo Mercy Hospital, Buffalo,
New York; American Cancer
Society, Erie County Unit,
Buffalo, New York

Tuberculosis and Respiratory
Disease Association, Olean Unit
Olean, New York

Northwestern Pennsylvania
Tuberculosis and Respiratory
Disease Society

Veterans Administration Hos-
pital, Buffalo, New York

American Cancer Society, Cat-
taraugus County Unit, Olean,
New York

School of Social Work
Syracuse University
Syracuse, New York

Tuberculosis and Respiratory
Disease Association of WNY
Erie County Unit

Buffalo, New York

American Cancer Society
Genesee County Unit
Batavia, New York

Doctors Hospital, Tonawanda,
New York; American Cancer
Society, Erie County Unit,
Buffalo, New York

Veterans Administration Hos-
pital, Batavia, New York

W.C.A. Hospital, Jamestown,
New York

 

29

 

 
 

 

 

 

 

In its role as an enabling agency RMP/WNY
brought together the various agencies initially
necessary for the creation of LAHEC. RMP is
facilitating the close cooperation of these agencies in
such a fashion that all are equal partners in this
enterprise. The Telephone Lecture Network will play
an integral role in fulfilling some of the educational
requirements of the Center.

RMP/WNY staff members were present during
the site-visit of LAHEC on July 12 and 13 by a joint
federal team from the Veterans Administration and
the Department of Health, Education, and Welfare.
RMP has supported the concept that LAHEC should
operate as a public, non-profit
corporation-for-education-and-scientific-purposes;
such an incorporation seems the most effective and
efficient manner both for reaching the goals sought
by the LAHEC committees and for managing the
funds it will receive from a broad category of sources,
both local and federal.

RURAL HEALTH PROBLEMS

Since the 9 counties are predominantly rural,
RMP/WNY has always had a special interest in rural
health problems. The Rural Health Manpower
Committee is comprised of a broad spectrum of
academicians, practitioners, representatives of
community groups, and health departments. This
committee asked to meet under the aegis of
RMP/WNY to consider ways in which the training of
health professionals can be more pertinent to rural
health care needs.

RURAL EXTERNSHIP PROGRAM

During the summer of 1970, the Student
American Medical Association, under contract with
the Appalachian Regional Commission, and in
cooperation with the Western New York Regional
Medical Program, developed a nine-week summer
program in which a total of nine students, from
schools of medicine, dentistry, and nursing, were
placed with preceptors in various rural communities
in three western New York counties—Allegany,
Cattaraugus, and Chautauqua. The students had the
opportunity to participate in rural medicine and to
experience, firsthand, the pattern of health care in
these communities. RMP/WNY placed students with
their individual preceptors. As a result of the
successful 1970 summer experience, the Rural Health

30

Manpower Committee expanded the program during
the summer of 1971. An eight-week interdisciplinary
rural externship program involved students in
medicine, dentistry, and the health-related
professions. A total of 20 students were placed with
preceptors in 12 communities within the region.
Central objectives of the program were (1) ‘to
encourage health science students to pursue careers in
rural areas and (2} to contribute to better
communication between the University center and
rural communities.

Flexibility in arranging schedules for individual
externs allowed the maximum orientation to, and
involvement in, the unique aspects of the rural
community. A liaison network of faculty
representatives, the student coordinator, the project
directors, and RMP/WNY staff assured smooth
administration of the program. The externship
program is currently being evaluated from the student
diary, preceptor record, personal interviews, and
questionnaires distributed at the orientation and at
the de-briefing sessions. A measure of local interest is
the $9100 contributed to the Rural Externship
Program by hospitals, physicians, and local
governments. .

“Community leaders in rural Allegany, the
smallest of the nine counties, have established a
committee which surveyed the health needs of the
county and, based on these well-documented needs,
developed with their local university a proposal for
improving health education and service in Allegany
County. “

The salary of a director of clinics for migrant
workers was assumed part of this year as a
developmental enterprise. RMP/WNY proposes to
support the RMP Rural Health Manpower Committee
in its activities; work closely with county health
officers and county public health committees in
meeting migrant workers’ health needs; work with
other groups concerned with rural health such as
Appalachian Regional Commission, the Office of

“Planning Services, OEO, and SAMA; and assist rural

people in making their voice heard in RMP and

“developing proposals and implementing projects to

meet their needs.
 

INNER CITY HEALTH PROBLEMS

Positive action has been taken through many
channels to assist inner city residents. Two major
proposals for next year involve two hospitals which
are located in and serve the inner city. One involves a
family practice training center and the second is an
attempt to minimize the in-hospital episodes in
long-term illness.

The Cooperative College Center at Buffalo is a
preparatory institution for students whose prior
academic experiences do not meet the demands of
college admissions. RMP/WNY’s Health Careers
Committee is helping the Center in developing Health
Careers Days, serving as a liaison between the Center
and the health community. RMP is assuring the
presence of faculty and students from area colleges
and SUNYAB, as well as representatives of county
and state health departments and local hospitals.

On June 23, 1971, a meeting was held in the
RMP. conference rooms between RMP/WNY core
staff and representatives of inner city organizations.
It was organized at the request of the inner-city
groups to seek specific short-term commitments of
RMP. Specific proposals to be submitted to RMP are
being constructed by inner city groups, in response to
this meeting. A staff member represents RMP/WNY
on Model Cities Health Committee.

HEALTH MAINTENANCE
ORGANIZATIONS

The concept of HMO’s has raised a number of
questions and has yet to be empirically documented

31

and tested. It behooves the Regional Medical
Program, which reflects many of the interests of
providers, to involve itself in the efforts which
validate the concept. RMP will participate in those
efforts supported by the medical societies and the
State University of New York at Buffalo.

The current status of the concept in this region
is as follows:

1. The RMP/WNY Director, together with
CHP, the University, and others in the
health field, are exploring means whereby
the new university campus can be the
basis for an HMO.

2. The Urban Development Corporation, in
consultation with one of the RMP/WNY
Board members and a group in the health
field, is devising a plan to provide an
HMO for a new population development
area on the Buffalo waterfront.

3. The staff of RMP have been closely
involved in the development, submission,
and rewrite of the HMO for Wyoming
County. This complicated document was
proposed under the leadership of one of
the RMP/WNY county committees. It
provides an opportunity for the current
providers to participate, but does not
eliminate the possibility for conducting
medical practice in the long established
pattern. This document was not subjected
to the RMP/WNY regional review process.
 

 

 

Director of the Regional Medica! Programs Service
Harold Margulies, M.D.

Executive Director for the Regional Medical Program for Western New York
John R.F. Ingall, M.D.

Regiona! Medical Program for Western New York
2929 Main Street
Buffalo, New York 14214

Telephone: (716) 835-0728

The Regional Medical Program for Western New York is affiliated with the School of Medicine
of the State University of New York at Buffalo.

As of March 1, 1972 the name of the program
was changed to Lakes Area Regional Medical
Program, Inc.