WY UE =O wy PROGRESS SUMMARIES Table of Contents Organization and Structure of Regional Medical Programs: 1. Planning 10. li. 12. Regional Advisory Groups--Composition and Methods of Appointment : Regional Advisory Groups--Activities Executive Committees--Composition and Activities Boards of Directors--Composition and Activities Categorical and other Planning Committees-—- Structure and Composition Categorical and other Regional Committees-~ Activities and Accomplishments Local and Area Advisory Group--Composition and Activities Core Staff--Organization, Size, Composition Core Staff--Consultant/Broker/Facilitator Role and Dacision-Making Activities: Planning and Feasibility Studies Institutional/Organizational Participation Regional Review and Approval Process Operational Activities; 13. 14. 15. 16. Project Sponsorship ‘Institutional/Organizational Participation Patient Care Training 17. ‘Cost. Sharing on Projects 18. Project Staffing } Relationships with Federal Programs: _19. Comprehensive Health Planning 20. Other Federal Programs ’ General Information: 21. Regional Size and Boundaries 22. Subregionalization 23. Program Information Activities January 1970 REGIONAL ADVISORY GROUPS -- COMPOSITION AND METHOD OF APPOINTMENT There are a total of 2,463 members on the 55 Regional Advisory Groups. The Regional Advisory Groups range in size from 12 to 229, the average size being 45. . ‘ From a professional (or occupational) standpoint, nearly half (46%) of the advisory group members are physicians. From an affiliation viewpoint, nearly two-thirds (65%) represent a health interest, institution, or provider group. A breakdown of Regional Advisory Group membership follows: . Table 1: By Profession Number ‘Percent TOTAL 2463 100 Physicians 1139 46 Registered Nurses . 142 6 Hospital & Nursing Home Administrators - 225 9 Other Health — 163 7 _ Business or Managerial 332 13 Other Non-Health Occupations 423 19 Table 2: By Affiliation Number Percent TOTAL 2463 100 Medical Schools 194 8 Affiliatéd Hospitals 120 5 Hospitals & Other Hospital Interests 286 12 Medical Societies 235 9 Public & Other Health Agencies 202 8 Voluntary Health Agencies 231 9 Health Practitioners , 349 14 Public or Consumer Representation ' 436 18 Others . 410 17 Highlights Since their initial establishment some three to four years ago, the Regional ‘Advisory Groups have been developing with a trend toward larger, more repre- sentative membership and a trend toward the Regional Advisory Groups determin- ing that membershp itself. To demonstrate the first point, there were 1,147 persons on Regional Advisory Groups in 1966 for an average membership of 29. Today, there are 2,463 Regional Advisory Group members for an average of 45. The trend toward these advisory groups determining their own membership is illustrated by the fact that in 1966, 31 of them were appointed by the governor, medical school dean or the participating health institutions of the region but now, only 13 of the advisory groups are appointed in this manner and 25 are appointed by their members or the chairman of the advisory group. Other highlights of Regional Advisory Groups are as follows: * They are indeed broadly representative of the health interests, institu- _ tions and groups of the region. . Virtually all of the country's medical schools are represented. . Most of the state medical societies are represented along with many local societies. . . oo -. Most of the state chapters of the American Heart Association and the American Cancer Society have representation. . Virtually all state health departments are represented by either the state health officer or his designee. “ . A significant number of practicing doctors, nurses and other health professionals are members. , * Public or consumer representation has grown slowly but steadily until it now stands at 18% compared with 14% in 1966. It should be noted, imore- over, that from a professional or occupational standpoint nearly one- third of advisory group members are not health professionals or employed in the health field. Some of these, however, are representative of a health interest such as lay trustees of hospitals or lay directors of voluntary health agencies. * In 50 of the 55 regions, the Regional Advisory Group is governed by formal by-laws. In the remaining 5 regions, the group operates.under less formal but mutually agreed upon operating procedures. Explanation and Comments Many of the persons on Regional Advisory Groups can be said to be representative of more than one sector of the health care community but each region has desig- nated only-the primary affiliation of each individual. For instance, almost all doctors are members of medical societies even though they may work for the American Heart Association and maintain a private practice. This kind of dupli- cation is impossible ‘to avoid but by specifying the primary affiliation, the duplication is reduced to a minimum. In reference to the method of appointing Regional Advisory Groups, the process in some cases is very involved and only the final appointing authority has been considered. , ‘Three of the categories in Table 2 deserve further explanation. The category Hospitals and other Hospital Interests includes hospitals not affiliated with a medical school, hospital associations and health insurance companies. Similarly, ae the "Other" category includes representatives of: (1) nursing schools and schools of public health, (2) faculty members of community. colleges and departments of a university not associated with the medical school, (3) health professional societies other than the medical societies and (4) government agencies (state and local) other than the departments of health. Also, the. category "Health Practitioner" is made up of providers of health care who are not identified with any particular institution. The great majority of persons in this category are practicing physicians but nurses, dentists, nutritionists and other health workers are included. Questionnaire Reference: II.B.4,5,&8. Analyst: Stephen Bell January 1970 REGIONAL ADVISORY GROUPS -- ACTIVITIES Regional Advisory Groups are involved in a wide range of activities. The primary functions more or less common to all, however, are overall program guidance -- that is, determination of the overall scope, nature and direction of the program policies and overall objectives and priorities -- and the review of operational proposals. All project applications must be reviewed and favorably recommended by the advisory group before they can be considered by the National Advisory Council. - To fulfill the function of overall program direction, the advisory groups have established committees for program planning and administration and in mast cases have established guidelines for program development. In addition to the formal review of projects, most Regional Advisory Groups have established their own guidelines for the type of projects which will be considered. One gross index of the level of activity of Regional Advisory Groups is the number of meetings held. More than half of the groups meet quarterly and over- all, the average frequency of meetings has been 4 times a year. Attendance at the 666 Regional Advisory Group meetings held over the last four years has averaged roughly 20 members per meeting. Highlights * Advisory groups, in addition to being a key planning body in the regions themselves, have been responsible for or stimulated the establishment of 831 categorical and other planning committees, task forces and subregional advisory groups. * They have reviewed 1,553 projects recommending 1,021 for approval. * In most regions the advisory group also established written guidelines for appropriate projects. * In most regions, the Regional Advisory Group serves as a facilitator in bringing together the health interests of the region; and it has through the interlocking directorate phenomenon and by other means, been an important mechanism for bringing about cooperation between the RMP and the various CHP agencies within the region. * There have been 666 RAG meetings over the past four years. An average of 20 persons attended each meeting for a percentage attendance of 57%. Explanation and Comments Virtually all of the regions indicated that even though the Regional Advisory “™ Group met at prescribed intervals, there was provision for the group to convene on short notice if the needs of the region made it necessary. The information in this analysis was derived on the one hand from a composite of two questions on the questionnaire dealing with the number of meetings and attendance as related to the number of RAG members and on the other hand from an anecdotal question concerning the "major accomplishments" of the Regional Advisory Group. Because of the type of data contained in these questions, the thrust of this analysis is commonality rather than diversity. To explain, the analysis deals with overall attendance and what most of the Regional Advisory Groups are doing instead of the range of attendance and the range of activities with which the Regional Advisory Groups concern themselves. As a result, the information may be misleading in that it does not reveal the individual "personalities" of the 55 Regional Advisory Groups. Questionnaire Reference: II.B.4,6,7 & 10 Analyst: Stephen Bell oN January 1970 EXECUTIVE COMMITTEES Forty-one (41) of the regions have executive committees, mostly of their Regional Advisory Groups which because of their activity level and desig- nated functions have substantial influence on program development. Generally, these executive committees function in some or all of cae fol- * lowing areas: Se ble ee | Act in the RAG's stead except on final project or policy decisions or subject to full RAG approval. Develop the agenda for RAG meetings and do those things which will expedite RAG operations. Act as the day-to-day advisor to the program coordinator and core staff on behalf of the RAG. Aid in the management of personnel and fiscal details of the program. Serve as appointing/nominating body for RAG and/or other committee memberships. Make substantial input to policy and priority decisions. wor Executive committee membership is not representative of the larger advisory group; it is very heavily weighted by by physicians and representatives of medical schools. Highlights * Of the 41 executive committees, 27 (68%) are appointed by the RAG; the others by grantees, coordinators, boards of directors, medical school deans or other Bpecitied bodies. However, 35 of the 41 (85%) do report to the RAG. Four (4) report to boards of directors of new corporations,one (1) to the coordi- nator and one (1) to a committee serving in an advisory capacity to the coordinator. 317 (75%) of the members of executive committees are also RAG members. 284 (67%) of the committee members are physicians. In four regions (Alabama, Albany, Maryland and North Carolina) all members are physicians; and in four others (Oklahoma, Metropolitan D. C. Georgia and Illinois) there is only one non-physician on each. oo * 102(24%) of the committee members represent medical schools. in three regions (Illinois, Maryland and North Carolina) there is only one non-medical school member. ' * RMP core staff accounts for 20 members or 5% of total committee membership. * While most of the committee action is subject to approval by the RAG or other parent body, there are several apparent exceptions: - In two regions (North Carolina and Rochester,) both the member- ships of which are dominated by physicians and medical school representatives they appear to have authority to reject project proposals. - Five committees have the authority to hire and/or fire the Coordinator. Representative of the kinds of activities, and indicative of the amount of influence of executive committees, is the following quote describing activities of the Washington/Alaska executive committee: "The Executive Committee has provided expert advice and counsel to ‘the Director in internal staff and organization matters, including the review of candidates for staff position, termination procedures, and revision of the organization structure. The Committee has been helpful with regard to external matters such as the sensitive and important relations between WARMP and others in the health field. The Executive Committee has served as a valuable review and reactor group relative to important and complex matters to be presented to the RAC as a whole. This has allowed indepth consideration of problems and when appropriate, the submission of recommendations to the RAC. . Individually and as a group, the Executive Committee has been of great assistance to the Director; his contacts with them are fre- quent and valuable. On the other hand, there is good reason to believe that the more frequent meetings with the Executive Committee have ise eee their understanding of the Program and their commit- ment to it." Questionnaire Reference: II.E.1-7. Analyst: Patty Mullins Regions: 55, of which 41 Regions reported having executive or steering committees. Supporting Tables Table 1: Membership Composition, by Profession Professional Category Physicians — Registered Nurses Hospitals & Nursing Home Administrators Other Health Business or Managerial Other Total Table 2: Membership Composition, by Affiliation Affiliation Medical School Affiliated Hospitals Other Hospital and Related Agencies Medical Society Public and Other Health Agencies Voluntary Health Agencies Health Practicioners Public or Consumer Other Total Number 284 16 31 25 34 33 423 Number 102 21 38 48 31 28 67 40 48 . 423 Percent 6 ae Doan fn 100% Percent 24% 5 8 il 8 7 16 10 11 1002 BOARD. OF DIRECTORS Boards of Directors administer new organizations or corporations which have been formed to manage the Regional Medical Programs in seventeen regions. The Regions report that the neutrality of these organizations benefits the regional programs by facilitating cooperation between dif- ferent health interests, particularly medical schools. These Boards are active bodies, meeting an average of 18 times a year, and have responsi-~ bility for administration and fiscal management of the programs as well as varying degrees of policy-making authority. With a total of 264 members, the Boards are composed mainly (69%) of physicians, and there is consider- able overlap in membership with the Regional Advisory Groups, (56% of board members are also on the RAG's). Highlights Boards of Directors are active administrative and policy shaping bodies of the Regional Medical Programs. The Kinds of influence that go into the boards is indicated in part by their composition. * Most of the board members (69%) are physicians, and 19% are non-health professionals (mostly businessmen). * Institutional representation, though spread fairly evenly, reflects a preponderance of medical school physicians (20%) and medical society representative (18%). * Board members are also members of the Regional Advisory Groups in eleven regions. This represents 56% of the total Board membership. In six of these regions the entire Board is on the RAG. * Boards range in size from 5 to 28 members with an average size of 16 members. They have met an average of 18 times a year: 6 Boards meet monthly or more often, 4 meet bimonthly, and the remaining 5 meet quarterly or less often. Their activity and influence are reflected in the kinds of responsibilities they have. * Almost all Boards are responsible for administration and financial management of the region or corporation. Some, such as Ohio Valley's Board, are concerned solely with administrative matters. Many Boards, such as Northeast Ohio and Western New York, also have major authority in developing policy and direction for the regional program. .* Boards of Directors also review and approve project proposals. In a few cases the Board's approval is necessary, along with approval of the RAG, for the project proposal to be submitted for national approval. The major benefit reported by the regions from forming a new corporation or organization to administer the Regional Medical Program is its neutrality which facilitates or enables cooperation between different health interests. Incorporation or the formation of a new organization has resulted in the following other benefits: * Effective mediation by the corporations between different medical schools in a region or between medical schools and other health interests. A broadened base of support gained for regional activities by bringing more new institutions into cooperation with the corporation or organization. . * Autonomy of operations, resulting in increased flexibility and increased convenience with fiscal and programmatic activities in the same place. Explanation and Comments Boards of Directors are generally defined as those bodies which have administrative authority over a corporation or organization formed to administer a Regional medical program. In one case (New Jersey) the Regional Advisory Group serves such a role and has been included as the Board since there is no other such body in that region. Another region (Northwestern Ohio) which has been included as having a Board, has no ‘new corporation, but does have a Board which exercises functional authority over the entire program. Questionnaire Reference: II1.D.1,2,7 Analyst: Ann Stone Table 1: Table 2: SUPPORTING TABLES Board of Director Composition by Profession Kind _ Number Physicians 183 Registered Nurses : 6 Hospital Administrators - 23 _ Other Health . 4 Business or Managerial - 24 Other 24 TOTAL 264 Board of Director Composition by Affiliation Kind Number Medical School 55 Affiliated Hospitals . 20 Other Hospital Interests . 28 Medical Society 48 . Public and Other Health Agencies 18 Voluntary Health Agencies 29 Health Practitioners 21 Public or Consumer vO 19 All Other * 26 — . TOTAL 264 Percent 6 Or @©WwH ho 100 Percent 20 8 10 18 7 11 8. 8 10 100 January 1970 CATEGORICAL DISEASE AND OTHER PLANNING COMMITTEES -- STRUCTURE AND MEMBERSHIP eee ees There are, in addition to the Regional Advisory Groups and their executive com- mittees, nearly 500 categorical disease and other planning committees within the 55 regions. These committees, which include over 5000 physicians, hospital administrators, medical center officials and others, have major responsibilities with respect to planning and program development, project review and in some instances, program administration. Their breakdown, along with membership compo- sition follows: © : Type of Committee . Number Percent _ No. of Regions “Categorical Disease (e.g. ‘224 45.5% . 50 heart, stroke) Functional (e.g. continuing 170 34.5% 48 education, prevention) Programmatic (e.g. review, 60 12% 31 evaluation) Administrative (e.g. nomina- _38 8% 21 tions) and Other 492 100Z% Committee Membership Composition by Profession Professional Category Number Percent Physicians 3,273 62% Registered Nurses 486 9% Hospital and Nursing Home Administrators 326 7% Other Health 346 62% Business or Managerial 312 6% Other 577 10% ~ ~ Total 5,320 100% Committee Membership Composition by Affiliation Affiliation Number Percent Medical School 872 16% Affiliated Hospitals 508 10% Other Hospital Interests — 879 " 17% Medical Society 212 4% Public and Other Health Agencies 290 5% Voluntary Health Agencies 355 7% _ Health Practicioners 1,180 22% ‘Public or Consumers 198 4Z . Other 826 15% no . ‘Total 5,320 100% ‘Highlights Committees, as vehicles for bringing diverse interests together, have succeeded in bringing together over 5,000 persons, mostly health professions and primarily physicians, to aid in the health planning process. * — All but two regions, Kansas and Mountain States, have committee or task force structure. Fifty of the fifty-three regions having a committee structure have cate- gorical disease (e.g. heart, diabetes) committees. Only Missouri, Northlands and Northern New England have none. - Forty-eight regions have "functional" committees dealing with such issues as manpower and rehabilitation which cross disease boundaries. There are none in Missouri, New Mexico, Rochester, Western New York or West Virginia. Four regions had committees on health costs, only one of which is still functioning. Four regions have . committees concerned with disadvantaged/ minority groups, and four with community health. There are two prevention committees. 5,320 individuals serve on the 492 committees, representing a vast amount of "volunteer" time and expertise being made available to RMP's. Committees are physician dominated; they account for 3,273 (62%) of the membership. Nurses represent 9% of membership, while hospital admin- istrators, other health professions and non-health business and managerial persons each represent 6% of membership. There is a conspicuously low representation by Comprehensive Health Planning agency personnel, who account for only 21 (0.3%) of all committee members, and 64 members of the public, who account for less than 200 (4%) of membership. There have been over. 2500 meetings. of committees, representing an average of 4-5 meetings annually per committee. Approximately 400 studies. have been conducted by committees and they have, additionally, reviewed over 1,700 project proposals and have actually developed over 300 operational projects for consideration for funding. While physicians as a profession seem to dominate committee membership, it should be noted that the composition by affiliation is not dominated by any single category and, indeed the physicians appear to represent a broad spectrum of interests. Nearly all of the regions have committees on heart, cancer and stroke; most have one or more concerned with the functional area of continuing education. As categorical restrictions are eased, there will probably be more functional committees springing up and there will probably be a corollary increase in the number of members representing professionals other than physicians and the public. Explanation and Comments For purposes of compilation, committees were classified into one of the follow- ing categories: , , ~ Categorical/Disease Committees include committees concerned with specific conditions or body systems. = Functional Committees include those concerned with issues which cross disease lines such as continuing education, prevention, computer and library. - Programmatic committees include those concerned with RMP planning, data collection, project review, and evaluation. '- Administrative and other committees include those concerned with the RMP organization itself and its administration, and those other committees which were not otherwise classifiable. Membership can be expressed in two ‘manners. ‘There are 5,320 individuals serving as committee members. These individuals, however, represent 5,624 memberships , since some serve on more than one committee. Two regions, Kansas and Mountain States, have no such committees, reducing the universe to 53 regions. Questionnaire Reference: II.F.1 & 2. Analyst: Patty Mullins Supporting Tables, Continued Table 1. Number of Committees, by Type, and Number of Regions Number of Number of Number of Number o Type of Committee Committees Regions Type of Committee Committees Regions Categorical 224 Functional 170 Heart 65 ~ 45 Continuing Education 45 37 Cancer . 60 48 Patient Services 4 3 ’ Stroke 54 46 Hospital Needs & Services 8 7 . Pulmonary/Respiratory 10 10 Radiation/Nuclear Medicine 5 5 Diabetes . 6 6 Library 11 12 Kidney/Renal 14 14 Communications/Information 16 16 Unspecified Related 7 7 Registeries 2 2 Pediatric Pulmonary 2. 2 Computer 4 4 - Dental 6 6 Health Costs 1 1 Manpower 11 11 , Nursing 17 15 Programmatic 60 Allied Health 8 a ' Extended Care 2 2 : Planning 10 10 Prevention 2 2 Data/Demography/Statistics 11 11 Rehabilitation 5 5 Epidemiology 4 4 Screening 7 7 Coordinative 15 13 Disadvantaged/Minority 4 4 ; Evaluation 7 7 Community Health 4 4i. Project Review 13 13 ccu 3 5 Other Functional Committees 9 9 Administrative 27 Administrative 11 9 Executive - 5 5 By Laws/ Nominations 11 9 a a a ther il 1 ao, - . January 1970 CATEGORICAL AND OTHER PLANNING COMMITTEES--ACTIVITIES AND ACCOMPLISHMENTS Categorical and other planning committees report a variety of activities and reflect several major trends. In nearly all regions (48) these committees have a major responsibility for project development and review of projects. In almost all regions (49) these committees also do a great deal of the arrangements. By providing a forum, these committees have effectively brought together various interest groups, particutarty for cooperative development of projects. . Committees generally help set objectives and priorities for RMP activities in 48 regions and also collect data about needs and resources of the regions. Many regions (34) have committees which provide technical assistance and -consultation and some (13) which set specific standards and guidelines for -facilities and projects. Committees in some regions (22) perform the evalu- ation of ongoing projects and programs in terms of goals and priorities. In addition, committees in at least 15 regions have conducted various studies to _ implement planning. Highlights Committee functions cover a broad spectrum of activities but there are several areas in which committees seem to have major responsibility. -These areas are _ project development and review and the establishment of categorical and broader “objectives. The following examples are illustrative of the range and kinds of committee activities. ; - % Committees have stimulated or developed over 400 projects and have reviewed over 1700 projects in 48 regions, with 690 (57%) of those reviewed being recommended for approval’ to their Regional Advisory Groups. Related activities, for example, have included: - The Bi-State RMP has developed a suggested protocol for project development which encourages the involvement as early as possible of the appropriate categorical committee in the form of an ad hoc planning group with the individuals or institutions which express initiative. . .The Northlands RMP Education Committee has developed a comprehensive review form for projects which reflects their policy statement. ao, In 44 regions committees collect data about the health needs and: . resources of the regions as a preliminary to establishing goals and priorities. For example: . The Greater Delaware Valley RMP Data Analysis and Monitoring Commit- tee has compiled statistics on health manpower, facilities and vital statistics in the form of The Greater Delaware Valley RMP Fact Book. . The Indiana RMP Regional Characteristic Committee has compiled a health data bank for use in regional planning. Committees have established categorical and broader objectives and priorities in 48 regions. For example, the Illinois RMP Cancer Committee, in addition to establishing objectives, has translated these objectives into a system for evaluating projects by weighing the type of project and the type of cancer according to their established priorities. Thirteen regions have committees which are specifically designated to develop regional program objectives and priorities. The Nebraska-South Dakota RMP Planning Committee, for example, has developed overall program goals and priorities as well as determining a rating system for priority assessment of projects. Committees report performing coordination and liaison functions in 49 regions. Such work is often the first step in forming cooperative arrangements and has also produced a number of other significant results. For example: \.. The New Jersey RMP Urban Health Task~- EOECes working with the Model . Cities Program, has an elected citizens’ health panel, and has pro- vided that each model city will whave a health planner and an elected citizens' health panel, and has “instituted the requirement that con- sumers be represented in policy formation and review of ambulatory care services in three major urban ghetto hospitals. - In Susquehanna Valley three hospitals, as a result of their involve- ' ment with various committees of the RMP, went out on their own and planned and established a community Mental Health Facility, raising _some funds on their own and receiving funds from sources other than RMP. ', The Greater Delaware Valley RMP Kidney Committee, through close liaison _ with the local chapter of the Kidney Foundation, has succeeded in get- ting legislation for patient care either introduced or passed in the Pennsylvania, Delaware, and New Jersey state legislatures. . Many regions report that the largely "neutral" and "non-Federal" nature - of RMP committees is appealing, and the access to, or voice in the disbursement of Federal dollars acts as an inducement to cooperation with a minimal ‘compromise of interests. * Technical review of projects and technical consultation is provided by committees in 32 regions. For example, the Ohio State RMP Stroke Task Force has a consultant committee which applies current technical know- ledge to the review of projects. * Committees in 13 regions. have set specific standards and guidelines for. . facilities, projects, cand institutions participating in their programs. » in the Central New York RMP the Cancer Committee and the Ad Hoc Com- mittee on-Radiotherapy established principles for the use of cobalt in different hospitals. — e Categorical committees of the Greater Delaware valley RMP have set specific standards and guidelines for model. acute care demonstration unit of several kinds which are included in project proposals. * Committees in 22 regions evaluate ongoing projects and programs after goals and priorities have been set and operational activities are under- way. For example: . The Nebraska-South Dakota RMP has. develped a formalized rating system _to determine a project's accomplishments of goals. _» The California RMP Coronary Care Unit Coordinating Committee, through contract with the Rand Corporation, has developed a uniform data collection system which serves as the basis for ongoing evaluation of CcU's. Their system is beginning to be used’ by CCU experts in other regions. ..* Committeeghave ‘conducted a variety of studies in at, least 15 regions. Many of these studies are concerned with solutions’ to: various health and planning problems. The Greater Delaware Valley RMP Cancer Committee, for example, prepared studies on the diagnosis and treatment of cancer of the cervix which have become the basis for a pilot program involving a low~income population. Explanation and Comments This analysis includes only ‘those ‘committee activities and accomplishments which the regions mention. It is quite possible that. commit tees perform many functions that the regions have, not mentioned in their ‘answers. For this reason, and because it is based on narrative answers, the quantification of committee function tends to be somewhat arbitrary, and it is intended only to give an idea of the relative extent of various committee functions. Questionnaire Reference: II.F. 3,4. Analyst: Ann Stone LOCAL AND AREA ADVISORY GROUPS Local and area advisory groups act as local interpreters of program objectives to their communities in 27 regions with a total of 4843 members. in the 335 advisory groups. These groups have the most local input into the planning process; they assist in project development and implementation and do much cooperative planning and coordination of activities with CHP 314 "b" agencies. These groups seem to be organized locally on the basis of hospitals, population or medical trade areas rather than medical schools. With 29% hospital-affilia- ted representatives and 15% public or consumer representation they are community-oriented and play a major role in determining local priorities for program activities according to the local needs. Highlights Local and area advisory groups handle a broad spectrum of RMP activities at the local level from setting priorities, program and project planning and development, coordination of community health activities to preliminary project review. The organization and . membership of these advisory groups is indicative of their local orientation.- . * There are 335 LAG's (or AAG's) in 27 regions with a total membership of 4843, and an average of 8 LAG's per region (excluding Georgia which has 129 LAG's). 21 regions have 10 or less LAG's. LAG's have an average of 21 members and have met approximately 5 times. ~ * . LAG's are most frequently organized on the basis of popula- tion or medical trade areas. Some are organized according to hospital areas and to local medical societies. Very few LAG's are organized geographically with respect to medical schools. * Institutional representation on LAG's indicates community orientation with 29% hospital representation, 19% health practitioners and 15% public or consumer representation. Physicians are the largest professional grouping represented on LAG's with 41% of the total membership. The role of local advisory groups is reflected by their activities and accomplishments. The regions report that, by providing a common meeting ground, LAG's have been an effective means for implementing cooperation between institutions and professions for the improvement of health care at the local level. By assessing local needs and resources LAG's determine local priorities for program activities. - In the Georgia RMP the LAG's from five hospitals in the Augusta area have agreed upon establish- ing an independently~operated cancer facility to serve all hospitals in the area. The LAG's have decided upon this facility as the best means of meeting the needs for cancer care in the area. LAG's assist in planning and developing project proposals and with the preliminary review of locally-initiated proposals. They also assist in implementing projects or components of projects at the local level. - In the Colorado-Wyoming RMP the Pueblo Action Group has worked with the community to design a project proposal aimed at improving the delivery of health care services to disadvantaged Chicanos. This project has taken the form of a health care delivery system utilizing "home care" as the basic structural unit. LAG's do a great deal of cooperative planning and coordi- nation with CHP 314 "b" agencies. In many cases the LAG and the CHP areawide health planning group are the same body, and the relationship with the 314 "b" agencies almost always includes overlapping membership and sharing of health information and data. - Three LAG's in the Western New York RMP have organi- zed themselves in such a manner to allow them to serve as a planning and review committee for both . the RMP and the CHP group in the region. = In the Oklahoma RMP the Ada LAG and the CHP group (in the Southern Oklahoma Development area) are jointly engaged in a Community Stroke Planning Program where the community involved includes six hospitals in five counties. Local advisory groups are often the site for coordination of efforts between regions where they intersect locally. - An Intermountain RMP LAG planned a workshop held in Reno, Nevada which was directed toward improving coordination between the Intermountain, Mountain States and California RMP's in the Reno area. ren Explanation and Comments The distinction between local and area advisory groups is very hazy and the functions of the two groups seem very similar, if not identi- cal. For this reason and because the reported incidence of the "area" groups is limited to a very few (6) regions, the two groups have been treated here as the same and for the most part can be considered to be local advisory groups. There also seemed to be some confusion between local advisory groups and subregions. Although most .(80%) of the regions consider LAG's to be the group concerned with the subregional geographic area, there seemed to be another distinction in that LAG's work through voluntary participation and the subregions have core staff field offices. , The most interesting thing about the LAG structural data is the vast range in the numbers and sizes of groups and their organizational bases. The question concerning the percentage of the population.encompassed — ‘by the local groups was apparently misinterpreted by a number of regions and thus is probably inconclusive. Questionnaire Reference: I1.C.1-9 and II.G.1-9 Analyst: . Ann Stone a Supporting Tables Table 1: Local Advisory Group Composition by Profession Kind Number Physicians * 2000. Registered Nurses - 445 Hospital Administrators 672 Other Health . 227 Business or Managerial 522 Other . 996 . Total 4843 Table 2: Local Advisory Group Composition by Affiliation Kind Number Medical Schools 715 Affiliated Hospitals - 452 Other Hospital Interests 954 Medical Society 401 Public and Other Health Agencies 500 Voluntary Health Agencies 349 Health Practitioners 904 Public or Consumer - 723 All Other 485 Total 4843 Percent 412% 9% 14% 5% 11% 20% 100% Percent 2% 9% 202 8% 10% 7% 19% 15% 10% 100% B.. Table 3: Organizational or Geographic Base of Local Advisory Groups Organizational or Geographic Base Number of Regions i/ Population or Medical Trade Areas 18 Hospitals > 8 Local Medical Societies 4 Medical Schools 3 Other 7 i/ Some regions have more than one basis for organizing LAG's; thus the number of regions does not add to 27. | Table 4: Distribution of Number of'Local Advisory Groups per Region Number of LAG's Number of Regions 1-5 - 11 6 - 10 - 10 11 - 15 1 16 ~ 20 0 21 - 25 1 Over 25 2% * Alabama has:45 LAG's and Georgia has 129 LAG's January 1970 CORE STAFF ORGANIZATION, SIZE AND COMPOSITION The diversified organizational structure, composition and size of the 55 Core staffs are reflective of the varying Regional approaches to dealing with local needs and problems. Some of the 1400 full-time equivalent Core staff members are organized primarily around the categorical diseases (e.g., Associate Directors for Heart, Cancer and Stroke), while others are organized along functional lines (e.g., Associate Directors for Community and/or Hospital Relations, Manpower Development, etc.). In addition to the central staff, several Regions have established subregional and/or institutional staffs (the latter usually located at medical schools) to facilitate and augment the efforts of local communities and RMP affiliated institutions in the planning and develop- ment of Regional Medical Programs. Core staffs range considerably in size from the smallest which are 2 and 12, to 135, the largest (California). Profession ; Nos. FTEs Percent of Total _ Physicians . ; 4 | 218 (16 Registered Nurses 66 5 Allied Health/Hospital Administration 50 3 Other Health Related a 61 , 5 Education Specialists 42 3 Administrative/Fiscal 131 0 - Other Professional/Technical 277 20 Secretarial/Clerical - 518 38 TOTAL 1,363 -—z. 100 Highlights Core staffs have grown from about 100 staff members in December 1966 to over 1600 in June 1969. These 1600 people comprise the 1363 FTEs noted above. Of _ particular interest are the following: . “* The average Core staff has 23 FTEs (27 people). About one-third of the Regions have less than 20 people for the Core, while another one-fifth have over 40 people. About 70% of the staff are full-time and 30% are _. part-time. * ALL but one Region (Susquehanna Valley) has a physician on its Core staff. Most physicians serve on a part-time basis, while most of the other pro- fessionals ~~ nurses, hospital administrators, education spécialists, etc. serve on a full-time basis. | " * About 13 Regions have no RNs, 30 have no hospital administrators, 24 have no education specialists, and 34 have no allied health person. * About 72% of the staff are located in the central core office, while 21% are institutionally based (e.g. in co-sponsoring medical schools, hospital councils etc.) and 7% serve as field or subregional staff. - Explanation and Comments Two occupational categories used in the Questionnaire "Other Professional" and "Administrative/Fiscal" carry 30% of the staffing reflected here. The former group may include some of the "generalists" who are dealing with the broader problems of building relationships with other agencies and institutions. For indeed, there does seem to be a trend toward using "non-health" generalists for these types of activities, thus limiting the effectiveness of using the tra- ditional health occupational categories to gain insights into core staffing arrangements. For example, several Regions are using such people as lawyers, former pharmaceutical detail men, and others with more general backgrounds to - handle management problems and community and institutional relationships. Questionnaire Reference: II.H.18&4. Analyst: Rhoda Abrams SUPPORTING TABLES TABLE 1 - Locale of FTE Core Staff Members Profession . ‘Total ’ Central Institutional Field TOTAL 1,363 993 (72%) 271 (21%) 99 (7%) Physicians 218 131 - 64 23 “Registered Nurses 66 45 14 7 Allied Health/Hospital Adm. 50 40 7, 3 Other Health Related 61 50 7: 4 Education Specialists 42 23. 16 : 3 Administrative/Fiscal 131 113 14 4 Secretarial/Clerical 518 370 109 39 16 Other 277 . 221 40 TABLE 2 - Full-time/Part-time Breakdown Profession Total 4 Full-time Part-time "TOTAL 1,625 100 1,122 503 Physicians 349 «21 122 227 Registered Nurses 74 5 58 16 Allied Health/Hospital Adm. 60 4 46 14 Other Health Related , 77 5 52 25 Education Specialists 42 2 30 12 Administrative/Fiscal 148 9 117 31 Secretarial/Clerical 569 35 467 , 102 Other 306 19 230. 76 ‘Iwo of the more significant, and increasingly visible, functions of the Core January 1970 CONSULTANT/BROKER/FACILITATOR ROLE OF CORE STAFF Staffs are those of (1) providing consultant or professional services to’ organizations in obtaining funds from other sources. local institutions and (2) serving as a facilitator or convenor of multiple interest groups to solve local problems. Regions varied considerably in the emphasis given to these functions. Generally these were activities not requiring RMP operational project funds, and very often, the RMPs assisted Highlights * 46 Regions provided anecdotes on the RMP core staff serving as a con- "sultant and technical resource in the Region. One Region even described one of its major accomplishments as creating a "health identity." * About 18 Regions reported anecdotes on technical assistance and broker- age functions related to hospitals and hospital associations. These ranged from assisting in the merger of hospitals to developing joint hospital services and specific clinical facilities. * 22 Regions reported anecdotes on the core staff serving as broker/ facilitator in getting other groups to come together to plan or imple- ment activities -~ generally not related to RMP funded operational project activities. ‘* 11 Regions reported on how the core staff facilitated the creation of new coordinating councils, most of which related to improving the plan- ning and organization of regional health education programs. * A few Regions reported accomplishments related to affecting the behavior _ of other organizations. Discussion A. Serving as a Technical Resource or Consultant Forty-six Regions reported examples or anecdotes of core staff serving as a technical resource and as providing consultation services to health organizations such as hospitals, CHP, educational institutions, Model Cities, OEO and others. This appears to be one of the major areas of activity for the core staff, although some Regions appear to be more heavily involved in this area than in others. For example, North Carolina reports that "this type of activity has consumed an increasing percentage of the time of RMP core staff members, . . . about 15%." , 1. Hospitals Maine: The core staff is "heavily involved in assisting an area of this region in which two towns have decided to build one joint hospital. There exists in each locality a small inefficient, acute unit at the “present time. Regional Medical Programsis in effect managing their total planning program which includes the acute care of the patient with heart disease, cancer, and stroke, the concept of progressive patient care, methods of patient flow and referral, new methods of construction, new methods of payment, and all the elements that go . into a future health care setup. This is being done in cooperation with the hospital. planning boards, the 314b agency of the area with. anticipated assistance from, in part, Regional Medical Program, and other assistance from the National Center of Health Services Research and Development." Hospital Associations | -Washington/Alaska, Intermountain, Iowa, Colorado-Wyoming and other Regions reported instances of providing assistance to state hospital associations. Consultation to Comprehensive Health Planning About eleven Regions reported examples of providing consultation ‘ser- vices fo CHP agencies -- both A&B. Consultation ranged from provid- ing data collection designs and services to helping to develop (B) applications. Educational Consultations This is one of the most active areas of core staff consultation .services. Activities ranged from serving as a resource on curricula development to the broader areas of planning for manpower development and cooperative regional educational programs. Connecticut: "T9 insure cooperative planning at the state level for expanding allied health manpower requirements, the CRMP staff serves as official consultants to the Connecticut Commission on Higher Edu- cation which is responsible for coordinating all post-high school educational planning. This has placed CRMP staff in position to offer ‘assistance in such areas as distribution of educational facilities, health occupation curricula, financing and affiliations between edu- . cational and clinical facilities and accreditation. At the Health © Service Area level, CRMP staff serve as a technical resource to a multi-agency group exploring development of an educational consortium for health occupation education." Model Cities and QOEO Cited by about 10 Regions were technical services to Model Cities, OEO and related agencies. The types of services and resources provided ranged. from assisting in the development of a grant appli- cation to providing. educational and other specialized resources. -. New Jersey: "The Urban Health Coordinator for Newark developed an application, which was funded, for the establishment of a Health Services Research Unit for the City of Newark. This unit of three technical specialists in health planning will serve as a pilot demonstration for health component planning for Model Cities through- out the country. The Urban Health Coordinator assigned to Hoboken ~ was instrumental in developing cooperative arrangements necessary to finance and conduct a household survey of Model Neighborhood residents' opinions on the health care they received. Involved were the Depart- ment of Community Affairs, the local Model Cities agency and Opinion Research Corporation of Princeton which carried out the survey. RMP staff contributed-to questionnaire design and construction. Also, ‘the Urban Health Coordinator arranged for the recruitment and train- ing of Model Neighborhood residents and interviewers." ‘Facilitating Cooperative Planning and Other Activities Among Other : Organizations and Groups About 22 Regions reported anecdotes reflecting this type of activity. Activities included: ‘Facilitating creation of new community coordinating councils, ‘Bringing organizations together for cooperative planning or specific problem solving. Influencing the decision and/or behavior patterns of particular groups and organizations. These efforts were aimed at problems ranging from general health planning to regional manpower problems, institutional probtems, regional laboratory services, and the like. - oe — ' Eleven Regions reported anecdotes-on how they facilitated the creation New, Coordinating Councils of new councils. Often these were concerned with regional educatinal problems, but other areas cited included inner city problems and cardiovascular services. _ Louisiana: "LRMP assumed the position that it should deal with institutions as a single entity on matters that related to the Medical Center as a whole. The Director, therefore, informed the three insti- ‘tutions of this approach. A committee was formed to act as the primary contact between the Medical. Center and. LRMP. Representatives began to discuss the problems confronting the Center in relationship to the RMP. It became quite evident that by working together, they could more effectively approach those non-RMP related issues as well and that it would be most desirable to have representatives from the top-most decision making bodies combine their efforts in devising a means to plan future activities together, while preserving their individual autonomy. In addition, representatives from the Board of. Directors of Charity Hospital met with these groups to discuss this approach. They jointly agreed to petition the State to establish the "Health ono Education Authority of Louisiana" to serve as a means for jointly -plan- ning the future growth of the Medical Center. The legislature responded . enthusiastically and passed the enabling act. HEAL is now a budding reality. Although HEAL came about through the efforts of many, many health professionals, civic leaders, lawmakers, etc., we cannot help but feel a certain degree of paternal pride since the effort began as an attempt at cooperation among these institutions for the purpose of participating in the Regional Medical Program." In North Carolina, a hospital commission has been developed on a seven county basis, and in Oregon, a.Portland Cardiology Council was formed. . Indiana helped organize an inner city council. Affecting the Decision and/or Behavior of Other Institutions In Northlands, the involvement of University Continuing Education fac- ulty in the Education Committee of NRMP has resulted in their taking an entirely new look at their relationships with peripheral areas, and in planning cooperative educational efforts to involve other ‘organized health interest groups. This relationship may also lead to use of some Core personnel within the University to participate in the “revision of core curricula for medical students, which is felt to be fundamental to achieving success in continuation education. Connecticut: The development of a radiation-therapy unit with a state institution in a peripheral area of the region provided CRMP staff an opportunity of cooperating with Connecticut Hospital Planning Commis— sion, Hill-Burton Agency, State Health Department, Yale Medical School and two general hospitals. to design the arrangements for patient care services so that it could function as a subregional center thus avoid- ing construction of similar facility in a neighboring community hospital. Questionnaire Reference: II.H.7. Analyst: ’ Rhoda Abrams January 1970 PLANNING AND FEASIBILITY STUDIES A total of 922 planning and feasibility studies have been completed, are under- way, Or proposed by the 55 regions. These studies fall into the following areas or patterns of emphasis: Types_of Study TOTAL Completed In Process Proposed - 922 344 417 161 Manpower and Training: 252 112 104 36 Physician manpower (53) (28) (19) ( 6) Nursing manpower (56) (27) (24) ( 5) Other health manpower (57) (24) (26) ( 7) Continuing education (86) (33) (35) (18) Services and Facilities: 194 81 83 30 Coronary care services and facilities . (69) (34) (29) ( 6) Other clinical services , and facilities (77) (27) (35) (15) Medical library resources (48) (20) (19) ( 9) Medical Demographic/Socio- economic: 373 123 175 75 Patient origin/referral (47) (17) (24) ( 6) * Disease patterns. (185) (67) (87) (31) Transportation and emergency _ care patterns (34) (8) | (15) (11) Communication patterns (31) ( 7) (15) ( 9) Demographic (55) (22) (24) ( 9) Health care costs /financing (21) ( 2) (10) ( 9) Other 103 28 55 "20 * About evenly divided among heart disease, cancer and stroke. Highlights There has. been a high concentration of studies in certain areas of interest; namely, disease patterns (185), continuing education (86), and other clinical services and facilities (77). This probably reflects the program's early emphasis on the categorical diseases and continuing education. -2- Other highlights of these planning and feasibility studies include: * Health care costs and financing (21), communication patterns (31), and transportation and emergency care patterns (34) were among the least studied areas. It appears, however, that health care costs and financing may be an area of increased interest at this time. For while only two such studies have been completed, an additional 19 are either underway or proposed. * Studies of smoking and health, health care of the poor, legal barriers to innovation in medicine, long-term care and home health care are among those in the "other" category. As to the relationship of these planning and feasibility studies to operational projects, some 195 projects were identified as having been developed because of a planning study. These were concentrated in the areas of services and facili- ties (63) and manpower and continuing education (64). Examples of how planning and feasibility studies have led directly to operational projects include the following: — * In Bi-State, a radiation therapy planning study pointed up the need for radiotherapy consultation and a shortage of radiation therapy technicians. This led to the development of a funded project for Telecopier Communica- tion Networks and Training Programs for Technicians. * In Indiana, there was an initial feasibility study of a multiphasic screen- ing program in which 1300 cases were processed. This allowed them to "shake down" the screening process and educate the screening technicians. This preliminary work led to the development of the Multiphasic Screening Program in Indianapolis, which plans to screen 30,000 within three years. * In New Jersey, a statewide survey was conducted to determine the present facilities and manpower training programs existing and proposed for cor- onary care and intensive care units. The results of this survey were used in the development of three coronary care nurse training proposals which have been funded and are now operating. ’ * In Northwestern Ohio, the preliminary success of a campaign to discourage smoking in Toledo led to an operational project funding an expanded effort. Many feasibility studies proved useful even though they did not lead to opera- tional projects. In Louisiana, for example, a study on the availability and distribution of health personnel has been used in the delineation of health care regions within that State and should facilitate more effective health care planning at both the local and State levels. In New Jersey, a heart screening survey was undertaken as a feasibility study in Newark. Working with the Model Cities agency, screening procedures were conducted on over 850 persons at three mobile trailer locations during a period of seven working days. Participants from the model neighborhoods acted as interviewers and were trained as techni- cians for the survey. A ne Some of the projects which were developed out of planning studies are currently being funded by other agencies and institutions in the regions. For example: * A study of stroke care in Tulsa, Oklahoma, led to the formation of the Hillcrest Hospital "Stroke Team," non-RMP funded. * In Albany, an operational proposal resulting from a planning study is being funded by the National Library of Medicine. * In Arizona, two projects were funded from other sources - (1) One-day workshop in Phoenix to demonstrate uses of IV in continuing education. (2) Three-day workshop at Cochise College for the training of Inhalation Therapy personnel. * A regional rehabilitation center in Nashville, Tennessee, received plan- ning support from the Tennessee Mid-South RMP. yo. Explanation and Comments Planning studies are generally viewed as aiming at a broad program area, such as the manpower and facilities resources in a region, the adequacy of and need for specialized clinical facilities, disease and patient referral patterns, and unmet educational needs. Feasibility studies, on the other hand, are usually aimed at assessing the workability and utility of particular program elements. This might include assessing the effectiveness of telephone, radio and television networks in linking community hospitals to university medical centers, or expLlor- ing various methods of patient care demonstrations. Questionnaire Reference: III A.1l. and 2. Analyst: Lyman Van Nostrand January 1970 PARTICIPATION IN RMP PLANNING AND DECISION-MAKING Representatives of about 6,800 health and other institutions and organi- zations have been or are actively involved in the planning and decision- making processes of the regions. Types and numbers of institutions represented are presented in the following table: Kind of Participant Number Per Cent Institution or Organization Represented of Total Educational Institutions, including Medical Schools 638 10 Medical Societies, State and Local 761 11 Nursing, Dental, and Other Health Professions Groups 546 8 Voluntary Health Agencies 721 11 Health Planning and Related Agencies 790 12 Hospitals and Other Care Institutions 2,621 39 Others, Largely Non-health 642 2 TOTAL 6,719 100% Highlights Regional planning and decision-making have involved a large number and broad spectrum of health institutions and organizations, particularly from the private and voluntary sectors. Specifically, representatives of: * Every state medical society, hospital association, heart associ- ation, and cancer society, as well as many local chapters of the state organizations. * Almost one-third of the nation's hospitals (2056) and about 60% (565) of its extended care facilities. * All state health departments and over 200 city and county health departments. * Almost all state Comprehensive Health Planning agencies and 126 areawide ones. * = =42 local OEO and 48 Model Cities programs. * All (104) medical schools, all schools of public health and 44 of the 56 dental schools in the U.S. Explanation and Comments Active involvement in regional planning and decision-making is defined to include (1) having representation on the. regional advisory group, categorical or planning committee; (2) conducting or administering planning studies or ao -2- sharing in the funding of such studies; (3) providing consultative services; (4) acting as advisory or clearance body for the region; and/or (5) otherwise making a substantial contribution to planning or decision-making. In the analysis of this question every effort has been made to eliminate dupli- cations of institution/organization listings between the various regions. In areas where there are overlapping regional boundaries, often representatives of the same institution will serve on planning bodies in more than one region. Likewise, some institutions administer studies, provide consultant services and perform various other functions jn 2 or more regions. In every instance where feasible, duplication was noted and the figures adjusted accordingly. In some cases, however, it was impossible to pinpoint duplications between the regions, so some of the figures appearing here may be slightly overstated. ) Questionnaire Reference: III. A. 9. Analyst: Joan Ensor SUPPORTING TABLES Table 1: Educational Institutions Participating Kind Number Percent Medical Schools 104 . 17 Nursing Schools 183 29 Dental Schools . 44 7 Schools of Public Health : 16 2 Schools of Education 101 16 Community and Junior Colleges . 97 15 All other 93 14 TOTAL 638 100 Table 2: Medical Societies and Physicians' Groups Participating - : d Kind | Number Percent State Medical Societies 52 7 State Osteopathic Societies 45 6 ‘County/local Medical Societies 530 70 American Academy of General Practice 45 6 All other 89 il TOTAL 761 100 Table 3: Nursing, Dental, and other Health Professional Groups Participating Kind , Number Percent State and Local Nursing Associations 151 28 State and Local Dental Associations 83 15 State Hospital Associations 52 a) Local Hospital Associations 71 13 All others 189 35 7 TOTAL 546 ‘100 Table 4: Voluntary Health Agencies Participating Kind Number Percent State Heart Associations 52 7 State Cancer Societies 5 52 7 Local Heart Associations 190 26 -. Local Cancer Societies 184 26 All others 243 34 TOTAL 721 100 SUPPORTING TABLES (continued) Table 5: Health Planning and Related Agencies Participating Kind Number Percent State Health Departments 52 7 City/County Health Departments . 223 28 State 314(a) Health Planning Agencies 51 7 Areawide 314(b) Health Planning Agencies 126 16 Regional Health and Hospital Councils 86 11 OEO Programs 42 5 Model Cities Programs 48 6 All Others : - 162 20 TOTAL | 790 100 Table 6: Hospitals and other Care Institutions Participating Kind Number Percent Short-term, Non~Federal Hospitals 1923 73 VA and Other Short-term Federal Hospitals 133 5 Nursing Homes and Extended Care Facilities 565 22 TOTAL 2621 100 Table 7: Other Institutions and Organizations Participating Kind Number Percent Insurance Companies 77 12 Labor Unions 73 11 - ‘Private Profit-making Companies 115 18 Non-profit Institutions 79 12 All Other 298 47 TOTAL 642 100 January 1970 REGIONAL REVIEW AND APPROVAL PROCESS Regional Advisory Groups must review and act upon all operational proposals. Only those favorably recommended or approved may be included in the regions' grant requests, The fact that slightly less than two-thirds of the proposed operational projects or activities presented to advisory groups have been approved by them -- 1021 out of a total of 1553 -- is evidence that this regional authority and responsi- . bility is being exercised ina critical, rather than mere rubber-stamp fashion. Disposition : Ref'rd Approved Disapproved Ret'd Other for Defer- Sources Pend- Total No. & No. kh Revis. red. Support ing RAG «1553 «1021s«66%Hsi2SLUHC1L0si8H_Ci“(it SCD Categorical & Other Pig. & Review Grps. 1508 858 54% 273 18% 189 147 Ll 133 Others: Executive Cmtes. 777 477 61% 140 18% 71 31 2 56 Bds. Directors 229 153 67% 26 11% 26 11 2 ll Local & Area Adv. Groups 268 197 74% 28 10% 15 4 3 21 All Others 696 419 60% 80.- 11% 64 70 18 45 Highlights ‘Most regions (45) have, in addition to their Regional Advisory Groups, a series of categorical and other planning and review committees to assist with the re- view of operational proposals. These committees generally review and evaluate proposed operational projects and activities for their technical or substantive merit prior to final action by the advisory groups. Far less frequently, other organizational components of the regions, such as executive committees (28), boards of directors of new corporations (10), and local or area advisory groups (21) also may be involved. : Other highlights of the regional review and approval process are as follows: *