imran ‘Grantee PROFILE: OKLAHOMA REGIONAL MEDICAL PROGRAM Director Originally Prepared By: Original Date : Updated University of Oklahoma Medical Center Dale Groom, M.D. e Frank G. Zizlavsky September 1, 1969 II. Iii. Iv. VI. VII. TABLE OF CONTENTS Geography Demography Politics Historical Review Core Staff Overall Organization Funded Operational Projects APPENDIX (I. GEOGRAPHY ° Geographic Definiticn of the Region: From the beginning this Region has been defined as the State of Okla- . homa. The original judgement was that the State constituted a logical regional unit. Neither Oklahoma nor its neighboring Regions have rigid- _ ly interpreted inter-regional boundary lines. For example, ORMP will encourage communities in the far eastern portions of Oklahoma to part- -icipate in any activities sponsored by the Arkansas Regional Medical Program at Ft. Smith,Arkansas. On the other hand, the cardiologists in Ft. Smith are already cooperating with the Oklahoma RMP coronary eare project, with approval of the Arkansas RMP. ENID . Se OKLAHOMA CITY 6 a _ IY. DEMOGRAPHY 1) 2) 3) 4) 5) Population -. 2.52 million (as of July 1, 1968) ‘a. 63% Urban b. 90% White, 7% Negro, 3% Other c. Median Age - 30 years (U.S. average 29. 4) 1960 Land Area - 68,887 square miles Health Statistics ‘Death Rates by Selected Causes/100,000 - 1967, Unpublished | a. Heart Disease - 368.8 (slightly higher) b. Malignant Neoplasms - 157.6 (slightly higher) c. Vascular lesions - 127.4 (high) d. General Arteriosclerosis - 19.9 (higher) e. Diabetes - 21. 4 (very high) Facilities a. University of Oklahoma School of Medicine - enrollment 396 b. Schools of Nursing - 11 (3 college or University affiliated) c. Schools of Medical Technology 13 d. Cytotechnology, University of Oklahoma (1) e. There are 138 hospitals with 19,202 beds Personnel Statistics a. As of 1967, there were 2,904 physicians (2,483 M.D.s and 421 D.0.s) for a rate of 119/100,000. b. As of 1966, there were 6,582 total nurses of which 4, 435 are employed. “JII. POLITICS Governor: Senators: Representatives: ae oN Dewey F. Bartlett (R) 1968-Present Fred R. Harris (D), 1966-1973 Government Operations Henry L. Bellmon (R), 1968-1975 Interior and Insular Affairs Ed Edmondson (D) Interior and Insular Affairs _John N. Happy Camp (R) ‘Interior and Insular Affairs John Jarman (D) Interstate and Foreign Commerce Tom Steed (D) Appropriations IV, HISTORICAL REVIEW November, 1965: Dr. James L. Dennis, Director and Dean of the University of Oklahoma Medical Center appointed a committee for Regional Medical Program, charging it with the responsibility of establishing a RMP. February, 1966: The Honorable Henry Bellmon, Governor of the State of Oklahoma, designated the University of Oklahoma Medical Center as the Planning Agency for the State and charged it with the responsibility of carrying out the feasibility studies and planning activities for the establishment of a RMP. March, 1966: . Governor Bellmon appointed a Regional Advisory Council. May 19, 1966: = Division of RMP received the first year planning application from the Oklahoma Regional Medical Program. Council's points of concern: 1. Question as to whether minority groups were included in the Advisory Group. (See February, 1967 #4) 2. Relationship of the Advisory Group to the direction of the project was not clear. (See July, 1967 #1) 3. Administrative relations were vague. 4. How this project would relate to other Public Health Service _ supported activities in Oklahoma needs délineation. 5. Relationship between budget and program activities was not clear. 6. Concerned about the direction of the project. since neither the _.... Director nor Associate Director was named. (See February, 1967 #1 and March, 1967 and October, 1968) 7. Role of the different staff members needs amplification. September, 1966: 01 Planning Award - $177,963 (9/1/66 through 8/31/67) February, 1967: Negotiating Site Visit: Site Visit Team: Dr. John Hamilton Mr. Ira Alpert Mr. Lawrence Coffin 1. ORMP is negotiating with individual for position of Director of Oklahoma RMP. 2. RAG is not active, and presently no rules or bylaws established. (See July, 1967 #1, and February, 1969 3. Little actual planning has taken place. 4, Negro dentist appointed to RAG. © oo March, 1967; ss Kelly M. West, M. D. appointed as Acting Director. Oklahoma RMP, together with the Missouri and Kansas Regions, co-sponsored. an. inter-regional Health Manpower Conference, hosted by the Kansas Region. July, 1967: _ORMP requested $302,834 for second year planning. Phase I is almost completed and Phase II will begin shortly. First year Progress Réport: 1. Two permanent advisory groups were established: -ORMP Advisory Council and the University of Oklahoma Medical Center Conmittee. 2. Oklahoma State Medical Association appointed a special _ liaison committee on ORMP. 3. Progress achieved developing liaison with various boards and committees, i.e. Health Intelligience Facility Board, Board of Oklahoma Health Sciences Foundation, Oklahoma Medical Research Foundation, etc. 4. Preliminary study of health library resources was undertaken. 5. Ad Hoc Committee on Heart and Cancer appointed. 6. Regional planning activity launched in diabetes and nutrition. 7. Ad Hoc Cancer Planning Group submitted preliminary report. August, 1967: Suggestions made from staff visit by Philip A. Klieger, M. D. “1. Actively involve RAG as program activities. accelerate. 2.. Submit a supplemental planning grant. 02 Continuation Planning Award - $156,801. This represents new funding of $27,056 and an estimated carry-over of $129,745 from first year of ORMP planning grant. Second year supplemental planning grant requested in the amount. of $125,299. The increase in staff to be supported by the supplemental grant would make it possible to involve more extensively the commun- ity hospitals of the Region in the planning process. November, 1967: Review Committee recommended funding for time and amount requested. Council approved second year supplemental planning grant. December, 1967; 02 supplemental planning grant awarded $125, 299 for a nine month _ period, This will help their | defined needs which were. not anticipated originally. tie May, 1968 01 Operational Grant submitted. This application requests continuation of core staff and includes a proposal entitled "A Regional Emphysema Program for Oklahoma." oo July, 1968: Third year continuing planning grant submitted. August, 1968: Council deferred action until November on application for new 7 operational grants and supplemental grants adding new operational projects to ex- isting operational programs. ‘August, 1968: 03 Continuation planning project awarded $323,993 (Direct costs) 43,707 (Indirect costs) . oo $367,700 os October, 1968: Dr. Dale Groom became Director of Oklahoma RMP/ Review Committee recommended deferral for site visit on new operational grant. November, 1968: Site Visit Committee: Henry Lemon, M.D., Chairman Elliott Rapaport, M.D. Ralph W. Ingersoll, Ph.D. . Anthony Komaroff, M.D. Mrs. Patricia McDonald Comments: This application should be reviewed in a way that strengthens the community outreach from the medical center and the innovative involve- ment of communities away from the medical center. * February, 1969: Election of ten new members to Oklahoma's Regional Advisory Group. February, 1969; Council approved new operational award which consisted of the following ten projects: Core (for 10 months only), coronary care, emphysema, continuing education, cancer control, library, smoking and health, mammography, nutrition and diabetes, cancer of the prostate. March, 1969: Representatives of ORMP met with DRMP staff for a negotiation meeting.” At this meeting, the ORMP was given the option of continuing urider two i i { grant awards until September, 1970 or terminating the planning grant early to have one operational grant in effect as of either April 1 or May 1, 1969. ‘The ORMP selected the one mechanism for funding effect- ive May 1, 1969. . May, 1969: Ol Operational Grant awarded $1,074,145 (Direct costs) 181,099 (Indirect costs) | $1,255,244 Total This period begins May 1, 1969 through April 30, 1970. The planning grant that had supported the 1970 core program has been terminated. CORE STAFF NAME Dale Groom, M.D. Neal H. Hardin, M.S. Robert G. Tompkins, M.D. Kenneth C. Hager Larry A. Fowler Donna Barlow, R.N., Ph.D. John M. White, Jr., M.S. Roger Wolfe Norman E. Goodwin tf TITLE Director Program Manager Coordinator, _ Tulsa Planning Program Coordinator, Health Career Re- cruitment Programs; _Exec. Director, Okla. Council for Health Careers Public Health Advisor Coordinator, Nurs- ing Activities Coordinator, Con- tinuing Education Health Related _ Professions Coordinator, Com- munications Media Director, Health Intelligence Facility INSTITUTION AFFILIATION U. Okla. Med Center U. Okla Med Center St. Francis Hospital, Tulsa U. Okla. Med. Center Division of. Regional Medical Programs — U. Okla. Med. Center U. Okla. Med. Center U. Okla. Méd, Center , U. Okla. Med. Center % OF TIME { 100% 100% 25% 100% 1007, 50% 100% 100% 100%, J oy | Soe Soaeeeeeremwenya ot t BIOGRAPHICAL INFORMATION 1) 2) 3) 4) Dale Groom, A.B., M.D., M.S. (In Medicine) a. b. Neal Harris Hardin, Jr. a. b. Ce d. Robert George Tompkins, M.S. (Med), M.D. a. ‘Director of Postgraduate Education, Medical College of South . / Carolina - 1960 : 1936 - A.B. - Hiram College, Ohio 1943 - M.D. - Medical College of Virginia 1} 1949 - M.S. ~ In Medicine, University of Minnesota 7 Hoos Internship - Passavant Memorial Hospital, Northwestern University - 1945 Fellow in Medicine, Mayo Foundation, 1945-49 : Born Tulsa, Oklahoma - 1912 . | | Associate Professor of Medicine - 1965; Assistant Dean at Medical College of South Carolina - 1966 October, 1968 - Became Director of Oklahoma RMP Born 1917 - Texas © , vo 1954 - B.S., Mathematics; Trinity University 1964 - M.A., Psychology; University of Arkansas 1964-1967 - Deputy Commandant, United States Air Force - Extension Course Institute , 1967 to Present - Program Manager 1943 °- B.S. - University of Washington it 1947.- B.M, .- Northwestern University Pe 1949 - M.D. - Northwestern University , 1953 - M.S. - University of Minnesota . 1949-50 Assistant Resident in Medicine - King County Hospital System, Seattle, Washington Fellow in Medicine - Mayo Clinic - Rochester, Minnesota - 5 years, 2’years in cardiovascular physiology and research 1960-64 Chairman, Department of Medicine, Saint Francis Hospital, Tulsa, Oklahoma Larry A. Fowler Born - 1938 1963 - B.S. - University of Louisville (Presently completing requirements for Master's degree in Public Health at University of Oklahoma) Division of Regional Medical Programs, Programs Assistance Branch assignee to ORMP VE. OVERALL ORGANIZATION | The grantee. is the Medical Center Research and Development Office of the University of Oklahoma Foundation, Inc. The University of Oklahoma Medical Center continues to serve as the agent for planning and oper- ations, _A. Planning Groups Oklahoma City: - Director and eight full-time staff. Coordinator (1) Secretary-Administrator (1) Program Manager (1) fo, Public Health Advisor (1) — me Ph.D. - Behavioral Scientist (1) Consultants (3) oe SOUR Wh eH Tulsa: 1. One Coordinator (1/3 time) 2. Secretary-Administrator (full-time) 3. Coordinator for Planning Activities in Nutrition and Diabetes. (part-time) Ada: No Staff Enid: No Staff The chairmen .of the planning groups in Ada and Enid report directly © to the Director of the Oklahoma RMP, B. Regional Advisory Group ‘The Advisory Council serves as the supervisory body and its functions and responsibilities are those set forth in the law creating the RMP and the guidelines by which these programs are administered. The principal Executive Officer for the program is the Director who is responsible to the Advisory Council and to the Vice President for Medical Center Affairs of the University of Oklahoma. The Executive se “ : % ee Committee is composed of eight members: Honorary Chairman is Governor Dewey F. Bartlett and Chairman is Dr. James L. Dennis who is also Vice President and Dean of the University of Oklahoma Medical Center. The- position of Chairman~Flect of the ORMP Advisory Group is nominated at the last meeting of the year for the next year's term of one year. In the following year he automatically becomes Chairman of the ORMP Ad- visory Group. This position is voted on by all ORMP Advisory Group “members. The Regional Advisory Group is composed of 37 members who broadly represent the state. One of the major and most useful functions of the Advisory Group has been the very substantial amount of parti- ‘cipation of individual members in various aspects of the program. The Advisory Group has also provided policy guidance and has developed policy. The RAG meets four times a year. Composition of the Advisory Group: In March, 1966, the Governor of the State of Oklahoma activated a “Regional Advisory Council." In accordance with the provisions of Public Law 89-239, members were broadly representative of both the total health care system of the State and the Citizens served by this system. To insure that the composition of the Advisory Group retains this broad representation which is so essential to its effectiveness, in January of each year the Advisory Group will undergo a process of appointments and retirements to be accomplished as follows: Terms of the Advisory Group members will normally be for three years. No member will serve more than four consecutive years. Approximately one-third of the total membership will be retired each year. Prospective new members will be nominated by the "Steering Comn- ittee" (see Section III, B-6) prior to the last scheduled annual meeting of each year. The Advisory Group members will have the opportunity to review the nominees and to make additional nomina- tions from the floor. Selection of new members will be by written ballot. The Advisory Group shall determine the number of members required to carry out its functions most effectively. The size of the Advisory Group will be determined by the vote of new appoint- ments. The Steering Committee will also determine which of the present members are recommended for continuation beyond the normal three-year term. ‘It is the responsibility ‘of the Director. ORMP, to insure that each new member has been thoroughly briefed on all facets of the ORMP prior to the first meeting after selection to and acceptance of Advisory Group mem- bership. Organization of the Advisory Group: The Governor of the State of Oklahoma will be Honorary Chairman of the Advisory Group. A quorum for conduct of Advisory Group business will consist of a majority of the membership. All members must be notified when business is to be conducted, Beginning in December, 1968, the Advisory Group will select from its membership a Chairman and a Chairman-Elect. The term of the Chairman will be for one calendar year (beginning January 1, 1969). Each subsequent year, at the last scheduled meeting of the year, the Ad- visory Group will select a Chairman-Elect who will assume his responsi- bilities on January 1 of the next calendar year, concurrent with his ‘predecessor's assumption of the Chairmanship. The Advisory Group may. delegate to the Steering Committee authority to act for the Advisory Group provided that the nature and limitations of such delegation are defined by the Advisory Group in advance. The Director of the ORMP, with the concurrence of the Advisory Group, will designate a permanent Secretary. The Secretary will be a member- without-vote of the Advisory Group and a member of the ORMP professional staff. Working committees will be appointed by the Chairman from the member- ship of the Advisory Group. The number of such committees will be at the discretion of the Advisory Group. Each committee will be guided in the conduct of its business by a Committee Chairman and a Comm- ittee Vice-Chairman. The selection of the committee membership and designation of its officers will be the responsibility of the .chairman of the Advisory Group in consultation with the Chairman-Elect and the Director of the ORMP., Persons who are not Advisory Group members may be appointed to these committees, but each Committee Chairman and a majority of the members of each committee must be Advisory Group members. An Advisory Group Steering Committee composed of the Advisory Group Chairman, Chairman-Elect, the Committee Chairmen, and the permanent Secretary will be responsible for the general governance of Advisory Group business. The Director of the ORMP will be advisory to, and non-voting member of, the Steering Committee. Conduct of Advisory Group Business: The Advisory Group will meet at the call of the Chairman at least three times each calendar year to insure an orderly and continuing review and evaluation of the ORMP planning and operational processes. ™ The Director of the ORMP is responsible for establishing an effective system for review and evaluation of the ORMP planning and operational projects which as a whole comprise the Oklahoma Regional Medical Program. The Advisory Group in this review and evaluation process will insure that the total program is structured to achieve the goals and objectives: as specified in the Act and as further defined by the -Advisory Group. C. Pattern of Flow The Oklahoma RMP has further formalized and modified their previous review process. 1. A proposal in detailed form is submitted to the ORMP. These are reviewed and modified by staff. 2. Primary reviewers (two to four RAG members and sometimes, one or two outside consultants) meet with the staff and any appro- priate consultant prior to the RAG meeting. 3. Proposals are returned for correction to be developed to a - final form. 4. "Final" form proposal submitted to RAG meeting where final review occurs. If approved, the project proposal is submitted for Division of Regional Medical Programs approval. If dis- approved, the project is returned to Project Director with notification and comments on disapproval. agaurzseras on oF. THES OKLAMOMA RE svoroxa”” 't SEE oo Vet STATE gt - ov | OKLAHOMA \ . HON. D.F, BARTLETT Ln COVERNGR seswesgeeimeie ee . * MED, CEXTEA ; ' opm RESEARCH & DEVELOP, - ADVISORY OFFICE OF THE = |. 2 GROUP UNIV. OF OKLA, | del “7 7 GTATSON sd |. FOUNDATION, INC. _{- [PLAN. OR ADVIS +" JASSOCIATIONS, f | GROUPS - AGENCIES, DIKECTOR s Exc. | omMP M.D. | COMMITTEES , . . ee - / ASSOC. DIRECTOR | . ORM? M.D. ae ae ae ob op ae —— ow — we ow 7 aT We z= PROGRAM _. -—- =e « — oR ape a ane - wt A . pe oe ~ - an — MANAGER _ MEDICAL SCLENTIPIC ASSISTANT FOR : MANAGEMENT AUMINISTRATION TD ee wach mates COMMUNITY RELATIONS! { wT ; | "G98. FOR COORD, FOR COORD, FOK [__AND_INFORMATiON _ | ASSISTANT FOR | [~ ASSISTANT FOR assis FOR] . CARDIOVASCULAR CANCER STROKE PROG. MANAGEMENT | | PERSONNEL i {YROJECT MANAGEMENT] | LACTIVITIZS Midj ACTIVITIES M.DJ}) [ACTIVITIES M.D EDUC. _& SCIENTIFIC] (_apyxx, sexvrces| [CANCER ACTIVITIES J ur COORD. FOR CGORD. FOR [COORDS FoR EDUCATS} | | Fiscat & | { Assistant FOR | po) NURSIN PEDIATRIC HL TULSA AREA activitizs | | viscal 6 rsosece MANAGEMENT LACTIVITIES, AMI ACTIVITIES. Ubi} IACTIVITIFG 1.9.1 to | caRarovasc. ACTIV] : “AUDIOZ——"1 . st ~ persoxveLl CHIEF 1 cb0mS FOR cutesy __vrsual _} ae asststs ST FOR ‘ej PLANNING; GRANTS{| EDUCATION let COMMUNICATIONS | . MANAGEMENT! ‘. Js EvatuaTioy prog! | activinte SYSTEMS t Lianary Ss} | [—~8eFr ce paSTROxE. ACTIV. "—SOdRD, FOR] se (~LINFor. Svcs; [“|__seaviczs | SSSYSEINE FOR LATED DISE. SYSTEMS ANALYSIS veenerye; . ee were ees eis, “ XT ee EIVITEE ss COMPUTER PROGRAMS TANNING} | PUBLICATIONG PROSECT MANAGEMENT ! ; GRANTS ; Le TULSA_AREA_o r ; . : NALUATION_J L__RECORDS com eT % SEE ADVISORY GROUP GUIDELINES & CPERATING PROCEDURES . 7 [—assistast FORT eA SEE ATTACHMENT IX, PROPOSAL FOR OPERATIONAL GRANT, 0/31/68 PROJECT MANAGEMENT ATTACHMENT V, PROPOSAL FOR OPERATIONAL GRANT, 8/3/68 RELATED DISEASE | poo : TA: , 2eUD yeuotqe ztue320 ‘yit FUNDED OPERATIONAL PROJECTS #1 -- CORE SUPPORT Objectives: This project will support core staff and central administrative expenses. A higher level of support is requested than is presently funded under the planning grant. The first year request is for funds in addition to the current planning grant, and the re- quest for future years will be total funding since the planning grant will expire after this year. #2 ~~ CORONARY CARE PROGRAM FOR OKLAHOMA Objectives: To develop a network for monitoring acutely ill cardiac patients and for promoting continuing education with respect to the management of these patients. The plan seeks to create acute coronary care beds in hospitals financially unable to develop complete coronary care units. The program calls for the development of "central ‘ monitoring units" (CMUs) in larger, usually urban hospitals. The CMUs will serve as coronary care units, but will also ee monitor electrocardiographic tracings relayed continuously by telephone lines from patients in smaller hospital "remote stations" (RS). Training programs for physicians, nurses, and allied health personnel are included. #3 -- A REGIONAL EMPHYSEMA PROGRAM FOR OKLAHOMA Objectives: A teaching and demonstration unit to be established at the . University of Oklahoma Medical Center would serve’ as a . regional emphysema unit. It would be available as a con- sultative and educational resource to community hospitals in the Region. Initially, hospitals in Oklahoma City, Muskogee, Stillwater, Tulsa and Clinton would cooperate in ‘the University of Oklahoma Medical Center Program. The © goal of the project, to improve the care of patients with emphysema at the community level, would be achieved by —recruiting and training personnel; developing continuing education programs; evaluating equipment and services; establishing more effective collaborative group relationships; ” improving and expanding screening activities and establish- ing evaluative mechanisms. , Objectives: #5 -~ A CANCER CONTROL PROGRAM FOR THE TULSA AREA . oe Objectives: #6 -- A REGIONAL PROGRAM TO IMPROVE LIBRARY AND INFORMATION SERVICES Objectives: _ - #4 += CONTINUING EDUCATION PROGRAM FOR THE ENID AREA A. prototype "medical education center" would be established. Ten surrounding counties with eight participating hospitals would be included. Continuing education modalities would include video tape, audio tape, library resources, self- | instructional materials, films, conference-type telephone communications, and short courses. A small core staff | operating primarily out of one hospital would coordinate | and evaluate the program. The project seeks to demonstrate the feasibility of a subregional "medical education center," and hopes to stimulate the development of a network of similar subregional centers. The first part seeks to evaluate the prevalence and character of cancer among roughly 50,000 people in a poverty area of | Tulsa. A second part seeks to develop a computerized ! tumor registry combining data from three major Tulsa | hospitals. A third part proposes to integrate the continuing education activities of three major Tulsa hospitals in the | field of cancer. A fourth part seeks to increasé communi- | cations in the field of cancer between physicians in Tulsa | and those in a sparsely populated county to the south of Tulsa. The fifth part would survey the quality and quantity | of rehabilitation services for cancer in Tulsa and in four | representative smaller communities. | i Oklahoma Regional Medical Program, primarily through the University of Oklahoma Medical Center Library, seeks to improve library information services by increasing the scope of services, increasing the speed of delivery, and improving the relevance of the information retrieved. Three model programs, involving five hospitals in Oklahoma. City, Tulsa, and Enid are proposed. Like those proposed for the regional unit, devices to speed references to various health professionals would be instituted in these hospitals. The = program would promote knowledge of the improved library facilities among the medical community. #7 - -- A REGIONAL PROGRAM OF PUBLIC EDUCATION ON SMOKING AND HEALTH (FUNDED IN CORE) Objectives: This program would merge the efforts of ORMP and the © Interagency Council on Smoking and Health. ORMP would essentially provide a coordinator for this already a functioning Council. The Council, in turn, would support the necessary staff, the bulk of the operational costs, and would mobilize volunteer support. #8 -- A REGIONAL PROGRAM TO PROMOTE EARLY DIAGNOSIS OF BREAST CANCER | WITH, SPECIAL EMPHASIS ON MAMMOGRAPHY , ; _ Objectives: A Regional Mammography Unit would be established at the . University Medical Center, under the supervision of a physician trained specially in gynecology and radiology. Oklahoma Regional Medical Program. would work with the Oklahoma Division of the American Cancer Society. Mass. mammography screening would be initiated in cooperation _ with the Oklahoma State Health Department. Provision for. including Zerography and Thermography in future years is included. #9 -~- A REGIONAL. PROGRAM IN NUTRITION AND DIABETES FOR OKLAHOMA Objectives: This program seeks to improve the care of diabetic patients at the community level, and to improve nutritional services in hospitals and nursing homes throughout Oklahoma. ‘The program would help support an ongoing diabetes demonstra- tion clinic at the University Hospital which would develop the teaching materials and manpower to extend improved care for diabetic patients throughout the Region. The program would organize workshops, seminars, and consultation ser- vices to physicians, nurses and dieticians, and would also seek to improve community education. The program would coordinate continuing education and public education with mass screening procedures performed by the State Health Department. #10 -- REGIONAL UROLOGY PROGRAM WITH INITIAL EMPHASIS ON CANCER OF THE PROSTATE ; Objectives: The program would create a consortium of urologists, each of whom would coordinate project activities within his own subregion. Thirteen subregions are identified. Initially, the program would appraise local facilities, resources, man- ‘power and medical practices as they relate to the diagnosis and treatment of cancer of the prostate. The program would analyze hospital records and tumor registries, with follow- up on all new cases, and would identify the local needs for =continuing education. This program would interdigitate’ with other proposed programs, such as the Tulsa poverty area program. -- . - APPENDIX -