-.

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Heart Disease, Cancer, Stroke,

And Related Diseases

Regional Medical Programs Service

Health Services and NleIltaI

Health Administration

Bethesda, Maryland 2W14

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REGIONS AND PROGRM COORDmATORS——OR DmEHORS

1 ALABAMAB. B. Weh, M.D.1917 Fifth Ave. S.Birmingham, Ala 35~”

2 ALBANY, N.Y.F. M. Woolsey, Jr., M.D.Assoc. Dean and Prof.Albany Med COIL

of Union Univ.47 New Scotland AvcAlbany, N.Y. 12208

3 ARIZONA ‘

I

I

I

D. W. Meliek, M.D.COILof MedU. of Arimna~~e~a~roadway

Tucson, Ark 85711

4 ARKANSASR. B. Boat, M.D.W Univ. Tower Bldg.12th at Univ.Little Rock Ark 72204

5 BI-STATEW. Stonenum HI, M.D.607 N. Grand Blv&St huis, Mo. 63103

6 CALIFORNIAPaul D. WardExec. DirectorCalif. Committee on RMPs6X Sutter St., #6OOSan Francisco, Ctif. 94102

E. Rapapo~, M.D.Area I CoordinatorCalif. Committee on RMPsSan Francisco General Hosp.22nd and Potrero Ave.San Francisco, Calif. 94110

R. M. Nesbit, M.D.Area 11 CoordinatorCafif. Committee on RMPsU. of Calif.—DavisSchool of MedicineDavis, CaMf.95616

J. L Wflq MD.Area HI CoordinatorCSUL Committee on RMPsStanford University703 Welch Rd., Suite G-1Palo Alto, Uf. x

D. Brayto~ MD.Area N ChrdinatorCalif. Committee on RMPs1539 UCLA Rehab. Ctr.West MediMl CampusLos Angeles, CaLL W24

D. W. Petit, WD.Area V CoordinatorCalif. Committee on RMPsUSC School of Medicine1 West Bay State StreetAlhambra, Calif. 91801

J. Peterson, M.D.Area W CoordinatorCalif. Commit& on RMPsLoma Linda U. Sck of Medhma Linda, Catif. ~

J. Stokes 111, M.D.Area WI CoordinatorCalif. Committee on RMPs7816 Ivanhoe Av~La JoUa, Calif. 923o7

R. C. Comb M.D.Area VHI CoordinatorCafif. Committee on RMPsU. of Cafif.-IrvineCalif. COKof MedicineIrvine, Calif. 92664

7 CENTRALNEW YORK

R. H. Lyons, M.D.State U. of N.Y.Upstate Medical Ctr.75o E Adams StSyracuse, N.Y. 13210

8 &LOO~l~CO.

H. W. Do- M.D.Univ. of ColoradoMedical Center4200 E 9th AvaDenver, COL80220

@9 CONNECTICUTH. T. ark, Jr., MD.272 George SLNew Haven, &w 06510

10 FLOWDAG. W. brimo~ Ma.Director, Horida RMP1 Davia Blvd, Suite 309Tam~ fi 336o6

G. C A&~ M.D.South Fh Area Cmr&~onda RMPFour Ambassadors801 S. Bayshore Dr.Miami, ~~ 33131

L Crevasse, M.D.North ~ Area Coor&Flo~da RMPLak~hore Towers= S.W. 13th StCain=viUe, H& 32601

11 GEORGIAJ. G. Barrow, M.D.Me& A- of G&938 Peachtree SL N.RAtIan@ G~ -

12 GREATERDELAWAREVALLEY

G. ~ammer, M.D.551 W. Lancaster Ave.Haverford, Pa. 19041

13 HAWAHM. Hasegawa, M.D.1301 Punchbowl SLHarknew PaWonHonolulu, Ha 96813

14 =01SWright Ada-, M.D.122 S. Michigan Ave.Chicago, RL ~

15. IND~AR. B. Stonebill, M.D.1300 W. Michigan StIndianapolis, Ind. %~2

4

-+,,’

16 INTEBMOUNTAIN~ ~ Caatlq M.D.Assm DeanU. of Utah COILof M~,50 No.th Mediml DriveSdt Lake City, Ut 84112

17 IOWAW. A. Kre~ MD., Ph.D.308MehoseAvfiIowaCity,1~ 5224o

18 KANSAS ,R. W. Bro~ M.D.3909Eaton StreetKansas City, fi filo3

19 LO~SIANAJ. ~ Sabatier, M.D.3714 CanalS*tNewOrleans,h 7011g

20 MAINEM. Chatterjee, M.D.295Water SLAugusta, Me. m

21 MARYLANDW. S. Spimr, Jr., M.D.550N. Broadway

9

,-Baltimore, Md 21x

22 MEMPmsJ. W. C&rtaon, MD.62 South DunkpMemphis, Tenm 8S1W

23 METROPOL~~WAS~NGTON, D.C.

A. E. Wenta, M.D.D.C Mediml %jem

, ~7 Eye SL N.W.( W-hington, D.C. -

!

I 24 MIC~GANA. E. Heuti% M.D.1111 MichiW AvaSuite ~

I Eaat &ing, MicL 48828

25 MISSISSIPPIG. D. tiphell, M.D.U. of Mh Med Ctr.~ N. State StJackson, Mi~ 39216

26 MISSOURIA. E. Riti, M.D.107 LewisHau406TurnerAveColumbia, Mo. 65M1

27 MOUNTAINSTATESA. M. popma, WD.525West Jefferson StBoise, Idaho 83702

S. c. Pratt, M.D.Dktor, Mountain Statea

RMP-MontanaP.o. Box 2829Great Falk, Mont 59401

L. M. PMIMW,M.D.Director, Mountain Statec

RMP-Nevada956 Willow StreetReno, Nevada 89502

C. O. Grfaale, M.D.Director, Mountain States

RMP-Wyoming31~ Henderaon D..Cbeyenne, Wyo. ml

28 NASSAU-SUFFOLKG. E. Hastin= M.D.1919 Midde COun~ Rd~ntercac~ N.Y. 11720

29 NEBRASKA.Som DAKOTA

H. Mor~, M.D.1408Sharp Bldg.tincoh, Neb. ~

R. H. ~y~, M.D.Aaao.Coordinators.DakNebraaka.~uthDakota RMPU. of S. Dak Med. School216 East ClarkVetilLion, S. D& 57069

5

30 NEW JERSEYA A. W* M.D.88 Rosa SLK Orange, N.J. 07018

31 NEW MEXICOR. H. Fita, M.D.U. of New Mexico

Medical %heol920 Stanford Dr., N.~Abuquerme, N.M. 87106

32 NEW YORK~TBOPOMTAN

I. J. Brightman, M.D.2 E 103rd SLNew York N.Y. 10029

33 NORTHCAROL~AM. J. Mmaer, M.D.4019 N. Roxboro Rd.Durhau N.C. 27704

34 NORTHDAKOTA~&Ati:vri~:, M.D.

Grand Fo;ks, N.D. s8201

B. D+er, M.D.10~5 Carnegie Ave.Cleveland, Obio MIM

36 NORTHERNNEW ENGLAND

J. E. Wennherg, M.D.u. of Vt COU of M~% Colchester AvaBWkgton, Vt OWI

37 NORTHLANDSW. R. MiUer,M.D.375 Jackson StSL Pad Miw SS101

38 ~&RowES~~

~ ~ Tittie, Jr., M.D.X13 MadisonAvenueToledo,OhiOWM

REGIONS AND PROGRM COORDINATORSOR DIRECTORS (Continued)

39 0~0 STATEN. C. Andrews, M.D.1480 West Lane Ave. ●

Columbus, Ohio 43221

40 OmoVALLEYW. E MeBeat~ M.D.P.o. Box 40251718 MexandriaDr.Lexington,Ky. 40504

41 om~MAD. Groom M.D.800 N.E 13tb Sto~ahoms city, ok 73104

42 OREGONE. L. Goldbhtt, MD.3181 S.W. Sam JackonPortland, Ore. 97201

43 PUERTO RICO~w~ima:~ox Mm.

Me&d Scienccc CampucU. of Puerto RicoP.O. Box MRCsosrra Heiehts StationPu&rtoRico-m

44 ROCHESTER,N.Y.R. C Parker, Jr., M.D.U. of RochesterMe&Ctr.260 CrittendenBlv&Rochester,N.Y. 1%20

45 SO- CAROL~AV. Moseley, M.D.MeL Coil. of S.C80 Barre StCharleston, S.C 29401

47 TENNESSEEM~-SOUTH

P. E. Tezchan, Mm.IIM Baker Bld~110 21st Ava SNashviUe, Tem 37203

a mmC. B. M- M.D.P.O. Box Qw WhiticAmtk T- 78712

49 TRI-STATEL Baurngartner,M.D.Exe~DirectorMe& Care and Edumtion

FoundationTwo Center PlssaBoston, MMa 021M

R Liurn.M.D.M- Sta~e CoordinatorTri.State RMPMe& Care and Mucation

FoundationTwo Center PI- Room 400Boston, M- 02108

C. B. Waker, M.D.NewHam~hireCoordinatorTri-StateRMP15 PleasantS~Concord,N.K 03301

H. S. M. ~, M.D.Rhode Island CoordinatorTri-State RMPBrown U. Program of

Medical ScienceProvidence, R.L 02912

50 WRGINIAE. R. Perez. M.D.Suite 1025, 7~ Bldg.700 E Main SLRichmond, V~ 23219

51 W~SSH~NGTON-

D. R. Sparkroau M.D.500“U” DistrictBl&1107 N.E 45th SLScatde, Wmk 98105

L BehontArea Ceor&-EsstemWmhWashington/Mmka RMP1130 Old Natiod Bank Bl&West 422 Bivercide Ave.Spokane, Wsck 99201

J. E kh, Mm.Area CooA.SouthUtem &Wschington/Nmka RMPGmtatim, ,Maka 99826

J. Aaze, Mm.Arm Coord.Centi

SouthGnti &kaWmbington/Msaka RMP519 Eighth Av~, Room ~Anchorag~ hka 99501

52 WEST WRG~UC D. Ho~and*W. V& Univ. Me& Cm.Morganto~ W. V& =

53 WESTERNNEw YORK

~.AR~~MI~aU,M.D.

StateU. of N.Y. at Buffalo2929MainSLBuffalo,N.Y. 14214

54 WESTERNPEmsYLvANM

R. R. Carpenter, M.D.508bery Bl&353oForb AmPittsburgh,Pa 15213

55 tiS~NSINJ. S. =tihhoeck, M.D.Wiscomin RMP, Iric.110 E Wiscomin A=MNwaukee, Wk 53202

* Actiog

e’\

6

NATIONM ~WSORY

M. J. BRENNAN. bLD. J. T. ENGLISH. M.D.President “ (Chairman) .Mick Cancer Foundation Administrator

and Prof. of Medicine Health Servims andWayne State University Mental Health Admh4811 John R Street ● ~ RockviUe PikeDetroit, Mick

B. W. CANNON, MD.Div. of NeurosurgeryU. of Tenne~eCOU of MedicineMemphis, Tenm

E L CROSBY, M.D.DirectorAmerican Hosp. Assoc.Chicago, ~

A R CURRERI, M.D.Prof. and HeadDcpL of SurgeryU. of WisconsinMadison, Wisu

M. E DEBAKEY, M.D.Prof. and ChairmanDepL of SurgeryPreR and Chief Exe~ Off.Baylor COU of MedHoustou Tmas

G. E BESSON, MD.877 West Fremont Ave.Sunnyvale, ~f.

I

L CHRISTMAN, PkD.Dean, School of Nursing~ Vanderbilt UniversityNashviUe, Tenm

H. W. KENNEY, M.D.; I Medical Director

Jo&n@$Andrew MemorialI i

; Tuskeg~e hstitute( ~ Tuskegee, &

H. M. LEMON, M.D.Prof. of Internal MedCOU of Meal, U. of Neb.Omaha, Neb.

W. D. MAYER, MD.Dean and DirectorU. of Mo. Md. CenterColumb~ Mm

Comcm

Bethesd% ML

B. W. EVERIST, JR, KD.Chief of PediatricsGreen Clinic7@ South Vienna StRuston, k

J. R. HOGNESS, M.D.Exeu Vice PresidentU. of WashingtonMl Admim Bldg.Seattle, Wash

F. S. MAHONEYW Prospect Ava, N.W.Washington, D.C.

C H. MILLIKAN, bLD.Constitant in NeurologyMayo ChnicRochester, Minn.

ED. PELLEGRINO, M.D.Director of the Med. Ctr.Stite U. of New YorkStony Brook N.Y.

REWW CO~mE

G. E M~ER, M.D.Director, Off. of Research

in Med Edu~COU of MeL, U. of ~Chicago, ~

J. S. MURTAUGHEeu secre~Board of MedicineNat Aademy of SciencesWashington, D.C.

A. PASCASIO, PkD.Dean, School of Health

Rehted ProfessionsU. of PittsburghPittsburgh, Pa

S. H. PROGER, MD.Physician-in-ChiefTufts N.E Med Ctr.Boston, Maw

C. H. W. RUHE, bLD.Assistant SecretaryCouncil on Med. ELAmerimm Me& Ass~Cbiqo, m

7

L M POPMA, M.D.Regional DirectorMountah Smtes Regional

MedicalProgram5b%mW~$:ffersonSt

,

R B ROTH, M.D.Vice Speaker of House

of Delegates of AmericanMedical Association

&ewp:t 41st street,

M. I. SHANHOL~, M.D.State Health CouState DepL of HedtbRichmond. Va

C TREENDirector, Pension and

Insurance DeptUnited Rubber, Cork

Linoleum and PlasticWorkers of Amerim

Akron, OMO

F. WYCKOFFX Corrtitos RoadWatsonviUe, CafiL

R J. SLATER, M.D.PresidentThe A- for the Aid

of Crippled ChildrenNew York N.Y.

bL W. SPELLMAN, MD.Department of SurgeryUCLA School of Me&Center for Hltk SciencesLos Angeles, Calif.

J. D. THOMPSONProf. of Pubfic HealthYale U. School of MedNew Haven, Conm

P. T. ~TE, M.D.Prof. and ChairmanDept of NeurologyMaquette U. Sch. of Med.Mflwaukee, Wia

HISTORY ~ P~POSES OF RWIONMo

\MEDICW PRWWS

On October 6, 1965, the Preident signed Public bw W239. It~uthorizcs the establishment and maintenance of Regional MedicalPrograms to as?ist the Nation’s health resources in making avai~lethe beat possible patient care for heart disease, cancer, stroke andrelated diseases. This legislation, which wfll be referred to in thispublication as The Act, was shaped by the interaction ”of at leastfour antecedents: the historical thrust toward region&ation ofhealth resources; the development of a national biomedicd researchcommunity of unprecedented size and productivity; the changingneeds of society; and finally, the paficdar legislative process leadingto The Act itself.

The concept of regiondization as a means to meet health needs4mtively and economically is not new. Bng the 19W’s, AssistantSurgeon &neral Joseph W. Mountin was one of the earliest pioneersurging this approach for the delivery of health services. The na-tional Committee on the Costa of Medicd Care dao focused attentionin 1932 on the potential benefits of regiondization. In that sameyear, the Bingham Associates Fund initiated the first comprehensiveregional effort to improve patient care in the United Sta~. Thisprogram linked the hospitals and programs for continuing educationof physicians in the State of Maine with the university centers of

~ Boston. Advocates of regiondization next gained national attentionmore than a decade later in the report of the Commission on HospitalCare and in the Hospital Survey and Construction (HiU-Burton)

,, Act of IM. Other proposab and attempts to introdum regionaliza-,,, tion of health resources can be chronicled, but a strong nationalq

.,,; movement toward regionalization had to await the convergence of

other factors which occurred in IN and 1%5.One of three factors was the creation of a national biomedicd

research effort unprecedented in history and unequdled anywhereelse in the world. The effect of this activity was and Continu- to beintensified by the swiftness of ita creation and expansion: at thebeginning of World War II the national expenditure for medical re-

1search totaled M million; by 1W7 it was @7 miflion; and in 1%7the total was $2.257 billion—a 5,~ percent incre- in 27 years.The most significant characteristic of this research effort is the tre-mendous rate at which it is producing new knowledge in the medicalsciences, an outpouring which only rwently began and which shows,.no signs of decline. As a resdt, chang= in health care have beendramatic. Today, there are cures where none existed before, anumber of diseases have all but disappeared with the application of

~,. new vaccin=, and patient care genera~y is far more effective than1:, even a decade ago. It has become apparent in the last few years,~i,. however, (despite substantial achievements), that new and better,.

means must also be found to convey the ever-increasing volume of.; research results to the practicing physician and to meet growing

complexities in medical and hospital care, including specialization,

?

8

increasingly intricate and expensive types of diagnosis and treat-ment, and the distribution of scarce manpower, facilities, and otherresources. ~e degree of urgency attached to the need to cope withth~ issues is heightened by an increasing public demand that thelatest and best health care be made avaflable to everyone. ~ispublic demand: in turn, is lar~elv an expression of expectations.aroused by awareness of the ~es~lts and promise of b~omedicalresearch.

In a sense, the national commitment to biomedical investigationis one manifestation of the third factor which contributed to thecreation of Regional Medical Programs: the changing needs ofsociety—in this case, health needs. me decisions by various privateand public institutions to support biomedical research were responsesto this societal need perceived and interpreted by thw institutions.In addition to the support of research, the same interpretive promssled the Federal Government to develop a broad range of other pro-grams to improve the quality and availability of health care in theNation. me Hill-Burton Program which began with the passage ofthe previously mentioned Hospital Survey and Construction Act ofIM, together with the National Mental Health Act of 1%, was thefirst in a series of post-World War II legislative actions havingmajor impact on health affairs. When the 89th Congress adjournedin 1=, 25 health-related bib had been enacted into law. Amongthese were Medicare and Medicaid to pay for hospital and physicianservices for the Nation’s aged and poor; the Comprehensive HealthPlanning Act to provide funds to each state for nonmategoncal healthplanning and to support services rendered through state and otherhealth activities; and Public Lw 8%239 authorizing Regional Medi-Cd Programs.

me report of the President’s Commission on Heart Disease,Cancer, and Stroke, issued in December 1~, focused attention onsocietal needs and led directly to introduction of the legislation au-thorizing Regional Medical Programs. Many of the Co~ission’srecommendations were significantly altered ‘by the Congress in the,legislative process but me Act was clearly passed to meet needsand problems identified and given national recognition in the Com-mission’s report and in the Congressional hearings preceding pas-sage in me Act., Some of these needs and problems were expressedas fo~ows:●

●

●

A program is needed to focus the Nation’s health resources forresearch, teaching and patient ~re on heart disease, cancer,stroke and related diseases, because together they cause 70 per-cent of the deaths in the United States.A significant number of Americans with these diseases die or aredisabled ~ause the benefits of present knowl+e h the medicalsciences are not uniforndy available throughout the country.mere is not enough trained manpower to meet the health needs ofthe American people within the pr~nt system for the delivery ofhealth services.

9

—●

●

●

●

Pressures threatening the Nation’s health resources are buildingbecause demands for health services are rapi~y increasing at f “

a time when increasing costs are posing obstacles for many whorequire these preventive, diagnostic, therapeutic and rehabfiitativeservicm. .A creative partnership must be forged among the Nation’s medi-cal scientists, practicing physicians, and W of the Nation’s otherhealth resources so that new knowledge can be translated morerapidly into better patient care. ~is partnership should make itpossible for every community’s practicing physicians to sharein the diagnostic, therapeutic and constitative resourw of majormedical institutions. ~ey should similarly be provided the op-porthity to participate in the academic environment of research,teaching and patient care which stimulates and supports medicdpractice of the highest quality.Institutions with high quality research programs in heart disease,cancer, stroke, and related diseases are too few, given the magni-tude of the problems, and are not unifotiy distributed through-out the country.mere is a need to educate the Dublic re~ardinz health affairs.Mucation in many cases wi~ ~~mit peop~e to e~tend their ownlives by changing prsonal habits to prevent heart disease, cancer,stroke and related diseases. Such education win enable indi-viduals to recognize the need for diagnostic, therapeutic or re-habilitative services, and to know where to find these servic~,and it will motivate them to seek such services when needed.

During the Congressional hearings on this bill, repr~ntatives ofmajor groups and institutions with an interest in the American healthsystem were heard, particularly spokesmen for practicing physiciansand community hospitals of the Nation. me Act which emergedturned away from tie idea of a detailed Fderal blueprint for action.Specifically, the network of “regional centers” recommended earlierby the President’s Commission was replaced by a concept of “regionalcooperative arrangements” among existing health resources. meAct mtablishes a system of grants to enable repr~ntativa of healthresources to exercise initiative to identify and meet local needswithin the area of the categorical diseases through a broady definedprocess. Recognition of geographical and societal diversities withinthe United States was the main reason for this approach, and spokes-men for the Nation’s health resources who testified during theharings strengthened the case for local initiative. ~us the degreeto which the various Regional Medical Programs meet the objectivesof me Act wfll provide a measure of how well local health resourcescan take the initiative and work together to improve patient care forheart disease, cancer, stroke and related diseases at the local level.

me Act is intended to provide the means for conveying to themedicd institutions and professions of the Nation the latest advancein medicd science for diagnosis, treatment, and rehabilitation of

10

1

9 patients ~icted with hea~ disease, cancer, stroke, or related”di-seases-and to prevent these diseases. me gran~ aufiorized by ~eAct are to encourage and assist in the “~tablishment of regionalcooperative arrangement among medical schools, r~arch institu-tions, hospitals, and other medicd institutions and agencies toachieve these ends bby research, education, and demonstrations ofpatient care. ~rotigh these means, the programs authorized by meAct are abo intended to improve generally the health manpower andfacilities of the Nation. - - -

In the two years since the President signed me Act, broa~yrepresentative groups have organized themselves to conduct RegionalMedicd Programs in more than W Regions which they themselveshave defined. ~ese Regions encompaw the Nation’s population.~ey have been formed bv the or~anizin~ groups using functional as

..”

weti-as geographic criteria. ~ese R&~n~- in~lude c~hinations of

t1,.3

entire stat~- (e.g. the Washington.Alaska Region), portions of sev-eral states (e.g. the Intermountain Region includes Utah and sec-tions of Colorado, Idaho, Montana, Nevada and Wyoming), singlestates (e.g. Gorgia), and portions of states around a metro~litancenter (e.g. the Rochester Region which includ~ the city and 11surrounding counties). Within these Regional Programs, a widevariety of organization structur~ have been develo@, includingexecutive and planning committ~, categorical disease task forces,and community and other types of sub-r%ion~ advisory committees.

Regions first may receive planning grants from the Division ofRegional Medicd Programs, and then my be awarded operationalgrants to fund activitim planned with initial and subsequent planninggrants. ~ese operational programs are the direct means for Re-gional Medical Programs to accomplish their objectiv~. Planningmoves a Region toward operational activity and is a continuingmeans for assuring the relevancy and appropriateness of operationalactivity. It is the effects of the operational activities, however, whichwill produce resul~ by which Regional Medical Programs win bejudged.

On November 9, 1%7, the President sent the Congress the Reporton Regiod Medi& Progrms prepared by the Surgeon &nerd ofthe Public Health Service, and submitted to the President through theSecretary of Health, Education, and Welfare, in compliance with meAct. me Report. details the progress of Regional Medical Programsand recommends continuation of the Programs beyond the June 30,1~, limit set forth in me Act. me President’s letter transmittingthe Report to the Congress was at once encouraging and exhortativewhen it said, in part: “Because the law and the idea behind it arenew, and the problem is so vast, the progr~ is just emerging fromthe planning state. But his report gives encouraging evidence ofprogre~and it promises great advances in spding researchknowledge to the patient’s bedside.” ~us in the find mven wordsof the President’s message, the objw’tive of Regior-d Medical Pro-grams is clearly emphasized.

11

II

~E NATmE AND POTmIfi OF REGIONWMEDICfi PROGRAMS

GOALIMPROVED PATIENT CARE

The Goal is described in the Surgeon &nerd’s Repoti as6s. . . clear and unequivocal. The focus is on the patient. The obj~tis to influence the present arrangemen~ for health ~rvices in amanner that wi~ permit the kt in modern medicd care for heartdisease, cancer, stroke, and related diseases to be avaflable to all.”

MEAN>THE PROCESS OF REGIONALIZATION

Note: Regi9ntition can connote more than a regional cooperative arrsnge-men~ but for the purpose of this publication, the two terms @ be usedinterchangeably. ne Act uses “regional cooperative arrangement,” but“regiondtition” has become a more convenient synonym.

A regional cooperative arrangement among the fufl array ofavailable health resources is a necessary step in bringing the benefitsof scientific advances in medicine to people wherever they live ina Region they themselves have defined. It enables patients to benefitfrom the inevitable specialization and division of labor which ac-company the expansion of medical knowledge because it provides asystem of working relationships among health personnel and theinstitutions and organizations in which they work. This requiresa commitment of individual and institution~ spirit and resourceswhich must be worked out by each Regional Medical Program. Itis facilitated by voluntary agreemen~ to serve, systematically, theneeds of the public as regards the categorical diseases on a regionalrather than some more narrow basis.

Regionalization, or a regional cooperative arrangement, withinthe context of Regional Medicd Programs has several other impor-tant facets:●

●

It is both function~ and geographic in character. Functionally,regionalization h the mechanism for linking patient care withhedtb research and education within the entire region to providea mutually beneficial interaction. nis ~teraction should occurwithin the operational activities as well as in the total program.The geographic boundaries of a region serve to define the popula-tion for which each Regional Program will be concerned andresponsible. This concern and responsibility should be matchedby responsivenw, which is effected by providing the populationwith a significant voice in the Regional Program’s decision-making process.It provides a means for sharing limited heal& manpower andfac~iti~ to maximize the qudity”and quantity of care ~nd serviceavailable to the Region’s population, and to do this as eco-nomically as possible. In some instan~, tiis may require inter-regional cooperation between two or among several RegionalPrograms.

12

● Finauy, it abo consdtutes a mechanism for coordinating i~categorical program with other health programs in the R~ionso that their combined effect may be increased and so that theycontribute to the creation and maintenance of a system ofcomprehensive health care within the entire Region.

Becaue tb time of kmhdge c~es tb _ of m-&re, regbdisation can best be viewed as a cotiimu processrather th a pkrn wh~h d tdy deve~d & thn i+m~d.This process of regionalization, or cooperative arrangement@, con-sists of at least the following elements: involvement, identification ofneeds and opportunities, assessment of resources, definition of ob-jectives, setting of priorities, implementation, and evaluation. ~flethese seven, elements in the process WU be described and discussedseparately, in practice they are interrelat~, continuous and ofienoccur simultaneously.

Znvdvmnt-Tbe involvement and commitment of individuals,organizations and institutions which WU engage in the activity ofa Regional Medicd Program, as well as those which will be tiectedby this activity, underlie a Regional Program. By involving in thesteps of- study and decision afl those in a @on who are ~sentialto implementation and ultimate SU-, better solutions may befound, the opportunity for wider acceptance of decisions is improved,and implementation of decisions is achieved more rapi~y. ~erattempts to organize health resour~ on a regional basis have ex-perienced difficulty or have been diverted from their objectivesbecause there was not this voluntav involvement and commitmentby the necessary individuals, institutions and organizations. The Act

‘B ~ q~te s~ific to =ure this n=easary involvement in RegionalMedicd Programs: it defines, for example, the minimum composi-tion of Regional Advisory Groups.

The Act states these Regional Advisory Groups must include“practicing physicians, medical center officials, hospital administra-tors, representativ~ from appropriate medical societies, voluntaryhealth agencies, and ‘representatives of other organizations, institu-tions and agencies concerned with activities of the kind to be carriedon under &e program and members of the public familiar with theneed for the services provided under tbe program.n To ensure amaximum opportunity for success, the composition of the RegionalAdvisory Group also should be reflective of the total spectrum ofhealth interests and resources of the entire Re@on. And it shouldbe broadly representative of the geographic areas and dl of thesocioeconomic groups which will be served by the Regional Program.

The Regional Advisory Group does not.have direct administrativeresponsibility for the Regional Program, but the clear intent of theCongress was that the Advisory Group wodd ensure that the RegionalMedical Program is planned and developed with the continuingadvice and assistance of a group which is broadly representative ofwe health interests of the Region. The Advisory Group must approveall proposrds for operational activities within the Regional Program,

13

r

and it prepares an annual statement giving ik evaluation of theeffectiven~s of the regional cooperative arrangements establishedunder the Regional Medical Program.

Identi~tion oj Needs and Opportunit~s-A Regional Me&c~Program identifies the needs as regards heart disease, cancer, strokeand related di~ within ‘tie entire Region. ~ese needs arestated in terms which offer opportuniti~ for solution.

~is process of identification of needs and opportunities for solu-tion requires a continuing analysis of the problems in delivering thebest medical care for the target diseases on a regional basis, andit goes beyond a generaked statement to definitions which can betranslated into operational activity. Particular opportunities may bedefined bK: id-s and approach- generated within the Region, ex-tension of activities already present within the Region, and ap-proaches and activities developed elsewhere which might be appliedwithin the Region.

Among various identified needs ~ere also are often relationshipswhich, when perceived, offer even greater opportunities for solutions.

In ”examining the problem of coronav care units throughout itsRegion, for example, a Regional Program may recognize that themore effective approach would be to consider the total problem ofthe treatment of myocardial infarction patients within the Region.~is broadened approach on a regional basis enables the RegionalProgram to consider the total array of resources within its Region inrelationship to a comprehensive program for the care of the myo-cardial infarction patient. ~us, what was a conmrn of individudhospitals about how to introduce coronary care units has been trans-formed into a project or group of related projects with much greaterpotential for effective and efficient utilization of the Region’s re-sources to improve patient care.

Assessment of Resources—As part of the process of regionalization,a Region continuously updates its inventory of existing resourcesand capabilities in terms of function, S@ number md quality.Every effort is made’to identify and use existing inventories, fillingin the gaps as needed, rather than setting out on a long, expensiveprocess of creating an entirely new inventory. Info~ation sourcesinclude state Hill-Burton agenci~, hospital and medical associations,and voluntary agencies. me invento~ provides a basis for informedjudgments and priority setting on activities proposed for develop-ment under the Region~ Progrm. It Cm ~80 be u~ to identi~

missing resourc~voids requiring new investment-and to developnew configurations of resources to meet needs.

Definition oj Objectives—A Regional Program is continuouslyinvolved in the process of setting operational objectives to meetidentified needs and opportuniti~. obj~tives are intefi stepstoward the Gal defined at the beginning of this section, and achieve-ment of th~ objectives shodd have an effect in the Region feltfar beyond the focal points of the individud activities. ~is can beone of the greatest contributions of Regional Me&cd Programs.

-

i\

*

“me completion of a new project to train nurses to care for cancerpatients undergoing new combinations of drug and radiation therapy,for example, should benefit cancer patients and should provideadditional trained manpower for many hospitals in the Region. Butthe project &o should have ch~enged the Region’s nursing andhospital commun~ti% to improve generally the continuing and in-service education opportunities for nurses within the Region.

$etti~ of Priorities-Because of kited manpower, fac~ties,financing and other resources, a Region assigns some order ofpriority to its objectives and to the steps to achieve them. Bmidtithe limitations on resources, factors include: 1) balance betweenwhat should be done first to meet the Region’s needs, in absoluteterms, and what can be done using existing resources and compe-tenu; 2) the potentials for rapid and/or substantial progress towardthe Goal of Regional Medical”Programs and progress toward re-giondization of health rmources and service; and 3) Programbalance in terms of disease categories and in terms of emphasis onpatient care, education and research.

Im+e-.on—~e purpose of the preceding steps is to providea base and imperative for action. In the creation of an initi~ Op-

erational program, no Region can attempt to determine d of the .program objectives possible, design appropriate projects to meet anthe objectives and then assign priorities before aeetig a grant toimplement an operational program which encompasses dl or evenmost of the projects. Implementation can occur with an initialoperational program encompassing even a smau number of weU-designed projects which WN move the Region toward the attainment

9

of valid program objectives. Because regiondization is a continuousprocess, a Region is expected to continue to submit supplemental andadditional operational proposals as they are developed.

Ev-hn—Each planning and operational activity of a Region,as we~ as the overall Regional Progr~ receiv~ continuous, quan-titative and qualitative evaluation wherever possible. Evaluation isin terms of attainment of interim objectives, the pro- of regionali-zation, and the Goal of Regional Medicd Programs.

Objective evaluation is simply a reasonable basis upon which todetermine whether an activity should be continued or altered, and,ultimately, whether it achieved its purposes. Mso, the evaluation ofone activity may suggest modifications of another activity whichwould increase its effectiveness,

Any attempt at evaluation implies doing whatever is feasible withinthe state of the art and appropriate for the activity being evaluated.~us, evaluation can range in complexity from simply counting num-bers of people at meetings to the most involved determination ofbehavioral changes in patient management.

As a first step, however, evaluation entaib a realistic attempt todesign activities so that, as they are implemented and finally con-cluded, some data will resdt which wiu be useful in determining thedegree of success attained by the activity.

CRITERIA—EVALUATION OF REGIONAL MEDICALPROGRAMS

The criterion for judging the success of a Region in implementingthe process of regiondization is the degree to which it can bedemonstrated that the Regional Program has implemented the sevenessential elements discussed in this ~apter: involvement, identifica-tion of needs and opportunities, assessment of r~ourcm, definitionof objectives, ~tting of priorities, implementation, and evaluation.

Wtimately, the overall succ~s of any Regional Medical Programmust be judged by the extent to which it can be demonstrated thatthe Regional Program has assisted the providers of health services indeveloping a system which makes available to everyone in the Regionimproved cue for heart disease, cancer, stroke, and related diseases.

PUBLIC MW 89-239c’

Through grants, to afford to the medical profession and the medical institu-tions of the Nation the opportunity of planning and implementing programsto make available to the American people the latest advances in the diag-nosis and treatment of heart disease, cancer, stroke, and related diseases byestablishing voluntary regional cooperative arrangements among . . .

Physicians . Voluntary Health Agencies

Hospitals . Federal, State, and LocalHealth Agencies

Medical Schools

Research Institutions ● Civic Organizations

REGIONALADVISORYGROUPS

The activities of Regi6nal Medical Programs are directed by fulltime Co-ordinators working together with Regional Advisory Groups which arebroadly representative of the medical and health resources of the Regions.Membership on these groups nationally is:

Officials

OtherHealthWorkers

VoluntaryHealth Age]

\PracticingPhysicians

Hospital. Administrators

Public Health

loyo

loyo

Total: 2315

Medical Center-School Officials

Other

Membersof the Public

17

19M DECEMBER

OCTOBER

DECE~ER

1966 ~BRUARY

APB3L ‘

JUNE

JULY

AUGUST

~BER

NOVE~ER

1967 JANUARY

FEBRUARY

APRIL

MAY

JUNEJULY

AUGUST~OBER

NOVEMBER

1968 JANUARY

FEBRUARYAPRILmY

JULY

AUGUST

OC70BER

NO=~ER

1%9 JANUARY

FEBRUARY

APR3L

mY

JULY

EVENTS

.epom of the P=ident’s;ommissiononH@fiDtiem,:ancer, and Stroke

.:on~tiond hearings

~nactment of P.L 89-X9

lational Advison Council m-ting

~stabhsbent of Division‘~limtion of prelitin~;uidehnesIational Advisow Council m=ting

ieview Gtittee mmtigIational Advisov Gucilmeting

leview Gtittee m=tingiational Advisow Gucil meting

‘ublimtion of Gtideties[eview Committee meting

iational Advisow Council meeting

{eview COmtittee meting

iational Advisow Council meethg

{ational Advisou Council m=ting

Review Co-ittee meeting

~ational Advisory Council m=ting

Repofi to tbe President & Con-

Reriew Comittee meettig

Wational AdvtiW ~uncil mmting

Review Gmtittee meetig

Yational AdvisoW Council meeting

Conference Work&op

Retiew Cowittee mmtig

National Advisoq Council meeting

Retiew Cotittee metig

National Adtisoq Councif m=ting

Renew Gtittee mwttig

Natioml Ad*n Councfl meeting

Retiw tikttm meeting

National Adtimw Comcil m=ting

Review Comittee meeting

National Adtiwq Comcil m=ting

Retiew G-ittee meeting

National Adtimw Coucil m~g

Retiew &mmittee m-

—

ACTfON 6

POHcy for mriew pmmd Ditision actititim wt

7 plmning Wan& awuded

3 planntig Wmts awaded

National tiews & hfomationfor Rep~ provided

10 phnning and 4 o~ratioml~mts awwdd

5 plannkg md 1 oWrational@ant awmdd

2 planning wants awarded

2 planning md 3 o~rationd~mts aw~dd

Regionfl activities md idempresented

1 plmning md 10 operationalWmts awmdd

1 o~rational gant awmdd

1 platiw and 7 owrational~mb awmded

9 o~rational ~anw awarded

.5 oyrational wanh aw~ded

.

.

o.

Additional publications on Regional Medical Programswhich are available on request are:

● DIRECTORY OF REGIONAL MEDICAL PROGRAMSRevised as of June 4, 1969 to IncludeAU Approved Operational Projects andProg~ Data

. GUIDELINE=Regional Medical ProgramsRevised May 1963

. S~ECTED BIBLIOGRAPW of RegionalMe&cd Programs First RevisionFebruary 1%9

● ~uM~mvE INDEX (May 1967-May 1%9)For News, Inforwtion ad DatiPublications

These publications and other maierial on RegionalMedicd Programs maybe obtained from:

PubKcations ServiceOffice of Communications and Public InformationRegional Medical Programs ServiceWiscon Building, Room 3~~ Rockville PikeBethesda, Maryland 2~14

Q. ..’.

* U. S. GOV~NM~ ~ ~G OF~CE : 196969549(1Q)

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