QUESTIONS FOR DR. WILSON

1.

2.

3.

4.

5.

6.

7.

8.

Dr. Wilson, can you tell us about your own involvement

with Regional Medical Programs (RMPs)?

What can you tell us about the intellectual and political

origins of the RMP program? How and why did the program

as it emerged differ from the recommendations in the

DeBakey report?

What do you think were the major accomplishments of RMPs?

What specific aspect were you personally most pleased

with?

Why was the RMP program moved in 1968 from NIH to HSMHA,

an agency that you headed from 1970 to 1973?

What can you tell us about why and how RMPs were

terminated?

How did RMPs relate to other programs designed to

integrate health care activities, such as comprehensive

Health Planning?

What can we learn from the RMP experience?

IS there any other

concerning RMPs?

point that you would like to make

GENERAL STATEMENT TO OPEN WILSON INTERVIEW

This is Dr. Donald Lindberg, Director of the National Library of

Medicine in Bethesda, Maryland. The interview that I am about to

conduct is one of a series of interviews designed to record and

document the history of Regional Medical Programs. With me in the

NLM studio today, July 24, 1991, is Dr. Vernon E. Wilson.

Background for Wilson Interview

Dr. Wilson was Administrator of the Health Services and MentalHealth Administration (HSMHA) in HEW, 1970-73. He also served asthe first Program Coordinator of the Missouri Regional MedicalProgram (established in 1966).

He served under two Secretaries of HEW:June, 1970 - October, 1972 Elliot RichardsonFrom November, 1972 Caspar Weinberger

House RMP oversight Hearings held May 8, 1973

Attachments:

American Men and Women of Science biographical sketch of Wilson

Copy of his presentation on ‘lProgramEvaluationt’at the 1967Conference on RMPs

VI? -.. $ ----- - .

r Exp Sta, Auburn Umv, 75-80; vpres agr, home econ a vet mea, w-;OC1-iEM GENETICS,NAT HEART,LUNG & BLOOD lNST,STS HEALTH, BETHESDA, MD. Mern: AAAS; Genetics Soc Am;;ti ASK Am SOCAnimal Se!; Am GenetlC As~” Res: Selection stud.ies~lium, mice, poult~ and swine; effects of matmg systems on selectlontic paratnetem. Madmg Add: Nat Hearl Lung & Blood Inst NIH BldgRockville Pike Bethesda MD 20205

STEPHEN ROSS, ,b OkIahoma City, OkIa, Mar 13, 46; m 67; c 2.ETIC ORGANIC CHEMISTRY. EdIJc: Rice Univ, BA, 69, MA, 72,them), 72. Prof Exp: NIHfelorgthem,CalifInstTechnol, 72-74;org them, Ind Univ, Bloomington, 74-787 assoc P,rof,78-80; ASSOC)RG CHEM, NY UNIV, 80- Concurrent Pos: S]gma Xi res award,v, 72. Mern: Royai Soc Chem; Am Chem Sot. Res: Development ofjroaches to the synthesis of naturally occurring compounds of,1significance, and the structure elucidation and tota~ synthesis of;tances. Mailing Add: DePtChernNYUnjVWashington Square Newr 10003

STEPHEN W, b Hackensack, NJ, Feb 6, 52; m 73; c 1.OMY OF PLANTHOPPERS.EdUC:RutgersUnjv,Bs,73;st Mo State LJniv, MA, 75; Southern Ill Univ, PhD(zool), 80. Proft prof biol, Calif StateUniv, Chico, 80-82; asst prof, 82-85, ASSOCIOL, CENT MO STATE UNW, WARRENSBURG, 85- Mere:oc Am. Res: Systematic and ecology of planthoppers (Homoptera:fea) with emphasis on Delphacidae. Mailing Add: Dept Biol Cent: Univ Warrensburg MO 64093-5053

STEVEN PAW., b New Castle, Pa Ott 12, 5Q m 72; c 1.CHEMISTRY. J3duc: Univ Pittsburgh, BS, 72; Duke Univ,:hem), 76. Prof Exp: Guest worker, Nat Heart, Lung & Blood Inst,78, staff fel, 78-79; vis scientist, Dept Med Biochem, WeI1come Resrroughs Wellcome Co, Research Triangle Park, NC, 79-81; ASSTs.SPROF, DEPT PHARM, DUKE UNIV MED Cl_R, DURHAM,Concurrent Pos: Fel neurol, Sch Med & Dent, George Washington6.7g. Mern: SOC Neurosci. Res: Biochemical aspects oflsmitter secretion and synapse formation; regulation ofmine and opioid peptide biosynthesis, neurobiology ,of adrenalin ceils. MaiJing Add: Dept Pharmacol Box 3813 Duke Univ Medam NC 27710

THEODORE ALEXANDER), b Elgin, 111, June 20, 35.AUTICAL ENGINEERING, BIOMECHANICS. Edt.m: Cornell%gPhysics, 58, PhD(aeronaut eng), 62. Prof Exp: Res scientist,trett Res Lab, 62-63 & Jet Propulsion Lab, 63-64; from asst prof to~f aeronaut & eng mech, 64-72, PROF AEROSPACE ENG &UNW MINN, MINNEAPOLIS, 72- Mere: Am Physiol SW. Res:my mechanics acoustics; fluid mechanics. Mailing Add: Dept ofe Eng & Mech Univ of Minn Minneapolis MN 55455

THOMAS EDWARD, b Chicago, Ill, Feb 20, 42; m 66; c 2.~NMENTAL & CHEMICAL ENGINEERING. Educ:]ternUniv, BS, 64, MS, 67; 111Inst Technol, PhD(environ eng), 69.x Asst prof environ eng, Rutgers Univ, New Brunswick, 67-70;.T POLLUTION CONTROL & WATER TREATMENT,~Y & HANSEN, 70- &fern: Am Inst Chem Engrs; Int Asn WaterRes; Water Pollution Control Fedn; Am Soc Civil Engrs; Am Watersn; Sigma X]. Res: Pollution control; advanced waste treatment;;hemical treatment processes; solids and sludge disposal; industrialatment; treatment plant operations. Mailing Add: 1527 E Flemingngton Heights IL 60004

THOMAS G(EORGE), b Annapolis, Md, Jan 19, 26; m 49; c 3.ICAL ENGINEERING. Educ: Harvard Univ, AB, 47, SM, 49,eng), 53. fJrof E~p: p~ysjcjs~ Us Naval ord Lab, 48, elec engr, USs Lab, 49-53; mgr res & deveIop, Magnetics, Inc, 53-59; assoc prof,mn dept, 64.70, pROF ELEC ENG, DUKE UNIV, 63- Mere: Instelectronics Engrs; Sigma Xi. Res: Magnetic devices, materials and~; nonlinear electromagnetic; energy convemion. Mailing Add:ZIec Eng Duke Univ Durham NC 27706

THOMAS HASTINGS, b phi~de]phia, pa, Jan 31, 25; m 52; c 2.LOGY. Educ: LJNV Pa, MD, 48; ShefXeld Univ, 51-53,hem), 53. Prof Exp: Instr physiol, Univ Pa, 49-50; instr biochem,iv, 56-57; assoc physiol, 57-59, from asst prof to assoc prof, 59-68,IYSIOL, HARVARD MED SCH, 68- Mere: Am Soc Biol Chem;iol SW; Brit Biochem SOC.Res: Active transport of materials across~ranes. Mailing Add: Dept of Physiol Harvard Med Sch Boston MA

.-. . .... .... .decomposition; rubber and inorganic ;hernistry. Mailing Add: 7 RockbrookDr Camden ME 04843

WILSON, THOMAS PUTNAIM, b New York, NY, Sept 4, 18; m 44, 80; c 1.HETEROGENEOUS CATALYSIS. Educ: Amherst CO], BA, 39; HarvardUniv, PhD(chem physics), 43. ProfExp: Res chemist, Manhattan Proj, M WKellogg Co, NJ, 43-44; res chemist, Kellex Corp. 44-45; res chemist,Manhattan Proj & S A M Labs, Chems & Plastics Dlv, 45-46 & 46-62, asstdir res, 62-72, res assoc, 72-73, CORP RES FEL, RES & DEVELOP DEPT,ETHYLENE OXIDE/GLYCOL DIV, UNION CARBIDE CORP, 73-Mem: Am Chem Sot; Catalysis Sot. Res: Kinetics and catalysis; catalyticreaction mechanisms; ethylene polymerization; catalyst development andcharacterization. Mailing Add: 701 Myrtle Rd South Charleston WV 25314

WILSON, THORNTON ARNOLD, b Sikeston, Mo, Feb 8, 21; m 44; c 3.AERONAUTICS. Educ: Ioura State Col, BS, 43; Calif Inst Technol, MS, 48.Prof Exp: Mem staff, 43-57, asst chief tech staff& proj eng mgr, 57-58, vpres& mgr Minuteman br, Aerospace Div, 62-64, vpres opers & planning, 64-66,exec vpres & dir, 66-68, pres, 68-72, CHIEF EXEC OFFICER & CHMN BD,BOEING CO, 72- Concurrent Pos: Sloan fel, Mass Inst Technol, 52-53; membd gov, Iowa State Univ Found. Mere: Nat Acad Eng; fel Am lnst Aeronaut& AstronauL Mailing Add: Boeing Co PO Box 3707 Seattle WA 98124

WILSON, TIMOTHY M, b Columbus, Ohio, Aug 3, 38; c 2. SOLID STATEPHYSICS. Educ: Univ FIL BS, 61, Ph?l(chem physics), 66. Prof Exp: Fe]solid state physics, Univ Fla, 66-68, asst prof them, 68-6% from asst prof toassoc prof physics, 69-78, asst dir exten, Col Arts & SCI, 77-79, sssoc direxten, 79-82, PROF PHYSICS, OKLA STATE UNIV, 78- Concurrent Pos:Res staff mem, Solid State Div, Oak Ridge Nat Lab, 74-75. Mere: Am PhysSot; Sigma Xi; Am Asn Physics Teachers. Res: Theoretical studies of theoptical and magnetic properties of impurities and defects in crystalline solids.Mailing Add: Dept Physics Okla State Univ Stillwater OK 74078

WILSON, VERNON EARI+ b Plymouth Co, Iowa, Feb 16, 15; m 47; c 2.MEDICAL ADMINISTRATION, FAMILY MEDICINE. Educ: Univ 111,BS, 50, MS & MD, 52. Prof Exp: Asst pharmacoI, Univ Ill, 50-52; intern, UnivHosp, Chicago, 52-53; asst prof, Sch Meal, Umv Kans, 53-59, asst dean schreed, 57-59, actg dean sch med & actg dir med ctr, 59; prof pharmacol, UnivMe-Columbia, 59-70, dean sch med & dir med ctr, 59-67, exec dir healthaffairs, 67-68, vpres acad affairs, 68-70; adminr, Health Serv & Merit HealthAdmin, Dept Heaith Educ & Welfare, Md, 70-73; prof community health,Univ Mo-Columbia, 73-74; vchancellor med affairs, Vanderbilt Univ, 74-81;RETIRED. Concurrent Pos: Exec officer, Mo State Crippled Children’s Serv,60-68; mem exec coun, Am Asn Med Cols, 6 1-67; mem, Am Bd Family Pratt,62-74; consult, USPHS, 65-69; coun mem med educ, AMA, 67-75; coordr,Mo Regional Med Prog, 66-68; mem coun fed relationship, Am Asn Univ,68-70; ed, Continuing Educ for Family Physician, 73-75; mem liaison comt,Grad Med Educ, 73-75. Mere: AMA; hon mem Acad Anesthesiol. Res: Renalpharmacolog~ medical education; public health administration. Mailing Add:Box 196 Rte No 1 Ashland MD 65010

WILSON, VERNON ELDRIDGE, genetics, phytopathology, see previousedition

WILSON, VI~OR JOSEPH, b Berlin, Ger, Dec 24, 28; m 53; c 2.NEUROPHYSIOLOGY. Educ: Tufts Col, BS, 48; Univ 111,PhD(physiol), 53.Prof Exp: Res assoc, 56-58, from asst prof to prof neurophysiol, 58-69, PROFNEUROPHYSIOL, ROCKEFELLER UNIV, 69- Mere: Am Physiol Sot;Soc Neurosci; Int Brain Res Org. Res: Organization and synaptic transmissionin the central nervous system, particularly the spinal cord and brain stem;vestibular system. Mailing Add: Rockefeller Univ 1230 York Ave New YorkNY 10021-6399

WILSON, VINCENT L, CHEMICAL CARCINOGENESIS, GENEREGULATION. Educ: Ore State Univ, PhD(pharmacol & toxicol), 80. Pro~Exp: SR STAFF FEL, NAT CANCER INST, NIH, 83- Mailing Add: NatCancer Inst NIH Bldg 37 Rm 2C09 Bethesda MD 20892

WILSON, WALTER DAVIS, b Merced, Calif, Ott 20, 35; m 59; c 3.ATOMIC PHYSICS. Educ: Univ Calif, Berkeley, BS, 57, PhD(nuclear eng),66. Prof Exp: Chem engr, Aerojet Gen Nucleonics, Calif, 58-59; mem techstaff high-altitude nuclear effects, Aerospace Corp, 65-69; PROF PHYSICS,CALIF POLYTECH STATE UNIV, SAN LUIS OBISPO, 69- ConcurrentPOS:Tech consult, Sci Applns, Inc, Calif, 71-75. Mere: Am Inst Physics. Res:High altitude physics, particularly electromagnetic field propagation,chemistry and trapped radiation; plasma physics; nuclear reactor theory.Mailing Add: Dept of Physics Calif Polytech IJniv San Luis Obispo CA 93407

WILSON, WALTER ERVIN, b Salem, Ore, Apr 1, 34. RADIOLOGICALPHYSICS. Educ: Willamette Univ, BA, 56; Univ Wis, MS, 58, PhD(physics),61. F’rof ExfJ: RADIATION PHYSICIST, PAC NORTHWEST LABS.— -- . - - .-. . .. ?-- f. -.--.. —--- n-”. G.1 D---I IT-;., L1A7 & lJniv

Proceedings: Conference on January 15-17, 1967 U.S. DEPARTMENT

Regional Medical Programs Washington, D.C. OF HEALTH,

EDUCATION, ANDI

WELFARE

Public Health Service

National Institutes of Health

Division of

Regional Medical Programs

For Sale by the Superintendent of Documents,

lJ. S. Government Prlntlng Of ftce,

Washington. D. C. ‘20402

Price 75 cer1t5 (paper cover%)

.

1“mmam,#

,, ‘ Program Evaluation

,.,’

)Ive ~ ‘to

II

;‘ ne di(emma of a dean from the dayical , ~ of his appointment is to know when toIIity:ln

:hat

ility

ndsries

je~malled,~ichJ of

speak out and when to remain silent.Speaking requires at least an acknowl-edged topic and at best a brief, flavor.

ful and meaty content. [n pursuing thesomewhat evanescent title assignedfor this topic—which evolved from“Program,” to “Program and Evalua.

tlon,” to “Program Evaluation,” I mustcorrfess that the merit of silenceloomed ever more attractive.

Since detailed discussion of technicalevaluation procedures would not beappropriate under our limits of time,let us compromise and discuss somewell known principles of program and,

for the health field, some relativelyunused principles of evaluation. Wewill examine both in the light of bppo~tunities presented by the RegionalMedical Programs.

The challenge to Regional Medical Pro-grqms, as I sea it, is to demonstrate

that this new endeavor, establishedprimarily in behalf of heart, stroke,cancer, and related diseases, is morethan a static assemblage of existing

resources. This in itself is a basis forvery careful thought. Most of the prin.

ciples and programs which can be con.sidered in the field of health and

health care have been studied by one

or another of the existing Govern.mental, academic, professional or vol.untary groups. Thus, at the outset kseems apparent that the aim of the

Regional Medical Programs must beone of syrrthesis, an effort to combinethese various factors into a wholewhich will be greater than the sum ofthe pans.

Vernon E. Wilson, M.D.Dean, School of Medicine, University of Missoud

Program Coordinator, Missouri Regional Medical Program

We have already heard that the ap.pearance of the Regional Medical Pro.grams through Federal legislation wasa dhect result of growing public andprofessional unrest centered around

the slow rate at which new knowledgewas being put to use. This concern isnot unique to tha health field but itis new as a major emphasis amongthe concerns of the health care profes.

sions. The agricultural and engineering

experiment station5, long an integralpart of the land-grant colleges, rewesent one attempt to deal with this .problem. The Engineers already have atdrm for it. They label this activity the“transfer of technology.”

It would appear then that the specialmission of Regional Medical ProgramsIs primarily one of. research In the“distribution of health care” with thefocus placed firmly upon the patient’sneeds, rather than upon those of theinstitution or the health professions.

Until the early part of this century the

healing arts possessed a dismallysmall amount of scientific information;consequently, tha need was primarilyfor basic medical knowledge. With themomentum now established in basicresearch we can give increased emphe.sis to Indirect factors, such as popula.

tlon size, number of related organiza.tlons and groups, Increased capabilitiesIn communication facilities, and anever accelerating rate of obsolescenceof knowledge. The magnitude of resent

Congressional appropriations Indicates

the need for immediate action, Addl.

tional and similar legislation is under

serious consideration. Tha compreherv

-21

sive health planning act provides alogical outlet for knowledge developedunder Regional Medical Programs.Thus, research being done in the more

limited field of Regional Medical Pro.

grams can be of value throughout the

total health care field.

Because of the large amount of timeand money to be expended, realistic

evaluation of the results is mandatory.Unfortunately, we are hampered by alack of effective measurement tools.We must start by using available andsimple techniques, while admittingtheir inadequacies. It is essential thatcollaborative research in system de.sign for the distribution of health care

*be initiated in concert with those aca-demic disciplines which have a long

tradition in simulation, systems re.search, and communications research,thus providing a base for continuinganalysis and measurement.

Existing resources for use in thedesign of such systems are impres-

sive indeed. If one looks at the greatarray of governmental health agencies,academic institutions, voluntary andprofessional groups, as well as sup-portive organizations like welfare agemties, community action groups andothers, it readily becomes apparentthat the major problem is not that ofcreating resources which could appro-priately handle the problem but rathera coordination of those resources intoan effective unit. Although to some thecomparison may be a bit unpalatable,I submit that this is a market and dia.

tribution process and should be harvdied as such. An approach of this kinddoes not deny the essential nature of

22

professional and academic ion.tributions; it will require a formal andscientific search for an appropriate re-lationship between all academicians

and professionals whose skills can be

helpful, Concurrentlyr the integrity of

the academic and research communi-ty must be preserved, both as an in.ternal system and as a part of societyat large. Thus, the analogy of market-ing is in all probability much morethan an analogy. It may prove to bean actual pattern which will provide uswith illustrations and some basic prin-ciples for fruitful pursuit of the tasksahead.

The Distribution Process. As a l~ymanin this special field, may I offer theoversimplified explanation that the

production and distribution processamounts to a coordination of manydisciplines, assembled for the con.tribution which each can make to asingle goal. While such grouping of re-sources, particularly in the research

process, suggests the antithesis of thetraditional academic departmental or.ganization, the concept is not unfamil-iar to academic institutions. It is

exemplified frequently in institutes onuniversity campuses, in Iand.grant ex-

periment stations, and research

centers. These patterns allow manydisciplines to proceed in a systematicfashion in searching for new informs.tion and combining that informationinto an orderly whole.

Taking the marketing analogy one step

further, the rational distribution proc-ess would be simulated and developedas follows:

The first step is the establishment ofneed, either recognized or unrecog.nized. The next step, after the need Isdetermined, is to define it and tocreate recognition of that specific need

in both the consumer and producer.

Here we have a direct parallel with theopportunities open to Regional MedicalPrograms.

Having identified a specific need orneeds, it is necessa~ to undertakebasic and applied research in materi.

als, resources and their synthesis. Themedical profession has expended pro.portionately small amounts of its ownenergies in the endeavor of synthesisand at the same time has frequentlypoorly utilized the contributions whichcould be made by other disciplines.

Having completed the “basic” researchand formulated working models, thenext step is the production and de-livery of materials and services whichmay come from a variety of places.In the analogy the patient may move

to the resources, or the resources may

be brought to the patient, but finallythe delivery process requires that theend product of health care be synthesized in a coordinated and personalizedmanner for the benefit of the consumer.

Market identification. If we consider

health care in the light of the patient’sneed, recognized or unrecognized, thefirst painful but necessary step will bea shift in emphasis. Much basic re-search has been sponsored upon theassumption that improvement of theprofessions and institutions will auto.

matically benefit patients. However, itmay be that the goals of the patient

and those of the profession are notalways the same, To accomplish ourtask we must now direct extensivestudy toward the patient and his needswithin the context of his normal pat.tern of living.

Professional action has classically

been one of response, after the patient

requests and is given access to theformal health care system. We mustnow accept responsibility for healthcare of the public as a dynamic, inti.mate part of dai [y perfo rma rice.

Identification of needs for concentrat-ed research endeavors will require the

development of end points or goalsagainst which the effect of change inqualitative performance can be meas-ured. Unfortunately, at present, suchend points are few and largely Unpr&ven.

Most of the measurement systems cur,rently used in the health professionsare quantitative rather than qualitativein nature. We can measure quite ade

quateiy deaths, morbidity, numbers oipersonnel, and similar items, but Wehave few means by which we can te$ithe impact of health care upon th~daily performance of a given individualThus, our first requirement is for tmeasurement system which can asses:

the ability of the individual to perfornas a useful member of society and hi’own attitude toward that performanceAlso required will be a measurement othe social or peer group’s estimate othe value of the individual’s contribution to the group and their attitud(toward that contribution. No single onof these factors can be used as th

sole parameter, but when assembledas a pattern they should provide atleast the first steps in a qualitativemeasurement of heafth care.

Since diagnosis is also a part of mar-ket definition and since diagnosis of.ten opens communications betweenprofessional individuals, early detec.tion of disease would appear to be alogical first research effort for imProve”ment in the distribution of health care.Such research avoids dre necessity ofpremature decisions having to do withdelivery of health care and would allowa “tooling up” of the communicationssystem tinder reduced emotional ten.sion. Much diagnostic support can beprovided to individual practitioners

with a minimal change in their presentpractice patterns.

Status of the patient needs study. In.teraction between individuals is heavily

influenced by the status, stated andfelt, of each person. We are proposingntalor changes in the status of the pa.tient in the health care system. Thiscalls for a “shorthand” method inter-woven into the system itself to assessstatus, and change in status, particu.Iarly of the patient.

ArJ interesting, correlation exists be.tween the way we use the time ofothers and our estimate of their im.portance. Crmscquently, accurate de”termination of our expenditure of thepatient’s time through the rfesign of

health services is accessible, measurecable, and Dotentia!ly valuable.

Another little used field of knowlerice,._-A ~~ advertisirrc re.

Iished knowledge about health is notutilized even by those best acquaintedwith it. Advcrtislnc research has a rich

body of basic knowledge and tech.mques dealing with facilitators, or whypeople choose one sewice or productas opposed to another. These toolsand techniques used so successfully inadvertising could be adapted and

should be useful in broadening publiceducation and personal responsibilityin health care.

Turning to the third item in our analo.

gY, namely research in materials an(fresources, we should comment first onbasic research which has a lonr2 uni.versity tradition and is the foundationupon which appiied research is corr-ducted. Basic research in almost allacademic disciplines will make impn~tant contributions to health care. HiEhon the list should be research insynthesis of systems, !ncluding model

building. In our past, testing throughmodels has had little systematic andcomprehensive attention. It could

produce large savings in time, as wellas funds, but will require the talents ofa variety of existing disciplines—theengineers, for example, who until re.cently were seldom formally invited into

the health research conversation.

An interesting facet of the dilemma re-lated to manpower shows in the factthat althoOGh we are faced with a tre-

mendous shortace of health personneland a low level of national unernployment, we as a health care group havelar~ely ignored one of our fyeatest po-tentials—the patient himself. He isusually the most involved, often the

.. ..--b..& amt certainly the

most hichly motivated party in the in.

terchan~e, yet we have assicnerl him

the most PilSSiVC role. Patients, i Sllbmit, may not be so helpless as sumcof o(lr practices would seem to imply,our friends in sociolo~y shoIIlrl be ableto help ~Jshere.

In the fourth and final phase of ouranalogy, we will face a variety of prob-lems in the delivery of health care.These include implementation of re-search and development in dis-tribution, All patients Shouid have ac-cess to the best source of carerefjardless of Eeofyaphy, financial re-sources, or special interests of particu-lar professional groups. New patternsare required.

The relationship between centers ofexcellence and the population whichthey would serve will need to bedefined. Most organizations which sup-port health care use politically deter-mined boundaries, i.e., the CitY,county, or State. The probability of

Eaining coordinated support from allinterested organizations for the assist.

ante of a single and specific individualwill be enhanced by a maximum over-

lap in geographical areas of designedresponsibility, This is particularly im.pmtant in evaluation pmcedurcs,

which dcperrd upon many Croups fortheir information.

A second problem to be ccmsidcreddeals wilh control. Shoukf such rfis-

tnbution syslems be totally under tlw

control of the health professions? Ifnot, how much of the process shouldbe crmdttctcd in cooperation with otherinterested Croups? When should con.

trol be turned to them?

A third problem concerns the obsoles.

cent mind, both as it relates to the

nwdicirl profession itself and to tflepltldic at Iarcc. R is clear thatplanned, continuing education for the

profession and the public is necessary.A searching look at potential integra.

tlOn of such education with the careprocess seems called for. Feedbackmechanisms must be established for aprogressive analysis of cause and

effect, or, at least, correlation betweencontinuing education and change.

A successful distribution systcm will it.self require an integrated informationservice. Information should be derived

from the home, from the avenue ofaccess to the health care system, thelocal hospital, and the large medicalcenter. It will require the developmentof common identification systems andvocabularies. Many of us hope that inthe very near future the social securitynumber will be issued at the time ofbirth, or entry into the country, and

will provide such identification. Theproposed information system shouldbe designed to utilize, assist andrefine present systems, not competewith them.

The decision frrr rtimyrosis anrf treat-

ment of the patient will take into ac.count his desires which, among otherthinEs, relate to the distance from

hcaltfl care and the patient’s knowl.cdce of and confidence in the recom-

mcndccl resource. Other considerationsare the adequacy of the health careresol[rces, the cost to the patient andtlm involved acencies, and the maxi.mum benefit from the care process

23

——

which includes such byproducts aseducation, research, and economic im-pact upon the community at large.

Finally, as we have already heard, no

matter how one may describe a Medi-

cal Region, it must interact with otherregions, Mechanisms must be devel.oped which will minimize the mechani-cal problems of interregional relation.ships and permit us to focus upon thepatient.

The Example. With no claims to as-sured success, the Missouri Regionalprogram has attempted to face thesechallenges in the planning process.Projects will arise from community

,groups and be funneled through arefinement process. This should en-courage maximum motivation and par.ticipation at the grassroots level.

A general objective of the program isthe development of models of earlydetection intefyated with continuingeducation.

Primary emphasis will be placed onthose endeavors which can be quanti.tatively evaluated, and the initial as-sumption is made that adequate infor-mation and communication willprovide qualitative improvement. The

long range plan provides for qualita-tive measurement of delivered healthcare.

Only a few projects are proposed forstudies of delivery of care. it is ourintent simply to be supportive to exist.ing care patterns while setting up thenecessary information. gathering mech.anisms. Under this plan, a request forinformation by the physician will be

24

met by a specific answer to the ques.tion, along with additional synopticbackground information or bibliogra.phies which should be helpful in his

continuing education. Such inquirieswill also serve as a guide to the physi.

cian’s needs, fn this manner diagnos.tic and delivery patterns of health carecan quickly be modified in detail whenresearch indicates the desirability ofdoing SO.

The data handling facility developed atthe University of Missouri for the pur-pose of extending the competency ofthe physician will be integrated withcooperative data handling programsestablished by hospitals, physician’soffices, and state agencies. This inte.grated system is expected to furnishfeedback and monitoring which willmake it possible to provide the desiredinformation while studying and coordi.nating the total process in an objectiveand efficient manner.

A University multidiscipline researchunit is developing new tools withwhich to measure achievement. ftsstaff members have joint appointments

with other schools on campus, includ-ing Nursing, Education, Engineering,Journalism, Business and Public Ad.

ministration, Liberal Arts, and Veteri.nary Medicine. Presently members ofthis unit are studying two differentcommunities in which they will mess.ure efforts toward community healthgoals, such as rehabilitation of the pa.tient, family reactions and the like.

In conclusion, let us review, quitebriefly, some goals worthy of consider.ation. These goals were picked be.

cause progress toward them can bemeasured. Their evaluation should giveus some insight into whether or notwe are moving in the direction that

may be most effective in meeting theactual needs of patients.

O The primary goal is to deliver thehighest percentage of quality patientcare as close to the patient’s home aspossible. This is not only economicalin the total picture but in keeping withthe desires of most patients. Certainlythe latter assumption merits study.

O Every patient should have equal ac-cess to any needed national resource.For very special services which are notavailable in the area, patients can besent to centers of excellence else-where, thus eliminating the necessityfor needless duplication of expensiveequipment, staff and facilities,

O Maximum coordination will besought between the inputs of thosewho provide health care directly, aswell as those involved in supporting

that care, such as welfare, communityresources, environmental controlgroups, and others.

O The development of programs to

assist in early and effective detectionof disease will be an important goal.The information gained can be used to

effect changes in delivery of health

care, both through personnef andsystems. Early detection is perhapsleast threatening to the present healthcare professions and is among theeasiest procedures to measure quanti.tatively. (t also possesses ‘the highestpotential for successful qualitativemeasurements of health care.

O Postgraduate education should be

integrated with detection and health

care systems.O Lay health education will be a vital

part of the regional program. Existingadult education and extension pro-grams and activities of voluntary or.ganizations will be utilized so that the

potential recipient of care may be in.formed as to the role which his physi-cian, the hospital, and the various SUPporting agencies will play and to the

things which he, the patient, can ex-pect, We need more scientifically de-signed studies of public attitudes to-ward health care.O Finally, in my view, a crucial goalwill be for each of the several regionsto take a unique approach to the spe-cial needs for their particular areas.Through meetings such as this one,we can share ideas so that a minimumof waste will ensue as we seek to meetour respective responsibilities.

New paths are seldom explored byfaint hearts. We need to be mindfui in

the development of new systems thatone may at times work with less thanperfect parts in order to set the systern itself in operation. It is possibleeven desirable, to have “proof runs”a practice long utilized by the printinfindustry. From tess than perfect initia

operations, changes and correctioncan be made to improve the fin?product.

As participants In this national pr(gram, I believe we dare not do Ies

than marshal the best availabie ta

ents, from whatever quarters, to joiin this quest for improved health cartThe opportunities are attractive an

challenging, to say the least.