mY 1971 - National Institutes of Healthcims,willbeoneofthetiir~ctsOfaid~dcranr; ... patient....
Transcript of mY 1971 - National Institutes of Healthcims,willbeoneofthetiir~ctsOfaid~dcranr; ... patient....
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mY 1971
ofHealth,-.
Educatim,
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,,‘.:t :.andWelfare ::.,:!.[,,
HealthSemicesandMentalHealthAtitiistration ;~~$(,,.
WgionalMedicalProgrm Sewice , \,,!,
Officeof -unications andWlic Information ~,,’
‘~esevignettesonRegionalMedicalProgFamactivitieswerecompiledessentiallyfxommaterialreceivedfromseveralof fie WS *bgFebruary1971, ~wterial wassubmittedinrespo~etoa requestforinfomtiononactivitiesthatrepresentedinnovativeapproaches;tomeetingregionalhealthneeds,Wyof thevignettesdescribe ~activitieswhichdependon theskillsof tiem professionalstaffs:representingtivestientsof ttieandfundsfromfieprofessional ;staffbudgetsratherthanseparatelyfundedprojects.
ll~ebriefs-ries whichfollowaretitendedtobe anecdotalfor ;purposesof illustrationxathert~ toprovidea fulldescription:of~ activities.Formoredetail~informationontheorganizationandactivitiesof~s, thereadershouldconsultthe”Fact’B6dkon ~~•ˆRegionalMedicalProgramsthathasbeenpreparedby theMglonal :MedicalProgramSenlce.
Manyof thevignettesdescribeactivitiesthatfallwithintiescopeofthe President’snationalhealthstrategy.me President’sHealtiMessageof February18,1971outlineda sfi-pointprogramto @lementthatstrategy.me vignettes,therefore,arearrangedunderthefourpointsof thatprogramthataremostrelevanttoM. Manyoftheactivitiesrelatetomorethanonepoint,andintheseinstancesthesmries arearrangedaccordingto tiemainemphasisinthe ~vi~ette,notintheactivity.h indexisincludedwhichprovidesafurtherbreakdownbysubject.
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me selectionofactivitiestobe ticludedintis compilationis ;:.
somewhatarbitra~in thatanequalor largerntier of illustration:withintheses- subjectareasandwithinadditionalareascouldhavebeendrawnfromotherRegionalMedicalPrograms. ;!
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Preface. . . . . . . . ● . ● . w . ● . ● . ● . . ● ● ● ● ● ‘ii
A. REORGANIZINGwDELI~Ry OFSERVI~
1. I~rovedSystafor WliveW ofCare . . . . . . : 1
2. HealthMaintenanceOrg~izations. , . . . . . . . 16
3. EfficientUseofHealthCareTe*ologY . . . . . . 20
B. MEETING~ SPECIAL~~OFS~CI~ W
10 RuralHealtiProgr~s. . . ● ● * “ “ s ● ● ● ● ● ●’25
2. NeigWorhoodHealthCentersandCltiics. . . . . . 32
3. AreaHealthEducationCenters. . . . . . . . . . . 43
C. MEETING~pEwwL~E~ OFOUTGROWINGMEDI~ SYSTEM
1. I~rovedServiceby ExistingPhysici~s,Nurses,and~lied HealthProfeSsionals. . . . . . . . . 45 ;
2. IncreasedUtiliZati~ofNw ~s ofAlliedHealthProfessionals. . . . ● ● “ ● c ● ● “ c ● 61
1. EarlyDetectionofDisease. . . . . . . . c . ● . 72 ;
2. HealthEducati~andInfomtion . . . . . . . . . 7g
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WSAS
llX1’1.!l?lMl~Nl’AIJIJJ’AJ;JIIJ)JjJ,I~.RySYSTIM
A ruralArkansascountywhichj.sagriculturallyricht]utwhichhasnophys~cims,willbeoneof thetiir~ctsOf aid~dcr anr;xP~r~mcntal:Jlcalth~livcryProjectbeingadministeredbytheArkansasRegionalMdical ProgramandtheArkansasComprehensiveHealthPlanningProgr~.,,
Motherproject@rget isanareainsoutheastArkansaswith? ~ppulationof 70,000anda physici~wpulationofonlY13c :;
Theprojectwill’covertheentirestateofArkansasandwilldealwith’.,,,;
fiveproblemareasidentifiedashealthmaintenmcemd preventive~sewices;manpowerrecruitment,training~d distribution;distributionofresources;emergingmedicdservices,andqualityofcare. The ,experimentalhealthdeliverysystawillbebuiltupontheregionalhospitalconceptwhichiscurrentlybeingevolvedintheState.Thisconceptproposestheorganizationof eightgeographicaldistricts>bachwitha regionalhospitalcenterwhifiwillsemicethermining ~hospitals-~th~thatdistrict~ .
Status:Professionalstaffactivity“@erimentalHealth%wicesPlminzand DelivewSYst~s”Grant-=$1,064,000(24&nths) ,:
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Pro~amcoversTheArkansasRegio~l~dical theentireStateof }~k~~, andhasbeenoper&tiOnals”ince”Februaw1, 1969.Its ,commitment-levelform ig70W= $887~506~d for~ lg71WaS$1>209~25}~Thesefundswereusedin1971to’support”atotalof 15projectsyof~;which4 werein theareaofgeneral‘continutigeducation,5for tra}plng.existinghealthperso~e~~.newskills)3 for”a~b~at~on ‘f~t~entandtrainingsenices,l’forcoordinationforhealthse~lces} ~.
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RGD,anda ntier of coreactivities. ,, .yj,..,
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MTSSOIJRT
A rehabilitationcenterhasbeenconstructedina ruralMissouricomity as theresultofa programofe~andedmedicalservicestotheareasupportedbytheMissouriRegionalMedicalProgram.Tntensivccareservices,rehabilitationservicesmd a homehealthagencywereset up in%ithville,whichwaswithouttheseservicespriortothethree-yearMRMP project.Aftertheseservicesweremadeavailable,theincreasedabilitytoprovidepatientcaremadeitfeasibleforthecomity toraise$500,000whichwasmatchedbyHill-WrtonfundstoconstmcttheSpelmanRehabilitationCenter.
At theendof thethreeyearperiod,MoRMPwasabletowithdrawa~stallof itsfundsfromtheactualoperationof theservicesastheybecameself-supporting.Ithasnowbeena yearsinceanyMoRMPfundshavebeene~endedinSmithvilleandtheseservicescontinuetobe self-supportingandof servicetotheultimateconsmer,thepatient.
Status:Operationalasof4/67- 4/701styear--$200,9572ndyear--$141,4733rdyear-- $48,745 +.
me MissouriRMPcoversthe’StateofMissouri,exclusiveofMetropolitanSt.Louis,.andhas.beenoperationalsinceApril1,1967. Itscommitmentlevelfor~1970 was$3,074,230,andforH 1971was$1,947,417.~esefundswereusedh N 1971to.supporta totalof 29projects,ofwhich1 wasintheareaof generalcontfiu~geducation~lfor $ralning?xistinghealthpersomelinnewskills,1 fortrainingnewhealthperso~eltiTfor.patientservices’demonstrations,6 fora combinationofpatientservicesandtiain~g,11forcoordinat{onforhealth,sqrvices,~2 for.R&D,anda nmber of coreactivities.
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Inm efforttoraisethequali~’of
CALIFORNIA
medicineh theWatts-Willowbrooksectionof LosMgelestheCaliforniaRegionalMedicalProgramisfin-dinga Department‘ofcomity MedicinefithenewhosPitalfiere.
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partof theCharlesR.DrewPostgraduateMedicalSchoolintheMartinLutherKingJr.General1iospital,thedepartmentwilldwelopa systemofmedicalcaret?sene tiecomityts 400)000medicallY~digent ~blacksandMexican-America~.
Scheduledtoopenti~iswinter,thehospitalwillbe thefirstinLosAngelesCountytomakeanefforttoplaceprivatepractitionerson thestaff.heal generalpractitionersIIavebeenencouragedtoenrollinanintensivecourseinfamilypracticeat theDrewMedicalSchoolwhi.~willmakethemelfgibletopasstheFamilyPracticehard. cm md ~theWiversityofSouthernCaliforniaareco-sponsoringthecourse.‘
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-ty Medicinewillhavea privatelYf~ded ~~•ˆ311cDepartmentofCohealthcareerspro~amtoprovidefinancialassistanceto localresidentsinterestedinhealthcareers.Nso includedinthedepar~entwillbea WDEX programtotrainmilita~ex-co~smen~a s~ool of all~e~healthprofessions,a comity mentalhealthcenter,anda clnlcal~researchfacility.
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Status:Operationalasof 7/681styear.-$211,3752ndyear-$498,3143rdyear-$441,338
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Californiaandtiocountiesme California~ coverstheentireStateofinNevada,andhasbeenoperationalsinceJulYl)lg680 Itscotitment
levelfor~ 1970was$8,012,055andfor~ 1971w= $6,220,0g4.~esefundswereusedin~ 1971tosupporta totalof 24projects,.ofwhl~~3 werein tieareaof generalcontinuingeducation;4 fortralnlnge~+stinghealthpersomelinn~ skills~1 fortrainingnewhealfipersonnel,;6forpatientse~i~s de~nstration??8 fora combinationofpatient~servicesandtraining,1 forcoordinationforhealthservices,1 for~~R&D,anda ntier of coreactivities. ‘f
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Thewe ofmilitaryhelicoptersandco~smentoprovideassistancetocivilianvicttiof trafficacci~ts andothermedicalaergenciesisbeingtestedtiththecooperationoftheColorado-~~g, MwtainStates,TexasandWastigton-~as~~gion~ Mdical~ogr~. TheMs broughttogetherCM
.~ providersof emergencymedicalsemices
forthepqose.oforganizingand@lementingthe~lita~ksistancetoSafetyandTraffic(~T) programintheirRegions.
Theprogramusesexisttigpersonnelandquipmentfrmmilitarytits intheareatotransportpatientsfromthesceneof theemergencyto tieappropriatemedicalfacili~or tocarrymedicalspecialistsandquipmenttotheemergen~scene.Interhospitaltransferof criticalpatientsisdso handledbyWT.
ThefeasibilityoftheprogramiscurrentlybetigtestedinareasofTexas,@lorado,Washington,hizonaandIdaho,Theprojectissponsoredby eightgovemnt agenciesandisatiisteredby a projectteamfromtheApartmentsof~fense,Transportation,tidHealth,E&cation,andWelfare.
Status:Professionalstaffactivity
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T1/J-s’rA’l’li
Fivecomity hospitalsonthenorthshoreofmssa~.husettshave,be~home careprogramsthroughtheeffortsof theTS~@ andtheMassachusettsHospitalAssociation.Suchprogr= willprovidecon-tinuityof careforhospitalizedpatientsafterdis~arge~aswel\asreducethelengthofstayinthehospital.TO date>onehospit?lh~.achieveda fullycoordinatedhmecarepro~m withexcellent~mlti-disciplinaryinput.Threehospitalsareplanningtohire ~fill-timenursecoordinatorsad.PAY~.oPeneda~~ mroved info~ationtiterchangewiththelocalVisitingNurseAssociation.me hospitalmovedtheV.N.A.ri~htintothehospitalbuildingandalsoappointedafull-timequalifiedwnurseascoordi~ator. -
status:Professionalstaffactiviv$2,500contract
. ~eTri-State~ coverstheentirestatesofMassi*Wetts,Mode ;Islmd,~dNw Hampshire,’and,has,been’@.era\i~alsinceFeb~a~ 1~1969.Itscmi~ent levelforN 1970was$1,467,436~d for’~TB•€UB••VB~ 1971,was$1,814,132.These”ftidswere~qed”inm l?7~to SUPPOrt ‘a totalof 5 projects,of~i~h”lfiasfol~~aiqingex~s~lngh~?l~personnelinnewstills,z forpatient.se.wlces’demonstrations,~z fora combinationofpatientservises~dtzqiningy~d a n~be~of coreactivities.
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MISSO~I
h improvedsurvivalratefollofingcardiacarrest,tiebuildfigof=additiontoa hospital,andthestimulationof stiilarprogramsthroughoutMissouriarethreeresultsof a cardiovascularprojectinSpringfield. ,
Springfield’sprogrmof comprehensiveatiission-to-dischargecareforallhigh-riskcardiovascularpatientslocatedina singleprogressivecaredivisionhasachieveda 30percentsurvivalratefollowingcardiac *
arrestandiscreditedwithsavingat least100 livesoverthelastfouryears.A cardiovascularcarenurse.training’Progr~)whichaccePt5applicantsfromallovertheState,wasstartedaspartof thisproject.
Theprojecthadbeendeadlockeddueto lackof fundsuntil1967,whentheMissouriRegionalMedi=lProgramfundedit. Theco~~itY wasthenabletobuild,tithprivatefunds,a $lOmillionadditiontoSt.Jokis }Iospitalwhichistobe completedbytheendofthisyear.
Anotherlargelyunexpectedresultisthatsimilarcardiovascularprogramshavebeenstartedinsmallercomunityhospit~sintheOzarks.At least18of 35hospitalsinthisruralareanowhave@roved carefacilitiesunderconstructionor intheplamingstages.
Status:Operationalasof 4/67- 6/701styear--$69,3472ndyear--$153,9783rdyear--$373,905
TheMissouri~ covers.the”pt?teofwssouriz‘xclWiveofMetroP1itm ;St.Louis,andhasbeenoperationalsinceApril1,lg67. Itsco~l~entlevelforw 1970w~s$3,074,230~d for~ lg71w= $l~g47~4\7*,~es?:fundswereusedin~ 1971to”~~rt’a totd’of,2gprojects,’?fwhl~‘.
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1 w=.intheareaofgeneralcontinu~ge~u$ation$1 ‘or‘raining‘xl~tnghealthperso~elinnewskills,lfortralnmgnewhealthpersonnel,forpatientservicesdemonstrations,6 fora combinationof patientservicesR~D,ad
andtraining,11”a numberof core
forcti’rdiwtionforh~alt!se~ic95>2 for.activities. ,,
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ILLINOIS
me mosteconomicallydepressedsectionof ficagowillhavea unifiedheal~ careprogr~toserveits350,000indigentpersons.Local ~D•ˆcitizensformedtheMid-SouthsideIIealthPlanningOrganizationandcompleteda comprehensiveplanfordelivery,ofhealficare.me plansturn thefra~entedavailablesemicesintoa comprehensiveprogrm.,IncludedinthepTogramaretheareafssevenhospitals. ,,.,.;.
ll~eorganizationwasfunded
Status:Professionalstaff1styear$18,432
by theIllinoisRegionalMedicalProgram:
activity
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me IllinoisRMPcoverstheStateof Illinois~’withtheexceptionof’[ ‘.thatpartincluded.intheBi-State~, andhas.been,operatlonalsinceFebmary1, 1970. Its.ctiitment’levelfor~.1970was$l~585,643,~dfor:~ 1971w= $l,5z4~2860~ese fundswere~~d “tin197! tosupporta totalof 7 projects,ofwhich4,wereforpatientsetii:e.s’d~??stra~tions,z forcoord~ati~”for,heal~sevice$>’lfor~~D?ad a~~e~.“!i,ofcoreacti~tie$o., ,. ., ,. ., . , ~~•
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COLOW/wOMING
A newlaborato~intheSanLuisValleywillcutby atleastone-thirdtheamountof ttieneededtodiagnosisstreptococcal~ectiom. ThisvalleyinSouthernColoradohasthehigheststreprateinthenation,a ratefourttieshigherthantherestof theState.Thepopulationis80percentlow-incomesp~isll-~eric~~Inaddition;fiereiSasunncrmigrantfarmworkerpopulation.
Beforetilelabwassetup,spectiensfromSanLuisweremailedfordiagnosestoDenver,adistanccofmorcthan200files.me lapseoftimeoccuringin tieroil-inprogr~oftenkepthealth.perso~elfromtreatingpatientssoonenoug~~topreventseriousco~llcatlonssu~ .asrhcmaticheartdisease.
Theblorado/WyomingRegionalMedicalProgrambroughttogethernearlyqhalfdozengroupstoestabllsnandfundthelabfacility.
Status:Professional$3,118
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Regional.andhas
TheColorado-Wyoming MedicalProgramcoverstheStatesofOloradoand,~~g> . beenoperationalsinceJ~MW 13 lg6g.Itscotitmentlevelfor~ 1970was$1,176,282.Wq;for:~ly~l was’.$963,224.Thesefidswere~ed inn 1971’tosuP@fl,?totalof13Ptijects,oftiich,lw- intheareaof generalcont~u~g’edu~!ipn~6 intheareaoftraintigexisting”health’Perso~el:~newskills~;l
3 inpatient’se~ices’d~onst~ti~~,intrainingnewhealthpersomel, ,.,1 incoordinationforhealthse~ices)1 forR~Ds~d”a ‘tier ‘fcore
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activities.
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(:losingof thehospitfllintl~ciso~atcdco~i tyof Southllcnd,Washington,md ficdr~~tlcredust~oninhealthcareintheareathatwouldhaveresultedhavebeenavertedthroughtheeffortsof theWashington/Al~kaRegionalMedical~ogr~” EarlYin 1~70>the.Ad-ministratorofWillapaHarbor~lospitalcontactedW/ARMPconcerninganextremeshortageofp~lysici~m~powcrintheareafil~~threatened.toforcetheclosingofhishospital.Fornearlytenyearstilecomityhadbeenattemptingunsuccessfullytorecruitnewphysici~s.w M ‘[staffresponded,spendingmanydaysovera periodofmonthswik localcitizensandhealthproviders.W/- wasinstmentalh organizingcomunityinterestandresourcesandin introducingoutsideresources,suchas theWiversityofWashingtonDivisionofComiv Development,theOP “B”agency,theCo~tyHealthDepar~ent>~d interestedphysiciansfromtiene~estlargecities”~ a resultofW/w-activities,thefirstnewphysiciansinyearshavenowlocatedin thecommunity,theCountyliealthDepartmentisprovidingadditionalsemicesbeyondthoseformerlyoffered,andseverallocalhealthservicespreviouslynotavailablehavebeenarranged.me localhospitalwillnotonlysurvivebutwillbe abletoimproveitsservice.Inaddition,contactsinitiatedandencouragedbyW/W ~haveresultedintiledevelopmentofanew andpromisingrelationship, ,“betweentheVirginiaMasonMedicalCenterinSeattleandtheWillapa”1larborHospital.Regularvisitsofhospitalpersonnelareoccurringinbothdirectionstoimprovethequalityof carethroughconsultationservicesandcontinuingeducation.
Status:Professionalstaffactivity
Washington/Al=~W coverstheentireStatesofWashington~di,MaskaandhasbeenoperationalsinceFebmaw 1,lg68. ~eir Cotit-mentlevelw= $1,606,157for~ 1~70’~d$1)447~8~5for~ lg?l~ ‘~~ese fundsweremed in1971tos~porta totalof 22projects,of -which7 wereforgeneralcontinu~geducation,3 fortrainingexistinghealtipersonnelinnewskills,z forpatientservicesdemonstration;.l,fora combinationof training~d patientse~ices,3 fo~coord?natlonforhealthservices,6 forR6D,anda numberofcoreac~ivlt~es.,~,,.4,, ,.....
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andstrokearclivingusefulandtheestablishmentoftheIfiartonindependentlivesas a resultof
RehabilitationCenter.TheCenterwassetupwi~ ties~Portoffie. .
Texas~~ toservepatientsfromtheCaneyValleyFlemorialHospital,GulfCoastMedicalCenterandothercomities ofthesurromdingsevencountieswhererehabilitativesemiceswerepreviouslymavailable.ExpertiseinmethodologyandprocedurestoimplementtherehabilitationprogramwasprovidedbytheBaylorCollegeofMedic~eatH?uston:Inadditiontoprovidingdirectpatientse~icesjthepro~~ ~ScoPlngwithproblemssuchasmanpowerneedsfortreatmentandservices,continuingeducationforphysiciansad alliedhealthprofessions,andincreasedcomity involvement.Theprogram!sacceptanceby thecommunityhasbeenassuredby thedegreeofparticipationbyphysicims,hospitals,socialandfrate~al90UPSad comi~ agencies”Acriteriaof theprogram’ssuccesscanalsobe measuredby therecentproposalof comity hospitalstoass~e,wi~~ a shortPe:iod.oftime,theentirefinancialassumptionoftheMartenRehabllltatlonprogram.Theprogramhasservedasa prototypeforthedevelopmentofothersuchactivitiesinvariouspartsof thecomtry.
Status:Oncoin~asof 7/1/68. .1s;ve=r-$100,9472id~ear- $127;0633rdyear-$72,068
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IheTex~ RMPcoverstheentireStateofTexas,~dhas beenoperationalsinceJuly1,1968. ItscommitmentlevelforN 1970was$2,220,891,andforR 1971was$1,158,696.ThesefundswereusedinW 1971tosupport.a totalof 20projects,ofwhich4 wereinthe’areaofgeneralcontinuingeducation,4 fortr~ningexistinghealthPerso~~lin’n~ skills~1,fortrainingnewhea~thpersonnel,5 forpatientservicesdemonstratlo~,z fora combinationofpatientservicesandstraining,3 fo~$oordin:tionforhealthse~ices,1 forR6D>’ad a n~er ‘fcoreactivities.o
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II~Cuscof specialstrokefacilit~csmd a‘teamapproachiscrcditcdwitha dropof almst a thirdinthedeathrateofstrokepatientsat theColumbiaHospitalincentralSouthCarolina.
Beforetheinstitutionofthestrokeproject,sponsoredby theSouth@rolinaRegionalPledicalmogr~, thedeathrate~ong patientshospitalizedforstrokewasS2percent.Aftertheopeningofa specialstrokeunitinthqhospital,theratedroppedto19percent. ...
Thereisan extremelyhighincidenceof acutecerebralvasm]]ar’dis~a<’~(stroke)inthecentralregionofSouthCarolina.ThestrokeprojectmakesthefirstcomprehensiveattemptintheStateto tiprovediagnosis,mmagementandrehabilitationofstrokepatients.
Thestroketem includesnurses,a speechtherapist,a dischargeplanner,anda publichealthnurse.Theteamapproachhasbeenfoundto speeddiagnosisandmanagementofpatientsandpermitsearlyrehabilitation.Intensiverehabilitationisstartedalmostimmediatelyafterthepatientisadmittedjmdhas shortenedtheaveragehospitalstayfrom21days”to 16days.Thishasreducedhospitalcostsnearly25percent.
Status:@eratiomlasof 8/68~;~~;;~‘-$108,652
--$69,2473rdyear--$ 62,906
TheSouthCarolinaM coversthe’entireState‘ofSouth’Carolina‘Itsco~ltmentlevel’f%d:“hasbeenoperationalstice’August’1,1968.
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w 1970was$988,082andforW1971 was$958~340.‘Thesefundswereusedti.~ lg71toswrt.;a t~t~lof l!P~jectsYof-fiich.2Were”’+ri’:’theareaofgeneral’cont@u~geducation,5 fortr?.~lngexlst~ghe?lthpersonnelinnewskills,7 “forpati&nt’servicesdemonstrations,1 fora combinationofpatientservicesmd training~1 forcoordi~tionforhealthservices,andanumberofcoreactivities.
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fiduseofhelicoptersto transportvictimsofcoronaryattacksandothermedicalaergencies’md for,the”delivefiofmedicalsefiicesisbetigstudiedh a projectqrted by the’WestVirginiaRegional~~mlProgrm. A statewide~st~isbefig developedtomeethealthtransportatiaprobltiina mo~ta~us areawitha rural,Uspersedpoptiation,poorhigtiysystem,andscarcityofhedfi care,resources.Variommodesandreties’ofmodesoftransportationwillbe tialyzedaswellasemergencyfacilitiesandC* cationsnetworks.mestudyisbe@ conductedby the”WestVirginiaWiversityCollegeof~gineeringh cooperationwiththeMversity’sSchoolofMedicine.
Status:Qerationalasof1/70lityear-$22,3082ndyear- $12,104
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~e WestVirginiaM coverstheentireStateofWestVirginia,andhasbeenoperationalsinceJanuary1,1970. Itsc-went levelforn 1970was$S24,048and’for~ 1971w~ $S80,978.~ese fun~ werewedin~ 1971tos~xt,a.tqtal ofq projects>ofwhi~ ~w~ ‘or.traini~exisftighqalfimrsowel ti.newskills~,l-fo~??~lentse~ces d~ons~,fatiq~,,2 for:ND,:anda ntier ofcoreactivities.
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A ~m~~SIW P~GW ~R KID~ DIS~E
me controlof renaldiseaseistheaimof a networkofregionalmedicalcentersinArkans=supported.bytheArkansasRegionalNledicalProgram.me centerswillbe ltied,totheWiversityofArkansasMedicalCenterinthecentralpartoftie’Statetieretreatmentofki~ey disease : ,patientswillbeprovidedthroughprogramsoftransplantation,didysisandtrainingforhomedialysis.me systemofsatellitecenterswillprovidenotonlybackupdidysisforpatientsandtraininginhomc :dialysis.butalsowillserveasProcurementcentersfortransplantationatke ~dicalCenterandas educ~tioncentersforboththeph~siciansandthelaypublicconceningkidneydisease.
Status:@ratioti asof 5/711styear--$201,800
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~eArk~as ~ cove~theentireState ofArkansas,andhasbeenoperatiotil,s@=, February1,1969. Itsco~tmentlevelfor~ lg70was$887~506andforN 19,71,was$1,209,251:~ese’fundswereusedhIg?ltosup~rt’atotal.of”15:projects,oftiifi4;were~ theareaofgeneral.cent-g education,5 fortrainingexisttighealthpersonnelinnewskillsj3 fo~a ctiinationofpatient~d~train~g~~~ices~’:1 forcoordinationforhealthsenices, 2 forR6D,andanwber”of >coreactivities. .,,,,.}:~!.(,... .,;,.
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WRTIICA~J,INA
JUGIONAJ>IZATIONOF SERI~I~S
A regionallaboratoryhasbeenestablishedinonepartofNorth.
Carolinawiththeaidof theNorthCarolinaRegionalMedicalProgrm,AlthoughnoRMPfwds wereputintotheeffort,NCRMPstaffcollaborated ‘witha groupofpractitionersandhospitalatinistratorstoestablisha singlelaboratorythatispresently”servtigthreehospitalsinNorthCarolinaandtwohospitalsinSouthCarolina.Theres~t hasbeen~rovedpatholo~ serviceswithobtioussavingsincapital .outlay.
Status:Professionalstaffactivity J
~eNorth Carolina~ coverstheentireStateofNorthCarolina, .andhasbeenoperationalsinceMarch1, 1968.Itscmitient levelforW 1970w= $2;047,486~d forW 1971was$1,844,692.These
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fundswereusedinn 1971foratotalof 21projects,ofwhich : ;10were.titheareaof,generalcontinuingeducation,forfortrainingexistinghealthpersonnel:innw skills,1 fortrainingnw health )
~fitipersmel,,lforpatientservicesdaonstrations,5,fora cmbina-tionofpatientservicesandtraining,and antier ofcore
Patientswhoneedhealthcam butdonotrequirehospitalizationarebeingaidedbyaHom HealthCareAgencyfomed tiBartontiunty,jKansas,withtheassistanceoftheKansasM. me Agency,upon
. request of~ physicianinthecounty,willsupplysocialservices,nursing,physicaltherapy,occupational~erapyandotherassistance.
.Status:professionalstaffactivi~
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fieKansasM coversthe.entire”$tateofK+aS~ fidh= been. ~* operational’since,J~e13”1967,‘“’”I@cmi~ent levelfor~ 1970{‘1
w*,.$l;346~744,~dfor:~.,1971titi$ly2362220.~~se.f~~ were j@& in~.1971to s~~rt a totalof.10projects,.of@ich 6 werejin”theareaofgeneral”cm”tinuing”educatiti,3 fortrainingexistinghealthpersonnelinnewstills,1 forWD, d antierof core ~activities. ,’;,
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A ~olWrc]lensivchealthcaresystem,incorporatingtheheal.timaintenanceorganizationconcept,isbeingdevelopedina 7-countyAppalachianareain theextremewesternpartofNorthCa~olinaknownastheStateofFranklin,wi’ti~theaidoftheNorthCarolinaRegionalMedicalP~ogram.~~esystemwillincludenursepractitionerclinics,grouppracticeinprovidingprimarycaresemices~back-~hospitalse~lces)ad apre-paymentpl~.
NCM alsohasbeenassistinginthefindingofoneofthesatelliteclinicsinthissystem.TheclinicinCanadaTownshipisoneofseverallocatedinmountain!fcoves1!wherelittleothermedicalse~iceisavailable.
Withtheassistanceof theNCW,.the StateofFranklinHealthAuthorityappliedforandreceiveda IW planninggrantof $40,000fromtheIiealthServicesandMntal HealthMnistration* T
Stfltw:Professionalstaffactivity
TheNorthCarolinaW coverstheentireStateofNorthCarolina,andhasbeenoperationalsince~rch 1,1968. Itsco~i~ent levelforpy lg70w~ $2,047,486md f6f’m”1971was$l,844,6g2.These.f~~ :wereused.inV lg71tosqpprt.atotalof?l.Pr”jects~sofwh~ch10 ‘:wereinthearea’of’generalcontinuingeducation,.? ~ort~alnlng;existinghealthpe~~o~eliri-ny~skills>f?r,~ralnlng‘W,hea?th..personnel,I forpatientse~icesd@onstra~loOS,“s<fora$~b+na~lonofpatientservicesandtralnin~,,andanwberqf coreactlvltles.~ ~..,,, ,.””,.. ,,.,,,...,
.,~.i:,. ,:,~.:!.’:., ,. , ...,. ,...~l.’a,..,,
,’
-16- .,
WISCONSIN
A prepaidhealthcareinsuranceprogramforthcblackcofimunityofMilwaukee’sinnercityhashcendevelopedwiththeassistanceof theWisconsinRegionalMedicdProgram.TheCreamCityCommunityl{calthCenterhasbeenestablishedbynineblackphysicianswhoorganizedintoa grouppracticetoprovidemedicdservicesforthehealthcenterclientele.TechnicalandfinancialassistancewereprovidedbytheWisconsinw forearlyplanningoftheCenter.GrantsfundswereobtainedfromtheOfficeof~onomicOpportmity,withWisconsinRMP=sistance,tohelpsupportthefirstyearofoperation.TheCenterisworkingwith~dicaid,BlueCross-BlueShieldandtheMilwaukeeti~mtyMedicalSocietytodevelopa completelyself-supportingexperi-mentalhealthmaintenanceorganization.
.-.-..Status:Professionalstaffactivi~
.●✎
TheWiscomin~ coverstheentireStateofWisco~inandhasbeenoperationalsinceSeptember1,1969.Theircomitientlevelwas$l,og8,42gforN 1970and$951,781forN lg71.Thesef~ds were ~~usedin1971 tosupporta“totalof13 projects,of,which4were in ~the areaof generalctitinuingeducation,2 fortrainingexisting; -healthpersonnelinnewskills,3forpatientsemicesdemonstratiofi,1 fora combtiationoftrainingandpatientsemi~s, .1forcoordinationforhealthsetitis,2 forR6D,anda.nmberofcore,activities.~D•ˆ,..
-17- ,.,.!..,.
...,.,
-1S
A modelhealthservi~esystemisbetigsetup h a ruralten-countyareasurromdingCornth,~ssissippi.Theareah~ a lowticorne~pdation. Thenewsystemwillbe setup asa healthmaintenanceorganizati(~n~*led~ theKaiserpl~” ~enon-prof}t~oqorationtillbeusingthirdpartypayors,computerrecord-kee~ln~,andpreliminaryscreeningbyparamedicalpersonnel.
TheMemphisRegionalMedicalProgramhasbeencoordinatingthisprogramincooperationwiththeDepartmentof$IousingandUrbanDevelopmentandtheAppalachianRegionalComission.
. .
.,
,
Status:Professionalstaffactivity “–
TheWmphisRegiomlMedicalProgrticoversparts,ofWestem.Tetikssee,NortherntississippiiEasternMkansasandprtionsof Kentuc~and”Missouri‘mdh=.beenqefatio~ls~ce JulY1~lg680,1tsco~i~~~~levelforN 1970w= $1,284~714.~dfirNlg71w* $g5~s7220fundswereused’tiW 1971tosupportatot~:of 13p~jectsl,of@ich1 wasinthe’,aieaoftrati~g?xist~ghe~lthp~rs~~el~new skllls>2 inpati~t sewicesdemonstrations,7 ina cornbfition’ofpatientsemicestidtraining~”2 initirdinationforhealth’services,1 forRGD,andanumberof coreactivities.
“j MUM ~IG-l~R~OODIU~-1 CmR’
~C blackcomity ofWrhm hasorganizeda neig~orhoodhealth
IcenterI)asedatLincoln1lospital,me LincolnNeighborhoodI{ealthCenterwillincorporatehealthmaintenanceorganizationconceptssuch
! as grouppracticeandpre-pa~ent.,i
1
,, ~e”NorthCarolinaRe ionalMedicalPro~m helpedtheblackleaders,1 fobtainStatefundingor fiehealthcenteraswellasnon-NC~ funds,.{ forrenovation,...$ hng d]ec~ ityorganizationsinvolvedin theclinicarethellcalth,.f. ScrviccResearchCenterof thehiversityofNorthCarolina,me:!-{ ~iversityIIospital,~rhm ComtyhealthDcpartient,krhm County.-,,4:, Wntal.Ilcalth@artint, 0~ andmy others.
.;
.1 Status:Professio~lstaffactivity.Z,:
;;~: me NorthCarolina~ coverstheentireStateofNorthCarolina,and,.++ hasbeenoperationalsinceMar* 1, lg68. Itsc~i~ent levelfor-,,.+;.$ H 1970was$2,047,486andforW 1971was$1,844,692.~ese fun~s ~-.4.,,:? wereusedinw 1971.tosupporta totalof21projects,ofwhich10...
!.. wereintheareaof’generalcontinuingeducati~~4 fortraining,- cxistinghealthpersonnelinnew,skills,1 fortra~ingn~ health
i personnel,1 forpatientservicesdemonstrations;5 fora c~ination,-!,+
[
ofpatientservicesandtratiing$~d an~er ofcoreactivities” ~~atiing
-19-
.,
MISSOURI
AUI’OMATJ:DPINSICI~’S ASSTST~.
Intherur:l]townof Salem,Missouri,population4000,thepatient:-ofgeneralpractitionerDr.BillyJackBassarebeingtreatedinoneofthemosthighlyautomateddoctor)sofficesinthenation.IIerethe‘tproductsi’ofthreeyearlsdevelopmentof eightMissouriRegionalMedicalProgram’sprojectsarecombinedina physician’sofficetodemonstratehowthesetechnologicaladvancescanprovidebetter,morecompletecareofthepatientandmre efficientuseofthephysician’stime.
~is system,bymeansofcomputerterminalstidspecialtelephonelines,linkstheautomatedphysicalexaminationequipmentandthepersonnelinDr.Basslsclinictoa computerattheUniversityofMissouri ~CollegeofEngineeringinCol@ia andto theMedicalSchcol’sspecialists.Inbrief,selectedparameterssuchasEKG,spirometry,eyeandhearingexamination,bloodpressure,patienthistory,andlaboratoryandx-raydata,areautomtedandcombinedina singlecomputerprint-outwiththephysiciansphysicalfindings.Thesystemissuchthatallof theelements(exceptthelaboratoryandx-rayfindings)areavailabletothephysicianwhenhe seesthepatientforthefirstttieandtheentirerecordmaybe calledup atanylaterdate. Thisinsuresa standardized,mre completework-upfortheuseofthephysicianandbeginstoattacktheproblemofprovidinga standardizedpatientrecordpermanentlystoredina centrallocation.
Thedevelo~entof thisprojecthas,atonetimeor another,involvedalmosteveryschoolattheUniversityofMissouri>severaltelephonecompanies,manypracticingphysicims,about20comity hospitalsandis,tothebestofourknowledge,theonlysystemunderdevelopmenttodayspecificallydesignedtomet theneedsoftheindividualpractitionerasanAutomatedPhysician’sAssistant.
Status:Cooperativeeffortof 8 MRMP projects.FundingasProject#72--7/1/71- 6/30/72--$153?537
The~ssouri~ coverstheStateofMissouri,exclUsiveofMe~ro~lit~st.huis, ~dk beenoperationalS~Ce APril1>1967*.ltsComltmentlevelforW 1970was$3,074,230andforW 1971was$1,947,417.Thesefundswereusedin~ 1971to.supporta totalof 29projects,ofwhi$h,.1 wasintheareaof generalcontfiu~geducation;1 fortrainfigexIstlnghealthperso~elinnewskills,1 fortrainingnew’healthperso~el>? ~forpatientservicesdmnstratio~,6 foracombinationofpatient“senices’andtraining,11forcoordinationforhealth’services,2 fofjR~D,anda numberof coreactivities. ,i
.::
-20- .,
,.~
..*
msAs
In:1fcasjIIi.litystudyofcon~lutcrizcdJllanagcmcntof theolltpaticntdiabetic,changein i.nsultirc~:o]mlcndcdby thecon~utcragreedwit]]tiloseof theph sician98percentoftilettict Inno fist~~edid ‘
. Ltheco~utcrm ‘ehazardousTecomlendations.. . - -
.
+
,
.
me projectwasfundedby theKans=Regional~dicalProgramandcarriedoutattheKans=hiversity~dicalCenterwiththeuseofalliedmedicalpersonnel.Basedon informationobtainedatpatientvisitsandexamplesofphysiciansprescriptio~undersimilarcir-tances, thecomputerrecommendeddiet,insul~n.dosage~~ddosagefororallyadmtii~teredd~gs. ItalsosPeclfledwhen1abora-toryexaminationsandfutiher
me projectdemonstratedthattheoutpatientdiabeticwouldwithoutsacrificingaccuracy.
consultationwasnecessa~.
useofa computerinroutinecareofcutdownonthephysician’sworkload
..,,
Status:Professionalstaffactivity
—’—
..me KansasM coverstheentireStateofKansas,andh= been
.5
operationalsinceJune1,1967.Itschtient levelfor~ 1970W- $1,346Y744andforH 1971was$1~236~220*~ese f~dswe”re
‘,
used’inH 1971tosupporta totalof 10projects,’ofwhi*6 were “fitie areaofgeneralcontinuingeducation,3for trainingexistinghealtipersonnelinnewskills,1 forR&D,andan~erofcore ~~activities. ,. .,.:,
-21-
.’
OB,NIOMA
I\c:irtpatientsin42smallruralhospitalsaremonitoredby}~calt~~.Persomelinninemajorhospitalsina p?o~ectsponsoredbY the~klahomaRegionalMediQlPro@am. prel~lna~~ta from.oneparticipatinghospitalbasedon 73remotely-monitoredpatle?tswithconfirmedacutemyocardialinfarctionshoweda 12.5%reductionintoemortalityratefrom22.1to9.6percent.
..,:
Telephonelinesareusedbothtomnitorthebedsmd for?ur~econversationsduringemergencies.&ch phonelme c~monltorsixbeds.Thelineissplit,withthefirstpartbeingusedformonitoringequipmentandthesecondpartforemergen~comicatiqns. Them~imum
nmber ofbedsthatonetecnici~isallowedtohandle1s12.
ParticipatingintheprojectaretheVeteransAdministration,Indi~}{ealthSewice,Statead privatehosPitals~ ‘kl*om~ ~sas adArktisas.
Operationalas 5/681styear- $420,0002ndyear- $414j~~03rdyear- $354,000
me OHa~ w covers-theentireStateofOkl*~ ~d hasbeen,-..
operationalsincemy 1,196g. Itscommitmentlevelform 1970was.$l~050,145ad forw 1971was$738,500.Thesef~~s Wereuse!.in~ ~1971tO sqpOfla totaln~erof @ projects’‘f‘hlch3w?re lnthe’areao.fgeneralwnttiuingeducation,1 fortrainingexlstlnghealthpersonnelinnewskills,4 fora combinationoftrainingandpatientsetiices,anda numberof coreactivities.
;.‘.:.,1,
,
[);1iJl:;Ilo1“(.);l[~C!l.llilS t.() 1“.’rilVCl.:1 .[”CWllUll(lt.L(l IIliICS toa cj.tyhosl)ital..lT(Jr’ilr”l
c1cctrocardj.ogram,1f thedoctorisI)flrtici.patingina pho]kcnctwo,rklinkingtheECCquipmenttoa cityhospital,hecantakethepatjcntts]~(;(;inhisoffice,andbymeansofspecialattachmentstothephonerccci.ver,transfittheECGpatte~toth~hOSPitalc A machine‘n‘c “hospitalwritestheECG,anda specialistreadsit. me doctorIStoldtheresultsoverthephone. ..
~is networkwasestablishedusingColorado~omingRegionalMedicalProgramseedmoney.me costof tienit tothephysicianis$95.hits inruralphysiciansofficesarelinkedtoanyoneof severalhospitalsinrasper.wofing;~nver}ColoradoSprings,GrandJunction,andGreeley,Colorado.
Status:Professionalstaffactivity$9,494
,,
‘:
me Colorado-WyomingRegional@loradoandWyoming,andhas
MdicalProgramcoverstheStatesofbeenoperationalsinceJanuary1, 1969.
Itsremitment-levei-forN 1970was$1.176.282andforN 1971was$963,224.~ese fundswereused.inN ~971”tosup~tia totalof 13projects,ofwhich1“wash theareaof”generalcontinuingeducat~on,6 intheareaoftrainingexistinghealthpersonnel,@’new skillsj1inttiiningn+ healthpersobel’,3 inpatientsemices’demonstratiofis,1 incoordinationforhealth”sefiices,1 forR6D,andanmber df’core”activities.
.,-23- ‘
>,.
WAS]IJN(~l’ON/AJLSW
a)M)U’l’liRI;I:A5JBJ.J.,1.’1Y1’l{~;CI’
Findingoutwhentousccomputersformedicalpurposes,~d whenNOTtousethemisthegoalof theMedicalComputerServicesProjectsupportedby theWashington/WaskaRegionalMedicalProgram.Forexample,onepartof thisprojectinvolvesdete~~figwhi~ iS We mosteffectivewayofgatheringa patientlshistory,by feedinginformationtoa co~uter,by givingt~~epatienta fo~ tOfillout>‘rby 1ettingthedoctorinterviewthepatientandtakenotesinthetraditionalway.Anotherphaseof theprojectisdeterminingtheefficiencyof computersin interpretingelectrocardiogr~.
~roughtheproject,a RegionalConferenceonMedicalco~uterSeniceswasheldinthefallof 1970. Itwasthefirstsuchmeetingin theregion,andoneof tielargestintieCO~tW. me Cofierence‘ad278participantsand22exhibitors.
me M~ projectissponsoredbyWashington/AlaskaRegionalMedicalProgramandtieWashingtonStateMedicalEducationandResearchFomdation.
Status:@erationalasof 2/701styear- $35,0002ndyear- ~re activity
..
1
I
~e~Washington/~askaRegionalMedicalProgramcoverstheStatesofWashingtonandAlaskamd hasbeenoperationalsinceFebrua~1,.1968.~eir chtment levelform 1970was$1,606,157andfor~ 1971was$1,447,885.~ese fundswereusedin1971to supportatotalof 22pro-.jecgs,7 ofwhichwerefoTgeneralcontinuingeducation,3Jfortraining~exi~tinghealthperso~elinn~ skills)2 forpa~~~ntse~+cesdemon-I.strations,l.fors b~ation ofPatient~d traln~g‘e~lces~:3‘o?\ ;coordinationforhealtilservices,6 forR~D,anda numberof coreactlvltles....j
, .:!::‘.,,.; -24-
.
.,
d
AIRTRkNSWRTATIONSYST~
A State-widemedicalairtrans~rtationsystemweeklyfliesa groupofspecialiststoTarboro~wi~~gton ~d otheroutlY~gareastoparticipateinclinicsprovidingmedicalcarenotothetiseavailabletothethousandsofruralresidentsintheseareas.Theairtrans-portationsysta”has~SO flo~ki~ys ~d otherorg~s fortr~sP1atfrommedicalcentersallalongtheEasternSeaboardtouniversitycentersintheState.
Thesmallcraftarealsousedinaneducationexchangeofphysicians.WiversityofNorthCarolinamedicalschooldoctorsareflowntotheNewHanoverHospitalinWilmingtononemoningaweek. On thereturntrippracticingphysiciansfromtheWilmingtonareatraveltotheuniversityforcontinuingeducationcourses.Theruralphysiciansmakea returnflighthomeintheevening.
Threeplanesmakeup thesystemwhichhasloggedmorethanonemillionpassengermilesinitsfirstthreeyearsofoperation.TheairtransportationsystemispartoftheNorthCarolinaRegionalMedicalProgram’sfmded projectinEducationandResearchinComity mdMedicalCare.
Status:Operationalasof 6/68Componentof“EducationandResearchinCommunityandMedicalCaren1styear--$209,2002ndyear--$201,1193rdyear--$240,9934thyear--$ 74,000
TheNorthCarolina~ coverstheentireStateofNorthCarolina,’and .hasbeenoperatiomlstice:k~h1,’lg68”Itscofitmentlevelfor >N 1970was$2,047,486andform 1971was$1,844,692.Thesefundswereused“hW 1971tosupporta totalof 21projects,ofwhich10werein”the-area’ofgeneralcontinuingeducation,4 fortra~ipgexistinghealthpeisonnel’ifinewskills,lfor trainingnew.healthpersonnel,-1forpatimtsetiicesdemonstratio~~’5 fora $o~~m?ionofpatientservicesandtraining,anda numberofcoreactlvltlesi,,
-25-.
,,
.,
:.
..,:.,.,. .,..‘.
~ee tosixtem ofs~dentsofmedicine>nursing>dgntistv~Wdsocialwork’arejoifingalre~yexist~gt~.~ ofP~Qf~55~.on~ls~~workinginurbanandruralpovertyareasthissummer.ItisthehopeofTemesseeMid-SouthRegionalMedicalProgramthats~dentswor@ngfithesete~ willbe rectiitedtotheregion.The’projectispartofHfs healthcareconsortiaprogram.
~ other”consofiiapilotprojectswillbe helptiganumber’of~r~Appalachian~ities developa cooperativehealthcaresystem,andacouragingloctinon-pmfessiOnasto’participateina localruralhe”dthcueprogram.
A consortiumapproach--whichmayormaynotbe alsoa grouppractice--hasbeen”adoptedby theRegiontohelpalleviatetheshortageofhealthmanpower.Itisexpectedthateachlocalitywilladopta typeofcomprehensivehealth~replan whichbestsuitsitsnee~. Mwever$theteamapproach,useofalliedhetithperso~el,andautomateddatamanagaentwillbe includedineachplan.
Theprojecttsgoalistoc~ensate forthelowpatient/phPici~ratiointheRegion*ich is118per100,000.~e nationalaverageis141per100,000.
Status:Professionalstaffactivity
The’Tennessee~d-%ut~ M’ ~verkthe StateofTennesseeandpartsof.
SoutiesternKentu~,@W:be~fi operatio~lsb@Feb=V 1,lg68~ ;Itsd-t levelforN 1970@ $2~l?8~l10~for ~ lg70~$1,747,3=.These-’were’tisedinlg71 foratotalof 26p~jects,qfwhiti4.werein the”areaofgeneraconttiingeducation,? for
*
train% existhghedthxr~~~el”fin~ s~lls~3.fort~a~w new~ 7 forpatientsetiicesdefinstratlon,3 fora ,:
~dthPrk~el’
@ination ofpatientse~ces andtrahing, 2 forR6D,anda n~erof coreactivities.
-26-
.
,
. .
wRmNm m
A rural,areaofSouthGeorgiaandNorthernnlti>erof seriousautoaccidentswillhavescrviccforthefirsttimeundera GeorgiaProject.
Floridawhichhasa staggeringround-the-clockemergencyRegionalMedicalProgram
Ina typicalyear,December1,1968,toDecember31,1969,therewere1,618motorvehicleaccidentsonthesectionofHighway1-75whichpassesthroughthisFloridaresortarea.At thatttie,allhospitalsintheareawererelyingonpracticingphysicianstobe calledon arotatingbasisforemergencies.Virtuallytheonlyambulancesavailablewerethosefromlocalfuneralhomes,which,’inmostcases,didnot meetmedicalstandards.~e populationof 200,000ina landareaof 3,800squaremilesisseinedby 96physiciansandtenhospitalswithacapacityof 838beds.
~~eprojectwillstaffandequipround-the-clo~emergencyroomsintwoof thelargerhospitals--PineviewGeneralatValdostaandVereenMemorialatMoultree--andprovideemergencyambulanceswithintensivecarecapabilities.Inaddition,MoodyAirForceBasehasagreedtopro-videhelicopterambulanceserviceindireemergencies.
me projecthasbeencoordinatedwiththeCommitteeonWergencyMedicalServicesof theMedicalAssociationof Georgia,theHighwaySafetyBureauandDivisionsof theStateDepartmentsofPublicHealthandEducation.
Status:Professionalstaffactivity.
me GeorgiaRMPcoverstheStateofGeorgiaandhasbeenoperational ;sinceJuly1,1968.~eir cotitmentlevelwas$1,922,571foi,M1970 >and$1,779,862for~ 1971.~ese fundswereusedin 1971to’~support23projectsofwhich6 were intheareaofgeneralcontinuing’education,6 fortrainingetistinghealthpersonnelinnewskills,2 fortrainingnewhealthpersonnel,3 forpatientservicesdemonstration,1 foracombinationof trainingandpatientservices,5 forcoordinationofhealthservices,andantier.ofcoreactivities. J, ,.
-27-
~tter healthservicesforpeopleinruralareashaverestlltcdf~mI.inkagesbetweentheWrshfieldClinic,a 400-bedmultisenicegrouppracticemd researchfacility,andsmall.crgroupandsolopracticesinthesparselysettledNorthCentralandNorthweste~regionsof
Inaddition,,collaboratingarrangementsbetweenrural.
Wisconsin.hospitalsandtheWrshfieldClinicarenowinoperationina numberofruralcommunitiesinthearea.Throughthesearrangements,cardiologists,~temists andothers~cialtyphysici~sprovideconsultation~d
.
clinicalfollow-upservicesforoutlyingphysi~iansandhealthfacilitiesona scheduledbasis.Plansarenowundemayto establishsatellite”healthstationstobemedby speciallypreparednursestowork~conjunctionwitha small~oup ofphysicianswhopracticeinShellLakewherethere isa smallhospital.TheWisconsin~w= inst~-montalinorganizinganddevelopingtheselinkages.
Status:Professionalstaffactivity
●
✌✎✎
andhasbeen .Plevelwasme WisconsinM coverstheentireStateofWiscons~
-rationalsinceSeptember1, 1969.Theirco~itment$l,0g8,42gforw 1970wd $951,781forH lg71.Thes~f~ds wer~ ~. zusedti1971 to s~rt a totalof13projects,of.~lch4.we~eintheareaofgeneralcontinutigeducation,2 fortr?ln~gexlstlng.healthpersonnelinnm skills,3forpatientservicesd~onstratlon, . ‘lfoi a combfitionoftrainingandpatientse~ices,1 ~0~~oordinatiov,forhealthsemices,2.forRGD,mdanumber of core’actlvltles..\-
-28-
A betterruralhealthcaredelive~systemisbeingdevelopedforthe25,000residentsofWestCentral~ine* The.~ine~h~ aidedtieareaplmers by consultativeservicesandllmtedflnanclalsupport,resultinginanOD operation~projectgr~t fortheprop~. mearea’splanistoapproachthesolutionofmedicalcaredelivewby agrouppracticemethod,comprehensiveprepaymentinsuranceanduseofalliedhealthWrsonnelpaswellasadvancedtechnologiesincludingtwo-way
Status:
.televi~ionad radiocomication.
Professionalstaffactivi~
TheMaine~ coverstheentireStateofMaine,andhasbeenoperation}sinceJuly1, 1968. Itsc-itment levelforW 1970was$956,904,andforW 1971was$814,42?.Thesefundswerewed inW lg71”tosuPPortatotalof’6projects,ofwhi~ 3 wereintheareaofgeneralcontinuingedumtion,2 fortrainingexistinghealthpersonnelinnewstills,1 forcoordinationforhealtiservices,anda ntier of,coreactivities.
GEORGIA
l)lly~icalt]lcrapistsareworkingh partsOf~lral‘eorgia‘]lere‘“home-carephysicaltherapyw& Previouslyavailable.T1-~etlle~aPlstsare’partof a GeorgiaRegionalMedicalProgr~projectlnvolvlngfiepoolingofmedicalpersonnelto providesemicestoremoteareasoftieState.
Ina ~cmnstrationproject,thephysicaltherapistassiL~cdtotllcnorth-eastareaof theStatebecomesself-supportinginl.cssthmlthreemonths.Thepopulationof 90,000isservedbysixcomlity hospitals,onenursinghome,~d oneextendedcarefacility,with250~ot:llbegs.mly onehospitalwasprovidingin-l~osPitalrehabilitation‘ervlccs.IntheSotltkeastarea,theworkloadfortheoriginalsingletherapistbecamesogreatthata secondtherapistw~added.~~efirst~erapistwasself-supportingwi~in sixmonths.me populationOt 100>OOOisservedDV sevenco~ity hospitals,twonursinghomesandoneextendedcarefacility,witi600totalbeds” ~ere wereonlYm~~lin-hospitalrehabilitationservices.
InitiallyGM paidtilesalariesof thephysicaltherapistswhoareresponsibleforprovidingservicestomedicalfacilities,aswellasdevelonin~homecarePro=~o Similarprojectsareplaed witiother
--~lliedhealthpersonnel.typesof
Status:Operationalasof 5/691styear-$23,4342ndycar- $1$,075
me GeorgiaM covers‘tieStateofGeorgiaandhasbeenoperationalStiC~July1,1968. Theircoti~ent levelwas$l}g22?571for~ 1970and$1,779,862for.W lg71.~1,779,862~ese @ds wereusedin1?71toswpor~23projectsoftich 6 wereintheareaofgeneralcontinuingeducation,6 fortrainingexistinghsal~Perso~el tinew skills>2 fortr~in~ng :;newhealthperso~el,3 forpatientse~icesde~~t~atio?>l.fora’combfiationof trainingandpatientscrviccs,5 forcoord~atlonof“hea~thservices,anda ntier of coreactivities”
.,
-30-
A hbdel.CitiesJlealthandWtritionProgramhasbeendevelopedby theAlabamaRMPtomeetthenutritionalneedsof thechronicallyill,dependentpre-schoolchildren,andpregnantadolescentsintheTuskegee-~con tiunty~ea. Nenty nutritionalassistants,aftercompletingasixmonthstrainingcourseattheTuskegeeInstitute,willworkwiththeruralpoorto implementtheprogramobjectives.,TheseindividualswillI)etrainedtoobservefamilynutritionpractices,instructandcounselinsoundnutritionpractices,assistinpreparingteac~,ingmaterialsandmakefollow-uphomevisitstoassistwithmenuplanning,foodbuyingandcookingskills,Ileywillalsoassistwithdietary:su~eysandworkwithcommunitygroups.Othercomponentsof theprogrm.aredirectedtowardestablishinga programofcontinuingeducationinnutritionforphysicitisandalliedhealthpersonnel,andevaluationofnutritionalstatusof individualsservedbytheprogrm. Theprogr~isbeingfundedjointlybytheModelCitiesProgramandthe~abamaRMP,incooperationwithAuburnMversiq, TuskegeeInstitute,TuskegeeVeteransAdministrationHospital,ComprehensiveHealthPlting (a)and(b)Agencies,andthePublicHealthDepartment.
Status:Ongoingasof 1/1/71lstyear(+~reemnths)2ndyear-
-$26,000-$104,000
,.:
-,
TheWabamaRegionalMedicalProgramcoverstheentireStateof ,:,
Nabama andhasbeenoperationalsinceApril.1,1969.‘~eirc-t- ‘.
mcntlevelfor~ 1970was$980,709andfor~ 1971was$766,278.Thesefids wereusedin1971tosupporta totalof 5 projects,3 of ~~w]~i~lwere.fQrtrainingexistinghealtiperso~elfinewskillsad 2fortraining’newhealthpersonnel,andanumberofcoreactivities.:
-31- ,,, ,.;.:
~e’Ficl& CornerNeighborhoodhealthCenterisprov}dingPr~aW carefortheurbanghettopopulationoftheDorchesterneighborhoodof’Boston,witiswportfromtheTri-StateW, thepe~~ent ~aritiesofBoston,theBostonDepartmentofHealthandIlospitals,~d ofiers.me centerisrunby an incorporatedcowiv gro~”called1’~eDc-tcfiinedpeopleofDorchester”andprovidescarefortheapproximately
17,000residentsof thearea.
Status:Professionalstaffactivity., $15,000contract
,,
The:Tri-State’~coverstheentireStatesof~ssachusetts,modeIslmd,=dN~IIWshire~ andhasbeenoperational,sinceFebruary1,1969. Itscommitmentlevelfor~ 1970was$1,467,436andfor~~lg71w= $1,814;132.Thesefundswereus~ inH 1971tosupporta totalof S projects,ofwhifi1 wasfortrainingexistinghealthpersonnelinnewskills,2 forpatientservicesdaonstratio~,2 fora.c~inationofpatientservicesandtraining,ad a n~berofcoreactivities.,!i,,.1
A NeighborhoodHealthCenter,whichincorporatesa mltiphasichealthscreeningfacility,isbecominga realityforthepopulationofoneof SaltLakeCityfslargestpovertypockets”TheHealthCenterwillserveapproximately61,0~0residentsofa 25squaremileareawhichischaracterizedby a lackofmedicalfacilities,privatephysicians,md inadequatepublictransportationrouteswhichwouldenablecitizenstoreachhealthcareh otherareas.TheCenteriswithina~delCitiesareaandanOfficeofEconomicOppfi~itY targetarea. Itinvolvesconjointfundingby theComunityHealthService,OEO,localresources,andtheIntermountainRegionalMedicalProgram.Thesecooperativeeffortsweredevelopedprimarilythroughthel~ staffanditscomity liaisonrepresentative,whowillalsoassistintheHealthCenter’sactivitieswhenitbecomesoperativeinJuly,1971.A memberoftheIW staffwillbe thefull-the~tiphasic ScreeningProjectDirector,andanothermemberwillservepart-timeasphysicimdirector.IN fundswillprovidetheequipmentandpersonnelforthescreeningprogramandthecomputerizationof allmedicalrecordsattheNeighborhoodHealthCenter.Inadditiontoprovidinghealthcaresemices,theHealthCenterresourceswillbe expendedintrainingLPNsasscreen~gaides,ando~er healthassistmts,whowillhe selectedfromtheareasemedby thefacility. . .
Status:Ongoingsince9/701styear--$203,1842ndyear--$358,176
TheIntermountainRegionalMedicalProgramcoverstheStateofUt~tidportionsof~oming,Mntana,Idaho,ColoradoandNevad@’and’~ “.Pbeen~erationalsinceApril1,lg67.~eirc~~i~ent level’was ‘$2,582,727forn 1970and$2,152,682for~ lg71. Thes~wdswe~e.usedin1971to supporta totalof14projects~2.of~1~ We?eforgeneralcontinuingeducation,Sfor traintigexistinghealthpersonnelinnewskills;2 forpatientservicesdemonstration,3 for%~mb~ationof trainingandpatientservices,2 forR6D,anda numberof coreactivities.
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‘rRI,-STAl’11
~O~INATIONOF SERVI~S
ThecityofProvidencehasnineneighborhoodhealthcentersthathavebeenoperativesince1968.Thoughthecentershadwell-qualified~hY~i~i~s,nonehada continuingrelationshipwitha hospital.l~eTri-StateW becameinvolvedinthedevelopmentof linkagebetweenthecentersandthecomunityhospitals.Contractswereawardedtotwoof thefivehospitalsinProvidencetotiethemto thecentersintheirrespectivesectionsofthecity. Inaddition,a corporationwasformedto combinethecenters.T~ providedtheassistanceof aphysicianwithe~erienceinmedicaleconomicstodeve~oPa Pe~mentmthod of financingcareofthecenters’patients.ThirdpartypaY-
mentsarebeingorganizedwithwelfareeligiblepatientson a cavitationbasis.N1 partieshaveagreedtoanew approachanddetailsare@rrentlybeingworkedout. Thesewillbe thefirstsuchcentersinNewEnglandtobe financedon thisbasis.
Status:Professional-staffactivityTwocontracts--$47,000and$20,000
,..,:
,:,.
i.,.,’
: ,
,~e Tri-StateM coverstheentireStatesofMassachusetts,Rhode ;Island,andNewHampshire,andhasbeenoperationalsinceFebrua~1,1969. Itscommitmentlevelform lg70was$1,467,436~d for ..w 1971was$1,814,132.Thesefundswereusedin~ 1971tosupport’a totalof 5 projects,ofwhich1wasfortrainingexistinghealth@rso~el innewskills,z forpatientservicesdemonstratio~,2 for.a combinationofpatientse~icesad training),%d a n~er ‘fcore~~•activities.
.,!I
-34-
A networkof threecomity healthinner-cityareasof Indianapolisis
centersinthedisadvantaged,beingswportedby tieIndi~a
RegionalMedicalProgramandseveralothera~~ncies.‘me MetrwolitmI1ealthCouncilfoundedandoperatesthecenters.me Comcilisa coalitionofprivate,publicandvoluntaryhealthinterest,professionalandconsumers,thatdecidedtoextendexistingframeworksfordeliveringcare. Ithasdevelopeda systemforbringingpersonalized,comprehensivecaretothousandsoffamiliesforwhom,previously,access”tocareandknowledgeabouttheavailabilityofhealthcareserviceshadalwaysbeenproble~. yleConcilpulledtogetherphysicians,nurses,otheralliedhealtiPerso~elanddevelopeda newtypeofworkers,thetrainedneighborhoodhealthaide.~is teamworkstogethertogetpeopleintothesystem.Publicacceptanceofthecentershasbeenexcellent,witi15,733visitsin1969.About80%of thepatientsseenreturnforfollow-upcare. Dataandexperiencefromthisprojectarenowbefigusedtodevelopevenbroadercooperativearrangements.
Status:Operational1/70- 12/701 yearfeasibilitystudy--$169,550
me IndianaRMPcoverstheentireStateof Indiana,andhasbeenoperationalsinceJanuary1, 1969.ItscofitmentlevelforW 1970was$1,271,411,andfor~ 1971was$968,842.~ese fundswereusedin~ 1971to supporta totalof6 projects,ofwhich2 wereintie~~•areaofgeneralcontinuingeducation,1 fortrainingexistin~healtipersonnelinnewskills,1 forpatientservicesdemonstrations,1 fora combinationofpatientservicesandtraining,1 forcoordinationforhealthservices,anda numberofcoreactivities;
7C
~. medicalclinics,onerequestedbythecitizens~d theotherstartedby localphysici~s,havebeensetup in~or, ~ral areasoftheStatewiththehelpof theArkansasRegionallledicalProgram.In”theblackcomity ofWrightWille,9 milessouthofLittleRock,theclinicwasrequestedbythetownspeoplewhoerectedtheclinicbuildingandset}lpa tokenpre-paymentplandeterminedlyabilitytopay. Thephysicim-lesstownisreceivingphysicimandlaboratows~~rt fromthelocalVeteransAdministration~losPital.LocalpeopleWd personnelfromtheOfficeofEconomicOpportunityworktogetherinperformingclericalduties.Localphysici~sestablishedtheclinicat.Jacksonville,a comity witha 60percentwhite,40percentblack>population.Theclinicoffersfmilypl~ing servicesoncea week,tidhasan tiunizationprogram.Italsohasbeendevelopedwiththeassistanceofthe- andO~.
S{atus:Professionalstaffactivity
. ....
-
tieArkansas~ coverstheentireStateofArkansasandhasbeen+rationalsticeFeb=w 1>1969.Theircotitmentlevelwas$$87,506forFYlg70~d $1,209,251forw 1971. ~le?efids were@ed in1971to SUPPOfl15.P~jectsYofwhich4 ‘ere.in‘hearea‘fgeneralcontinuingeducation,5 fortrainingexistinghealthperso~elinnewskills,3 fora combinationof trainingandpatientservims,1forcoordimtionforhealthse~ices)Z forR~D~~d~~~~ber ‘fco”reactivities.
.;:.,,,
-’36-
.:
,
i
SANIZRNANIXIVALLl~Y0~-PATI~TC~~~CS
‘il~rccout-]~atielltclinicswillbc se~~.ngsixdisadv~tagedinthenortheastSanFernmdoValleyas a resultof a studyundertakenby theCaliforniaRegionalMedicalProgram.
colnllunitiesof thearea
lhcareaisinneedof additionalhealthcarefacilitiesnowduetothedestructionofhospitalsintherecentearthquake.Particularlyneededisa ncwmethodof tr=sportingpersonstotheremaininghospitals.Anewloca]hLIStransportationsystcmforpatientsistobe setUP :1sPartof theproject.
Gearedforfuturedevelopmentjntoa health’maillten:~ccorg~ization,theclinicswillbe staffedbycomity healthaides.1lcpro~~willservesixcomities whicharecontiguo~anddisadvantaged,butwhichdiffergreatlyfromonemotherincharacter”For~xwl~> onegrowiscomposedofretired,middle-classwhiteslivingintrailers,whileanotherismadeupofelderlypoorperso~whoarenotvev mobile.Athirdcontingentisa poorcomity whifiisSOpercentblack>20Per%ntMexican-Americ~.
Includedintheprojectwillbe alliedheal~ careertrafi~gprogr~involvinglocalcollegesandschools.FundsfromtieOfficeofEconomicOpportunityhavebeenr~uestedtosupplatCm monies”However,ifOEOfundsarenotgrmted,Cmwill continueitsfin~cialsWPortuntilothersourcesoffundingcanbe fomd.
Status:Professionalstaffactivity
TheCaliforniaW coverstheentireStateofCaliforniaandtwocounties;inNevada,andhasbeenoperationalsinceJuly1, 1968. ItscommiticntlevelforN 1970was$8,012,055andforFY 1971was$6,220,0g4.~}esefindswereusedinN 3971tosupporta totalOf’24projects,ofwhl~}3 wereintheareaofgeneralcontinuingeducation?4 fortrainingeXlstillghealthperso~elinn- skills,1 fortrainingnewhealth’personnel,6forpatientservicesdemonstrations,8.fora CotiinationOfPa~ieUt. u
andtraining,1 forcoordinationforhealthse~lces~1 ‘orservicesR6D,anda numberof-coreactivities.
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ILLINOIS
VMLH CLINIC
Alt.l~ollghit.is locatedacljacenttoO1}Cof the].argestmedicalcenters~11‘the’world,(;tlic;lgots‘Yallcy’thadlittl.eav:lilablemedicalcareuntiI theopcnjngof i] freemedicalclinicin 196g.~lepop~ll~tiollof10,000inthislowincomeareaadjoiningtheWestSideMedicalCenteris95percentblack.
Whentheclinicstartedoperattig,itsserviceswerelimitedtoacutecare. Now,however,fullclinicservicesareprovided,includinggynecological,pre-natalandpost-natalcare,emergen~se~ic~s,screeninganddiagnosticcare,nutritionalcounselfig~~d socialservices.DentalandX-raycareareprovidedata back-~institution.Seriouslyillandinjuredpersonsarereferredto thehiversityIfospitalandothernearbyfacilities.
TO date,3500patientshavebeentreated.Itise~ectedtiatthisnumberwillincreaseto6000inthenextyear. Pedlatrlcteamcareisprovided.Otherteamsarebeingformedinadult,maternity,andcomity care.
TheI~ providedinitialfundingandcontinuestofundwe clinicfsinnovativeaspects.Thecostsof routinecarehavebeenasswdbyotheragencies.
statlL~:Professionalstaffactivity$71,400planningstudy
.
me’IllinoisRMPcoverstieStateof Illinois,withtheexceptionofthatpartincludedintheBi-StateIM),andhasbeenoperationals~nccFebfiary1, 1970. Itscmitient levelforW 1970was$1,585,643,andfor,~ 1971was$1,524,286.~ese fundswereusedinW 1971tosupporta totalof 7 projects,ofwhich4 wereforpatientservicesdemonstra-tions,z forc~rdinati~forhealthse~ices~1 for’R&D2~d an%ber’of coreactivities.
,’.
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Indigentpatientswillbe givenprivateappoin~entswiththe-s~ef~nilyphysicianeachttietheyvisitthehospital-basedcllnlchcingsetup athtiddlesexGeneralHospitalinNewB~swick. Oneofthegoalsofthisprojectistoseeifitismoreefficientthanthetraditionalneighborhoodclinicarrangementwherepatientswaitforthefirstdoctoravailable,andthenarereferredtootherclinicsiftheyneedspecialists.
Aimingat a teamapproach,inadditiontogeneralpractitionerstheMiddlesexI1ospitalclinicwillhaveobstetrici=-mycologistsandotherspecialists.Ifa patientneedstoseea typeof specialistnotassignedto theclinic,hetillbe referredtoa specificphysici,~on thehospitalstaff.Stiilarly,ifheneedsX-rays,labwork,orpharmaqsemices,hewillbereferredtohospitalfacilities.
TheclinicwillserveapproxfitelY4,000personsbegi~inginSeptember1971. MiddlesexHospitalwaschosenasthepilotsiteforthistypeofprojectbecauseitislocatedinthemiddleof a low-incomearea. ~ding tfieprojectareMedicare,Medicaid,hospitalresources,andtheNewjerseyRegionalMedicalProgr~.
Status:1styear--$143.000
.,...’.
TheNewJerseyRMPcoverstheentirestateofNewJerseyandhasbeen ;operationalsince@ril 1,.1969.Theircomtimnt levelwas$1,237,781forN 1970and$1,225,026forW 1971,Thesefundswereusedin1971to s~port11projects,ofwhich4 wereintheareaofgeneralcontinuingeducation,2,fortrainingexistinghealthpersonnelinnewskills,1 forpatientservicesdemonstrations,1 fora com-binationof tratiingandpatientsemices,2 forcoordiantionforhealthservices,1 forR~D,anda numberofcoreactivities,
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LIVINGSTON-~~~w~DIW ALLIANCE
As anoutqowthofextracareprovidedformigrantsummer.a commity clinichasbeenestablishedatcooperationwiththeStanfordhiversitySchooloftieassistanceof theGliforniaRegionalMedicalProgr~. Forthe
workersduringtheLivingstoninMedicineandwith
last25years,thisruralcommunityof3,000wassenedbyonlyonephysician.Thephysician’sofficealsoservedastheclinicformigr~tworkers.Aftersearchingmsucessfullyforyearstofinda replacemcnttthedoctorfinallyfeltableto leavethecomity whentheclinic
,.,
tookoverhealthcarere~nsibilities.
Theclinic,Aich beganoperatinglasts~er, isstaff~dqY st~f?rdmedicalstudentsandcom:mityresidents.A heartspeclallst,pedlatricianyandan internistspendtwodayseachattheclinic.Inaddition,sevenmedicalstudentsandtwostudentnursesworkthereona full-timebasis.Theclinicisopento allLivingstonresidents5 daysa weekandemergenciesarehandledon a 24-hour-a-daybasis.
~ity residentsinitiateda fund-raisingc~aign topayforsuppliesintheday-to-dayoperationoftheclinic.~eyhave fo~ed severalcommitteesto workinconjunctionwiththeclinic.Theseticlude;m’outreachprogramwing communityaidestohelpbreakdownthelanguagebarrierandtohelpcitize~ffid--mdtr~spo~ th~ to--ProPer ,medicaltreatmentinthearea;a comitteeon thespecialproblemsoftheillandagedsuchastransportation,properdiet,andregularmedicalcheck-ups;anda familyplanningcomittee.
.Status:Professionalstaffactivity
,TheCaliforniaM coverstheentireStateofCaliforniaandtwocounties “inNevada,andhasbeenoperatio~lsinceJuly1,1968.Itscomi~ent ;ievelfor~ 1970was$8,012,055andforn lg71was$6,220,0g4.ThesefundswereusedinW lg71to supprta totalof 24p~jects~ofwhich *3were intheareaofgenerflcontinuingeducation,4 fortrainingexistinghealthpersonnelinnewskills,1 fortrainingnewhealthpersoMel,6forpatientservicesdemonstrations,8 fora combimtionofpatientservicesandtraining,1 forcoordinationforhealthsenices,1 forR6D,anda numberof coreactivities.
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KTMTE~+ITMIINDIANHEAL~iCLINIC
At theirlocalp~-w~s> Kimte~itapi1ndias1eam ‘fhealthclinicservicesavailabletothem. Mostofthemembersofthe20to 30smalltribesintheSeattleareahaverecentlyrovedfromtheirreservationstothecity.Manyarcindigent.Theydonotknowwhereto go formedicalhelp.
Therefore,theKtiatechitapiIndian1lealthClinicsendsrepres~n~ativ~sto thetribalmeetingsto telltheKinatechitaPis*OU~ thec~lnlccurrentlyoperatinginspaceinthePublicHealthServicehospitalinSeattle.
TheclinicbeginfunctioningonshoestringfundsfromtheOfficeofEconomic@port~i~. Itisnowopenthreenightsaweek!se~ingfrom20to 30patientsanight. TheWashington/~~kaRegionalMedicalprogramhopestoexpmd clinic~Urs ad tien~ber ofPersonsse~ed”
Thepurposeof theclinicistoassisttheurbanIndianinlearninghowtousetheexistingsystemofmedicalmd socials~wices,ra~her.th~toprovidea continuingseparatehealthcarefacilltyfora mlnorltygroup. Itisa cooperativeeffortof theWreau of0~, theWashingtonDepartmentofHealthandSocialw/w..
IndianAffairs,-Services,andthe’
Status:professionalstaffactivity1styear--begmmg 1/72--$44,080
....,,
TheWashington/AlashRegionalMedicalProgr~ coverstheStatesOf .WashingtonandAlaskaandhasbeenoperationalsinceFebfi~l> lg680 ..5
~eir cdtment level’forN lg70was$1,606,157ad forV’lg71WaS$1,447,885.~ese fundswereusedinlg71TOswprt a totalof 22projects,7 ofwhichwereforgeneralcontinuingeducation)3 fortrainingexistinghealthpersofil’innewskills~2 fo~?atient~~e~icesdmnstrations,1 fora combinationof.patientandtralnlngsenlces,3 forcoordinationforhealth.services,6 forR6D;anda n~ber of ,.coreactivities.
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Nineheartclinicsprovidediagnosticandfollow-~careforindigentpersonsinSouthCarolina.me clinicatSpart=burg,whichisf~dedbytheSouthCarolina~gionalMedicalprogr~~is.fairlYtW}cal”Itisresponsiblefora three-co~tyareawitha growingpopulationofapproximately220,000.me clinicprovidessenices--includingcardiaccatherization--forindigentpersonswithcongenitalheartdisease,vasc~ardiseaseorother’complexconditions.ItalsodisseminatesinfomtiontophysiciansinSpartanburg,merokeeand~ion counties.
~ring a recentsix-monthperiod,theclinictreated136heartpatientsandrecordedan averageattendmceof 24physici~sandnursesatthemnthlyclinicconferences.
me clinicissponsoredincooperationwiththeStatebard ofHealthandtheStateHeartksociation.
Status:Operatiomlasof 8/681styear--$24,6g22ndyear--$24,2203rdyear--$22,058
.
me SouthCaroltiaM coverstheentireStateofSouthCarolina,ad ~hasbeenoperatio~lsficeAuWt 1>lg680 Its’coWitment1evel‘or .~ 1970was$988,082=d for:Wlg71W= $g58z3400?hese.fidSwereusedin~ 1971to su~rt a total”of16projects>.of~~ch2Wer~
.
b theareaof generalcofitfiu~geducation>5,fo!:trainlngex~st?ng7 forpatientse~lcesdemonstrations,healthperso~elfi.n~skills>
1 fora combinatioriofpatient.serv$cesmd t~~~~g} } forCOO~~inatiOnforhealthsemices,andari~er ofcoreactlvlties” .,.
llntra~.ncdl~crsonsweretaktigX-raysinsmallerhospitalsh therural[;rcatBendareauntiltheKansasRegionallledicalI)rograminstituteda X-raytechnologytrainingprogram.Fourteenmedicalteclmicians,nursesandotherhospitalpersonnel--whowereservingasX-rayte~icims becausetherewereno trainedtechnicians.available--participatedinclasseslleldattheCentralKansas ~~~MedicalCenter.
Becausetheequipmentusedatthetrainingcoursewasnotalwayslikethatat thetrainees’hospitals,asthesecondphaseof thecoursetheradiologictechnicianfromCm visitedthesmallerhospitalstoassistthetraineesintheirownlaboratories.Fih of thetraineesatworkbeforeandafterthecoursearebeingevaluatedby ~T.
Thistrainingprogramisoneofseveralthatareconductedaspartofa prototypeareahealtheducationcenterthathasbeendevelopedbytheKRMPin theGreatBendarea.
Status:“GreatBendEducationalPro~m’l@erationalasof 5/69l;tyear- $105,757”2ndyear- $105,7573rdyear- $1os,7s74thyear-$105,757
TheKansasM coverstheentireomrationalsinceJune1,1967.
StateofKansas,andhasbeenItscmitment levelforW 1970
w~s$1,346,744andforfi 1971was$1,236,220.Thesefundswerewed inN 1971tosupporta totalof 10projects,ofwhich6were,intheareaofgeneralcontinuingeducation,3 fortrainingexistinghealthpersonnel-innewskills;1 forR6D,anda numberofc~re “ ~activities.
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.,
‘lMoheartattackvictimsintheremoteAlaskacomunityof S~pt:larea]ivctodayI>ccausctheirphysici~sparticipatedina reg~on-~ig~programof continuing~dicaleducation”Inthisprogrmp~~~~c~~~hadlearnedhowto insertcentraltransvenouspace~kers.ledgesavedthelivesofthetwostrickenpatients.
TheprograminwhichthebctorsparticiPated~alongwith.otherphysicims~nursesandotherhealthprofessionalsfromremoteareas)lsheldthroughthekivefsityofWashingtonatseveralcen~ers‘n‘he‘egiono~~ecentersincludeSeattle,T*oma,Anchorage,y~~az Spokme,andWenatchee.”Theyprovidea placeforhealthperso~el~ remoteareastomeetwiththeirurbm colleaguestodiscussthenewestmethodsofmedi=ltreatment.
ThecentersarepartofWWI, a region-wideprogramofmedicaleduca-tiondesi~edtoprovide~re physiciansfOrCO~~itiesfiWashington>~aska,MntanaandIdaho@~).
TheWashington/uaska~gionalWdicalProgramhasplayedan fiportmtroleinthedevelopmentofthew P~9~0 Forex~le> W/_providessupportforre@ar visitsof consult~t-teachersfromthecenterstoremoteareasinwashin~onad~aska” As ar~sulto! thesevisits,physiciansinthe.outly~gareasre@arlY com=cate ‘lththoseinthecenters,andthereismorefrequentreferralof~ml .patientstodoctorsinthecities>whentheiro~physicia.s1acktheresourcestoprovidethebesttreatment.
Status:Professionalstaffactivity
lkeWashington/WaskaM coverstheentireStatesofWashingtonandMaska andhasbeenoperationals~ce Feb~a~ 1,lg68*~eir co~it- ,.,,mentlevelwas$1,606,157forFY 1970and$1,447,885for~ 1971.~ese fundswereusedin 1971tosupporta totalof 22projects,of. .which7 wereforgeneralcontinuingeducation>3 fortra~lngexlst+ng
,...
healthpers~el innewskills,2 forpatientservices,~ fo;coordln~tionforhealthservices,6 forR6D,anda numberofcoreactivities.
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.,. .
TheuseofreninSsaYs todetermineifa patient’shighblood~ressureissurgicallyremediablehasresultedinthecureofpersonsinruralareaswh othe~isewouldstillbe sufferingfromhypertension.Theexpandeduseofthisnew”diawostictectiiqueis.oneoutcomeof a conttiuingeducationmurse forphysiciansheldin17hospitalsintheCambria-SomersetareaofWesteWPennsylv~ia,withthesupportofth~WesternPennsylvaniaWgionalMedicalProgram.
As anotherpartofthisprogram,physiciansfromtheDiversityHealthCenterinPittsburghvisitcomunityhospitals,andwithoneofthelocalphysiciansastheirguide,helpintheroutine=re ofpatients.Ifnecessary,theurbanphysicianofferstotakepatientsto theHealthCenterlaboratoryfortests.Thisexpandedconsultationandreferralsystembetweenthec- ityphysicianandHealthCenterspecialistshasrestitedinthedoubltigof theuseofmoremodem diagnostictechniquesby localdoctors.~
Status:@erationalasof 7/691styear- $34,0002ndyear- $39,0003rdyear- $25,484
,..
TheWesternPennsylvaniaM coversthecityofPittsburgh,and28surroundingcounties,mdhasbeenoperationalsinceJuIY1, lg6g.Theirmmmitmentlevelwas’$934,041forN 1970~d$996,338forW1971.Thesefundswereused.in1971to”suppo~’?totalof 7 projects;.ofwhich2 were,M the”areaofgeneral.conttiuing~ed~cation,2 fortrainti~.existinghealthpersonnel’,innewskills,2for patientservicesdemonstration,1 for”coordi~tionforhealthsewices~andanumberof coreactivities.
-45-
~ly thirtyregistereddietiti~sservea muchgreaternumberof small
hospitalsandnursinghomesinruralCentralmd WesternKansas.TWO
of thesedietiti~ orgmizeda dietarycenterh CentralKansasMdicalCenter~~eretheyhold coursesforthecookswhosewe theseinstitutions
~~iththehelpof theKans~’RegionalMedicalProgr~,eightclassesfor80cooksfrom12countieshavebeenheld. Subjectsta~ghtby‘ie‘“registereddietiti~sincludedgeneralprinciplesofdletetlcs~sanitationandpersomlhygieneinthepreventionof foodpoisoning,diabeticandfat-controlleddietsandthei~ortanceof sodium-balanc~~diets.
Status:@rational asof 2/6g1styear--$18,2642ndyear--$12,836
me KansasRMPcoverstie entireStateofKansas,andh~ been,operationalsinceJune1,1967. Itsc-itment’levelfor~ 1970W= $1,346,744andform 1971was$1,236,220.Thesef~ds,wereUSd h w 1971 tosupporta totalof10projects;of.~}ch6 yer~intheareaof generalcontinuingdUCati~, 3 fortralnlngexl:tl?ghealthperso~elinn~ skills;1 forR~D)ad ?n~er ‘fcore~,activities.
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‘1’hcst’mdardsoFpaticntcareinthenursinghomesofWesternPcnnsylvani:1havebeenimprovedthrougha tratiingprojectundertakenby thatRegion’sw. AS ofFebruary1971,42homes,one-thirdof thenursinghomesprovidingskilledcareh theRegion,haveparticipatedina trainingprojectto tiprovethequalityoftheirnursingandadministrativeservices.An intensive8-monthcourse,plannedandimplementedwiththesupportof specialistsinhospitalmanagement~dnursfigeducation ,fr~mth~diversityHealth~nter inPittsburgh,hastrained137nursesandadministrators.Wsing practicesinthbparticipatinghomeshavebeensi~ificantlyimprovedashavethesocialsenicesprovidedbythehomes.Variousadministrativeprocedureshavebeenimprovedthroughthedevelopmentof suchpracticesasprospectivebudgetingandpersonnelmagement. Thisprojectisalsobeingstudiedasameansofprovidingalternativestothemore~expensivehospitaltipatientcare.
Status:~)erationalasof 7/691styear- $125,0002ndyear-$136,0003rdyear-$22,000
TheWesternsurrounding
pennsylvaniaw coversthecityofpittsburgh,~d 28 ~count~iesand’h~been.operationalsince’July1 1969 ~eir
comitment”levelwas$934,041forNlg70 ~d $g96~338for~ lg7~. .~ese fundswereusedin1971tosupporta totalof 7.projects,ofwhich2 wereintheareaof generalcontinuingeducation,2 fortrainingexistinghealthpersonnelinnewskills,2 forpatientse~ices.,demonstration.1 forcoordinationforhealthservices,andanumberof :.core.activities.
,..,”.,
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CON1’INUTNGPWNARY ~UTION
Fivenewlungfictionlahratories,twonewinhalation~herapy.~drehabilitationcenters,hd threenewrespiratorylntenslvecaremitshavebeenestablishedasa resultofa conttiuingeducationprojectinpuhonarydiseasesforphysicianssponsoredbytheIndianaRegionalMedicalProqm.
me projectconsistedof a five-dayintensivetrainingcourseattheIndianaWiversityMedical@nter followedby dne-days~posiathroughouttheyearatthetrain=s’parentinstitutions;~?i?g thefirstyearof theproject,12physiciansfromnineareasparticipated.~ring thesecondyear,thentier of traineesroseto2gfrom16a~=”
Aftercompletingthecourse,thetraineestrainedotherphysicimsintheirlocalityinthecareofpatientswithpulmonavdise~e. Thetennewrespiratoryfacilitiesweredevel~edatthelocallevelbytraineesandthephysicianstieytrained.
Status:@erational1/70- 12/71--$15,873
TheIndiana~ coverstheentireStateofIndiana,andhasbeenoperationalsinceJanua~1,lg6g. Itscmitient levelform }g70was$1,271,411,andfor~ 1971was$968,842.~ese f~ds wereusedinW 1971tosupporta totalof 6 projects,ofwhich2werein theareaofgeneralcontinuingeducation,1 fortratiingexistinghealthpersonnelinn~ skills,1 forpatientservicesdemonstrations1 fora c~ination ofpatientsenicesad training>1 forCoordinationfof.,healthservices,anda numberofcoreactivities.
.:..:.,...,,
-48-
.
lhcfirsteducationaltelevisionnetworkdevotedtoservingtheprivatephysici~md othermedicalpcrso~~lhasbecnest~li$hedbYtheGeorgiaRegional~ledicalprogr~. ~len~leProJectbegain1968>sixmedicalinstitutio~werepartofthenetwork.Today,theneti~orkhasgrownto22hospitals,doctors!officesandclinics.
TheAtlanta-basednetworkbroadcastsanaverageof22hoursa weekandhasa tapelibraryofmorethm 500pro~~. ~~loughfieGeorgiaRegionalMedicalTelevisionNetworkhasceasedweeklyState-widebroadcastsinfavorof a tapelendtiglibraw~itdoesProduce~dbroadcastliveandvideotapedprogr~ overanAtlantaMetropolit~Ne~rk. Morethan44percentofGeorgiatsphysici-,~dnurses,mdnearlyone-thirdof alltheState’shospitalemployeesarewithintheGm broadcastrange.~rther,87percentof allphysici=s,80percentof allnursesand69percentofallhospitalemployeesintheStatehaveaccesstoeitherlivebroadcastsorvideotaperecordtigs.
Tobe responsivetoprofessionalnee~, Gm issendinga listof50 topicstoallmedicalpersonnelwithinthebroadcastrangeforrankinginorderofpreference.The25mostpreferredtopicswill heselectedforproduction.Whenprogramsarebroadc=t,a s~ling Ofviewerresponsewillbe taken.Theprojectisa cooperativeeffortofWry ~iversity,theMedicalCollegeofGeorgia,~d GM.
Status:Operationalasof 5/681styear- $522,4gl2ndyear- $355,8823rdyear-$148,561
.
~c Gcorgia~ coverstheStateofGeorgiaandhas”beenoperational s:,
sinceJuly1,1968. Theircoti~nt l~elwas $l,g22,571for~}g70. and$1,779,862for~ 1971,Thesefundswereusedh 1971tosupport
23projectsofwhich6 werein tieareaof generalcontinuingeducation?6 fortrainingexistinghealthpersomelinnewskills,Z fortrain~g”newhealthperso~el?3 forpatientse~icesd~onstration>l.fo.r‘?,.combinationof trainingandpatientservices,s forcoordlnatl?nOf ~~healthsemices,anda ntier of coreactivities;
Strokepati.cntsarcgettingoutofbcdsooner,areabletofeedanddressthemselvesearlier,andhaverfewercomplicationsasa resultofa basiscontinutigeducationprogramfornursesh Centralia,Washington,andtheadjoiningtownof~ehalis.
Centraliahasa populationof 10,000andislocated90milesfromSeattle.Localcitizensandhealthpersonnelsetup theprogramofrestorativealdrchahilitativenursingatCentraliaComity College.Nursinghomesandhospitalsprovidedtheinitialfundingfortheproject.me fund-in~wasmatchedby theWashingtonStateIIeart&sociationandsupplementedin-1969byWashington/M=kaRegionalMedicalProgramfinds.
Tedmiquesacquiredthroughtileprogramareusedby theentirenursingteam--including.registerednurses,practicalnursesmd nurses’aides--inparticipatinghospitals,nurskghomes,andprivatehomes.
.-
.Status:Operationalasof 7/69
1styear-$4,7002ndyear-$13,000
me Washington/MaskaRegionalMedicalProgramcoverswe StatesofWashingtonand~aska andhasbeenoperationalsinceFebruary1,1968.71~circofi~nt levelforW 1970was$1,606,157andfor~ 1971was
I $1,447,885.~ese fundswereusedh 1971to.support.atotalof 22;, projects,7 ofwhitiwereforgeneralcontinuingeducation,3 fortrain-$.. ingexistinghealthpersonnelinnewskills,2 forpatient:se~ices~, demonstrations,l.fora c~inationofpatientandtrainingservices,3i forcoordinationforhealtisenices,6 forRGD~~d an~er Of cOre
activities.
...
j<
.
-50-
~re ~la a quatierofallemployednursesinSouthCarolinareceivedtrai~figtimouth-to-muthresuscitationand$losedch~stmassageduringthefirstyearofa SouthCarolinaRcglonalMedicalProgramand,heartAssociationproject.
~epilot programwasheldinhrchesterCountY1~osPital.First,phusici~sandnursesweretrainedinthemethodsusedtorevivevictimsofheartattack,suffocation,electricsh~ck~~d d~o~i~g: Thenthetrainingwasbroadenedtoincludeinhalationtherapists,firemen,policemenandotheremergencyperso~el.
‘Meprojecthasbeenexten~dtoinclude208freetrainingProg~Y*Ina nwber of counties,allhospitals:staffshavehadthetralnlng.~enty-fiveof thefofly-~eco~ties~ theStateha~~g at 1e=tonehospital,havehadoneormorehospital-basedtralnlngprogrms.
Status:Operationalasof 8/681styear-- $4?J7742ndyear-- $4D,6453rdyear-- $40j341
TheSouthCarolinaW coverstheentireStateofSouthCarolina,and ~ :hasbeenoperationalsinceAu~t 1,1968.“Its,co~.i~entlevelfor~1970was$988,082andfor.~ 1971W= $?58,340..Thesefids wereUSedinW 19,71.to”supporta totalof16projects,ofwhich2~re intheareaof generalconttiutige~cation,5 for.tra~~gexist+nghealthper~nnelinnewskills,7.for~atientsemicesdemonstration,1 for ~a combinationofhealthservices,
patientsetiicb$”andtraining,lforcoordinationforanda number”ofcoreactivities.
-51-
NO~WS.,
S1-10RT-~RMRESIDENCIESFORPW~ITIO~RS
Generalpractitioners,internistsandsurgeonsarebeingtrainedfor ~~periodsofone-tbeemonthsina specialityorcombinationof specialitiesat thefitiyoClinic,mder a regionalpostgraduatemedicaleducationprogramsupportedbytheNor~ads RegionalMedicalProgram.Thespecialitiesavailableareneurology,hematology,gastroenterology,oncology,ad cardiovascularmedicine.Eventuallyenvisionedforstate-wideparticipation,theprojectinitiallyinvolvesphysiciansfromfivesoutheastern~nnesota
status:Professionalstaff
Northlands~ covers
hospitals.
activity
The theentireStateOfMiMesOta,~dh= beenoperationalsinceMarch1,1969. Itscmitment levelfor~ 1970was$1,676,227,andforH 1971w= $1,157,524.Thesefindswereusedin~ 1971tosupportatota~of8 projects,ofwhich6were inthearea ~ofgeneralcontinuingedutition,1 fortra~~g existinghealthpersonnelinn~ stills;1 forcoordinationforhealthservices,anda n~er ofcoreactivities.
-52-
.
.
.
.
LPNPROGMI
Standardizedtrainingplishcdby a trainingc:oronaucaremits.
forLicensedPracticalNurseswillbe accom-programforLPNsworkingintheStaters~is projectrepresentsoneofthefirstattempts
intheNationtoofferstan-~rdizedCm trainingforLPNs.
At present;NewJerseytsLPNshavea varietyofeducationalback-grounds,rangingfromformaltrainingtolicensebywaiver.me of .thegoalsof theNewJerseyRegionalkdicalProgram-sponsoredtrainingisto insurethatallLPNsworkingincoronarycareunitswillhavebeenadequatelytratiedforthenewdutiestheywillbecalledupontoperformasRegisteredNursesmve intosupervisoryroles.Anothergoalistodetefie specificallywhatnewdutiestheLPNsshouldbeallowedtoperform.Clinicalexperiencewillmake@ atleasthalfof thecourse.
Althoughthepilotcourseoftheprogramwillbe givenat}Iackensack~Iospitalthisfall,it isexpectedthataftertheinitialtwocoursestheprogramwillbe decentralizedto 20hospitalsinSussex,Warren,BergenandPassaiccomties.
Status:@erationalasof 4/711styear- $31,10~
~~eNcwJersey~ coverstheentirestateofNewJerseyandhasbeen :operationalsince~ril 1,1969.~eir co@tment levelwas$1,237,781“bfor~ 1970and$l,225,026for~ 1971. ~esc fundswereusedin1971to support11projects,ofwhich4 wereM theareaofgeneralcon-tinuingeducation,2 fortratiing”existinghealthpersonnelinnewskills,1 forpatientservicesdemonstrations,1 fora c@inationoftrainingandpatientservices,2 forcoordinationforhealthservices,lfor R~l),anda numberof coreactivities.
-53-
MShS
InactivenursestitheGreaterKansasCityareaarebe;ngretra~edinsix-weekrefreshercoursessupportedby theK~sas RegionalMedical~ogram. ClassroomworkisreceivedattheH headquartersinK~&sCitywithclinicalexperi~ceatanyoneof 15areahospitalsinK~sas City,Missouri;Kansas.City,Kansasor Independence,Missouri.Thecourse,orientedtoretraininactivenurseswhodesiretomaintain.~d extendtheirprofessiomlcompetence,isdesl~edtost~ulate
.
self-confidencebyupdattignursingskills.Theam ofthe?rogr~isto returnthesenursesto activepractice@d therebyrellevetheshortageof trainednurses.AppmximatelY75%ofthenursesretrainedto datehavereturnedtoactivepractice.
Status:@eratioMl asof 5/681styear--$60,4162ndyear--$72,5133rdyear-- $36,8024thyear--$36,802
,
TheKansas~ coverstheentireStateofKansas?andhasbeen ;
operationalsinceJune1,1967. ItscommitmentlevelforW 1970W= $1,346,744=d for~ lg71W= $1~236>220”~ese ‘redswere
.
usedin~ 1971tosupporta totalof10projects;:o’fwhich6 wereIn tieareaofgeneralcontinuingeducation,3 fortrainingexistinghealthperso~elfin~ skills,1 forRGD~~danqer.of coreactivities. H
’54-,, .
MMmIVA~l)~B;NISTS INSTROmPR~m
RetiredhealthpersonnelhavebeenbroughtbacktoworktomeettheneedfortrainedtherapistsinIndiana,
NllentheIndianaRegionalMedicalProgram~sstrokeprojectbegan,only3Soutof.the112generalhospitalsh theStatehadphysicaltherapyservice,15hadoccupationaltherapyse~ice,~d only14hospitalshadboth. Theprojecthasplacedteamscomposedof a physicaltherapist, anoccupationaltherapist,anda languagetherapistineachof five,are~intheState,kng thetherapistsaremany.whohadessentiallyretired.Aftermakingregularvisitstohospitalsto.helpdeterminetheirneeds,theteamsdeveloptrainingprogramsfornursesor laypersonnelso thattheycanbettercareforstrokepatients.A three-beddemonstrationteachingcenter,wherepatientsinvariousstatesof cerebralvasculardiseasearediagnosed~ldtreated,reinforcesthe1~ stroketrainingprogram.
~ter ~0 yearsOfprojectoperation,thereareonly3gho~pital~whicharewithoutfulltherapeuticfacilities,However,allof the39haveat leastonepersonwhoistrainedinoneof thethreetherapeuticdisciplines.
Status:Operationalasof 1/691stYear-$222,1162ndYear-$281,2413rdyear-’$211,so0
me Indiana~erational
~ coverstheentireStateof Indiana,andhasbeen;“
sinceJanua~1,1969.Itscmitient levelfor~ 1970was$1,271,411,andfor~ 1971was$968,842.Thesefundswereusedinw 1971tosupporta totalof6 projects,ofwhich2werein.the’areaofgeneralcontinuingeducation,1 fortrainingexistinghealthpersonnelinnewskills,lforpatientsewicesdemonstrations;l,fora combinationofpatientse~ic,esandtraining,1 forcoordinationforhealtiservices,andantier ofcoreactivities.
-55-
GEORGIA
~N1’IMjINGlil)U~TION
Twenty-siXcourseswereofferedGeorgiafsphysiciansthisyearinaprogramofcontinuingclfiicaleducationSPO~OredbYtl~eGeorgia ‘RegionalFlcdicalPro~~, ThecoursesarctaughtattheMedicalCollegeof Georgiaandthe~ory ~versity SchoolofMedicineand,includetopicsrelatingtoki~ey disease)heartdisease>respiratordisease~gastrointestinaldisturb~ces,endocrinedise=e)C~CeT>,Yte~almedicine,neurology~,liverdise~e~andobstetricsand~~~coIogy.
Beforetheprojectbegantii1968,therewasno organizedpl~ by thetwomedicalSC11OO1Sto.provideclinically-orientedcont~utige~cationsessionsbecausetheschoolslackedfunds. ;.,
As ofFebruary197140physicianshadparticipatedintheprogrm.Additionalphysici~sandatleast60nursesandotheralliedhealthprofessionalswillparticipatetitienearfu~re- Itishopedfiatthoset~ingpartinthisprogramwillthensene aSresourcesconsultantstocontinuingeducationprogramsintheirlocalhospitals.
Status:Operationalasof 5/681styear- $47,4922ndyear- $91,0853rdyear-$41,000
TheGeorgiaM coverstheStateofGeorgiamd hasbeenoperationalsinceJuly1,1968.Theircomitmentlevelwas$1,922,571for~ 1970and$1,779,862for~ 1971.fiesefundswereusedin1971tosupport23projectsofwhi~ 6 wereintheareaofgeneralcontinuingeducation,’.6fortrainingexistinghealthpersonnelinnewskills,2.fortrainingnewhealthpersonnel,3 forpatientservicesdaonstration,1 foracombinationoftrainingandpatientservices,5 forcoordinationofhealthservices,anda numberof coreactivities.
,.
M:l)l(fil,INIX)[WT1ONS1:WICEVIA‘fl:l,I~l)ll~
j)]~y~i~j;~sp~~cti~ing in smalltowsandisolatedmral areasofAlabamahaveinstantaccesstospecialistsattheMiversityofAlabaa inBirmingham,throughtheMedicalInformationServiceviaTelephone;knowninAlabamamedicalcirclesasMIST. Callscanbeplacedfreeof chargefromanypointinAlabama,atanytimeof thedayornight,on the~ST circuit.To.date,morethan750oftheState’s2,200practickgphysicianshadplacedsome4,500callsre-questingthelatestandbesttrea~entfora varietyofmedicalprob-lems.MISTswitchboardoperatorsaretrainedtolocatespecialistsinallfieldson split-secondnotice.TheprogramwasdevelopedthroughthecooperativeeffortsoftheNabamaRegionalMedicalPro-gram,theWiversityof~abama inBimingham,andtheAmericanMedicalAssociation’sMucationandResearchFred. Ithasservedasa proto~e forsimilarprogramsbeingdevelopedinotherRegions.
Status:@goingsince4/1/711styear- $21,000carryoverfundsand$10,000care
funds2ndyear- unfunded-willbe corestaffactivity
staff
The~abamaRegionalMedicalProgramcoverstheentireStateof ;AlabamaandhasbeenoperationalsinceApril1,1969.Theircommit-mentlevelfor~ 1970was$980,709andfOrW lg71w=$766,278~ ,Thesefundswereusedti’1971tosupporta totalof S projects,3 ofwhich”werefortrainingexistinghealthpersomelinnewskil~sand 2fortrainingnewhealthpersonnel,anda ntier of coreactivities.
-57-
Kansashealthprofessionalsaroundtheclockaspartof
canthe
~4e~ical Libra~SysttimProject.
placerequestsformedicalifiormationKansasRegionalMedicalProgrmlsCallscanbemadetothecentral
libraryorits”tfieebr-m~esona freetelephoneline.Trainedmedicallibrariansanswerphonesonweekdaysandnightcallsarerecordedandansweredthefollowingday.
FromJuly,1969,toNovember,1970,3,779personsusedthelibra~,Of these47percentwerephysicians.~ring thesecondyearof operationtherewasa 120percentincreaseinrequests,md m iqcreascof 87per-centin thenumberofhealthprofessionalsusingthesenice. Itwasfoundthatruralphysiciansusetheservicemorethm urbanphysicians.
IllccentralofficeislocatedintheClendeningMedicalLibraryatthediversityofKansasMeficalCenter.Branchesareatsto~ont-vailhospital,Topeka;WichitaStateMiversiw;andCentralK~sasMedicalCenter,GreatBendo hng theservicesofthelibraryaredrugproductinformation,medicalreferences,preparationofbibliographies,aluinsubmittingrequestsin~DM @edicalLiteraturekalysis)andphotocopyingandmailingjournalarticles.
Status:Operationalasof 2/691styear-$208,545.2ndyear-$88,889
.~eKansas~ coverstheentireStateofKansas,andhasbeenopera-tionalsinceJune1,1967. ItscommitmentlevelforH 1970was$1,346,744andfor~ 1971was$1,236,220.Thesefundswereusedin ,,PY1971tosupporta totalof 10projects,ofwhich6werein theareaofgeneralcontinuingeducation,3 fortrainingexistinghealti,personnelinn~ skills,1 forR~D,anda ntier ofcoreactivities.
-58-
I~IN
r;~)~SI~NOF~~1~ LIB~y E~~SION.SERVI~ ,.
IndianaphysicianscancalltheirlocallibrariesforanYmedicalreferencematerial=d pickup a xeroxedcopyof themat;xialat thelibrarywihtinthenextdayor two. Illelocallibraryteletypesthephysician’srequestto~e medicallibraryat theIndianaMiversitykdicalCenterin Indianapolis,me medicallibrarythenmailsxeroxedcopiesof therequestedmaterialtothelocallibrary.
me networkreaches150c~ itiesandhas1,052patrons,Inanaveragemonth,580articlesaresuppliedto Indimaphysicias,Inaddition,theprojecthasconductedthreesetiars,fora totalot40non-professionallibrarypersonnelwhoworkinhospitallibrariesthroughouttheregion.me seminarsweredesignedtoupgradethe”quali~of serviceinhospitallibraries,
Status:Operationalasof 1/711styear-$26,1972ndyear-$21,800
M coverstheentireStateof Indiana,andhasbeenfieTndimaoperationalsinceJanuary1, 1969.Itscmitment-levelforH 1970was$1,271,411,andforW 1971was$968,842.~ese’fundswereusedinFY 1971tosupporta totalof 6 projects,ofwhich2werein theareaofgeneralcontinuingeducation,l’fortrainingexisting,healthpersmel innewskills,1 forpatientsewicesdmofi’trations,lfor.a cdinationofpatientservicesandtraining,1 forcoordinationfor ●
healthsenices,anda ntier ofcoreactivities. .,:,,
.,::-59-
WSAS
Takingintoaccomtthelifestyleofthemigrantworker,theKansasRegionalMedicalProgramhxdevelopeda methodofputtingtheworkers’medicalrecor~ina concise,durable,andeasilyavailableform.
Themethodincludesa mntrallibravs~tem>~ i~ntific?tionc?rd>and‘aneducationalprogram.Thelibra~housescomprehensivemedicalrecordsforallmigrants.Therecordsareavailableon a 24-hour-a-daybasistoallphysici~ md i~titutionsviatelephone>~>-ortelegraph.Recordsarefiledbynumber,andthenumberscross-filedtwiceby socialsecuritynumberasWC1laSby n~e ~d dateOf birth.
Becauseof thesuccessoftheSocialSecurityAdministrationinconvincingmigrantstocaw socialsecuritycar~~ w evectstheissuingofhealthidentifi=tioncardstobe readilyaccepted.Theplastic-laminatedcardshowsthepatient’scolorphoto,hisn~e,socialsecuritynumber,dateofbirth,MigrantMedicalRecordsnumber,andvitalmedicalinformationsuchasdiabetesorantibioticsensitivity.Thebackofeachcardcamies~tructionsinbothmglish andSpanishforereachingthew libraw.
ParticipationisbeingencouragedthroughMigrantHealthServicefieldworkers,migrantschoolsandthedevelopmentofa shortaudio-visualpro~am,nanated~ SP~iS~>forUSeatbifihcontrolclinics‘dhigrant
Status:
gatheringssuchasfamilynights.
ProfcssiOnalstaffactivity
fieK-as M coverstheentireStateofKwsas,andh= been ~~•operationalsinceJune1,1967. ItscommitmentlevelforW 1970 ~W* $1,346,744andfor~ 1971was$1,236,220.~ese f~ds were~~•usedin~ 1971tosupporta totalof10projects,ofwhich.6j.wereinthe.areaofgeneralcontinuingeducation>3 fortralnlngexistingheal~ perso~elinn~ skills>1 forR~D>ad a n~erofcoreactivities=
-60-
.
. ?,..*
‘lhcabilityofphysiciansto servemore.patientsisbeingexpandedthroughthePhysicim’sksist’antI}rogr.ambeingcarriedoutatl~elkiversitySchoolofMedi&e withsupportfromtheNorthCarolina~@ andfromothersources.Thisprogramwasoneofthefirstofitskindinthenationandisbeingemulatednationallybymanyotherpmgrams.PhysicianassistatgraduatesarepresentlyworkingwithlocalpractitionersintheStateofNorthCarolinaandarefunctioningasa welcomedadditiontothehealthcareteam.
Status:Operationalasof 7/1/701styear--$183,321
TheNorthCarolinaM coverstheentireState.of:NorthCarolina, ;andhasbeenoperationalsinceMarch’1,19680,ItscommitmentlevelforW 1970was$2,047,486andforW 1971was.$l,844;692..Thesefundswereusedin~ 1971tosupport.atota~.of,21projects,ofwhich10wereintheareaofgeneralcontinuing.~ducation’g4 fortrainingexistinghealth~rsotielinnew,skil~s,1 for,trainingnewhealthpersonnel,1 forpatientservices’demonstrations,5 fora combinationofpatientservicesandtraining,anda numberofcoreactivities. \
,.
-61-
IWSTVIRGINIA
]]ecauscofanacuteshortageofpediatriciansinrural‘areas,a progr~hasbeeninstitutedtotrainpediatricnursepractitioners.~~eprogramissupportedbytheWestVirginiaRegionalBkdical.ProgramincooperationwititheWestVirginiaMiversitySdool ofNursingand .
theDepartmentofPediatricsat“tieWiversivtsShool ofMedicine.:
lkcconcepthaswontheacceptanceofpediatriciansaswellas theSchoolof-Nursingwhichmade-anexceptionnursesreceivingpediatrictrainingtobe
Afterfourmonthsof training,thenursesinruralareas.Fournursesweretrainedextensiveprogramplannedforthefuture.
toitspolicyby allowing:
non-baccalaureatestudents.
areplacedinprivateclinicsthefirstyear,witha more
status;Professionalstaffactivity “
TheWestVirginiaM coverstheentireStateofWestVirginia,and.,.2
hasbeenoperationalsinceJanuary1,1970. Itscomitmentlevelforw 1970was$524,048andfor~ 1971was$580,978..~e?e $~ds were
.
usd in~ 1971tosupporta totalof,4 projects,ofwhlchlwasfortrainingexistinghealthperso@elinnewskills,lfo~patient .servicesdemonstrati~s,2,forRGD,and.anumberofcoreact+yities.,.
,.,. ,,,’.
-62- ~
A multipflas:icscreeningprogrmsupportedby theIndimaRegionalMedicall~rograllf13ssho~ thatrelativelyuneducatedindigenouspersonsfromtf~cpovertyareacanbe effectivelytrainedtoconductthetestingaccurately.Today,35 tecfmicians,nlany,ofwhomdidnot havea highschooleducation,havebeentrained,Theprojectalsohasshownthatitcanpickupdiseases.S@ling of screeneestidicatethatapproxi[nately50%ofthesepatientshada significanttestabnormalityofwhichtheyhadnopreviousknowledge,Themultiph~icscrecn~ngprogra]shavebeenmovedrecentlyintoneighborhoodhealthcenterswhichf~asresultedinanexcellentfollow-upon screenedpatients.Effortsarebeingmadetoscreenlargenumberofpatientstobringthecostdowntoabout$35perpatientfor22tests.
Status:@erati.onalasof 12/681styear-$225,0002ndyear-$265,0003rdyear-$196,000
me Indianamerational
N coverstheentireStateof Indiana>andhti’beensinceJanua~1,1969. Itscmitment levelfor~ 1970
w~ $1,271,411,andfor~ 1971was$968,842.Thesef~ds wereusedinW 1971,tosupporta totalof 6 projects;of.which2werein the ~~~areaofgeneralcontinuingeducationalfortrainingexisting’healthpersonnel.innewskills,1 forpatientservicesdemonstrations,’1 fora [email protected];1 forcoordinationfor,hcaltiservices,andantier ofcoreactivities.
-63-
“1’i/J-S’1’A’l’J~
A GcrjatricNursePractitionerprogramhasbeendevelopedattheCam-bridgeHospital(municipalhospitaljwiththecooperationof theBostonhiversitySchoolofNursing.Theprogramwillteachnursestotakeovermuchof thecareof olderpersons,particularlyinnursinghomesandextendedcarefacilities.Supportisbeingprovidedbythe ~Tri-State~, theCommonwealthFundandtheCityofCambridge.
Status:Coreactivity$9,000contract
***
A pediatricNursePractitionerprogramhasbeendevelopedby theMassachusettsGeneralliospitalwiththeaidof a T~ contract.Thecoursewasdevelopedinsucha waythatitcouldbegivenforcreditatNortheasternhiversityandbecomeself-supportingona tuitionbasis.
Status:Professionalstaff$10,000contract
activity
TheTri-StateM coverstheentireStatesofMassachusetts,ModeIsland,andNewHampshire,andhasbeenoperationalsinceFebrua~l,1969. Itscommitmentlevelfor~ 1970was$1,467,436andforW 1971was$1,814,132.Thesefun~ wereusedin~ 1971tosupporta’totalof 5 projects,ofwhich1 wasfor,trainingexistinghealthpersonnelinnw skills,2 forpatientsevices.dmomtratio~~ 2fora c~bina-tionofpatientservicesandtraining,anda numberofcoreactivities.,.<... .. ,,, .,,.:,,,...!
-64-
.
.
,
}ImfllNWUATION TWIMICIAN
Thehealthevaluationtechnician.aprofessional,hasbeendeveloped-inmllltiphasicscreeningprojectfundedbv theMmhis ~. ‘The
newlydefinedalliedhealthcomectionwitha Memphis-based
technicianassistswithphysiological~ests.I~tially,”seventec~i-ciansweretratied,manyofwhomwereghettoresidentswhoserapportwithclients.isofgreatadvantage.Othertechniciansarealsobeingtrainedintheoperationof computerterminalsused!inthescreeningprocess.
Theprojectwillannuallyscreenabout20,000personsfor,heartdisease,cancer,strokeandrelateddiseases.Patientsaredrawnfmm thecityofMemphisIfospitalOut-PatientClinicandWelfarerecipientsintheinnercity.
Status:OperationalTrainingis“PreventionandRelated
asof 5/70componentofproject# 17,Services-Ifeart,Cancer,StrokeDiseases”- 1styear(16months)--$269,470
TheMemphisRegionalMedical~gram coverspartsofWesten.Tennessee,iNorthernMississippi,EasternArk~sasandprtions~fKentuckyandMissouriandhasbeenoperationalsinceJuly1~.1968.~,Itscomitmentlevelform 1970was$1~284,714and,forW 1971,was,$955$722.Thesefunds~re usedinW1971 tosupporta totalof 13:projects,ofwhich1 w= ti”tfiearea,oftrainingexist~ghealthpersofielinnew skills,2 inpatient,setiicesdetinstrations,7,ina mmbinationofpatientservicesandtraining,2 incmrdination1{GD,~d a n~er ofcoreactivities.
forhealth se@ces; 1 for
T~I-STATE
Fomer militarymedicalcovsmen arebeingretrainedasphysicians,assistatstoe~and theavailabilityofprimarymedicalcareinruralNewFmgland.The~DEX programisbeingsponsoredbytheNewHampshireMedicalSocietyandtheDartmouthMedicalSchoolwiththeassistanceoftheTri-StateRegionalMedicalProgram.
Eachassistantwillspenda year,workingfora physicianinprivatepractice.~thoughhewillmaintainradiocommunicationswiththephysician,the.assistantwillmakehousecallsandvisitnursinghomesbyhimself.Hewillalsoassistat surgery,applyandremovecasts,andperfomsomelaboratorywork.
Ina recent’suneybytheNewHampshireMedicalSociety,doctorsfeltthatbetween11and12percentoftheircasescouldhavebeentreatedby a trainedphysician’sassistant.Amonggeneralpractitioners,itwasfeltthat14.5percentoftheircasescouldhavebeenhandledby atrainedassistant.
Status:Professionalstaffactivity
.
TheTri-State.RMPcoverstheentireStatesofMassachusetts,RhodeIsland,andNewHampshire,andhasbeenoperationalsinceFebruary1,:’1969.“Itscommitmentlevelfor~ 1970was$1,467,436Wd for ‘.W1971 was$1~814,132.Thesef~ds wereused.inH 1971tosupporta totalof 5 projects,ofwhich1 wasfortraining’existinghealthpersonnelinnewskills,2 forpatientservices-demonstrations,.2 fora c~binationofpatientservicesand-trainingj(tida’number ~ofcoreactivities. ~ÿ• ,,.,.
-66-
Nurses:.trcl.c:~rnfi~gtoass~nemy of thet:lsksoftilepediatricia~whi.ICworking,closelyunderIUSsupervisionin?traintigprogra~beingsui>portcdl)ytheMatieRegionalMedicalprogra, The16-weekPediatricNurse~sociatecourseisbetigpresentedat ~ Mine MedicalCenterinPortland,usinglocalnurse,,andph icianresources,
zThefirst
classof stinursesgrad~ted‘~Mar 1970. Thesenurses,areparticipatinginModelCities.,areasofLewistonandPortland,WestCentralMainetsCo~rchensivc[lealthPlanningefforts,[leadStartprogrm, WebbcrhospitalChildren!sclinicandthePcnobscotBayMedicalCenter’shealthprogral. .
Status:OngoingasofWcemer 19691styear-$18,0002ndyear- $10,000- contract
~e MaineM coverstheentireStateof’Maine~andhasbeenoperational isinceJuly1, 1968. Itsc~i~ent levelfor~1970’was$956,904,andfor~ 1971was$814,422.Thesefundswereus~din~ 1971’tosupportatqtalof 6 projects,.ofwhich3 were:in’theareaofgeneral’”continuing@cation,2 fortrainingexistinghealthpersonnel,innewskills,1 forcoordinationforhealthservices,andanfier ofcoreactivities:
,,
-67- ~
WST VIRGINIA
A programtotra~nSchool[lea]thAideswhowillserveprim:lrily:ls1.i.nl<sI)ctwecnschoolhealthprogramsand.[amil.icswhol~avcchildrenw~ti~healthpr@lcmsisbeingdcvclopcdw:iththeissistanccof theWestVirginj.a:W>. TheseAideswillalsoassistinthescmiccandcducation:ll ,programsintheschools.Othertypesofncw,heal.thm~powcrto1)ctrainedarePediatricNursePractitionersandAudit-Tec~icians.Thelatterwillbe trainedtogleanpertinentinformationfromptitientcarerecords,bothinthephysician’sofficeandinhospitals.
Status:professionalstaffactivity
.
TheWestVirginia~ coverstheentireStateofWest,Virginia,and ;’hasbeenoperationalsinceJanuary1,1970.ItscommitmentlevelforM 1970was$524,048andfor~,1971w~ $580,978.Thesefundsw6re. .wdin~ 1971”tosupportatotalof 4 projects,ofwhich.lwasfor ‘trainingexis.tingheal~”.persotiqlinnew skills,lf orpatientserviceS”@monstratiti,2 forR~D,anda numberofcoreactivities.
-68-
IOWA .,
PEDIATRICCLINIW ASSOCIAms
A sumey showsthatparentsareaswellsatisfiedwithextinctionsperformedbynewly-trainedpediatricclinicalassociatesaswiththoseby physici=sh a screenfigprogr~for~ldrenwi~ heartdisease.ThecltiicalassociatesarebeingaddedtotheteamofmedicalpersonneltitheIowaRegionalMedicalProgrmproject.
~C associatesconducttiitialandfollow-qtite~iews)Perfo~limitedextinctions,andco~selthecfildren~d fieirParents.
M a partof theirtraining,tieassociatesarer~ulredtoP=S Wejuniormedicalclasspediatricexamfiationtco~?rlsonsbe~eenth~performanceoftheassociatesandthatofpediatrlci~s~dpedlatrlccardiologistsshowthattiietwogrowstjud~entsarefia~e~nt atleast90percentof thetfie.
Inthelastyear~morethti3300childrenhalvebeenscreenedbytiethreepediatricclinical*sociatestrainedthusfar.
Status:Operationalasof 4/69Co~onentof “DiagnosisandFollow-upCareof~ildrenwithHeartDiseasell1styear- $52,7gg2ndyear-$55,6933rdyear-$51,400
me IowaM coverstheentireStateof Iowa,~dh~ beenoPrationalsinceJuly1,1968. Itscommi~entlevelforW 1970was$716,744,andforN 1971was$573,247.Thesefmdswereused’in~ 1971tosupport ~a totalof7 projects,ofwhich4werefortrainingexistinghealth’ >personnelinnewskills,1 fortrainingnewhealthpersomel,1 forpatientservicesdmonstrati~s,1 forcoordinationforhealthsemices,anda n@er of coreactivities. .1 ,!
.,
WIFORNIA
INDIANCOhfikWImIW~l AIDES
IIealthAidesfromwithintheIndiancomm~ityarehelpingtocreateanawarenessofproperhealthcareina mountaino~;egionfi-nor~e~CaliforniawhichPreviouslyhashadaMost nomedlcalseMces. TheseveralthousandIndimslivinginanisolatedareatilesizeof.modeIslandarcservedby onlyfivedoctors.I1tioldt(andDelNorteCounties,andpartofTrinityCountyarcincludedinthisarea.
Inthenextthreeyears,theIndianhealthaideswillhelpsetUP anextensivehealtheducationprogramstressingpreventionandearlyde-tection.Fosteringanawarenessofproperhcalficareis~ es?ent}alelementof theprogram..ThehealthaideswillstressSUA rout~elte~~asregularcheck-qsforbabies>~dPre-natalCareo
me ~iversityof Califo~iaatBerkeleyiscoo~eratingtitit]leCalifoniaRegionalMedicalPrograminthisproJect.
Status:Professionalstaffactivity
1
!
‘fieCaliforniaRMPcoverstheentireStateof CaliforniaandtwocountiesjnNevadaYandhasbeenoperationalsinceJuly1,1968.ItscotimntlevelforJW 1970was$8,012,055andforN 1971was.$6,220,0g4.~~esef~ds wereusedin~ 1971tosupporta totalof 24projects,of,which3 wereintheareaof generalcontinuingeducation,4 fortrainingexistinghealthpersonnelinnewskills,1 fortrainingnewhealthperso~el,6forpatientservicesdemonstrations,8 fora combination?fpatientservicesandtraining,1 forcoordinationforhealthsenlces,1 forR~D,anda numberof.coreactivities.
-70-
Revisionof theState~svaguehealthlawswillbe consideredby 40IIcalthleadersduringa two-yearstudyof thehealtimanpowerlawsfundedhy theWestVirginiaRegionalMedicalProg~. me studywillenablehealthe~ertstoadviselawyerson specificrevisionsornewlawsthatwillallowtheStatetocopemoreefficientlywithitshca]thpersonnelshortageproblems.
Il]cpresentlaws,accordingto~~} officials,arctoov:~g~le,:~~1leavetoomuchtointc~rctation.ForCXfUT~C,a lawP:~sscdolllY.re-centlyallowsforthepracticeofnurseass~stants,butdOCSnot:lIICludC?i.nthiscategory,pediatricnursepractitionerswhohaverecentlybeentrainedunderanotherW project.
Itisexpectedthatfiangesinthehealthmanpowerlawwillresultinaddedflexibilityin theuseofhealthmanpowerwhilemaintainingorefiancingprotectionforthepatient.Itisalsohopedthatthroughthesechanges,WestVirginiawillbe encouragedtodevelopa healthManpowerCouncil.
Status:ProfessionalstaffactivitY
TheWestVirginia~ coverstheentireStateofWestVirginia,andh~ beenoperationalsinceJmuaw 1, 1970..Itsc~ifient levelfor .;w 1970was$524,048andforN 1971was$580,978.“Thesefunds.were@ed inW 1971tosupporta totalof 4 projects,ofwhich.lw= for ‘trainingexistinghealtiperso~elinn~ skills>1 forPatient‘enicesd~onstrations~2 forR~D,andanumberof coreactivities.
-71-
S[;IUIENIN(;l.NPAH;RSONWIGUDNl~l)llI:fi.lllCLINIC
Screeningforsicklecellanemiaandforl.eaclpoisontigwillbe twoof tileservicesofferedby a neighborhoodhealthclinicbeingsetupinPatersonwiththecombinedfundsoftheModelCitiesProgram,thecityIleal.thDepartmnt,andtheFamilyPlanningksociationofPasaic.
me clinicispartofanexperimentalrevampingof thecityfshealthdeliveryprograminwhichtheNewJerseyRegionalMedicalProgramisplayingan importantrole. me aimoftheprogramistodeliverclirectservicesto lowincomepatients.Mng servicestobcofferedarcmedicalexaminations,~ screening,dentalservices,familyplanning,pediatricservicesanddiabetesscreening.
PatersonisoneStatewhich,onplanningstaff.Citiesarealso
of thenineFederally-designatedModelCitiesinthetheinvitationof themayor,isprovidedwith~Inaddition,21State-designatedtimunityMvelopmentprovidedwithW staff.
Status:Professionalstaffactivity
~lcNW Jersey~ coverstheentirestateofNcw*Jerseyandhasbeenoperationalsincc@ril,1,1969.Ihcircomi~elltl~v~lwas$1,237,781for~ 1970and$1.,225,026for~ 1971.~esc fundswereusedin1971to support11projects,ofwhich4 wereh thear~aOf
$
generalcontinuingeducation,2 fortrainingexist.inghcalthpersonncl ~innewskills,1 forpatientservicesdemonstrations,1 fora co-mbinationof trainingandpatientsemices,2 forcoordinationforhealth .stirvices,l.forR6D,anda numberofcoreactivities. ‘,,
Fiestasandchurchservicesarealsotimesforhealthcheck-upsinSanJoaqui.nValley.hder a programconceivedby theSanJoaquinlledicalSocietyandFomdationforMedicalCare,andfundedby the
the
CaliforniaRegionalMedicalProgram,a mobilehealthunittravelstomigrantworkercampsandotherpovertypocketssouthofStockton.Becausemanyof thesepeoplearereluctanttoseekpreventivemedicalcare,themobileunitappearsatplacesandoccasionswherethepeoplewillbe alreadygathered.
~legoalof theprogramistoscreen3,000personsa yearduringthenextthreeyears.Multiphasictestsaregivenby a staffofbi-lingualdoctors,registerednurses,andtechniciansina mobileunitmadeup ofthreetrailers.Facilitiesandpersonnelaremadeavailableby~lealthFacilities-llealthTestingServicesofBerkeley.
OrganizationswhichhelpedformulatetheprogramincludetheBlackiJnityConference,SanJoaquinCountyIIealthDepartment,SanJoaquin&neralHospital,StocktonCo~ ityActionCouncil,StocktonChamberofCommerce.Mexican-hericanPoliticalAssociation.SouthStocktonParish,
status:
:;
and’StocktonWfied SchoolDistrict. ‘
Qerationalasof 5/701styear- $26,6672ndyear- $160,000
me California~ coverstheentireStateofCaliforniaandtwocotities;inNevadajandhasbeenoperationalsinceJuly1,1968. Itsco~tmentlevelforW 1970was$8,012,055andforW 1971was$6,220~094..Thesef~ds wereusedinFY 1971to supporta totalof.24projects,ofwhich3 wereintheareaof general’continuingeducation,4 fortraintigexistinghealthpersonnelinnewskills,1 fortrainingnewhealthpersonnel,6 :forpatientservicesdemonstrations,8 fora combinationofpatientse@icesandtraining,1 forcoordinationforhealthservices,1 forR6D,and,antier of coreactivities.
.,‘1,,
-73-.
OPEW1’ION111-BLOOD
Over1,200highriskindividualsforhypertensionhavebeencontactedandatiost500hypertensivehavebeenseenandbroughtundertreatmentthroughOperationHi-Blood,centeredattheOF~WayneMinerNeighborhoodIIealthCenterinKansasCity. Programsforthephysiciansof theareaarebeingdeveloped.Thetrainingofnewalliedhealthpersonnel.asmedicalassistantsandthedevelopmentofoutreachcentersiswellunderway.Cooperatingintheseeffortshavebeena numberof agencies,includingthe~fissouriRegionalMedicalProgram.
Status:@erational.asof 7/691styear-- $56,7412ndyear--129,9853rdyear--160,237
TheMissouriRMPcoverstheStateofMissouri,exclusiveofMetropolitanSt.,Louis;andhasbeenoperationalsinceApril1,1967.:.Itscommitment ~levelfor~ 1970was$3,074j230andfor~ 1971was$1,947,417.Theseftidswereusedinw 1971to supporta totalof 29projects,of,whiti1 wasintheareaof generalcontinuingeducation,1 fortrainingexisting
.
healthperso~elinnewskillsjl.fortrainingnewhealthpersonnel,7.forpatientsemicesdemonstrations,6 for’acombinationofpatienttiservicesandtraining,11 forcoordinationforhedthserivces,2forR~D,anda numberof coreactivities; , ,.:,,’
-74-
mSSM/MID-SO~l
hULTIPl~ICSCHING PROGW
Sixtypatientsa dayfromtheinnercityofNashvillearebeingscrccncdina Tennesseeflfid-.SouthRegionalfiledicalProgram-fundedproject.Follow-upiscarriedoutwiththecooperationof anOKONeighborhood1lealtl~Centerandthereorganized,comprehensiveout-patientdepartmentofl~bbardIlospital,theteachinghospitalofMeharryMedicalCollege,Thescreeningandfollow-upprogramisbeingextendedtocoveranentireruralpoorpopulationinthecountiesofllumphrcy,I[oustonandStewartinMd-Tennesseeat therequestofco~ity leaders.
Status:@erationalasof 2/68l~tyear- $436,0252ndyear- $605,9063rdyear- $604,5354thyear- $307,897
,
we TennesseeMid-SouthMcovers theStateofTennesseeandpartsofSouthwestem.Ken@cky;andhasbeeno erationalsinceFeb~ary1, 1968. ~ ~~•
!Its,cmitmentlevelfor~ 1970was 2,128,110andfor~ 1970was$1,747,352.Thesefundswereusedin 1971foratotalof 26projects,ofwhich4 werein theareaofgeneralcontinuingeducation,7 fortrainingexistinghealthpers~nnelfin~ skills,3fortrainingnewhealthpersonnel,7,forpatientsemicesdemonstrations,3 foracombhationof,patient:ervices,andtraintig,2.f~rR6D2~d a nuMberof’coreactivities. ~ ‘ ,,,,,,.:
,.,. -75-
Twenty-fivethousandchildrenhavebeenscreenedforheartdiseaseintheMissouriRegionalMedicalB09~ PhonoCardioSc~Project”As of thebegiMingof 1971,356childrenwifiprevio~lYwdetectedmurmurshavebeenrefe~edtofieirpllysici~sforfoll”~-~?‘n:‘fwhomrequiredopenheartsurgeryonanurgentbasis.me screeningisbeing conducted by theMissouriIieartAssociation,Workfigth~ouglltileSChOOl system,tithan ~ressi~e amountof activemvolvemcntbypersonsintheRegion.Therehavebeen40,000letterssenttoparents,over3,000schoolofficialsandteachershaveactivelycooperatedandover10,000hourshavebeenputinbyIIeartAssociationvolunteers.
Status:~crationalasof 4/69
2nd~ear- $34;0553rdyear- $18,000
The:MissouriM’ coverstheStateofMissouri,exclusiveof’~troPO1itmSt:Louis,tidhasbeenoperationalSince@ril 1,lg67* 1tsco~lt~ntlevelfor~ 1970was$3,074,230andforw 1971was$1,947,417.Thesefids wereusedin W 1971tosupporta totalof 2gprojects,?fwhi~1 w~sin theareaof generalcontinuingeducation,l,fort~ainlng,existinghealthpersomelinnewskills,1 fortrainingnewhealtiperso~el,7.forpatientservicesd~nstratio~,6 fora cotiinationofpatient ~servicesandtraining~’11forcoord~~tion.forhealthse~ice~>2forR~D,anda numberof coreactivities.
-76-
NA$SAU-SUI;I;O1,K
Eightyblackphysici- anddentistsIlaveorg~izedinto-anewen:i~callcdtheNassau-SLlffolkClinicalSoci~Wjwi~ tileasslst~’ce‘*theNassau-SuffolkRegional~~e~icalpro~r~” ‘e ‘ociety‘as!“ped.todealwitisomeofthemajorproblemsoflowincomeblacksllvlngInthearea. SixteenhealthComitteesof thisgrouphavefomed,havingbothproviderandconsumerrepresentation.me firstProjecttobeundertakenisaneducationandscreeningprogramforsicklecellanemia..~leSocietywillthenmoveintootherhealthproblempeculiartoblacks.
status: Professionalstaffactivity
me Nassau-SuffolkM coversthecountiesofNassauandSuffolk(LongIsland,NewYOrk)andhasbeenwerati~alsinceJ~e 18,lg7,1.I~s:cmi~ent levelfor=lg71w~ $7g4,4g4.~e?efudsweremed inm 1971tosupporta totalof7 projectstqf.filch1 w= m ‘ieareaofgeneralcontinuingeducation,1 fortralnlngnewhealthperso~el,‘1,forpatient’servicesbo~trati~sz 1 fora ctifitlo?‘fp~t~~~t
. .
servicesandtratiing,2 forcoordinationforhealfise~lces~WD, anda numberofcoreactivities.
-77-
IOWA
SCREENINGFORDIS~E RISKFACTORS
SchoolchildreninMuscat~e,Iowa,arebeingscreenedforearlyriskfactorsof corona~hea~ disease~hYPertenSion~st~ke~‘besity~‘ddiabetes.
The37OOchildreningradesthreethrough12wereex~inedastoheight,,
weight,blwd pressure>sem choleste~l,se~ trigYlceridead bloodsugar.of thefirst160studentsstudied,7.1PercentoftheboYs~d10percentof thegirlshadhighsem triglyceride,11.1percentOf .theboysand10.4percentofthegirlswereobese>~d 1104Percent‘ftheboysand12percentofthegirlshadhighbloodpressurereadings.
FO11OW-UPtestsaswellascounselingforfmiliesof childrenwithhighriskfactorsarescheduledforthes~er. InNov~berof ~g72~childreningradesonethroughthreewillbe tested.Studentswillbe retestedmtil co~letionoftheproject.
SupportingagenciesaretheIowaRegionalMedicalProgr~~theResearch@nter ofthe~iversityofIowa,andtheNationalInstitutesofHealth.
Status:Operationalasof7/68 ,...,1styear-- $88,7g0 1.
2ndyear-- $55,6933rdyear--$51,400
?
~eIowa N coverstheentireStateof Iowa,andkS beenoperationalsificeJuly1,lg68. Itsc~i~ent levelfor~ 1970‘as$716$744‘dfor’~ lg71was$573,247.
:.:
These-fundswereusedin~ 1971to suppotia total.of7 projects,ofwhich4 werefortraintigexistinghealth
.
persomeltinewskills,1 fortrainingnewhealthperso~el,1 for.patient.se~icesd~nst~tiom~ 1 forcoordination’forhealthservices,anda nder”of coreactivities.
,,..,’
-78-
A newschoolhealthprogramconductedby theNledicalProgrmishelpingto compensateforservicesthatacco~aniesgeneralpopulation
WestVirginiaRegionalthelossofmedical10SSin~shur Counw.
Thestrongestremaininginstitutioninthiscomitywi~ amedi~economiclevelis thecountyschoolboard.Workfigbough tieboard,w isaimingitsprogramatfifti,stitl~,~dseven~~@?ders” fl~echildrenwillbe taughtphysiologyofthecirculato~,resplratoq,~dnervoussystems.A pediatricnursepractitioner,a S~OOlhealthaide}anda dentalhygienistwillhelpinticearlydetectionofdiseaseandpreventivecare.An ~ual amountofhealthmanpowerwillbemadeavailableby theschoolsystemthroughitslocaloptionontheuseofTitleI educationalfinds.
Status:Operationalasof 6/711styear-$37,267
TheWestVirginiaM coverstheentireStateofl~estVirginia,andhasbeen@erati~al sficeJ~uav 1,lg70~ Its.c~i~ent level‘or $w 1970was$524,048andfor~ 1971w~ $580,978.ThesefundswereUSedin~ 1971to.supwrta.totalof4 projects>offii~ + w= fortrainingexistinghealfipers~~elhn~ skills,1 forpatlen~;servicesdemo~trati~, 2 forRGD,ad a n~ber O:COr~actlvltles*.,
-79-
~ORGIA
LEARNING
‘tArcYouaimedat
IU;.SO~~SSERVI(XS
IlcadyTo (;o1lomcand1shelpingpatientsmakea
YourIIomc l~cadyI:orYou,” a l}:~)lllctbettertransitj.onfromhospitalto
homeenvironment,hasbeenproducedby theState’sEasterSeal.Societywiththehelpof(;eorgiaRegionalMcdicalProgramtsI,earnj.ngRcsourccsServices.
LRSproductionassistancehasalsobeengiventoa rehabilitationclinicfora sound/slidepatientorientationprogram.Inaddition,GRMPpersonnelarehelpingdevelopa gameideatohelpnonreadingdiabeticslearnaboutproperdiet.
.
ThedemonstrationLRSislocatedinAtlanta.Itprovidesassistancetomedicaleducatorsin thedevelopmentandeffectiveuseof audio-visualaids. Itwillalsosene asa trainingfacilityfor’newaudio-visualtechnicians.Atpresent,thereisnoothermeansof trainingaudio-visualpersonnelrecruitedfromlocalareas.
Status:Operationalasof9/711styear- $20,000
lfieGeorgia~ coverstheStateofGeorgiaandhasbeenoperationalsinteJuly1,1968; Theircoti~ent levelwas$1,922,571forN 1970and$1,779,862forH 1971.~ese fundswereusedir,1971tosupport23projectsofwhi&”6 wereintheareaofgeneralcontinufigeducation,6 fortrainingexistinghealtiperso~elh newskillsi.~,fortr~~n~g.n~ healthpersonnel,3 forpatientsenicesdemonstratlon~lfor acombinationoftrainingandpatientsemices,5 forcoordinationofheqlthservices,andanumberof coreactivities.
?
.s
.
$,.;
,,
,.,,,
.
-80- , ,,
;..
WIS~NSIN
S~>’anisll-speakingcitizenswholivejnthesouthinnercitysectionofllilwaukeearegainingaccesstomedicalcarewifithehelpofa]IcalthInfomatiol~andReferralCenter.Milwa~eeCO~tY~fitafivervfinehealthcarefacilitiesfortheindigent.Somefinditdif~icult,however,toenterthesystembecauseof languageor~wlturalbarriers.Withtheassistanceof theWisconsinRegj-ona~MedicalPro~am tiecenterisaidingtheSpanish-speakingcitizensOC tl~careamakeuseof theresourcesfiichareavailabletothcrnandprc)vi(lcwhatareessentiallysatelliteclinicalactivitieswithintheneighllor-hoodsiCOmmunityhealthaidesarcbeingtrainedtostafftheccntcr.
Status:l)rofcssionalstaffactivity
TheWisconsinM coverstheentireStateofWisconsinandhasbeen .operationalsinceseptefier1,lg6g.~eir cofi~ent levelw~s
,“ :~
$1,098,429form 1970ad $951,781for~ 1971.Thesefundswerewed in1971 to.supporta totalof 13projects,ofwhich4 wereintheareaof generalcontinuhgeduc~tion,2fOrtr?infigexist~g.,. :;“healthpersonnelin“newskills,3 forpatient‘servicesdemonstratlop~1 fora co@inationof train-gandpatientservices’,1 fo~coo;din~tionfoihealthservices,2 forRGD, and ander Ofcore activities” ~•J•H•J•
..
A pllonccalltoticComity Re.fcrral;~dInformationse~i~c (CRJS)
bringsSantaMa residentsinformationonhealthandotherservicesavailableintheareas
WithsupportfromtheCaliforniaRegionalMedicalpro~~, WS bcg~Itisstaffedpri~rilYbY vol~teers> ad
*
operatinginMayof 1970.receives18to20newclientsdaily--mostlYtiroughphonecalls.
rCRIS
staffhasonhandinformationfromOrangeCountyagenciescon:e~ed
4i~
withhealthandothersocialservices.Ifa callerrequeststiormation 1 ~
whichCRISdoesnothave,thestaffmakeseveryefforttoobtaintheIi
information.
Fundingcomesfromm, theAmerim CancerSocietyanda varietyofin-kindcontributio~.
Status:ProfessionalstaffactiviW: :
$15,000contract
.
me Califonia~ coverstheentireStateofCaliforniaandtwo$OmtiestiNevada,md~s.beenWeratto~l s~ce JUIY 1? 1968* 1ts com~~&~”level for w 1970was$8,012,055ad for~ lg71w~ $6,220>Og4*@ds weretiedh ~ 1971toSWPOrta totalot 24projects~.of‘hi+ .3’wereh theareaof generalcontinuingeducation,4’fortra~g exlst~nghealtipersonnelinn~ sR1ls,1 fortraintignewheal~perso~el,6forpatientsefiqesd-~trations~8-fora C~~tiOn ?fpat~~~r:Senices ~d traintig~,l for,coordinatlonfor.heal~se~lces).
,..J
R6D,anda tier of”coreactivities.
-82-
hergency
INDEX
27
8030
70a2al
1459
74
;;55
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✎
✎
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. . .
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.,
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70, 77, 79,. 2, 5, 15,
[{ealthEducationE1meHealthCareI .
.
.
.
.
.
.
.
. . . . . 41,IndianHealth. .57, al;
32~35, 38, 39, *7i, 75, 77,InformationandReferralServicesInnerCityHealthProgr-. . .(3,/,17,19,
. .
. .LaboratoryFacilities . . . . a,
.*. 58,. . . . . . . .. . . . . ● ☛☛
. . . . . .
. . . . . ...
.
.
.
...
.
.LibraryServices. .
DevelopmentEhtion . 9, 10, 25, 31,43-45,48-50,56,1,
. .
. .
. .
. .
. .
. .
. .
. .
. . . . . . .......
●3;. .. .. .. .. .
i3;
. . . . . ..*31,33,35,37,. . . . . .*..’. . .
. . . .
. . ..0.
. . .
.,.
. . .
. . . 3,6, 13,46, 47, 5i-53. . . 20, 60
Sp&&y-TtitingMedicalRecor& -11I
Systm . . . ● ✎✎✎☛ .00
● .*** ● . . 8, 40, 60; 73. . . . . . . 31,33,67,72
MigrantHealthModelCities .
. . . . . ● ☛
✎ ✎ ✎ ✎ ✎ ✎ ✎
. 2,’10, 11, 30i5~3i, ’3i, *4b, 46, 57, 62, 75
RehabilitationRuralHeal* .
. “. . .
. 69, 72, 74, 76-7a33, 63, 65, 73, 7S
Screening. . . . . . . .MtiphicS~eAng
.
...
.
...
. .
. .. .. .
.
...
.●
.
...
.
.
.,,.,-
,
-a3-#