A 7iy5a45 &?- “~’&4,676,501

7,099

2,239

23,307

15,000

10,000

183

5

1

95

2

10

34

163

180

Consumers

Physicians

Dentists

Registered Nurses

Licensed Practical Nurses

Other Health Professionals

Hospitals

Medical Schools

State Division of Health

County Health Departments andNursing Services

U. S. Senators

U. S. Representatives

State Senators

State Representatives

HSA Governing Body Members

Our mission 2

Our process 4

Plans in action

Access: Where to go for help 6

Education: Reyond the classroom 9

Resources: The spirit ofcooperation 12

Services: Emergency! 14

Gift of life: Timmy and “Herbie” 16

The future: Dr. Wyeth Hamlin 18

Credits 20

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On one end of the scale are doctors, nurses, tech-nicians, health institutions and agencies who havethe talents and resources for providing health care.On the other end of the scale are the people ofMissouri who need this care. At the scale’s fulcrumfor the past ten years has been MoRMP, encouragingformation of cooperative arrangements in the healthfield to bring the best possible health care to Mis- “sourians at the lowest cost.

When P.L. 89-239 was signed into law in 1965,regional medical programs were dedicated to educa-tion, research, training and demonstration in heartdisease, cancer, stroke and related diseases. Overthe last 10 years, the federal government has alteredRMP orientation, directing the programs to approachhealth problems common to the treatment of all thesediseases.

Through grants and contracts, MoRMP has sup-ported demonstration models and innovative proj-ects designed to improve the organization and deliv-ery of patient services and the productivity and distri-bution of health manpower. Along the way, MoRMPhas had many successes and a few failures. But agreat deal about implementing health care plans hasbeen learned.

In this brief brochure, MoRMP hopes to sharesome of this hard-earned knowIedge,

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3

Bringing consumers and providers together totranslate health care plans into action is the rationalebehind the MoRMP process.

At the heart of this process is our RegionalAdvisory Group. Composed of up to 60 representa-tives of both consumer and provider interests, thisvolunteer group annually consults state healthplanners, volunteer health agencies and interestedconsumers to assess Missouri’s health needs. Thisdemocratic process produces a set of priorities ,which forms the framework for MoRMP activities.

The MoRMP process is not a “one-way street. ”Adhering to Regional Advisory Group priorities,we may solicit program proposals from health pro-fessionals designed to improve local health services.For example, if it has been determined that some ofMissouri’s rural health facilities are ‘unevenly dis-tributed, we may contact and work with local hos-pitals to help them share resources. Or health pro-viders may approach us with program ideas. BecauseRegional Advisory Group members and consultantslive in all areas of the state, there is ample oppor-tunity for communication between MoRMP andhealth personnel and consumers.

No matter who approaches whom, MoRMP worksclosely with health providers to create and imple-ment effective local health programs.

To date, we have been involved with 167 suchprograms. Each of these has been carefully monitoredby our staff and technical advisers to make sureoriginal goals are being met and that Missouri’shealth needs are being satisfied.

The MoRMP process of review, selection, im-plementation and evaluation unites providers, con-.sumers and administrators to make h;alth programsresponsive to the people of Missouri. Behind thescenes of each of our cooperative health programsdescribed on the following pages lies this time-tested process.

4

The three-room apartment in mehopolitan KansasCity is small and dark. On the TV set in the crowdedliving room stand photos of grandchildren, somereligious pictures and a collection of knickknacks.This is the home of Flossye Carter, 54, and herbeloved cat, Tom Dooley.

“I talk to Tom DooIey, That’s why he’s as smartas he is. It’s just me and Tom DooIey. ”

Seven years ago, Ms. Carter visited the federally-subsidized Wayne Miner Neighborhood HealthCenter. A staff doctor discovered that Ms. Carterhad hypertension, a condition in which higher thannormal pressure is exerted against the blood vessel’sinner walls. Medication now stabilizes her bloodpressure.

“I don’t think I wouId be here if it weren’t forthe Wayne Miner people and Project Hi-Blood, ”Ms. Carter says. Undetected hypertension can lead toheart attack, stroke and related diseases.

In the late 1960’s, medical researchers wereexpressing concern over the high incidence of hyper-tension in the black population. In 1968, WayneMiner staff members, who serve a predominantlyblack neighborhood, worked with MoRMP to developa blood pressure screening and treatment program forarea residents. The project began in 1969.

Since most blacks were unaware of the potentialproblerhs of high blood pressure, the projectstaff’s problem was one of communication. TheirsoIution - personalized home visits by trainedneighborhood personnel.

Since 1969, Project Hi-Blood has screened over40,000 persons for high blood pressure throughhome, church and school visits, neighborhoodmobile units or the Wayne Miner clinic itself. Ofthose screened to date, approximately 25 per centwere found to be hypertensive. Follow-up screeningsand home visits by staff members make certainthese patients consult their physicians regularly andfollow prescribed treatment.

Project Hi-Blood provides hypertensive patientsaccess to preventive medical care. Making health careaccessible, responsive and affordable to people inKansas City and to all Missourians has been a majorMoRMP concern. Because the medical field is highlytechnological and its services expensive, healthresources are necessarily limited and unevenlydistributed. Communities, especially those in ruralareas, can attract and support only so many healthprofessionals, clinics and hospitals. But localresidents may not know what services are avail-able and how to use them. Here are four MoRMP-supported programs that havevices and patients together.

brought health ser-

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o In Sedalia, the Missouri Chapter of the Ameri-can Academy of Pediatrics supports a travelingclinic for children. Some rural Missouri patients, whofind medical expenses steep and health care facilities

. inaccessible, fail to seek preventive medical helpfor their children, Some of these children reachschool age without being properly immunized or

0 receiving periodic medical examinations. To over-come this problem, a medical staff visits churches,town halls, schools, or other public buildings in a13-county area and offers its services for a minimalfee, based on the family’s ability to pay. For hvoyears, MoR!MP worked ~vith the clinic to provide“out-reach” workers who maintain follow-up com-munication with the families to make sure childrencontinue visits and receive prescribed treatment.

● The Sedalia-centered program brings preven-tive health care to rural families. Another program inBoone County, sponsored by Older AmericansTransportation Service (OATS) provides transporta-tion for the elderly to medical facilities, Cooperationbetween OATS and MoRMP extended the service tothe handicapped. A small fleet of vans now providesa transportation service for nearly 5,OOOhandicappedand elderly area residents. For a small fee, passengerscan ride to and from doctor’s offices, hospitalsand clinics.

o In Dunklin County, strong community supportand assistance from MoRMP led to the establish-ment of a volunteer bIood bank. Thirteen hundredand twenty-five residents’ blood types are recorded,and donors are called when the need arises. Before

7

the bank was organized, Dunklin County MemorialHospital had to purchase expensive blood from com-mercial agencies. Hosuital statistics showed thatbIood fro; volunteer honors is less apt to causehepatitis than blood purchased from commercialagencies.

o Problems of accessing healti care are notalways physical in nature. They can be problems ofcommunication. Two MoRMP-supported programsat Kansas City General Hospital led to a highlysuccessful consumer advocacy service. Manypatients were bewildered by medicaI terminology,dissatisfied with services and confused about pre-scribed treatment. Busy hospital staff members wereunable to devote enough time to patient com-munication.

Several nonprofessional community residents,with whom patients could easily identify, weretrained to interview patients and provide liaisonbetween them and hospital staff. The program hashelped patients understand what services are avail-able to them and how best to use these services.The hospital has benefited by smoother relationsbetween staff and patients.

The problems of accessing health care are two-fold. Missouri’s health resources are concentrated inlarger population centers. People who live in smallercommunities or those who have economic or physicallimitations may find it difficult to reach healthfacilities that can give them the best care. Even ifheaIth resources are within reach, people may notknow how to access them.

Neighborhood hypertension screenings, travelingchild health clinics, community blood banks,transportation services for the elderly and handi-capped and consumer advocacy programs are onlya few of the ways in which MoRMP has cooperatedwith local agencies to bring health resources andpeople together. MoRMP believes that using healthresources to their full advantage prevents waste inmanpower and facilities, lowers medical costs andbrings better health care to more people.

(s

Julia Smith bends over baby Joshua’s crib to strokehis tiny back, As he sleeps peacefully, Mrs. Smithreflects on the struggle, only a month earlier, to savehis life.

Joshua was born prematurely in January 1976 atSt. Elizabeth’s Hospital in Hannibal. Only hours afterhis birth, doctors diagnosed hyaline membranedisease, a frequent lung malfunction in prematurebabies. When Joshua experienced total respiratoryfailure, he was immediately placed on a respiratorand administered life-support treatment. In 12 hours,Joshua was pronounced stable. In 16 days, he wassleeping in his own crib at home.

“~~e were so heIpIess. If it hadn’t been for themarvelous staff at the hospital and the Lord’sguidance, we wouldn’t have our priceless babies, ”,Mrs, Smith says. The Smith’s daughter, Joy, was bornprematurely with hyaline membrane disease at St.Elizabeth’s only 14 months earlier. Both Smith babiesowe their lives to the development of a middle riskinfant nursery at the Hannibal Hospital.

Many premature babies born in Missouri’s smallerrural hospitals cannot get the specialized care theyneed unless transported to a medical center, a riskyprocess. It was the dream of the obstetrics andpediatrics staff at St. Elizabeth’s to improve theircapacity to care locally for problem newborns.

The hospital purchased expensive life-savingequipment and altered their facilities for an intensivecare nursery. JNloRMP worked with the staff todevelop a middle risk education program for St.Elizabeth’s staff and interested regional health carepersonnel.

Since 1974, a contagious dedication to educationhas spread through the entire hospital, and the im-

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proved staff skills has significantly reduced St.E1izabeth’s infant morbidity rate. But the hospital’ssuccess story reaches beyond its own walls. Healthcare professionals traveI as far as 90 miles to visitthe model nursery, attend classes and share newinformation.

With the mass of medical knowledge doublingevery ten years, health professionals are faced withthe challenge of keeping abreast of new technology.This is a particular problem for health professionalspracticing in isolated rural areas.

Helping to bridge this information gap and bringthe benefits of new medical knowledge to allMissourians is one of MoRMP’s primary functions.Over the past five years, MoRMP has served as acatalyst for more than a hundred health manpowereducation programs, like the one in Hannibal, whichhave improved services in Missouri’s hospitals,nursing homes, pharmacies and laboratories.

Bringing the classroom to the student is the con-cept behind hospital education programs. More thana thousand health care professionals have com-pleted training sessions in intensive care, emergencyservices, hospital administration and other skills inMoRMP-coordinated programs in local hospitals

or nearby colleges. Without these programs, manyprofessionals would have had to leave their jobs andpatients to receive training at distant educationalinstitutions.

MoRMP efforts to improve professional skillsextend beyond individual classrooms. Fulfilling itsrole as an implementer of health plans, MoRMP rec-ognized the value of state-wide efforts to equalizeand standardize health education opportunities.

● To help all Missouri nurses maintain and up-date their skills, MoRMP worked with the MissouriNurses Association to develop a state-wide con-tinuing education program.

● In conjunction with the Missouri NursingHome Association, the Missouri Department ofEducation and six state universities, MoRMP tackIedthe problem of improving the quality of nursing homecare. Through this program, over 100 persons havebeen trained as food handling supervisors. Andadministration has been made easier by state-wideinstruction for medical records personnel.

a To relieve manpower shortage in rural Mis-souri, MoRMP, in conjunction with the MissouriHospital Association, supported a high school healthcareer recruitment program designed to locally trainand employ health care professionals. A direct “hotline” to over 3,0oo high school counselors bringshealth career information to thousands of potentialdoctors, nurses and technicians.

● To update and standardize services in ruralpharmacies, MoRMP worked with the School of Phar-macy at the University of Missouri-KansasCity to develop an operating manual. The manual isnow being tested in several rural hospital pharmaciesand will soon be distributed throughout the state.

o To overcome the lack of formal training of manylaboratory technicians, MoRMP sponsored a primaryeducation program in urban and rural areas. Todate, over 59 technicians have received training.

These are just a few examples of MoRMP’smany efforts to increase the number and effective-ness of health manpower in Missouri. Only throughcontinued education, can doctors, nurses and tech-nicians give patients like Joshua and Joy Smiththe immediate, specialized care they deserve. Knowl-edge means progress and progress means life,

Mrs. Smith says it best. “In the 14 monthsbetween the time Joy and Joshua were born, I couldtell that the nursery staff was even better prepared.They knew more. Why, Joshua was more ill thanJoy, but his recovery was speedier. There isn’t enoughI can say about the doctors and nurses at St.IIlizabeth’s.”

“There’s that Dr. Cofer!” beams the nurse. Dr.Cofer smiles and waves acknowledgement as hebreezes from the corridor into his Chillicothe office.

“What have ~ve got here?” Appointment book inhand, the receptionist explains that he is scheduled toperform an electrocardiogram. Dr. Cofer recognizeshis patient and calls him by name into the examiningroom. The door closes. A co-worker pokes her headinto the office to confirm a speaking engagement.Yes, Dr. Cofer ~vill speak on drug abuse to a sixthgrade class next ~veek.

The examination is over. Dr. Cofer explains hemust be at Hedrick Medical Center [“Gotta blast!”)and hops into the family car, His large frame andgood natured disposition fit comfortably into thestation wagon littered with children’s schooldrawings.

Dr. Cofer is a busy man. But he likes his work,the town of Chillicothe and its people. His exu-berance is infectious.

At Hedrick Medical Center, Dr. Cofer parks thecar and winds his way through hospital corridorsto the coronary unit. He is here to visit 71-year-oldDelbert Stephenson, a Waverly farmer, for whom heinstalled a pacemaker the week before.

Dr. Cofer is an internist and cardiologist. Inaddition to his private practice, he serves five of the12 member hospitals of the Green Hills Cooperative,a non-profit corporation formed in 1972 to sharehealth services, education and personnel.

Before Dr. Cofer came to the cooperative, mostarea heart patients who needed pacemakers had totravel to Kansas City for the operation, a hardshipfor a patient like Delbert Stephenson.

Dr. Cofer says he thinks the Green Hills Coopera-tive is a good concept. It attracts specialty services,like the one he provides, lowers medical costs topatients and facilitates hospital administration.

MoRMP was instrumental in initiating the GreenHills Cooperative and has given it support over thelast four years. The member hospitals have pooledresources to sponsor in-service training and con-tinuing health education programs, to cut supplycosts through a group purchasing plan, to alleviatenurse recruitment problems by establishing a schoolof nursing at Trenton Junior College, to form aninter-hospital communications system and to sharepersonnel,

Sharing health resources has brought betterhealth care to the people of the rural Green Hills areawhose hospitals were plagued by rising costs andhealth manpower shortages. MoRMP has workedwith many health agencies to build similar coopera-tive efforts in other areas of t-he state. The followingthree programs are good examples.

● More than 10 small rural hospitals in the state’ssouthwest region are sharing the services of twophysical therapists. Visiting hospitals, nursinghomes and patients’ homes, the therapists administerdirect patient care and conduct training sessions

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for nursing staffs. MoRMP served as the catalyst forthis cooperative effort.

● At the Kirksvil]e College of OsteopathicMedicine a cooperative regional pathology labora-tory was established among five area hospitals.None of these rural hospitals could have borne alonethe burden of supporting a well-equipped laboratoryand trained pathologists. In about one and a halfyears, this regional laboratory performed over 64,000valuable tests. MoRMP paid a portion of the labora-tory’s personnel and travel costs for over a year.With MoRMP funding ended, the laboratory con-tinues to serve the area, its costs shared by memberhospitals.

o For the past two years, MoRMP has helpedthe city of Independence conduct a health survey.House-to-house volunteers are making local citizensaware of available heaIth care resources and arecollecting information needed to plan future areahealth services. Preliminary results of the survey arebeing submitted to the city of Independence forreview and action. The local health department wasso impressed with the survey that they decided tocontribute support to its completion, Two-thirds ofthe city had been canvassed by December 1975.

Cooperation is the key to sharing health resources.It was only through the cooperation of health institu-tions and professionals that these valuable services,at reduced costs, were made available in these Mis-souri regions. But many Missourians, especiallythose living in rural areas, still lack the services ofa cardiologist like Dr. Cofer, the skills of a physicaltherapist or the advantages of having a sophisticatedlaboratory close at hand.

Health resources are not evenly distributed overMissouri’s cities and countryside. Throughregional health surveys, like the one in Independence,Missourians can find out just what health servicesare and are not locally available. And through theMoRMP-tested concept of regional health resourcesharing, they can overcome service shortages bysharing health personnel, facilities and equipment.MoRMP demonstration models prove that coopera-tion in health care works.

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Shortly before 9 a.m. on a Saturday in earlyJanuary, James Cmssgrove, 19, left his home nearKirksville to return to college in Oklahoma. MinutesIater, he lost control of his car and drove into a bridgeabutment. The car Ieft the road, crashed into aravine, and James was pinned inside, the motorpressed against his legs.

In exactly six minutes after the KirksvilleHospital of Osteopathic Medicine was notified of theaccident, two Emergency Medical Technicians(EMTs) were on the scene. Charles Gulley climbedinto the back seat of the Crossgrove car and puttraction on James’ neck. He kept the air passageclear while encouraging his patient to talk to preventblood from getting into the lungs. James’ palettewas split, and he had a fractured jaw and multiplefacial injuries. One lung had collapsed, and hisspleen was lacerated.

While Gulley tended his patient, Mike McKimbegan to pry the motor loose from James’ legs.A wrecker could not make it down into the ravine,so McKim radioed the hospital for two more EMTs,Randy Lewis and Jay McClintock. With the help ofthree Missouri State Highway Patrolmen andpassers-by, the four EIMTs managed to free Jamesfrom the car. They placed him on a back board,put his leg in a splint and continued suctioningblood out of his mouth.

At exactly 9:35, only 37 minutes after they hadarrived, the EMTs were in the ambuIance with theirpatient, headed for the hospital. But their job did notend at the hospital doors. All four E,MTs continuedto tend James in the emergency room foranhour and ahalf until he went into surgery.

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Five weeks later, James Crossgrove was releasedfrom the hospital. He cannot remember his accidentor the care he received from the four EMTs atthe accident site, but, according to his physicianDr. Edward Herrmann, he owes his life to theirskill and composure. “If James had not received theexpedient treatment he had at the site of the accident,his injuries would have been more difficult to treat,if not fatal. ”

James Crossgrove was fortunate to be attended bytrained EMTs who were backed up by direct radiohospital communication and a well-equippedambulance. If he had had his accident three yearsearlier, he might not have been so lucky.

Before 1974, most emergency patients, especiallythose in rural areas, were transported to hospitals infuneral hearses or private cars. These vehicleswere not staffed by trained emergency medicalpersonnel, had no emergency equipment and noradio communication. A farmer, injured in a chainsaw accident, might have had to ride to a distanthospital in the bed of a pickup truck. Althoughmost city residents enj eyed the service of ambulancesand attendants, no Ia\v existed to regulate theiroperation.

In 1974, the state legislature passed Senate Bill57, and Missouri emerged from the “dark ages” ofemergency medical care. Senate Bill 57 requires all

ambulances to be licensed, specially equipped andstaffed by certified, trained EMTs.

To help communities compIy with the new law,MoRMP helped organize 18 EMT training courses,procure emergency ambulances and equipment andestablish localIy-integrated emergency systems.

● Project RESQU, covering 33 counties in south-western Missouri, offers the 81-hour Department ofTransportation EMT course. MoRMP providestraining equipment and instructor compensation.Over 543 EMTs have successfully completed thiscourse and are certified by the Missouri Bureau ofEmergency Medical Services. In response to requestsfrom local communities, RESQU also helped or-ganize 13 area tax-supported ambulance districts.These districts and commercial and hospital ser-vices now provide the southwest area with 75 ambi-ances. With MoRMP aid, RESQU helps many of theseambulance services procure equipment and vehicles.

● In northeast and north central Missouri, theCollege of Osteopathic Medicine sponsors an.MoRMP-supported emergency medical services pro-gram. [n 1971, according to the Emergency MedicalServices Plan for the State of Missouri (1973) quaIityemergency medical service was virtually unavailablein this predominantly rural region. The 10-countyarea was served by only four qualified ambulancesand 26 trained personnel, Only one of the sevensurrounding hospitals had communication facilitiesbesides the telephone.

Today, with MoRMP help, a total of 18 licensedambulances serve the area with the aid of a new com-munication system. And over 255 persons have com-pleted the 81-hour E.MT course. MoR.MP also helpeddesign a regional EMS plan.

● In Missouri’s southeastern Bootheel region,there were no ambulances before 1974. Emergencypatients were transported to one of the six area hos-pitals, a distance of up to 35 miles, in funeral hearses.There were no qualified EMTs. Now over 200 EMTs,trained through an .MoRMP project, are qualified foremergency service, and local communities are es-tablishing ambulance districts and services.

Missouri’s emergency morbidity rate has beengreatly reduced in just the last t~vo years. If an emer-gency victim is, quickly treated by a qualified atten-dant and transported to a medical facility in a well-

equipped ambulance with a communication system,chances for his survival are much greater than if hemakes the same trip in a funeral hearse or privatevehicle. Helping communities make the costly transi-tion from minimal emergency service to a state-licensed service has been an important MoRMPgoal. But the task has only begun, More ambulancesand more EMTs are needed. And, most importantly,public and professional awareness of the emergingambulance services and their cooperation withtrained EMTs is needed to coordinate local effortsinto a state-wide emergency medical system.

Who is Timmy? Timmy Kissel is a tow-headedseven-year-old in the first grade at Maddox Elemen-tary School in St. Louis who can’t wait for the LittleLeague baseball season to start.

Who is “Herbie”? “Herbie” is Timmy’s name forhis new kidney, the gift of life that alIows him toattend school, play with his friends and lead theactive life of a healthy child.

Timmy and “Herbie” were united in a six-hourtransplant operation in September 1975 at BarnesHospital in St. Louis, The transplant culminatedTimmy’s struggle with polycystic kidney disease,two years of dialysis at St. Louis Children’s Hospitaland numerous hospitalizations for treatment relatedcomplications. Timmy’s successful transplant is alsoa hallmark in the progress of Missouri’s kidney pro-gram.

Before 1968, an end stage renal disease (ESRD)patient in Missouri had to rely on private funds orpublic donation to pay for dialysis on an artificialkidney machine, an expense which runs into thou-sands of dollars a year, To help ease the financialburden of the ESRD patient and to develop neededdialysis facilities, the Missouri legislature beganappropriating funds in March 1968 for a state kidneyprogram.

The legislature, impressed with MoRMP’s provenmechanisms for reviewing proposals and monitoringgrants, asked MoRMP to develop a state dialysis

program with these funds. Since 1968, MoRMP hasadministered, at no cost to the state, the more than$4 million allocated for Missouri’s renal program,making all funds available for direct patient care.The number of the state program’s dialysis andtransplant facilities has risen from the initial two to10 in 1976. Seventeen patients were treated in 1968;more than 1,200 patients have been treated sincethen.

With MoRMP help, the state has taken steps overthe last seven years to facilitate transplantation.Dialysis can run as high as $30,000 a year, while theaverage cost of a transplant is $15,000, Success-ful transplants save lives and reduce treatment costsper patient, making more state funds available for theincreased patient load, Recently, the federal govern-ment extended Medicare to kidney victims, but withcertain restrictions. Payment begins only after thepatient has been on dialysis three months and thenonly covers 80 per cent of the costs. Transplantcosts are entirely covered.

In 1969, kidney disease was added to the list ofcategorical diseases for which RMPs had specificdirectives. Since then, MoRMP has helped establishpublic and professional education programs, acomputer data bank, a laboratory quality controlsystem and the development of a three-state kidneynetwork in cooperation with the Department ofHealth, Education and Welfare.

Educational programs

Most ESRD patients cannot live indefinitely ondialysis; they need new kidneys. But many obstaclesstand between the ESRD patient and the donor kidneythat may save his life. Donor kidneys are scarce;people do not know of the desperate need for trans-plantable kidneys, To overcome lack of publicawareness, MoRMP supports educational programssponsored by two Missouri kidney foundations.

With brochures, films, slide shows, mediacampaigns, and the distribution of organ donor cards,the kidney foundations reach thousands of Mis-souri citizens, Through the efforts of these two educa-tional programs, it is estimated that approximately292 kidneys will be available in 1976-77 for trans-plantation,

Besides public education, efforts are also made bythe foundations to educate professionals to thepressing need for organ donation and the techniquesof retrieving cadaver kidneys.

Computer bank and laboratory qualitycontrol

Another obstacle that stands between the ESRDpatient and a compatible donor kidney is time. Acadaver kidney is only viable a few hours. To speedthe process of matching the donor kidney with asuitable recipient, IMoRMP supports a computeroperated by the Midwest Organ Bank, Inc. of KansasCity that stores the names and relevant medical data

of ESRD patients from Missouri and the surroundingeight-state area. Results of Laboratory tests on thedonor kidney are quickly and efficiently matchedwith a compatible recipient by the computer. AnMoRMP-supported laboratory quality control systemmaintains standards for these laboratory tests.

ESRII Network #9

When the Social Security Act was amended tomake ESRD patients eligible for Medicare, the federalgovernment made provisions to set up regulatorynetworks to supervise renal disease care. RMPswere asked to help establish the developingnetworks until funding applications were approved.

MoRMP has been closely involved with the devel-opment of Network #9 which includes all of Kansasand Missouri and part of southern and centralIllinois. The net work coordinating council, com-posed of representatives of Medicare-approvedhealth care facilities, will be responsible for ESRDquality control assurance and peer review.

Over the last seven years, MoRMP has been instru-mental in helping Missouri become a national leaderin the treatment of kidney disease. But the story doesnot end here, Approximately 835 Missourians willneed dialysis and eventual transplantation in 1976.To assure these and future ESRD patients of ade-quate medical care, no link in the cooperative chain ofdirect patient care, public and professional educa-tion, tissue typing laboratory control and com-puterized patient registry can be broken.

/7

It is satisfying to report that Flossye Carter’shypertension is stabilized, that James Crossgrove ison the road to recovery, that Timmy Kissell has hisnew kidney, that little Joshua Smith has fully re-covered from the sudden illness which threatenedhis life, and that the heart patients of rural north-west Missouri continue to benefit from the special-ized skills of Dr. Tom Cofer. After all, theseare some of the hoped-for end results of the Mis-souri Regional Medical Program process.

Important as these are, they are just the tip of theiceberg. Not so apparent are the thousands of heartdisease victims across the state whose lives havebeen saved in cardiac intensive care units staffed byspecially trained personnel, the victims of kidneyfailure whose lives have been productively extendedthrough an effective dialysis and transplant program,or the countless others who have benefited from anyof the 167 programs, all products of cooperativeplanning and enterprise between the MoRMP andmany individuals and institutions intent on im-proving health services for the people of Missouri.

Recognizing the specific health needs of a com-munity, determining innovative solutions andbringing together human and material resources toimplement those solutions are the components ofthe Missouri Regional Medical Program process.

From the vantage point of observer and partici-pant in that process, as a member of our RegionalAdvisory Group over the past few years, I haveconcluded that the MoRMP process has been success-ful because:

it has been entirely voluntary,it is built on cooperative arrangements between

health providers and institutions, andit has depended on the direct involvement of

providers who looked beyond their otvninterests to those of the community.

On June 30, ten years to the day since it receivedits first grant, MoRMP ~vill cease operations. Inkeeping with the provisions of Public La\v 93-641,responsibility for health services development willthen belong to the newly organized Health SystemsAgencies (HSAS).

These agencies ~vill be responsible for healthplanning and regulation in their respecti~e areas.They will face the demanding tasks of agency organi-zation and gaining community participation in thedevelopment of comprehensive health plans for theirareas. It appears that only minimal resources ~rill bemade available to them for these purposes. ,\’o fundswill be available for health services de~elopmentbefore July 1977, at the earliest.

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Since 1967, hfissouri Regional Medical Programhas been responsible for the investment of over $28million in federal funds and over $4 million in statefunds to improve health services for the people ofMissouri. As MoRMP leaves the scene, we areespeciaHy concerned that vital programs which wehave fostered may be forced to terminate for lack ofappropriate transitional support, We are concernedthat the already large investment of time, energy andresources in HSA organization may be erodedthrough underfunding. And we are concerned thatsome of the knowledge and skills acquired in tenyears of helping communities improve their healthservices may be overlooked as the new agenciesattempt to cope with problems of organization.

‘rOO otten, ]?~rS[)llfiJL,,U.VQU... . . . . .... ~agencies must devote most of their energies todeveloping plans and not enough to carrying outthese plans, It is through effective implementation ofprograms that Flossye Carter’s hypertension wasdetected and James Crossgrove’s injuries treated.

We sincereIy hope that these concerns are ground-less ancl that early and appropriate action will betaken so that transition from the old to the new can beaccomplished without undoing the advances inprogram and process which have been so harcl won.

The lives of future patients like Joshua Smithand Timmy Kissel depend on it.

Dr. Wyeth Hamlin, M.D., HannibaI, Me., is chairman ofthe Regional Advisory Group.

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Arthur Rikli, M. D., CoordinatorFred Frazier, Communications DirectorMeJissa Thomas, EditorWilliam Helvey, Photographer

Additional photos by j. Greer, Mannyl\relvman.

This brochure is published by the Llissouri

Regional Medical Program, 406 TurnerAvenue, Lewis Hall, Columbia, Missouri 65201

MoRMP is funded through the Division ofRegional h4edical Programs, U.S. Departmentof Health, Education and Welfare. The viewsexpressed herein do not necessarily representthose o-f the supporting agencies,

Postage paid at Columbia, Missouri.Printed May 1976.

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