assessment of rural health research. executive control data … · 2014. 1. 14. · rural health...

DOCUMENT RESUNE

ED 106 040 RC 008 513

TITLE Assessment of Rural Health Research. ExecutiveSummary.

INSTITUTION Control Data Corp., Arlington, Va. ProfessioaalServices Div.

SPONS AGENCY Department of Agriculture, Washington, D.C. Office ofPlanning and Evaluation.

PUB DATE [75]NOTE 52p.; For related document, see RC 008 512

EDRS PRICE NF-$O.76 HC-$3.32 PLUS POSTAG"DESCRIPTORS Definitions; *Evaluation Methoas; Financial Support;

Health Programs; *Health Services; Knowledge Level;*Research Projects; *Research Reviews (Publications);*Rural Areas; Sumaative Evaluation

ABSTRACTCulminating a 6-month assessment effort by Control

Data Corporation's (CDC) Engineering Management Operations (EMO), thereport was prepared to help meet the Department of Agriculture's needfor an assessment of (1) rural health care services research as awhole and (2) the knowledge contained in that research. The CDC"Final Report" was presented in a large volume in order to make theentire data base available for different policy uses, assessmentmethodological applications, and further discussions. Prepared by EMOafter the completion of the Final Report, this executive summaryfurther explains the presumptions, assumptions, methodologies,conclusions, and recommendations of that report. Policy-relevantfindings of the assessment are suamarized and clarified by: (1)

presenting the models and objectives (values) used in the systemsapproach which produced the Final Report's recommendations; and (2)demonstrating a potential systems approach to the utilization of theFinal Report's data base elements toward the goal of achieving acomprehensive knowledge assessment. The accepted researchpublications are categorized by: (1) indepth subject category and (2)document access number. (NQ)

4.

O

6. Singleton, Project Directorcp S. Wyban, Analyst

Executive SummaryAssessment of Rural Health Research

Contract Number 12-01-01-5-510 Task Order 2

Ate. 00, ps-

t---f

LAJIntroduction

The Assessment of Rural Health Research, Final Report, {FinalReport} culiminated a modest six month assessment effort byControl Data Corporation's {CDC's} Engineering Management ,Operations {EMO} for the United States Department of Agriculture'sOffice of Planning & Evaluation {OPE} to help meet the Depart-ment's need for an assessment of rural health care servicesresearch as a whole and an assessment of the knowledge containedin that research. This need was mandated by Sections 104, 118and 603 of the Rural Development Act of 1972, which respectively:

o Authorized loans to rural communities for developmentof essential community facilities'{inciuding healthfacilities }.

o Authorized loans to private entrepreneurs for theestablishment of business or industrial enterprises{including health facilities }.

o Authorized and directed the Secretary of Agricultureto coordinate the various Federal rural developmentprograms {including rural development research of whichrural health is a component }.

Section 603 requirements were delegated to the Under Secretaryof Rural Development and portions further delegated to theRural Development Service {RDS}

The CDC Final Report was presented in a large volume in orderto make the entire data base available for different policy uses,different assessment methodological applications and furtherdiscussions. The Final Report will be available shortly throughthe NTIS and possibly the ERIC technical information systems.This Executive Summary was prepared by EMO after the completionof the Final Report. It was prompted by the perceived need tofurther explain the presumptions, assumptions, methodologies,conclusions and recommondations of that Final Report. It willsummarize and clarify policy-relevant findings of the assessment

may'

Le:)U I. DEPARTMENTOF HEAL/N.

EDUCATION A WELFARENATIONAL INSTITUTE OF

EDUCATILN.TN'S oocumemr i1AS SEEN REPRODUCE° EXACTLY As RECEIVED FROMTHE PERSON OR oleGANizATIoNorlIGINATING of POINTS

OF VIEW OR OPINIONS

k)STATED 00 N0T NECESSARILY REPRESENTOFFICIAL NATIONAL

INSTITUTE OF.EDUrATION POSITION OR POLICy 0002

o Presenting the models and objectives {values} used inthe systems approach which produced the recommendationsof the Final Report {Section 12}-

o Demonstrating a potential systems approach to theutilization of the data base elements of the Final Reporttoward the goal of achieving a comprehensive knowledgeassessment. Such an effort ideally would be institution-alized.

The Systemaj-proach to Research

..-systems approach to easearch is referred to hereafteras "tetiary research" "Tertiary research" denotes themonitoring, collecting, classifying and aggregating of basicand applied research documents as well as development documents*In systems terminology, this tertiary research wayldjbe synonymousto a formalized feedback network controlled by definAtive policygoals and/or knowledge needs. This approach should ideally beused in administering and planning any sizeable research anddevelopment program by the administrative body in control ofthe allocation of research funds.

Conceptually this "tertiary research" is integrated into a"social action" policy planning process, impacting the threelevels of creative policy planning as described. by Erich Jantsch--the normative {the "ought"}, strategic {the "can"} and theoperational {the "will"}.** In assessing the rural health careresearch programs, the following research and development modelwas used as a standard: Tertiary

ResearchActivity

MMU

-M 0

O CW 0

Basic.Research DevelopmentActivity data Research data Activities

Activity

* This assessment study would be classified as tertiary research,but of a preliminary nature. This will be discussed furtherlater.

** "Social Action" concept as described in the Final Report pages2-4 and 5-1 corresponds roughly to Erich Jantsch's "rational'creative action" {"From Forecasting & Planning to PolicySciences", Policy Sciences 1 {1970}, 31-47}

2

0003

Specifically the ideal "tertiary research" activity iscomposed of-the following:

o a "normative" policy expressing the "oughts" orspecific values which reflect directly on the

. problems, here the rural health problems. Thiswould include "normative" statements on the desiredquality of rural health and possible rural healthservices models to attain such a level,

o a technical information system, which collects, -

classifies and aggregates research and developmentdocuments producing policy inputs and receivingpolicy feedback, -

o a Management Information System, which collectsresearch administration data on ongoing and pastresearch and development activities.

NASA's research and development program is an example ofsuch a "tertiary research" program. In NASA's tertiary researchmechanism its Scientific and Technical Information Facilityperforms the function of a Technical Information system. This"tertiary research" concept is described further in the finalsection of this summary.

Limitations Affectin Desi n & Data of Stud

The assessment "system" was limited and thus its design anddata affected by the following factors:

o limited assessment resource funding by USDA-

o limited time-

o fragmentation/scattering of rural health research {finalreports and publications} among countless periodicals,technical information systems, and the strong prospectthat'a majority of research is not disseminated inperiodicals or technical information systems-

o lack of a structured USDA {or DHEW} rural health "normative"policy and thus specific rural health policy needs andnon needs.

o a vacuum of research methodologies heretofore for a"knowledge assessment" of rural health research.

To deal with the first three limitations {resources, timeand fragmentation/scattering of the research} several trade-offswere jointly planned and approved by EMO, OPE and several know-ledgeable individuals in other USDA agencies. These trade-cffsare presented in the Final Report and the reader is referred to

3

0004

Section 2, page 2-3 to 2-12 of that report. Summarily theywere: limiting the search to documents which were availablein the District of Columbia area - information systems andlimiting the research site to within the United States and itsterritories, and limiting the documents' publishing date topost-December 31, 1969. Originally only publications fromcompleted research or completed significant substages of researchwere to be surveyed. However during the assessment effort itwas decided by CDC and OPE to include a limited assessment ofongoing research to provide a more complete view of the ruralhealth care situation.

Regarding the fourth limitation {lack of structured USDArural health policy and thus specific policy knowledge needs},ENO conduct a two part task to fill this void. This furtherdefined and refined the objectives of the study and indicatedtentative policy knowledge needs {see Section 2, pages 2-1 to2-2}.

The first part of this task was an informal interviewing ofseveral key public sector {USDA ft DHEW} and private sectorpeople related to or responsible for rural health care service {s }.The consensus of this informal interviewing was that the assess-ment effort would be useful if it

o Inventoried {listed} research of rural health careservices,

o Identified problem-oriented research of depth andquality for use to decision-makers, i.e., researchin which alternative courses of action are comparedin terms of desired outcomes, subject to the constraintsof resources and value preferences,

o Evaluated this problem-oriented research as to quality.

This informal interviewing also brought forward two hypothesestobe discussed later.

The second part of this task was a review of pendingCongressional legislation relevant to rural health administrativeactions and relevant to rural health agency actions. Threegeneral national. health goals were derived; they are improve-ment of access, assurance of quality and containment of costs.The results of this two-part effort were used to mitigate thelimiting effects of unstructured USDA rural health policy andthus define the knowledge needs that may be of use when USDAdoes formulate such a structured rural health policy.

The last limitation deserves more explanation. In thehistory of health services research, no convention of tools,characteristics and procedures has been formulated to be usedin a so-called "knowledge assessment" of health care services

4

0005

[

.0.

or the subcomponent rural health care services. Health ServicesResearch and R&D in Perspective edited by E.E. Flook andPJ Sanazaro cites this problem and presents the precurser5of such a convention. Any "ideal" knowledge assessment wouldinvolve aggregating the data elements in the research documentsidentified and comparing these aggregated data elements withmodels of the "ideal" rural health care services delivery systemcomponents. Such an "ideal" knowledge assessment is beyond thecurrent "state of the art" of rural health care services method-ologies because of a lack of health services research aggregatingmethodologies.

Consequently the fifth limitation to vacuum of "knowledgeassessment" rural health services methodologies} -was handledby surveying what methodologies existed and formulating aknowledge assessment aggregating framework from data elementsof relevant papers. These papers were identified through anindependent literature search without publishing date limitations,ie, pre -1970 papers were included* This knowledge assessmentframework and a demonstration of its utilization will be pre-sented later in this summary by applying a model of an "ideal"rural health care services delivery system.

These five limitations led to recommendations 1, 4 and 6presented in Final Report, Section 12.

Recommendation 1} "The creation of a comprehensive ruralhealth policy with a supporting, i.e., complementary ruralhealth care management information system and evaluationtechniques." More specifically this system would be both amanagement information system and a technical information system.

Recommendation 4} "The need for applied research into amethod of aggregating the results of rural health care servicesresearch into a structured scientific model of the existingrural health care services system".

Recommendation 61 "The need to explain to researchers theimportance.of disseminating their research publications [andespecially final reports] to the national information systemsor to a rural health care services management informationsystem., i.e., increase the 'social action' consciousness ofrural health care services researchers."

These recommendations as well as others will be reinforcedlater in this summary.

Definitions

This assessment study concentrated on "problem-oriented"research. To do this two series of classifications were

* See attached bibliography of these papers.

S

0006

established to reflect the attributes of a specific researchstudy which may increase its usefulness as input into thefurther understanding of and/or the improvement of rural healthservices. The first series, research type, is based on thespecific research's stated or implied objective {s} and iseither Sociomedical ism- or Research and Development {R&D}{See pages 2-4 to 2-5} In a simplistic sense, the basicdifference between SM and R&D is the time frame in which changecan be expected. The R&D studies are concerned with improve-ments which can be implemented in the short run while the SMstudies are concerned with long-range plans and policies.

The second series, outcome type, is based on the specificresearch's conclusions and results and is either Tact Description{FD}, Problem Analysis IPAI2 Recommendatioa {R} or Other -COI.Each relevant study is classified by research type and outcometype. Thus these series combine the strict conventional con-ceptions of "research" with those of "development". In theresulting classification spectrum interfaces between research anddevelopment activities are.less distinct but functionally moreindicative of that activity's social action orientation.

However the'relationship between this classification systemand the conventional conceptions of research and development mustbe specified not only to communicate the findings more universallybut to provide a framework to compare rural health care servicesand development with research and development efforts in otherareas, e.g., the life sciences. This transformation is donevisually using the abbreviations presented above.

SM/FDBasic ResearchR&D/FD

SM/PAApplied ResearchSM/R

40/PADevelopmentR&D/R

It should be noted that documents classified as SM/0 andR&D/0 are in the strictest sense not research or development.These categories were included to meet the contractor's wish fordocumented analytical essa/s and as an overflow classificationfor miscellaneous but inte-esting documents.

Basic Research {SM/FD, R &D /FD} "is concerned with exploration ofthe unknown. It is primarily motivated by the desire to pursueknowledge'for its own sake. As such, it is free from the needto meet immediate objectives, but is undertaken to increase theunderstanding of natural laws. This kind of knowledge discoveredthrough basic research forms a groundwork for subsequent appli-cations. which produce economic growth and material progress and

6

0007

can lead to improvements in social conditions"*

Applied Research {SM/PAI SM/R} is concerned with funding themeans for meeting a recognized need- It draws upon the generalprinciples established by basic research investigations and inturn creates additional knowledge- It differs from basic researchin that it is oriented toward practical applications rather thantoward investigation for its own sake- In the course of appliedresearch activity the first pilot steps may be taken to reducean abstract idea to a useful purpose, frequently as a forerunnerto development."**

Development {R&D/PA, R &D /R} is the systematic use of knowledgeand understanding gained from reserth and directed to theproduction of useful materials, devi%es, systems and methods;such work includes the design, testing and improvement of proto-types and processes. Development is directed to generallypredictable and very specific ends, and because such work resultsso often in tangible products, it can be readily associated withdistinct national goals. " * ** In the case of rural health careservices research and development such national goals might be

=equality of access, assurance of quality and containment of costs.

Assessment of Rural Health Care Research - Overview Findings

Only federally funded activity will be addressed here becauseof its pragmatic policy relevancy- Of 321 documents {periodicalarticles and final reports} which met all screening criteria,47-are "other" outcome types leaving 274 which are strictlyresearch and development documents- Note the funding sourcedistribution of these 274 documents.

FundingBasic Researchwhole % partial

Applied Researchwhole % partial

Developmentwhole partial

Federal Government 52.5 40.8 44.8 41.2 67.5 41.2Regional Government 3.8 14.8 1.3 5.9 4.1 11.7State Government 12.5 18.5 21.0 11.? 4.1 11.7Local Government 3.? 2.6 2.0 11.?Educational Insti-tutions 10.0 18.5 13.0 23.6 10.0 6.0

Private {Associa-tions, Businesses,Foundations & Funds 2.5 13-7 7.9 17.6 2.0 11.7

Other 18.? 9.2 10.0 6.0

*Federal Funds for Research, Development and Other Activities,Volume XVIII, NSF, Washington, D.C., 1969, page la-

**Ibid, page 14***Ibid, page 19

0008

1

The federal government, basically DHEW, USDA and 0E0, dominates"basic and applied research" and, as expected, especially dominates"development". Overall 143 or 52.2% of the strictly research anddevelopment documents are federally funded wholly or partially.This domination is reinforced by observing that "Regional Government" includes Regional Medical Programs iRMPI, ComprehensiveHealth Planning {CHP} and other federally supported planning andimplementation groups.

The basic, applied and development distribution of federallyfunded research and development is as follows:

No %"lb

Development 45 31.5Applied 47 32.8Basic 51 35.7

143 100

The geographic scope of this federally funded activity, thatis the site to wt.ich it was addressed, is i.s follows:

Geographic Scope

NationalRegionalStateLocal

Basic Research

No. %

Applied Research

No. %

Development

No. %

9 17.7 13 27.8 8 17.87 13.7 6 12.8 3 6.74 8.0 12 25.4 9 20.0

31 60.6 16 34.0 25 55.5

51 100 47 100 45 100

As mentioned previously, the informal interviewing activitiesset forth two hypotheses. The hypotheses are:

1) Basic research substantiating deficiencies in ruralhealth care services research is abundant.

2) Applied research into the operating relationships ofthe rural health care services "system" and aboutalternative operating improvements for decision makingis lacking. Thus design, testing and improvement ofprototypes and processes {"development" in the presentterminology} would be included in this category.

The assessment effort experience substantiates these hypotheses.

For example, consider that the Cooperative State ResearchService {CSRS} is representative of USDA rural health careservices research funding authority and the Health Services andMental Health Administration IHSMHAI is representative of DHEW

8

0003

rural health care services research funding authority. Then thetotal and sccial sciences subtotal budgetary obligations forfiscal 1970 { "social sciences" because of its disciplinariandomination of rural health care services research} in thousandsof dollars is as follows:

Basictotal

Research*socialsciences

Applied Research**total social

sciences

Development***total social

sciencesCSRSHSMHA

23,66343,615

5,2617,103

38,607128,361

8,584131008

{none designated}9,534 {not broken

out}

This pattern of basic research, applied research and developmentrelative funding proportions follows the federal obligatedbudgetary allocation omitting NASA, the Atomic Energy Commission{AEC} and the Department of Defense {DOD} for fiscal 1970 regard-less of subject area.of dollars:

These totals are shown below in millions

Basic Research Applied Research Developmenttotal total total

Federal Government ****{omitting NASA, AEC & DOD} 947 1,365 493

The CSRS applied-research-to-basic-research funding proportionin 1970 of 1.6 {8,584/5,261} is not reflected in the assessmentfindings, assuming a direct correspondence between budgetaryallocation levels and number of projects.

Clearly this fact can be explained through the assessment'sdesign trade-off of inventorying only District of Columbia areainformation systems and not inventorying research not in thesesystems. However it is EMO's opinion that rural health servicesresearch and development not controlled by a "tertiary research"activity, i.e. not systematically reclaimed from the hinterlandof field research and properly aggregated, is in reality researchundirected toward solving any practical rural health problems.Research and development programs should be directed towardpurposes beyond the training of graduate students and remuneration

*Table C-31, and C -4?, Federal Funds for Research, Development andOther Scientific Activities, Volume XVIII, Washington, D.C.,National Science Foundation, 1969

**Ibid, Table C-50 and C-66***Ibid, Table C-69

****Ibid, pages 10 through 14

9

0010

of researct.ars and their institutions. Thus the failure to "find"such research and development in no way undermines this position--- it reinforces the "tertiary research" conceptual need.

The transformation from assessment research type/outcome typeto conventional research and development definitions could alsobe used as an explanation for the lack of correlation betweenthe CSRS appliedresearch -to- basic- research funding proportionand the assessment findings. However from a pragmatic point ofview, the definition transformations are practical and reflectactual evaluation of the research as well as its intended basic,applied or development purpose.

The appliedresearch -to- development- activity budgetaryproportion in fiscal 1970 is interesting. The HSMHA patternfollows closely that of the federal government, omitting NASA,AEC and DOD. However CSRS has no designated developmentbudgetary obligations. Nevertheless the assessment findingsdo reflect a substantial but lower applied-to-developmentproportion, possibly a result of "social action" consciousnesson the researcher's part or bias from the assessment classifi-cation/evaluation {research type/outcome type} terminology.

Contrasting the above research and development fundingproportions, the pattern which emerges when total federalobligated budgetary allocations including NASA, AEC and DOD.are considered is critically different. The fiscal 1970 figuresin millions of dollars are as follows:

Federal Government*{including NASA,AEC and DOD}

Basic Researchtotal

2,399

Applied Researchtotal

3,713

Developmenttotal

10,376

Obviously the NASA, AEC and DOD group has heavy technology-intensive, hardware-dependent development programs. There mayalso be correlation between this pattern and the well definedpolicy objectives and Congressionally backed policy priorities ofthese threl agencies. Furthermore all three agencies have highlydeveloped "tertiary research" activities to best allocate theirresearch funding resources among those knowledge need areasrelated to their distinct policy objectives.

Without considering the quality or depth of knowledge of therural health care services research, in light of the profoundhealth inadequacies of specific rural areas {see the Final Report,Section 9 and its Appendix I-2 for statistical examples of theseinadequacies}, the assessment effort results and the above inter-pretations tend to support the two hypotheses offered above. Inessence the present basic, applied and developmental mix is

0011

inadequate to come to grips with the deficiencies of rural healthcare services delivery systems. Based on extensive searching,it is doubtful that USDA and DHEW {the two major federal ruralhealth research and development sources - 0E0 is now under DREW}possess "tertiary research" activities systematically directedby structured rural development policy objectives. Based on theuncoordinated research exposed in Section 7 of the Final Report,it is even more doubtful that they coordinate these "tertiaryresearch" activities. This direction and coordination would belisted under "intramural" development activities in the FederalFunds for Research, Development and Other Scientific Activities,Volume XVIII WO do find that two thirds of HSMHA developmentbudgetary obligations are intramural but we could find noexamples of such comprehensive rural health "tertiary research".As shown, CSRS has no development budgetary obligations listed.CSRS's CRIS is a management information system, not a technicalinformation system as would be required by a "tertiary research"program. The National Agricultural Library's CAIN system is atechnical information system but is not comprehensive enough forrural health. These two systems uill be discussed further. Theother information systems surveyed iNTIS, ERIC, SIE, NLM, etc-see Final Report, page 2-10 to 2-111 do not meet the "tertiaryresearch" requirements for a technical information'system forrural health.

This "tertiary research" inadequacy or nonexistence is viewedfrom a different perspective in Table 1, Resear;ch Performers withFederal Funding - Assessment Stat. tics. Note the paucity ofUSDA and DHEW performed {intramural} development activity. Asimilar dearth exists with the "Health Planning Agencies" andwould be explained by the funding weaknesses of CHP's and toa lesser degree RMP's Also note the dominance of colleges anduniversities in all three classifications of research and develop-ment activities. This is born2 out in Table 2 which shows fiscal1970 budget obligation figures in thousands of dollars. {TheAgricultural Research Service, ARS, is shown because it is USDA'slargest research and development component}

We would like to refer back to the "geographic scope"distribution presented earlier in this section. "Locally" focusedresearch, that is subcounty, county or multi-county within aspecific state, dominates basic, applied and development activities.The pervasiveness of rural health care delivery problems are ofsuch a nature that this local focusing of research is appropriate.The basis of the Knowledge Assessment, Section 7 of the FinalReport, is a high resolution spectrum of rurality linked to thecounty as a geographical unit. However such "local" orientedresearch will not deliver its maximum potential unless thisresearch is aggregated through the "tertiary research" conceptpresented in this summary. Thus any plans for increased areawideresearch {"Regional" and "National"} should be a systematicallyderived mixture of such areawide studies and formalized "tertiaryresearch" activity concentrating in part on the aggregation ofthis local research.

0012

Table 1 - Research Performers with Federal Funding - AssessmentStatistics

Basic AppliedNo. No. %

Private Ed. Institutions1

2

3 5.8

23

12.2,

Health RelatedMiscellaneous

total:

Public Ed. Institutions

5

AgriculturalComponents 9 6Health Related 3 4Miscellaneous 7 6

total: 19 36.6 16 39.0

Professional Associations 2 3.8 4...

Non-Profit Institutions 8 15.4 1 2.4

Profit Institutions amINNI OEMs 2 4..9

Federal GovernmentUSDA 3 2DHEW 2 4Other FederalAgencies 2 1

Quasi-FederalAgencies

total:

1

15.4

2

22.08 9

Health PlanningAgencies' 15.4 3 7.3

State GovernmentAgencies 3.8 4 9.8

Sub-State GovernmentAgencies 2 3.8 1 2.4

i

12

001.3

DevelopmentNo. %

-2-.

2 5.0

4

310

17 42.6

1 2.5

2 5.0

1

2

1

=MD

4 10.0

3 7.5

8 20.0

3 7.5

Table 2*

Research Performers with Federal Funding - NSF Statistics

Total

23,663

43,615

66,8t6

38,607

128,361

78,037

Intramural

775

15,269

53,199

1,263

16,886

74,730

Extramural

Industrial

Firms

MIN

ON

O

IMM

O 3

93

440

Universities 1

Colleges

221774

25,184

1,884

37,157

62,376

1,419

Other

non-orofit

114

1,902

90

187

24,647

MIM

EO

Other

.110

111.

1,152

16,56941

Foreign

.110

111. 108

6,710

7,790

1,407

Basic Research:

CSRS

HSMHA

ARS

Applied Research;

CSRS

HSMHA

ARS

Development:

CSRS

HSMHA

ARS

9,534

12,706

6,030

12,252

504 3

385

281

2,573

MIM

EO

42

MIM

EO 170

*Ibid, Table C -29, C-50 and C-69 in thousands of dollars.

From this data the following hypothesis is formulated:"tertiary research" activity or an analogous activity is conductedby the Agricultural Research Service and the Cooperative StateResearch Service in their agricultural development efforts aswell as by other USDA agencies involved in agricultural develop-ment. Consequently the CSRS has a management information systemwith high agricultural development resolution {CRIS }. TheNational Agricultural Library's CAIN system is the counterparttechnical information system with high agricultural developmentresolution. Rural development resolution including rural healthservices research is relatively lower and warrants seriousdiscussion and action.

In summary these considerations and interpretations form thebasis for recommendations No. 213,517 and 9 presented in theFinal Report, section 12.

Recommendation 21 "The need for a single agency to be active atthe Federal level with the responsibility for synthesizingsystematic planning for a.national rural health care system."

The implementation here of course is flexible. Yet thecoordination responsibilities delegated to the Rural DevelopmentService {RDS} [Rural Development Act of 1972 section 603] couldbe ideally realized here. If the RDS were given the tools toconduct rural health "tertiary research" regardless of the fundingsource, e.g. DHEW or HUD, then it would be in the prime positionto coordinate all federally funded rural health care services andfurnish authoritative rural health policy components as inputs intoHEW's National Council on Health Planning and Development {NCHPD }.The NCHPD has been mandated by National Health Planning andResources Act of 1974 {PL 93 -641} as the mechanism to conduct"development" activities in the nation's health care services"system". Recommendations 11 3 and 4 are reinforced by thisrecommendation. Implementation of this recommendation by RDS{or another USDA component} would require close RDS/NCHPDcooperation.

Recommendation 3, "The continuation of'the data base resultingfrom this assessment effort by not only continuing to inventory,classify, and evaluate, but to enlarge its capture techniques andsubject areas. The purpose would not only involve the effectivedissemination of rural health care services research to researchersand decision-makers, but the coordination of rural health careservices research in-house and out-of-house. Thus, one majorrural health care services research data base would stimulate a .

systematic approach to the problems of rural health."

This addresses the stated need for a technical informationsystem as the heart of a "tertiary research" activity linked toa management information system.

Recommendation 5, "More constructive dialogue between researchers{academicians} and the policy-makers to lessen the 'conflict'between their respective theoretical and practical orientations,

14

0015

hopefully leading to more problem-oriented research by more'social action' oriented researchers and more management orientedpolicy-makers who systematically know what objectives they want"

This will be of prime importance to any successful implemen-tation of a "tertiary research" activity, ie Recommendations213,41 and 6 It will also be a necessity for the attainment ofRecommendation 7 below.

Recommendation 7, "The need to increase the amount of "problem-oriented research" recognizing the need for other types of research.Rural health problems require such problem-oriented research ifsolutions are to be found"

This means an increase in applied research and developmentactivities. However historically such emphasis on developmentactivities only accompanies political mandates and should beaccompanied by "tertiary research" activities controlled by aconcrete systems approach effected policy direction {involvingnormative, strategic and operational policy levels}

Recommendation 9, "The investigation by USDA into the nationalhealth services data system being constructed by DHEW's Centerfor Health Statistics" We would anticipate that any nationalhealth care services delivery system, whose planning and imple-mentation has been mandated by PL 93-641, would utilize veryheavily this "national health services data system" to zero inon geographical problem areas and health needs of those problepareas. Likewise the implementation of Recommendation 2 withRDS or any other USDA component would require closer RDS/NCHPD--,cooperation. The Center for Health Statistics would be a logicalpoint to increase this cooperation and ensure that rural areasare included "properly" {proper rural resolution} in this "nationalhealth services data system" [The Office of Rural Health'sZDHEW} impact on increasing this "rural resolution" has not beenobserved as of this time]

Demonstration of a Use of The Assessment's_ Data Base Elements

As stated above, the systems approach to rural health careservices research {and development activities} used in theassessment effort is based on the following:

o To systematically control the direction and thus attainthe practical social objectives of any large researchand development program, "tertiary research" activitymust be implemented.

o "Tertiary research" activity necessarily involves know-ledge assessments on an almost continual basis. "Ideal"knowledge assessments involve "aggregating the dataelements in the research documents identified and comparing

1:

0016

these aggregated data elements with models of the'ideal' rural health care services delivery systemcomponents."

This "aggregating" task ensures the input of normative policyelements, personified through the choice of "ought to" models,into the "tertiary research" activity. Thus the "tertiary research"activity is brought out of an environment isolated from decision-makers and is connected through feedback mechanisms to policyformulation and to the decision-makers. This will be seen moreeasily by a closer look at this "ideal" knowledge assessmentmethodology. A visual step-by-step conception of it is presentedin Figure 1.

The assessment effort embodied in the Final Report approximates,within the limitations discussed earlier, steps 112,3 and part ofstep 4. The "geographic aggregation" of step 3 shows potentiallylarge knowledge vacuums in a "rurality definition spectrum" takinginto account experimentally isolated variables {see "Bibliography").of "economy of scale" and ."access distance" {see Section 7, FinalReport }. This is the basis for the Final Report's Recommendation 8.

Recommendation 8, "The adoption of more dynamic concepts of'rural', e.g. the concepts behind the indepth assessment to includethe dimensions of economies of scale and access distances of ERSYsnon-commuter/commuter counties concept". Since step 4 is onlypartially complete the demonstration will proceed from there.

First "policy determined models of the Department's ruralhealth care services involvement and goals" would have to beidentified. For the purpose of the demonstration, relevant policyelements will be assumed as follows:

o What part will USDA play in DHEW's NCHPD activities andother health activities?

USDA will work cooperatively with DHEW and will supplythe authoritative rural health care services policy inputs.

o How'will these "policy inputs" be obtained?

RDS's Economic Development Division {which is studyingCHP areas and developing a data base about these areas},will be given the tools and responsibility to carry ouLrural health care services tertiary research activity,regardless of funding source. RDS would be responsiblefor coordinating all federal rural health care servicesresearch and for inputting the authoritative rural healthcare services policy into DHEW's NCHPD and ether healthactivities.

16

0017

1

Collect, research

and development

final documents.

{represented by

Section 4 of Final

Report}

O O 00

2Classify /evaluate, as

to research type/out-

come type & subject

areas {The classifi-

cation represented

summarily by Appendixes

G-1 to G-7, Final Report

& Tables 3&4 of Executive

Summary through the use

of Appendix F, and the

"screening criteria" of

pages 4-1 to 4-4, Final

Report.

The evaluation,

represented by Section 5,

Final Report.}

3"Geographically aggre-

gate" along rurality

definition spectrum.

{Identifying vacuums}

{represented by Section

7 of Final Report}

6Policy

Modifications,

Status Quo or

Restructuring

5b.

Ideal Knowledge Assessment

of Applied Research. Activities

5c

Ideal Knowledge Assessment

of Development Activities

Fi ure 1

.4

"Knowledge aggregatd' along

policy determined "models"

of the Department's rural

health care servi4es

involvement and goal {s }.

{represented partially

by Section 9 and Appen-

dixes I-1 and 1-2 of

Final Report}

o What is the normative policy of the USDA as it addressesrural health care services goals?

Those goals are full equality of access, high quality ofcare and the attainment of rural health standards on apar with urban health standards in specific rural areas,i.e., the most rural areas {the highest numbered ruralitycodei in Section 71 fingfgport}.

o What rural health care services delivery system model ormodels, as well as criteria, does the USDA consider orwant to be considered as part of its normative policy toattain the above stated goals?

This model is shown in Figure 2-1 of the Final Report.Furthermore this model is the framework for the subjectcategorization format {Appendix F} used in the assessmenteffort and part of step 2 of the "ideal" knowledge assess-ment methodology.

At this point it would.be possible to complete step 4, the"knowledge aggregation" by reorganizing the subject categorizationformat alpha-numerically along the delivery system model repre-sented by Figure 2 of the Final Report. An example of this processis shown in Figure 2 for "general health", representing part ofthe aggregating template.

Please note that IV-Evaluation, X-Technology and XI-Methodologyare subject areas of the subject categorization format which supportthe knowledge assessment component of the "tertiary research"activity in the larger sense. That is they are used in steps'112131 and 4 of Figure 1.

Using the appropriate "aggregating template" and the potentialknowledge vacuum areas as a guide, the specific research anddevelopment documents are acquisitioned from the technical infor-=mation system. For example, the user interested in the consumeraspect of rural health care would acquisition the documents whichdealt with the subject categories IAll IA21 IA31 VIM, VIID11VIID41 IXA and IXE These documents and those for any other subjectarea can be easily identified by using Table 3. Appendix F,Subject Categorization Format of the Final Report is the narrativekey to the alphanumeric code of the subject areas. The documentnumber in Table 3, e.g. 0051 is the entry into Appendix G-1,Research Publications Accepted - By Title, Final Re ort yieldingspecific bibliographic data for the documents desire Thesedocuments are then acquisitioned and analyzed for data elementsusing as the standard the knowledge required to implement thepolicy derived model rural health care delivery system. Section 9of the Final Report is a suggested starting point for such a"knowledge aggregation." Steps 5 and 6 of Figure 1 are thus theresults of this iterative process. Obviously this approachrequires appropriate resources of funding, time and talent {bothacademician and decision making}

la0019

I

Consumer

VIA

0.00

.0.1

0.01

0011

1011

1/ L__VII E

E / 1

1 2 3

I

Environment

o Sociomedical

o Socioeconomic

VII Di

IXB

IXC

IXE

D2 13

D4

Figure 2

Health

Screening

System

X.

Provider/

Health

Processor

renmeemen)

.0#

Personnel

IA(- - VIII-

Ilb lc

VII

I' ./A

2a

2b 2c

C2 C3 C4 C

1I

II

S3a

3b 3c

1 cIIF

*-Ate

IIG

IIID

National

Rural Health

Goals

Facilities

4I IA

Va2a bI

b c1

1 c

3a

KEY

.....)knowledge linkages

.4

and interfaces

knowledge aggregation,*

elements

external model

impact

model inputs/

outputs

Table 4 is a reordering of Table 3 so that a one-to-onecorrespondence can be made with Appendix G-1 of the Final Reportyielding indepth subject categorization for specific documents-Tables 3 and 4 represent indepth subject categorizations fromAppendix F, Final Report and constitute data not in that FinalReport but gathered during the assessment effort. It is hopedthese tables will extend the usefulness of the Final Report.

The above discussion should clarify: the recommendations ofSection 12 of the Assessment of Rural Health Research FinalReport, in the broader concept of "tertiary research" activity;the relationship of a comprehensive knowledge assessment withsuch a "tertiary research" activity and the requirements for suchan activity; and the position of the assessment effort to date.in relation to this "tertiary research" concept, ie, the FirialReport represents the beginning step toward a comprehensiveknowledge assessment as well as an important component in the"tertiary research" concept. It is this concept which isnecessary to overcome the pervasive problems of rural health careservices delivery and to a larger degree rural development.

20

. 0021

4oe

BIBLIOGRAPHY

Committee on Agriculture and Forestry, U.S. Congress, Charac-tgrLtsaf_-sioU.S.RuralAr4ithNon-CornmutinPoulation92nd Congress, 2nd Session, 6/1972.

Goldmark, Peter C. "The Need for a New Rural Society",Michigan Business Review. May, 1974, pg. 5-9.

Jantsch, Erich, "From Forecasting and Planning to PolicySciences", Policy Sciences 1 {1970} 31-47.

Kraenzel, Carl F., Billind the Cities, A Rural Regionalist HasHis Say. Montana State University imimeograph3- 9/1467.

MacQueen, John C. A Plan for the Distribution of Physicians,and the Health Care Units Needed to Provide Health Services inIowa. ERIC Accession Number ED076891..

Morrison, Peter A., Interim Report by RAND Corporation for theEdna McConnell Clark Foundation, Progress Review Meeting 2/15/74{unpublished }.

Rainey, Kenneth D., Public Services in Rural Areas, Academy forContemporary Problems, 2/12/74 {unpublished }.

US. Bureau of the Census. People of Rural America by DaleE. Hathaway, J. Allen Beegle, and W. Keith Bryant {A 1960Census Mimeograph }. GPO, Washington, D.C 1968.

044

TABLE 3 - RESEARCH PUBLICATIONS ACCEPTED

By Indepth Subject Category

By Document Access Number -

0023

Subject Category

Document Access

Description

IAls

082

(Involves several indices of

R. N. Care Conditions)

094

101

110

112

122

125

132

136

142

155

-167

189

196

191

212

214

219

221

222

223

230

235

241

242

243

246

260

266

265

266

290

297

303

Naturopaths

Nurse practitioners

Nurse, practical and registered

Physicians

TABLE 3

AESEARcji PUPUCATIONS ACCEPTED

IL12/1111aLUISILAIAllir

SUBJECT CATEGORY

(See Appendix fl

Pine' Report)

I IA

Ski

/Ala

DOCUMENT ACCESS

NUMBER

DESCRIPTION

004

035

139

162

Supply

005

041

063

123

131

277

105

133

171

Recruitsent of sh.ist4Aans

202

295

004

006

(13 categories allied health

personnel)

009

015

029

031

03S

037

050

055

056

061

076

079

/

CD CDND

CJI

Subject Category

Document Access

Dumber

Description

I

Subject Category

Document Access

Number

IAla

IAlb

IAlc

311

318

321

015

054

079

087

089

044

101

102

115

197.

198

221

222

23S

242

241

260

211

270

271

278

297

301

310

311

318

051

132

189

196

221

IA?

IA2a

IA2b

IA3

Ih3a

IA3b

IA3c

IB

IB1

IBla

105

202

031

039

112

200

230

285

269

303

321

099

154

271

269

202

031

218

285

303

321

099

218

005

041

044

133

258

013

17S

21111

301

004

008

Physicians and hospitals

Spaech and hearing specialist

Podiatrists

Supply


Podiatrists

13 categories of allied health

personnel

23

...

Description

Subject Catimpory

'acumen! Access

Number

'ascription

Subject Category

)ocument Access

Number

ISla

191b

191c

IO2a

IS3a

IC

IC1

ICla

031

03S

112

125

132

265

303

321

257

OSI

132

031

112

26S

303

321

031

265

303

321

005

040

044

133

243

012

G31

447

016

112

122

132

201

265

210

Supply

ICla

IC1b

IC1c

IC2

IC2a

CD CD

IC2b

IS IOU

IE

IC/

IE2a

IE3a

IE4a

ICS

II

303

321

047

087

066

132

243

031

047

112

201

265

321

047

005

031

131

317

266

COS

031

265

303

321

202

155

1SS

302

155

202

246

00S

Utilization of dental aux, and

dentists (type of practical

Post-graduate education

Nurses

Nurses

/Mien health Side

Nurses

Emergency medical services

Supply of facilities

"ascription

Subject Category

Document Access

Number

Descriotion

IIAlc

216

Retirement communities

240

241

245

26E.

275

Satellite health facilities

286

IIAld

031

034

Delivery

126

Supply

146

157

i

146

CD

CD

199

Supply of health facilities

Nn

275

Supply

ft,..

262

Satellite health facilities

i

263

Supply

285

Sup-ly

303

Supply

321

Supply

IIA2

076

136

154

166

277

IIA2b

010

200

Short term hospital

IIAlc

055

120

121

266

IIA2d

031

066

148

Subject Category,

Document Access

Description

Number

II

139

162

Health facility supplies (ambulatory,

lab, hospitals, mental health clinics,

nursing homes, dental facilities

(offices and clinics)}

IIA

041

136

193

194

209

261

264

46

IIA1

039

061

084

116

124

125

131

IIAla

297

IIAlb

037

115

266

247

IIAlc

009

070

072

073

115

120

161

171

203

subject Category

Document Access

Maher

Description

II12d

031

Subject Category

Document Access

Description

064

Supply of mental retard. services

and facilities

ItA2d

165

285

285

Supply

303

Supply

303

Supply

321

321

1113

026

IIA2e

294

IIB3c

147


IIA3d

031

and facilities

146

IZ93d

031

265

14?


303

and facilities

321

Supply

285

IZB

005

303

Supply

041

C.)

CD

IIC

321

061

044'

046

116

SIN

013

CX)

223

065

IIC1

024

114

141

125

IIC1d

121

Supply

175

IID

146

165

1??

231

IID2d

146

268

IIE

265

314

303

Supply

IIBIc

072

Comprehensive planning

321

Held

031

IZE1

07i

064

Supply of mental retard.

153

Migrant educational project

and facilities

158

Migrant school health service

282

Supply

254

283

Supply

255

265

Supply

301

Mental

303

Supply

ItElc

128

321

Supply

IZE2

148

Supply

1282

028

196

176

IIE2b

300

185

IIE3

147

Supply

314

services

Subject Category

Document Access

.Number

1164

053

OAS

154

192

220

257

/US

052

053

204

261

IIGA

.160

IIN

264

CD

III

038

075

275

ILIA

048

164

204

IIIA1

105

134

240

IIIAle

095

101

135

151

274

292

31d

111Alb

006

023

095

242

243

253

Description



Emergency 'medical services

Mobile coronary tare unit

Gamma organiaationNfunded

various ways

University sponsored

Migrant health

Subject Category

Document Access

!ascription

Number

LIES

052

053

143

148

190

220

IIF

261

301

309

IIF2

103

195

214

217

IIF3

121

1,0

IIF4

291

IIFS

300

ZIG

016

193

144

II61

209

225

261

1162

209

225

261

1163

011

062

085.

145

252

308

1164

007

052



Labs - supply and cost

Services for the blind

Services for the blind


Subject Category

Document Access

Number

IIIB

046

046

11191

134

11161a

042

175

246

IIIBlb

253

IIIBlc

041

044

045

.064

0?2

104

C165

Cop

258

265

Meld

086

114

174

176

304

IIIC

046

314

IIIC1

134

IIIC1c

024

072

IIICld

173

IIICle

280

III!

006

016

027

048

066

083

054

Description

Subject Category;

Document Access

Description

Number

IIIAlb

318

IIIAlc

011

041

072

045

14?

251

274

IIIAld

066

064

248

IIIAle

073

143

184

195

IIIAlf

034

170

315

Haig

076

103

142

270

305

II1A2

124

-MAU

030

144

212

titlac

212

IIIA2e

183

195

Invent health

Comprehensive racial service

planning

OCO/U. of North Carolina

U.S. Public Health Service and

Gillette Co.

HMO's

Comprehensive social service

planning

306


309

HOspital

I

Subject Category

Document Access

Description

Subject Category

Document Access

Description

Number

IVA1

216

aso

IVAla

049

046

163

208

254

30?

IVAlb

152

259

IVAlc

162

CD IVA2

033

Co

045

C..,

1 ??

)-4

276

IVA2a

071

299

IVA2b

299

IVA3

175

IVA3a

049

IVA4

134

173

276

299

IVASa

254

255

256

316

IVASb

124

300

IVASd

134

149

DAM/

052

Retirement community

Summary of all migrant programs

Migrant school health program


III)

106

139

164

165

164

168

229

23?

240

246

252

254

255

256

263

264

268

272

294

304

3011

301

317

319

IIID1

018

HIE

319

IVA

041

082

111

209

251

IVA1

063

081

123

124

17?

Hospital merger

Family planning

Family planning

Subject Category

Document Access

Desckption

Number

IVC2

009

INE

MO

IMM

IN

020

050

0t4

Indian health manpower shortage

104

108

154

162

166

221

230

Cr)

245

IVC3

027

Special target of disadvantaged

1\.`)

families

054

family planning

077

Dissemination information on

Medicare

CAA

09S

Migrant health

104

Evaluation of feasibility study

117

bay care center and nutrition

155

234

Transfer payments to rural poor

V036

113

139

VA

045

0S6

063,

126

130

140

142

146

156

Rural Indian health

Subject Category

Document Access

Number

Description

IVASe

053


093

Evaluation of a program designed

to produce rural physicians

220

249

302

IV61

056

063

123

203

238

26?

284

IVAle

077

161

206

IVO3

236

IVB5e

093

IVC

001

023

097

215

IVC1

OSO

0S9

070

OAS

066

104

145

iS0

230

24S

261

In the field health services

Nutrition education

Evaluation of a program designed

to pi.oduce rural physicians

Helicopter ambulance service

CD

Subject Category

Document Access

Description

Subject Category.

Document Access

Number

Description

Number

VA

262

VE

0411

275

220

307

VE1

087

312

VES

174

Migrant health service

VA1

089

180

Migrant health service

099


Vf

048

13?

VI

048

181

VIA

038

205

056.

244

124

259

184

261

204

267

234

transfer payments to rural poor'

281

240

288

273

VAR

259

319

48

046

VIA'

030

048

044

065

212

140

2IS

142

232

146

VIA2

217

156

219

175

232

au

VIA3

232

147

VIB

042

VC

048

VIB1

043

067

VIC

040

142

1711

196

206

312

232

VC1

259

VIC3

163

281

VIE

269

Mobile coronary care unit

VS

140

VIIA

014

201

032

-11

Subject Category

Document Access

Number

Subject Category

Desdription

Document Access

Wueber

127

VIIA

VIIC

097

210

110

233

111

24?

125

287

213

VIIB

002

222

020

278

021

320

022

VIIC1

212

029

295

032

VIIC1d

30?

057

VIIC4

172

067.

CD

VIIC4a

239

076

VII)

013

094

106

098

1P4

130

126

175

164

VIID1

021

172

022

175

02S

207

Drug abuse

026

210

067

211

010

224

100

235

113

239

117

262

140

265

233

27S

247

292

vine

019

299

021

301

067

VII

C019

076

021

080

029

Description

r 1Subject Category

Document Access

Desiription

Number

VIID4

226

228

233

235

253

274

281

VIIDS

OSS

064

140

Distribution of medical care accord-

ing to ages income and residence

216


C)

VIIE

014

Ut

31S

ul

VIIE1

075

076

166

261

272

VIIE2

1SS

166

170

186

236

261

VIII

004

005

Personnel and facilities

031

,41

.61

048

Comprehensive

134

Cost of drugs

182

310

VIIIC

060

VIIIDS

060

IXA

021

Subject Category

Document Access

Description

Number

VIID2

VIID3

VIM

100

113

116

116

114

122

127

124

226

227

226

237

2S3

274

277

274

246

003

033

065

067

207

227

273

313

002

016

096

067

075

076

104

114

137

224

Subject Category

Postulant Access

Desiription

Subject Category,

Document Access

Description

Number

Number

IXE

926

Urban-rural differentials of health

IXA

036

facilities and related differences

040

in disabilitiet

060

033

Nature and extent of mental illness

080

Migrant health

in sparsely

populated areas

116

,

059

Applying technology to pilot pro-

jest relative to Puerto Rico unique

135

146

problems

153

Migrant educational program

067

Problems of Native Americans (Indians)

176

10?

Asthmatic and hay fever in rural

174

children

180

11$

Health and employment interrelatedness

191

CD

12$

Probleis of Native Americans (Indians)

205

CAD

151

Black doctor shortage

206

156

Indian healtn problems

223

157

Indian health problems

249

174

282

18?

Maldistribetion

283

212

Doctor shortages

316

Migrant school health program

233

Community organisation and health

IXO'

074

236

Rural school psychological services

092

XA

01?

16?

048

249

144

305

26?

IXC

009

294

183

Occupational employees only

XI

007

IXD

081

039

124

059

168

144

192

Maldistribution of US population

192

229

Problem areas in local rural developeen

294

250

XC

017

287

XE

104

Railroads

313

IXE

025


facilities and related differences

in disabilities.

/

Subject Category

Document Access

Deseription

Number

XIB

090

091

092

105

129

152

159

16?

186

=236

CD

260

1

CA,

264

...a

267

296

XIC

076

063

i064

Computer simulation

096

136

141

166

Essay on rural research process

Pragmatism

231

Problems in researching in rural

areas

26?

Systems approach application

Subject Category

Document Access

Description

Number

..

XE

XIA

XIB

160

215

012

025

026

032

043

044

049

05?

062

074

oil.

091

102

10?

124

13?

141

161

210

211

213

22S

230

231

244

263

265

26?

r

311

320

003

010

Influence of automobile

Helicopter ambulance service

Asthmatic I hay fever in rural children

Documeut

Subject

001

IA la

IIAlc

IVC2

'XC

010

IIA2b

XIS

011

IIG3

IIIAlc

012

ICIa

XIA

CD

013

I81

CD

1181

C!

VIID

CL)

014

VIIA

VIIE

OIS

IAle

IA16

016

116

IIID

017

XA

XC

01

111)1

014

VII

Cv/ID2

024

IVC2

VIIB

021

VII8

VIIC

VIID1

VIID2

IXA

022

VIIB

VIID1

023

IIIAlb

IVC

1

..101

w


By Document Acme Number

By Indepth Subject Category

DOCUMENT

SUBJECT

ACCESS NUMBER

CATEGORY ADDITIONAL DESCRIPTION

See

Appendix

F Final

Report

001

IIIAlb

IVC

002

VIIIB

vlIDV

003

VIID3

Xle

004

IAla

I 181a

VIII

00S.

IA

Ie

IC

ID

IC

II

Supply of facilities

VIII

Personnel end facilities

006

IIIAlb

III)

00?

IIG4

X8

00

lAla

13 categories of allied h. pers.

I8la

13 catempries of allied h. pars.

311

Seamen!

Subject

Access NUmbar

Eataporu Additional Demeriotion

031

IIAld

Supply

IIA2d

Supply

IIA3d

Supply

Mild

Supply

IIB2d

Supply

II03d

Supply

IIE

Supply

VIII

Manpower t facilities

032

VIIA

VIIB

XIA

033

IVA2

IXE

Nature s extent of mental illness in

sparsely populated areas

034

IIAld

Delivery

IIIAlf

035

I iCom-

All levels of mpr supply anti distribution

Prehenslve}

IAla

IBla

031

V IXA

037

IAla

IIAlb

036

III

General organisation funded various ways

VIA

034

IA2a

Socueent

Subject

Access %giber

Catemory

Additional Sescriotion

024

IIC1

IIICIc

025

VIIP1

IXE


facilities and related difference in dis-

abilities

NIA

021

VIIS1

IXE

XIA

02?

III!

IVC3

Special target of disadvantaged families

026

1182

1163

024

IAla

VIIB

VIIC

030.

IIIA2a

VIAL

031

IAla

IA2a

IA 3a

102a

103a

ICIa

IC2a

IS

It

3?

z

locusent

Access Number

Subject

Cateeory

Additionallescriotion

034

IIA1

X8

040

IC

VIC

Decuaent

Subject

IXA

041

IA

046

YE

IS

VF

IIA

VI

II8

VIII

IIIAlc

XA

IIIB1c

044

PlAla

IVA

PIA 3a

loIA1

042

IIIBla

VIB

XIA

043

VIB1

050

IA la

XIA

IYC1

044

118

IVC2

IIIAlc

051

IAlc

XIA

IBlc

045.

11181c

052

LIES

Emergency aedical service

IYA2

1164

Emergency medical service

044

Y8

11GS


IVASe


047

Ida

053

'US

1164

Emergency Radical service


IClb

Util. of dental aux. a dentists,

(type of

practical

II6S

Faergency medical service

IC2a

IVASe


IC2b

0S4

ass

IAlb

IAla

Family planning

Family planning

041

ILIA

lilt

1118

IIA2c

VA

VIIDS

VB

VC

lecument

Lsess Number

Subject

Catenary

Additional Description

06.

VC

VIIB

VIID1

VIID2

VIID3

VIID4

IXE


Oka

Ina

IC lc

064

IIIAld

VIIDS

CD

070

IIAlc

C)

IVC1

wpth

071

IIE1

N1

IVA2a

07.

IIAlc

II81c

Comprehensive planning

IIIAlc

III81c

II1C1c

073

IIAlc

I: awie

074

XIk

IXB

075

III


VaD4

VIIE1

076

IIIAlg

VII8

VIID2

VIID4

VIIE1

077

IVC3

Dissemination of information on medicare

Document

Subject

Access Number

Catenary

Additional Descriotion

056

VA

VIA

057

VII8

XIA

056

IA la

IVB1

054

IVt

IXE

Applying Leib. to pilot project

relative

to Puerto Rico's unique problems.

X8

01.0

VIIIC

VIIIDS

IXA

061

IAla

IIA1

IIC

062

1163

XIA

063'

IA

IVA1

IVB1

VA

01.4

IIBld

Supply of mental rater& service and facilities

integrated services

II82d

Nupply of mental retard. service and facilities

integrated services

II81c

Mental retard. service and facilities. inte-

grated services

as 066

II111

V8

VIID3

IIIAld

1118

Document

Subject

Access Number

Cateoory Additional Description

043

IVASe

Evaluation of program designed to produce

rural physicians

IVBSe

Evaluation of program designed to produce

rural physicians

ri4

IAla

18

IC IVC2

Indian H. Mpr. shortage

V/18

045

IIIAla

Migrant health

IIIAlb

Migrant health

IIIAlc

Migrant health

IVC3

4,:o

IVAla

XIC

047

IVC

VIIC

048

IIIB

Vila

044

IAlb


IA2b


IA3b


VA1


100

VIM!

101

IAla

IAlb

IIIAla

102

IAlb

XIA

103

IIF2

IIIAlg

OEO and U. of North Carolina

104

IVC1

IVC2

IVC3

Evaluation of feasibility study

Document

SMI)ject

Access Number

Cateaory

Additional lescriotion

078

IAla

IIA2

XIC

074

/Ala

IAlb

060

VIID2

IXA

Migrant health

081

IVA1

IXD

082

IAla

Involves several indices of N.H. CareConditions

IVA

083

III)

XIC

084

III)

XIC

Computer simulation

06S

1163

1164

IVC1

086

IIIBld

IVCI

087

IAlb

IC1b

VE1

086

I/A2d

IVC3

XIA

0114

IAlb

IIA1

VA1

040

VI1D1

XI8

341

XIA

XI8

042

IXB

XI8

40

1

CD CD

bP1'

hP.,

locusent

Access Number

Subject

Cateoory

'..

Additional Descriotioll

Document

Access pumber

Subject

tateoory


11?

116

114

120

121

122

123

124

12S

121.

12?

126

VIID1

VIID2

IXE

VIID2

VIM

IIAlc

IIA2c

IIA2c

IIF3

IAla

ICla

VIID2

IA

IVA1

IY81

IIA1

II1A2

IVA1

IVASb

VIA

IXD

IAla

Selo

IIA1

II81

VIIC

IIAld

IICld

VA VII8

VIIA

VIID2

IIElc

IXE

Health and eaployeent interrelatedness

Supply

Supply


1

104

10S

101.

10?

106

104

110

111

112

113

114

11S

111

11?

XE

IA1

IA2

IIIA1

III,

VIID

IXE

XIA

IVC2

XIB

Mac

VIM%

IAla

VIIC

IVA

VIIC

IAla

IA2a

IBla

IS2a

IC la

IC2a

V VIM

VIID2

II81

IIIBld

(Alb

IIAlb

IIAlc

IIA1

IIC

VIID2

IXA

IVC3

Railroads

Asthmatic and hay fever in rural children

Asthmatic and hay fever in rural children

Day care center and nutrition

CD

14=

b

Cu

1

Document

hccess dumber

Subject

Cateoorw


Document

Access Nusber

Subject

Cateaore


134

140

141

142

143

144

14S

146

147

148

III21

IIIC1

III,

V VA

VI

VD

VIIDS

XI*

XIC

YAla

IIIAlg

VA

V8

VC

'ICS

IIIAle

XA

X9

1163

IVC1

VA

V0

VC

IXA

I193c

1183d

V83

IIAld

IIA2d

IIA3d

11E2

IIE3

Distribution of medical

care according to age.

income and residence

Supply - mental retard. face'

Supply

mental retard. fac.

Supply - mental retard. fac.

Supply

Supply

124

130

131

132

133

134

135

136

137

13a

134

VIID2

XIA

XI9

VA VHS

IA

ID

IIA1

IAla

IAlc

I81a

Illc

Ida

IC1c

IA1

IB IC

IVA4

IVASd

VIII

IIIAla

IXA

IAla

IIA2

VA1

VIID4

XIA

IIA

XIC

I (Com-

prehensive)

II (Com-

prehensive)

IIIA1

Comprehensive - all h. mpr.

Cost of drugs

O OP6

Document

Acc

ess

Subject

Coteoory

Additional lescriotion

Document

Access Number

subject

Coteaory


MIM

S

LIES

IIIA2a

IVASd

11E4

IVC1

IIIAla

IXE

IVA1b

XIB

IIE1

IXA

IA2b

IIA2

IIG4

IAlo

IE3o

IE4a

VA

VB IXE

IIAld

IXE

IIE1

IVC3

IVC2

XIB

1161

XE IIAlc

IVBla

IVA1c

IVC2

Labs

supply and cost

HMO's

Black doctor shortage

Migrant ed. proj.

Migrant ed. proj.

Nurses

Nurses

Nurses


Problems of Native Americans (Indians/


Indian health problems

Migrant school h. eery.

Migrant school h. serv.

Influence of automobile

_pus

her

113

114

16S

111

11?

166

164

170

171

172

173

174

17S

171

/VAla

VIC3

ILIA

IIID

IIA2d

III)

IIA2

vIIE1

VIIE2

IX8

XIB

Ix,

XIC

III)

VIIB

IIIAlf

VIIE2

IA1

IIAlc

VII8

VIIC4

IIICld

IVA4

III81d

IXE

181

1182

IIIBla

IVA3

VB

VIIB

VIID

1182

11181d

Summary of all migrant prog.

Hospital merger

Essay on rural rbsearch process pragmatism

Family planning

Family planning

Recruitment of physicians

146

144

1S0

161

152

153

154

1SS

156.

167

156

169

110

162

Document

MAUI-Dumber

Subject

Cateoory


Document

Subject

112

IN

Access Numh2r

Cateoory


17?

113

IIA

IID

IIG

.IVA1

114

IIA

IVA2

IIG

VIC

115

11F2

IXA

IIIAle

Comprehensive social service planning

171

YES

Hig. h.

sere

IIIA2e

IXA

1%IIAld

1110

vEs

Hip h. sere

IID2d

IXA

11E2

161

VA

119

?IAlb

X IA

Male

112

ISupply

148

.IAla

IAlb

Nurse practitioner

Nurse practitioner

II

H. foci. supplies (mental and dental H. facil-

ities, ambulance, labs, nursing homes}

IAlc

Nurse practitioner

VIII

Pharmacy facilities - supply

144

IAla

Nurses, practical and registered

113

IIIA2e

IIAld

Supply of H. facilities

IXC

Occupational employees only

200

IA2a

Nursing shortages

1114

Male

IIA2b

Short term hospital - 20

VIA

201

Ida

111S

.IIB1

IC2a

II82

VD

Melt

202

IA1

1111

IVC2

IA?

VIIE2

IA3

1E2

117

IAla

IXE

naldistributior.

203

ICS

IIAlc


1111

1III,

XIB

181

IAla

Naturopaths

204

IIIA

IAlc

Naturopaths

VIA

1110

IIIES

Services

blind

20S

VAI

IIF3

Services - blind

IXA

141

IIC1

201

VIC

IXA

IXA

192

1164

20?

VII8

Drug abuse

IXD

Maldistribution of U.S.

Pop

.VIID3

CDC)

$011

CI°

Document

Subject

gssmusdikartauct

220

VE

221

IAla

IAlb

IAlc

IvC2

22e

IAla

IAlb

VIIC

223

Ws

IIC

ISA

224

VII8

VIID4

225

II61

me

MIA

22i

VIID2

VIID4

227

um*

VIID3

22$

VIII)?

VIID4

224

IIID

IXD

230

IAla

IA2a

IVC1

iime

DIA

231

II01

XI*

XIC

232

VIAL

VIA2

vIA3

VIC

%


Demon!

,mess Numb'''.

Subject

Catenary

:filditional_Descriotion

206

an

210

211

212

213

214

21S

IlL

II?

21$

214

220

IVA1.

IV8la

IIA

IIG1

1162

INS

IVA

VIIA

:IIIAB

III B

:A

IAla

IIIA2a

IIIA2c

VIA1

VIIC1

In

:IIIAC

11A1;1;

Ivc

VIA1

XE

IIAlc

IvAl

VIIDS

IIF2

VIA2

IA3a

IA3c

111:::

!ICS

IIG4

IVASe

Doctor shortages

Physicians

Helical). ambulance sow.

Helicop. ambulance sere.

Helicop. asbulancs serif.


Ratirecent community

Ratirmasnt community

Podiatrists

Podiatrists

Prehospital coronary care

PrehospitaLcoronary care

Local rural dev. prob.

8141411

Problems in researching inrural areas

Secumemt

iccess Number

Subject

citemory

Additioqp1 Discriotion

Document

Access Number

Subject

Cateoory


241

IAla

233

VIIA

IAlb

'JUDI

247

VIIA

VIID4

VIID1

IXE

Community organization and health

244

IIIAld

234

IVC3

Transfer payment to rural poor

IIID

VIA

241

IVASs

In the field h. services

235

IAla

IXA

IAlb

IX0

VIIB

2S0

IVA1

IXD

231

VIID4

vIIE2

2S1

IIIAlc

IXE

Rural school psychological services

252

IVA

1163

23?

III,

VIID2

253

III,

IZIAlb

234

IV81

IV83

IIIBlb

XIB

VIID2

231

VII8

VIID4

VIIC4a

2S4

IIE1

240

IIAlc

III,

IVASa

IIIA1

IIID

2SS

IIE1

VIA

III,

IVASa

241

IAla

IIAlc

251.

IIID

242

IAla

IVASa

IAlb

2S?

/81b

IIIAlb

2SS

IIG4

18

243

, IAla

IIII1b

11181c

244

VA1

2S4

IVAla

XIA

IVA1b

24S

IIAlc

VA1

IVC1

VA2

IVC2

bocusent Number

Subject

Catemoru

ktgitional Dlocriotjen

Illecuesnt

AssaujigiOer

Subject

Catemory

_Additiesal Descrintion

gecess

270

IAlb

264

VC1

IIIAlg

260

IAla

.IAlb

271

IAlb

IA2b

261

IIA

272

IIID

IIF

VIIE1

IIG1

273

VIA

IIG2

VIID3

1165

274

IIIAla

IVC1

VIID2

VA1

VIID4

VIIE1

275

IIAlc

Satellite h.

tic.

VIIE2

IIAld

Satellite h.

tact

362

VA

CD

III

VA

Satellite h.

Satellite h.

tic.

fee.

263

VIIB

IIID

CJj

VIIB

Satellite h.

fac.

XIA

IVA2

264

IIA

IVA 4

IIID

VB

265

VIIB

27?

IA

XIA

IIA2

266

IAla

VIID2

IA lb

271

IAlb

ID2a

VIIC

IIAlb

274

IIIAlc

IIAlc

VIID2

ro

IVBI

260

IIICle

VA1

XIB

XA

261

VA1

266

VC1

1101

IIIB1c

262

IIAld

Supply

IIID

IIBlc

Supply

264

IIH


IXA

VIE


263

IIAld

Supply

IIBld

Supply

Document

Subject

Access Number

Cateeory Additiohal

'ascription

243

IC1

IC2

244

IIA2e

IIID

XA

XB

45

IA1

VI/C1

246

IIIBla

XIS

24?

IAla

I8lb

IIAla

I/Alb

241

IES

VIID2

244

IVA2a

IVA2b

IVA 4

V/I8

300

IIE2b

IIFS

IVASb

301

181

11E1

Mental health

IIF

Vile

302

1E4

Indian h. aids

WAS,

Nutrition education

303

IAla

Supply

IA2a

Supply

IA3a

181a

IBOa

I83a

IC la

1

Document

Subject

Access Number

Cateoory Additional Description

283

264

265

216.

28?

288

269

240

291

IXA

IY81

xI8

IAla

IA2a

IA3a

IBla

I82a

183a

IC la

IC2a

IE

IIAld

Supply

IIA2d

Supply

IIA3d

Supply

IIB1d

Supply

II82d

Supply

IIA3d

Supply

IIE

Supply

IIAlc

IIA2c

VIIA

IX1

XIA

XIB

XIC

Systems approach applications

IAla

VA1

IA2a

Speech and hearing specialist

IA2b

Speech and hearing specialist

IAla

All personnel, planning policy

ICla

All personnel, planning policy

IIF3

IIF4

IIIAla

VIIB

5

Document

Accass Number

Subject

Cateaory

Additional Descrio:ion

Document

Accegg Number

Subject

Cateaory


303

304

30S

30b

307

308

304'

310

311

312

313

314

IC2a

IE

IIAld

IIA2d

IIA3d

IIBld

IIB2d

I183d

IIE

IIIBld

IIID

IIIAlg

IX8

IAlb

MAU

IvAla

VA

YIICId

IIG3

III)

IIF

IIIA2e

IIID

/Ab

VIII

IAla

IAlb

XIA

VA VC

VIID3

IXD

1181

1102

.

Supply

Supply

Supply

Supply

Supply

Supply

Supply

U. S. Public Health Service and Gillette Co.


Hospital

Phsylcian assistants

31S

316

317

3111

314

CD CD

fl

NI 320

321

IIIAlf

VIIE

VIASa

IXA

ID

IIID

IAla

IAlb

MAI&

IIIAlb

IIIC

III,

IIIE

VIA

VIIC

XIA

IAla

IA2a

IA 3a

IBla

182.

IB3a

ICla

IC2a

IE

IIAld

IIA2d

IIA3d

1181d

IIBP.d

IIB3d

IIE

81g. school h. pros'.

nig. school h. prog.

Post grad. ed.

Post grad. ed.

Family planning

Supply

Supply

Supply

Supply

Supply

Supply

Supply

I

assessment of rural health research. executive control data … · 2014. 1. 14. · rural health...

Documents