Opportunities for collaboration between RESEP and BLCP clinics Cecile Rose, MD, MPH National Jewish Health Medical Director, Miners Clinic of Colorado September 2009

Types of coal mines

Underground longwall mining: high levels of respirable dust & freshly fractured particulates

BLCP (Black Lung) Clinics u Birmingham Health Care, Birmingham, AL u National Jewish Health, Denver, CO u Shawnee Health Services & Development, Carterville, IL u J.H. Stroger Hospital, Chicago, IL u Muhlenberg Community Hospital, Greenville, KY u Mountain Comprehensive Health Corporation, Whitesburg, KY u Miners’ Colfax Medical Center, Raton, NM u Ohio Department of Health, Columbus, OH

BLCP (Black Lung) Clinics u Centerville Clinics, Fredericktown, PA u Alveoli, Inc./Lungs at Work, McMurray, PA u Altoona Regional Health System, Altoona, PA u Regional Education & Community Health Services, LaFollette, TN u St. Charles Community Health Clinic, St. Charles, VA u West Virginia Department of Health, Charleston, WV u North Wyoming Community Action Program (NOWCAP), Worland, WY

RESEP (Radiation Exposure Screening and Education Program) Clinics u North Country HealthCare, Flagstaff, AZ u University of New Mexico Health Sciences Center, Albuquerque, NM u Northern Navajo Medical Center, Shiprock, NM u University of Nevada School of Medicine, Las Vegas, NV u Dixie Regional Medical Center, St. George, UT u Utah Navajo Health Systems, Montezuma Creek, UT u National Jewish Health, Denver, CO

Mission of BLCP and RESEP Clinics u To provide outstanding, efficient, convenient and cost effective clinical services – including surveillance, diagnosis, treatment, follow-up/referral and pulmonary rehabilitation. u To provide patient-centered benefits counseling and referral, education, support and prevention services to miners with lung and other health care needs.

Diseases affecting coal, metal and uranium miners u Coal Worker’s Pneumoconiosis u Emphysema/COPD/ industrial bronchitis u Silicosis u Pulmonary fibrosis u Cor pulmonale from lung disease u Noise-induced hearing loss

Silica-related health effects u Silicosis u Mycobacterial infection u Industrial bronchitis & COPD u Extrapulmonary diseases (autoimmune and renal) u Lung cancer u Pleural abnormalities

Diseases of RESEP patients (miners, millers, transporters, down-winders, site workers u Kidney cancer u Other chronic renal diseases u Leukemia and lymphomas u Multiple myelomas u Cancers of the thyroid, breast, esophagus, stomach, pharynx, small intestine, pancreas, bile ducts, gall bladder, salivary gland, urinary bladder, brain, colon, ovary or liver.

BLCP and RESEP Screening Clinical Services u Medical and occupational history u Physical exam u Spirometry u Chest x-ray with B-read u Audiometry u ABGS/oximetry u Education (smoking cessation, nutrition, etc.) u Benefits counseling u Results letter/referral u Follow-up/case management

Additional RESEP Clinical Services u Laboratory studies: CBC/metabolic panel/urinalysis u Fecal occult blood sample u Mammogram and gyne exams for females

MCC Diagnostic/Treatment Services u Complete histories and physical examinations u Body plethysmographic PFTs u Exercise physiology with arterial catheter u Methacholine challenge u HRCT u PET scan u Biopsy u Comprehensive therapy guided by diagnosis u Pulmonary rehabilitation u Appropriate physician referral

Medical management u Treatment of co-morbid diseases u Smoking cessation if needed u Supplemental oxygen (based on rest and exercise oximetry or ABGs) u Pulmonary rehabilitation u Bronchodilators (if airflow limitation present) u Antibiotic therapy for upper respiratory infections u Vaccination (Pneumovax, yearly influenza)

Managing patients with exposure-related disease u Removal from exposure –MSHA Part 90 status for working coal miner with CWP u Counseling/legal referral –Worker’s compensation – state-based –DOL Black Lung benefits (underground coal miners) –DOJ Radiation Exposure Screening and Education Programs (RESEP) – uranium miners u Impairment/disability assessment u Medical follow-up and assessment of disease progression/complications

Outreach efforts and overlap u Partnerships with local hospitals for yearly screening clinics and diagnostic referral –Pueblo, Craig and Montrose, CO –Page, Arizona –Wyoming u Collaborations and referral arrangements with sister clinics out west –Miners Colfax, Raton, NM –NOWCAP, Sheridan, WY u Coordinated pulmonary rehabilitation network

Shared outreach efforts u Press releases/newspaper articles u Radio u Letters/meetings –Union locals –Miners’ retiree groups –Previously screened miners –Primary care physicians u Fairs: –Health fairs –Mine rescue contests

Shared educational materials, political efforts and meetings u Annual fall meeting of the National Coalition of Black Lung and Respiratory Diseases Clinics u Monthly RESEP phone calls u Meetings on the “hill” u Communication with elected officials

Opportunities for Collaboration u Outreach –Assuring geographic accessibility and convenience –Cultural and linguistic competency u Benefits Counseling –Educating staff –Approaches to helping patients complete and submit DOL and RECA forms –Optimize reports for disability –Build support in non-DOL/DOJ legal arenas

Opportunities for Collaboration u Sister Clinic Collaborations –Joint outreach and marketing –Shared resources (e.g., brochures, questionnaires) –Cross clinic-staff education –Referral when appropriate u Pulmonary Rehabilitation –Increase efficiency, convenience, reimbursement –Group model –Statewide network and QA u Database management and CQI u Prevention Services

Other thoughts and ideas?