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

3. Types of coal mines

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

5. 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

6. 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

9. 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

10. 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.

11. 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

12. 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

13. 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.

14. 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

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

16. 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

17. 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)

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Other thoughts and ideas?