Opportunities for collaboration between RESEP and BLCP clinics

Cecile Rose, MD, MPHNational Jewish Health

Medical Director, Miners Clinic of ColoradoSeptember 2009

Types of coal mines

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

BLCP (Black Lung) Clinics Birmingham Health Care, Birmingham, AL National Jewish Health, Denver, CO Shawnee Health Services & Development,

Carterville, IL J.H. Stroger Hospital, Chicago, IL Muhlenberg Community Hospital, Greenville, KY Mountain Comprehensive Health Corporation,

Whitesburg, KY Miners’ Colfax Medical Center, Raton, NM Ohio Department of Health, Columbus, OH

BLCP (Black Lung) Clinics Centerville Clinics, Fredericktown, PA Alveoli, Inc./Lungs at Work, McMurray, PA Altoona Regional Health System, Altoona, PA Regional Education & Community Health Services,

LaFollette, TN St. Charles Community Health Clinic, St. Charles,

VA West Virginia Department of Health, Charleston,

WV North Wyoming Community Action Program

(NOWCAP), Worland, WY

RESEP (Radiation Exposure Screening and Education Program) Clinics

North Country HealthCare, Flagstaff, AZ University of New Mexico Health Sciences Center,

Albuquerque, NM Northern Navajo Medical Center, Shiprock, NM University of Nevada School of Medicine, Las

Vegas, NV Dixie Regional Medical Center, St. George, UT Utah Navajo Health Systems, Montezuma Creek, UT National Jewish Health, Denver, CO

Mission of BLCP and RESEP Clinics

To provide outstanding, efficient, convenient and cost effective clinical services – including surveillance, diagnosis, treatment, follow-up/referral and pulmonary rehabilitation.

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

Coal Worker’s Pneumoconiosis

Emphysema/COPD/ industrial bronchitis

Silicosis Pulmonary fibrosis Cor pulmonale from lung

disease Noise-induced hearing

loss

Silica-related health effectsSilica-related health effects Silicosis Mycobacterial infection Industrial bronchitis &

COPD Extrapulmonary diseases

(autoimmune and renal) Lung cancer Pleural abnormalities

Diseases of RESEP patients (miners, millers, transporters, down-winders, site workers

Kidney cancer Other chronic renal diseases Leukemia and lymphomas Multiple myelomas 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

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

Additional RESEP Clinical Services

Laboratory studies: CBC/metabolic panel/urinalysis

Fecal occult blood sample Mammogram and gyne exams for females

MCC Diagnostic/Treatment Services

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

Medical management

Treatment of co-morbid diseases Smoking cessation if needed Supplemental oxygen (based on rest and exercise

oximetry or ABGs) Pulmonary rehabilitation Bronchodilators (if airflow limitation present) Antibiotic therapy for upper respiratory infections Vaccination (Pneumovax, yearly influenza)

Managing patients with exposure-related disease

Removal from exposure– MSHA Part 90 status for working coal miner with CWP

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 Impairment/disability assessment Medical follow-up and assessment of disease

progression/complications

Outreach efforts and overlap

Partnerships with local hospitals for yearly screening clinics and diagnostic referral– Pueblo, Craig and Montrose, CO– Page, Arizona– Wyoming

Collaborations and referral arrangements with sister clinics out west– Miners Colfax, Raton, NM– NOWCAP, Sheridan, WY

Coordinated pulmonary rehabilitation network

Shared outreach efforts

Press releases/newspaper articles

Radio Letters/meetings

– Union locals– Miners’ retiree groups– Previously screened miners– Primary care physicians

Fairs:– Health fairs– Mine rescue contests

Shared educational materials, political efforts and meetings

Annual fall meeting of the National Coalition of Black Lung and Respiratory Diseases Clinics

Monthly RESEP phone calls

Meetings on the “hill” Communication with

elected officials

Opportunities for Collaboration

Outreach– Assuring geographic accessibility and convenience

– Cultural and linguistic competency

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 Sister Clinic Collaborations

– Joint outreach and marketing– Shared resources (e.g., brochures, questionnaires)– Cross clinic-staff education– Referral when appropriate

Pulmonary Rehabilitation– Increase efficiency, convenience, reimbursement– Group model– Statewide network and QA

Database management and CQI Prevention Services

Other thoughts and ideas?