Opportunities for collaboration between RESEP and BLCP clinics

1
Opportunities for collaboration between RESEP and
BLCP clinics

• Cecile Rose, MD, MPH
• National Jewish Health
• Medical Director, Miners Clinic of Colorado
• September 2009

2
(No Transcript)
3
Types of coal mines
4
Underground longwall mining high levels of
respirable dust freshly fractured particulates
5
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

6
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

7
(No Transcript)
8
(No Transcript)
9
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

10
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.

11
Diseases affecting coal, metal and uranium miners

• Coal Workers Pneumoconiosis
• Emphysema/COPD/ industrial bronchitis
• Silicosis
• Pulmonary fibrosis
• Cor pulmonale from lung disease
• Noise-induced hearing loss

12
Silica-related health effects

• Silicosis
• Mycobacterial infection
• Industrial bronchitis COPD
• Extrapulmonary diseases (autoimmune and renal)
• Lung cancer
• Pleural abnormalities

13
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.

14
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

15
Additional RESEP Clinical Services

• Laboratory studies CBC/metabolic
  panel/urinalysis
• Fecal occult blood sample
• Mammogram and gyne exams for females

16
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

17
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)

18
Managing patients with exposure-related disease

• Removal from exposure
• MSHA Part 90 status for working coal miner with
  CWP
• Counseling/legal referral
• Workers 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

19
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

20
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

21
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

22
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

23
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

24
Other thoughts and ideas?