National Jewish Health Rural Miners Outreach Clinics
Need: Early detection of health risks associated with mining in the Western region of the United States.
Intervention: The National Jewish Health Miners Clinic of Colorado developed two rural outreach programs that partner with local healthcare facilities to offer free medical screening for active and retired miners and historic uranium industry workers.
Results: Since beginning in 2003, these programs have served over 2,000 miners and historic uranium industry workers. Dust disease of the lungs have been detected on chest X-ray screenings in 16% of patients, abnormal breathing tests have been found in 24%, and other chronic conditions have been detected.
Because those in the mining industry are at risk from
exposure to silica dust and other hazards, early
detection and proactive care can help mitigate the
effects of serious respiratory diseases and other
illnesses. Using geological survey databases,
pulmonologists at National Jewish Health in Denver,
Colorado, identified locations in their service area
where miners live and work. Contacts were made with
outlying rural healthcare facilities, with the goal of
partnering for annual clinics to reach susceptible miners
and historic uranium industry workers who live in rural
Benefits counseling to working
and retired miners and uranium industry workers
The first of these Black Lung Clinics was offered in
2003. The RESEP Program began in 2009. Both programs are
funded by the Heath
Resources & Services Administration (HRSA) through
the federal Department of Health and Human Services.
Clinics are held annually at partnering facilities in
urban and rural locations in Colorado, Arizona, and
After individual findings from medical screenings have
been analyzed, the National Jewish Health Miners Clinic
team sends letters to participating miners, outlining
their results and providing recommendations for care and
follow up of any abnormalities. For results that require
urgent action, a phone call is made directly to the
miner. With written consent, the team contacts their
local healthcare providers to share results and
recommendations in order to facilitate care.
Over 2,000 miners have been screened since the
programs began, averaging around 400 miners annually.
Most of the miners are retired or disabled (63%), though
over 20% are currently mining and 17% are former miners
who are still working.
The vast majority (95%) of participants in the
medical screening programs have been referred for follow
up or to receive other services based on their clinic
findings. Some of the specific findings that prompted
referral, health education, and/or benefits counseling
366 (16%) have an abnormal chest X-ray showing
dust disease of the lung (pneumoconiosis).
114 (5%) had other chest X-ray abnormalities that
needed additional evaluation.
566 (24%) had abnormal lung values from
spirometry testing (breathing test).
1,636 (70%) had high blood pressure.
67 (3%) had low oximetry (oxygen percentage).
1,741 (75%) had chest symptoms such as shortness
of breath, cough, or wheezing that needed additional
243 (10%) received counseling for smoking
The commitment by local hospital partners to host a
yearly Black Lung or RESEP Clinic can be taxing. It
requires clinic space, typically for 2-4 days, and
radiology personnel to do chest X-rays for purchase and
interpretation by National Jewish Health. The Miners
Clinic of Colorado brings all other necessary equipment
and personnel to staff outreach clinics.
Obtaining high-quality, usable chest X-ray images to
determine the presence of a dust-related lung disease
takes experience and careful attention to detail.
A large urban healthcare system like National Jewish
Health approaching a rural healthcare facility and
offering to provide occupational lung disease services to
their community members could be seen as presumptuous.
Cultural sensitivity and awareness of unique community
strengths and needs are essential. Assuring communication
with local medical providers and facilitating local
follow-up of patients with screening abnormalities are
also essential to the program's success.
Even though the outreach clinics are located closer
to communities where miners live and work, participants
may still have to drive for several hours (sometimes in
poor weather conditions) to take advantage of these free
services. The Miners Clinic makes sure that each person
has an appointment and that the clinics are adequately
staffed so that miners don't have to wait long to
complete their evaluation.
The collaborative relationship between National Jewish
Health and rural facilities has been vital to the success
of the National Jewish Health Miners Clinic of Colorado
program. Below are some keys for a successful
relationship between a larger healthcare facility and
rural hospitals and clinics.
For a large healthcare system to operate programs
like these on a local level, planning and communication
ahead of time are key.
Reach out to rural partners
each time a clinic needs to be scheduled so the most
effective plan can be implemented.
Try to understand the community from a local
Develop processes to communicate with local
providers and patients so they know why these clinics
In addition to using traditional and social media
outreach strategies, work with the healthcare
facility to create advertisements and promote the
program through avenues specific to the local
Send letters to notify past participants about an
Running an outreach clinic is a big undertaking for
both the facility doing the outreach as well as the rural
facility. Allocate enough time for preparation, travel,
set up, evaluating miners, and providing health education
and benefits counseling.
Since every site is different, flexibility is key for
this kind of a partnership.
Be sure to make local referrals. If medical
assistance beyond the services offered by the local
facility is needed, then refer the patient to a larger
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.