Description

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 areas.

Under the umbrella of the National Jewish Health Miners Clinic of Colorado, 2 rural outreach clinic programs were established. The Black Lung Clinic Program is focused on miners at risk from dust exposure during coal, metal, and stone mining and drilling. The Radiation Exposure Screening and Education Program (RESEP) Clinic provides services for Cold War era uranium miners, millers, and ore transporters who were exposed to hazardous radiation and dust before 1972. Both programs offer free medical screenings including:

• An exam with a medical provider
• A simple breathing test
• A chest X-ray
• Health education
• Case management
• Referral to local medical providers
• 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 Wyoming.

Rural sites include:

• Memorial Regional Health, Craig, Colorado
• Montrose Memorial Hospital, Montrose, Colorado
• Canyonlands Healthcare, Page, Arizona

Urban sites include:

• Parkview Medical Center, Pueblo, Colorado
• Banner Wyoming Medical Center, Casper, Wyoming

Services offered

Eligible miners are screened at the rural outreach clinics in order to detect respiratory and other diseases. All participants complete the following:

• Medical and occupational history questionnaire
• Physical exam
• Spirometry (simple breathing test)
• Chest X-ray with B-reading (to detect lung abnormalities caused by mine dust inhalation)
• Oximetry (oxygen percentage in blood)

Additional services are provided as needed:

• Blood gas testing (for RESEP Clinic participants with other abnormalities)
• Brief social service needs assessment (including mental health and food insecurity)
• Health education (smoking cessation, nutrition, exercise)
• Case management to connect patients to local medical services
• Referrals to and communication with local providers
• Referral for more in-depth evaluation in the occupational lung disease clinic at National Jewish Health
• For those who are eligible, benefits counseling and assistance with filing claims through the Department of Labor as part of the Black Lung Benefits Act or the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) and through the Department of Justice as part of the Radiation Exposure Compensation Act (RECA)

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.

Results

• 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 include:
  • 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 evaluation.
  • 243 (10%) received counseling for smoking cessation.

Challenges

• 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.

Replication

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 perspective.
  • Develop processes to communicate with local providers and patients so they know why these clinics are important.
  • 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 population.
  • Send letters to notify past participants about an upcoming clinic.
• 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 healthcare system.

Contact Information

Dymond Ruybal, Program Coordinator
National Jewish Health's Miners Clinic of Colorado
877.255.5864
ruybald@njhealth.org