Rural Health Care Services Outreach Grant Program - Project Track: Special Track; Focus Area: Chronic Lower Respiratory Disease Target Population: Current and retired miners from Navajo Nation. Our secondary target population includes health care providers who serve miners on Navajo Nation. Proposed Rural Service Area: Navajo Nation sections of Utah, Arizona and New Mexico. Navajo Nation miners live in rural, underserved communities with limited access to health care and are disproportionately affected by chronic lower respiratory diseases. To address this disparity, we propose to expand delivery of our three-step mobile health care model to the Navajo Nation. Our model includes (i) comprehensive mobile screening services; (ii) telemedicine and telementoring for miners and providers, respectively; and (iii) mobile Miners’ Impairment Examinations (MINE). Our project goal is to improve access to comprehensive health services for Indigenous miners. Our long-term goal is to create strong, sustainable local resources and capacity for improving miner health outcomes. Our project has three objectives. The first objective is to determine portability of our New Mexico-based mobile health care screening model to the Navajo Nation. Mobile screening will be supplemented by telemedicine. Health outcomes will be compared between miners served on the Navajo Nation vs. those served in NM outside of the Navajo Nation. Data garnered will aid in establishing the generalizability of the model to other Indigenous, mining-intense regions of the country. The second objective is to compare the effectiveness of a mobile MINE clinic on the Navajo Nation to the fixed MINE clinic in NM outside of the Navajo Nation, thus establishing the evidence base for using mobile MINE services in Indigenous mining communities. The third objective is to assess telementoring-related improvement in Navajo Nation provider competencies. We will incorporate our currently utilized, evidence-based screening and comprehensive care model as well as emerging trends in mobile health care. The expected project outcomes include Performance Improvement Measurement System (PIMS) measures, as well as patient and provider project measures. For patients, the specific measures are the index of new chronic conditions detected and patient satisfaction. For providers, the specific measures include satisfaction, self-efficacy, and competency related to telemedicine services. Our regional partnership titled "Southwest Mining Health Center of Excellence" consists of four consortium members; three existing and one new member. The existing members are the Miners’ Colfax Medical Center (an RHC), the University of New Mexico (an Academic Health Center), and the Northwest Community Action Program (a rural community action partner). Canyonlands Healthcare (an RHC) is the new member. 75% of consortium members are located in a HRSA-designated rural area. Consortium members were selected based on their history of serving rural underserved populations including providing health care to rural miners within the Navajo Nation. The NM mobile screening clinic was recognized as an innovative model by the Rural Health Information Hub in 2016 and our Mining Advisory Council and Miners’ Wellness ECHO Program were separately recognized by HRSA. We have expanded the clinic to include innovative satellite-based telehealth and mobile MINE services to increase service capacity. Funding Preference: MCMC, a NM State facility, is requesting a funding preference based on qualification for designated HPSA status (HPSA ID 1351820837, See Attachment 11).
