For questions or additional information contact: ronan@uab.edu

{slide=Introduction}

• The 2011 ATS/ERS/JRS/ALAT guidelines list a number of recommendations for the diagnosis and clinical management of patients with IPF
• The level of understanding and adherence to the guidelines among non-academic practicing pulmonologists is limited
• The UAB “bundle of care” identifies specific measures drawn from the 2011 guidelines to help address this gap
• This project sought to address the practice gaps and barriers to optimal management of patients with IPF through:
  • Identifying specific education needs through nominal groups,
  • developing education based on those needs, and
  • measuring specific practice change, based on the UAB bundle of care, following completion of the education activity

{/slide}

{slide=Objectives & Methods}
Objectives

• Increase delivery of evidence-based care in accordance with expert guideline recommendations at the physician, team, and practice level
• Communicate best practices in the management of patients with IPF that allows physicians to compare their own clinical performance with expert guidelines
• Increase the percentage of patients with IPF appropriately managed and monitored, based on the expert guideline recommendations

Methods

• Community pulmonologists provide perspective on central question.
• baseline data related to bundle-of-care measures collected
• Pulmonologists complete an education intervention and post-test that addressed the issues prioritized by the nominal groups
• A follow-up visit compare pre- and post-intervention performance on the bundle-of-care measures

{/slide}

{slide=Process/Results}
Physician provided and discussed responses to this question:

From your perspective, as a clinician, what are the barriers to achieving optimal care of patients with IPF?

Group Session	# Participants	# Items	# Items Ranked	In-session Votes	Weighted Votes
Group #1	6	20	16	30	90
Group #2	6	15	13	30	90
Group #3	3	15	9	15	45
Total	15	50	38	75	225

• All participants contribute responses to the question
• Responses captured verbatim
• Process continues until group feels all significant ideas are captured
• Each participant selects and ranks five of the items contributed
• Group reviews and evaluates results
• 3 raters identified most critical themes, actionable themes incorporated into education content

{/slide}

{slide=Process/Results, continued}
Actionable themes: Improve physician basic knowledge; Reduce barriers to diagnosis; improve physician-physician and physician-patient communication

• Top 5 Score Identifies items that the groups feel most strongly about
• Number Score How often participants refer to a theme or issue
• Average Score Standardizes the score for each theme

{/slide}

{slide=Conclusions}
Nominal Groups Key Findings:

• Diagnosis of IPF: Need for earlier inclusion of IPF in the differential diagnosis of a patient presenting with dyspnea, cough, and crackles in lung auscultation
• include appropriate protocol for performing and interpreting HRCT
• Diagnosis of IPF: Information on when to consider a surgical lung biopsy
• Management of IPF: Symptom management, including control of cough, referral to palliative care and rehabilitation
• Management of IPF: When to consider anti-fibrotic therapy with nintendanib or pirfenidone; how to monitor for safety/adverse events, when to stop/switch therapies

Post-Intervention Performance

• Increased percentage of eligible patients who were treated with pirfenidone or nintedanib (20% at baseline and 46% at follow up)
• Increased percentage of patients who had routine clinic visits with PFTs at least once within the past 6 months (40% at baseline and 64% at follow up)
• Increased percentage of patients who were monitored for exercise-induced hypoxemia with a 6MWT or equivalent at least once in the past 6 months (7% at baseline, and 36% at follow up)
  {/slide}