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


  • 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



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



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?
ngt process

 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




Actionable themes: Improve physician basic knowledge; Reduce barriers to diagnosis; improve physician-physician and physician-patient communication

ngt results1 ipf

ngt results2 ipf
ngt results3 ipf
  • 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


results



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)