A Multidisciplinary Team Approach to the Care of Patients With Advanced Interstitial Lung Disease (ILD) in the Outpatient Setting

Abstract

SESSION TITLE: Diffuse Lung Disease Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: A significant number of patients with idiopathic pulomary fibrosis (IPF) are hospitalized during their disease course; hospitalizations from respiratory causes are associated with increased mortality. We examined the outcomes associated with our outpatient-based patient-centered multidisciplinary care model for advanced ILD, including looking at ER visits, hospitalizations, and in-hospital deaths. METHODS: A retrospective chart review was completed on patients with known advanced ILD who had undergone outpatient multidisciplinary assessment, either at an ILD clinic or in the community, and had individualized action plans for effective symptom management in place that were escalated based on patient needs. Data was collected on demographics, diagnosis, disease severity, periodic multidisciplinary assessments, symptom-based action plans (for dyspnea, cough, respiratory infections, etc) and advance care planning. Follow-up data was collected on subsequent ER visits, hospitalizations, and overall functional status. RESULTS: 12 Patients were reviewed; 10 had a diagnosis of IPF. Mean DLCO and supplemental oxygen requirements at latest assessments were 24% and 15L, respectively. All patients were seen by a multidisciplinary care team consisting of physicians, respiratory therapists, physiotherapists, occupational therapists, dieticians and nurses. All patients had home care, advance directives, and action plans in place. Mean follow-up period from initial assessment to death was 8 months (1-21 months). There were no presentations to ER and only 8 total admissions to hospital among 12 patients (mean of 0.67) following initial multidisciplinary assessments. 7 Patients were managed at home, 1 in hospice and 2 on palliative care wards in the days prior to death. One patient died in hospital; one patient is still alive. All patients were independent of their BADLs in the weeks prior to death or latest assessment. CONCLUSIONS: Implementation of an outpatient multidisciplinary care model for advanced ILD may lead to decreased acute care utilization, including ER visits and hospitalizations. Use of individualized, symptom-based action plans help patients maintain (better symptom control, independence, and the ability to live at home. CLINICAL IMPLICATIONS: Effective symptom management in ILD can decrease burden the on patients, families, and health care systems, minimizing the need for acute care hospitalization. This may have a significant positive impact on mortality in this patient population. DISCLOSURE: The following authors have nothing to disclose: Jean Du Plessis, Meena Kalluri, Janice Richman-Eisenstat No Product/Research Disclosure Information