PFF Teal = MAIN COLORS PFF Green = Light Green = Red = HIGHLIGHT COLORS Light Grey = Dark Grey = Black = CLINICAL CARE: MULTIDISCIPLINARY DIAGNOSIS SESSION LEADERS: CHARLENE D. FELL, MD, MSC MARVIN I. SCHWARZ, MD

PFF Teal = MAIN COLORS PFF Green = Light Green = Red = HIGHLIGHT COLORS Light Grey = Dark Grey = Black = HOW TO ORGANIZE MDD IN THE REAL WORLD CHARLENE D. FELL, MD, MSC CLINICAL CARE: MULTIDISIPLINARY DIAGNOSIS NOVEMBER 14, 2015

Outline  Why organize an MDD Rounds?  The key players  When, where, and how  Documentation

How an ILD MDD Works

Idiopathic Interstitial Pneumonia What is the Effect of a Muldisciplinary Approach to Diagnosis? Flaherty KR et al. AJRCCM 2004; 170: Interobserver agreement among all participants at step 5: κ = 0.88 (0.81, 0.94)

Why organize a MDD Rounds?  A MDD is considered the gold standard in establishing the diagnosis in ILD  Diagnostic accuracy is improved with a multidisciplinary diagnosis  Making the correct diagnosis is critical in order to:  Educate and prognosticate  Treat appropriately  Anticipate and screen for comorbidities  Enroll into clinical trials

 What kinds of cases will be discussed? — All new cases of ILD? — All new cases of IIP? — All patients suspected of having IPF? — All patients being screened for participation in a clinical trial?  Will you review patients not seen at your centre?

 Who should be involved? + Clinician + Thoracic Radiology + Pulmonary Pathology + ILD Clinic Nurse + Fellows and trainees ± Rheumatology ± Thoracic Surgery  Chair (“Champion”) Organize rounds Take notes Timekeeper

 Radiology  Paul Burrowes  John Henry MacGregor  Tracy Elliot  Andy Lee  Carmen Lydell  Michael Bristow  Pathology  Margaret Kelly  Francis Green  Rheumatology  Sharon LeClercq  ILD Clinic RN  Kirk Mathison

 When? — Regularly scheduled  Where? — Projector and screen — Access to diagnostic imaging software — Access to projection microscope — Access to telehealth

 A mechanism to get the case list and pertinent clinical information to the MDD team.

MDD Case List Worksheet

 Documenting the Outcome of the MDD — Structured MDD note:  List of participants  Clinical question and DDx  Key radiographic features and DDx  Key pathologic features and DDx  Consensus Diagnosis and recommendations  Compensation  Evolution of your MDD

Thank you!