1. PFF Teal = 0+160+175 MAIN COLORS PFF Green = 120+162+47 Light Green = 193+216+47 Red = 242+102+73 HIGHLIGHT COLORS Light Grey = 220+220+210 Dark Grey = 100+98+76 Black = 0+0+0 CLINICAL CARE: MULTIDISCIPLINARY DIAGNOSIS SESSION LEADERS: CHARLENE D. FELL, MD, MSC MARVIN I. SCHWARZ, MD

2. PFF Teal = 0+160+175 MAIN COLORS PFF Green = 120+162+47 Light Green = 193+216+47 Red = 242+102+73 HIGHLIGHT COLORS Light Grey = 220+220+210 Dark Grey = 100+98+76 Black = 0+0+0 HOW TO ORGANIZE MDD IN THE REAL WORLD CHARLENE D. FELL, MD, MSC CLINICAL CARE: MULTIDISIPLINARY DIAGNOSIS NOVEMBER 14, 2015

3. How to organize an MDD in the real world Charlene D Fell Division of Respirology November 14, 2015

4. Disclosures  Research Grants  Roche (InterMune)  Scientific Advisory Board  Roche (InterMune)  Boehringer Ingelheim  Speaker’s Fees  Roche (InterMune)  Boehringer Ingelheim I have taken the appropriate steps to ensure that the use of third party material in this presentation falls under fair dealing or the educational exceptions in the Copyright Act (Canada).

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

6. http://cliparts.ca

7. How an ILD MDD Works http://cliparts.ca

8. Idiopathic Interstitial Pneumonia What is the Effect of a Muldisciplinary Approach to Diagnosis? Flaherty KR et al. AJRCCM 2004; 170:904-10 Interobserver agreement among all participants at step 5: κ = 0.88 (0.81, 0.94)

9. 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

10.  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?

11.  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

12.  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

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

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

15. MDD Case List Worksheet

16.  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

17. Thank you! cfell@ucalgary.ca