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

4. http://cliparts.ca

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

6. 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)

7. 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

8.  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?

9.  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

10.  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

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

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

13. MDD Case List Worksheet

14.  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

15. Thank you! cfell@ucalgary.ca