Abstract
Background
The gold standard for interstitial lung disease (ILD) diagnosis is multidisciplinary discussion (MDD); however, access is often limited by geographic barriers, time constraints, and the number of centers with ILD expertise.
Objective
To assess the educational and clinical impact of a novel videoconferencing MDD program for the diagnosis and management of ILD.
Methods
We performed a retrospective observational study of the Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely (MILDDER) program, a videoconferencing MDD platform initiated by the Toronto General Hospital in Toronto, Canada. We used anonymized survey data from attendees (trainees and practicing physicians) and referring physicians who attended MILDDER between 2018 and 2023. Self-reported ILD confidence before and after MILDDER participation and general program satisfaction were assessed using a 10-point Likert scale. ILD confidence questions were stratified by clinical practice experience. Wilcoxon signed-rank testing for paired data was used to determine statistical significance in the subgroup that completed a MILDDER semester (bimonthly sessions for 6 mo). Written survey responses were assessed qualitatively and grouped by theme. Clinical outcomes, including patient characteristics, new or changed ILD diagnoses, new investigations requests, and new treatment suggestions, were assessed.
Results
Three hundred seventeen attendees and referring physicians completed pre-MILDDER questionnaires. Overall, they reported low confidence in their ability to diagnose and manage ILD. After they attended a MILDDER semester ILD, their confidence increased by a median of 3 to 4 points in the overall group. Among respondents with ⩾5 years of clinical practice experience, there was no change in ILD diagnostic confidence after MILDDER; however, management confidence increased by a median of 2 points. A statistically significant increase in all areas of ILD confidence assessed was noted in the subgroup of 70 participants with complete pre- and post-MILDDER semester surveys. Respondents were generally very satisfied with MILDDER. New or changed ILD diagnoses occurred in 86 (50.6%) presented cases, new investigation requests occurred in 40 (22.7%) cases, and new medications were recommended for 30 (17%) cases.
Conclusion
Videoconferencing MDD platforms such as MILDDER are feasible and can be used as a tool for physician education and remote management of ILD.
Keywords: interstitial lung disease (ILD), multidisciplinary discussion (MDD), telemedicine, education
The diagnosis and management of interstitial lung disease (ILD) is a complex and rapidly evolving field that can be perceived as difficult, even for experienced clinicians (1). Despite this, pulmonary trainees report limited clinical exposure to ILD (2, 3), and pulmonary fellows nearing graduation are significantly less confident in their ability to manage ILD than other more common pulmonary diseases (3).
The current gold standard for ILD diagnosis is a multidisciplinary discussion (MDD) involving, at minimum, a respirologist, a radiologist, and a pathologist with expertise in ILD (4–6). The goal of MDDs is to establish a confident ILD diagnosis and management plan. Although the exact modus operandi can vary, face-to-face or voice-to-voice MDDs are preferred (4). MDDs have been shown to improve diagnostic accuracy compared with diagnoses made independently (7); however, their access is often limited by geographic barriers, time constraints, and the limited number of centers with ILD expertise (5, 8).
Although virtual MDDs have the potential to mitigate some of the barriers of in-person MDDs, to date, very few studies have investigated their potential role. Grewal and colleagues previously reported that remote MDDs of external patients were feasible and that most referring physicians were satisfied with the service (9). However, this group used an in absentia patient review format (where no member of the MDD team has physically assessed the patient), which may be suboptimal for diagnostic thoroughness and comprehensive management of ILD (10).
The general objective of this study was to assess the educational and clinical impact of a novel videoconferencing MDD program for the diagnosis and management of ILD. We hypothesized that the videoconferencing MDD program would improve self-reported attendee (trainees and practicing physicians) and referring physician ILD confidence, that participants would be satisfied with the program, that videoconferencing MDDs would be feasible, and that case-related clinical outcomes would be similar to those previously described for in-person MDDs.
Methods
The MILDDER Program
The Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely (MILDDER) program is a videoconferencing MDD that occurs twice per month with a panel of two ILD trained respirologists, a chest radiologist, and a lung pathologist with expertise in ILD from the Toronto General Hospital (TGH). Physicians referring a patient to the TGH ILD clinic are offered this service in place of an in-person assessment. Our group believes that MILDDER is a reasonable alternative for diagnosis and management of ILD when in-person consultation is not possible because of geographic or time constraints. Referring physicians participate in the MDD remotely while their patient is being discussed. Each MDD session is 1 hour in duration and includes the review of two patient cases as well as 20 minutes of continued medical education accredited teaching on various ILD topics delivered by one of the two academic ILD respirologists on the planning committee (see Table E1 in the data supplement). Other trainees and physicians in the province can also join the sessions remotely for educational purposes. When individuals register to attend a MILDDER session, they are also invited to attend a full “semester” of MILDDER, which consists of a 1-hour session every 2 weeks for 6 months (12 sessions or 12 h total). MILDDER uses the Adobe Connect platform, which allows both written and verbal interactions between attendees and presenters, all while the patient’s case is being presented (Figure E1). The general objectives of the MILDDER program are to provide ILD-related education to trainees, community respirologists, and radiologists and to improve patient access to MDD by providing remote assessments. The MILDDER program is endorsed by the Ontario Lung Association and the Canadian Pulmonary Fibrosis Foundation.
Study Design and Population
This retrospective observational study used anonymized survey data collected through the MILDDER platform. All attendees (trainees and practicing physicians) and referring physicians who remotely joined a MILDDER session between December 8, 2018, and October 19, 2023, and who completed a pre-MILDDER questionnaire (Figure E2) were eligible for inclusion. A subgroup of these participants completed a full 6-month MILDDER semester and were identified by the presence of a completed a post-MILDDER semester survey (Figure E3). Each patient case presented at these sessions was also eligible for inclusion. When attendees or referring physicians filled multiple questionnaires during the study period, only the first pre- and/or postsurvey was included. Referring physicians, attendees, and patient cases with incomplete questionnaires were excluded. This study was approved by the TGH Research Ethics Board (REB 24-5027).
Survey Data
MILDDER participants are prompted to complete a pre-MILDDER questionnaire (Figure E2) upon registering for MILDDER. They are also prompted to complete a post-MILDDER semester survey (Figure E3) at the end of a semester. Session attendance is monitored via the MILDDER platform. Only participants who attend all 12 sessions in a given semester are prompted to complete the post-MILLDER semester questionnaire. Referring physicians are prompted to complete pre- (Figure E4) and postquestionnaires (Figure E5) for the patient cases they refer. All questionnaires were designed by the MILDDER planning committee, and β-testing and usability were assessed by the committee. The MILDDER planning committee consists of two academic ILD respirologists (one with education training and one with research training), one rheumatologist, one radiologist, and one community respirologist (all with expertise in ILD). The two academic respirologists designed the initial questionnaires, which were then assessed by the rest of the committee, and any suggested changes were implemented through an iterative process until consensus was achieved. The questionnaires are stored in a secure database within the MILDDER platform and anonymized (deidentified and coded) before viewing.
Pre- and post-MILDDER semester questionnaires (Figures E2 and E3) contain demographic data, questions regarding the attendee’s self-evaluated confidence with diagnosis and management of ILD, and questions regarding the attendee’s satisfaction with the MILDDER program. Pre- and post-MILDDER case questionnaires (Figures E4 and E5) contain information on the presented patient’s ILD diagnosis, investigations, imaging findings, and treatments. Questions are answered using either a 10-point Likert scale (where 1 is “strongly disagree” and 10 is “strongly agree”) or written responses.
Outcomes
The primary outcomes of this study were attendees’ (trainees’ and practicing physicians’) and referring physicians’ ILD confidence before and after participation in the MILDDER program, as well as general satisfaction with the videoconferencing MDD program. The feasibility of a videoconferencing MDD platform as a tool for physician education and diagnosis and management of ILD, as well as ILD case-related clinical outcomes, were secondarily assessed. ILD case-related clinical outcomes included baseline patient characteristics and the proportion of new or changed ILD diagnoses, new investigations requests, and new treatment suggestions post-MILDDER.
Statistical Analysis
Demographic data was described using means (standard deviations [SDs]) and medians (interquartile ranges [IQRs]), as appropriate, for numerical variables and counts (percents) for categorical variables. Pre- and post-MILDDER ILD confidence was assessed by comparing median (IQR) or mean (SD) 10-point Likert scale responses to the questionnaire’s “ILD confidence questions” before and after a 6-month MILDDER semester, as appropriate. Relevant ILD confidence questions were stratified by the respondent’s number of years of clinical practice experience (<5 yr and ⩾5 yr). A 5-year cutoff was chosen because most residency trainee programs in Canada are 2–5 years in duration, thus allowing differentiation between trainees and practicing physicians. Wilcoxon signed-rank testing for paired data with a significance level of 0.05 and a one-tailed hypothesis was performed on the subgroup of participants with complete pre- and post-MILDDER semester surveys to test our hypothesis that completing a MILDDER semester would improve ILD diagnosis and management confidence. General satisfaction with the videoconferencing MDD platform was assessed by median (IQR) or mean (SD) 10-point Likert scale responses to the questionnaires “General satisfaction questions,” as appropriate. Written responses from the questionnaires relating to both ILD confidence and general satisfaction were assessed qualitatively by thematic analysis by a respirologist with additional training in ILD (S.P.). Case-related clinical outcomes were described using counts (percents) and means (SDs).
Results
Attendee and Referring Physician Demographics
Four hundred three trainees, practicing physicians, and referring physicians registered for a MILDDER session during the study period. Most (81%) were based in Toronto, Ontario, Canada, or in the Greater Toronto area (population 6.2 million [11]). Most were respirologists (58%), followed by radiologists (11%) and family physicians (1%). Thirty percent of respondents did not disclose their specialty or identified it as “other.” The average age of MILDDER registrants was 32.7 ± 8.4 years old, and 39.8% identified as female. Registrants had a range of 0 to 48 years of clinical practice experience (median of 1 [IQR, 2] yr) and saw a median of 2 (IQR, 6) ILD cases each month.
Attendee and Referring Physician ILD Confidence
Pre-MILDDER questionnaires were completed by 317 attendees and referring physicians, and the results are presented in Table 1. In general, respondents had low confidence with diagnosis and management of ILD before attending MILDDER. Respondents with less than 5 years of clinical practice experience self-reported lower baseline ILD knowledge than those with 5 years of practice experience or more. When asked the question, “Describe the biggest challenges you face with your ILD patients,” 112 (51.1%) respondents reported insufficient knowledge base, 37 (16.9%) reported lack of exposure to ILD cases, 26 (11.9%) reported difficulty identifying imaging patterns, and 25 (11.4%) reported low confidence with ILD diagnosis and management as the most frequent challenges. Access to radiologists and/or pathologists with ILD expertise was also identified as a barrier by 28 (12.8%) respondents.
Table 1.
Pre-MILDDER semester interstitial lung disease confidence questions
| Pre-MILDDER | |
|---|---|
| (N = 317) | |
| Question 1, median (IQR) I feel confident making a diagnosis of ILD in the majority of patients without referral to an ILD center or the MILDDER program. | |
| Overall | 4 (4) |
| <5 yr of clinical practice experience | 2 (4) |
| ⩾5 yr of clinical practice experience | 7 (3) |
| Question 2, median (IQR) I have access to the required radiology expertise at my center to allow me to confidently determine if a patient has a UIP pattern on a high-resolution CT scan of the chest. | |
| Overall | 7 (5) |
| Question 3, median (IQR) I have access to the required pathology expertise at my center to allow me to confidently determine if a patient has a UIP pattern on a surgical lung biopsy. | |
| Overall | 5 (6) |
| Question 4, median (IQR) I feel confident treating patients with IPF once I have made the diagnosis. | |
| Overall | 4 (5) |
| <5 yr of clinical practice experience | 3 (4) |
| ⩾5 yr of clinical practice experience | 7 (4) |
| Question 5, median (IQR) I feel confident treating patients with non-IPF ILD once I have made the diagnosis. | |
| Overall | 4 (5) |
| <5 yr of clinical practice experience | 3 (4) |
| ⩾5 yr of clinical practice experience | 6 (4) |
Definitions of abbreviations: CT = computed tomography; ILD = interstitial lung disease; IPF = idiopathic pulmonary fibrosis; IQR = interquartile range; MILDDER = Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely; N/A = not applicable; UIP = usual interstitial pneumonia.
Data are presented as median (IQR) 10-point Likert scale responses and are stratified by number of years of clinical practice experience.
Seventy attendees and referring physicians attended bimonthly MILDDER sessions for 6 months (completed a semester) and completed the post-MILDDER ILD knowledge questionnaire. The overall median 10-point Likert scale responses to all questions about confidence with diagnosis and management of ILD increased by 3 to 4 points after attending a MILDDER semester. For respondents with 5 or more years of clinical practice experience, ILD diagnosis confidence did not increase after MILDDER, but ILD management confidence did. When asked, “Describe how MILDDER has helped address the challenges you face with your ILD patients,” 22 (44%) responded that access to MDD was appreciated, 14 (28%) responded that MILDDER allowed them to review ILD topics and recent studies in the field, and 7 (14%) responded that MILDDER increased their confidence in diagnosis of ILD.
A subgroup analysis of the 70 participants with linked pre- and post-MILDDER semester surveys is presented in Table 2. A statistically significant increase in ILD diagnostic and management confidence (for both idiopathic pulmonary fibrosis [IPF] and non-IPF ILD) was noted after attending a MILDDER semester. Although the median Likert scale response for question 4 remained the same pre- and post-MILDDER semester, the IQR was smaller, which reflects increased confidence.
Table 2.
Subgroup analysis of participants with complete pre- and post-MILDDER semester surveys
| Pre-MILDDER (n = 70) |
Post-MILDDER (n = 70) |
P Value | |
|---|---|---|---|
| Question 1, median (IQR) I feel confident making a diagnosis of ILD in the majority of patients without referral to an ILD center or the MILDDER program. | |||
| Overall | 6 (2) | 7 (3) | <0.001 |
| Question 4, median (IQR) I feel confident treating patients with IPF once I have made the diagnosis. | |||
| Overall | 8 (4) | 8 (2) | 0.002 |
| Question 5, median (IQR) I feel confident treating patients with non-IPF ILD once I have made the diagnosis. | |||
| Overall | 5 (4) | 7 (3) | <0.001 |
Definitions of abbreviations: ILD = interstitial lung disease; IPF = idiopathic pulmonary fibrosis; IQR = interquartile range; MILDDER = Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely.
Data are presented as median (IQR) 10-point Likert scale responses. Wilcoxon signed-rank testing with a significance level of 0.05 and a one-tailed hypothesis was performed to determine statistical significance (P < 0.05).
Satisfaction with the Videoconferencing MDD Program
Post-MILDDER satisfaction questionnaire results are presented in Table 3. Overall, attendees and referring physicians were very satisfied with the MILDDER program. After completing their first semester, all 70 respondents enrolled in a new MILDDER semester. Referring physicians were also highly satisfied with the program, with a median satisfaction score of 10 out of 10 (IQR, 1).
Table 3.
Satisfaction with MILDDER questions
| Median (IQR) 10-Point Likert Scale Responses (n = 69) |
|
|---|---|
| Question 1, median (IQR) MILDDER has met the stated learning objectives. |
10 (1) |
| Question 2, median (IQR) MILDDER has satisfied my expectations. |
10 (1) |
| Question 3, median (IQR) MILDDER has conveyed information that will change how I care for my patients. |
9 (3) |
| Question 4, median (IQR) MILDDER was free of commercial bias. |
10 (0) |
| Question 5, median (IQR) MILDDER conveyed information that applied to my practice. |
10 (1) |
Definition of abbreviations: IQR = interquartile range; MILDDER = Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely.
Data are presented as median (IQR) 10-point Likert scale responses.
ILD Cases
Two hundred two ILD cases were presented at MILDDER during the study period. Fifty-six percent of patients presented were male, and patient age ranged from 19 to 90 years old. A description of the pre-MILDDER working diagnoses, as well as baseline investigations and treatments, is presented in Table 4. Before MDD, referring physicians’ confidence in the working diagnosis was low, with a mean 10-point Likert scale response of 5.1 ± 1.1/10.
Table 4.
Pre- and post-MILDDER session interstitial lung disease diagnoses, investigations, and treatments
| Pre-MILDDER (n = 202) |
Post-MILDDER (n = 176) |
|
|---|---|---|
| Working diagnosis | ||
| IPF | 45 (22.3%) | 42 (23.9%) |
| Non-IPF | 157 (77.7%) | 125 (71%) |
| Not ILD | 0 (0%) | 9 (5.1%) |
| Non-IPF diagnoses | ||
| Unclassifiable ILD | 74 (36.6%) | 72 (40.9%) |
| HP | 22 (10.9%) | 24 (13.6%) |
| CTD-ILD | 12 (5.9%) | 10 (5.7%) |
| NSIP | 10 (5%) | 1 (0.6%) |
| IPAF | 7 (3.5%) | 7 (4%) |
| Other | 32 (15.8%) | 11 (6.3%) |
| Confidence in ILD diagnosis | ||
| 10-point Likert scale response, mean (SD) | 5.1/10 (1.1) | 7.5/10 (1.7) |
| Investigations performed to date include: | ||
| Autoimmune serologies | 166 (82.2%) | — |
| Bronchoscopy/BAL | 25 (12.4%) | — |
| Lung biopsy | 30 (14.9%) | — |
| Lung transplant assessment | 0 (0%) | — |
| Current ILD treatment includes: | ||
| Antifibrotics (pirfenidone or nintedanib) | 20 (9.9%) | — |
| Prednisone | 34 (16.8%) | — |
| Mycophenolate | 26 (12.9%) | — |
| Azathioprine | 0 (0%) | — |
| Rituximab | 3 (1.5%) | — |
| Cyclophosphamide | 0 (0%) | — |
| None | 136 (67.3%) | — |
Definition of abbreviations: BAL = bronchoalveolar lavage; CTD = connective tissue disease; HP = hypersensitivity pneumonitis; ILD = interstitial lung disease; IPAF = interstitial pneumonia with autoimmune features; IPF = idiopathic pulmonary fibrosis; MILDDER = Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely; NSIP = nonspecific interstitial pneumonia.
When not specified, data are presented as counts (percents).
Post-MILDDER ILD diagnoses are presented in Table 4. The distribution of IPF versus non-IPF diagnoses remained similar post-MILDDER (see Figure 1). Interestingly, MDD identified nine patients with non-ILD diagnoses such as pulmonary edema, aspiration, infection, or emphysema. Referring physicians’ confidence in the ILD diagnosis increased post-MILDDER, with the mean 10-point Likert scale response going from 5.1 ± 1.1/10 to 7.5 ± 1.7/10.
Figure 1.
Pre- and post-MILDDER ILD diagnoses. Color key: light blue = IPF; light green = unclassifiable ILD; orange = HP; pink = CTD-ILD; dark green = NSIP; dark blue = IPAF; red = other; gray = not ILD. CTD = connective tissue disease; HP = hypersensitivity pneumonitis; ILD = interstitial lung disease; IPAF = interstitial pneumonia with autoimmune features; IPF = idiopathic pulmonary fibrosis; MILDDER = Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely; NSIP = nonspecific interstitial pneumonia.
Of the 170 patients with complete pre- and post-MILDDER case presentation data, 86 (50.6%) had a new or changed ILD diagnosis after MILDDER. Out of the 176 patients with post-MILDDER data available, 40 (22.7%) patients had new investigations recommended, including 11 lung biopsies (surgical lung biopsy, transthoracic lung biopsy, or lung cryobiopsy). New medications were recommended for 30 (17%) patients, and discontinuation of medications was recommended for 15 (8.5%) patients.
Discussion
The MILDDER program is a novel videoconferencing MDD platform with integrated continued medical education accredited learning on various ILD topics. The present study found that MILDDER improved attendees’ and referring physicians’ ILD confidence and was highly ranked in terms of satisfaction. Half of the patient cases presented at MILDDER had a change in ILD diagnosis, and many suggestions to complete additional investigations or consider alternative treatments were made. These findings suggests that videoconferencing MDD platforms are feasible and can act as a tool for physician and learner education in addition to patient care.
Before attending MILDDER, attendees and referring physicians, most of whom were in early career, reported an insufficient knowledge base as the most significant challenge they face when caring for patients with ILD. They also self-reported low confidence with the diagnosis and management of both IPF and non-IPF ILDs. ILD is a complex and rapidly evolving field, and limited formal ILD training in respirology residency programs (2, 3) may contribute to physicians’ feeling of inexperience. Interestingly, patients with ILD also frequently report a lack of ILD awareness among their care teams (1, 12). These knowledge gaps are of concern and contribute to the frequent diagnostic delays (1), inappropriate use of diagnostic tests such as surgical lung biopsy (13), and inappropriate treatments (13) observed in patients with ILD. In our study, after attending a MILDDER semester, attendees self-reported more confidence in diagnosing and managing ILD. In the subgroup of participants with linked pre- and post-MILLDER survey data, the reported increase in confidence was statistically significant. Participants appreciated the opportunity to review ILD topics and recent studies in the field. Previous reports have shown that education outreach programs can improve physician ILD knowledge (14); however, the present study suggests that videoconferencing MDD platforms can also facilitate knowledge dissemination and physician education.
MILDDER attendees and referring physicians were very satisfied with the program and identified improved access to MDD as a key strength. Although in-person MDDs are the current gold standard for ILD diagnosis (4–6), with increasing regionalization of health care and a push to refer complex ILD cases to expert centers, access to in-person MDD can be difficult for physicians who work outside of academic centers (8). Delayed access to an ILD center has been shown to increase mortality in certain types of ILD (15), and innovative strategies are needed to mitigate these care accessibility issues. Virtual MDDs have the advantage of being more readily accessible than in-person MDDs and have been shown to reduce wait times for patient assessments (9). MILDDER distinguishes itself from other virtual MDDs by allowing both visual and audio discussion (videoconferencing) with the referring physician, mitigating some of the downsides of remote patient assessments. Despite the advantages of virtual MDDs, they have not been compared “head-to-head” with traditional in-person MDDs, and they come with certain organizational barriers such as ensuring secure platforms for data sharing (8). Furthermore, the issue of high case referral volume remains difficult to mitigate even with virtual MDD platforms (8).
Case-related outcomes after MILDDER were found to be clinically relevant, with half of patients having a new ILD diagnosis or change in ILD diagnosis after MILDDER. These numbers are similar to previously reported outcomes for in-person MDDs (16–18). For example, a large retrospective observational study by De Sadeleer and colleagues (16) previously showed that in-person MDD resulted in a new or changed diagnosis for 41% of patients. Another study by Ageely and colleagues (17) showed a change in 37% of ILD diagnoses after in-person MDD in their academic center. Our results suggest that videoconferencing MDDs may provide diagnostic abilities similar to those of in-person MDDs. Our study also noted a significant proportion of new investigation requests and treatment modifications after MILDDER, which are likely to be impactful to patient care.
Limitations
This study has several limitations. First, using survey data introduces the potential for sampling bias and voluntary response bias, and attendees who enjoyed the MILDDER program may have been more likely to complete surveys. Because attendees were not required to complete surveys, the response rate (and thus sample size) was affected. Second, the fact that this study was conducted at a single tertiary center and that the population of attendees and referring physicians captured was young and in the early stages of their career could affect the generalizability of the results. We did attempt to mitigate the latter issue by stratifying ILD confidence survey questions by number of years of clinical practice. Given limitations in our dataset, it was not possible to stratify results by medical specialty, practice setting, location, or number of ILD cases seen each month. Third, we were not able to delineate which component of MILDDER (the lecture vs. the case presentation) contributed to the impact on increased ILD confidence. In addition, although not a primary study outcome, qualitative assessment of survey written responses was performed by one individual, which may have introduced bias. Finally, the MILDDER program was made possible by access to an unrestricted educational grant, and the demonstrated feasibility of videoconferencing MDDs must be interpreted within this context. Because other centers may not have access to such funding structures, the feasibility of similar programs outside of the TGH may be impacted. Despite these limitations, we were able to reliably demonstrate the positive educational and clinical impact of our videoconferencing MDD program for the diagnosis and management of ILD. Strengths of our study include its large sample size, its diverse population of both learners and practicing physicians, and its novel videoconferencing platform that includes the patient’s referring physician while the case is being discussed.
Conclusions
In summary, videoconferencing MDD platforms such as MILDDER are feasible and can be used as a tool to improve physician and trainee confidence with the diagnosis and management of ILD. Attendees reported high satisfaction with the videoconferencing MDD platform, and observed case-related outcomes were similar to those previously described with in-person MDDs. Although videoconferencing MDD platforms have the potential to facilitate access to MDDs and to subspecialized ILD care, more research is needed to validate their use in other centers and to assess their impact on ILD care delivery.
Supplemental Materials
Acknowledgments
Acknowledgment
The authors thank the attendees and referring physicians who participated in MILDDER and completed the pre- and postsurveys that made this research possible. The authors also thank Boehringer Ingelheim for providing an educational grant that helps support the MILDDER program. Finally, the authors thank Michelle Mercado and Antonio Cassano for their help in coordinating the MILDDER program.
Footnotes
Although this research received no external funding, the MILDDER program is supported by an unrestricted educational grant from Boehringer Ingelheim Canada.
Author Contributions: All authors helped conceptualize this study. S.P. acquired the data. S.P. and J.H.F. analyzed the data, interpreted the results, and wrote the manuscript. S.S., L.F., and M.M. read and provided revisions of the manuscript. All authors read and approved the final manuscript for publication. All authors take responsibility for the content of the manuscript, including the data and analyses.
Artificial Intelligence Disclaimer: No artificial intelligence tools were used in writing this manuscript.
This article has a data supplement, which is accessible at the Supplements tab.
Author disclosures are available with the text of this article at www.atsjournals.org.
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