Table 2.
Items That Achieved Consensus in the Modified Delphi Survey as Essential or Important for an ILD Clinic
| Items That Are Essential to Have for an ILD Clinic | Items That Are Important to Have for an ILD Clinic |
|---|---|
| Members of the ILD team | |
| Physicians | |
| Having expertise in ILD (a certain number of years working in ILD patient care) | |
| Having at least 2 or more pulmonologists working the ILD clinic | |
| Nurses | Dedicated ILD nurse |
| If a clinic has advanced practice providers | |
| Close supervision by physicians | |
| Their role should be mainly longitudinal care of ILD patients | |
| Research coordinators | Clinic coordinators |
| Fellows and trainees | |
| Infrastructure of ILD clinics | |
| General | |
| ILD clinic sees a minimum number of patients per year | |
| ILD clinic sees a minimum of 100 unique patients/ya | |
| Minimum number of clinics per week | |
| Ease of access to clinic | |
| Triaging and rerouting referrals to ILD clinics from general pulmonary clinics | |
| Triaging of ILD patients before new patient visit to avoid multiple visits (prescheduling tests before the visit, obtaining prior records and imaging, and so forth) | |
| The maximum time from referral to new appointment is less than 2 mo for a standard new patient visitb | Maximum time from referral to new appointment is less than 7-10 d for an urgent patient visit |
| Patient management strategies | |
| Providing a mix of primary management, collaborative/shared care, and consultative management | Providing primary management of ILD care |
| Exposure history | |
| Obtain a structured occupational and environmental exposure history for all new ILD patients | |
| Resources for ILD clinics | |
| Pulmonary rehabilitation | |
| A pulmonary rehabilitation facility in close proximity (within a 30-60-min drive from the center) to the ILD clinica | |
| Ancillary services within the same institution | |
| General rheumatology | Access to rheumatologists with expertise in ILD |
| Thoracic radiology | Access to sleep clinic |
| Pulmonary pathologya | |
| Thoracic surgeon | |
| Pulmonary hypertensiona | |
| Cardiology | |
| Palliative care | |
| Experience in treating patients with advanced lung diseases | |
| Availability in outpatient, inpatient, and hospice care | |
| Pulmonary function testing | |
| Same-day appointments as the ILD clinic visit | |
| Radiology | |
| Dedicated ILD HRCT protocol | |
| HRCT available same day or next day of clinic visita | |
| Research | |
| Participation in research | |
| Participation in clinical trials | |
| Participation in patient registriesa | |
| Patient education | |
| Patient education is delivered by physiciansa | |
| Patient education is delivered by nurses | |
| ILD clinic participates in local patient support groups | |
| Multidisciplinary conference | |
| Having a multidisciplinary conference | Frequency is at least once/2 wks |
| Staff (routinely participates in ILD conference) | |
| Pulmonologists | Trainees |
| Radiologists | |
| Pathologists | |
| Discussing the following types of patients at multidisciplinary conference | |
| Complex cases with diagnostic or therapeutic dilemmas | |
| Patients who already have undergone surgical lung biopsy | |
| Patients in whom a surgical lung biopsy is being considered |
ILD = interstitial lung disease.
a
If threshold for agreement were increased to > 80%, these items would have been considered important, but not essential, for an ILD clinic.
b
Maximum time to new patient visit < 1 mo or < 3 mo for a standard new patient visit were important, but not essential.