ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Exploring Relationships Between Resources and Practices of ILD Centers and Outcomes in Patients with Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry
Session Title
TP26 - TP026 DIAGNOSIS, ASSESSMENT, AND PROGNOSIS OF FIBROTIC ILD
Abstract
A1868 - Exploring Relationships Between Resources and Practices of ILD Centers and Outcomes in Patients with Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry
Author Block: J. A. De Andrade1, T. Kulkarni2, M. L. Neely3, A. S. Hellkamp3, A. Hajari Case4, D. A. Culver5, K. Guntupalli6, S. Bender7, C. S. Conoscenti7, L. D. Snyder3, on behalf of the IPF-PRO Registry investigators; 1Vanderbilt University School of Medicine, Nashville, TN, United States, 2University of Alabama at Birmingham, Birmingham, AL, United States, 3Duke Clinical Research Institute, Durham, NC, United States, Duke University Medical Center, Durham, NC, United States, 4Piedmont Heathcare, Atlanta, GA, United States, 5Cleveland Clinic, Cleveland, OH, United States, 6Baylor College of Medicine, Houston, TX, United States, 7Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States.
Rationale: Performance benchmarks for the diagnosis and management of IPF have not been established. We used data from the IPF-PRO Registry, an observational registry of patients with IPF managed at specialized centers across the US, to describe centers’ resources and practices and to assess associations between site practices and patient outcomes.Methods: A survey was sent to the IPF-PRO Registry enrolling centers to gather information on their resources, operations, and self-assessment practices. For every site that enrolled ≥10 patients, we calculated the 1-year event rate of clinically relevant outcomes (Table). Site-specific event rates were estimated using the Kaplan-Meier method for all outcomes except hospitalization, for which the cumulative incidence function was used. To assess whether site-level heterogeneity existed for each patient-level outcome, we tested whether the variance of a random site effect was >0, adjusting for difference in patient case-mix. If evidence of site-level heterogeneity was found, we investigated potential drivers of the heterogeneity by looking at associations between site practices and outcomes using forward stepwise selection (with an alpha-to-stay of 0.05). Results: Data were provided by 27 centers. At all centers, physicians and nurses are primarily involved in direct patient care, but at a minority of centers, patients are also seen by pharmacists, social workers, or respiratory therapists. Median (Q1, Q3) site-specific one-year event rates are shown in the Table. There were no outcomes for which the site variance component was significantly different from 0 after controlling for patient case-mix (p≤0.05), but the p-value for hospitalization was 0.052. The site practices “starting/completing an ILD-related quality improvement project in the previous 2 years” (reported by 11 sites) and “routine participation in some form of remote monitoring” (reported by 6 sites) were associated with hospitalization, with HR 0.60 (95% CI: 0.44, 0.82; p=0.01) and HR 1.46 (95% CI: 1.04, 2.05; p=0.028), respectively.Conclusions: Based on data from specialized ILD centers participating in the IPF-PRO Registry, patients at sites that started/completed an ILD-related quality improvement project had a lower risk of hospitalization. Sites where patients participated in routine remote monitoring had a higher risk of hospitalization. It is unknown whether this was because these patients were monitored less closely through in-clinic visits or had disease progression detected earlier via remote monitoring. No other systems, resources, or practices studied were associated with patient outcomes.
Author Block: J. A. De Andrade1, T. Kulkarni2, M. L. Neely3, A. S. Hellkamp3, A. Hajari Case4, D. A. Culver5, K. Guntupalli6, S. Bender7, C. S. Conoscenti7, L. D. Snyder3, on behalf of the IPF-PRO Registry investigators; 1Vanderbilt University School of Medicine, Nashville, TN, United States, 2University of Alabama at Birmingham, Birmingham, AL, United States, 3Duke Clinical Research Institute, Durham, NC, United States, Duke University Medical Center, Durham, NC, United States, 4Piedmont Heathcare, Atlanta, GA, United States, 5Cleveland Clinic, Cleveland, OH, United States, 6Baylor College of Medicine, Houston, TX, United States, 7Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States.
Rationale: Performance benchmarks for the diagnosis and management of IPF have not been established. We used data from the IPF-PRO Registry, an observational registry of patients with IPF managed at specialized centers across the US, to describe centers’ resources and practices and to assess associations between site practices and patient outcomes.Methods: A survey was sent to the IPF-PRO Registry enrolling centers to gather information on their resources, operations, and self-assessment practices. For every site that enrolled ≥10 patients, we calculated the 1-year event rate of clinically relevant outcomes (Table). Site-specific event rates were estimated using the Kaplan-Meier method for all outcomes except hospitalization, for which the cumulative incidence function was used. To assess whether site-level heterogeneity existed for each patient-level outcome, we tested whether the variance of a random site effect was >0, adjusting for difference in patient case-mix. If evidence of site-level heterogeneity was found, we investigated potential drivers of the heterogeneity by looking at associations between site practices and outcomes using forward stepwise selection (with an alpha-to-stay of 0.05). Results: Data were provided by 27 centers. At all centers, physicians and nurses are primarily involved in direct patient care, but at a minority of centers, patients are also seen by pharmacists, social workers, or respiratory therapists. Median (Q1, Q3) site-specific one-year event rates are shown in the Table. There were no outcomes for which the site variance component was significantly different from 0 after controlling for patient case-mix (p≤0.05), but the p-value for hospitalization was 0.052. The site practices “starting/completing an ILD-related quality improvement project in the previous 2 years” (reported by 11 sites) and “routine participation in some form of remote monitoring” (reported by 6 sites) were associated with hospitalization, with HR 0.60 (95% CI: 0.44, 0.82; p=0.01) and HR 1.46 (95% CI: 1.04, 2.05; p=0.028), respectively.Conclusions: Based on data from specialized ILD centers participating in the IPF-PRO Registry, patients at sites that started/completed an ILD-related quality improvement project had a lower risk of hospitalization. Sites where patients participated in routine remote monitoring had a higher risk of hospitalization. It is unknown whether this was because these patients were monitored less closely through in-clinic visits or had disease progression detected earlier via remote monitoring. No other systems, resources, or practices studied were associated with patient outcomes.
