Diagnostic test interpretation and referral delay in patients with interstitial lung disease

David Pritchard, Ayodeji Adegunsoye, Elyse Lafond, Janelle Vu Pugashetti, Ryan DiGeronimo, Noelle Boctor, Nandini Sarma, Isabella Pan, Mary Strek, Michael Kadoch, Jonathan H. Chung, Justin M. Oldham

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

BACKGROUND: Diagnostic delays are common in patients with interstitial lung disease (ILD). A substantial percentage of patients experience a diagnostic delay in the primary care setting, but the factors underpinning this observation remain unclear. In this multi-center investigation, we assessed ILD reporting on diagnostic test interpretation and its association with subsequent pulmonology referral by a primary care physician (PCP). METHODS: A retrospective cohort analysis of patients referred to the ILD programs at UC-Davis and University of Chicago by a PCP within each institution was performed. Computed tomography (CT) of the chest and abdomen and pulmonary function test (PFT) were reviewed to identify the date ILD features were first present and determine the time from diagnostic test to pulmonology referral. The association between ILD reporting on diagnostic test interpretation and pulmonology referral was assessed, as was the association between years of diagnostic delay and changes in fibrotic features on longitudinal chest CT. RESULTS: One hundred and forty-six patients were included in the final analysis. Prior to pulmonology referral, 66% (n = 97) of patients underwent chest CT, 15% (n = 21) underwent PFT and 15% (n = 21) underwent abdominal CT. ILD features were reported on 84, 62 and 33% of chest CT, PFT and abdominal CT interpretations, respectively. ILD reporting was associated with shorter time to pulmonology referral when undergoing chest CT (1.3 vs 15.1 months, respectively; p = 0.02), but not PFT or abdominal CT. ILD reporting was associated with increased likelihood of pulmonology referral within 6 months of diagnostic test when undergoing chest CT (rate ratio 2.17, 95% CI 1.03-4.56; p = 0.04), but not PFT or abdominal CT. Each year of diagnostic delay was associated with a 1.8% increase in percent fibrosis on chest CT. Patients with documented dyspnea had shorter time to chest CT acquisition and pulmonology referral than patients with documented cough and lung crackles. CONCLUSIONS: Determinants of ILD diagnostic delays in the primary care setting include underreporting of ILD features on diagnostic testing and prolonged time to pulmonology referral even when ILD is reported. Interventions to modulate these factors may reduce ILD diagnostic delays in the primary care setting.

Original languageEnglish (US)
Number of pages1
JournalRespiratory research
Volume20
Issue number1
DOIs
StatePublished - Nov 12 2019

Keywords

  • Computed tomography
  • Diagnostic delay
  • Idiopathic pulmonary fibrosis
  • Interstitial lung disease
  • Pulmonary function test

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Pritchard, D., Adegunsoye, A., Lafond, E., Pugashetti, J. V., DiGeronimo, R., Boctor, N., Sarma, N., Pan, I., Strek, M., Kadoch, M., Chung, J. H., & Oldham, J. M. (2019). Diagnostic test interpretation and referral delay in patients with interstitial lung disease. Respiratory research, 20(1). https://doi.org/10.1186/s12931-019-1228-2