Idiopathic interstitial pneumonia: do community and academic physicians agree on diagnosis? Academic Article Article uri icon

Overview

MeSH

  • Humans
  • Physicians
  • Prognosis

MeSH Major

  • Academic Medical Centers
  • Community Medicine
  • Lung Diseases, Interstitial

abstract

  • Treatment and prognoses of diffuse parenchymal lung diseases (DPLDs) varies by diagnosis. Obtaining a uniform diagnosis among observers is difficult. Evaluate diagnostic agreement between academic and community-based physicians for patients with DPLDs, and determine if an interactive approach between clinicians, radiologists, and pathologists improved diagnostic agreement in community and academic centers. Retrospective review of 39 patients with DPLD. A total of 19 participants reviewed cases at 2 community locations and 1 academic location. Information from the history, physical examination, pulmonary function testing, high-resolution computed tomography, and surgical lung biopsy was collected. Data were presented in the same sequential fashion to three groups of physicians on separate days. Each observer's diagnosis was coded into one of eight categories. A kappa statistic allowing for multiple raters was used to assess agreement in diagnosis. Interactions between clinicians, radiologists, and pathologists improved interobserver agreement at both community and academic sites; however, final agreement was better within academic centers (kappa = 0.55-0.71) than within community centers (kappa = 0.32-0.44). Clinically significant disagreement was present between academic and community-based physicians (kappa = 0.11-0.56). Community physicians were more likely to assign a final diagnosis of idiopathic pulmonary fibrosis compared with academic physicians. Significant disagreement exists in the diagnosis of DPLD between physicians based in communities compared with those in academic centers. Wherever possible, patients should be referred to centers with expertise in diffuse parenchymal lung disorders to help clarify the diagnosis and provide suggestions regarding treatment options.

publication date

  • May 15, 2007

has subject area

  • Academic Medical Centers
  • Community Medicine
  • Humans
  • Lung Diseases, Interstitial
  • Physicians
  • Prognosis

Research

keywords

  • Comparative Study
  • Journal Article

Identity

Language

  • eng

PubMed Central ID

  • PMC1899268

Digital Object Identifier (DOI)

  • 10.1164/rccm.200606-833OC

PubMed ID

  • 17255566

Additional Document Info

start page

  • 1054

end page

  • 1060

volume

  • 175

number

  • 10