Idiopathic Interstitial Pneumonia

Abstract

Rationale: Treatment and prognoses of diffuse parenchymal lung diseases (DPLDs)varies by diagnosis.Obtainingauniform diagnosis among observers is difficult. Objectives: Evaluate diagnostic agreement between academic and community-based physicians for patients with DPLDs, and deter- mine if an interactive approach between clinicians, radiologists, and pathologists improved diagnostic agreement in community and academic centers. Methods: 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 examina- tion,pulmonaryfunctiontesting,high-resolutioncomputedtomog- raphy, and surgical lung biopsy was collected. Data were presented in the same sequential fashion to three groups of physicians on separate days. Measurements and Main Results: Each observer'sdiagnosiswascoded into one ofeight categories. A statistic allowingfor 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 agreementwasbetterwithinacademic centers(0.55-0.71)than within community centers ( 0.32-0.44). Clinically significant disagreement was present between academic and community- based physicians(0.11-0.56).Community physicianswere more