Kavitha Selvan, MD, Assistant Professor of Medicine at Northwestern University in the Northwestern Medicine Interstitial Lung Disease and Pulmonary Fibrosis Program, recently completed a CHEST quality improvement grant, awarded in 2023 as part of the Bridging Specialties®: Timely Diagnosis for ILD program. With her project complete, she shared how it has impacted patient care, affected providers, and supported her growth as a clinician.
For her project, Dr. Selvan worked at the University of Chicago through a dedicated partnership with the Primary Care Group (PCG), with the mission of streamlining and shortening the time to diagnosis for patients with ILD and bringing together pulmonologists and primary care providers (PCPs).
She credits the grant for giving her the opportunity to collaborate with providers across medical subspecialties and better understand barriers to providing quality patient care.
“The conversations I had with key stakeholders in the PCG group at the inception of this project, particularly related to the time constraints that must be navigated in primary care clinic visits, helped shape the design of our project and how I personally practice and communicate as a pulmonary specialist,” Dr. Selvan said.
Throughout this project, she assessed diagnosing ILD among underrepresented minority populations in Chicago and used a clinician-facing toolkit with resources focused on steps to take when a patient displays signs of ILD.
The findings have helped to create awareness about ILD and revealed improvement in communication between PCPs and pulmonary subspecialists.
“This gain is critical,” Dr. Selvan said. “PCPs are on the front line of evaluating new respiratory complaints. A deeper understanding of ILD risk factors and recommended evaluation, and ease of communication with subspecialists, may help streamline timely referral and diagnosis.”
Overview and outcomes
Dr. Selvan’s project was conducted in two phases over the course of six months: a clinician implementation phase (with 151 PCG providers) and a patient implementation phase (with 2,217 patients presenting to primary care appointments).
In the clinician implementation phase, her team provided educational content on ILD, developed by CHEST, to PCG providers and posted diagrams on evaluation of suspected ILD in provider workrooms located in the primary care clinic, Dr. Selvan said. Then, they surveyed PCG providers on their knowledge and comfort in preintervention and postintervention evaluation of suspected ILD.
“The provider survey data revealed that following the intervention, providers felt more comfortable communicating with institutional ILD providers,” Dr. Selvan said. “Barriers in communication between primary care and specialist providers contribute to the significant delays in ILD diagnosis, and we’re hopeful that addressing these barriers will streamline ILD diagnosis for our high-risk, underserved population.”
In the patient implementation phase, the project team distributed ILD risk factor questionnaires to all patients checking in to appointments in the primary care clinic and made this data available to PCG providers in real time through electronic medical records, Dr. Selvan said. They then analyzed PCG provider diagnostic ordering and referral practices with survey responses before and after project implementation. They evaluated time from initial PCG provider referral to a pulmonary subspecialist to final diagnosis of ILD (with findings revealing an average of 62 days).
“We found that patients with two or more positive risk factors identified on the ILD risk factor questionnaire were more likely to have diagnostic orders placed that are recommended in the evaluation of suspected ILD (including pulmonary function tests, computed tomography imaging, and/or referral to pulmonary subspecialists),” Dr. Selvan said.
With more education on ILD, providers felt more comfortable communicating with ILD providers, appropriate diagnostic orders were placed, and ILD diagnoses were confirmed in a timely manner.
Fostering growth
From her Pulmonary and Critical Care Fellowship at the University of Chicago to her current role as Assistant Professor of Medicine at Northwestern University, Dr. Selvan looks back at what the CHEST grant offered her with gratitude and excitement for what’s to come.
“This grant has helped kickstart my career as an ILD physician in so many ways,” she said. “I was able to forge important partnerships with PCG providers, who will subsequently serve as a referral base to my clinical ILD practice and who now have a more personal relationship with me through this project.”
When it comes to the project data, the findings have highlighted more of the path ahead, laying the groundwork for continued research on ILD, she said.
“I had the opportunity to generate important clinical data that created a foundation for subsequent research projects I aim to conduct related to identifying risk factors for the progression of interstitial lung abnormalities—a radiologic precursor to ILD,” Dr. Selvan said.
Over the course of the CHEST grant, Dr. Selvan gained valuable leadership skills from managing a multidisciplinary team and researching a topic she’s passionate about.
In the end, the project highlighted the importance of expanding awareness and making the toolkit resources more accessible in the community, while also encouraging closer relationships between PCPs and pulmonary specialists. These efforts contributed to earlier ILD diagnoses and improved patient outcomes, Dr. Selvan said.
Moving forward
CHEST encourages all clinicians—PCPs and pulmonary specialists—to familiarize themselves with the ILD Clinician Toolkit. It contains specific resources focusing on the steps to take when a patient displays signs of ILD. These assets include an ILD-specific patient questionnaire to download and use in practice, an e-learning module for reviewing key symptoms (like crackles on auscultation) and suggested patient workups, and a decision-making tool that walks through three patient scenarios.
Opportunities like this are made possible by generous contributions from CHEST donors. Make a gift to CHEST and select “Clinical Research” to help aid future research into interstitial lung disease and much more.
