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The CHEST Board of Regents (BOR) held their summer meeting for 3 days starting June 20 in Coeur D’Alene, Idaho. The key drivers of the BOR are to continuously assess and adjust our strategic plan to further CHEST’s mission and to be good fiducial stewards in allocating resources. At this meeting, the BOR continued its efforts in both of these areas.
CHEST’s mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. The budget for fiscal year 2019-2020 facilitates the expansion of this mission by allocating more resources for e-learning and for the improving engagement and member experience.
Specifically, the Board is placing significant emphasis for more content to be digital, downloadable, digestible, and (hopefully) addictive. Aside from allocating capital for updates of existing equipment, Board Designated Funds were made available for an aggressive redesign of content delivery. Over the next 2 years, CHEST will achieve single sign on for all our learning platforms; enhance mobile access; and deploy mobile apps for gaming, personalized learning, and just-in-time education. The effort also aims to streamline journal and topic workflows and launch personalized content recommendations for our members.
Our formal strategic planning continued with an external review of our recent environmental scan and 5- year plan by a select group of entrepreneurs and innovators. Board members engaged in a rich debate about ways to better focus the organization. The group noted that the best time for strategic initiatives is now, while the association is doing well and highly functioning, rather than waiting for difficult times to initiate a potentially more painful course correction.
Education is the base for our entire enterprise. The BOR had a vigorous discussion about the development of a clinician educator track with certification and was introduced to CHEST’s new Chief Learning Officer. The CHEST staff plans a deeper dive into needs assessment and developing a business plan around this program.
Communication is also a core part of our mission. The BOR recognizes that more needs to be done to support the NetWorks. For this year’s annual meeting, plans have been made to move the NetWork meetings into two time slots, unopposed by other scientific content, and to rename these meetings “NetWork Featured Lecture and Open Forum.” The rationale for the name change is to make the meetings more inviting by referring to them as “open forums.” CHEST 2019 will feature improved signage in common areas to highlight the NetWork meetings, providing times and locations. The goal is to at least double attendance. Dr. Stephanie Levine, President-Elect of CHEST, is forming a task force to explore other ways of enhancing NetWork engagement.
In order to expand CHEST educational impact, the Board launched a new global events strategy. These global educational programs were another focus of the Board of Regents. Staff provided updates on the CHEST Congress Thailand 2019 in collaboration with the Thoracic Society of Thailand. There were more than 1,000 delegates representing 57 countries. The meeting was supported by our partner, Kenes, which will also be helping with smaller regional meetings, including the June meeting in Athens in collaboration with the Hellenic Thoracic Society. CHEST is in the advanced stages of planning a CHEST Congress in Bologna, Italy, in summer 2020 in conjunction with our colleagues in that country. CHEST is putting together a 5-year plan for regional meetings with a variety of local medical societies throughout the world. To support this, the Governance Committee recommended augmenting the Council of Global Governors with an Executive Committee. This group will serve as a small, strategic set of individuals, appointed by the Governance Committee, to assist in furthering the global strategy and efforts of the organization. Going forward, the Chair of the Executive Committee will serve as a member of the Board of Regents for a 2-year term, to better represent international concerns at a board level.
The BOR addressed additional items, including reviewing the process for selecting Master FCCPs and a very positive update on our CHEST 2019 meeting in New Orleans. They also enhanced coordination with the CHEST Foundation Board of Trustees (BOT) via joint meetings. The CHEST Foundation BOT celebrated success in matching funds for the one million dollar grant to establish the Erin Popovich Endowment. Additional fundraising plans include holding five separate events in the next year, including a repeat of last year’s Feldman Family Foundation Poker Night.
The CHEST Board of Regents (BOR) held their summer meeting for 3 days starting June 20 in Coeur D’Alene, Idaho. The key drivers of the BOR are to continuously assess and adjust our strategic plan to further CHEST’s mission and to be good fiducial stewards in allocating resources. At this meeting, the BOR continued its efforts in both of these areas.
CHEST’s mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. The budget for fiscal year 2019-2020 facilitates the expansion of this mission by allocating more resources for e-learning and for the improving engagement and member experience.
Specifically, the Board is placing significant emphasis for more content to be digital, downloadable, digestible, and (hopefully) addictive. Aside from allocating capital for updates of existing equipment, Board Designated Funds were made available for an aggressive redesign of content delivery. Over the next 2 years, CHEST will achieve single sign on for all our learning platforms; enhance mobile access; and deploy mobile apps for gaming, personalized learning, and just-in-time education. The effort also aims to streamline journal and topic workflows and launch personalized content recommendations for our members.
Our formal strategic planning continued with an external review of our recent environmental scan and 5- year plan by a select group of entrepreneurs and innovators. Board members engaged in a rich debate about ways to better focus the organization. The group noted that the best time for strategic initiatives is now, while the association is doing well and highly functioning, rather than waiting for difficult times to initiate a potentially more painful course correction.
Education is the base for our entire enterprise. The BOR had a vigorous discussion about the development of a clinician educator track with certification and was introduced to CHEST’s new Chief Learning Officer. The CHEST staff plans a deeper dive into needs assessment and developing a business plan around this program.
Communication is also a core part of our mission. The BOR recognizes that more needs to be done to support the NetWorks. For this year’s annual meeting, plans have been made to move the NetWork meetings into two time slots, unopposed by other scientific content, and to rename these meetings “NetWork Featured Lecture and Open Forum.” The rationale for the name change is to make the meetings more inviting by referring to them as “open forums.” CHEST 2019 will feature improved signage in common areas to highlight the NetWork meetings, providing times and locations. The goal is to at least double attendance. Dr. Stephanie Levine, President-Elect of CHEST, is forming a task force to explore other ways of enhancing NetWork engagement.
In order to expand CHEST educational impact, the Board launched a new global events strategy. These global educational programs were another focus of the Board of Regents. Staff provided updates on the CHEST Congress Thailand 2019 in collaboration with the Thoracic Society of Thailand. There were more than 1,000 delegates representing 57 countries. The meeting was supported by our partner, Kenes, which will also be helping with smaller regional meetings, including the June meeting in Athens in collaboration with the Hellenic Thoracic Society. CHEST is in the advanced stages of planning a CHEST Congress in Bologna, Italy, in summer 2020 in conjunction with our colleagues in that country. CHEST is putting together a 5-year plan for regional meetings with a variety of local medical societies throughout the world. To support this, the Governance Committee recommended augmenting the Council of Global Governors with an Executive Committee. This group will serve as a small, strategic set of individuals, appointed by the Governance Committee, to assist in furthering the global strategy and efforts of the organization. Going forward, the Chair of the Executive Committee will serve as a member of the Board of Regents for a 2-year term, to better represent international concerns at a board level.
The BOR addressed additional items, including reviewing the process for selecting Master FCCPs and a very positive update on our CHEST 2019 meeting in New Orleans. They also enhanced coordination with the CHEST Foundation Board of Trustees (BOT) via joint meetings. The CHEST Foundation BOT celebrated success in matching funds for the one million dollar grant to establish the Erin Popovich Endowment. Additional fundraising plans include holding five separate events in the next year, including a repeat of last year’s Feldman Family Foundation Poker Night.
The CHEST Board of Regents (BOR) held their summer meeting for 3 days starting June 20 in Coeur D’Alene, Idaho. The key drivers of the BOR are to continuously assess and adjust our strategic plan to further CHEST’s mission and to be good fiducial stewards in allocating resources. At this meeting, the BOR continued its efforts in both of these areas.
CHEST’s mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. The budget for fiscal year 2019-2020 facilitates the expansion of this mission by allocating more resources for e-learning and for the improving engagement and member experience.
Specifically, the Board is placing significant emphasis for more content to be digital, downloadable, digestible, and (hopefully) addictive. Aside from allocating capital for updates of existing equipment, Board Designated Funds were made available for an aggressive redesign of content delivery. Over the next 2 years, CHEST will achieve single sign on for all our learning platforms; enhance mobile access; and deploy mobile apps for gaming, personalized learning, and just-in-time education. The effort also aims to streamline journal and topic workflows and launch personalized content recommendations for our members.
Our formal strategic planning continued with an external review of our recent environmental scan and 5- year plan by a select group of entrepreneurs and innovators. Board members engaged in a rich debate about ways to better focus the organization. The group noted that the best time for strategic initiatives is now, while the association is doing well and highly functioning, rather than waiting for difficult times to initiate a potentially more painful course correction.
Education is the base for our entire enterprise. The BOR had a vigorous discussion about the development of a clinician educator track with certification and was introduced to CHEST’s new Chief Learning Officer. The CHEST staff plans a deeper dive into needs assessment and developing a business plan around this program.
Communication is also a core part of our mission. The BOR recognizes that more needs to be done to support the NetWorks. For this year’s annual meeting, plans have been made to move the NetWork meetings into two time slots, unopposed by other scientific content, and to rename these meetings “NetWork Featured Lecture and Open Forum.” The rationale for the name change is to make the meetings more inviting by referring to them as “open forums.” CHEST 2019 will feature improved signage in common areas to highlight the NetWork meetings, providing times and locations. The goal is to at least double attendance. Dr. Stephanie Levine, President-Elect of CHEST, is forming a task force to explore other ways of enhancing NetWork engagement.
In order to expand CHEST educational impact, the Board launched a new global events strategy. These global educational programs were another focus of the Board of Regents. Staff provided updates on the CHEST Congress Thailand 2019 in collaboration with the Thoracic Society of Thailand. There were more than 1,000 delegates representing 57 countries. The meeting was supported by our partner, Kenes, which will also be helping with smaller regional meetings, including the June meeting in Athens in collaboration with the Hellenic Thoracic Society. CHEST is in the advanced stages of planning a CHEST Congress in Bologna, Italy, in summer 2020 in conjunction with our colleagues in that country. CHEST is putting together a 5-year plan for regional meetings with a variety of local medical societies throughout the world. To support this, the Governance Committee recommended augmenting the Council of Global Governors with an Executive Committee. This group will serve as a small, strategic set of individuals, appointed by the Governance Committee, to assist in furthering the global strategy and efforts of the organization. Going forward, the Chair of the Executive Committee will serve as a member of the Board of Regents for a 2-year term, to better represent international concerns at a board level.
The BOR addressed additional items, including reviewing the process for selecting Master FCCPs and a very positive update on our CHEST 2019 meeting in New Orleans. They also enhanced coordination with the CHEST Foundation Board of Trustees (BOT) via joint meetings. The CHEST Foundation BOT celebrated success in matching funds for the one million dollar grant to establish the Erin Popovich Endowment. Additional fundraising plans include holding five separate events in the next year, including a repeat of last year’s Feldman Family Foundation Poker Night.
What’s new for CHEST 2019?
Head to New Orleans this October for CHEST Annual Meeting 2019 for the latest original research, postgraduate courses, interactive case-based discussions, simulation sessions, CHEST Games, and more! CHEST 2019 allows clinician members of the entire health-care team to stay up to date on pulmonary, critical care, and sleep medicine. There are many new and exciting things happening at CHEST 2019, and we are excited to give you a sneak peek.
The simulation sessions are better than ever and include a full day of cadaver-based courses and brand new hands-on sessions in bronchoscopy, advanced critical care echocardiography, and airway management, that will put your skills to the test. You don’t want to miss these simulation sessions that allow you to learn from our expert faculty to advance and develop valuable skills and apply your knowledge.
Visit CHEST in the exhibit hall to see the new additions we have added to amplify your experience. The new FISH Bowl innovation competition will allow you to learn about new solutions and ideas that were submitted in education and clinical disease for pulmonary, critical care, and sleep medicine. The finalists will be presenting live in Experience CHEST and competing for prizes in each category. CHEST games will be back again in a new space in the exhibit hall. Be sure to bring your team to play the popular Nodal Nemesis and the other games that test your skills in new and creative ways.
CHEST 2019 plans to make your life easier by providing you with the latest updates in patient care at the annual meeting, but we are also planning on making it easier in other ways. New this year, you can update your professional headshot in our new complimentary headshot booth. Plan on a visit to the new CHEST Wellness Zone. This area is designed to help you relax and recharge while at CHEST and includes meditation, posture consultants, aromatherapy, foot massage, and yoga. Attend CHEST 2019 with some peace of mind knowing that your children can be cared for at the Kiddie Corp childcare program for kids ages 6 months to 12 years.
According to William Kelly, MD, FCCP, CHEST 2019 Program Chair, “We are excited about these new opportunities that will help you improve your patient care. We’re taking concrete steps to make your learning, your practice, and your life a little easier.”
We look forward to seeing you at CHEST 2019 in New Orleans, Louisiana, October 19-23!
Head to New Orleans this October for CHEST Annual Meeting 2019 for the latest original research, postgraduate courses, interactive case-based discussions, simulation sessions, CHEST Games, and more! CHEST 2019 allows clinician members of the entire health-care team to stay up to date on pulmonary, critical care, and sleep medicine. There are many new and exciting things happening at CHEST 2019, and we are excited to give you a sneak peek.
The simulation sessions are better than ever and include a full day of cadaver-based courses and brand new hands-on sessions in bronchoscopy, advanced critical care echocardiography, and airway management, that will put your skills to the test. You don’t want to miss these simulation sessions that allow you to learn from our expert faculty to advance and develop valuable skills and apply your knowledge.
Visit CHEST in the exhibit hall to see the new additions we have added to amplify your experience. The new FISH Bowl innovation competition will allow you to learn about new solutions and ideas that were submitted in education and clinical disease for pulmonary, critical care, and sleep medicine. The finalists will be presenting live in Experience CHEST and competing for prizes in each category. CHEST games will be back again in a new space in the exhibit hall. Be sure to bring your team to play the popular Nodal Nemesis and the other games that test your skills in new and creative ways.
CHEST 2019 plans to make your life easier by providing you with the latest updates in patient care at the annual meeting, but we are also planning on making it easier in other ways. New this year, you can update your professional headshot in our new complimentary headshot booth. Plan on a visit to the new CHEST Wellness Zone. This area is designed to help you relax and recharge while at CHEST and includes meditation, posture consultants, aromatherapy, foot massage, and yoga. Attend CHEST 2019 with some peace of mind knowing that your children can be cared for at the Kiddie Corp childcare program for kids ages 6 months to 12 years.
According to William Kelly, MD, FCCP, CHEST 2019 Program Chair, “We are excited about these new opportunities that will help you improve your patient care. We’re taking concrete steps to make your learning, your practice, and your life a little easier.”
We look forward to seeing you at CHEST 2019 in New Orleans, Louisiana, October 19-23!
Head to New Orleans this October for CHEST Annual Meeting 2019 for the latest original research, postgraduate courses, interactive case-based discussions, simulation sessions, CHEST Games, and more! CHEST 2019 allows clinician members of the entire health-care team to stay up to date on pulmonary, critical care, and sleep medicine. There are many new and exciting things happening at CHEST 2019, and we are excited to give you a sneak peek.
The simulation sessions are better than ever and include a full day of cadaver-based courses and brand new hands-on sessions in bronchoscopy, advanced critical care echocardiography, and airway management, that will put your skills to the test. You don’t want to miss these simulation sessions that allow you to learn from our expert faculty to advance and develop valuable skills and apply your knowledge.
Visit CHEST in the exhibit hall to see the new additions we have added to amplify your experience. The new FISH Bowl innovation competition will allow you to learn about new solutions and ideas that were submitted in education and clinical disease for pulmonary, critical care, and sleep medicine. The finalists will be presenting live in Experience CHEST and competing for prizes in each category. CHEST games will be back again in a new space in the exhibit hall. Be sure to bring your team to play the popular Nodal Nemesis and the other games that test your skills in new and creative ways.
CHEST 2019 plans to make your life easier by providing you with the latest updates in patient care at the annual meeting, but we are also planning on making it easier in other ways. New this year, you can update your professional headshot in our new complimentary headshot booth. Plan on a visit to the new CHEST Wellness Zone. This area is designed to help you relax and recharge while at CHEST and includes meditation, posture consultants, aromatherapy, foot massage, and yoga. Attend CHEST 2019 with some peace of mind knowing that your children can be cared for at the Kiddie Corp childcare program for kids ages 6 months to 12 years.
According to William Kelly, MD, FCCP, CHEST 2019 Program Chair, “We are excited about these new opportunities that will help you improve your patient care. We’re taking concrete steps to make your learning, your practice, and your life a little easier.”
We look forward to seeing you at CHEST 2019 in New Orleans, Louisiana, October 19-23!
CHEST Foundation at Board Review
The CHEST Foundation is excited to be a part of this year’s CHEST Board Review in Phoenix, and we can’t wait to see you! We are hosting two receptions and invite you to attend and learn more about how the CHEST Foundation supports you, your colleagues, your patients, and the greater community while also taking the time to relax with your peers and board review faculty. The receptions are scheduled for Saturday, August 17 (for Sleep and Critical Care Board Review), and Wednesday, August 21 (for Pulmonary Board Review) immediately following your scheduled sessions. Please join us for hors d’oeuvres and beverages. This year, we are featuring surprise, guest speakers from CHEST leadership who will share why they are passionate about the Foundation’s mission and offer simple ways you can become further involved with the CHEST Foundation. You won’t want to miss this networking opportunity and the chance to learn more about what the Foundation has been doing!
This summer, we are focused on supporting young and early-career clinicians and are raising money at this year’s at Board Review to support travel grants to CHEST 2019. These travel grants provide early-career clinicians the funds needed to attend CHEST 2019. This program further develops the future leaders of CHEST and allows clinicians to take full advantage of career-development and networking opportunities that the annual meeting offers. If you’re interested in how you can make a difference in someone’s life, visit our website (foundation.chestnet.org), or find us at Board Review! We would love to share more with you about all the great work the Foundation is doing.
We can’t wait to see you in Phoenix to celebrate all your hard work!
The CHEST Foundation is excited to be a part of this year’s CHEST Board Review in Phoenix, and we can’t wait to see you! We are hosting two receptions and invite you to attend and learn more about how the CHEST Foundation supports you, your colleagues, your patients, and the greater community while also taking the time to relax with your peers and board review faculty. The receptions are scheduled for Saturday, August 17 (for Sleep and Critical Care Board Review), and Wednesday, August 21 (for Pulmonary Board Review) immediately following your scheduled sessions. Please join us for hors d’oeuvres and beverages. This year, we are featuring surprise, guest speakers from CHEST leadership who will share why they are passionate about the Foundation’s mission and offer simple ways you can become further involved with the CHEST Foundation. You won’t want to miss this networking opportunity and the chance to learn more about what the Foundation has been doing!
This summer, we are focused on supporting young and early-career clinicians and are raising money at this year’s at Board Review to support travel grants to CHEST 2019. These travel grants provide early-career clinicians the funds needed to attend CHEST 2019. This program further develops the future leaders of CHEST and allows clinicians to take full advantage of career-development and networking opportunities that the annual meeting offers. If you’re interested in how you can make a difference in someone’s life, visit our website (foundation.chestnet.org), or find us at Board Review! We would love to share more with you about all the great work the Foundation is doing.
We can’t wait to see you in Phoenix to celebrate all your hard work!
The CHEST Foundation is excited to be a part of this year’s CHEST Board Review in Phoenix, and we can’t wait to see you! We are hosting two receptions and invite you to attend and learn more about how the CHEST Foundation supports you, your colleagues, your patients, and the greater community while also taking the time to relax with your peers and board review faculty. The receptions are scheduled for Saturday, August 17 (for Sleep and Critical Care Board Review), and Wednesday, August 21 (for Pulmonary Board Review) immediately following your scheduled sessions. Please join us for hors d’oeuvres and beverages. This year, we are featuring surprise, guest speakers from CHEST leadership who will share why they are passionate about the Foundation’s mission and offer simple ways you can become further involved with the CHEST Foundation. You won’t want to miss this networking opportunity and the chance to learn more about what the Foundation has been doing!
This summer, we are focused on supporting young and early-career clinicians and are raising money at this year’s at Board Review to support travel grants to CHEST 2019. These travel grants provide early-career clinicians the funds needed to attend CHEST 2019. This program further develops the future leaders of CHEST and allows clinicians to take full advantage of career-development and networking opportunities that the annual meeting offers. If you’re interested in how you can make a difference in someone’s life, visit our website (foundation.chestnet.org), or find us at Board Review! We would love to share more with you about all the great work the Foundation is doing.
We can’t wait to see you in Phoenix to celebrate all your hard work!
In Memoriam: Mark J. Rosen, MD, Master FCCP
Past President (2006-2007) of the American College of Chest Physicians, leader, educator, mentor, and friend, Dr. Mark Rosen, Master FCCP, died on July 3, 2019. Dr. Rosen’s distinguished career in pulmonary and critical care medicine spanned more than 4 decades, marked by his deep commitments to medical education and patient care. His research and administrative accomplishments at New York City and Long Island hospitals were many, but clinical medicine and teaching were always at the top of his list. Mark’s unmistakable way of incorporating both clarity and humor into his roles of clinician, teacher, colleague, and friend provided us all with respect and adoration for this unforgettable individual.
Mark’s distinguished leadership involvement with CHEST began well before his term as President. Two years after completing his fellowships in pulmonary and critical care medicine, he became an FCCP in 1982, and his engagement with the American College of Chest Physicians began. During the 1990s and into the 2000s, Mark provided CHEST with his teaching expertise serving as faculty and director for the Pulmonary Board Review Courses. In 1998, he was Chair of the CHEST Annual Meeting, and from 1999 to 2005, he served on the ACCP-SEEK Editorial Boards for Pulmonary Disease and Critical Care Medicine. Mark served on the CHEST Board of Regents for many years, on the CHEST Foundation Board of Trustees, and as a Chair or member on numerous CHEST committees, some of which included Education, Nominations, Membership, Marketing, and Finance. He was the CHEST Governor for the City of New York and Chair of the Council of Governors. His leadership in all of these capacities was exemplary, as was his guidance as CHEST President from 2006 to 2007. Most recently, Mark served as CHEST Director of Global Education and Strategic Development (2011-2014) followed by CHEST Medical Director (2014-2016). Mark strived to uphold and strengthen the quality of the education that CHEST provided to all health-care professionals. His imprint on the educational and clinical foundations of CHEST, along with the many friendships he made along the way, will be remembered always.
CHEST extends heartfelt condolences to Mark’s wife of 37 years, Ilene, and the Rosen family and many friends and colleagues.
Past President (2006-2007) of the American College of Chest Physicians, leader, educator, mentor, and friend, Dr. Mark Rosen, Master FCCP, died on July 3, 2019. Dr. Rosen’s distinguished career in pulmonary and critical care medicine spanned more than 4 decades, marked by his deep commitments to medical education and patient care. His research and administrative accomplishments at New York City and Long Island hospitals were many, but clinical medicine and teaching were always at the top of his list. Mark’s unmistakable way of incorporating both clarity and humor into his roles of clinician, teacher, colleague, and friend provided us all with respect and adoration for this unforgettable individual.
Mark’s distinguished leadership involvement with CHEST began well before his term as President. Two years after completing his fellowships in pulmonary and critical care medicine, he became an FCCP in 1982, and his engagement with the American College of Chest Physicians began. During the 1990s and into the 2000s, Mark provided CHEST with his teaching expertise serving as faculty and director for the Pulmonary Board Review Courses. In 1998, he was Chair of the CHEST Annual Meeting, and from 1999 to 2005, he served on the ACCP-SEEK Editorial Boards for Pulmonary Disease and Critical Care Medicine. Mark served on the CHEST Board of Regents for many years, on the CHEST Foundation Board of Trustees, and as a Chair or member on numerous CHEST committees, some of which included Education, Nominations, Membership, Marketing, and Finance. He was the CHEST Governor for the City of New York and Chair of the Council of Governors. His leadership in all of these capacities was exemplary, as was his guidance as CHEST President from 2006 to 2007. Most recently, Mark served as CHEST Director of Global Education and Strategic Development (2011-2014) followed by CHEST Medical Director (2014-2016). Mark strived to uphold and strengthen the quality of the education that CHEST provided to all health-care professionals. His imprint on the educational and clinical foundations of CHEST, along with the many friendships he made along the way, will be remembered always.
CHEST extends heartfelt condolences to Mark’s wife of 37 years, Ilene, and the Rosen family and many friends and colleagues.
Past President (2006-2007) of the American College of Chest Physicians, leader, educator, mentor, and friend, Dr. Mark Rosen, Master FCCP, died on July 3, 2019. Dr. Rosen’s distinguished career in pulmonary and critical care medicine spanned more than 4 decades, marked by his deep commitments to medical education and patient care. His research and administrative accomplishments at New York City and Long Island hospitals were many, but clinical medicine and teaching were always at the top of his list. Mark’s unmistakable way of incorporating both clarity and humor into his roles of clinician, teacher, colleague, and friend provided us all with respect and adoration for this unforgettable individual.
Mark’s distinguished leadership involvement with CHEST began well before his term as President. Two years after completing his fellowships in pulmonary and critical care medicine, he became an FCCP in 1982, and his engagement with the American College of Chest Physicians began. During the 1990s and into the 2000s, Mark provided CHEST with his teaching expertise serving as faculty and director for the Pulmonary Board Review Courses. In 1998, he was Chair of the CHEST Annual Meeting, and from 1999 to 2005, he served on the ACCP-SEEK Editorial Boards for Pulmonary Disease and Critical Care Medicine. Mark served on the CHEST Board of Regents for many years, on the CHEST Foundation Board of Trustees, and as a Chair or member on numerous CHEST committees, some of which included Education, Nominations, Membership, Marketing, and Finance. He was the CHEST Governor for the City of New York and Chair of the Council of Governors. His leadership in all of these capacities was exemplary, as was his guidance as CHEST President from 2006 to 2007. Most recently, Mark served as CHEST Director of Global Education and Strategic Development (2011-2014) followed by CHEST Medical Director (2014-2016). Mark strived to uphold and strengthen the quality of the education that CHEST provided to all health-care professionals. His imprint on the educational and clinical foundations of CHEST, along with the many friendships he made along the way, will be remembered always.
CHEST extends heartfelt condolences to Mark’s wife of 37 years, Ilene, and the Rosen family and many friends and colleagues.
New Editor in Chief takes the reins
CHEST welcomed Peter J. Mazzone, MD, MPH, FCCP, in July, as the new Editor in Chief of the journal CHEST®. Dr. Mazzone is the Director of the Lung Cancer Program and Lung Cancer Screening Program for the Respiratory Institute at the Cleveland Clinic in Ohio.
His clinical interests include nodule management and the prevention, screening, diagnosis, staging, and characterization of lung cancer; his research has focused on the development of molecular biomarkers for lung cancer detection. Dr. Mazzone has been a member of CHEST since 1999 and an FCCP since 2004. He has served in several CHEST leadership positions, including member of the CHEST Lung Cancer Living Guidelines Steering Committee and program chair for the CHEST 2017 annual meeting, among others. Dr. Mazzone has provided some insights into the structure and strategies of the journal going forward, so don’t miss his editorial in the July issue of CHEST®.
CHEST welcomed Peter J. Mazzone, MD, MPH, FCCP, in July, as the new Editor in Chief of the journal CHEST®. Dr. Mazzone is the Director of the Lung Cancer Program and Lung Cancer Screening Program for the Respiratory Institute at the Cleveland Clinic in Ohio.
His clinical interests include nodule management and the prevention, screening, diagnosis, staging, and characterization of lung cancer; his research has focused on the development of molecular biomarkers for lung cancer detection. Dr. Mazzone has been a member of CHEST since 1999 and an FCCP since 2004. He has served in several CHEST leadership positions, including member of the CHEST Lung Cancer Living Guidelines Steering Committee and program chair for the CHEST 2017 annual meeting, among others. Dr. Mazzone has provided some insights into the structure and strategies of the journal going forward, so don’t miss his editorial in the July issue of CHEST®.
CHEST welcomed Peter J. Mazzone, MD, MPH, FCCP, in July, as the new Editor in Chief of the journal CHEST®. Dr. Mazzone is the Director of the Lung Cancer Program and Lung Cancer Screening Program for the Respiratory Institute at the Cleveland Clinic in Ohio.
His clinical interests include nodule management and the prevention, screening, diagnosis, staging, and characterization of lung cancer; his research has focused on the development of molecular biomarkers for lung cancer detection. Dr. Mazzone has been a member of CHEST since 1999 and an FCCP since 2004. He has served in several CHEST leadership positions, including member of the CHEST Lung Cancer Living Guidelines Steering Committee and program chair for the CHEST 2017 annual meeting, among others. Dr. Mazzone has provided some insights into the structure and strategies of the journal going forward, so don’t miss his editorial in the July issue of CHEST®.
Environmental Scan: Economy and workforce
The health care workforce is being transformed by profound demographic changes and the steady growth of the U.S. health sector. In addition, the movement of physicians out of private practice to employment by medical centers has accelerated. And a new generation of health care professionals is demanding a sustainable work/life balance. These trends will combine to change the work environment of chest physicians.
Spending
The United States spends about twice as much on health care as any other industrialized nation and this fact is driving an increasingly urgent public discussion about options and means of reducing costs.1 Medicare and Medicaid already account for about a quarter of federal government spending and those numbers are expected to rise as baby boomers age.1 Employer spending on health care as a percentage of wages has doubled since the 1980s.2
Workforce supply
An expanding health care sector means a growing demand for health care labor. Health care occupations are projected to grow 18% from 2016 to 2026, faster than the average for all occupations and adding 2.4 million new jobs to the economy.3 Expert testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions in May 2018 projected shortages of physicians in the coming years. According to estimates of the Health Resources and Services Administration (HRSA), there is a need for 13,800 additional primary care physicians in areas – especially rural – that are designated as health professional shortage areas. Signs of a worsening situation include projected shortages of 20,000 primary care physicians by 2025, according to HRSA, and 42,600-121,300 physicians by 2030, according to the Association of American Medical Colleges. The demand for physicians will exceed supply by 46,000-90,000 by 2025. An update to that research increased the projected shortage range to 61,700-94,700 by 2025.4 These shortages will result in recruiting challenges for many medical centers, especially those in rural areas.
Employment
Private practice is becoming the less common structure of employment for physicians. According to American Medical Association data, physician ownership of practices dropped below 50% for the first time in 2016.5 The trend toward employed versus private practice physicians is expected to continue. The size of practices is growing, with about one-third of physicians working in a hospital-owned practice or employed directly by a hospital and around 40% in practices of 10 physicians or more.5 Of every 10 physician practices, 3 were hospital owned in 2016.6 Physicians are being called upon to do more data entry and administrative work; 21% of physicians’ time is now spent on nonclinical paperwork.7 The ripple-out effects of what amounts to a seismic shift in the work structure and work environment for physicians are only beginning to be studied in terms of overall personal satisfaction and impact on patient care.
Stephanie M. Levine, MD, FCCP, the designate president of the American College of Chest Physicians and professor of medicine in the division of pulmonary diseases and critical care medicine at the University of Texas, San Antonio, recognizes the significance of the move from private practice to employment and suggests that advantages could be offset by some potential negatives practicing chest physicians. She noted, “Pros include potentially more job security, more predictable work hours, perhaps a reduction in some of the traditional administrative ‘hassles’ with running a private practice, and possibly a better and healthier work/life balance. Some think that physician input and leadership in the employed model may have more influence on a health care system than in an individual private practice. Nonclinical work may be decreased, but it is not clear that this is true.
“The negatives include a loss of autonomy, a potential loss of personal ownership of our patients’ health, and the loss of a unique personal culture of private practice. Physicians may be subject to metrics imposed by the employer. In addition, we may see more job turnover since physicians could be less invested emotionally and financially; fewer patients seen since the structure is often salary based and not based on productivity; and increased shift work, set work hours, and schedules. Thus, the employer-based model may actually contribute to the ongoing physician shortage.”
Dr. Levine stressed the role of training programs to prepare physicians for what may lie ahead. “Training programs must prepare physicians for what to expect as employees.”
Changing expectations
An evolution of expectations about a healthy work/life balance has occurred in many professions, including the health care profession. While younger practitioners may be more likely to embrace the changes occurring within health care, they are often more vocal about their desire for a healthy work/life balance and may be less likely to spend time away from family and friends rather than completing administrative tasks. Parenting is increasingly regarded by women and men as compatible with a full and rewarding career as a physician. So these changing expectations about work/life balances mean health care institutions will have to adjust their own expectations in order to recruit and maintain top-quality staff.
Stress and burnout
Workforce shortages, overwhelming administrative tasks, and a variety of forces that come with employment in a large medical system are causing stress and burnout in many physicians. In a 2018 Medscape study of more than 15,000 physicians, 42% reported burnout, and 15% admitted to experiencing either clinical or colloquial forms of depression.8 Dr. Levine acknowledges that many chest physicians are at risk for burnout. “In our field of medicine, particularly with those that practice in an intensive care setting, we are faced with the high stress and emotional experiences we encounter in the life and death nature of our jobs. We care for the sickest patient population, and are often facing life and death clinical needs as well as end-of-life discussions and care. Burnout is a potential threat to both patient safety and the quality of healthcare that we practice.”
Dr. Levine strongly urges colleagues to remain vigilant to this potentially devastating condition in their fellow physicians and in themselves. She said, “If you suspect you are feeling the symptoms of burnout, or have been told so by a colleague, then talk to a peer or colleague, take personal time to do something you enjoy, and/or join a support group. But better than that, try to preempt burnout by developing a strong emotional peer support group in or out of work, practicing mindfulness training, and paying attention to wellness and self-care.”
Burnout is finally being recognized by medical institutions as a significant factor in physician health and performance, and in the recruitment and attrition of staff. Dr. Levine sees progress in how health care institutions deal with burnout, wellness, and work/life balance among staff and trainees. In a hopeful note, Dr. Levine suggested that institutional responses to burnout and the workplace factors that fuel burnout may improve work conditions for physicians in the future.
These trends in the U.S. economy and workforce will mean a steady growth of the health care sector for the foreseeable future, continued political and social pressure to control costs, fewer physicians in private practice, and a potential move away from unhealthy work/life ratios currently so common among physicians.
Dr. Levine concluded that it is up to training programs to prepare trainees for these sea changes to the practice of medicine.
References
1. https://www.healthleadersmedia.com/finance/healthcare-spending-20-gdp-thats-economy-wide-problem
2. PwC Health Research Institute
3. https://www.bls.gov/ooh/healthcare/home.htm
4. https://www.hfma.org/Content.aspx?id=60811
5. https://www.ama-assn.org/about-ama/research/physician-practice-benchmark-survey
6. http://www.physiciansadvocacyinstitute.org/
7. https://omahamedical.com/wp-content/uploads/2016/12/2016-Survey-of-Americas-Physicians-Practice-Patterns-and-Perspectives.pdf
8. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235
The health care workforce is being transformed by profound demographic changes and the steady growth of the U.S. health sector. In addition, the movement of physicians out of private practice to employment by medical centers has accelerated. And a new generation of health care professionals is demanding a sustainable work/life balance. These trends will combine to change the work environment of chest physicians.
Spending
The United States spends about twice as much on health care as any other industrialized nation and this fact is driving an increasingly urgent public discussion about options and means of reducing costs.1 Medicare and Medicaid already account for about a quarter of federal government spending and those numbers are expected to rise as baby boomers age.1 Employer spending on health care as a percentage of wages has doubled since the 1980s.2
Workforce supply
An expanding health care sector means a growing demand for health care labor. Health care occupations are projected to grow 18% from 2016 to 2026, faster than the average for all occupations and adding 2.4 million new jobs to the economy.3 Expert testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions in May 2018 projected shortages of physicians in the coming years. According to estimates of the Health Resources and Services Administration (HRSA), there is a need for 13,800 additional primary care physicians in areas – especially rural – that are designated as health professional shortage areas. Signs of a worsening situation include projected shortages of 20,000 primary care physicians by 2025, according to HRSA, and 42,600-121,300 physicians by 2030, according to the Association of American Medical Colleges. The demand for physicians will exceed supply by 46,000-90,000 by 2025. An update to that research increased the projected shortage range to 61,700-94,700 by 2025.4 These shortages will result in recruiting challenges for many medical centers, especially those in rural areas.
Employment
Private practice is becoming the less common structure of employment for physicians. According to American Medical Association data, physician ownership of practices dropped below 50% for the first time in 2016.5 The trend toward employed versus private practice physicians is expected to continue. The size of practices is growing, with about one-third of physicians working in a hospital-owned practice or employed directly by a hospital and around 40% in practices of 10 physicians or more.5 Of every 10 physician practices, 3 were hospital owned in 2016.6 Physicians are being called upon to do more data entry and administrative work; 21% of physicians’ time is now spent on nonclinical paperwork.7 The ripple-out effects of what amounts to a seismic shift in the work structure and work environment for physicians are only beginning to be studied in terms of overall personal satisfaction and impact on patient care.
Stephanie M. Levine, MD, FCCP, the designate president of the American College of Chest Physicians and professor of medicine in the division of pulmonary diseases and critical care medicine at the University of Texas, San Antonio, recognizes the significance of the move from private practice to employment and suggests that advantages could be offset by some potential negatives practicing chest physicians. She noted, “Pros include potentially more job security, more predictable work hours, perhaps a reduction in some of the traditional administrative ‘hassles’ with running a private practice, and possibly a better and healthier work/life balance. Some think that physician input and leadership in the employed model may have more influence on a health care system than in an individual private practice. Nonclinical work may be decreased, but it is not clear that this is true.
“The negatives include a loss of autonomy, a potential loss of personal ownership of our patients’ health, and the loss of a unique personal culture of private practice. Physicians may be subject to metrics imposed by the employer. In addition, we may see more job turnover since physicians could be less invested emotionally and financially; fewer patients seen since the structure is often salary based and not based on productivity; and increased shift work, set work hours, and schedules. Thus, the employer-based model may actually contribute to the ongoing physician shortage.”
Dr. Levine stressed the role of training programs to prepare physicians for what may lie ahead. “Training programs must prepare physicians for what to expect as employees.”
Changing expectations
An evolution of expectations about a healthy work/life balance has occurred in many professions, including the health care profession. While younger practitioners may be more likely to embrace the changes occurring within health care, they are often more vocal about their desire for a healthy work/life balance and may be less likely to spend time away from family and friends rather than completing administrative tasks. Parenting is increasingly regarded by women and men as compatible with a full and rewarding career as a physician. So these changing expectations about work/life balances mean health care institutions will have to adjust their own expectations in order to recruit and maintain top-quality staff.
Stress and burnout
Workforce shortages, overwhelming administrative tasks, and a variety of forces that come with employment in a large medical system are causing stress and burnout in many physicians. In a 2018 Medscape study of more than 15,000 physicians, 42% reported burnout, and 15% admitted to experiencing either clinical or colloquial forms of depression.8 Dr. Levine acknowledges that many chest physicians are at risk for burnout. “In our field of medicine, particularly with those that practice in an intensive care setting, we are faced with the high stress and emotional experiences we encounter in the life and death nature of our jobs. We care for the sickest patient population, and are often facing life and death clinical needs as well as end-of-life discussions and care. Burnout is a potential threat to both patient safety and the quality of healthcare that we practice.”
Dr. Levine strongly urges colleagues to remain vigilant to this potentially devastating condition in their fellow physicians and in themselves. She said, “If you suspect you are feeling the symptoms of burnout, or have been told so by a colleague, then talk to a peer or colleague, take personal time to do something you enjoy, and/or join a support group. But better than that, try to preempt burnout by developing a strong emotional peer support group in or out of work, practicing mindfulness training, and paying attention to wellness and self-care.”
Burnout is finally being recognized by medical institutions as a significant factor in physician health and performance, and in the recruitment and attrition of staff. Dr. Levine sees progress in how health care institutions deal with burnout, wellness, and work/life balance among staff and trainees. In a hopeful note, Dr. Levine suggested that institutional responses to burnout and the workplace factors that fuel burnout may improve work conditions for physicians in the future.
These trends in the U.S. economy and workforce will mean a steady growth of the health care sector for the foreseeable future, continued political and social pressure to control costs, fewer physicians in private practice, and a potential move away from unhealthy work/life ratios currently so common among physicians.
Dr. Levine concluded that it is up to training programs to prepare trainees for these sea changes to the practice of medicine.
References
1. https://www.healthleadersmedia.com/finance/healthcare-spending-20-gdp-thats-economy-wide-problem
2. PwC Health Research Institute
3. https://www.bls.gov/ooh/healthcare/home.htm
4. https://www.hfma.org/Content.aspx?id=60811
5. https://www.ama-assn.org/about-ama/research/physician-practice-benchmark-survey
6. http://www.physiciansadvocacyinstitute.org/
7. https://omahamedical.com/wp-content/uploads/2016/12/2016-Survey-of-Americas-Physicians-Practice-Patterns-and-Perspectives.pdf
8. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235
The health care workforce is being transformed by profound demographic changes and the steady growth of the U.S. health sector. In addition, the movement of physicians out of private practice to employment by medical centers has accelerated. And a new generation of health care professionals is demanding a sustainable work/life balance. These trends will combine to change the work environment of chest physicians.
Spending
The United States spends about twice as much on health care as any other industrialized nation and this fact is driving an increasingly urgent public discussion about options and means of reducing costs.1 Medicare and Medicaid already account for about a quarter of federal government spending and those numbers are expected to rise as baby boomers age.1 Employer spending on health care as a percentage of wages has doubled since the 1980s.2
Workforce supply
An expanding health care sector means a growing demand for health care labor. Health care occupations are projected to grow 18% from 2016 to 2026, faster than the average for all occupations and adding 2.4 million new jobs to the economy.3 Expert testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions in May 2018 projected shortages of physicians in the coming years. According to estimates of the Health Resources and Services Administration (HRSA), there is a need for 13,800 additional primary care physicians in areas – especially rural – that are designated as health professional shortage areas. Signs of a worsening situation include projected shortages of 20,000 primary care physicians by 2025, according to HRSA, and 42,600-121,300 physicians by 2030, according to the Association of American Medical Colleges. The demand for physicians will exceed supply by 46,000-90,000 by 2025. An update to that research increased the projected shortage range to 61,700-94,700 by 2025.4 These shortages will result in recruiting challenges for many medical centers, especially those in rural areas.
Employment
Private practice is becoming the less common structure of employment for physicians. According to American Medical Association data, physician ownership of practices dropped below 50% for the first time in 2016.5 The trend toward employed versus private practice physicians is expected to continue. The size of practices is growing, with about one-third of physicians working in a hospital-owned practice or employed directly by a hospital and around 40% in practices of 10 physicians or more.5 Of every 10 physician practices, 3 were hospital owned in 2016.6 Physicians are being called upon to do more data entry and administrative work; 21% of physicians’ time is now spent on nonclinical paperwork.7 The ripple-out effects of what amounts to a seismic shift in the work structure and work environment for physicians are only beginning to be studied in terms of overall personal satisfaction and impact on patient care.
Stephanie M. Levine, MD, FCCP, the designate president of the American College of Chest Physicians and professor of medicine in the division of pulmonary diseases and critical care medicine at the University of Texas, San Antonio, recognizes the significance of the move from private practice to employment and suggests that advantages could be offset by some potential negatives practicing chest physicians. She noted, “Pros include potentially more job security, more predictable work hours, perhaps a reduction in some of the traditional administrative ‘hassles’ with running a private practice, and possibly a better and healthier work/life balance. Some think that physician input and leadership in the employed model may have more influence on a health care system than in an individual private practice. Nonclinical work may be decreased, but it is not clear that this is true.
“The negatives include a loss of autonomy, a potential loss of personal ownership of our patients’ health, and the loss of a unique personal culture of private practice. Physicians may be subject to metrics imposed by the employer. In addition, we may see more job turnover since physicians could be less invested emotionally and financially; fewer patients seen since the structure is often salary based and not based on productivity; and increased shift work, set work hours, and schedules. Thus, the employer-based model may actually contribute to the ongoing physician shortage.”
Dr. Levine stressed the role of training programs to prepare physicians for what may lie ahead. “Training programs must prepare physicians for what to expect as employees.”
Changing expectations
An evolution of expectations about a healthy work/life balance has occurred in many professions, including the health care profession. While younger practitioners may be more likely to embrace the changes occurring within health care, they are often more vocal about their desire for a healthy work/life balance and may be less likely to spend time away from family and friends rather than completing administrative tasks. Parenting is increasingly regarded by women and men as compatible with a full and rewarding career as a physician. So these changing expectations about work/life balances mean health care institutions will have to adjust their own expectations in order to recruit and maintain top-quality staff.
Stress and burnout
Workforce shortages, overwhelming administrative tasks, and a variety of forces that come with employment in a large medical system are causing stress and burnout in many physicians. In a 2018 Medscape study of more than 15,000 physicians, 42% reported burnout, and 15% admitted to experiencing either clinical or colloquial forms of depression.8 Dr. Levine acknowledges that many chest physicians are at risk for burnout. “In our field of medicine, particularly with those that practice in an intensive care setting, we are faced with the high stress and emotional experiences we encounter in the life and death nature of our jobs. We care for the sickest patient population, and are often facing life and death clinical needs as well as end-of-life discussions and care. Burnout is a potential threat to both patient safety and the quality of healthcare that we practice.”
Dr. Levine strongly urges colleagues to remain vigilant to this potentially devastating condition in their fellow physicians and in themselves. She said, “If you suspect you are feeling the symptoms of burnout, or have been told so by a colleague, then talk to a peer or colleague, take personal time to do something you enjoy, and/or join a support group. But better than that, try to preempt burnout by developing a strong emotional peer support group in or out of work, practicing mindfulness training, and paying attention to wellness and self-care.”
Burnout is finally being recognized by medical institutions as a significant factor in physician health and performance, and in the recruitment and attrition of staff. Dr. Levine sees progress in how health care institutions deal with burnout, wellness, and work/life balance among staff and trainees. In a hopeful note, Dr. Levine suggested that institutional responses to burnout and the workplace factors that fuel burnout may improve work conditions for physicians in the future.
These trends in the U.S. economy and workforce will mean a steady growth of the health care sector for the foreseeable future, continued political and social pressure to control costs, fewer physicians in private practice, and a potential move away from unhealthy work/life ratios currently so common among physicians.
Dr. Levine concluded that it is up to training programs to prepare trainees for these sea changes to the practice of medicine.
References
1. https://www.healthleadersmedia.com/finance/healthcare-spending-20-gdp-thats-economy-wide-problem
2. PwC Health Research Institute
3. https://www.bls.gov/ooh/healthcare/home.htm
4. https://www.hfma.org/Content.aspx?id=60811
5. https://www.ama-assn.org/about-ama/research/physician-practice-benchmark-survey
6. http://www.physiciansadvocacyinstitute.org/
7. https://omahamedical.com/wp-content/uploads/2016/12/2016-Survey-of-Americas-Physicians-Practice-Patterns-and-Perspectives.pdf
8. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235
CHEST Clinical Perspectives explores the emerging field of precision medicine
For clinicians seeking to provide a pathway to treatment or diagnosis that is individualized to the patient, a recent study found that the issues go beyond awareness or a patient’s degree of comfort – there remains the question of something as simple as: what should we call it?
Clinicians remain uncertain whether to name the new field precision or personalized medicine according the new CHEST Clinical PerspectivesTM white paper, “Precision Medicine: Adoption of Emerging Methods of Evaluation and Therapy.” A survey of leading community clinicians from among CHEST membership found that only 35 % called tailoring medical treatment to the individual characteristics of each patient “precision medicine,” with 24% preferring “personalized” medicine. Thirty-six percent of respondents used the terms interchangeably.
Beyond the communication issues, the study found that most clinicians surveyed did not know enough about precision medicine to adopt it into their practice. Those surveyed reported that they wanted to see more published studies on the effectiveness of the newly available tools before discussing these options with their patients.
The majority of the respondents were general pulmonologists with intensivists and interventional pulmonologists also responding. The study was led by Nichole T. Tanner, MD, MSCR, FCCP, of the Medical University of South Carolina. Dr Tanner will be hosting a webinar to review the conclusions of this paper at 10:00 AM CT on Tuesday, July 30.
More information about CHEST Clinical PerspectivesTM, part of the CHEST Analytics program, can be found at insights.chestnet.org. To suggest a topic to be covered in a future issue, contact Linda Tomczynski, [email protected] or +1 (224) 521-9593. Register today at https://hubs.ly/H0jqCGb0.
For clinicians seeking to provide a pathway to treatment or diagnosis that is individualized to the patient, a recent study found that the issues go beyond awareness or a patient’s degree of comfort – there remains the question of something as simple as: what should we call it?
Clinicians remain uncertain whether to name the new field precision or personalized medicine according the new CHEST Clinical PerspectivesTM white paper, “Precision Medicine: Adoption of Emerging Methods of Evaluation and Therapy.” A survey of leading community clinicians from among CHEST membership found that only 35 % called tailoring medical treatment to the individual characteristics of each patient “precision medicine,” with 24% preferring “personalized” medicine. Thirty-six percent of respondents used the terms interchangeably.
Beyond the communication issues, the study found that most clinicians surveyed did not know enough about precision medicine to adopt it into their practice. Those surveyed reported that they wanted to see more published studies on the effectiveness of the newly available tools before discussing these options with their patients.
The majority of the respondents were general pulmonologists with intensivists and interventional pulmonologists also responding. The study was led by Nichole T. Tanner, MD, MSCR, FCCP, of the Medical University of South Carolina. Dr Tanner will be hosting a webinar to review the conclusions of this paper at 10:00 AM CT on Tuesday, July 30.
More information about CHEST Clinical PerspectivesTM, part of the CHEST Analytics program, can be found at insights.chestnet.org. To suggest a topic to be covered in a future issue, contact Linda Tomczynski, [email protected] or +1 (224) 521-9593. Register today at https://hubs.ly/H0jqCGb0.
For clinicians seeking to provide a pathway to treatment or diagnosis that is individualized to the patient, a recent study found that the issues go beyond awareness or a patient’s degree of comfort – there remains the question of something as simple as: what should we call it?
Clinicians remain uncertain whether to name the new field precision or personalized medicine according the new CHEST Clinical PerspectivesTM white paper, “Precision Medicine: Adoption of Emerging Methods of Evaluation and Therapy.” A survey of leading community clinicians from among CHEST membership found that only 35 % called tailoring medical treatment to the individual characteristics of each patient “precision medicine,” with 24% preferring “personalized” medicine. Thirty-six percent of respondents used the terms interchangeably.
Beyond the communication issues, the study found that most clinicians surveyed did not know enough about precision medicine to adopt it into their practice. Those surveyed reported that they wanted to see more published studies on the effectiveness of the newly available tools before discussing these options with their patients.
The majority of the respondents were general pulmonologists with intensivists and interventional pulmonologists also responding. The study was led by Nichole T. Tanner, MD, MSCR, FCCP, of the Medical University of South Carolina. Dr Tanner will be hosting a webinar to review the conclusions of this paper at 10:00 AM CT on Tuesday, July 30.
More information about CHEST Clinical PerspectivesTM, part of the CHEST Analytics program, can be found at insights.chestnet.org. To suggest a topic to be covered in a future issue, contact Linda Tomczynski, [email protected] or +1 (224) 521-9593. Register today at https://hubs.ly/H0jqCGb0.
Environmental Scan: Drivers of change in health care
CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: the CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.
Chest physicians are witnessing a revolution within the environment in which they practice. Information technology, changing consumer behavior, and the social imperative to contain costs are coming together to transform health care.
Innovation in the prevention, diagnosis, and treatment of health-related issues is being fueled by the emergence of accessible and affordable technology-based solutions and changes in patient approaches to health care. Consumers and employers are increasingly motivated to look for cost-effective options for health in care delivery and for economical access to innovations.1 Organizations will need to respond with a strategy that aligns with the changing environment and position physicians to lead these trends in the direction of improved patient care.2
Enabling technologies like electronic health records, blockchain, and artificial intelligence will increase connectivity among all the stakeholders in the health-care system. The exponential increase in connectivity means growing engagement of health systems, health plans, patients, and families in all aspects of health care. For health-care providers, these technologies will mean an acceleration of the requirement to generate data in clinical settings and utilize data for clinical decision making. Easily available data on outcomes and, most importantly, cost of treatment will be expected at point of service.3
Access to information will continue to empower consumers to take an active role in their own health care. More patients will be comfortable with delivery of some health care via digital devices, apps, and virtual access to treatment. The market will respond with technology that helps consumers navigate health-care systems, explore options, and communicate directly with providers. The use of apps and virtual encounters is expected to transform the role of primary care providers: patients will increasingly utilize nonphysician resources in outpatient settings, bypassing primary care physicians and reaching out to specialty care as needed.4
David A. Schulman, MD, FCCP, Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, and Editor in Chief of CHEST Physician, has seen the transformation of patient behavior and attitudes in his own practice.
“In general, they have done far more research about their health problems before seeking my counsel than patients did previously. Many use the internet not just to read about their symptoms and diseases, but also to connect with others having similar issues, sharing experiences, treatments, outcomes, and emotions; in some ways, this is the new ‘crowdsourcing’ of medicine.”
Patients who do their own “research” can present a challenge for physicians. Dr. Schulman noted, “I am often surprised about the misconceptions about disease that derive from information gleaned from a web-based source. One need not look any farther than the groundswell of misinformation being spread about vaccinations to see the potential downside of the pervasive availability of medical ‘facts’ online. Since we are unlikely to convince our patients to avoid the online milieu entirely, our role as health-care providers is to help our patients process and appropriately weigh the information that they receive, potentially partnering with our national societies to help curate such information.”
Dr. Schulman’s approach to the potential of patient misinformation is to initiate almost all discussions with patients with the question “Have your read or seen anything about this condition?” He said, “It is rare for patients to answer negatively. And listening to them speak about their understanding of their disease provides me with invaluable information about how the remainder of our visit should be spent. Do we need to correct misunderstandings? Are there gaps in the explanation that I can fill? Can we move directly into a conversation about treatment options? Can I provide you with some additional resources that might help to further your knowledge about the condition?”
Generational factors will play a big role in health-care demand and delivery. Health-care companies are already building lower cost delivery models to capture the millennial market.4 Cost-saving digital tools and virtual contacts are currently most commonly used by younger patients.5 Physicians need to understand and be a part of this trend, Dr. Schulman argued. “We should embrace telemedicine and mobile applications to collect data from the patients in their day-to-day lives. While insurance coverage of telemedicine is far from universal at the moment, and the reliability of mobile applications is highly variable, we know that a growing number of our patients are already relying on their digital devices to manage their health. In much the same way that we will need to help patient evaluate online information, we should work with our national societies to support the creation of tools that will allow us to collect data in the home environment in a more robust and reliable fashion.”
The proportion of the US population over the age of 65 is increasing yearly.6 Six out of 10 Americans live with a chronic illness, such as heart disease or diabetes. These and other chronic diseases are the leading drivers of the $3.3 billion annual health-care costs.7 Cost containment for these older patients and those with chronic illness will involve a focus on quality and outcomes data, a drive to deliver treatment in lower cost outpatient settings, and an acceleration of the adoption of value-based models currently underway.8
Taken together, these trends will mean a growing digital interface between physician and patient, a more active consumer-patient, and the availability of a vast array of new tools to access and manage health-care data.
- Delivery of procedures and services will trend from physicians to other members of the health-care team and to lower cost, outpatient settings.9
- Health-care systems will ramp up investment in products and services that improve outcomes and cost effectiveness.10
- Increased regulatory requirements and new payment models mean an ever-growing utilization of information technology by providers to fulfill data imperatives.11
- Physicians will have an increased need for tools that prioritize costs and outcomes data at the point of care.12
- Integration of data from new technologies will touch every aspect of health-care delivery with the objective of improving outcomes and, in turn, reducing costs.13
- Changing consumer attitudes toward delivery of care will be based on a growing familiarity of patients with a digital or virtual interface with providers, facility with health-care apps, and preference for a menu of options for health-care delivery.14
Dr. Schulman concluded, “We can no more expect our patients to ignore the full panoply of medical information on the internet and digital tools on their mobile devices than we can tell the tide not to come in. The die is cast; this is the world within which we must ply our trade. By identifying best practices and sharing our successes, we can come through this revolution better for the experience.”
References
1. https://www.modernhealthcare.com/article/20181220/NEWS/181229992/number-of-outpatient-facilities-surges-as-industry-values-more
2. https://www.accenture.com/us-en/insights/health/digital-health-tech-vision-2018
3. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
4. PcW Health Research Institute: Top health industry issues of 2019
5. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
6. https://www.census.gov/newsroom/press-releases/2017/cb17-100.html
7. https://www.cdc.gov/chronicdisease/index.htm
8. https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/health-care-current-december4-2018.html
9. PcW Health Research Institute Top health industry issues of 2019: The New Health Economy comes of age
10. https://www.accenture.com/us-en/insights/health/digital-health-tech-vision-2018
11. https://www2.deloitte.com/insights/us/en/industry/life-sciences/medtech-research-and-development-innovation.html
12. https://www2.deloitte.com/insights/us/en/industry/health-care/volume-to-value-based-care.html
13. https://www2.deloitte.com/insights/us/en/industry/health-care/volume-to-value-based-care.html
14. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: the CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.
Chest physicians are witnessing a revolution within the environment in which they practice. Information technology, changing consumer behavior, and the social imperative to contain costs are coming together to transform health care.
Innovation in the prevention, diagnosis, and treatment of health-related issues is being fueled by the emergence of accessible and affordable technology-based solutions and changes in patient approaches to health care. Consumers and employers are increasingly motivated to look for cost-effective options for health in care delivery and for economical access to innovations.1 Organizations will need to respond with a strategy that aligns with the changing environment and position physicians to lead these trends in the direction of improved patient care.2
Enabling technologies like electronic health records, blockchain, and artificial intelligence will increase connectivity among all the stakeholders in the health-care system. The exponential increase in connectivity means growing engagement of health systems, health plans, patients, and families in all aspects of health care. For health-care providers, these technologies will mean an acceleration of the requirement to generate data in clinical settings and utilize data for clinical decision making. Easily available data on outcomes and, most importantly, cost of treatment will be expected at point of service.3
Access to information will continue to empower consumers to take an active role in their own health care. More patients will be comfortable with delivery of some health care via digital devices, apps, and virtual access to treatment. The market will respond with technology that helps consumers navigate health-care systems, explore options, and communicate directly with providers. The use of apps and virtual encounters is expected to transform the role of primary care providers: patients will increasingly utilize nonphysician resources in outpatient settings, bypassing primary care physicians and reaching out to specialty care as needed.4
David A. Schulman, MD, FCCP, Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, and Editor in Chief of CHEST Physician, has seen the transformation of patient behavior and attitudes in his own practice.
“In general, they have done far more research about their health problems before seeking my counsel than patients did previously. Many use the internet not just to read about their symptoms and diseases, but also to connect with others having similar issues, sharing experiences, treatments, outcomes, and emotions; in some ways, this is the new ‘crowdsourcing’ of medicine.”
Patients who do their own “research” can present a challenge for physicians. Dr. Schulman noted, “I am often surprised about the misconceptions about disease that derive from information gleaned from a web-based source. One need not look any farther than the groundswell of misinformation being spread about vaccinations to see the potential downside of the pervasive availability of medical ‘facts’ online. Since we are unlikely to convince our patients to avoid the online milieu entirely, our role as health-care providers is to help our patients process and appropriately weigh the information that they receive, potentially partnering with our national societies to help curate such information.”
Dr. Schulman’s approach to the potential of patient misinformation is to initiate almost all discussions with patients with the question “Have your read or seen anything about this condition?” He said, “It is rare for patients to answer negatively. And listening to them speak about their understanding of their disease provides me with invaluable information about how the remainder of our visit should be spent. Do we need to correct misunderstandings? Are there gaps in the explanation that I can fill? Can we move directly into a conversation about treatment options? Can I provide you with some additional resources that might help to further your knowledge about the condition?”
Generational factors will play a big role in health-care demand and delivery. Health-care companies are already building lower cost delivery models to capture the millennial market.4 Cost-saving digital tools and virtual contacts are currently most commonly used by younger patients.5 Physicians need to understand and be a part of this trend, Dr. Schulman argued. “We should embrace telemedicine and mobile applications to collect data from the patients in their day-to-day lives. While insurance coverage of telemedicine is far from universal at the moment, and the reliability of mobile applications is highly variable, we know that a growing number of our patients are already relying on their digital devices to manage their health. In much the same way that we will need to help patient evaluate online information, we should work with our national societies to support the creation of tools that will allow us to collect data in the home environment in a more robust and reliable fashion.”
The proportion of the US population over the age of 65 is increasing yearly.6 Six out of 10 Americans live with a chronic illness, such as heart disease or diabetes. These and other chronic diseases are the leading drivers of the $3.3 billion annual health-care costs.7 Cost containment for these older patients and those with chronic illness will involve a focus on quality and outcomes data, a drive to deliver treatment in lower cost outpatient settings, and an acceleration of the adoption of value-based models currently underway.8
Taken together, these trends will mean a growing digital interface between physician and patient, a more active consumer-patient, and the availability of a vast array of new tools to access and manage health-care data.
- Delivery of procedures and services will trend from physicians to other members of the health-care team and to lower cost, outpatient settings.9
- Health-care systems will ramp up investment in products and services that improve outcomes and cost effectiveness.10
- Increased regulatory requirements and new payment models mean an ever-growing utilization of information technology by providers to fulfill data imperatives.11
- Physicians will have an increased need for tools that prioritize costs and outcomes data at the point of care.12
- Integration of data from new technologies will touch every aspect of health-care delivery with the objective of improving outcomes and, in turn, reducing costs.13
- Changing consumer attitudes toward delivery of care will be based on a growing familiarity of patients with a digital or virtual interface with providers, facility with health-care apps, and preference for a menu of options for health-care delivery.14
Dr. Schulman concluded, “We can no more expect our patients to ignore the full panoply of medical information on the internet and digital tools on their mobile devices than we can tell the tide not to come in. The die is cast; this is the world within which we must ply our trade. By identifying best practices and sharing our successes, we can come through this revolution better for the experience.”
References
1. https://www.modernhealthcare.com/article/20181220/NEWS/181229992/number-of-outpatient-facilities-surges-as-industry-values-more
2. https://www.accenture.com/us-en/insights/health/digital-health-tech-vision-2018
3. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
4. PcW Health Research Institute: Top health industry issues of 2019
5. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
6. https://www.census.gov/newsroom/press-releases/2017/cb17-100.html
7. https://www.cdc.gov/chronicdisease/index.htm
8. https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/health-care-current-december4-2018.html
9. PcW Health Research Institute Top health industry issues of 2019: The New Health Economy comes of age
10. https://www.accenture.com/us-en/insights/health/digital-health-tech-vision-2018
11. https://www2.deloitte.com/insights/us/en/industry/life-sciences/medtech-research-and-development-innovation.html
12. https://www2.deloitte.com/insights/us/en/industry/health-care/volume-to-value-based-care.html
13. https://www2.deloitte.com/insights/us/en/industry/health-care/volume-to-value-based-care.html
14. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: the CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.
Chest physicians are witnessing a revolution within the environment in which they practice. Information technology, changing consumer behavior, and the social imperative to contain costs are coming together to transform health care.
Innovation in the prevention, diagnosis, and treatment of health-related issues is being fueled by the emergence of accessible and affordable technology-based solutions and changes in patient approaches to health care. Consumers and employers are increasingly motivated to look for cost-effective options for health in care delivery and for economical access to innovations.1 Organizations will need to respond with a strategy that aligns with the changing environment and position physicians to lead these trends in the direction of improved patient care.2
Enabling technologies like electronic health records, blockchain, and artificial intelligence will increase connectivity among all the stakeholders in the health-care system. The exponential increase in connectivity means growing engagement of health systems, health plans, patients, and families in all aspects of health care. For health-care providers, these technologies will mean an acceleration of the requirement to generate data in clinical settings and utilize data for clinical decision making. Easily available data on outcomes and, most importantly, cost of treatment will be expected at point of service.3
Access to information will continue to empower consumers to take an active role in their own health care. More patients will be comfortable with delivery of some health care via digital devices, apps, and virtual access to treatment. The market will respond with technology that helps consumers navigate health-care systems, explore options, and communicate directly with providers. The use of apps and virtual encounters is expected to transform the role of primary care providers: patients will increasingly utilize nonphysician resources in outpatient settings, bypassing primary care physicians and reaching out to specialty care as needed.4
David A. Schulman, MD, FCCP, Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, and Editor in Chief of CHEST Physician, has seen the transformation of patient behavior and attitudes in his own practice.
“In general, they have done far more research about their health problems before seeking my counsel than patients did previously. Many use the internet not just to read about their symptoms and diseases, but also to connect with others having similar issues, sharing experiences, treatments, outcomes, and emotions; in some ways, this is the new ‘crowdsourcing’ of medicine.”
Patients who do their own “research” can present a challenge for physicians. Dr. Schulman noted, “I am often surprised about the misconceptions about disease that derive from information gleaned from a web-based source. One need not look any farther than the groundswell of misinformation being spread about vaccinations to see the potential downside of the pervasive availability of medical ‘facts’ online. Since we are unlikely to convince our patients to avoid the online milieu entirely, our role as health-care providers is to help our patients process and appropriately weigh the information that they receive, potentially partnering with our national societies to help curate such information.”
Dr. Schulman’s approach to the potential of patient misinformation is to initiate almost all discussions with patients with the question “Have your read or seen anything about this condition?” He said, “It is rare for patients to answer negatively. And listening to them speak about their understanding of their disease provides me with invaluable information about how the remainder of our visit should be spent. Do we need to correct misunderstandings? Are there gaps in the explanation that I can fill? Can we move directly into a conversation about treatment options? Can I provide you with some additional resources that might help to further your knowledge about the condition?”
Generational factors will play a big role in health-care demand and delivery. Health-care companies are already building lower cost delivery models to capture the millennial market.4 Cost-saving digital tools and virtual contacts are currently most commonly used by younger patients.5 Physicians need to understand and be a part of this trend, Dr. Schulman argued. “We should embrace telemedicine and mobile applications to collect data from the patients in their day-to-day lives. While insurance coverage of telemedicine is far from universal at the moment, and the reliability of mobile applications is highly variable, we know that a growing number of our patients are already relying on their digital devices to manage their health. In much the same way that we will need to help patient evaluate online information, we should work with our national societies to support the creation of tools that will allow us to collect data in the home environment in a more robust and reliable fashion.”
The proportion of the US population over the age of 65 is increasing yearly.6 Six out of 10 Americans live with a chronic illness, such as heart disease or diabetes. These and other chronic diseases are the leading drivers of the $3.3 billion annual health-care costs.7 Cost containment for these older patients and those with chronic illness will involve a focus on quality and outcomes data, a drive to deliver treatment in lower cost outpatient settings, and an acceleration of the adoption of value-based models currently underway.8
Taken together, these trends will mean a growing digital interface between physician and patient, a more active consumer-patient, and the availability of a vast array of new tools to access and manage health-care data.
- Delivery of procedures and services will trend from physicians to other members of the health-care team and to lower cost, outpatient settings.9
- Health-care systems will ramp up investment in products and services that improve outcomes and cost effectiveness.10
- Increased regulatory requirements and new payment models mean an ever-growing utilization of information technology by providers to fulfill data imperatives.11
- Physicians will have an increased need for tools that prioritize costs and outcomes data at the point of care.12
- Integration of data from new technologies will touch every aspect of health-care delivery with the objective of improving outcomes and, in turn, reducing costs.13
- Changing consumer attitudes toward delivery of care will be based on a growing familiarity of patients with a digital or virtual interface with providers, facility with health-care apps, and preference for a menu of options for health-care delivery.14
Dr. Schulman concluded, “We can no more expect our patients to ignore the full panoply of medical information on the internet and digital tools on their mobile devices than we can tell the tide not to come in. The die is cast; this is the world within which we must ply our trade. By identifying best practices and sharing our successes, we can come through this revolution better for the experience.”
References
1. https://www.modernhealthcare.com/article/20181220/NEWS/181229992/number-of-outpatient-facilities-surges-as-industry-values-more
2. https://www.accenture.com/us-en/insights/health/digital-health-tech-vision-2018
3. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
4. PcW Health Research Institute: Top health industry issues of 2019
5. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
6. https://www.census.gov/newsroom/press-releases/2017/cb17-100.html
7. https://www.cdc.gov/chronicdisease/index.htm
8. https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/health-care-current-december4-2018.html
9. PcW Health Research Institute Top health industry issues of 2019: The New Health Economy comes of age
10. https://www.accenture.com/us-en/insights/health/digital-health-tech-vision-2018
11. https://www2.deloitte.com/insights/us/en/industry/life-sciences/medtech-research-and-development-innovation.html
12. https://www2.deloitte.com/insights/us/en/industry/health-care/volume-to-value-based-care.html
13. https://www2.deloitte.com/insights/us/en/industry/health-care/volume-to-value-based-care.html
14. https://www.accenture.com/us-en/insights/health/digital-health-primary-care
This month in the journal CHEST®
Editor’s picks
EDITORIAL
The CHEST Editorial Team: Serving Our Contributors and Readers
By Dr. P. J. Mazzone
ORIGINAL RESEARCH
Pulmonary Arterial Histologic Lesions in Patients With COPD With Severe Pulmonary Hypertension
By Dr. V. Bunel, et al.
Pulmonary Edema Following Initiation of Parenteral Prostacyclin Therapy for Pulmonary Arterial Hypertension: A Retrospective Study
By Dr. N. A. Khan, et al.
Lung Allocation Score Thresholds Prioritize Survival After Lung Transplantation
By Dr. S. S. Li, et al.
EVIDENCE-BASED MEDICINE
Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report
By Dr. A. B. Chang, et al.
Editor’s picks
Editor’s picks
EDITORIAL
The CHEST Editorial Team: Serving Our Contributors and Readers
By Dr. P. J. Mazzone
ORIGINAL RESEARCH
Pulmonary Arterial Histologic Lesions in Patients With COPD With Severe Pulmonary Hypertension
By Dr. V. Bunel, et al.
Pulmonary Edema Following Initiation of Parenteral Prostacyclin Therapy for Pulmonary Arterial Hypertension: A Retrospective Study
By Dr. N. A. Khan, et al.
Lung Allocation Score Thresholds Prioritize Survival After Lung Transplantation
By Dr. S. S. Li, et al.
EVIDENCE-BASED MEDICINE
Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report
By Dr. A. B. Chang, et al.
EDITORIAL
The CHEST Editorial Team: Serving Our Contributors and Readers
By Dr. P. J. Mazzone
ORIGINAL RESEARCH
Pulmonary Arterial Histologic Lesions in Patients With COPD With Severe Pulmonary Hypertension
By Dr. V. Bunel, et al.
Pulmonary Edema Following Initiation of Parenteral Prostacyclin Therapy for Pulmonary Arterial Hypertension: A Retrospective Study
By Dr. N. A. Khan, et al.
Lung Allocation Score Thresholds Prioritize Survival After Lung Transplantation
By Dr. S. S. Li, et al.
EVIDENCE-BASED MEDICINE
Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report
By Dr. A. B. Chang, et al.
Biologics. NetWork name change. Rapid sequence intubation. Competitive bidding. Genomic classifier.
Airways disorders
Asthma biologics: which patients?
Biologic therapies targeting specific inflammatory pathways promise “precision” medicine for severe asthma. Because these therapies are expensive and have different mechanisms of action, appropriate patient selection is crucial. To date, the biologics have been primarily used in severe asthma.
Severe asthma has been defined as “asthma which remains uncontrolled on high-dose inhaled corticosteroids plus a second controller for the previous year or systemic corticosteroids (for 50% or more of the previous year) to prevent it from becoming uncontrolled, or which remains uncontrolled despite this therapy” (Chung, et al. Eur Respir J. 2014;43:343).
Severe asthma is an infrequent to rare occurrence. Only 5% to 10 % of patients have severe asthma (Varsano, et al. Respir Med. 2017;123:131). Indeed, one study suggests that only 3.6% of patients meet criteria for it (Hekking, et al. J Allergy Clin Immunol. 2015;135[4]:896).
Not all difficult to control asthma is severe. With aggressive management of comorbidities and appropriate assessment of medication adherence/inhaler technique, up to 50% of uncontrolled asthmatics can reach therapeutic goals with traditional stepwise inhaler-based therapies (Tay, et al. J Allergy Clin Immunol Pract. 2017;5[4]:956; Hekking, et al. J Allergy Clin Immunol. 2015;135[4]:896). Yet, incorrect inhaler technique (MDI and DPI) is unacceptably frequent and has not improved over the past 40 years (Sanchis, et al. Chest. 2016;150[2]:394). Furthermore, correct inhaler technique was found in only 15.5% of health-care providers and has worsened in recent years (Plaza, et al. J Allergy Clin Immunol Pract. 2018;6[3]:987).
After establishing appropriate diagnosis, control of comorbidities, proper inhaler technique, and medication adherence, evaluation of a severe asthmatic’s inflammatory phenotype is necessary. Several phenotypes have emerged, including the severe allergic asthma phenotype and the severe eosinophilic asthma phenotype. Molecular phenotyping allows stratification into type–2–high vs type–2-low patients, which helps guide selection of the appropriate biologic. Options include: (1) anti-IgE (omalizumab); (2) anti-interleukin–5 (mepolizumab and reslizumab); (3) anti-interleukin-5 receptor alpha (benralizumab); and (4) anti-interleukin-4 receptor alpha and interleukin-13 (dupilumab).
Targeted biologics for specific severe asthma phenotypes may be cost effective long-term. However, long-term side effects need to be assessed and pharmaco-economic studies need to be performed.
Megan Conroy, MD
Steering Committee Fellow-in-Training
Stuart M. Garay, MD, FCCP
Steering Committee Chair
Clinical research and quality improvement
Anew, redefined, and enriched
CHEST Physician readers may not know that Clinical Research recently changed its name to include quality improvement (QI). Its new mission is “to provide a forum for clinical research, QI, research ethics, and regulatory aspects, as topics of multidisciplinary discussion and collaboration.” Medical education has become a natural addition to our NetWork’s scope, as this field of scholarly activity has emerged and grown tremendously in the past decade. Interestingly, the number of session submissions to CHEST 2019 increased by a whopping 32% vs 2018, while our NetWork saw an even more impressive increase of 42% in submissions deemed Clinical, Education Research, or QI.
The initial concept of a CHEST Clinical Research NetWork was narrower, aiming to fill gaps between our members’ interests and activities with those of pharmaceutical industry partners and equipment and device manufacturers. Its scope evolved, and our NetWork became the home of all clinical research endeavors not pinned to a specific condition, disease class, or membership category.
QI emerged in other industries long ago, using scientific methods and known to be foundational for any organization’s capacity to survive in competitive environments, become more efficient, satisfy customers, improve outcomes, and develop better work flows and conditions for employees and business partners.
If the QI world strives to achieve certainty with confidence levels less than 0.0001, it is interesting that in our scientific quest we settle for P less than .05. Self-indulgence? Simplistically speaking, are we tolerating “defect rates” of 5%, while others aim for 6 sigma thresholds? These are a few thoughts on how health care can learn from other industries and apply more stringent standards for scholarly activities in clinical research, education, and QI.
In conclusion, while it continues to strive to build the infrastructure of future CHEST clinical research nodes for randomized or observational multicentric studies, Clinical Research and QI NetWork enthusiastically embraces the fields of medical education and QI into its enriched activity scope and scale.
Octavian C. Ioachimescu, MD, PhD, FCCP
Steering Committee Member
Critical care
Rapid sequence intubation
Casey and colleagues recently published a study (N Engl J Med. 2019;380[9]:811) that challenges the long-held view that rapid sequence intubation (RSI) should not include ventilation attempts between induction and laryngoscopy. Airway management purists will say that true RSI is pre-oxygenate, give a sedation agent followed immediately by a paralytic agent, and immediate laryngoscopy as soon as the patient is paralyzed. However, RSI has come to mean the use of a sedation agent and a paralytic agent without specific timing of when to give the paralytic.
Purists would also say RSI is done for patients who are at a high risk for aspiration. In this study, the amount of subjectively reported aspiration was actually lower in the YES BVM group: 2.5% vs 4.0%. The presence of a new opacity on chest radiograph within 48 hours was 16% vs 15%, suggesting that there is no significant difference in the incidence of aspiration.
In this study, 40% in the NO BVM group and 30% in the YES BVM group had O2 desaturations below 90%. These statistics highlight the fact that it is imperative to pre-oxygenate all patients who will undergo intubation. Critically ill patients have little reserve. These patients are on the steep portion of the oxygen dissociation curve. The saturations will drop quickly. It is better to avoid any desaturation if possible.
This study demonstrates that bag-mask ventilation between induction and laryngoscopy can help prevent severe desaturation with a number needed to treat to prevent one severe hypoxic event is nine.
John Gaillard, MD, FCCP
Steering Committee Member
Home-based mechanical ventilation and neuromuscular disease
Pressures of competitive bidding process
Advancements in invasive and noninvasive ventilator technology have allowed patients with neuromuscular conditions and severe COPD to transition from institutional care to living at home. Ventilator support is reserved for severe or progressive respiratory impairment where interruption would lead to serious negative consequences. Access to this technology does entail significant cost, as monthly rental fees range from $660 to $1,352 and yearly ventilator claims for chronic respiratory failure have increased from 29% in 2009 to 85% in 2015 (US Dept HHS, OIG Data brief 2016). There is a current proposal to include home mechanical ventilators with oxygen and other services in competitive bidding programs (CBP). Since oxygen was included in CBP, access to liquid oxygen systems and payments for oxygen have decreased significantly. Of patients using home oxygen since July 1, 2016, 59% reported difficulties with access to oxygen-related equipment and services (American Association for Respiratory Care Comment on Federal policies, aarc.org).
Ventilator-dependent patients should not be subjected to the pressures of CBP when trying to obtain the equipment, supplies, and access to experienced medical providers that are necessary to remain in their homes. Beyond denying ventilatory support to some, CBP may also result in other unintended consequences, including the increased use of otherwise avoidable tracheostomies to ensure coverage for appropriate services. CHEST, including the Home-Based Mechanical Ventilation and Neuromuscular Disease NetWork and other patient groups, has advocated that home mechanical ventilators should be permanently excluded from the CBP to protect these fragile and vulnerable patients.
Jeanette Brown, MD, PhD
Steering Committee Member
Interstitial and diffuse lung disease
New genomic classifier
A confident diagnosis of idiopathic pulmonary fibrosis (IPF) relies on the radiographic pattern of usual interstitial pneumonitis (UIP), although in some cases, histologic confirmation is warranted. Transbronchial biopsy (TBBx) does not provide adequate tissue for diagnosis, thus patients are subjected to the risk of a surgical biopsy. A promising new test can increase confidence in the diagnosis of IPF. The Envisia Genomic Classifier (Veracyte) is a recently approved test to aid in the diagnosis of IPF. It utilizes 190 genes and RNA sequencing, combined with machine learning, to create an algorithm that determines the presence of UIP on samples derived from TBBx.
A proof-of-principle study described the characteristics of the genomic classifier in distinguishing UIP for 53 training subjects and 31 test subjects. To ensure validation, this new test was compared with a diagnosis determined by histopathologic review from expert pathologists. Specificity was 86% and sensitivity 63% in distinguishing UIP vs non-UIP patterns. Although false-negatives were a concern due to IPFs heterogeneous involvement of the lung, combining multiple specimens from a single patient increased accuracy.
The recently-published BRAVE study was a validation and utilization study, proving the test’s success in identifying UIP on TBBx samples. The test was again compared with diagnostic histopathology, demonstrating 88% specificity and 70% sensitivity. In addition, two multidisciplinary teams had an 86% agreement on diagnoses when using pathology vs the genomic classifier. The classifier is commercially available and is covered by Medicare in the United States.
As with all new technology, it is expected that its use will increase in the future and that we will learn more about how, and in whom, to best utilize this tool.
Samantha D’Annunzio, MD
Steering Committee Member
References
Pankratz DG, et al. Ann Am Thorac Soc. 2017;14[11]1646.
Raghu G, et al. Lancet Respir Med. 2019 Jun;7(6):487.
Airways disorders
Asthma biologics: which patients?
Biologic therapies targeting specific inflammatory pathways promise “precision” medicine for severe asthma. Because these therapies are expensive and have different mechanisms of action, appropriate patient selection is crucial. To date, the biologics have been primarily used in severe asthma.
Severe asthma has been defined as “asthma which remains uncontrolled on high-dose inhaled corticosteroids plus a second controller for the previous year or systemic corticosteroids (for 50% or more of the previous year) to prevent it from becoming uncontrolled, or which remains uncontrolled despite this therapy” (Chung, et al. Eur Respir J. 2014;43:343).
Severe asthma is an infrequent to rare occurrence. Only 5% to 10 % of patients have severe asthma (Varsano, et al. Respir Med. 2017;123:131). Indeed, one study suggests that only 3.6% of patients meet criteria for it (Hekking, et al. J Allergy Clin Immunol. 2015;135[4]:896).
Not all difficult to control asthma is severe. With aggressive management of comorbidities and appropriate assessment of medication adherence/inhaler technique, up to 50% of uncontrolled asthmatics can reach therapeutic goals with traditional stepwise inhaler-based therapies (Tay, et al. J Allergy Clin Immunol Pract. 2017;5[4]:956; Hekking, et al. J Allergy Clin Immunol. 2015;135[4]:896). Yet, incorrect inhaler technique (MDI and DPI) is unacceptably frequent and has not improved over the past 40 years (Sanchis, et al. Chest. 2016;150[2]:394). Furthermore, correct inhaler technique was found in only 15.5% of health-care providers and has worsened in recent years (Plaza, et al. J Allergy Clin Immunol Pract. 2018;6[3]:987).
After establishing appropriate diagnosis, control of comorbidities, proper inhaler technique, and medication adherence, evaluation of a severe asthmatic’s inflammatory phenotype is necessary. Several phenotypes have emerged, including the severe allergic asthma phenotype and the severe eosinophilic asthma phenotype. Molecular phenotyping allows stratification into type–2–high vs type–2-low patients, which helps guide selection of the appropriate biologic. Options include: (1) anti-IgE (omalizumab); (2) anti-interleukin–5 (mepolizumab and reslizumab); (3) anti-interleukin-5 receptor alpha (benralizumab); and (4) anti-interleukin-4 receptor alpha and interleukin-13 (dupilumab).
Targeted biologics for specific severe asthma phenotypes may be cost effective long-term. However, long-term side effects need to be assessed and pharmaco-economic studies need to be performed.
Megan Conroy, MD
Steering Committee Fellow-in-Training
Stuart M. Garay, MD, FCCP
Steering Committee Chair
Clinical research and quality improvement
Anew, redefined, and enriched
CHEST Physician readers may not know that Clinical Research recently changed its name to include quality improvement (QI). Its new mission is “to provide a forum for clinical research, QI, research ethics, and regulatory aspects, as topics of multidisciplinary discussion and collaboration.” Medical education has become a natural addition to our NetWork’s scope, as this field of scholarly activity has emerged and grown tremendously in the past decade. Interestingly, the number of session submissions to CHEST 2019 increased by a whopping 32% vs 2018, while our NetWork saw an even more impressive increase of 42% in submissions deemed Clinical, Education Research, or QI.
The initial concept of a CHEST Clinical Research NetWork was narrower, aiming to fill gaps between our members’ interests and activities with those of pharmaceutical industry partners and equipment and device manufacturers. Its scope evolved, and our NetWork became the home of all clinical research endeavors not pinned to a specific condition, disease class, or membership category.
QI emerged in other industries long ago, using scientific methods and known to be foundational for any organization’s capacity to survive in competitive environments, become more efficient, satisfy customers, improve outcomes, and develop better work flows and conditions for employees and business partners.
If the QI world strives to achieve certainty with confidence levels less than 0.0001, it is interesting that in our scientific quest we settle for P less than .05. Self-indulgence? Simplistically speaking, are we tolerating “defect rates” of 5%, while others aim for 6 sigma thresholds? These are a few thoughts on how health care can learn from other industries and apply more stringent standards for scholarly activities in clinical research, education, and QI.
In conclusion, while it continues to strive to build the infrastructure of future CHEST clinical research nodes for randomized or observational multicentric studies, Clinical Research and QI NetWork enthusiastically embraces the fields of medical education and QI into its enriched activity scope and scale.
Octavian C. Ioachimescu, MD, PhD, FCCP
Steering Committee Member
Critical care
Rapid sequence intubation
Casey and colleagues recently published a study (N Engl J Med. 2019;380[9]:811) that challenges the long-held view that rapid sequence intubation (RSI) should not include ventilation attempts between induction and laryngoscopy. Airway management purists will say that true RSI is pre-oxygenate, give a sedation agent followed immediately by a paralytic agent, and immediate laryngoscopy as soon as the patient is paralyzed. However, RSI has come to mean the use of a sedation agent and a paralytic agent without specific timing of when to give the paralytic.
Purists would also say RSI is done for patients who are at a high risk for aspiration. In this study, the amount of subjectively reported aspiration was actually lower in the YES BVM group: 2.5% vs 4.0%. The presence of a new opacity on chest radiograph within 48 hours was 16% vs 15%, suggesting that there is no significant difference in the incidence of aspiration.
In this study, 40% in the NO BVM group and 30% in the YES BVM group had O2 desaturations below 90%. These statistics highlight the fact that it is imperative to pre-oxygenate all patients who will undergo intubation. Critically ill patients have little reserve. These patients are on the steep portion of the oxygen dissociation curve. The saturations will drop quickly. It is better to avoid any desaturation if possible.
This study demonstrates that bag-mask ventilation between induction and laryngoscopy can help prevent severe desaturation with a number needed to treat to prevent one severe hypoxic event is nine.
John Gaillard, MD, FCCP
Steering Committee Member
Home-based mechanical ventilation and neuromuscular disease
Pressures of competitive bidding process
Advancements in invasive and noninvasive ventilator technology have allowed patients with neuromuscular conditions and severe COPD to transition from institutional care to living at home. Ventilator support is reserved for severe or progressive respiratory impairment where interruption would lead to serious negative consequences. Access to this technology does entail significant cost, as monthly rental fees range from $660 to $1,352 and yearly ventilator claims for chronic respiratory failure have increased from 29% in 2009 to 85% in 2015 (US Dept HHS, OIG Data brief 2016). There is a current proposal to include home mechanical ventilators with oxygen and other services in competitive bidding programs (CBP). Since oxygen was included in CBP, access to liquid oxygen systems and payments for oxygen have decreased significantly. Of patients using home oxygen since July 1, 2016, 59% reported difficulties with access to oxygen-related equipment and services (American Association for Respiratory Care Comment on Federal policies, aarc.org).
Ventilator-dependent patients should not be subjected to the pressures of CBP when trying to obtain the equipment, supplies, and access to experienced medical providers that are necessary to remain in their homes. Beyond denying ventilatory support to some, CBP may also result in other unintended consequences, including the increased use of otherwise avoidable tracheostomies to ensure coverage for appropriate services. CHEST, including the Home-Based Mechanical Ventilation and Neuromuscular Disease NetWork and other patient groups, has advocated that home mechanical ventilators should be permanently excluded from the CBP to protect these fragile and vulnerable patients.
Jeanette Brown, MD, PhD
Steering Committee Member
Interstitial and diffuse lung disease
New genomic classifier
A confident diagnosis of idiopathic pulmonary fibrosis (IPF) relies on the radiographic pattern of usual interstitial pneumonitis (UIP), although in some cases, histologic confirmation is warranted. Transbronchial biopsy (TBBx) does not provide adequate tissue for diagnosis, thus patients are subjected to the risk of a surgical biopsy. A promising new test can increase confidence in the diagnosis of IPF. The Envisia Genomic Classifier (Veracyte) is a recently approved test to aid in the diagnosis of IPF. It utilizes 190 genes and RNA sequencing, combined with machine learning, to create an algorithm that determines the presence of UIP on samples derived from TBBx.
A proof-of-principle study described the characteristics of the genomic classifier in distinguishing UIP for 53 training subjects and 31 test subjects. To ensure validation, this new test was compared with a diagnosis determined by histopathologic review from expert pathologists. Specificity was 86% and sensitivity 63% in distinguishing UIP vs non-UIP patterns. Although false-negatives were a concern due to IPFs heterogeneous involvement of the lung, combining multiple specimens from a single patient increased accuracy.
The recently-published BRAVE study was a validation and utilization study, proving the test’s success in identifying UIP on TBBx samples. The test was again compared with diagnostic histopathology, demonstrating 88% specificity and 70% sensitivity. In addition, two multidisciplinary teams had an 86% agreement on diagnoses when using pathology vs the genomic classifier. The classifier is commercially available and is covered by Medicare in the United States.
As with all new technology, it is expected that its use will increase in the future and that we will learn more about how, and in whom, to best utilize this tool.
Samantha D’Annunzio, MD
Steering Committee Member
References
Pankratz DG, et al. Ann Am Thorac Soc. 2017;14[11]1646.
Raghu G, et al. Lancet Respir Med. 2019 Jun;7(6):487.
Airways disorders
Asthma biologics: which patients?
Biologic therapies targeting specific inflammatory pathways promise “precision” medicine for severe asthma. Because these therapies are expensive and have different mechanisms of action, appropriate patient selection is crucial. To date, the biologics have been primarily used in severe asthma.
Severe asthma has been defined as “asthma which remains uncontrolled on high-dose inhaled corticosteroids plus a second controller for the previous year or systemic corticosteroids (for 50% or more of the previous year) to prevent it from becoming uncontrolled, or which remains uncontrolled despite this therapy” (Chung, et al. Eur Respir J. 2014;43:343).
Severe asthma is an infrequent to rare occurrence. Only 5% to 10 % of patients have severe asthma (Varsano, et al. Respir Med. 2017;123:131). Indeed, one study suggests that only 3.6% of patients meet criteria for it (Hekking, et al. J Allergy Clin Immunol. 2015;135[4]:896).
Not all difficult to control asthma is severe. With aggressive management of comorbidities and appropriate assessment of medication adherence/inhaler technique, up to 50% of uncontrolled asthmatics can reach therapeutic goals with traditional stepwise inhaler-based therapies (Tay, et al. J Allergy Clin Immunol Pract. 2017;5[4]:956; Hekking, et al. J Allergy Clin Immunol. 2015;135[4]:896). Yet, incorrect inhaler technique (MDI and DPI) is unacceptably frequent and has not improved over the past 40 years (Sanchis, et al. Chest. 2016;150[2]:394). Furthermore, correct inhaler technique was found in only 15.5% of health-care providers and has worsened in recent years (Plaza, et al. J Allergy Clin Immunol Pract. 2018;6[3]:987).
After establishing appropriate diagnosis, control of comorbidities, proper inhaler technique, and medication adherence, evaluation of a severe asthmatic’s inflammatory phenotype is necessary. Several phenotypes have emerged, including the severe allergic asthma phenotype and the severe eosinophilic asthma phenotype. Molecular phenotyping allows stratification into type–2–high vs type–2-low patients, which helps guide selection of the appropriate biologic. Options include: (1) anti-IgE (omalizumab); (2) anti-interleukin–5 (mepolizumab and reslizumab); (3) anti-interleukin-5 receptor alpha (benralizumab); and (4) anti-interleukin-4 receptor alpha and interleukin-13 (dupilumab).
Targeted biologics for specific severe asthma phenotypes may be cost effective long-term. However, long-term side effects need to be assessed and pharmaco-economic studies need to be performed.
Megan Conroy, MD
Steering Committee Fellow-in-Training
Stuart M. Garay, MD, FCCP
Steering Committee Chair
Clinical research and quality improvement
Anew, redefined, and enriched
CHEST Physician readers may not know that Clinical Research recently changed its name to include quality improvement (QI). Its new mission is “to provide a forum for clinical research, QI, research ethics, and regulatory aspects, as topics of multidisciplinary discussion and collaboration.” Medical education has become a natural addition to our NetWork’s scope, as this field of scholarly activity has emerged and grown tremendously in the past decade. Interestingly, the number of session submissions to CHEST 2019 increased by a whopping 32% vs 2018, while our NetWork saw an even more impressive increase of 42% in submissions deemed Clinical, Education Research, or QI.
The initial concept of a CHEST Clinical Research NetWork was narrower, aiming to fill gaps between our members’ interests and activities with those of pharmaceutical industry partners and equipment and device manufacturers. Its scope evolved, and our NetWork became the home of all clinical research endeavors not pinned to a specific condition, disease class, or membership category.
QI emerged in other industries long ago, using scientific methods and known to be foundational for any organization’s capacity to survive in competitive environments, become more efficient, satisfy customers, improve outcomes, and develop better work flows and conditions for employees and business partners.
If the QI world strives to achieve certainty with confidence levels less than 0.0001, it is interesting that in our scientific quest we settle for P less than .05. Self-indulgence? Simplistically speaking, are we tolerating “defect rates” of 5%, while others aim for 6 sigma thresholds? These are a few thoughts on how health care can learn from other industries and apply more stringent standards for scholarly activities in clinical research, education, and QI.
In conclusion, while it continues to strive to build the infrastructure of future CHEST clinical research nodes for randomized or observational multicentric studies, Clinical Research and QI NetWork enthusiastically embraces the fields of medical education and QI into its enriched activity scope and scale.
Octavian C. Ioachimescu, MD, PhD, FCCP
Steering Committee Member
Critical care
Rapid sequence intubation
Casey and colleagues recently published a study (N Engl J Med. 2019;380[9]:811) that challenges the long-held view that rapid sequence intubation (RSI) should not include ventilation attempts between induction and laryngoscopy. Airway management purists will say that true RSI is pre-oxygenate, give a sedation agent followed immediately by a paralytic agent, and immediate laryngoscopy as soon as the patient is paralyzed. However, RSI has come to mean the use of a sedation agent and a paralytic agent without specific timing of when to give the paralytic.
Purists would also say RSI is done for patients who are at a high risk for aspiration. In this study, the amount of subjectively reported aspiration was actually lower in the YES BVM group: 2.5% vs 4.0%. The presence of a new opacity on chest radiograph within 48 hours was 16% vs 15%, suggesting that there is no significant difference in the incidence of aspiration.
In this study, 40% in the NO BVM group and 30% in the YES BVM group had O2 desaturations below 90%. These statistics highlight the fact that it is imperative to pre-oxygenate all patients who will undergo intubation. Critically ill patients have little reserve. These patients are on the steep portion of the oxygen dissociation curve. The saturations will drop quickly. It is better to avoid any desaturation if possible.
This study demonstrates that bag-mask ventilation between induction and laryngoscopy can help prevent severe desaturation with a number needed to treat to prevent one severe hypoxic event is nine.
John Gaillard, MD, FCCP
Steering Committee Member
Home-based mechanical ventilation and neuromuscular disease
Pressures of competitive bidding process
Advancements in invasive and noninvasive ventilator technology have allowed patients with neuromuscular conditions and severe COPD to transition from institutional care to living at home. Ventilator support is reserved for severe or progressive respiratory impairment where interruption would lead to serious negative consequences. Access to this technology does entail significant cost, as monthly rental fees range from $660 to $1,352 and yearly ventilator claims for chronic respiratory failure have increased from 29% in 2009 to 85% in 2015 (US Dept HHS, OIG Data brief 2016). There is a current proposal to include home mechanical ventilators with oxygen and other services in competitive bidding programs (CBP). Since oxygen was included in CBP, access to liquid oxygen systems and payments for oxygen have decreased significantly. Of patients using home oxygen since July 1, 2016, 59% reported difficulties with access to oxygen-related equipment and services (American Association for Respiratory Care Comment on Federal policies, aarc.org).
Ventilator-dependent patients should not be subjected to the pressures of CBP when trying to obtain the equipment, supplies, and access to experienced medical providers that are necessary to remain in their homes. Beyond denying ventilatory support to some, CBP may also result in other unintended consequences, including the increased use of otherwise avoidable tracheostomies to ensure coverage for appropriate services. CHEST, including the Home-Based Mechanical Ventilation and Neuromuscular Disease NetWork and other patient groups, has advocated that home mechanical ventilators should be permanently excluded from the CBP to protect these fragile and vulnerable patients.
Jeanette Brown, MD, PhD
Steering Committee Member
Interstitial and diffuse lung disease
New genomic classifier
A confident diagnosis of idiopathic pulmonary fibrosis (IPF) relies on the radiographic pattern of usual interstitial pneumonitis (UIP), although in some cases, histologic confirmation is warranted. Transbronchial biopsy (TBBx) does not provide adequate tissue for diagnosis, thus patients are subjected to the risk of a surgical biopsy. A promising new test can increase confidence in the diagnosis of IPF. The Envisia Genomic Classifier (Veracyte) is a recently approved test to aid in the diagnosis of IPF. It utilizes 190 genes and RNA sequencing, combined with machine learning, to create an algorithm that determines the presence of UIP on samples derived from TBBx.
A proof-of-principle study described the characteristics of the genomic classifier in distinguishing UIP for 53 training subjects and 31 test subjects. To ensure validation, this new test was compared with a diagnosis determined by histopathologic review from expert pathologists. Specificity was 86% and sensitivity 63% in distinguishing UIP vs non-UIP patterns. Although false-negatives were a concern due to IPFs heterogeneous involvement of the lung, combining multiple specimens from a single patient increased accuracy.
The recently-published BRAVE study was a validation and utilization study, proving the test’s success in identifying UIP on TBBx samples. The test was again compared with diagnostic histopathology, demonstrating 88% specificity and 70% sensitivity. In addition, two multidisciplinary teams had an 86% agreement on diagnoses when using pathology vs the genomic classifier. The classifier is commercially available and is covered by Medicare in the United States.
As with all new technology, it is expected that its use will increase in the future and that we will learn more about how, and in whom, to best utilize this tool.
Samantha D’Annunzio, MD
Steering Committee Member
References
Pankratz DG, et al. Ann Am Thorac Soc. 2017;14[11]1646.
Raghu G, et al. Lancet Respir Med. 2019 Jun;7(6):487.