title: Idiopathic interstitial pneumonia: do community and academic physicians agree on diagnosis?
abstract: BACKGROUND
  Treatment and prognoses of diffuse parenchymal lung diseases (DPLDs) varies by diagnosis. Obtaining a uniform diagnosis among observers is difficult.
  
  
  OBJECTIVE
  Evaluate diagnostic agreement between academic and community-based physicians for patients with DPLDs, and determine if an interactive approach between clinicians, radiologists, and pathologists improved diagnostic agreement in community and academic centers.
  
  
  METHODS
  Retrospective review of 39 patients with DPLD. A total of 19 participants reviewed cases at 2 community locations and 1 academic location. Information from the history, physical examination, pulmonary function testing, high-resolution computed tomography, and surgical lung biopsy was collected. Data were presented in the same sequential fashion to three groups of physicians on separate days.
  
  
  RESULTS
  Each observer's diagnosis was coded into one of eight categories. A kappa statistic allowing for multiple raters was used to assess agreement in diagnosis. Interactions between clinicians, radiologists, and pathologists improved interobserver agreement at both community and academic sites; however, final agreement was better within academic centers (kappa = 0.55-0.71) than within community centers (kappa = 0.32-0.44). Clinically significant disagreement was present between academic and community-based physicians (kappa = 0.11-0.56). Community physicians were more likely to assign a final diagnosis of idiopathic pulmonary fibrosis compared with academic physicians.
  
  
  CONCLUSIONS
  Significant disagreement exists in the diagnosis of DPLD between physicians based in communities compared with those in academic centers. Wherever possible, patients should be referred to centers with expertise in diffuse parenchymal lung disorders to help clarify the diagnosis and provide suggestions regarding treatment options.
authors.affiliation: University of Michigan Health System, Ann Arbor, MI 48109-0360, USA. flaherty@umich.edu
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Flaherty
authors.forename: Adin-Cristian
authors.initials: AC
authors.lastname: Andrei
authors.forename: Talmadge E
authors.initials: TE
authors.lastname: King
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raghu
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
authors.forename: Athol
authors.initials: A
authors.lastname: Wells
authors.forename: Nadir
authors.initials: N
authors.lastname: Bassily
authors.forename: Kevin
authors.initials: K
authors.lastname: Brown
authors.forename: Roland
authors.initials: R
authors.lastname: du Bois
authors.forename: Andrew
authors.initials: A
authors.lastname: Flint
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gay
authors.forename: Barry H
authors.initials: BH
authors.lastname: Gross
authors.forename: Ella A
authors.initials: EA
authors.lastname: Kazerooni
authors.forename: Robert
authors.initials: R
authors.lastname: Knapp
authors.forename: Edmund
authors.initials: E
authors.lastname: Louvar
authors.forename: David
authors.initials: D
authors.lastname: Lynch
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Nicholson
authors.forename: John
authors.initials: J
authors.lastname: Quick
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Thannickal
authors.forename: William D
authors.initials: WD
authors.lastname: Travis
authors.forename: James
authors.initials: J
authors.lastname: Vyskocil
authors.forename: Frazer A
authors.initials: FA
authors.lastname: Wadenstorer
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wilt
authors.forename: Galen B
authors.initials: GB
authors.lastname: Toews
authors.forename: Susan
authors.initials: S
authors.lastname: Murray
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
mesh_terms: D000046:Academic Medical Centers; D003154:Community Medicine; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology; D010820:Physicians; D011379:Prognosis