Implementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project

Implementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project TEMITOPE FOWORA This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3243836/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Delayed referrals to supportive care services often result in impaired health-related quality of life (HRQL) among patients with idiopathic pulmonary fibrosis (IPF). Pulmonologists can adhere to the ATS clinical treatment guidelines through the use of the patient-reported outcome measure (PROM) tool, which can improve referral to supportive care services. Local problem : No PROM tool in the pulmonary clinic could assess patients' health-related quality of life (HRQL) of patients due to the disease burden of Idiopathic pulmonary fibrosis (IPF), hence delayed referral to supportive care services. Method : A pre and post-retrospective analysis of the chart Intervention : The King's Brief Interstitial Lung Disease (KBILD) questionnaire was implemented as an evidenced-based PROM tool in the pulmonary clinic Result : The use of the K-BILD questionnaire increased pulmonologist's awareness of stability or progression of disease burden among IPF patients based on HRQL, hence an increase in the referral of patients to supportive care services Conclusion : The results suggest that implementing an evidence-based PROM tool such as the KBILD questionnaire can increase referrals to supportive care services in a busy pulmonary clinic idiopathic pulmonary fibrosis supportive care services quality improvement evidence-based care King brief interstitial lung disease questionnaire American thoracic society Health-related quality of life and clinical guideline implementation Figures Figure 1 Figure 2 Introduction Health-related quality of life (HRQL) is impaired in most patients with interstitial lung disease (ILD) such as Idiopathic pulmonary fibrosis (IPF) due to symptoms such as progressive dyspnea and fatigue, limitations on physical activities and social isolation [18]. The symptoms of IPF, particularly cough, and dyspnea, invariably worsen as the disease progresses, with notable activity intolerance of activities of daily living (ADLs) [19]. The American Thoracic Society (ATS) recommended a multi-faceted approach to managing the IPF disease, including antifibrotic therapy, consideration of early referral for a lung transplant, early referral to pulmonary rehabilitation, and treatment of disease co-morbidities, referral to palliative care, nutritional assessment, psychosocial support for patients, and caregiver support [10]. Background Idiopathic pulmonary fibrosis (IPF) is an unpredictable lung disease with fibrotic changes and an overwhelming disease burden to the patient and their caregivers. IPF is associated with high mortality and morbidity, negatively impacting their health-related quality of life (HRQL). Idiopathic pulmonary fibrosis is a progressive lung disorder with scarring of the lungs from an unknown cause and a poor long-term prognosis [ 9 ]. Idiopathic Pulmonary Fibrosis (IPF) affects approximately 5 million people worldwide, with an average age of 66 years and an average life span of 3–5 years after a confirmed diagnosis by pulmonologists [ 2 , 15 ]. IPF is an unrelenting interstitial lung disease (ILD) associated with a high symptom burden and reported low HRQL [ 5 ]. IPF has no cure outside a lung transplant; however, supportive care and palliative care, as outlined by the ATS guidelines, ensure sustainable quality of life as the disease progresses [ 2 , 15 ]. Supportive care services such as oxygen therapy, pulmonary rehabilitation, and lung transplant are vastly underutilized among pulmonologists; hence the referrals are often delayed. Because the disease course can be unpredictable, initiating an early treatment plan after the clinical diagnosis is essential to optimize symptoms management and address palliative care planning [ 8 ]. Pulmonary fibrosis's vast psychosocial and emotional burden suggests that supportive care services should be prioritized in all clinical practices in agreement with the latest ATS treatment guidelines [ 20 ]. Supportive care services are essential in managing IPF because symptom control presents tremendous challenges to pulmonologists and caregivers [ 9 , 19 ]. Purpose Statement At the outpatient pulmonary clinic in urban Maryland, it was noted that pulmonologists do not use a self-reported patient-reported outcome measures (PROMs) tool, which could screen IPF patients who may need support care services. Current practice was examined, and it was identified that there are unmet supportive care needs for patients with IPF. Implementing a PROM tool, such as the King's Brief Interstitial Lung Disease Questionnaire (KBILD) questionnaire within the pulmonary office, will enable pulmonologists to assess the Health-related quality of life (HRQL) status. The ATS guidelines for treating and managing IPF support pharmacologic and non-pharmacologic interventions [ 5 ]. While pulmonologist's s may utilize available pharmacologic interventions to slow the disease progression of IPF, non-pharmacologic interventions remain a critical factor in managing dyspnea for these populations [ 5 ]. Supportive care measures such as pulmonary rehabilitation, oxygen therapy, and palliative care may positively impact the HRQL of patients [ 5 ]. Project Aims This quality improvement pilot project aims to implement a self-reported PROM tool, the King's Brief Interstitial Lung Disease (KBILD) questionnaire, within an outpatient pulmonary clinic in urban Maryland while assessing its impact on referrals to supportive care services in compliance with the ATS guidelines compared to current practice at the point of care. Available Knowledge The 2022 American Thoracic Society (ATS) IPF clinical practice guidelines were reviewed, focusing on recommended screening and treatment options for adult IPF patients. The ATS clinical guidelines on IPF suggest that the HRQL of patients could be improved by increased use of palliative and supportive care services [ 16 ]. For this to happen, pulmonologists would need to understand the impact of the disease on their patients. This project contributes to implementing evidence-based nursing practice by replicating previous evidence-based research by [ 3 , 4 , 14 ], all supporting feasible interventions to promote best practice that ultimately improves patient care in a clinical setting. While there is limited research on the benefits of early referral to palliative care and supportive care services, research support using self-reported PROM tools such as KBILD in the clinical setting to better assess patients' HRQL [ 7 ]. In addition to the standardized practice of pulmonary function tests (PFT) and six-minute walk tests (6MWT) in evaluating disease severity, the PROM tool provides a different perspective. Hence, this project is translating Prior’s research on implementing the King's Brief Interstitial Lung Disease (KBILD) questionnaire and its impact on early referrals to supportive and palliative care [ 14 ]. Prior’s reseach study aims to facilitate the use and interpretation of the KBILD questionnaire in clinical practice and clinical trials incorporating HRQL outcomes [ 14 ]. A self-reported health questionnaire such as KBILD is an effective PROM tool to improve communication between pulmonologists and patients [ 21 ]. Pulmonologists may not always realize all the aspects of supportive care services such as oxygen therapy, pulmonary rehabilitation program, lung transplant consultation, and palliative care referral. A few IPF patients accessed palliative care in the years before death despite disease burden, largely due to inadequate assessment of the need for referral [ 22 ]. Early referral to supportive services and palliative care can reduce frequent hospitalizations related to uncontrolled respiratory symptoms that could be fatal with or without a prolonged need for a mechanical ventilator machine [ 22 ]. Strategies to improve early access to palliative care in an outpatient setting are urgently required among this population. Theoretical Framework The Stevens star model of knowledge transformation (Fig. 1 ) and the Ajzen theory of planned behavior [ 1 ] were the theoretical foundations of this quality improvement project. The Stevens star model of knowledge transformation (Fig. 1 ) enhanced providers' participation and desire to implement PROM tools such as an evidence-based King’s Brief Interstitial Lung Disease (KBILD) questionnaire into the clinical practice. The project fostered the implementation of advanced evidence-based knowledge into clinical practice using the Ajzen theory of planned behavior [ 1 ]. The Ajzen theory of planned behavior was used to explore the pulmonologist's behavior in adopting and implementing the KBILD questionnaire in the pulmonary clinic. The theory of planned behavior can be used to explain best and predict pulmonologists' intentions and perceived benefits of using the KBILD questionnaire to improve clinical outcomes at the point of care [ 3 ]. Therefore, this theory was used to explore intention by pulmonologists while assuming that individuals are rational beings who carefully process information before making intentional decisions [ 3 ]. The Ajzen theory of planned behavior concerning this project was to explore pulmonologist's s' intentions to implement the KBILD questionnaire and the choice to establish its usefulness in patient outcomes [ 3 ]. Method This quality improvement pilot project utilized a convenience sample of 462 patients to predict a phenomenon, propose timely referrals to supportive care services, and understand the significance of using a questionnaire. This project explored if a relationship existed between implementing the KBILD questionnaire and referrals for patients diagnosed with IPF before and after providing a PROM tool in an outpatient pulmonary clinic. The expectation was increased patient referrals for patients with IPF following the intervention. Project Setting The project setting, a pulmonary clinic in urban Maryland, comprises 12 pulmonologists specializing in pulmonary medicine and interstitial lung diseases (ILD). The clinic currently did not use a self-reported PROM tool to assess disease burden due to IPF-related symptoms that negatively impacted patients' health-related quality of life (HRQL). Sample Selection A convenience sample was used from an outpatient pulmonary clinic of patients seen thirty days before and thirty days after the intervention implementation. There was no randomization of subjects, for the variables were considered but not manipulated [ 13 ]. The patient population was identified from a retrospective analysis of the project facility's electronic medical record (EMR), the primary data source. The project sample population was 60 years and older, English-speaking, and must have a clinical diagnosis of IPF documented in the chart. The pulmonologists caring for the patient must be employed at the project site. Exclusion criteria included all the patients with non-IPF pulmonary fibrosis due to other known conditions, such as connective tissue diseases. Thirty-eight patients who met the inclusive criteria of IPF diagnosis were selected for chart review. Ethical Considerations There was no known risk of potential harm to patients, for the goal of this project focused on using an evidence-based tool to improve healthcare delivery. The ethical principles were met through careful data collection and the protection of the privacy of the charts reviewed. Patients' confidentiality was enforced by using de-unidentifiable data that cannot be linked to a particular patient. Data collected for this project was securely maintained in a password-protected personal computer supported by the investigator. The raw data was kept until the final project was submitted, accepted, and approved; all data files were permanently deleted upon completion. Implementation The patients completed the KBILD questionnaire during an office visit or electronically during a telemedicine visit if it cannot be completed in the clinic. Ensuring the patient feels in control of their care plan was crucial, so completing the questionnaire and reviewing the questions promoted the proper conversation between the patient and the pulmonologists earlier in the disease process [ 6 ]. Measurement The KBILD questionnaire provided a brief and accurate measurement of respiratory symptoms during the visit. KBILD is a valid and reliable instrument for patients with IPF because it reflects dyspnea's impact on HRQL and physical functional capacity [ 6 ]. Compared to other HRQL questionnaires, KBILD is short, with only 15 items, and is easy to complete with the same validity as other HRQL tools in terms of internal consistency, concurrent validity, and test-retest reliability [ 6 ]. The KBILD questionnaire addressed psychological, breathlessness and activity, and chest symptoms among patients within the 15 questions of the three domains [ 12 ]. KBILD had high internal consistency, moderate to concurrent solid validity, good test-retest reliability, high validity across patients with different times since diagnosis, and high discriminative ability in known groups [ 6 ]. The questionnaire's total score ranges are 0-100, of which 100 represents the best health status [ 6 ]. The questionnaire intraclass correlation coefficients for domains and total score among patients with IPF were 0.83–0.98 [ 12 ]. Internal consistency was assessed with Cronbach's α coefficient of 0.94 for the KBILD total score [ 12 ]. Data collection Data collection was limited to patients with an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10) diagnosis of J84.112, an idiopathic pulmonary fibrosis diagnosis [ 11 ]. The investigator then evaluated the EMR for those medical records to include only English-speaking patients 60 and older in data collection. The data were collected at two separate time intervals. The initial data collection was conducted thirty days before the intervention. KBILD questionnaire was provided to the patients at the beginning of their visit. The completed questionnaire was presented to the pulmonologists to review during the visit. Thirty days after implementing the KBILD questionnaire in the pulmonary clinic, data were collected on patients limited to IPF diagnosis. There were 28 in the comparative group and 10 in the intervention group. Data from the medical records included a completed KBILD questionnaire and pulmonologist referral orders at the end of a scheduled visit. Data Analysis The descriptive data for age, gender, and race were collected for the comparative and implementation patients. The variables of gender and race are displayed in Table 1 . There were 12 (42.9%) females and 16 (57.1%) males in the comparative group and five (50.0%) females, and five (50.0%) males in the implementation group. The comparative group had six (21.4%) Black and 22 (78.6%) White patients, and the implementation group had two (20.0%) Black and eight (80.0%) White. This project has dichotomous variables such as "Yes" or "No." and Phi, a chi-square-based measure of association, evaluated the strength of the relationships between the variables. Chi-square tests were conducted to compare the percentage of patients with referrals in the comparative and implementation group. Before conducting the chi-square test analysis, frequency counts and range scores were performed to check for data entry errors and prepare the data for analysis. The frequency counts, and range scores showed that the data met the assumptions of the chi-square test. The level of significance was set to .05. There was not any error identified in the data collection or data analysis. Type I and Type II errors were considered; these errors could occur if there is a diagnosis coding error, a clerical error on the part of the pulmonologist, and an error through missing questionnaires or incomplete questionnaires. The lack of randomization can also lead to an error because the project used a convenient sample. The patients treated thirty days before the intervention was included in the baseline group, represented by the number "1" for the spreadsheet. The patients treated within the clinic thirty days after implementing the KBILD questionnaire were part of the intervention group, represented by the number "2" for the spreadsheet with a completed questionnaire. The patients treated within the clinic 30 days after implementing the questionnaire were part of the intervention group, represented by the number "3" for the spreadsheet with missing data for the completed questionnaire. The dependent variables were supportive care services referral to services such as lung transplant, pulmonary rehabilitation, and oxygen therapy ordered by a pulmonologist. That is, the presence of referral to any supportive care services was documented as yes, noted as 1, and no, documented as 2. The data was entered into an Excel© spreadsheet and were exported to IBM® SPSS© version 27 for statistical analysis. Table 1 Descriptive Data for Gender and Ethnicity Comparative Group (n = 28) Implementation Group (n = 10) Variable n % n % Gender Male 16 57.1% 5 50.0% Female 12 42.9% 5 50.0% Race Black 6 21.4% 3 25.0% White 22 78.6% 7 58.3% The variables of gender and race are displayed in Table 1 . There were 12 (42.9%) females and 16 (57.1%) males in the comparative group and five (50.0%) females and five (50.0%) males in the implementation group. The comparative group had six (21.4%) Black and 22 (78.6%) White patients, and the implementation group had two (20.0%) Black and eight (80.0%) White patients. Results As noted in Table 2 , the mean age for the comparative group was 77.64 years (SD = 7.32), ranging from 62 to 92. The mean age for the implementation group was 75.80 years ( SD = 6.51), ranging from 66 to 86 (Table 2 ). The chi-square test compared referrals for the comparative and implementation groups. The supportive care referral outcomes were evaluated for this project: palliative care, lung transplant, pulmonary rehabilitation, and oxygen therapy referrals. The chi-square was used to compare referrals for the comparative and implementation groups. There were no lung transplant referrals in the comparative (n = 0, 0.0%) nor the implementation group (n = 0, 0.0%). The statistical analysis was not conducted because all data points indicated no lung transplant referrals in either patient group. The PR referral results are displayed in Table 3 . There was an increase in PR referrals from the comparative ( n = 4, 14.3%) to the implementation ( n = 5, 50.0%) group, X ,2(1, N = 38) = 5.20, p = .023. The increase was statistically significant, as indicated by a p-value less than .05. The pulmonary rehabilitation referrals showed significant Table 2 Baseline Data for Age Comparative Group (n = 28) Implementation Group (n = 10) Variable M SD M SD Age 77.64 7.32 75.80 6.51 Note. M = mean; SD = standard deviation The descriptive data for age was presented in Table 2 . The mean age for the comparative group was 77.64 years ( SD = 7.32 ), with a range from 62 to 92. The mean age for the implementation group was 75.80 years ( SD = 6.51 ), with a range from 66 to 86 Source Implementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project Table 3 Chi-Square Results for Pulmonary Rehabilitation Referrals Comparative Group (n = 28) Implementation Group (n = 10) Variable n % n % \(\text{ꭕ²}\) df p Pulmonary rehabilitation referral 4 14.30 5 50.0 5.20 1 0.02 Oxygen therapy referral 15 53.6 3 30.0 1.64 1 .20 The PR referral results are displayed in Table 3 . There was an increase in PR referrals from the comparative ( n = 4, 14.3%) to the implementation ( n = 5, 50.0%) group, X ,2 (1, N = 38) = 5.20, p = .023. The increase was statistically significant, as indicated by a p-value that was less than .05. improvement, as indicated by a p-value of less than .05 in the chi-square test analysis. The oxygen therapy referral results showed a decrease in oxygen therapy referrals from the comparative (n = 15, 53.6%) to the implementation (n = 3, 30.0%) group, X, 2(1, N = 38) = 1.64, p = .200. The decrease was not statistically significant, as indicated by a p-value that is greater than .05. The palliative care referral analysis revealed no palliative care referrals for the comparative (n = 0, 0.0%) nor the implementation group (n = 0, 0.0%). Summary statistics were computed for the KBILD scores of the implementation group. The ten patients administered the KBILD questionnaire had a score ranging from 42 to 86. The mean score was 67.40 (SD = 12.87). Among the implementation group, the mean score indicated a moderate impact of their lung condition on their health. Figure 2 displays the minimum, maximum, and mean scores for the KBILD instrument. Among the implementation group, the mean score indicated a moderate impact of their lung condition on their health-related quality of life. Discussion Early referral is possible using the KBILD questionnaire to identify patients with reduced KBILD scoring (< 50 points) who may benefit from early referrals to supportive and palliative care. This quality improvement pilot project reviews the functionality of an outpatient pulmonary clinic and how to improve compliance with ATS guidelines and increase screening and referral to supportive care services. Compliance with the ATS guidelines allows pulmonologists to review the treatment plan more often and promote individualized care plans. The project showed that a self-reported questionnaire could help pulmonologists perceive the implication of the disease on the patient's HRQL. IPF is a progressive lung disease requiring routine pulmonary function testing and clinical evaluation; hence the self-reported questionnaire will ensure pulmonologist's s integrate needed supportive care measures as the disease progresses. The consistent use of self-reported questionnaires such as King's Brief Interstitial Lung Disease (KBILD) can improve patient communication as the disease worsens, increasing referral to needed services. This tool has improved the recognition of patients with IPF with a potential need for palliative and supportive care, reducing late referrals. The KBILD tool has enhanced awareness to discuss what is essential to the patient and their caregivers. The tool guides the pulmonologists in identifying issues of concern to the patient during the office visit, thus guiding appropriate referral to palliative and supportive care. This quality improvement project enhances awareness and realization that pulmonologists underutilized supportive care services. This project supports the need to implement evidence-based PROM tools and ATS guidelines in managing patients with IPF at the pulmonary clinic. Limitation Some limitations to this quality improvement pilot project include the lack of a randomized sample, restricted inclusion criteria, the use of a single pulmonary clinic, the small sample size, and a limited time frame. A randomized sampling from multiple pulmonary clinics could have solidified the generalizability of the findings. The project could have significantly impacted a larger sample size of patients with other forms of pulmonary fibrosis and interstitial lung diseases. Lastly, the time frame to implement the project was thirty days, which was inadequate to measure an actual increase in referrals to all supportive care services needed. This project is a retrospective analysis of the chart of a few patients followed in the pulmonary clinic within thirty days. The relatively short duration of the project may be responsible for fewer referrals than anticipated. This project finding indicates that much more extensive multisite sample size research is needed to explore the impact of the PROM tool on early referral to needed supportive care services among patients with interstitial lung diseases, not limited to IPF. Recommendations The results of this project offer many worthy recommendations for future projects within the interstitial lung disease (ILD) community and an outpatient pulmonary practice such as the project setting. Even though this project did not produce statistically significant results across all assessed outcomes, the KBILD questionnaire was clinically significant among pulmonologists at the project site. This project's findings increase pulmonologists' awareness of the importance of using a self-reported PROM tool for HRQL assessment among IPF patients. The ATS guideline also recommended palliative care involvement to help with symptom management and referral for lung transplantation at the time of diagnosis. Conclusion The role of interstitial lung disease (ILD) nurse practitioners working alongside pulmonologists is critical in ensuring the clinical pathway and management of patients with idiopathic pulmonary fibrosis (IPF) are well streamlined per the ATS guideline. The 2022 ATS idiopathic and progressive pulmonary fibrosis clinical practice guidelines support treatment with pharmacological and nonpharmacological therapies. The ILD nurse practitioner in clinical practice can provide comprehensive evaluation and assessment using a patient-reported outcome measures (PROM) tool. The tool will access mortality risk and clinical and non-clinical implications of this disease on HRQL and provide needed referrals as appropriate in a busy pulmonary clinic. The ILD nurse practitioner can ensure the clinical guidelines are well interpreted in the clinical setting to guide informed decisions by pulmonologists at the point of healthcare delivery. Declarations Availability of data and materials All data generated or analyzed during this study are included in this published article, and its additional information files are available from the corresponding author upon reasonable request. Acknowledgements The completed tables and figures, and referencing was provided by the author, Temitope Fowora, DNP, CRNP Funding This project was not funded. Author information Author and Affiliations Temitope Fowora - The University of Maryland St. Joseph Medical Center (UM SJMC) Towson, Maryland, USA Corresponding author Not applicable Ethics declarations Ethics approval and consent to participate This project does not involve human participants. In collaboration with the Institutional Review Board (IRB), The College of Nursing and Health Care Professions at Grand Canyon University determined that this quality improvement project does not meet the definition of human subject research. The project qualifies as Quality Improvement; therefore, further IRB review was not required. Consent for publication Not applicable References Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. https://doi.org/10.1016/0749-5978(91)90020-T . Anderson C, Tocchi C, Morrison L, Rackley C. A smart phrase to improve documentation of supportive measures for idiopathic pulmonary fibrosis. J Nurse Practitioners. 2020;16(2):126–30. https://doi.org/10.1016/j.nurpra.2019.09.008 . Appleby BE. Implementing guideline-checklists: Evaluating health care providers intentional behaviour using an extended model of the theory of planned behaviour. J Eval Clin Pract. 2019;25(4):664–75. https://doi.org/10.1111/jep.13075 . Boucher N, Nicolla J, Ogunseitan A, Kessler E, Ritchie C, Zafar Y. Feasibility and acceptability of a best supportive care checklist among clinicians. J Palliat Med. 2018;21(8):1074–7. https://doi.org/10.1089/jpm.2017.0605 . Fenwick KE, Swan BA. Managing dyspnea in individuals with idiopathic pulmonary fibrosis. J Hospice Palliat Nurs. 2020;22(6):447–55. https://doi.org/10.1097/NJH.0000000000000687 . Hoyer N, Prior T, Bendstrup E, Wilcke T, Shaker S. Risk factors for diagnostic delay in idiopathic pulmonary fibrosis. Respir Res. 2019;20(1):1–9. https://doi.org/10.1186/s12931-019-1076-0 . Kim JW, Clark A, Birring SS, Atkins C, Whyte M, Wilson AM. Psychometric properties of patient reported outcome measures in idiopathic pulmonary fibrosis. Chronic Resp Dis. 2021;18:147997312110339–925. https://doi.org/10.1177/14799731211033925 . Lindell K. Nonpharmacological therapies for interstitial lung disease. Curr Pulmonol Rep. 2018;7(4):126–32. https://doi.org/10.1007/s13665-018-0211-6 . Meyer K, Nathan S. (2019). Idiopathic Pulmonary Fibrosis [electronic resource]: A Comprehensive Clinical Guide / edited by Keith C. Meyer, Steven D. Nathan. (2nd ed. 2019.). Springer International Publishing. https://doi.org/10.1007/978-3-319-99975-3 . Moran-Mendoza O, Colman R, Kalluri M, Cabalteja C, Harle I. A comprehensive and practical approach to the management of idiopathic pulmonary fibrosis. Expert Rev Respir Med. 2019;13(7):601–14. National Center for Health Statistics (NCHS). (2009). International classification of diseases, tenth revision (ICD-10). Retrieved from https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf . Patel A, Siegert R, Brignall K, Gordon P, Steer S, Desai S, Maher T, Renzoni E, Wells A, Higginson I, Birring S. The development and validation of the King's Brief Interstitial Lung Disease (KBILD) health status questionnaire. Thorax. 2012;67(9):804–10. https://doi.org/10.1136/thoraxjnl-2012-201581 . Polit DE, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 10th ed. Lippincott Williams & Wilkins; 2016. Prior TS, Hoyer N, Hilberg O, Shaker SB, Davidsen JR, Bendstrup E. Responsiveness and minimal clinically important difference of SGRQ-I and K-BILD in idiopathic pulmonary fibrosis. Respir Res. 2020;21(1):91–1. https://doi.org/10.1186/s12931-020-01359-3 . Raghu, G., Remy-Jardin, M., Myers, J., Richeldi, L., Ryerson, C., Lederer, D., Behr,J., Cottin, V., Danoff, S., Morell, F., Flaherty, K., Wells, A., Martinez, F., Azuma,A., Bice, T., Bouros, D., Brown, K., Collard, H., Duggal, A., … Wilson, K. (2018).Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 198 (5), e44–e68. https://doi.org/10.1164/rccm.201807-1255ST. Raghu, G., Remy-Jardin, M., Richeldi, L., Thomson, C. C., Inoue, Y., Johkoh, T., Kreuter,M., Lynch, D. A., Maher, T. M., Martinez, F. J., Molina-Molina, M., Myers, J. L.,Nicholson, A. G., Ryerson, C. J., Strek, M. E., Troy, L. K., Wijsenbeek, M., Mammen,M. J., Hossain, T., … Wilson, K. C. (2022). Idiopathic Pulmonary Fibrosis (an Update)and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine , 205 (9), e18–e47. https://doi.org/10.1164/rccm.202202-0399ST. Stevens KR. (2004). The ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-Based Practice. The University of Texas Health Science Center, San Antonio. Retrieved from http://www.acestar.uthscsa.edu on 12th, March 2022. Wapenaar M, Patel A, Birring S, Domburg R, Bakker E, Vindigni V, Sköld C, Cottin V, Vancheri C, Wijsenbeek M. Translation and validation of the King’s Brief Interstitial Lung Disease (KBILD) questionnaire in French, Italian, Swedish, and Dutch. Chronic Resp Dis. 2017;14(2):140–50. https://doi.org/10.1177/1479972316674425 . Wuyts WA, Wijsenbeek M, Bondue B, Bouros D, Bresser P, Robalo Cordeiro C, Hilberg O, Magnusson J, Manali ED, Morais A, Papiris S, Shaker S, Veltkamp M, Bendstrup E. Idiopathic pulmonary fibrosis: Best practice in monitoring and managing a relentless fibrotic disease. Respir Int Rev Thorac Dis. 2020;99(1):73–82. https://doi.org/10.1159/000504763 . Sgalla G, Iovene B, Calvello M, Ori M, Varone F, Richeldi L. Idiopathic pulmonary fibrosis: Pathogenesis and management. Respir Res. 2018;19(1):1–18. https://doi.org/10.1186/s12931-018-0730-2 . van Manen MJG, Geelhoed JJM, Tak NC, Wijsenbeek MS. Optimizing quality of life in patients with idiopathic pulmonary fibrosis. Ther Adv Respir Dis. 2017;11(3):157–69. https://doi.org/10.1177/1753465816686743 . Smallwood N, Mann J, Guo H, Goh N. Patients with fibrotic interstitial lung disease receive supportive and palliative care just prior to death. Am J Hospice Palliat Med. 2021;38(2):154–60. https://doi.org/10.1177/1049909120938629 . Additional Declarations No competing interests reported. Supplementary Files TemitopeFoworaAppendixAImplementingaPROMtool.docx TemitopeFoworaAppendixBImplementingaPROMtool.docx TemitopeFoworaSPSSDATAONE.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3243836","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":239651903,"identity":"b291419c-55ea-454c-8071-b587f0b768da","order_by":0,"name":"TEMITOPE FOWORA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYNACAwsZBvYGMIOwYh6IFgkeBp4DYAaxWhiAWiQSwAzCWuzZew8+5imQ4OGf+fzqhh8FEgz87d0J+G3hOZdszAN0mMTtnLKbPUCHSZw5uwG/FokcM8kZIL/czkm7AdQL9E4uQS3mP0Fa5G+eSbv5h0gtZgwfgFoMbrAfu02cLWfOJUuAtBieyWG7LQPyFCG/sLf3HvyQ8MdGTu748Wc33wAZ/O29+LXAYwbIMEDhEqOF/QERqkfBKBgFo2AkAgCdTj8wH9/qkwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Maryland Medical Center","correspondingAuthor":true,"prefix":"","firstName":"TEMITOPE","middleName":"","lastName":"FOWORA","suffix":""}],"badges":[],"createdAt":"2023-08-08 03:29:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3243836/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3243836/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":44742188,"identity":"915d5632-1ad8-4e39-8b08-6a8168ed3345","added_by":"auto","created_at":"2023-10-16 23:30:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":198425,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe Stevens Star Model of Knowledge Transformation © (Stevens, 2004)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Academic Center for Evidence-based Practice (ACE) Star Model is a simple 5-point star, and it explains how knowledge is transformed at five significant stages, starting from primary research and continuing through the stages of evidence summary, translation, integration, and evaluation (Stevens, K. R. 2004). Copyright\u0026nbsp;\u003ca href=\"https://ojin.nursingworld.org/table-of-contents/volume-18-2013/number-2-may-2013/impact-of-evidence-based-practice/#Stevens04\"\u003eStevens 2004\u003c/a\u003e. Reproduced with permission.\u003c/p\u003e\n\u003cp\u003eStevens, K. R (2004). The ACE Star Model of EBP:\u0026nbsp; Knowledge Transformation. Academic Center for Evidence-Based Practice. The University of Texas Health Science Center, San Antonio. Retrieved from http://www.acestar.uthscsa.edu on 12\u003csup\u003eth\u003c/sup\u003e, March 2022.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3243836/v1/36824d388b354012604dab6a.png"},{"id":44741016,"identity":"ebfc5ecc-75b3-4d56-bcc0-3acae998abfe","added_by":"auto","created_at":"2023-10-16 23:22:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20687,"visible":true,"origin":"","legend":"\u003cp\u003eKBILD Scores for the Intervention Group (N=10)\u003c/p\u003e\n\u003cp\u003eFigure 2 displays the minimum, maximum, and mean scores for the KBILD instrument. Among the implementation group, the mean score indicated a moderate impact of their lung condition on their health.\u003c/p\u003e\n\u003cp\u003eSummary statistics were computed for the KBILD scores of the implementation group. The ten implementation patients that were administered the KBILD had a score ranging from 42 (minimum) to 86 (Maximum). The mean score was 67.40 (\u003cem\u003eSD = 12.87\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eSource:\u003c/p\u003e\n\u003cp\u003eImplementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3243836/v1/6474e7cc1847905499b12181.png"},{"id":53712296,"identity":"83d20040-bbbd-47ff-bf65-1eedadac8593","added_by":"auto","created_at":"2024-03-29 08:30:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":502049,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3243836/v1/fe641186-ba36-4311-aa17-4c62a97e6ec8.pdf"},{"id":44741018,"identity":"e2ea796e-3ad8-4962-b1ba-0d00b4dfc97b","added_by":"auto","created_at":"2023-10-16 23:22:53","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":143587,"visible":true,"origin":"","legend":"","description":"","filename":"TemitopeFoworaAppendixAImplementingaPROMtool.docx","url":"https://assets-eu.researchsquare.com/files/rs-3243836/v1/c5c29ab35245f19a09f44e43.docx"},{"id":44741019,"identity":"7c439755-6a06-4e86-bb71-a59454cef98c","added_by":"auto","created_at":"2023-10-16 23:22:53","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":107231,"visible":true,"origin":"","legend":"","description":"","filename":"TemitopeFoworaAppendixBImplementingaPROMtool.docx","url":"https://assets-eu.researchsquare.com/files/rs-3243836/v1/945849d0ceac1a884522799e.docx"},{"id":44741017,"identity":"74584d33-a4de-4311-be7c-b8f1d4d5c70b","added_by":"auto","created_at":"2023-10-16 23:22:53","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":20191,"visible":true,"origin":"","legend":"","description":"","filename":"TemitopeFoworaSPSSDATAONE.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3243836/v1/f287355abd248d274d762daf.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealth-related quality of life (HRQL) is impaired in most patients with interstitial lung disease (ILD) such as Idiopathic pulmonary fibrosis (IPF) due to symptoms such as progressive dyspnea and fatigue, limitations on physical activities and social isolation [18]. The symptoms of IPF, particularly cough, and dyspnea, invariably worsen as the disease progresses, with notable activity intolerance of activities of daily living (ADLs) [19]. The American Thoracic Society (ATS) recommended a multi-faceted approach to managing the IPF disease, including antifibrotic therapy, consideration of early referral for a lung transplant, early referral to pulmonary rehabilitation, and treatment of disease co-morbidities, referral to palliative care, nutritional assessment, psychosocial support for patients, and caregiver support [10].\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eIdiopathic pulmonary fibrosis (IPF) is an unpredictable lung disease with fibrotic changes and an overwhelming disease burden to the patient and their caregivers. IPF is associated with high mortality and morbidity, negatively impacting their health-related quality of life (HRQL). Idiopathic pulmonary fibrosis is a progressive lung disorder with scarring of the lungs from an unknown cause and a poor long-term prognosis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Idiopathic Pulmonary Fibrosis (IPF) affects approximately 5\u0026nbsp;million people worldwide, with an average age of 66 years and an average life span of 3\u0026ndash;5 years after a confirmed diagnosis by pulmonologists [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. IPF is an unrelenting interstitial lung disease (ILD) associated with a high symptom burden and reported low HRQL [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. IPF has no cure outside a lung transplant; however, supportive care and palliative care, as outlined by the ATS guidelines, ensure sustainable quality of life as the disease progresses [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Supportive care services such as oxygen therapy, pulmonary rehabilitation, and lung transplant are vastly underutilized among pulmonologists; hence the referrals are often delayed. Because the disease course can be unpredictable, initiating an early treatment plan after the clinical diagnosis is essential to optimize symptoms management and address palliative care planning [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Pulmonary fibrosis's vast psychosocial and emotional burden suggests that supportive care services should be prioritized in all clinical practices in agreement with the latest ATS treatment guidelines [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Supportive care services are essential in managing IPF because symptom control presents tremendous challenges to pulmonologists and caregivers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePurpose Statement\u003c/p\u003e \u003cp\u003e At the outpatient pulmonary clinic in urban Maryland, it was noted that pulmonologists do not use a self-reported patient-reported outcome measures (PROMs) tool, which could screen IPF patients who may need support care services. Current practice was examined, and it was identified that there are unmet supportive care needs for patients with IPF. Implementing a PROM tool, such as the King's Brief Interstitial Lung Disease Questionnaire (KBILD) questionnaire within the pulmonary office, will enable pulmonologists to assess the Health-related quality of life (HRQL) status. The ATS guidelines for treating and managing IPF support pharmacologic and non-pharmacologic interventions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While pulmonologist's s may utilize available pharmacologic interventions to slow the disease progression of IPF, non-pharmacologic interventions remain a critical factor in managing dyspnea for these populations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Supportive care measures such as pulmonary rehabilitation, oxygen therapy, and palliative care may positively impact the HRQL of patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProject Aims\u003c/p\u003e \u003cp\u003e This quality improvement pilot project aims to implement a self-reported PROM tool, the King's Brief Interstitial Lung Disease (KBILD) questionnaire, within an outpatient pulmonary clinic in urban Maryland while assessing its impact on referrals to supportive care services in compliance with the ATS guidelines compared to current practice at the point of care.\u003c/p\u003e \u003cp\u003eAvailable Knowledge\u003c/p\u003e \u003cp\u003e The 2022 American Thoracic Society (ATS) IPF clinical practice guidelines were reviewed, focusing on recommended screening and treatment options for adult IPF patients. The ATS clinical guidelines on IPF suggest that the HRQL of patients could be improved by increased use of palliative and supportive care services [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For this to happen, pulmonologists would need to understand the impact of the disease on their patients. This project contributes to implementing evidence-based nursing practice by replicating previous evidence-based research by [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], all supporting feasible interventions to promote best practice that ultimately improves patient care in a clinical setting. While there is limited research on the benefits of early referral to palliative care and supportive care services, research support using self-reported PROM tools such as KBILD in the clinical setting to better assess patients' HRQL [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition to the standardized practice of pulmonary function tests (PFT) and six-minute walk tests (6MWT) in evaluating disease severity, the PROM tool provides a different perspective. Hence, this project is translating Prior\u0026rsquo;s research on implementing the King's Brief Interstitial Lung Disease (KBILD) questionnaire and its impact on early referrals to supportive and palliative care [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Prior\u0026rsquo;s reseach study aims to facilitate the use and interpretation of the KBILD questionnaire in\u003c/p\u003e \u003cp\u003eclinical practice and clinical trials incorporating HRQL outcomes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A self-reported health questionnaire such as KBILD is an effective PROM tool to improve communication between pulmonologists and patients [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Pulmonologists may not always realize all the aspects of supportive care services such as oxygen therapy, pulmonary rehabilitation program, lung transplant consultation, and palliative care referral. A few IPF patients accessed palliative care in the years before death despite disease burden, largely due to inadequate assessment of the need for referral [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Early referral to supportive services and palliative care can reduce frequent hospitalizations related to uncontrolled respiratory symptoms that could be fatal with or without a prolonged need for a mechanical ventilator machine [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Strategies to improve early access to palliative care in an outpatient setting are urgently required among this population.\u003c/p\u003e \u003cp\u003eTheoretical Framework\u003c/p\u003e \u003cp\u003eThe Stevens star model of knowledge transformation (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and the Ajzen theory of planned behavior [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] were the theoretical foundations of this quality improvement project. The Stevens star model of knowledge transformation (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e) enhanced providers' participation and desire to implement PROM tools such as an evidence-based King\u0026rsquo;s Brief Interstitial Lung Disease (KBILD) questionnaire into the clinical practice. The project fostered the implementation of advanced evidence-based knowledge into clinical practice using the Ajzen theory of planned behavior [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The Ajzen theory of planned behavior was used to explore the pulmonologist's behavior in adopting and implementing the KBILD questionnaire in the pulmonary clinic. The theory of planned behavior can be used to explain best and predict pulmonologists' intentions and perceived benefits of using the KBILD questionnaire to improve clinical outcomes at the point of care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, this theory was used to explore intention by pulmonologists while assuming that individuals are rational beings who carefully process information before making intentional decisions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The Ajzen theory of planned behavior concerning this project was to explore pulmonologist's s' intentions to implement the KBILD questionnaire and the choice to establish its usefulness in patient outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e"},{"header":"Method","content":" \u003cp\u003eThis quality improvement pilot project utilized a convenience sample of 462 patients to predict a phenomenon, propose timely referrals to supportive care services, and understand the significance of using a questionnaire. This project explored if a relationship existed between implementing the KBILD questionnaire and referrals for patients diagnosed with IPF before and after providing a PROM tool in an outpatient pulmonary clinic. The expectation was increased patient referrals for patients with IPF following the intervention.\u003c/p\u003e \u003cp\u003eProject Setting\u003c/p\u003e \u003cp\u003eThe project setting, a pulmonary clinic in urban Maryland, comprises 12 pulmonologists specializing in pulmonary medicine and interstitial lung diseases (ILD). The clinic currently did not use a self-reported PROM tool to assess disease burden due to IPF-related symptoms that negatively impacted patients' health-related quality of life (HRQL).\u003c/p\u003e \u003cp\u003eSample Selection\u003c/p\u003e \u003cp\u003eA convenience sample was used from an outpatient pulmonary clinic of patients seen thirty days before and thirty days after the intervention implementation. There was no randomization of subjects, for the variables were considered but not manipulated [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The patient population was identified from a retrospective analysis of the project facility's electronic medical\u003c/p\u003e \u003cp\u003erecord (EMR), the primary data source. The project sample population was 60 years and older, English-speaking, and must have a clinical diagnosis of IPF documented in the chart. The pulmonologists caring for the patient must be employed at the project site. Exclusion criteria included all the patients with non-IPF pulmonary fibrosis due to other known conditions, such as connective tissue diseases. Thirty-eight patients who met the inclusive criteria of IPF diagnosis were selected for chart review.\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003eThere was no known risk of potential harm to patients, for the goal of this project focused on using an evidence-based tool to improve healthcare delivery. The ethical principles were met through careful data collection and the protection of the privacy of the charts reviewed. Patients' confidentiality was enforced by using de-unidentifiable data that cannot be linked to a particular patient. Data collected for this project was securely maintained in a password-protected personal computer supported by the investigator. The raw data was kept until the final project was submitted, accepted, and approved; all data files were permanently deleted upon completion. Implementation\u003c/p\u003e \u003cp\u003eThe patients completed the KBILD questionnaire during an office visit or electronically during a telemedicine visit if it cannot be completed in the clinic. Ensuring the patient feels in control of their care plan was crucial, so completing the questionnaire and reviewing the questions promoted the proper conversation between the patient and the pulmonologists earlier in the disease process [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMeasurement\u003c/p\u003e \u003cp\u003eThe KBILD questionnaire provided a brief and accurate measurement of respiratory symptoms during the visit. KBILD is a valid and reliable instrument for patients with IPF because it reflects dyspnea's impact on HRQL and physical functional capacity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Compared to other HRQL questionnaires, KBILD is short, with only 15 items, and is easy to complete with the same validity as other HRQL tools in terms of internal consistency, concurrent validity, and test-retest reliability [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The KBILD questionnaire addressed psychological, breathlessness and activity, and chest symptoms among patients within the 15 questions of the three domains [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. KBILD had high internal consistency, moderate to concurrent solid validity, good test-retest reliability, high validity across patients with different times since diagnosis, and high discriminative ability in known groups [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The questionnaire's total score ranges are 0-100, of which 100 represents the best health status [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The questionnaire intraclass correlation coefficients for domains and total score among patients with IPF were 0.83\u0026ndash;0.98 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Internal consistency was assessed with Cronbach's α coefficient of 0.94 for the KBILD total score [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eData collection was limited to patients with an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10) diagnosis of J84.112, an idiopathic pulmonary fibrosis diagnosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The investigator then evaluated the EMR for those medical records to include only English-speaking patients 60 and older in data collection. The data were collected at two separate time intervals. The initial data collection was conducted thirty days before the intervention. KBILD questionnaire was provided to the patients at the beginning of their visit. The completed questionnaire was presented to the\u003c/p\u003e \u003cp\u003epulmonologists to review during the visit. Thirty days after implementing the KBILD questionnaire in the pulmonary clinic, data were collected on patients limited to IPF diagnosis. There were 28 in the comparative group and 10 in the intervention group. Data from the medical records included a completed KBILD questionnaire and pulmonologist referral orders at the end of a scheduled visit.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe descriptive data for age, gender, and race were collected for the comparative and implementation patients. The variables of gender and race are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were 12 (42.9%) females and 16 (57.1%) males in the comparative group and five (50.0%) females, and five (50.0%) males in the implementation group. The comparative group had six (21.4%) Black and 22 (78.6%) White patients, and the implementation group had two (20.0%) Black and eight (80.0%) White. This project has dichotomous variables such as \"Yes\" or \"No.\" and Phi, a chi-square-based measure of association, evaluated the strength of the relationships between the variables. Chi-square tests were conducted to compare the percentage of patients with referrals in the comparative and implementation group. Before conducting the chi-square test analysis, frequency counts and range scores were performed to check for data entry errors and prepare the data for analysis. The frequency counts, and range scores showed that the data met the assumptions of the chi-square test. The level of significance was set to .05. There was not any error identified in the data collection or data analysis. Type I and Type II errors were considered; these errors could occur if there is a diagnosis coding error, a clerical error on the part of the pulmonologist, and an error through missing questionnaires or incomplete questionnaires. The lack of randomization can also lead to an error because the project used a convenient sample. The patients treated thirty days before the intervention was included in the baseline group, represented by the number \"1\" for the spreadsheet. The patients treated within the clinic thirty days after implementing the KBILD questionnaire were part of the intervention group, represented by the number \"2\" for the spreadsheet with a completed questionnaire. The patients treated within the clinic 30 days after implementing the questionnaire were part of the intervention group, represented by the number \"3\" for the spreadsheet with missing data for the completed questionnaire. The dependent variables were supportive care services referral to services such as lung transplant, pulmonary rehabilitation, and oxygen therapy ordered by a pulmonologist. That is, the presence of referral to any supportive care services was documented as yes, noted as 1, and no, documented as 2. The data was entered into an Excel\u0026copy; spreadsheet and were exported to IBM\u0026reg; SPSS\u0026copy; version 27 for statistical analysis.\u003c/p\u003e \u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Data for Gender and Ethnicity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComparative Group (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImplementation Group (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eVariable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eGender\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e50.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e50.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e58.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe variables of gender and race are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were 12 (42.9%) females and 16 (57.1%) males in the comparative group and five (50.0%) females and five (50.0%) males in the implementation group. The comparative group had six (21.4%) Black and 22 (78.6%) White patients, and the implementation group had two (20.0%) Black and eight (80.0%) White patients.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAs noted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the mean age for the comparative group was 77.64 years (SD\u0026thinsp;=\u0026thinsp;7.32), ranging from 62 to 92. The mean age for the implementation group was 75.80 years (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.51), ranging from 66 to 86 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The chi-square test compared referrals for the comparative and implementation groups. The supportive care referral outcomes were evaluated for this project: palliative care, lung transplant, pulmonary rehabilitation, and oxygen therapy referrals. The chi-square was used to compare referrals for the comparative and implementation groups. There were no lung transplant referrals in the comparative (n\u0026thinsp;=\u0026thinsp;0, 0.0%) nor the implementation group (n\u0026thinsp;=\u0026thinsp;0, 0.0%). The statistical analysis was not conducted because all data points indicated no lung transplant referrals in either patient group. The PR referral results are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There was an increase in PR referrals from the comparative (\u003cem\u003en\u0026thinsp;=\u0026thinsp;4, 14.3%)\u003c/em\u003e to the implementation (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5, 50.0%) group, \u003cem\u003eX\u003c/em\u003e,2(1, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;38)\u0026thinsp;=\u0026thinsp;5.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.023. The increase was statistically significant, as indicated by a p-value less than .05. The pulmonary rehabilitation referrals showed significant\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Data for Age\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparative Group (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImplementation Group (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote. \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;mean; \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe descriptive data for age was presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean age for the comparative group was 77.64 years (\u003cem\u003eSD\u0026thinsp;=\u0026thinsp;7.32\u003c/em\u003e), with a range from 62 to 92. The mean age for the implementation group was 75.80 years (\u003cem\u003eSD\u0026thinsp;=\u0026thinsp;6.51\u003c/em\u003e), with a range from 66 to 86\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSource\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eImplementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-Square Results for Pulmonary Rehabilitation Referrals\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparative Group (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImplementation Group (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{ꭕ\u0026sup2;}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003edf\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary rehabilitation referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen therapy referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eThe PR referral results are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There was an increase in PR referrals from the comparative (\u003cem\u003en\u0026thinsp;=\u0026thinsp;4, 14.3%)\u003c/em\u003e to the implementation (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5, 50.0%) group, \u003cem\u003eX\u003c/em\u003e\u003csup\u003e,2\u003c/sup\u003e(1, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;38)\u0026thinsp;=\u0026thinsp;5.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.023. The increase was statistically significant, as indicated by a p-value that was less than .05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eimprovement, as indicated by a p-value of less than .05 in the chi-square test analysis. The oxygen therapy referral results showed a decrease in oxygen therapy referrals from the comparative (n\u0026thinsp;=\u0026thinsp;15, 53.6%) to the implementation (n\u0026thinsp;=\u0026thinsp;3, 30.0%) group, X, 2(1, N\u0026thinsp;=\u0026thinsp;38)\u0026thinsp;=\u0026thinsp;1.64, p\u0026thinsp;=\u0026thinsp;.200. The decrease was not statistically significant, as indicated by a p-value that is greater than .05. The palliative care referral analysis revealed no palliative care referrals for the comparative (n\u0026thinsp;=\u0026thinsp;0, 0.0%) nor the implementation group (n\u0026thinsp;=\u0026thinsp;0, 0.0%). Summary statistics were computed for the KBILD scores of the implementation group. The ten patients administered the KBILD questionnaire had a score ranging from 42 to 86. The mean score was 67.40 (SD\u0026thinsp;=\u0026thinsp;12.87). Among the implementation group, the mean score indicated a moderate impact of their lung condition on their health. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e displays the minimum, maximum, and mean scores for the KBILD instrument. Among the implementation group, the mean score indicated a moderate impact of their lung condition on their health-related quality of life.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEarly referral is possible using the KBILD questionnaire to identify patients with reduced KBILD scoring (\u0026lt;\u0026thinsp;50 points) who may benefit from early referrals to supportive and palliative care. This quality improvement pilot project reviews the functionality of an outpatient pulmonary clinic and how to improve compliance with ATS guidelines and increase screening and referral to supportive care services. Compliance with the ATS guidelines allows pulmonologists to review the treatment plan more often and promote individualized care plans. The project showed that a self-reported questionnaire could help pulmonologists perceive the implication of the disease on the patient's HRQL. IPF is a progressive lung disease requiring routine pulmonary function testing and clinical evaluation; hence the self-reported questionnaire will ensure pulmonologist's s integrate needed supportive care measures as the disease progresses. The consistent use of self-reported questionnaires such as King's Brief Interstitial Lung Disease (KBILD) can improve patient communication as the disease worsens, increasing referral to needed services. This tool has improved the recognition of patients with IPF with a potential need for palliative and supportive care, reducing late referrals. The KBILD tool has enhanced awareness to discuss what is essential to the patient and their caregivers. The tool guides the pulmonologists in identifying issues of concern to the patient during the office visit, thus guiding appropriate referral to palliative and supportive care. This quality improvement project enhances awareness and realization that pulmonologists underutilized supportive care services. This project supports the need to implement evidence-based PROM tools and ATS guidelines in managing patients with IPF at the pulmonary clinic.\u003c/p\u003e \u003cp\u003eLimitation\u003c/p\u003e \u003cp\u003eSome limitations to this quality improvement pilot project include the lack of a randomized sample, restricted inclusion criteria, the use of a single pulmonary clinic, the small sample size, and a limited time frame. A randomized sampling from multiple pulmonary clinics could have solidified the generalizability of the findings. The project could have significantly impacted a larger sample size of patients with other forms of pulmonary fibrosis and interstitial lung diseases. Lastly, the time frame to implement the project was thirty days, which was inadequate to measure an actual increase in referrals to all supportive care services needed. This project is a retrospective analysis of the chart of a few patients followed in the pulmonary clinic within thirty days. The relatively short duration of the project may be responsible for fewer referrals than anticipated. This project finding indicates that much more extensive multisite sample size research is needed to explore the impact of the PROM tool on early referral to needed supportive care services among patients with interstitial lung diseases, not limited to IPF.\u003c/p\u003e \u003cp\u003eRecommendations\u003c/p\u003e \u003cp\u003eThe results of this project offer many worthy recommendations for future projects within the interstitial lung disease (ILD) community and an outpatient pulmonary practice such as the project setting. Even though this project did not produce statistically significant results across all assessed outcomes, the KBILD questionnaire was clinically significant among pulmonologists at the project site. This project's findings increase pulmonologists' awareness of the importance of using a self-reported PROM tool for HRQL assessment among IPF patients. The ATS guideline also recommended palliative care involvement to help with symptom management and referral for lung transplantation at the time of diagnosis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e The role of interstitial lung disease (ILD) nurse practitioners working alongside pulmonologists is critical in ensuring the clinical pathway and management of patients with idiopathic pulmonary fibrosis (IPF) are well streamlined per the ATS guideline. The 2022 ATS idiopathic and progressive pulmonary fibrosis clinical practice guidelines support treatment with pharmacological and nonpharmacological therapies. The ILD nurse practitioner in clinical practice can provide comprehensive evaluation and assessment using a patient-reported outcome measures (PROM) tool. The tool will access mortality risk and clinical and non-clinical implications of this disease on HRQL and provide needed referrals as appropriate in a busy pulmonary clinic. The ILD nurse practitioner can ensure the clinical guidelines are well interpreted in the clinical setting to guide informed decisions by pulmonologists at the point of healthcare delivery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article, and its additional information files are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe completed tables and figures, and referencing was provided by the author, Temitope Fowora, DNP, CRNP\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor and Affiliations\u003c/p\u003e\n\u003cp\u003eTemitope Fowora - The University of Maryland St. Joseph Medical Center (UM SJMC) Towson, Maryland, USA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis project does not involve human participants. In collaboration with the Institutional Review Board (IRB), The College of Nursing and Health Care Professions at Grand Canyon University determined that this quality improvement project does not meet the definition of human subject research. The project qualifies as Quality Improvement; therefore, further IRB review was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAjzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179\u0026ndash;211. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0749-5978(91)90020-T\u003c/span\u003e\u003cspan address=\"10.1016/0749-5978(91)90020-T\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson C, Tocchi C, Morrison L, Rackley C. A smart phrase to improve documentation of supportive measures for idiopathic pulmonary fibrosis. J Nurse Practitioners. 2020;16(2):126\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nurpra.2019.09.008\u003c/span\u003e\u003cspan address=\"10.1016/j.nurpra.2019.09.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAppleby BE. Implementing guideline-checklists: Evaluating health care providers intentional behaviour using an extended model of the theory of planned behaviour. J Eval Clin Pract. 2019;25(4):664\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jep.13075\u003c/span\u003e\u003cspan address=\"10.1111/jep.13075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoucher N, Nicolla J, Ogunseitan A, Kessler E, Ritchie C, Zafar Y. Feasibility and acceptability of a best supportive care checklist among clinicians. J Palliat Med. 2018;21(8):1074\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/jpm.2017.0605\u003c/span\u003e\u003cspan address=\"10.1089/jpm.2017.0605\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFenwick KE, Swan BA. Managing dyspnea in individuals with idiopathic pulmonary fibrosis. J Hospice Palliat Nurs. 2020;22(6):447\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/NJH.0000000000000687\u003c/span\u003e\u003cspan address=\"10.1097/NJH.0000000000000687\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoyer N, Prior T, Bendstrup E, Wilcke T, Shaker S. Risk factors for diagnostic delay in idiopathic pulmonary fibrosis. Respir Res. 2019;20(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12931-019-1076-0\u003c/span\u003e\u003cspan address=\"10.1186/s12931-019-1076-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JW, Clark A, Birring SS, Atkins C, Whyte M, Wilson AM. Psychometric properties of patient reported outcome measures in idiopathic pulmonary fibrosis. Chronic Resp Dis. 2021;18:147997312110339\u0026ndash;925. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/14799731211033925\u003c/span\u003e\u003cspan address=\"10.1177/14799731211033925\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindell K. Nonpharmacological therapies for interstitial lung disease. Curr Pulmonol Rep. 2018;7(4):126\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s13665-018-0211-6\u003c/span\u003e\u003cspan address=\"10.1007/s13665-018-0211-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer K, Nathan S. (2019). \u003cem\u003eIdiopathic Pulmonary Fibrosis [electronic resource]: A Comprehensive Clinical Guide\u003c/em\u003e / edited by Keith C. Meyer, Steven D. Nathan. (2nd ed. 2019.). Springer International Publishing. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-319-99975-3\u003c/span\u003e\u003cspan address=\"10.1007/978-3-319-99975-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoran-Mendoza O, Colman R, Kalluri M, Cabalteja C, Harle I. A comprehensive and practical approach to the management of idiopathic pulmonary fibrosis. Expert Rev Respir Med. 2019;13(7):601\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Center for Health Statistics (NCHS). (2009). International classification of diseases, tenth revision (ICD-10). Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf\u003c/span\u003e\u003cspan address=\"https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel A, Siegert R, Brignall K, Gordon P, Steer S, Desai S, Maher T, Renzoni E, Wells A, Higginson I, Birring S. The development and validation of the King's Brief Interstitial Lung Disease (KBILD) health status questionnaire. Thorax. 2012;67(9):804\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/thoraxjnl-2012-201581\u003c/span\u003e\u003cspan address=\"10.1136/thoraxjnl-2012-201581\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolit DE, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 10th ed. Lippincott Williams \u0026amp; Wilkins; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrior TS, Hoyer N, Hilberg O, Shaker SB, Davidsen JR, Bendstrup E. Responsiveness and minimal clinically important difference of SGRQ-I and K-BILD in idiopathic pulmonary fibrosis. Respir Res. 2020;21(1):91\u0026ndash;1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12931-020-01359-3\u003c/span\u003e\u003cspan address=\"10.1186/s12931-020-01359-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaghu, G., Remy-Jardin, M., Myers, J., Richeldi, L., Ryerson, C., Lederer, D., Behr,J., Cottin, V., Danoff, S., Morell, F., Flaherty, K., Wells, A., Martinez, F., Azuma,A., Bice, T., Bouros, D., Brown, K., Collard, H., Duggal, A., \u0026hellip; Wilson, K. (2018).Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. \u003cem\u003eAmerican Journal of Respiratory and Critical Care Medicine, 198\u003c/em\u003e(5), e44\u0026ndash;e68. https://doi.org/10.1164/rccm.201807-1255ST.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaghu, G., Remy-Jardin, M., Richeldi, L., Thomson, C. C., Inoue, Y., Johkoh, T., Kreuter,M., Lynch, D. A., Maher, T. M., Martinez, F. J., Molina-Molina, M., Myers, J. L.,Nicholson, A. G., Ryerson, C. J., Strek, M. E., Troy, L. K., Wijsenbeek, M., Mammen,M. J., Hossain, T., \u0026hellip; Wilson, K. C. (2022). Idiopathic Pulmonary Fibrosis (an Update)and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. \u003cem\u003eAmerican Journal of Respiratory and Critical Care Medicine\u003c/em\u003e, \u003cem\u003e205\u003c/em\u003e(9), e18\u0026ndash;e47. https://doi.org/10.1164/rccm.202202-0399ST.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStevens KR. (2004). The ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-Based Practice. The University of Texas Health Science Center, San Antonio. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.acestar.uthscsa.edu\u003c/span\u003e\u003cspan address=\"http://www.acestar.uthscsa.edu\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e on 12th, March 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWapenaar M, Patel A, Birring S, Domburg R, Bakker E, Vindigni V, Sk\u0026ouml;ld C, Cottin V, Vancheri C, Wijsenbeek M. Translation and validation of the King\u0026rsquo;s Brief Interstitial Lung Disease (KBILD) questionnaire in French, Italian, Swedish, and Dutch. Chronic Resp Dis. 2017;14(2):140\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1479972316674425\u003c/span\u003e\u003cspan address=\"10.1177/1479972316674425\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWuyts WA, Wijsenbeek M, Bondue B, Bouros D, Bresser P, Robalo Cordeiro C, Hilberg O, Magnusson J, Manali ED, Morais A, Papiris S, Shaker S, Veltkamp M, Bendstrup E. Idiopathic pulmonary fibrosis: Best practice in monitoring and managing a relentless fibrotic disease. Respir Int Rev Thorac Dis. 2020;99(1):73\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000504763\u003c/span\u003e\u003cspan address=\"10.1159/000504763\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSgalla G, Iovene B, Calvello M, Ori M, Varone F, Richeldi L. Idiopathic pulmonary fibrosis: Pathogenesis and management. Respir Res. 2018;19(1):1\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12931-018-0730-2\u003c/span\u003e\u003cspan address=\"10.1186/s12931-018-0730-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Manen MJG, Geelhoed JJM, Tak NC, Wijsenbeek MS. Optimizing quality of life in patients with idiopathic pulmonary fibrosis. Ther Adv Respir Dis. 2017;11(3):157\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1753465816686743\u003c/span\u003e\u003cspan address=\"10.1177/1753465816686743\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmallwood N, Mann J, Guo H, Goh N. Patients with fibrotic interstitial lung disease receive supportive and palliative care just prior to death. Am J Hospice Palliat Med. 2021;38(2):154\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1049909120938629\u003c/span\u003e\u003cspan address=\"10.1177/1049909120938629\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"idiopathic pulmonary fibrosis, supportive care services, quality improvement, evidence-based care, King brief interstitial lung disease questionnaire, American thoracic society, Health-related quality of life, and clinical guideline implementation","lastPublishedDoi":"10.21203/rs.3.rs-3243836/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3243836/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Delayed referrals to supportive care services often result in impaired health-related quality of life (HRQL) among patients with idiopathic pulmonary fibrosis (IPF). Pulmonologists can adhere to the ATS clinical treatment guidelines through the use of the patient-reported outcome measure (PROM) tool, which can improve referral to supportive care services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLocal problem\u003c/strong\u003e: No PROM tool in the pulmonary clinic could assess patients' health-related quality of life (HRQL) of patients due to the disease burden of Idiopathic pulmonary fibrosis (IPF), hence delayed referral to supportive care services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: A pre and post-retrospective analysis of the chart\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e: The King's Brief Interstitial Lung Disease (KBILD) questionnaire was implemented as an evidenced-based PROM tool in the pulmonary clinic\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e: The use of the K-BILD questionnaire increased pulmonologist's awareness of stability or progression of disease burden among IPF patients based on HRQL, hence an increase in the referral of patients to supportive care services\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The results suggest that implementing an evidence-based PROM tool such as the KBILD questionnaire can increase referrals to supportive care services in a busy pulmonary clinic\u003c/p\u003e","manuscriptTitle":"Implementing a PROM tool to improve the supportive care services referral patterns of adult idiopathic pulmonary fibrosis patients in a pulmonary clinic: A quality improvement pilot project","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-16 23:22:48","doi":"10.21203/rs.3.rs-3243836/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7f0aaadf-280d-41f7-87bf-2fe84f210759","owner":[],"postedDate":"October 16th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-29T08:22:24+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-16 23:22:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3243836","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3243836","identity":"rs-3243836","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}