Improving Care Coordination for Advanced Lung Disease

Improving Care Coordination for Advanced Lung Disease
Collaborative, multi-specialty program is expanding transplant access.

While there are natural intersections among pulmonary medicine, allergy, and thoracic surgery, it can be challenging to coordinate patient care and provide a clear pathway to transplant and other advanced therapies. To address this gap, Vanderbilt University Medical Center has launched the Vanderbilt Lung Institute, a unique collaboration designed to deliver streamlined and comprehensive care for patients with all types of respiratory diseases.

Conceived by Timothy Blackwell, M.D., director of the Vanderbilt Division of Allergy, Pulmonary and Critical Care Medicine, the institute is led by surgical director Matthew Bacchetta, M.D., associate chair of thoracic surgery, and medical director Joao de Andrade, M.D., a professor of pulmonary and critical care medicine.

“Vanderbilt is geographically and intellectually well-located to provide superb care for patients with lung diseases, and it’s incumbent upon us to build a world-class system to meet those needs,” Bacchetta said. “We are driven to develop a team of first-rate clinicians and researchers working together to create the future of advanced therapies for our patients.”

“We’re working to increase access throughout our system for patients with complex and advanced lung disease.”

“What makes the Vanderbilt Lung Institute unique around the country is the governance of it – a collaborative integration of resources and talent from pulmonary medicine, allergy and thoracic surgery,” de Andrade added. “We’re working to increase access throughout our system for patients with complex and advanced lung disease.”

Streamlining Pulmonary Care

The Vanderbilt Lung Institute recently opened a 10,000-square-foot clinic space, in addition to an existing clinic on Vanderbilt’s main campus and five Vanderbilt Asthma, Sinus, and Allergy Program locations. By combining three programs under one umbrella, the institute provides more seamless care navigation.

“Beyond opportunities for service line growth, we have a strong sense of responsibility to our patient population and to our community,” de Andrade said. Vanderbilt sits in the middle of the I-65 corridor, which has the nation’s highest prevalence of chronic lung diseases such as COPD, lung cancer and interstitial lung disease.

The institute includes a variety of specialty clinics with the goal of integrating and expanding both clinical care and patient-centered research. Areas of focus include interstitial lung disease (ILD), pulmonary hypertension, COPD and lung cancer. The ILD program holds a weekly care conference that includes pulmonologists, thoracic radiologists, lung pathologists and rheumatologists across all training levels. “This is the standard for how ILD should diagnosed and treated,” de Andrade noted. “We are the only center within a 200-mile radius that has such a robust interdisciplinary approach to patient care.”

The institute incorporates a sophisticated interventional pulmonology program, where patients have access to the most advanced diagnostics. In collaboration with the Vanderbilt Heart and Vascular Institute, pulmonary thromboendarterectomy is offered for patients with chronic thromboembolic pulmonary hypertension. An advanced respiratory care unit established at the medical center with 29 monitored beds serves pre- and post-transplant patients and others with advanced lung disease.

Leading Transplant Expertise

The institute’s team has proven expertise in rehabilitating and transplanting lungs that would not be accepted at many other transplant centers using ex vivo lung perfusion (EVLP). They are also successfully using organs donated after cardiac death and hepatitis C-infected donors, Bacchetta said, plus extracorporeal membrane oxygenation (ECMO) to keep severely ill patients alive until they can receive a transplant. The approaches are already helping expand patient access to transplant.

De Andrade says the institute will focus on growing other programs that address advanced lung disease and better support community physicians. He and Bacchetta are in dialogue with practices across Tennessee and beyond, with the goal of understanding needs and creating seamless avenues for communication and collaboration.

“Beyond opportunities for service line growth, we have a strong sense of responsibility to our patient population and to our community.”

“Our feeding programs into transplant were not very developed – we had huge bottlenecks,” de Andrade said. “We have recently recruited three additional faculty with expertise in transplant and advanced lung disease and our ILD Program was expanded from three to five providers, which led to a reduction in the waiting time for an appointment from four months to 20-30 days.”

Supporting Translational Research

The Vanderbilt Lung Institute has established a research core to support the growth of its already substantial clinical and translational research portfolios, de Andrade said. The research core has dedicated coordinators, regulatory experts and financial personnel.

“At a place like Vanderbilt, with its history of innovation and research, any patient who walks through the door should be offered the opportunity to participate in research – whether it be through a registry or participating in clinical trials of emerging therapies.”