Formation and Growth of a Bronchiectasis and Pulmonary Nontuberculous Mycobacteria Multidisciplinary Program Using a Patient-Centered and Integrated Care Model Improves Outcomes

BACKGROUND: Bronchiectasis and pulmonary nontuberculous mycobacteria (NTM) infections are chronic diseases that can cause debilitating respiratory symptoms, exacerbations, and even lead to respiratory failure. Clinical care has historically been provided by individual specialists, but multidisciplinary care teams have recently emerged to improve evaluation of underlying etiology and interventions that disrupt the trajectory of disease progression. RESEARCH QUESTION: Does a multidisciplinary care program reduce bronchiectasis exacerbations or improve sputum conversion rates in pulmonary NTM infections? STUDY DESIGN AND METHODS: This is a retrospective study of INTEGRATE, a multidisciplinary bronchiectasis and NTM care program launched in 2019 and shaped by the principles of a patient-centered and integrated care (PC-IC) model. Those who consistently submitted microbiologic samples and received prescriptions through the program were included in outcome models. Interrupted time series analysis and segmented Poisson regression were used to compare bronchiectasis exacerbation rates prior to and following INTEGRATE consultation. Sputum culture conversion of NTM was analyzed by Cox hazard regression to estimate the hazard ratio. RESULTS: The analysis included 453 individuals cared for at INTEGRATE, evaluated for demographic characteristics, encounter frequency, and clinical characteristics. INTEGRATE was associated with a 36% reduction in quarterly exacerbations in the year following consultation compared with the pre-consultation trend (rate ratio, 0.64; 95% CI, 0.55-0.74; P = .0004). Among individuals with NTM lung infection, those followed up at INTEGRATE had shorter time to culture conversion compared with general care (hazard ratio, 0.68; 95% CI, 0.47-0.97; P = .0311), indicating a higher rate of conversion over time. Furthermore, an established multidisciplinary conference improved provider comfort and perceived practice safety. INTERPRETATION: The INTEGRATE multidisciplinary program for bronchiectasis and pulmonary NTM disease has been well received, with PC-IC argued as the ideal model. Further studies are needed to identify specific measures and timing to inform quality improvement and broader implementation.