Abstract Introduction Racial disparities in idiopathic pulmonary fibrosis (IPF) outcomes are well-documented: Black patients with IPF are less likely to receive antifibrotics and are more likely to be hospitalized and die at younger ages than white patients. The specific points in the IPF care pathway where these inequities emerge remain unclear. Therefore, we mapped IPF care pathways in a large national cohort to identify points where delayed care may contribute to racial disparities. Methods We used the TriNetx Healthcare Database, which contains de-identified electronic health record and claims-based data from 130 million patients at 104 healthcare organizations. We identified adults (⩾ 50 years) diagnosed with IPF from 2016-2023 with the following previously validated criteria: 1) at least two ambulatory visits for IPF (ICD-10 J84.112), 2) at least one ambulatory visit for a non-IPF diagnosis prior to first IPF visit, and 3) a CT chest in the two years prior to first IPF encounter. Using process mining, which uses event-time data to map care processes, we created care pathway maps stratified by EHR-derived race (white vs. Black) to visualize frequency of and median time between care events and outcomes. Mapping started at the first qualifying chest CT, and subsequent care events assessed were IPF diagnosis, first pulmonary function tests (PFTs), and first autoimmune serologies. Outcomes were antifibrotic initiation, alternate ILD diagnosis, or death; patients without an outcome were censored at end-of-follow-up in the dataset. Results There were 2533 white patients (median diagnosis age diagnosis 73 IQR 67-78) and 190 Black patients (median diagnosis age 68 IQR 63-75). Median days were numerically longer for Black patients between: first CT to IPF diagnosis (147 vs 125 days), first CT to first autoimmune testing (48 vs 34 days), first autoimmune testing to IPF diagnosis (258 vs 109 days), first PFTs to IPF diagnosis (247 vs 187 days), and IPF diagnosis to antifibrotic treatment (68.5 vs 49 days) (Figure). Overall, 59 (31%) Black patients started antifibrotics vs 1016 (40%) white patients, 22 (11.5%) Black patients received an alternate diagnosis vs 234 (9.2%) of white patients, and 15 (7.9%) Black patients died vs 262 (10.3%) white patients. Conclusions Using a process mining approach, we found that Black patients have more days between multiple key IPF care points than white patients. Next steps include assessing for the statistical and clinical significance of these differences to identify high-yield care pathway targets for future interventions to improve care equity. This abstract is funded by: American Lung Association Catalyst Award
Shankar et al. (Fri,) studied this question.