Related Experiment Video
Updated: Jan 17, 2026
Growing a Cystic Fibrosis-Relevant Polymicrobial Biofilm to Probe Community Phenotypes
Published on: April 19, 2024
Formation and Growth of a Bronchiectasis and Pulmonary Nontuberculous Mycobacteria Multidisciplinary Program Using a
B Shoshana Zha1, Martin Ieong1, Isabella Cheng1
1Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep, Department of Medicine, University of California, San Francisco, San Francisco, CA.
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.
Related Concept Videos
01:30Chronic Obstructive Pulmonary Disease-V: Nursing Management
Assessment
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:29Chronic Obstructive Pulmonary Disease-V: Management
Smoking Cessation
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: