Raine Rosalind, Xanthopoulou Penny, Wallace Isla, Nic A' Bháird Caoimhe, Lanceley Anne, Clarke Alex, Livingston Gill, Prentice Archie, Ardron Dave, Harris Miriam, King Michael, Michie Susan, Blazeby Jane M, Austin-Parsons Natalie, Gibbs Simon, Barber Julie
Department of Applied Health Research, University College London, London, UK.
Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
BMJ Qual Saf. 2014 Oct;23(10):867-76. doi: 10.1136/bmjqs-2014-002818. Epub 2014 Jun 9.
Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions.
We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans.
The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91).
Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care.
多学科团队（MDT）会议被认为能做出更好的决策，并在国民医疗服务体系（NHS）中广泛用于慢性病管理。然而，其有效性的证据并不一致。我们的目的是通过研究影响MDT治疗计划实施的因素来调查MDT有效性的决定因素。这是有效性的一种替代衡量方法，因为它处于健康改善的路径上，并反映了考虑到临床和非临床信息的团队决策。此外，该衡量方法可在针对不同病症的MDT之间进行比较。
我们对伦敦和北泰晤士的12个MDT进行了一项前瞻性混合方法研究。通过观察370次MDT会议、采访53名MDT成员以及查阅2654份患者病历收集数据。我们研究了患者相关因素（疾病、年龄、性别、贫困程度、是否提及他们的偏好及其他临床/健康行为）和MDT特征（使用“团队氛围量表”和技能组合进行衡量）对MDT治疗计划实施的影响。
MDT会议中每增加一个专业组，实施的调整后几率（或可能性）就降低25%。在目标明确、流程清晰且“团队氛围”良好的MDT中，实施的可能性更大（团队氛围量表（TCI）得分每增加一个单位，调整后比值比为1.96；95%置信区间为1.15至3.3）。实施情况因疾病类别而异，心理健康团队的调整后实施几率最低。生活在贫困程度较高地区的患者实施情况也较低（与最不贫困地区相比，最贫困地区患者实施的调整后几率为0.60，95%置信区间为0.39至0.91）。
更高的多学科性不一定与更有效的决策相关。明确的目标和程序也至关重要。应定期监测决策的实施情况，以确保公平提供护理。
