Gagliardi A R, Honein-AbouHaidar G, Stuart-McEwan T, Smylie J, Arnaout A, Seely J, Wright F C, Dobrow M J, Brouwers M C, Bukhanov K, McCready D R
University Health Network, Toronto, Canada.
Ottawa Hospital, Ottawa, Canada.
Eur J Cancer Care (Engl). 2018 Mar;27(2):e12727. doi: 10.1111/ecc.12727. Epub 2017 Jun 21.
Diagnostic assessment programmes (DAPs) coordinate multidisciplinary teamwork (MDT), and improve wait times and patient satisfaction. No research has established optimal DAP design. This study explored how DAP characteristics influence service delivery. A mixed methods case study of four breast cancer DAPs was conducted including qualitative interviews with health-care providers and retrospective chart review. Data were integrated using multiple approaches. Twenty-three providers were interviewed; 411 medical records were reviewed. The number of visits and wait times from referral to diagnosis and consultation were lowest at a one-stop model. DAP characteristics (rural-remote region, human resources, referral volume, organisation of services, adherence to service delivery targets and one-stop model) may influence service delivery (number of visits, wait times). MDT, influenced by other DAP characteristics (co-location of staff, patient navigators, team functioning), may also influence service delivery. While the one-stop model may be ideal, all sites experienced similar and unique challenges. Further research is needed to understand how to optimise the organisation and delivery of DAP services. Measures reflecting individual, team and patient-reported outcomes should be used to assess the effectiveness and impact of DAPs in addition to more traditional measures such as wait times.
诊断评估项目（DAPs）协调多学科团队合作（MDT），并缩短等待时间，提高患者满意度。目前尚无研究确定DAPs的最佳设计。本研究探讨了DAPs的特征如何影响服务提供。对四个乳腺癌DAPs进行了混合方法的案例研究，包括对医疗服务提供者的定性访谈和回顾性病历审查。采用多种方法整合数据。共访谈了23名提供者；审查了411份病历。在一站式模式下，从转诊到诊断和会诊的就诊次数和等待时间最少。DAPs的特征（农村偏远地区、人力资源、转诊量、服务组织、对服务提供目标的遵守情况和一站式模式）可能会影响服务提供（就诊次数、等待时间）。受其他DAPs特征（工作人员同地办公、患者导航员、团队运作）影响的MDT也可能影响服务提供。虽然一站式模式可能是理想的，但所有站点都面临着相似和独特的挑战。需要进一步研究以了解如何优化DAPs服务的组织和提供。除了诸如等待时间等更传统的指标外，还应使用反映个体、团队和患者报告结果的指标来评估DAPs的有效性和影响。
