Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Division of Urology, Baylor College of Medicine, Houston, TX.
J Pediatr Surg. 2020 Nov;55(11):2397-2402. doi: 10.1016/j.jpedsurg.2020.05.002. Epub 2020 May 6.
Pediatric patients with complex colorectal and genitourinary conditions often require coordinated multidisciplinary care; however, this coordinated care can be hard to structure and deliver. The purpose of this paper is to review the development and implementation of a multidisciplinary colorectal and pelvic health program, one year after the program's initiation.
This is an observational retrospective 1-year study (10/1/2017 to 9/30/2018). In fiscal year (FY) 2018, a multidisciplinary colorectal and pelvic health program was initiated. The program development incorporated bimonthly team meetings, educational conferences, and initiation of three clinics: a complex colorectal and genitourinary reconstruction clinic, a bowel management clinic, and a colonic motility clinic. Conditions treated included complex anorectal and cloacal malformations, Hirschsprung disease, and idiopathic constipation. The fiscal year was selected to provide comparative administrative data after program implementation.
During the study period, 121 patients underwent comprehensive collaborative evaluation of which 58 (47%) were new to the institution compared to 12 (19%) new patients in the previous year (p < 0.001). In FY 2018, there were 130 procedures performed and 512 collaborative visits with an average of 47 visits per month. This was a 3.4-fold increase in visits compared to FY2017 (171 visits). Of the new patients, 60% (35/58), traveled a median of 181 miles, representing 33 statewide counties, and 4 states compared to a median of 93 miles in the previous fiscal year (p = 0.004).
The development of a colorectal and pelvic health program is feasible and requires a collaborative approach, necessitating multiple service lines within an institution. Program creation and implementation can result in rapid institutional clinical growth by filling a local and regional need through coordinated multidisciplinary care.
IV.
患有复杂结直肠和泌尿生殖系统疾病的儿科患者通常需要多学科协作护理；然而，这种协作护理很难构建和实施。本文的目的是回顾一个多学科结直肠和骨盆健康计划的发展和实施情况，该计划在启动一年后进行评估。
这是一项观察性回顾性研究（2017 年 10 月 1 日至 2018 年 9 月 30 日）。在 2018 财年，启动了一个多学科结直肠和盆腔健康计划。该计划的发展包括每两个月一次的团队会议、教育会议以及三个诊所的设立：复杂结直肠和泌尿生殖系统重建诊所、肠道管理诊所和结肠动力诊所。治疗的疾病包括复杂的肛门直肠和会阴畸形、先天性巨结肠病和特发性便秘。选择该财年是为了在计划实施后提供比较性管理数据。
在研究期间，有 121 名患者接受了全面的协作评估，其中 58 名（47%）是新到该机构的患者，而前一年有 12 名（19%）新患者（p<0.001）。2018 财年，共进行了 130 次手术和 512 次协作就诊，平均每月就诊 47 次。与 2017 财年的 171 次就诊相比，就诊次数增加了 3.4 倍。在新患者中，60%（35/58）来自距离中位数为 181 英里的 33 个全州县和 4 个州，而前一年的中位数为 93 英里（p=0.004）。
结直肠和盆腔健康计划的发展是可行的，需要一种协作的方法，需要机构内的多个服务线。通过协调多学科护理，满足当地和区域需求，该计划的创建和实施可以迅速促进机构内的临床增长。
IV。
