Sydney West - Translational Cancer Research Centre, Western Sydney Local Health District, PO Box 533 Wentworthville, Sydney, NSW, 2145, Australia.
Tumour Program Strengthening Initiative innovation manager (2019), Western Sydney Local Health District, Sydney, Australia.
BMC Health Serv Res. 2021 Mar 6;21(1):203. doi: 10.1186/s12913-021-06203-y.
While multidisciplinary teams (MDTs) are now considered an essential part of cancer care decision-making, how they perform varies widely. The authors hypothesised that a comprehensive, multipronged improvement program, and associated annual member survey, could strengthen MDT performance across a whole cancer service.
The study comprised the introduction of a structured program, the Tumour Program Strengthening Initiative (TPSI) linked with an annual survey of member's perceptions of their performance. Three iterations of the survey have been completed (2017, 2018 and 2019). Generalised estimating equations (GEEs) were used to test for a difference in the proportion of positive survey responses between 2017 and 2019 adjusted for team clustering.
Twelve teams participated in TPSI. One hundred twenty-nine, 118 and 146 members completed the survey in 2017, 2018 and 2019, respectively. Of the 17 questions that were asked in all three years, nine showed significant improvement and, of these, five were highly significant. Documenting consensus, developing Terms of Reference (TORs), establishing referral criteria and referring to clinical practice guidelines showed most improvement. Questions related to patient considerations, professional development and quality improvement (QI) activities showed no significant change.
TPSI resulted in sustained and significant improvement. The MDT survey not only allowed MDT members to identify their strengths and weaknesses but also provided insights for management to flag priority areas for further support. Overall program improvement reflected the strengthening of the weakest teams as well as further improvement in highly performing MDTs. Importantly, the initiative has the potential to achieve behaviour change amongst clinicians.
虽然多学科团队（MDTs）现在被认为是癌症治疗决策的重要组成部分，但它们的表现差异很大。作者假设，一个全面的、多管齐下的改进计划，以及相关的年度成员调查，可以加强整个癌症服务的 MDT 表现。
该研究包括引入一个结构化的计划，即肿瘤项目强化倡议（TPSI），并与成员对其表现的年度调查相结合。已经完成了三次调查（2017 年、2018 年和 2019 年）。使用广义估计方程（GEE）来检验 2017 年至 2019 年之间，在考虑团队聚类的情况下，积极调查结果的比例是否存在差异。
12 个团队参与了 TPSI。分别有 129、118 和 146 名成员在 2017、2018 和 2019 年完成了调查。在所有三年中都提出的 17 个问题中，有 9 个显示出显著的改善，其中 5 个是非常显著的。记录共识、制定职权范围（TORs）、建立转诊标准和参考临床实践指南显示出最大的改善。与患者考虑、专业发展和质量改进（QI）活动相关的问题没有显示出显著的变化。
TPSI 带来了持续和显著的改善。MDT 调查不仅使 MDT 成员能够识别他们的优势和劣势，还为管理层提供了见解，以确定需要进一步支持的优先领域。总体项目改进反映了对最薄弱团队的加强，以及高绩效 MDT 的进一步改进。重要的是，该倡议有可能在临床医生中实现行为改变。
