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门诊多学科(MDT)服务模式运行状况及关键影响因素的实证研究:一项中国四川省的横断面研究

Empirical Study on the Operational Status and Key Influencing Factors of Outpatient Multidisciplinary (MDT) Service Model: A Cross-Sectional Study in Sichuan Province, China.

作者信息

Wang HuanLin, He Qian, Guo Yuan, Feng GuoWen, He Xuan, Wan Zhi

机构信息

Rare Diseases Center West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.

Department of Outpatient West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.

出版信息

J Multidiscip Healthc. 2025 Jul 31;18:4431-4442. doi: 10.2147/JMDH.S528489. eCollection 2025.

Abstract

BACKGROUND

Currently, there is a lack of baseline research on outpatient Multi-Disciplinary Team (MDT) services. Through conducting a cross-sectional survey in Sichuan Province, China, this study aims to explore the current status and influencing factors of outpatient MDT services, providing a reference for their further development.

METHODS

A questionnaire survey was conducted in June 2024 on tertiary medical institutions in Sichuan Province using the cluster sampling method. A total of 203 valid questionnaires were collected, yielding an effective response rate of 91.0%. Descriptive statistics, correlation, and difference tests were employed to analyze the survey data.

RESULTS

The development rate of outpatient MDT in tertiary medical institutions in Sichuan Province was 77.3%, and the start-up time was mainly concentrated in the past five years. About 87.3% of the hospitals set up fixed MDT teams with the number of ≤10, which was still in the development stage. In terms of MDT organization and management, 96.8% of the hospitals have issued relevant management systems, but the cognitive differences of MDT function positioning lead to significant heterogeneity in organization and management and operation mode. The analysis of key influencing factors shows that team dynamics is the primary internal driving factor, while medical insurance policy is the primary external influencing factor.

CONCLUSION

Medical institutions need to promote the standardized development of outpatient MDT from the two dimensions of system construction and mechanism innovation: first, improve the institutionalized management framework: integrate the core link of MDT into the hospital quality management system through the construction of standardized workflow. Second, establish a refined assessment mechanism: focus on process indicators such as the standardized rate of case discussion and the implementation rate of the scheme, support an interdisciplinary performance incentive system, and mobilize the enthusiasm of departments and doctors to promote their rapid development.

摘要

背景

目前,关于门诊多学科团队(MDT)服务的基线研究尚显不足。通过在中国四川省开展横断面调查,本研究旨在探索门诊MDT服务的现状及影响因素,为其进一步发展提供参考。

方法

2024年6月采用整群抽样法对四川省三级医疗机构进行问卷调查。共收集到203份有效问卷,有效回收率为91.0%。运用描述性统计、相关性分析和差异检验对调查数据进行分析。

结果

四川省三级医疗机构门诊MDT的开展率为77.3%,启动时间主要集中在过去五年。约87.3%的医院设立了固定的MDT团队,团队人数≤10人,仍处于发展阶段。在MDT组织管理方面,96.8%的医院已出台相关管理制度,但对MDT功能定位的认知差异导致组织管理和运作模式存在显著异质性。关键影响因素分析表明,团队活力是主要的内部驱动因素,而医保政策是主要的外部影响因素。

结论

医疗机构需从制度建设和机制创新两个维度推动门诊MDT的规范化发展:一是完善制度化管理框架:通过构建标准化工作流程,将MDT的核心环节纳入医院质量管理体系。二是建立精细化评估机制:关注病例讨论规范率、方案执行率等过程指标,支持跨学科绩效激励体系,调动科室和医生的积极性,推动其快速发展。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5238/12325103/5ec394c402df/JMDH-18-4431-g0001.jpg

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