应用TOPSIS法综合评价肿瘤多学科首席专家团队的医疗工作质量

摘 要：［目的］ 通过应用TOPSIS法对医院肿瘤单病种多学科首席专家团队的医疗工作质量进行综合评价,为肿瘤多学科诊疗模式管理工作的评价与改善提供理论依据。［方法］ 应用TOPSIS法从工作量、质量、效率3个维度,13个指标方面对医院8个肿瘤单病种多学科首席专家团队2014~2017年的医疗工作质量进行综合评价和分析。［结果］ 评价结果与医院各多学科团队实际医疗工作情况相符,医疗质量基本呈逐年上升趋势,2017 年医疗质量最佳,2014 年最差。［结论］ 肿瘤多学科诊疗模式的规范运作有助于医疗工作质量的提高,可以在医院管理工作中推广使用,同时应加强对各团队工作的综合评价,促进肿瘤MDT模式的发展。     

恶性肿瘤多学科综合诊疗模式的探索

多学科专家协作组(multidisciplinary team,MDT)诊疗模式已经成为恶性肿瘤诊疗的国际趋势.中国医学科学院肿瘤医院从2000年开始探索,开展针对住院患者和门诊患者的多种形式的MDT诊疗模式,出台了相应的规范制度和激励机制,对MDT诊疗工作的开展起到了积极作用.MDT诊疗模式的发展和壮大,加强了学科间的协作,提高了医疗质量,保障了患者的治疗效果.     

多学科团队（MDT）模式在头颈肿瘤综合治疗中的探索及意义

恶性肿瘤的治疗需要多学科共同参与制定针对患者的个体化方案,因此多学科团队（multidisciplinar-y team,MDT）模式在肿瘤治疗中被提出并在全球范围内广泛实践。我国 MDT 起步晚,缺乏统一的规范,各级医疗机构 MDT 水平差异较大。本文将以四川省肿瘤医院在 MDT 实践中的经验为例,阐述 MDT 在头颈肿瘤个体化治疗中的意义,提出 MDT 的组织模式,目前存在的问题及发展方向。目的在于促进 MDT 模式在头颈肿瘤综合治疗中的推广和成熟。     

MDT诊疗及在妇科恶性肿瘤中的应用

传统的单学科诊疗模式,患者需多次转诊,耗时长,治疗依从性差。MDT多学科诊疗模式整合各个科室的优势,制定个体化高质量的诊疗方案,改善患者预后。该文对MDT的历史演变,传统单学科诊疗模式和MDT诊疗模式的对比,MDT的目标和作用,MDT有效性的循证依据,MDT的团队建设,MDT诊疗过程的障碍和难点,远程视频会议及AI技术在MDT中的运用以及在妇科肿瘤患者中运用的临床实践作一评述。     

基于TOPSIS法的单病种多学科首席专家团队综合评价

摘 要：［目的］应用TOPSlS(technique for order preference by similarity to ideal solution)法对肿瘤医院多学科专家协作组(multidisciplinary team,MDT)运行模式的发展状况进行横向的综合评价,发现各团队MDT运行模式整体发展的优劣程度,为构建MDT模式综合评价的指标体系和具体方法提供理论指导和实践支持。［方法］采用TOPSIS法从学术队伍、科学研究、医疗服务、人才培养、经济效益、社会效益6个维度,34个指标方面对医院8个肿瘤单病种多学科首席专家团队2018年的发展状况进行综合评价和分析。［结果］甲状腺癌多学科首席专家团队位列第一,肺癌多学科首席专家团队处于8个团队中的最低水平,评价结果与各团队发展现状基本相符。［结论］本研究确定的评价维度及具体评价指标,能够为管理部门对各多学科团队的统一监管、完善考核办法及多学科诊疗模式综合评价指标体系提出一些切实可行的策略建议。     

一例胃低分化腺癌合并同时性多发性结直肠腺癌的MDT诊治

多学科综合治疗协作组（multi－disciplinary team,MDT）诊治模式符合精准医学和个体化治疗的准则,目前逐渐成为一种主流模式。这一模式能够弥补不同学科对疾病认识上的不足,提高医疗质量,并且能使患者利益最大化。本文总结本院诊治的1例罕见胃低分化腺癌合并同时性多发性结直肠腺癌患者的资料,通过治疗过程中多次MDT讨论,制定适合该患者的最佳诊断和治疗方案,体现出MDT诊治的优势,最终使患者获益。     

新辅助放化疗后直肠癌术后肺转移的多学科诊疗模式决策及结果评价

  目的  了解多学科协作（multidisciplinary team,MDT）模式下直肠癌术后肺转移治疗决策现状和结局,为加强医疗质量管理、完善MDT模式提供依据。  方法  回顾性收集2007年7月至2015年2月北京大学肿瘤医院680例接受术前新辅助治疗联合根治术的直肠癌患者临床资料,调查术后发生肺转移的患者在MDT模式下的治疗决策、执行情况和生存结局。  结果  研究纳入85例术后肺转移患者,68例采用MDT模式治疗,其中28例建议行局部根治,40例建议行姑息治疗;决策总执行率为89.7%（61/68）,未执行者均选择进一步保守治疗。局部根治的患者在直肠原发灶术后首次发生复发/转移后的3年复发/转移后生存率（survival after recurrence,SAR）高于姑息治疗患者（84.8% vs.37.6%,P < 0.001）。  结论  在MDT模式运行良好的情况下,直肠癌根治术后肺转移的治疗决策执行率较高,部分患者在该模式下有机会获得根治且预后良好;引入“患者参与”和“社会支持”将有助于构建全新MDT模式和提高医疗质量管理水平。      

肿瘤医院开展多学科诊疗的探索

肿瘤疾病开展多学科专家协作组(MDT)诊疗模式是恶性肿瘤的合理诊疗模式,目前在我国正受到高度关注和广泛推广.MDT诊疗的规范化是保障诊疗效果和患者获益的基石.该文在结合辽宁省肿瘤医院推进MDT工作的基础上,凝练出MDT工作的核心理念.首次提出了以循证规范为基石,以整体联动、平等协作为途径,以医患和谐、患者获益为宗旨,以学科整合、共同发展为愿景的“4C”理论.通过持续改进,MDT诊疗理念内涵不断得到丰富,MDT的标准化和常态化定能使更多的肿瘤患者获益.     

大肠癌治疗模式变迁

自1963年浙江省肿瘤医院成立,大肠癌即做为医院发展重点学科之一,在长达50年的发展历程中,大肠癌治疗模式从建院之初的单一手术治疗,到后来科内综合治疗、分科综合治疗,再到现在的临床多学科工作团队（multidisciplinary team,MDT）治疗。年治疗大肠癌患者从建院之初的不足200例,上升到现在的1200例,5年生存率从最初不足40%提高至60%以上,综合治疗的进步,以及多学科MDT治疗是疗效提高的主要原因。     

中国Ⅳ期原发性肺癌多学科团队诊疗实施指南

Ⅳ期原发性肺癌患者虽然有多种治疗选择, 但由于病情复杂, 疾病异质性较大, 在诊疗过程中出现的问题可能会涉及全身多个系统和器官, 因此, 在临床实践过程中经常需要不同学科之间相互协作。多学科团队(MDT)是指由来自两个以上的相关学科, 组成固定的工作组, 针对某一疾病的特定患者, 通过会诊形式, 提出适合患者的最佳个体化治疗方案, 并由相关学科单独或多个学科联合执行该治疗方案。MDT是一种广为推崇的诊疗模式, 特别适用于肿瘤患者, 已经成为国际上恶性肿瘤诊疗的基本原则, Ⅳ期原发性肺癌的诊疗也遵循MDT原则。为了促进中国Ⅳ期原发性肺癌MDT模式的健康发展和Ⅳ期原发性肺癌诊疗水平的提高, 中国医师协会肿瘤医师分会和中国医疗保健国际交流促进会肿瘤内科分会共同组织全国专家编写了中国Ⅳ期原发性肺癌多学科团队诊疗实施指南, 供临床医师参考。     

多学科诊疗模式在本科生肿瘤学临床实习教学中的作用与意义

目的:探讨在医学本科生临床实践教学中实施多学科诊疗模式（multidisciplinary team,MDT）教学法的作用及现实意义。方法:分析临床实习阶段的医学本科生对肿瘤MDT及其发展、应用缺乏认知现状,并结合笔者所在肿瘤学教学团队回顾性对比分析2017年与2016年学员教学效果。结果:2017年MDT教学组中学员肿瘤学理论考试、肿瘤病例分析成绩均显著高于2016年对照组,且教学满意度更高,学员合作能力、学习积极性及学习兴趣亦显著增强。结论:MDT教学模式可以培养临床肿瘤医学生的整体医学观和综合诊疗临床思维,加强本科生肿瘤疾病诊治技能、临床科研能力,培养和提升其医学人文情怀。     

Clinical application of multidisciplinary teams in tumor therapy

Multidisciplinary team (MDT) model is a diagnostic and treatment model characterized by interdisciplinarity,integration,centralism,individualization,and precision and is becoming more common in the management of complex malignancies.MDT emphasizes team spirit and a personalized treatment strategy according to the actual condition of each patient.A cooperative and effective mnltidisciplinary team is an important guarantee for delivering high-quality services to parents.Under the guidance of a medical humanistic concept,MDT provides reasonable,effective,convenient,and a full range of excellent quality medical service to patients.The MDT maximizes parent benefits,and it is the developmental direction for large-scale general hospitals.At the same time,the MDT is also an important measure to strengthen the core competitiveness of hospitals.Here,we introduce the clinical application of the model in tumor therapy as well as the current state and development in our hospital.     

口腔癌的多学科协作诊治模式

口腔癌是头颈部最常见的恶性肿瘤,传统的单一治疗模式已无法满足治疗的需要。多学科协作诊疗模式（MDT ）对提高患者生存率、改善预后起着重要作用。较传统单一学科诊疗模式,MDT 为患者提供了全方位个体化的高质量诊疗,其对于医学教育与科研同样有所帮助。MDT 在国外已广泛开展,但在国内尚处于起步阶段,需要重视并规范化开展口腔癌的多学科协作诊治模式。      

China special issue on gastrointestinal tumors-Improved survival after multidisciplinary team decision for patients with advanced gastrointestinal cancer: A multicenter,noninterventional, controlled study

Formal multidisciplinary team (MDT) discussions in clinical practice require time and space but have unclear survival benefits for advanced gastrointestinal cancer patients. Our study aimed to investigate the long-term survival of patients with advanced gastrointestinal cancer after MDT decision. From June 2017 to June 2019, continuous MDT discussions on advanced gastrointestinal cancer were conducted in 13 medical centers in China. MDT decisions and actual treatment received by patients were prospectively recorded. The primary endpoint was the difference in overall survival (OS) between patients in the MDT decision implementation and nonimplementation groups. The secondary endpoints included the implementation rate of MDT decisions and subgroup survival analysis. A total of 461 MDT decisions of 455 patients were included in our study. The implementation rate of MDT decisions was 85.7%. Previous treatment had an impact on MDT decision-making. The OS was 24.0 months and 17.0 months in the implementation and nonimplementation groups, respectively. The implementation of MDT decisions significantly reduced the risk of death in multivariate analyses (hazard ratio = 0.518; 95% confidence interval: 0.304-0.884, P = .016). Subgroup analysis showed a significant difference in survival of patients with colorectal cancer, but not in survival of patients with gastric cancer. The rate of secondary MDT discussion was only 5.6% among patients who the MDT decisions were discontinued due to changes in their condition. MDT discussion can prolong the OS of patients with advanced gastrointestinal cancer, especially those with colorectal cancer. Timely scheduling of the subsequent MDT discussion is necessary when the disease condition changes.     

Multidisciplinary team meetings in cancerology: setting priorities for improvement

Resulting medical decision from a multidisciplinary team (MDT) meeting has to be accurate regarding to various patient criteria and relevant specialists participation. The target is to optimize treatment or management options for patients taking into account patients' benefit. The aim of our study was to examine quality criteria of MDT meeting processes, implementation of the MDT decision, and the follow-up of national or regional clinical guidelines. The results lead us to discuss about care management in cancer. Ten various medical specialities of MDT meetings were studied. Relevant multidisciplinarity varied between MDT meetings specialities and was effective between 55 and 100%. Implementation of the decisions that arise from MDT meetings was 86.3%. The most frequent grounds of non-application were patient refusal and new or previous unknown clinical data. The percentage of MDT meetings decisions following national or regional recommendations was 74%. The main reason of not following was the complexity of clinical patient circumstances. Participation in MDT meetings is more and more time-consuming related to enforce the completeness referred to the Plan Cancer (National recommendations). Leading to completeness raises questions about medical time employment and meaning of the MDT meeting for standard clinical cases. The priority seems to enforce multidisciplinarity rather than reach completeness.     

Multidisciplinary team working across different tumour types: analysis of a national survey

BackgroundUsing data from a national survey, this study aimed to address whether the current model for multidisciplinary team (MDT) working is appropriate for all tumour types.Patients and methodsResponses to the 2009 National Cancer Action Team national survey were analysed by tumour type. Differences indicate lack of consensus between MDT members in different tumour types.ResultsOne thousand one hundred and forty-one respondents from breast, gynaecological, colorectal, upper gastrointestinal, urological, head and neck, haematological and lung MDTs were included. One hundred and sixteen of 136 statements demonstrated consensus between respondents in different tumour types. There were no differences regarding the infrastructure for meetings and team governance. Significant consensus was seen for team characteristics, and respondents disagreed regarding certain aspects of meeting organisations and logistics, and patient-centred decision making. Haematology MDT members were outliers in relation to the clinical decision-making process, and lung MDT members disagreed with other tumour types regarding treating patients with advanced disease.ConclusionsThis analysis reveals strong consensus between MDT members from different tumour types, while also identifying areas that require a more tailored approach, such as the clinical decision-making process, and preparation for and the organisation of MDT meetings. Policymakers should remain sensitive to the needs of health care teams working in individual tumour types.     

妇科恶性肿瘤多学科诊疗中国专家共识（2022年版）

近年来,随着妇科恶性肿瘤综合治疗新策略的不断涌现,以及生殖肿瘤学和遗传肿瘤理念的演进,传统的“单学科诊疗”模式已难于以最优的方案解决患者的诊疗问题。多学科诊疗（multidisciplinary team,MDT）可以使患者获得最科学、最合理的诊疗,有利于改进和完善现有的治疗方式,从而提高医疗效率及质量。基于MDT领域国内外最新研究进展及临床实践经验,中国抗癌协会妇科肿瘤专业委员会组织国内妇科肿瘤及相关领域的专家,针对妇科恶性肿瘤MDT运行流程、监测评估及质量控制,制订了《妇科恶性肿瘤多学科诊疗中国专家共识（2022年版）》,希望通过本共识,提高中国临床工作者对于妇科恶性肿瘤MDT的认识,以指导和规范MDT在妇科恶性肿瘤诊疗中的临床运用。