Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review

Daniel Pilsgaard Henriksen, Zandra Nymand Ennis, Vasiliki Panou, Jørgen Hangaard, Per Bruno Jensen, Sofie Lock Johansson, Subagini Nagarajah, Marianne Kjær Poulsen, Mette Juel Rothmann, Karoline Schousboe, Stine Jorstad Bugge, Louise Brügmann Jessen, Ida Ransby Schneider, Ann Dorthe Olsen Zwisler, Kurt Højlund, Per Damkier, Daniel Pilsgaard Henriksen, Zandra Nymand Ennis, Vasiliki Panou, Jørgen Hangaard, Per Bruno Jensen, Sofie Lock Johansson, Subagini Nagarajah, Marianne Kjær Poulsen, Mette Juel Rothmann, Karoline Schousboe, Stine Jorstad Bugge, Louise Brügmann Jessen, Ida Ransby Schneider, Ann Dorthe Olsen Zwisler, Kurt Højlund, Per Damkier

Abstract

Introduction: Multidisciplinary Team Conferences (MDTs) are complex interventions in the modern healthcare system and they promote a model of coordinated patient care and management. However, MDTs within chronic diseases are poorly defined. Therefore, the aim of this scoping review was to summarise the current literature on physician-led in-hospital MDTs in chronic non-malignant diseases.

Method: Following the PRISMA-ScR guideline for scoping reviews, a search on MDT interventions in adult patients, with three or more medical specialties represented, was performed.

Results: We identified 2790 studies, from which 8 studies were included. The majority of studies were non-randomised and focused on a single disease entity such as infective endocarditis, atrial fibrillation, IgG4-related disease, or arterial and venous thrombosis. The main reason for referral was confirmation or establishment of a diagnosis, and the MDT members were primarily from medical specialties gathered especially for the MDT. Outcomes of the included studies were grouped into process indicators and outcome indicators. Process indicators included changes in diagnostic confirmation as well as therapeutic strategy and management. All studies reporting process indicators demonstrated significant changes before and after the MDT.

Conclusion: MDTs within chronic diseases appeared highly heterogeneous with respect to structure, reasons for referral, and choice of outcomes. While process indicators, such as change in diagnosis, and treatment management/plan seem improved, such have not been demonstrated through outcome indicators.

Keywords: Multidisciplinary team conferences.

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
The PRISMA flow diagram for studies included in the scoping review.

References

    1. Wright FC, De Vito C, Langer B, et al. Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer Oxf Engl 1990 2007; 43: 1002–1010.
    1. Rankin NM, Fradgley EA, Barnes DJ. Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps. Transl Lung Cancer Res 2020; 9: 1667–1679.
    1. Rosell L, Alexandersson N, Hagberg O, et al. Benefits, barriers and opinions on multidisciplinary team meetings: a survey in Swedish cancer care. BMC Health Serv Res 2018; 18: 249.
    1. Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treat Rev 2016; 42: 56–72.
    1. Laurent E, Lemaignen A, Gras G, et al. Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study. Rev Epidemiol Sante Publique 2019; 67: 149–154.
    1. Wales KE, Saxena A, Gray TG. Evidence for the urogynaecology multidisciplinary team meeting: evaluation from a secondary care perspective. Int Urogynecology J 2020; 31: 1181–1189.
    1. Walsh SLF, Wells AU, Desai SR, et al. Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study. Lancet Respir Med 2016; 4: 557–565.
    1. Kushner DS, Strasser DC. Stroke inpatient rehabilitation team conferences: leadership and structure improve patient outcomes. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 2020; 29: 104622.
    1. Seuren LM, Stommel W, van Asselt D, et al. Multidisciplinary meetings at the emergency department: a conversation-analytic study of decision-making. Soc Sci Med 1982 2019; 242: 112589.
    1. Ke KM, Blazeby JM, Strong S, et al. Are multidisciplinary teams in secondary care cost-effective? A systematic review of the literature. Cost Eff Resour Alloc CE 2013; 11: 7.
    1. Houssami N., Sainsbury R. Breast cancer: multidisciplinary care and clinical outcomes. Eur J Cancer Oxf Engl 1990 2006; 42: 2480–2491.
    1. Keating NL, Landrum MB, Lamont EB, et al. Tumor boards and the quality of cancer care. J Natl Cancer Inst 2013; 105: 113–121.
    1. Tattersall MHN. Multidisciplinary team meetings: where is the value? Lancet Oncol 2006; 7: 886–888.
    1. Prabhu Das I, Baker M, Altice C, et al. Outcomes of multidisciplinary treatment planning in US cancer care settings. Cancer 2018; 124: 3656–3667.
    1. Soukup T, Lamb BW, Arora S, et al. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Multidiscip Healthc 2018; 11: 49–61.
    1. Prades J, Remue E, van Hoof E, et al. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy Amst Neth 2015: 119: 464–474.
    1. Richeldi L, Launders N, Martinez F, et al. The characterisation of interstitial lung disease multidisciplinary team meetings: a global study. ERJ Open Res 2019; 5: 00209.
    1. Koné Pefoyo AJ, Bronskill SE, Gruneir A, et al. The increasing burden and complexity of multimorbidity. BMC Public Health 2015; 15: 415.
    1. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018; 169: 467–473.
    1. Patel M, Shilliday IR, McKay GA. A combined diabetes renal clinic improves risk factor management and progression of renal disease in a district general hospital. J Eval Clin Pract 2009; 15: 832–835.
    1. Voorend CGN, Joosten H, Berkhout-Byrne NC, et al. Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach. Eur Geriatr Med 2021; 12: 931–942.
    1. Siaw MYL, Malone DC, Ko Y, Lee JY-C. Cost-effectiveness of multidisciplinary collaborative care versus usual care in the management of high-risk patients with diabetes in Singapore: short-term results from a randomized controlled trial. J Clin Pharm Ther 2018; 43: 775–783.
    1. Covidence - Better systematic review management. Covidence
    1. Janssens ACJW, Gwinn M, Brockman JE, et al. Novel citation-based search method for scientific literature: a validation study. BMC Med Res Methodol 2020; 20: 25.
    1. Aston SJ, Reade S, Petersen B, et al. Extraordinary virtual multidisciplinary team meetings - a novel forum for the coordinated care of patients with -complex conditions within a secondary care setting. Future Healthc J 2018; 5: 218–223.
    1. Camou F, Dijos M, Barandon L, et al. Management of infective endocarditis and multidisciplinary approach. Med Mal Infect 2019; 49: 17–22.
    1. Chahal JK, Antoniou S, Earley M, et al. Preventing strokes in people with atrial fibrillation by improving ABC. BMJ Open Qual 2019; 8: e000783.
    1. Evén G, Spaak J, von Arbin M, et al. Health care professionals; experiences and enactment of person-centered care at a multidisciplinary outpatient specialty clinic. J Multidiscip Healthc 2019; 12: 137–148.
    1. Goodchild G, Peters RJ, Cargill TN, et al. Experience from the first UK inter-regional specialist multidisciplinary meeting in the diagnosis and management of IgG4-related disease. Clin Med Lond Engl 2020; 20: e32–e39.
    1. Tan C, Hansen MS, Cohen G, et al. Case conferences for infective endocarditis: a quality improvement initiative. PloS One 2018; 13: e0205528.
    1. Mauger C, Gouin I, Guéret P, et al. Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases. J Med Vasc 2020; 45: 192–197.
    1. Weber C, Beaulieu M, Djurdjev O, et al. Towards rational approaches of health care utilization in complex patients: an exploratory randomized trial comparing a novel combined clinic to multiple specialty clinics in patients with renal disease-cardiovascular disease-diabetes. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc 2012; 27(Suppl 3): iii104-iii110.
    1. Borgstrom E, Cohn S, Driessen A, et al. Multidisciplinary team meetings in palliative care: an ethnographic study. BMJ Support Palliat Care 2021: bmjspcare-2021-003267. in press. DOI: 10.1136/bmjspcare-2021-003267.
    1. Raine R, Xanthopoulou P, Wallace I, et al. Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study. BMJ Qual Saf 2014; 23: 867–876.
    1. Collister D, Pyne L, Cunningham J, et al. Multidisciplinary chronic kidney disease clinic practices: a scoping review. Can J Kidney Health Dis 2019; 6: 205435811988266.
    1. Spaak J. Integrated, Multidisciplinary, Person-centered Care for Patients With Complex Comorbidities: Heart, Kidney and Diabetes - a Randomized Trial, 2021.
    1. Rafiq M, Keel G, Mazzocato P, et al. Extreme consumers of health care: patterns of care utilization in patients with multiple chronic conditions admitted to a novel integrated clinic. J Multidiscip Healthc 2019; 12: 1075–1083.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever