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Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study

Published on Oct 1, 2014in Health Services and Delivery Research
· DOI :10.3310/hsdr02370
Rosalind Raine32
Estimated H-index: 32
,
Isla Wallace4
Estimated H-index: 4
+ 13 AuthorsJulie Barber18
Estimated H-index: 18
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Abstract
Background Multidisciplinary team (MDT) meetings have been endorsed by the Department of Health as the core model for managing chronic diseases. However, the evidence for their effectiveness is mixed and the degree to which they have been absorbed into clinical practice varies widely across conditions and settings. We aimed to identify the key characteristics of chronic disease MDT meetings that are associated with decision implementation, a measure of effectiveness, and to derive a set of feasible modifications to MDT meetings to improve decision-making. Methods We undertook a mixed-methods prospective observational study of 12 MDTs in the London and North Thames area, covering cancer, heart failure, mental health and memory clinic teams. Data were collected by observation of 370 MDT meetings, completion of the Team Climate Inventory (TCI) by 161 MDT members, interviews with 53 MDT members and 20 patients, and review of 2654 patients’ medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation indicator, whether or not their preferences and other clinical/health behaviours were mentioned) and MDT features (team climate and skill mix) on the implementation of MDT treatment plans. Interview and observation data were thematically analysed and integrated to explore possible explanations for the quantitative findings, and to identify areas of diverse beliefs and practice across MDT meetings. Based on these data, we used a modified formal consensus technique involving expert stakeholders to derive a set of indications of good practice for effective MDT meetings. Results The adjusted odds of implementation were reduced by 25% for each additional professional group represented [95% confidence interval (CI) 0.66 to 0.87], though there was some evidence of a differential effect by type of disease. Implementation was more likely in MDTs with clear goals and processes and a good team climate (adjusted odds of implementation increased by 7%; 95% CI 1% to 13% for a 0.1-unit increase in TCI score). Implementation varied by disease category (with the lowest adjusted odds of implementation in mental health teams) and by patient deprivation (adjusted odds of implementation for patients in the most compared with least deprived areas were 0.60, 95% CI 0.39 to 0.91). We ascertained 16 key themes within five domains where there was substantial diversity in beliefs and practices across MDT meetings. These related to the purpose, structure, processes and content of MDT meetings, as well as to the role of the patient. We identified 68 potential recommendations for improving the effectiveness of MDT meetings. Of these, 21 engendered both strong agreement (median ≥ 7) and low variation in the extent of agreement (mean absolute deviation from the median of < 1.11) among the expert consensus panel. These related to the purpose of the meetings (e.g. that agreeing treatment plans should take precedence over other objectives); meeting processes (e.g. that MDT decision implementation should be audited annually); content of the discussion (e.g. that information on comorbidities and past medical history should be routinely available); and the role of the patient (e.g. concerning the most appropriate time to discuss treatment options). Panellists from all specialties agreed that these recommendations were both desirable and feasible. We were unable to achieve consensus for 17 statements. In part, this was a result of disease-specific differences including the need to be prescriptive about MDT membership, with local flexibility deemed appropriate for heart failure and uniformity supported for cancer. In other cases, our data suggest that some processes (e.g. discussion of unrelated research topics) should be locally agreed, depending on the preferences of individual teams. Conclusions Substantial diversity exists in the purpose, structure, processes and content of MDT meetings. Greater multidisciplinarity is not necessarily associated with more effective decision-making and MDT decisions (as measured by decision implementation). Decisions were less likely to be implemented for patients living in more deprived areas. We identified 21 indications of good practice for improving the effectiveness of MDT meetings, which expert stakeholders from a range of chronic disease specialties agree are both desirable and feasible. These are important because MDT meetings are resource-intensive and they should deliver value to the NHS and patients. Priorities for future work include research to examine whether or not the 21 indications of good practice identified in this study will lead to better decision-making; for example, incorporating the indications into a modified MDT and experimentally evaluating its effectiveness in a pragmatic randomised controlled trial. Other areas for further research include exploring the value of multidisciplinarity in MDT meetings and the reasons for low implementation in community mental health teams. There is also scope to examine the underlying determinants of the inequalities demonstrated in this study, for example by exploring patient preferences in more depth. Finally, future work could examine the association between MDT decision implementation and improvements in patient outcomes.
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  • Citations (20)
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References120
Newest
Published on Dec 2, 2014in Mental Health Review Journal
William O'Driscoll1
Estimated H-index: 1
(UCL: University College London),
Gill Livingston60
Estimated H-index: 60
(UCL: University College London)
+ 5 AuthorsRosalind Raine32
Estimated H-index: 32
(UCL: University College London)
Purpose – The purpose of this paper is to explore physical and mental health patients’ experience of multidisciplinary team (MDT) care and decision making in order to highlight factors underlying effective care and to identify areas in which patient experience could be improved. Design/methodology/approach – Totally, 12 MDTs within the North Thames area participated; the authors recruited 13 patients from physical health MDTs and seven patients from mental health MDTs. The authors conducted semi...
Published on Oct 1, 2014in BMJ Quality & Safety7.04
Rosalind Raine32
Estimated H-index: 32
(UCL: University College London),
Penny Xanthopoulou4
Estimated H-index: 4
(UCL: University College London)
+ 13 AuthorsMiriam Harris3
Estimated H-index: 3
Objective Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision m...
Published on Sep 1, 2013in International Psychogeriatrics2.48
Mark Wilberforce14
Estimated H-index: 14
(University of Manchester),
Sue Tucker10
Estimated H-index: 10
+ 3 AuthorsDavid Challis37
Estimated H-index: 37
(University of Manchester)
Background: Community mental health services are regarded as the preferred first tier of specialist psychogeriatric support, with integrated multidisciplinary teams believed to offer improved decision-making and greater continuity of care than separate single-profession services. In England over 400 community mental health teams (CMHTs) form the cornerstone of such support, yet research has neither assessed progress toward integrating key professional disciplines nor the nature of their membersh...
Published on Aug 2, 2013in European Heart Journal23.24
Stuart J. Head35
Estimated H-index: 35
(EUR: Erasmus University Rotterdam),
Sanjay Kaul1
Estimated H-index: 1
(UC: University of California)
+ 7 AuthorsArie Pieter Kappetein43
Estimated H-index: 43
(EUR: Erasmus University Rotterdam)
Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called ‘Heart Team’ concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is larg...
Published on Jun 1, 2013in International Journal of Surgery
Rozh Jalil9
Estimated H-index: 9
(Barts Health NHS Trust),
Maria Ahmed9
Estimated H-index: 9
(St Mary's Hospital)
+ 1 AuthorsNick Sevdalis51
Estimated H-index: 51
(St Mary's Hospital)
Abstract Background It is becoming a standard practice worldwide for cancer patients to be discussed by a multidisciplinary team (MDT or ‘tumour board') in order to formulate an expert-derived management plan. Evidence suggests that MDTs do not always work optimally in making clinical decisions and that not all MDT decisions get implemented into care. We investigated factors influencing decision-making and decision implementation in cancer MDTs. Methods Semi-structured interviews were carried ou...
Published on May 1, 2013in Health Economics2.03
Laura Vallejo-Torres11
Estimated H-index: 11
(UCL: University College London),
Stephen Morris34
Estimated H-index: 34
(UCL: University College London)
Economic analyses of equity which focus solely on horizontal inequity offer a partial assessment of socioeconomic inequity in healthcare use. We analyse income-related inequity in cardiovascular disease-related healthcare utilisation by individuals reporting cardiovascular disease in England, including both horizontal and vertical aspects. For the analysis of vertical inequity, we use target groups to estimate the appropriate relationship between healthcare needs and use. We find that including ...
Published on Mar 1, 2013in Annals of Surgical Oncology3.68
B. W. Lamb7
Estimated H-index: 7
(Imperial College London),
Nick Sevdalis51
Estimated H-index: 51
(Imperial College London)
+ 2 AuthorsJohn Green31
Estimated H-index: 31
Background Anecdotally, organizational factors appear to have an effect on the quality of decision-making in the multidisciplinary team (MDT) meeting. We assess the effect of the number of team-members present, number and order of cases, and the timing of meetings on the process of decision-making in MDT meetings.
Published on Jan 1, 2013in Cost Effectiveness and Resource Allocation1.68
K Melissa Ke1
Estimated H-index: 1
(UoB: University of Bristol),
Jane M Blazeby55
Estimated H-index: 55
(UoB: University of Bristol)
+ 3 AuthorsWilliam Hollingworth5
Estimated H-index: 5
(UoB: University of Bristol)
Objective To investigate the cost effectiveness of management of patients within the context of a multidisciplinary team (MDT) meeting in cancer and non-cancer teams in secondary care.
Published on Dec 1, 2012in BMC Health Services Research1.93
Rozh Jalil9
Estimated H-index: 9
(Imperial College London),
Benjamin W. Lamb12
Estimated H-index: 12
(Imperial College London)
+ 2 AuthorsJames Green23
Estimated H-index: 23
Background The MDT-Coordinators’ role is relatively new, and as such it is evolving. What is apparent is that the coordinator’s work is pivotal to the effectiveness and efficiency of an MDT. This study aimed to assess the views and needs of MDT-coordinators.
Published on Oct 1, 2012
Michael A. West101
Estimated H-index: 101
,
Beverly Almo-Metcalfe1
Estimated H-index: 1
+ 9 AuthorsPaul B. Naylor5
Estimated H-index: 5
Cited By20
Newest
Published on Dec 1, 2019in BMC Cancer2.93
Christian Heuser1
Estimated H-index: 1
(University Hospital Bonn),
Annika Diekmann (University Hospital Bonn)+ 5 AuthorsNicole Ernstmann19
Estimated H-index: 19
(University Hospital Bonn)
Background Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Furthermore, it has been shown that in some breast cancer centers in Germany, patients participate in MTCs and that participation is associated with sociodemographic and breast cancer center-related factors. Health literacy (HL) has been shown to be predictive for individual health behavior and is an important prerequisite for patient participation in health...
Published on Dec 1, 2018in BMC Health Services Research1.93
Linn Rosell2
Estimated H-index: 2
(Lund University),
Nathalie Alexandersson2
Estimated H-index: 2
+ 1 AuthorsMef Nilbert38
Estimated H-index: 38
(Lund University)
Background Case review and discussion at multidisciplinary team meetings (MDTMs) have evolved into standard practice in cancer care with the aim to provide evidence-based treatment recommendations. As a basis for work to optimize the MDTMs, we investigated participants’ views on the meeting function, including perceived benefits and barriers.
Published on Sep 27, 2018
Louise Cummings13
Estimated H-index: 13
Published on Sep 1, 2018in Laryngoscope2.34
Katherine Steele (East Kent Hospitals University Nhs Foundation Trust), Andy Hall2
Estimated H-index: 2
+ 2 AuthorsArvind Singh13
Estimated H-index: 13
(Northwick Park Hospital)
Published on Jul 4, 2018in Journal of Interprofessional Care1.77
Ellinor K. Olander13
Estimated H-index: 13
(City University London),
Rose Coates4
Estimated H-index: 4
(City University London)
+ 2 AuthorsDebra Salmon11
Estimated H-index: 11
(City University London)
ABSTRACTThis multi-method evaluation assessed the perceived impact of interprofessional workshops targeting enhanced collaboration between healthcare professionals who care for women during and after pregnancy. Current policy recommends partnership working to improve care for women and babies, however, there is little interprofessional education in this area. Five one-day workshops were delivered to 18 healthcare professionals (47.4% of the 38 healthcare professionals registered). The workshop w...
Published on Jun 1, 2018
Christian Heuser1
Estimated H-index: 1
,
Annika Diekmann + 1 AuthorsNicole Ernstmann19
Estimated H-index: 19
Hintergrund Ein zentrales Instrument multidisziplinarer Versorgung in der Onkologie sind multidisziplinare Tumorkonferenzen (MTK). Die meisten MTK finden ohne die Teilnahme von Patienten statt und es ist unklar, welchen Nutzen und welche Risiken die Patientinnenteilnahme an MTK hat. Fragestellung Das vorliegende Forschungsvorhaben zielt auf die Beantwortung folgender drei Fragestellungen ab: 1) Wie unterscheiden sich MTK mit und ohne Patientinnenteilnahme hinsichtlich Organisation und Interaktio...
Published on Jun 1, 2018in Australasian Psychiatry0.94
Charlotte Woody1
Estimated H-index: 1
(Centre for Mental Health),
Amanda J. Baxter25
Estimated H-index: 25
(Centre for Mental Health)
+ 2 AuthorsHarvey Whiteford60
Estimated H-index: 60
(UW: University of Washington)
Objectives:Multidisciplinary teams in mental health receive limited guidance, leading to inconsistent practices. We undertook a systematic review of the characteristics and practices of multidisciplinary team reviews for patients with severe mental illness or in relevant mental health service settings.Methods:Sources published since 2000 were located via academic database and web searches. Results were synthesised narratively.Results:A total of 14 sources were analysed. Important characteristics...
Published on Apr 2, 2018in British Journal of Hospital Medicine0.53
Anthony Howard1
Estimated H-index: 1
(LGI: Leeds General Infirmary),
Jim Zhong (LGI: Leeds General Infirmary), Julian Scott4
Estimated H-index: 4
(University of Leeds)
Discussion about and management of patients through multidisciplinary team meetings has become the standard of care in medical and surgical specialties, but does the team nature of these provide a legal shield for clinicians? This article discusses the legal implications of decision making within a multidisciplinary team.
Published on Feb 1, 2018in British journal of pain
Pungavi Kailainathan1
Estimated H-index: 1
(Imperial College Healthcare),
Stephen R. Humble2
Estimated H-index: 2
(Imperial College London)
+ 3 AuthorsGursimren Lidder1
Estimated H-index: 1
(Imperial College London)
Inconsistencies in the availability and quality of pain service provision have been noted nationally, as have lengthy waiting times for appointments and lack of awareness of the Pain Clinic role. The 2013 NHS England report stated that specialist pain services must offer multispecialty and multidisciplinary pain clinics. This national survey of multidisciplinary pain service provision in the United Kingdom and Ireland provides a snapshot of pain service provision in order to review and highlight...
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