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多学科协作(MDT)


多学科协作(MDT)
——通向医学未来的必经阶段

Outpatient & ER Internal Med & Surgery

Women & Children

1915

State council

Central Government
Forbidden City

CPC headquarter

Mega trends 现代医学诊疗模式大趋势
传统模式:单学科诊疗(看人生的病)

必经阶段:多学科协作 (看生病的人)

多学科协作
Multidisciplinary teamwork (MDT)

MDT是国际顶尖综合医院和专科医院的共识
? Cambridge (1766) : At least 2 or 3 rounds of MDT disscusion for each cancer patient. ? Mass. General (1811) : Unite specialists across the hospital to offer patients comprehensive, state-of-the-art medical care. ? Mayo Clinic (1863) : Providing the best care to every patient through

integrated clinical practice, education and research.
? Johns Hopkins (1879) : Providing patient-centered medicine to prevent, diagnose and treat human illness . ? MD Anderson (1941) : Multidisciplinary, research-driven patient care throughout each phase of the cancer care cycle.

MDT的核心理念
? 以病人为中心 ? 针对特定疾病,依托多学科团队,制定规范化、个体

化、连续性的综合治疗方案。

MDT的核心目标
? 为患者设计最佳诊疗方案,确保最佳疗效。

? 提升学科的诊疗能力和学术水平。
? 医教研健康管理真正融合,推动医学科学进步。

MDT 适用于各个学科

MDT 适用于各个学科
? 例如:我院内分泌科:以多学科协作为特色的理念
? 甲状腺疾病会诊中心(内分泌、外科、眼科、妇产科、核医学) ? 糖尿病足防治中心(内分泌、整形、血管外科、骨科、社区医院) ? 妊娠糖尿病产后随访门诊(内分泌、产科)

? 糖尿病并发症筛查和治疗随访门诊(内分泌、肾内、心内、眼科)
? 肥胖和糖尿病前期管理门诊(内分泌、营养) ? 内分泌高血压专业门诊(内分泌、泌尿外科、影像、神外、介入)

MDT 适用于各个学科
肿瘤治疗是典型的例证

假如我是患者
今年80岁,有严重的冠心病、肺气肿,
刚刚被确诊前列腺癌,我该怎么办?

传统医疗模式下,医患双方的共同困惑
? 关于医院的选择:
– 综合医院能治好我的肿瘤吗? – 专科医院能保证我的医疗安全吗?

? 关于前列腺癌:
– 就诊科室或医生不同,治疗方案差异巨大 – 多种治疗方法可选:手术、放疗、介入、冷冻、化疗、内分泌治 疗、靶向治疗、生物治疗等 – 不同治疗方法各有优缺点 – 对单一学科 / 医生的治疗效果有所担忧

? 关于高龄及心肺疾病:
– 如何平稳控制,耐受各项治疗措施?

MDT 是医患双方的必然选择
通过MDT,与患者充分沟通,为患者找到最适合病情的科 学合理的综合诊疗方案,在保证医疗安全的前提下使患者获

得最佳疗效。

综合医院案例:MDT at Mass. General
? Centers and services – Multidisciplinary Care Centers
? Cancer Center ? Critical Care Center ? Digestive Healthcare Center ? Heart Center ? MassGeneral Hospital for Children ? Transplant Center ? Vascular Center 就诊途径一

– All departments
? Department of Urology 就诊途径二

就诊途径一: The Cancer Center
? The Cancer Center: – Offers a coordinated team approach tailored to the individual needs of each patient。 – Totally 39 treatment programs. ? Prostate Cancer

Prostate Cancer :Multidisciplinary Patient Care
? New patients are generally seen within two weeks of referral.

? At your first appointment, you will meet the genitourinary
cancer specialists who will be involved in your care. ? These specialists may include:
– Urologists and surgical oncologists experienced in the latest prostate
cancer surgery approaches, including laparoscopic and robotic surgery

– Radiation Oncologists who specialize in delivering the optimal
therapeutic dose while protecting healthy tissue – Medical Oncologists to prescribe the most effective treatments,

including hormone therapy, chemotherapy and immunotherapy

? In addition, you may also see:
– Pathologists specializing in urologic cancers – Radiologists specializing in genitourinary cancer imaging

– Oncology nurses and nurse practitioners who specialize in cancer care
– Oncology psychiatrists and social workers experienced in helping with the cognitive side effects of cancer and treatment, as well the emotional and spiritual side of the cancer experience – A nutritionist to help you with questions about diet and nutrition during treatment – Palliative care providers to improve quality of life

? This team will work with you to develop a treatment plan that balances potential side effects and benefits of treatment. They will continue to monitor your care and communicate regularly with you and your referring physician about your progress.

就诊途径二: Department of Urology
? Treatments & Services
– Cancer: Bladder, Kidney, Penile, Prostate and Testicular Cancer Program – Erectile Dysfunction Service

– Female Urology Program
– Geriatric Urology Program

– Kidney Stone Program

? Compassionate & Personalized Care
? Our urologists work closely with all of the clinicians on each patient's treatment team, a comprehensive and highly coordinated approach managed through the worldrenowned Mass General Cancer Center.

? Depending on your illness and diagnosis, your treatment
team includes your urologist along with medical oncologists, radiation oncologists, radiologists and pathologists. ? You also have access to the wide variety of resources and support services available through the Cancer Center.

如何为高龄及心肺疾患保驾护航
? Unite specialists across the hospital to give Consultations and support services to ensure we deliver the highest quality and safest care possible.

专科医院案例:MDT at MD Anderson
Multidisciplinary Cancer Care Centers:
Most of the new patients who come to MD Anderson every year are treated in
one of our specialized Cancer Care Centers or clinics, which embody the team approach to cancer care that has become an MD Anderson trademark – Brain & Spine Center – Head & Neck Center

– Breast Center
– Colorectal Center – Endocrine Center

– Leukemia Center
– Lymphoma & Myeloma Center – Melanoma & Skin Center

– Gastrointestinal Center
– Genitourinary Center 就诊途径 – Gynecologic Oncology Center

– Sarcoma Center
– Thoracic Center

就诊途径: Genitourinary Cancer Center
? MD Anderson’s Genitourinary (GU) Cancer Center provides personalized care for cancers of the urinary tract and male genital tract. The center is one of the most active programs in the country for GU cancers. Our goal is to control the cancer and preserve the best quality of life after treatment for:
– Prostate cancer

– Bladder cancer
– Kidney cancer – Testicular cancer – Penile cancer – Nonmalignant tumors of the urinary tract and male reproductive system – Von Hippel Lindau disease (VHL)

? Why Choose MD Anderson's Genitourinary Center?
– Most-advanced genitourinary cancer treatments including proton
therapy, gene therapy and targeted therapies – Advanced surgical techniques including laser, cryosurgery and

robotic laparoscopic procedures
– Highly specialized team of experts – Dedication to maintaining optimum function and quality of life

– Range of clinical trials of new treatments for genitourinary cancer

? We take a team approach to GU cancer, and our expert medical oncologists, surgical oncologists and radiation

oncologists -- each highly specialized in a particular type of
GU cancer — collaborate closely to customize your treatment.

如何为高龄及心肺疾患保驾护航
? Specialty & Treatment Centers
– Cancer Prevention Center – Cardiopulmonary Center – Integrative Medicine Center – Internal Medicine Center – Mohs/Dermasurgery Unit

– Orthopaedic Center
– Julie Kyte Center for Reconstructive Surgery – Pain Management Center

– Proton Therapy Center
– Radiation Treatment Center – Stem Cell Transplantation & Cellular Therapy Center

– Supportive Care Center

? Cardiopulmonary Center
– The Cardiopulmonary Center brings together experts who perform diagnostics and treat cancer patients for diseases of the heart, vasculature, airway and lungs. MD Anderson's multidisciplinary team includes cardiologists, pulmonologists, nuclear medicine personnel, midlevel providers and technical staff who provide diagnostics, as well as comprehensive treatment and management of patients with cardiac and/or pulmonary conditions. – Our physicians provide the latest diagnostics and treatments, including:
? Three-dimensional echocardiography with speckle and strain testing

? Cardiac catheterization laboratory
? World-class interventional pulmonary lab ? Pulmonary function testing ? Cardiac and pulmonary stress testing ? Polysomnography studies

以该患者为中心的MDT团队构成
前列腺癌核心团队 前列腺癌支持团队

心血管、呼吸、老年内科等协作学科

我院前列腺癌MDT诊治现状

MDT改善前列腺癌等预后的循证医学证据

Jefferson Kimmel Cancer Center的研究显示:采用MDT管理前 列腺癌患者,10年生存率显著高于NCI SEER登记系统内的没 有采用MDT管理患者的生存率。 原因:个体化综合治疗方案更为及时、合理、有效。

MDT 组织结构

MDT 普遍模式
? 针对特定疾病 / 器官 / 系统

?
?
– – –

联合接诊 / 查房 / 讨论 / 会议等
多学科固定医生参与
核心团队 支持团队 协作诊治学科 (更广义MDT)

? ? ?

固定时间,固定周期,固定地点 形成诊治决议 由MDT团队科室执行追踪

MDT 基本条件
? 有一定的病例数(可多病种联合) ? 确定的召集人,固定团队及专家替代制度 ? 诊治决议可执行 ? 团队人员志同道合,沟通无障碍

MDT最关键标志
? 让患者体验到!

国内现阶段开展MDT 的挑战
? ? 宏观:待合理的医疗服务价格体系 医院:模糊的医院及学科发展规划

?
?

学科:传统的学科管理话语权模式
医生:个体的诊疗行为主观随意性

MDT 的可操作性
?
– – – –

可操作性:结合具体情况,寻求突破点,以点带面
Blind dates / Matchmaking 有人推动,走到一起是开始,保持下去是进步,形成团队是成功。 从大家感兴趣的事做起,从最容易的事做起,从对方最需要的事做起 协作始于自觉,完善需要制度

?

“行胜于言”,“说一尺不如干一寸”

MDT 模式下医院的发展

综合医院、专科医院:殊途同归
? MDT模式下:肿瘤治疗等将不再有综合医院和专科医院的界限。
? News on Cambridge University Hospital website (13 September 2013) :
CUH will be the first general hospital to be accredited by Organization of European Cancer Institutes (OECI) as a comprehensive cancer center. ? Comment from Dr. Keith McNeil:

“It is fantastic news that we have been
recognized as one of the best cancer centers in the world. … … cancer will be one of the top priorities for us in the future. ”

?

综合医院、专科医院:殊途同归
– 综合医院:依托综合实力,发展特色专业 – 专科医院:做精特色专业,兼顾综合发展

MDT是通向医学未来的必经阶段
没有协作的竞争是低水平的竞争

医学未来在于医学本质的回归
传统模式:单学科诊疗(看人生的病) 必经阶段:多学科协作(看生病的人) 医学本质:人文之关爱(看生病的人)
To cure sometimes, to relieve often, to comfort always. ----E. L. Trudeau (1848-1915)






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