目的 分析安徽省某三级综合医院多学科综合诊疗模式(MDT)实施过程中存在的问题,系统分析影响因素,并探讨相应的对策。方法 采用随机抽样的方法,分别抽取150名医护人员和200例患者进行MDT知晓度情况调查。患者调查有效问卷192份,调查的主要内容为否参与过MDT、对于MDT的知晓;医护人员调查有效问卷135份,调查的主要内容主要包括是否参与过MDT、对于MDT的知晓、认为影响MDT实施的因素等。结果 参与过MDT的医护人员对多学科综合诊疗的总知晓率为76.92%,未参与MDT的医护人员总知晓率为66.97%,差异无统计学意义(χ2=0.970,P=0.325);参与过MDT的患者对多学科综合诊疗的总知晓率为33.33%,高于未参与MDT的患者(5.66%),差异有统计学意义(χ2=19.56,P<0.001);医护人员对于多学科综合诊疗的知晓率均高于患者,两者差异有统计学意义(χ2=124.07,P<0.001)。多学科综合诊疗模式的实施主要受到参与MDT影响正常工作、存在科室间利益纠纷、缺少考评制度等内部因素的影响,主要的外部影响因素有患者对MDT不了解、传统诊疗模式影响、无MDT具体流程和标准等。结论 多学科综合诊疗模式知晓率不高,实施MDT影响因素多,医院应建立健全相关配套性制度、提高医护人员参与积极性,同时利用多种形式加大MDT宣传力度,为患者提供更全面及时高质量的诊疗服务。
Abstract
Objective To understand the problems existing in the implementation of Multi-disciplinary team in a three-level general hospital in Anhui Province, analyze the influencing factors systematically and discuss the corresponding countermeasures. Methods Random sampling method was used to select 150 medical staff and 200 patients for MDT awareness survey. A total of 192 valid questionnaires were collected from patients, the main contents of the survey were whether they had participated in MDT and knew about MDT.A total of 135 valid questionnaires were collected from medical staff, the main contents of the survey included whether they had participated in MDT, their knowledge of MDT, and the factors that influence the implementation of MDT. Results The total awareness rate of MDT among medical staff who had participated in MDT was 76.92%, and the total awareness rate of MDT among medical staff who had not participated in MDT was 66.97%. There was no significant difference between the two groups(χ2=0.970,P=0.325). The total awareness rate of MDT among patients who had participated in MDT was 33.33%, which was higher than that of patients who had not participated in MDT (5.66%), the difference was statistically significant(χ2=19.56,P<0.001).The awareness rate of medical staff to MDT was higher than that of patients, and the difference was statistically significant (χ2= 124.07,P<0.001). The implementation of MDT was mainly affected by internal factors such as influence on normal work, existence of interest disputes between departments, lack of evaluation system, etc. The main external factors included patients,; ignorance of MDT, influence of traditional diagnosis and treatment mode, absence of specific processes and standards of MDT,etc. Conclusions The awareness rate of MDT was not high, and there were many factors influencing the implementation of MDT. The hospital should establish and improve the relevant supporting system, improve the enthusiasm of medical staff to participate, and use various forms to increase the MDT publicity to provide patients with more comprehensive, timely and high-quality diagnosis and treatment services.
关键词
三级综合医院 /
多学科综合诊疗 /
影响因素
Key words
Tertiary general hospital /
Multiple disciplinary team /
Influencing factors
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参考文献
[1] 焦岳龙,余飞.多学科联合诊疗管理模式治疗甲状腺疾病的探索与实施成效——以上海某三甲医院为例[J].中国卫生产业,2019,16(10):65-67.
[2] 杨莹,刘奎,帕提古丽·尼亚孜.多学科专家组诊疗模式在阻塞性睡眠呼吸暂停低通气综合征中的应用[J].中国病案,2018,19(1):109-112.
[3] 甘露,张男,董晓晶,等.基于多学科诊疗模式下的乳腺癌患者全程管理公众号内容的构建[J].中国癌症防治杂志,2018,10(3):182-187.
[4] 秦霞玉.新医改模式下多学科一体化诊疗的实践与思考[J].江苏卫生事业管理,2018,29(1):63-66.
[5] 李道佩.对2011年版卫生部三级综合医院评审标准实施细则的商榷[J].中国医院药学杂志,2013,33(13):1091-1093.
[6] 李钟仁,杜勤,王敬茹,等.基于患者视角的多学科综合诊疗模式现状和对策研究[J].中国医院,2016,20(8):34-3.
[7] 是俊凤,陆秉,潘晨麟,等.依托学科群建设构建多学科综合诊疗模式的实践与思考[J].中国医院,2016,20(7):3-5.
[8] 鲍瑞庆,左民,张秧儿,等.信息化支撑下的门诊多学科协作诊疗的优化运行研究[J].中国医院,2016,20(7):9-11.
[9] 何辅成,李锋,李文娟.多学科综合诊疗模式对促进医院学科建设的探讨[J].中国医院,2016,20(7):12-13.
[10] 陆秉,姚革,是俊凤,等.多学科协作诊疗门诊管理模式现状分析[J].现代医院管理,2016,14(1):67-68.
[11] 范理宏,郑乐乐,陈善豪,等.基于临床路径的多学科协作肺癌诊疗模式探讨[J].中国医院管理,2015,35(1):31-33.
基金
2018年度安徽高校人文社会科学研究重点项目(项目编号SK2018A0160);安徽医科大学第一附属医院博士科研项目(项目编号BSKY2019037);安徽医科大学医学人文研究中心项目(YJSK202017)
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