多學科協(xié)作mdt-ppt課件

1、Women & ChildrenInternal Med & SurgeryOutpatient & ERState councilCPC headquarter1915Mega trends現代醫(yī)學診療模式大趨勢現代醫(yī)學診療模式大趨勢傳統(tǒng)模式：單學科診療看人生的?。﹤鹘y(tǒng)模式：單學科診療看人生的?。┍亟涬A段：多學科協(xié)作必經階段：多學科協(xié)作 （看生病的人）（看生病的人）多學科協(xié)作多學科協(xié)作Multidisciplinary teamwork (MDT)Multidisciplinary teamwork (MDT)MDT是國際頂尖綜合醫(yī)院和?？漆t(yī)院的共識是國際頂尖綜合醫(yī)院和專科醫(yī)院的共識Camb

2、ridge (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 pract

3、ice, 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的核心理念的核心理念 以病人為中心以病人為中心 針對特定疾病，依托多學科團隊，制定規(guī)范化、個

4、體針對特定疾病，依托多學科團隊，制定規(guī)范化、個體化、連續(xù)性的綜合治療方案。化、連續(xù)性的綜合治療方案。MDT的核心目標的核心目標 為患者設計最佳診療方案，確保最佳療效。為患者設計最佳診療方案，確保最佳療效。 提升學科的診療能力和學術水平。提升學科的診療能力和學術水平。 醫(yī)教研健康管理真正融合，推動醫(yī)學科學進步。醫(yī)教研健康管理真正融合，推動醫(yī)學科學進步。MDT 適用于各個學科適用于各個學科 例如：我院內分泌科：以多學科協(xié)作為特色的理念例如：我院內分泌科：以多學科協(xié)作為特色的理念 甲狀腺疾病會診中心內分泌、外科、眼科、婦產科甲狀腺疾病會診中心內分泌、外科、眼科、婦產科、核醫(yī)學）、核醫(yī)學） 糖尿病足防

5、治中心內分泌、整形、血管外科、骨科糖尿病足防治中心內分泌、整形、血管外科、骨科、社區(qū)醫(yī)院）、社區(qū)醫(yī)院） 妊娠糖尿病產后隨訪門診內分泌、產科）妊娠糖尿病產后隨訪門診內分泌、產科） 糖尿病并發(fā)癥篩查和治療隨訪門診內分泌、腎內、糖尿病并發(fā)癥篩查和治療隨訪門診內分泌、腎內、心內、眼科）心內、眼科） 肥胖和糖尿病前期管理門診內分泌、營養(yǎng)）肥胖和糖尿病前期管理門診內分泌、營養(yǎng)） 內分泌高血壓專業(yè)門診內分泌、泌尿外科、影像、內分泌高血壓專業(yè)門診內分泌、泌尿外科、影像、神外、介入）神外、介入）MDT 適用于各個學科適用于各個學科MDT 適用于各個學科適用于各個學科腫瘤治療是典型的例證腫瘤治療是典型的例證今年今

6、年80歲，有嚴重的冠心病、肺氣腫，歲，有嚴重的冠心病、肺氣腫，剛剛被確診前列腺癌，我該怎么辦？剛剛被確診前列腺癌，我該怎么辦？假如我是患者假如我是患者傳統(tǒng)醫(yī)療模式下，醫(yī)患雙方的共同困惑傳統(tǒng)醫(yī)療模式下，醫(yī)患雙方的共同困惑 關于醫(yī)院的選擇：關于醫(yī)院的選擇： 綜合醫(yī)院能治好我的腫瘤嗎？綜合醫(yī)院能治好我的腫瘤嗎？ ?？漆t(yī)院能保證我的醫(yī)療安全嗎？?？漆t(yī)院能保證我的醫(yī)療安全嗎？ 關于前列腺癌：關于前列腺癌： 就診科室或醫(yī)生不同，治療方案差異巨大就診科室或醫(yī)生不同，治療方案差異巨大 多種治療方法可選：手術、放療、介入、冷凍、化療、內多種治療方法可選：手術、放療、介入、冷凍、化療、內分泌治療、靶向治療、生物治

7、療等分泌治療、靶向治療、生物治療等 不同治療方法各有優(yōu)缺點不同治療方法各有優(yōu)缺點 對單一學科對單一學科 / / 醫(yī)生的治療效果有所擔憂醫(yī)生的治療效果有所擔憂 關于高齡及心肺疾?。宏P于高齡及心肺疾?。?如何平穩(wěn)控制，耐受各項治療措施？如何平穩(wěn)控制，耐受各項治療措施？MDT 是醫(yī)患雙方的必然選擇是醫(yī)患雙方的必然選擇 通過通過MDT，與患者充分溝通，為患者找到最適合病情的，與患者充分溝通，為患者找到最適合病情的科學合理的綜合診療方案，在保證醫(yī)療安全的前提下使患者科學合理的綜合診療方案，在保證醫(yī)療安全的前提下使患者獲得最佳療效。獲得最佳療效。綜合醫(yī)院案例：綜合醫(yī)院案例：MDT at Mass. Gen

8、eralMDT at Mass. General Centers and services Multidisciplinary Care Centers Cancer Center 就診途徑一就診途徑一 Critical Care Center Digestive Healthcare Center Heart Center MassGeneral Hospital for Children Transplant Center Vascular Center All departments Department of Urology 就診途徑二就診途徑二就診途徑一： The Cancer Ce

9、nter The Cancer Center: Offers a coordinated team approach tailored to the individual needs of each patient。 Totally 39 treatment programs. Prostate CancerProstate Cancer ：Multidisciplinary Patient CareNew patients are generally seen within two weeks of referral. At your first appointment, you will

10、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 t

11、he 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 genitourinar

12、y 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 yo

13、u 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 w

14、ith you and your referring physician about your progress.就診途徑二： 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 & Perso

15、nalized Care Our urologists work closely with all of the clinicians on each patients treatment team, a comprehensive and highly coordinated approach managed through the world-renowned Mass General Cancer Center. Depending on your illness and diagnosis, your treatment team includes your urologist alo

16、ng 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. Unite specialists across the hospital to give Consultations and support services to ensure we deliver the

17、 highest quality and safest care possible. 如何為高齡及心肺疾患保駕護航如何為高齡及心肺疾患保駕護航專科醫(yī)院案例：?？漆t(yī)院案例：MDT at MD AndersonMDT at MD Anderson Brain & Spine Center Breast Center Colorectal Center Endocrine Center Gastrointestinal Center Genitourinary Center 就診途徑就診途徑 Gynecologic Oncology Center Head & Neck Center Leukemi

18、a Center Lymphoma & Myeloma Center Melanoma & Skin Center Sarcoma Center Thoracic CenterMultidisciplinary 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 car

19、e that has become an MD Anderson trademark就診途徑：就診途徑： Genitourinary Cancer Center Genitourinary Cancer Center MD Andersons 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

20、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 M

21、D Andersons 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 opt

22、imum 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 close

23、ly to customize your treatment. 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 Radia

24、tion Treatment Center Stem Cell Transplantation & Cellular Therapy Center Supportive Care Center如何為高齡及心肺疾患保駕護航如何為高齡及心肺疾患保駕護航 Cardiopulmonary Center The Cardiopulmonary Center brings together experts who perform diagnostics and treat cancer patients for diseases of the heart, vasculature, airway and

25、lungs. MD Andersons multidisciplinary team includes cardiologists, pulmonologists, nuclear medicine personnel, mid-level providers and technical staff who provide diagnostics, as well as comprehensive treatment and management of patients with cardiac and/or pulmonary conditions. Our physicians provi

26、de 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以該患者為中心的以該患者為中心的M

27、DTMDT團隊構成團隊構成 前列腺癌核心團隊前列腺癌核心團隊前列腺癌支持團隊前列腺癌支持團隊心血管、呼吸、老年內科等協(xié)作學科心血管、呼吸、老年內科等協(xié)作學科我院前列腺癌我院前列腺癌MDTMDT診治現狀診治現狀MDT改善前列腺癌等預后的循證醫(yī)學證據改善前列腺癌等預后的循證醫(yī)學證據Jefferson Kimmel Cancer Center的研究顯示：采用的研究顯示：采用MDT管理前管理前列腺癌患者，列腺癌患者，10年生存率顯著高于年生存率顯著高于NCI SEER登記系統(tǒng)內的沒登記系統(tǒng)內的沒有采用有采用MDT管理患者的生存率。管理患者的生存率。原因：個體化綜合治療方案更為及時、合理、有效。原因：個

28、體化綜合治療方案更為及時、合理、有效。MDT 組織結構組織結構MDT 普遍模式普遍模式針對特定疾病針對特定疾病 / / 器官器官 / / 系統(tǒng)系統(tǒng)聯合接診聯合接診 / / 查房查房 / / 討論討論 / / 會議等會議等多學科固定醫(yī)生參與多學科固定醫(yī)生參與核心團隊核心團隊支持團隊支持團隊協(xié)作診治學科協(xié)作診治學科 （更廣義（更廣義MDTMDT）固定時間，固定周期，固定地點固定時間，固定周期，固定地點形成診治決議形成診治決議由由MDTMDT團隊科室執(zhí)行追蹤團隊科室執(zhí)行追蹤MDT 基本條件基本條件 有一定的病例數可多病種聯合）有一定的病例數可多病種聯合） 確定的召集人，固定團隊及專家替代制度確定的召

29、集人，固定團隊及專家替代制度 診治決議可執(zhí)行診治決議可執(zhí)行 團隊人員志同道合，溝通無障礙團隊人員志同道合，溝通無障礙MDT最關鍵標志最關鍵標志 讓患者體驗到！讓患者體驗到！國內現階段開展國內現階段開展MDT 的挑戰(zhàn)的挑戰(zhàn)宏觀：待合理的醫(yī)療服務價格體系宏觀：待合理的醫(yī)療服務價格體系醫(yī)院：模糊的醫(yī)院及學科發(fā)展規(guī)劃醫(yī)院：模糊的醫(yī)院及學科發(fā)展規(guī)劃學科：傳統(tǒng)的學科管理話語權模式學科：傳統(tǒng)的學科管理話語權模式醫(yī)生：個體的診療行為主觀隨意性醫(yī)生：個體的診療行為主觀隨意性MDT 的可操作性的可操作性可操作性：結合具體情況，尋求突破點，以點帶面可操作性：結合具體情況，尋求突破點，以點帶面Blind dates / Matchmaking有人推動，走到一起是開始，保持下去是進步，形成團隊是有人推動，走到一起是開始，保持下去是進步，形成團隊是成功。成功。從大家感興趣的事做起，從最容易的事做起，從對方最需要從大家感興趣的事做起，從最容易的事做起，從對方最需要的事做起的事做起協(xié)作始于自覺，完善需要制度協(xié)作始于自覺，