Interdisciplinary clinical practice has become an essential objective for the management of complex cases in a large number of health facilities in Quebec and elsewhere. However, this highly desirable practice cannot be implemented on demand and requires a carefully designed approach in combination with continuous feedback between the various partners involved in the management and functioning of an interdisciplinary team. The purpose of this research was to provide teams with a tool to help them identify their strengths and weaknesses in order to ensure continuous improvement.
Following a comprehensive review of the literature on microsystems ensuring interdisciplinarity in health, we identified a large number of elements considered to be important factors allowing effective interdisciplinarity. These factors were used to construct a questionnaire that was submitted to several stages of validation (qualitative and statistical) designed to enable health professionals to measure their degree of integration of the concepts allowing interdisciplinary clinical practice.
This approach allowed validation of this questionnaire (Cronbach's alpha greater than 0.97). During the validation process, the number of questions of the questionnaire was reduced from 99 to 65.
The various steps of validation of the questionnaire allowed the development of a relevant tool to promote continuous improvement of interdisciplinary clinical teams.
Multidisciplinary team meetings (MDTMs) have developed into standard of care to provide expert opinion and to grant evidence-based recommendations on diagnostics and treatment of cancer. Though MDTMs are associated with a range of benefits, a growing number of cases, complex case discussion and an increasing number of participants raise questions on cost versus benefit. We aimed to determine cost of MDTMs and to define determinants hereof based on observations in Swedish cancer care.
Data were collected through observations of 50 MDTMs and from questionnaire data from 206 health professionals that participated in these meetings.
The MDTMs lasted mean 0.88?h and managed mean 12.6 cases with mean 4.2?min per case. Participants were mean 8.2 physicians and 2.9 nurses/other health professionals. Besides the number of cases discussed, meeting duration was also influenced by cancer diagnosis, hospital type and use of video facilities. When preparatory work, participation and post-MDTM work were considered, physicians spent mean 4.1?h per meeting. The cost per case discussion was mean 212 (range 91-595) EUR and the cost per MDTM was mean 2675 (range 1439-4070) EUR.
We identify considerable variability in resource use for MDTMs in cancer care and demonstrate that 84% of the total cost is derived from physician time. The variability demonstrated underscores the need for regular and structured evaluations to ensure cost effective MDTM services.