| BackgroundTumor-related diseases will not only cause harm to residents’ physical and mental health,but also bring heavy economic burden of disease,and significantly affect economic and social development.Under common promotion of cancer treatment,medical technology development,resource integration and utilization needs,as well as the patient-centered service concept,tumor multidisciplinary team model is emerging.In recent years,the country has paid more and more attention to the development and promotion of the tumor multidisciplinary team model,however,there are still insufficient operational development of tumor multidisciplinary team model.In the case that the country has not established the unified quality evaluation standard and supervision system of tumor multidisciplinary team model.And there is still a lack of scientific tumor multidisciplinary team model operation quality evaluation tools,which makes many hospitals unable to carry out quality evaluation.These deficiencies not only cause the waste of resources but also affect the development of tumor multidisciplinary team model.Based on the above background,it is necessary and urgent to develop a scientific and effective operation quality evaluation tool for tumor multidisciplinary team model.ObjectiveThis study takes the "structure-process-outcome" three-dimensional quality evaluation model as the theoretical framework and constructs the operation quality evaluation index system of tumor multidisciplinary team model from the three aspects by combining qualitative and quantitative research methods.And we carries out empirical verification in a sample hospital in order to find weak links and propose the targeted improvement strategies of tumor multidisciplinary team model.To go further,it provides scientific basis and reference experience for promoting the development and standardized operation of tumor multidisciplinary team model in the future.MethodsFirstly,this study sorted out the development and evaluation status of tumor multidisciplinary team model at home and abroad through literature review in order to extracted related quality evaluation indicators.The semi-structured interview method was used to interview hospital administrators,medical departments and clinical departments experts about tumor multidisciplinary team model and extracted relevant indicators to form a draft of evaluation indicators.Secondly,we designed the expert consultation questionnaire and selected twenty experts to conduct correspondence consultation of the index system by Delphi method.The index weights were calculated by analytic hierarchy process method.Finally,based on the constructed index system,we empirically analyzed the operation of tumor multidisciplinary team model in a sample hospital through questionnaire survey and calculated the score by fuzzy comprehensive evaluation method in order to verify the feasibility and scientificity of the index system.Results(1)Through two rounds of expert consultation,we construct the operation quality evaluation index system of tumor multidisciplinary team model which includes three primary indicators,nine secondary indicators and thirty-six tertiary indicators.The two rounds of expert positive coefficient are 90.0%and 100%,the authority coefficient are 0.87 and 0.88,and the coordination coefficient are 0.241 and 0.319.After the second round of expert consultation,the average importance of each indicator are between 3.85 and 4.90,the full score ratio are between 15%and 90%,and the coefficient of variation are between 0.06 and 0.25.(2)The weight coefficients of the tertiary indicators are calculated by AHP as"structure index"(0.3119),"process index"(0.1976),and "outcome index"(0.4905),among which"outcome index”has the highest weight.Among the nine secondary indicators,the top three by weight are"clinical effect index"(0.2643),"team building index"(0.1937),and"operation efficiency index"(0.1458).The analytic hierarchy process calculation results show that the consistency ratio CR values of the tertiary indicators are less than 0.1,which conforms to the logical standard.(3)The overall score of tumor multidisciplinary team model of sample hospitals is 8.70 points,which belongs to "excellent" rating according to the principle of maximum membership.There are several indicators belong to "general"rating,which include" having the tumor multidisciplinary team model funds index"(6.52 points),"establishing an information platform index"(6.92 points),"communicating treatment plan with patients and their families in timely manner index"(7.04 points),"continuously tracking the implementation of treatment plan index"(6.70 points)and the index of "follow-up of the prognosis of MDT cases"(6.62 points).In addition the above indicators’score are relatively low,the other indicators were all belong to"excellent" rating.Conclusions and SuggestionsAccording to the principle of index system construction,a scientific evaluation index system of tumor multidisciplinary team model was constructed by using a variety of research methods.The index source has scientific basis,the index hierarchy is clear,the weight is reasonable and the construction process is standardized.Through empirical research,we verified the practicability and feasibility of the constructed index system which can evaluate the operation of hospital tumor multidisciplinary team model and found relatively weak links.According to the development status and the problems found in the empirical evaluation,the following suggestions are put forward:(1)Increase the investment of funds and improve the efficiency of using funds to develop tumor multidisciplinary team model.(2)Build the tumor multidisciplinary team model information platform to realize information management.(3)Attach importance to patient-centered and establish strict follow-up system.(4)Strengthen the feedback of evaluation results and continuously improve the closed-loop management process of tumor multidisciplinary team model. |
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